Particulate versus non-particulate corticosteroids for transforaminal nerve root blocks. Comparison of outcomes in 494 patients with lumbar radiculopathy

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Bensler, Susanne; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [Orthopaedic University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

2018-03-15

We set out to compare outcomes in CT-guided lumbar transforaminal nerve root block patients receiving either particulate or non-particulate corticosteroids. This was a retrospective comparative effectiveness outcomes study on two cohorts of lumbar radiculopathy patients. 321 received particulate and 173 non-particulate corticosteroids at CT-guided transforaminal lumbar nerve root injections. The particulate steroid was used from October 2009 until May 2014 and the non-particulate steroid was used from May 2014. Pain levels were collected at baseline using an 11-point numerical rating scale (NRS) and at 1 day, 1 week and 1 month. Overall 'improvement' was assessed using the Patients' Global Impression of Change (PGIC) at these same time points (primary outcome). The proportions of patients 'improved' were compared between the two groups using the Chi-square test. The NRS change scores were compared using the unpaired t-test. A significantly higher proportion of patients treated with particulate steroids were improved at 1 week (43.2 % vs. 27.7 %, p = 0.001) and at 1 month (44.3 % vs. 33.1 %, p = 0.019). Patients receiving particulate steroids also had significantly higher NRS change scores at 1 week (p = 0.02) and 1 month (p = 0.007). Particulate corticosteroids have significantly better outcomes than non-particulate corticosteroids. (orig.)

Asymmetry of the multifidus muscle in lumbar radicular nerve compression

International Nuclear Information System (INIS)

Farshad, Mazda; Gerber, Christian; Farshad-Amacker, Nadja A.; Dietrich, Tobias J.; Laufer-Molnar, Viviane; Min, Kan

2014-01-01

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

Asymmetry of the multifidus muscle in lumbar radicular nerve compression

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

2014-01-15

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

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)

Postoperative Radiculopathy Caused by a Retained Fractured Pedicle Cannulation Probe and Its Mechanism of Extraction.

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Yuk, Frank; Steinberger, Jeremy; Skovrlj, Branko; Mascitelli, Justin; Cho, Samuel K; Caridi, John M

2017-11-01

Spine surgery relies heavily on technology and surgical instrumentation. Improperly used instrumentation can be detrimental to the patient. Despite multiple checkpoints to ensure that foreign bodies are not retained in surgery, numerous case reports have described retained foreign bodies; however, none of these cases involve retained instrumentation after open spine surgery. Of the retained objects, 4 were sponges and one was a Jamshidi needle fragment. Although smaller objects are more commonly the culprits, surgical instruments can break off, remain stuck, and cause clinical sequelae. This case presents a retained fractured pedicle finder as the cause of right L5 radiculopathy. To our knowledge, this report is the first to describe an instrumentation-associated postoperative radiculopathy. Because of the strength with which the object was impacted, its extraction proved difficult. The technique of removal using a mallet and osteotome in 4 directions to loosen its hold in the vertebral body. Attempts and eventual successful removal are described. Copyright © 2017 Elsevier Inc. All rights reserved.

Development of a patient-reported outcome instrument for patients with lumbar radicular pain

OpenAIRE

Ibsen, Charlotte; Schiøttz-Christensen, Berit; Handberg, Charlotte; Nielsen, Claus Vinther; Hørder, Mogens; Maribo, Thomas

2017-01-01

Background Low back pain (LBP) is the leading cause to years lived with disability. 10–20% of patients with LBP experience radicular pain (lumbar radiculopathy). Patient-reported outcomes (PROs) play an important role in advancing patient-centered health care. Although patient involvement is essential to develop valid patient-centred PRO instruments patients are not always involved. The International Classification of Functioning, Disability and Health (ICF) are proposed to facilitate consist...

[A swollen, painless calf caused by neurogenic muscle (pseudo)-hypertrophy

NARCIS (Netherlands)

Warrenburg, B.P.C. van de; Zwarts, M.J.; Engelen, B.G.M. van

2003-01-01

Neurogenic muscle (pseudo) hypertrophy of the calf was diagnosed in a 60-year-old man, who presented with chronic, painless and unilateral calf enlargement caused by a chronic S1 radiculopathy due to a lumbar disc hernia in the L5-S1 interspace. The differential diagnosis of a swelling of the calf

Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging.

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Altinkaya, Naime; Cekinmez, Melih

2016-01-01

To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P  0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation.

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

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

2016-08-01

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

Spine imaging after lumbar disc replacement: pitfalls and current recommendations

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Sandén Bengt

2009-07-01

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

Lumbar foraminal stenosis, the hidden stenosis including at L5/S1.

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Orita, Sumihisa; Inage, Kazuhide; Eguchi, Yawara; Kubota, Go; Aoki, Yasuchika; Nakamura, Junichi; Matsuura, Yusuke; Furuya, Takeo; Koda, Masao; Ohtori, Seiji

2016-10-01

In patients with lower back and leg pain, lumbar foraminal stenosis (LFS) is one of the most important pathologies, especially for predominant radicular symptoms. LFS pathology can develop as a result of progressing spinal degeneration and is characterized by exacerbation with foraminal narrowing caused by lumbar extension (Kemp's sign). However, there is a lack of critical clinical findings for LFS pathology. Therefore, patients with robust and persistent leg pain, which is exacerbated by lumbar extension, should be suspected of LFS. Radiological diagnosis is performed using multiple radiological modalities, such as magnetic resonance imaging, including plain examination and novel protocols such as diffusion tensor imaging, as well as dynamic X-ray, and computed tomography. Electrophysiological testing can also aid diagnosis. Treatment options include both conservative and surgical approaches. Conservative treatment includes medication, rehabilitation, and spinal nerve block. Surgery should be considered when the pathology is refractory to conservative treatment and requires direct decompression of the exiting nerve root, including the dorsal root ganglia. In cases with decreased intervertebral height and/or instability, fusion surgery should also be considered. Recent advancements in minimally invasive lumbar lateral interbody fusion procedures enable effective and less invasive foraminal enlargement compared with traditional fusion surgeries such as transforaminal lumbar interbody fusion. The lumbosacral junction can cause L5 radiculopathy with greater incidence than other lumbar levels as a result of anatomical and epidemiological factors, which should be better addressed when treating clinical lower back pain.

Myelopathy hand in cervical radiculopathy

International Nuclear Information System (INIS)

Hosono, Noboru; Mukai, Yoshihiro; Takenaka, Shota; Fuji, Takeshi; Sakaura, Hironobu; Miwa, Toshitada; Makino, Takahiro

2010-01-01

The so-called 'myelopathy hand', or characteristic finger paralysis, often recognized in cervical compression myelopathy, has been considered a unique manifestation of cervical myelopathy. We used our original grip and release test, a 15-second test in which finger motion is captured with a digital camera, to investigate whether cervical radiculopathy has the same characteristics as myelopathy hand. Thirty patients with pure radiculopathy, id est (i.e.), who had radiating arm pain and evidence of corresponding nerve root impingement on X-ray images or MRI scans, but did not have spinal cord compression, served as the subjects. In contrast to other radiculopathies, C7 radiculopathy was manifested by a significant reduction in the number of finger motion cycles on the affected side in comparison with the unaffected side, the same as in myelopathy hand. Uncoordinated finger motion was significantly more frequent on the affected side in C6 radiculopathy than on the unaffected side. These findings contradict the conventional notion that myelopathy hand is a unique manifestation of cervical myelopathy, but some radiculopathies manifested the same kinds of finger paralysis observed in myelopathy hand. (author)

[Biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy].

Science.gov (United States)

Qian, J; Yu, S S; Liu, J J; Chen, L; Jing, J H

2018-04-03

Objective: To analyze the biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy using the finite element method. Methods: Three healthy adult males (aged 35.6 to 42.3 years) without spinal diseases were enrolled in this study and 3D-CT scans were carried out to obtain the parameters of lumbar spine. Mimics software was applied to build a 3D finite element model of lumbar spine. Graded resections (1/4, 2/4, 3/4 and 4/4) of the left superior articular process of L(5) were done via percutaneous transforaminal endoscopic lumbar discectomy. Then, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine were recorded after simulating the normal flexion and extension, lateral flexion and rotation of the lumbar spine model during different resections. The data were compared among groups with analysis of variance. Results: Comparing with the normal group, after 1/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets showed significant differences during left lateral flexion and rotation of lumbar spine ( q =8.823, 8.248, both P biomechanics and the stability of lumbar spine changed partly after 1/4 resection of the superior articular process and obviously after more than 2/4 is resected. The superior articular process should be paid more attention during foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy.

Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

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Hasankhani, Ebrahim Ghayem; Ashjazadeh, Amir

2014-01-01

Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome. PMID:25187873

A case of piriformis syndrome presenting as radiculopathy

Directory of Open Access Journals (Sweden)

Rammurthy Kulkarni

2015-01-01

Full Text Available Piriformis syndrome has always remained as a diagnostic dilemma because of its varied presentation. Piriformis syndrome is myofascial dysfunction syndrome which causes pain not only because of trigger points within the muscle but also due to peripheral neuritis of the sciatic nerve. The sciatic neuritis is due to compression of the nerve as it passes through the greater sciatic foramen. The symptoms of sciatic nerve entrapment caused by the piriformis syndrome can be easily mistaken for radiculopathy as the nerve entrapment causes pain which radiates down below the knee and can go up to the foot. Electromyography (EMG and nerve conduction velocity (NCV studies can help differentiating these two conditions and can eliminate the need for the magnetic resonance imaging (MRI. In this paper, we have reported a case of piriformis syndrome which mimicked S 1 radiculopathy, where diagnosis was confirmed by diagnostic piriformis injection.

Clinical application of percutaneous lumbar puncture to treat sciatica caused by lumbar disc herniation under CT guidance

International Nuclear Information System (INIS)

Wang Linyou; Li Yuan; Shao Yangtong

2004-01-01

Objective: To evaluate the effect of the percutaneous lumbar puncture to treat sciatica caused by lumbar disc herniation. Methods: 75 cases of lumbar disc herniation with significant clinical signs were confirmed by CT scan. The technique of the percutaneous lumbar puncture led the needle to approach nerve root and injected medicine diffusing into extraduramater, and then relieved the symptom of sciatica. Results: The rate of success of percutaneous lumbar puncture guided by CT reached to 100%. After two weeks of follow-up, the symptom of pain was obviously improved and disappeared in 63.3% cases. There were 23.0% cases needed a second procedure, and no change was obsesved in 9.3% cases. Conclusions: The percutaneous lumbar puncture guided by CT to treat sciatica resulted from lumbar disc herniation is one of the safe, reliable, effective new methods with no complication. The long term effectiveness is still in need of investigation. (authors)

Cervical interlaminar epidural steroid injection for unilateral cervical radiculopathy: Comparison of midline and paramedian approaches for efficacy

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Yoon, Ji Young; Kwon, Jong Won; Yoon, Young Cheol [Dept. of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lee, Jong Seok [School of Business Administration, Hallym University, Chuncheon (Korea, Republic of)

2015-06-15

The objective of this study was to compare the clinical outcomes of the cervical interlaminar epidural steroid injection (CIESI) for unilateral radiculopathy by the midline or paramedian approaches and to determine the prognostic factors of CIESI. We retrospectively analyzed 182 patients who underwent CIESI from January 2009 to December 2012. Inclusion criteria were no previous spinal steroid injection, presence of a cross-sectional image, and presence of follow-up records. Exclusion criteria were patients with bilateral cervical radiculopathy and/or dominant cervical axial pain, combined peripheral neuropathy, and previous cervical spine surgery. Short-term clinical outcomes were evaluated at the first follow-up after CIESI. We compared the clinical outcomes between the midline and paramedian approaches. Possible prognostic factors for the outcome, such as age, gender, duration of radiculopathy, and cause of radiculopathy were also analyzed. Cervical interlaminar epidural steroid injections were effective in 124 of 182 patients (68.1%) at the first follow-up. There was no significant difference in the clinical outcomes of CIESI, between midline (69.6%) and paramedian (63.7%) approaches (p = 0.723). Cause of radiculopathy was the only significant factor affecting the efficacy of CIESI. Patients with disc herniation had significantly better results than patients with neural foraminal stenosis (82.9% vs. 56.0%) (p < 0.001). There is no significant difference in treatment efficacy between the midline and paramedian approaches in CIESI, for unilateral radiculopathy. The cause of the radiculopathy is significantly associated with the treatment efficacy; patients with disc herniation experience better pain relief than those with neural foraminal stenosis.

Cervical interlaminar epidural steroid injection for unilateral cervical radiculopathy: Comparison of midline and paramedian approaches for efficacy

International Nuclear Information System (INIS)

Yoon, Ji Young; Kwon, Jong Won; Yoon, Young Cheol; Lee, Jong Seok

2015-01-01

The objective of this study was to compare the clinical outcomes of the cervical interlaminar epidural steroid injection (CIESI) for unilateral radiculopathy by the midline or paramedian approaches and to determine the prognostic factors of CIESI. We retrospectively analyzed 182 patients who underwent CIESI from January 2009 to December 2012. Inclusion criteria were no previous spinal steroid injection, presence of a cross-sectional image, and presence of follow-up records. Exclusion criteria were patients with bilateral cervical radiculopathy and/or dominant cervical axial pain, combined peripheral neuropathy, and previous cervical spine surgery. Short-term clinical outcomes were evaluated at the first follow-up after CIESI. We compared the clinical outcomes between the midline and paramedian approaches. Possible prognostic factors for the outcome, such as age, gender, duration of radiculopathy, and cause of radiculopathy were also analyzed. Cervical interlaminar epidural steroid injections were effective in 124 of 182 patients (68.1%) at the first follow-up. There was no significant difference in the clinical outcomes of CIESI, between midline (69.6%) and paramedian (63.7%) approaches (p = 0.723). Cause of radiculopathy was the only significant factor affecting the efficacy of CIESI. Patients with disc herniation had significantly better results than patients with neural foraminal stenosis (82.9% vs. 56.0%) (p < 0.001). There is no significant difference in treatment efficacy between the midline and paramedian approaches in CIESI, for unilateral radiculopathy. The cause of the radiculopathy is significantly associated with the treatment efficacy; patients with disc herniation experience better pain relief than those with neural foraminal stenosis.

A history of lumbar disc herniation from Hippocrates to the 1990s.

Science.gov (United States)

Truumees, Eeric

2015-06-01

In ancient times, a supernatural understanding of the syndrome of lumbar radiculopathy often involved demonic forces vexing the individual with often crippling pain. The ancient Greeks and Egyptians began to take a more naturalistic view and, critically, suspected a relationship between lumbar spinal pathology and leg symptoms. Relatively little then changed for those with sciatica until the classic works by Cotugno and Kocher arrived in the late 18th century. Early lumbar canal explorations were performed in the late 1800s and early 1900s by MacEwen, Horsley, Krause, Taylor, Dandy, and Cushing, among others. In these cases, when compressive pathologies were found and removed, the lesions typically were (mis-)identified as enchondromas or osteochondritis dissecans. To better understand the history, learn more about the first treatments of lumbar disc herniation, and evaluate the impact of the early influences on modern spine practice, searches of PubMed and Embase were performed using the search terms discectomy, medical history, lumbar spine surgery, herniated disc, herniated nucleus pulposus, sciatica, and lumbar radiculopathy. Additional sources were identified from the reference lists of the reviewed papers. Many older and ancient sources including De Ischiade Nervosa are available in English translations and were used. When full texts were not available, English abstracts were used. The first true, intentional discectomy surgery was performed by Mixter and Barr in 1932. Early on, a transdural approach was favored. In 1938, Love described the intralaminar, extradural approach. His technique, although modified with improved lighting, magnification, and retractors, remains a staple approach to disc herniations today. Other modalities such as chymopapain have been investigated. Some remain a part of the therapeutic armamentarium, whereas others have disappeared. By the 1970s, CT scanning after myelography markedly improved the clinical evaluation of patients with

Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging

Energy Technology Data Exchange (ETDEWEB)

Altinkaya, Naime [Baskent University Medical School, Department of Radiology, Adana (Turkey); Cekinmez, Melih [Baskent University Medical School Adana, Department of Neurosurgery, Adana (Turkey)

2016-01-15

To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P < 0.05). The MLD increased on the diseased side with symptom duration by lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P < 0.05). The cut-off values for the MLD measurements were 5.3 mm (sensitivity = 62.3 %, specificity = 55.5 %; P < 0.05). In groups A, B, and C, the median CSA of the multifidus muscle was not significantly different between the diseased and the normal side (P > 0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation. (orig.)

Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging

International Nuclear Information System (INIS)

Altinkaya, Naime; Cekinmez, Melih

2016-01-01

To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P < 0.05). The MLD increased on the diseased side with symptom duration by lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P < 0.05). The cut-off values for the MLD measurements were 5.3 mm (sensitivity = 62.3 %, specificity = 55.5 %; P < 0.05). In groups A, B, and C, the median CSA of the multifidus muscle was not significantly different between the diseased and the normal side (P > 0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation. (orig.)

The unique case of foot drop secondary to a large ovarian cyst.

Science.gov (United States)

Ahmad, Maleeha; Kumar, Aditaya; Thomson, Simon

2014-08-01

We describe the unique case of a 58-year-old woman who presented with right leg radiculopathy caused by an ovarian cyst mimicking lumbar pathology. A review of the literature shows that this is a rare case where a histologically confirmed benign ovarian cystadenoma (of indeterminate type) is shown to cause foot drop and radiculopathy.

Groin pain associated with sacroiliac joint dysfunction and lumbar disorders.

Science.gov (United States)

Kurosawa, Daisuke; Murakami, Eiichi; Aizawa, Toshimi

2017-10-01

We investigated the prevalence of groin pain in patients with sacroiliac joint (SIJ) dysfunction, lumbar spinal canal stenosis (LSS), and lumbar disc herniation (LDH) who did not have hip disorders, and evaluated the clinical features that distinguished SIJ dysfunction from LSS and LDH. We evaluated 127 patients (57 men, 70 women, average age 55 years) with SIJ dysfunction, 146 (98 men, 48 women, average age 71 years) with LSS, and 124 (83 men, 41 women, average age 50 years) with LDH. The following data were retrospectively collected from the patients' medical charts: (1) the prevalence of groin pain for each pathology; (2) corresponding spinal level of LSS and LDH in the patients with groin pain; (3) the pain areas in the buttocks and back; pain increase while in positions such as sitting, lying supine, and side-lying; an SIJ shear test; and four tender points composed of the posterior superior iliac spine (PSIS), long posterior sacroiliac ligament (LPSL), sacrotuberous ligament (STL), and iliac muscle. Fifty-nine (46.5%) patients with SIJ dysfunction, 10 (6.8%) with LSS, and 10 (8.1%) with LDH reported groin pain. Of the 10 patients with LSS, five presented with cauda equina symptoms, two had stenosis of L2-L3, and three had stenosis below L3-L4. The other five presented with radiculopathy: the corresponding nerve root was L2, L3, and L4 in one patient each, and L5 in two. Of the 10 patients with LDH, eight presented with radiculopathy: the corresponding nerve root was L2 and L4 in three patients each, and L5 in two. Two patients presented with L4-L5 discogenic pain without radiculopathy. In patients with groin pain, pain provoked by the SIJ shear test and the tenderness of the PSIS and LPSL were significant physical signs that differentiated SIJ dysfunction from LSS and LDH. (Fisher's exact test, P<0.05) CONCLUSION: The prevalence of groin pain in patients with SIJ dysfunction was higher than in those with LSS or LDH. When patients who do not have hip disorders

Lateral Pectoral Nerve Injury Mimicking Cervical Radiculopathy.

Science.gov (United States)

Aktas, Ilknur; Palamar, Deniz; Akgun, Kenan

2015-07-01

The lateral pectoral nerve (LPN) is commonly injured along with the brachial plexus, but its isolated lesions are rare. Here, we present a case of an isolated LPN lesion confused with cervical radiculopathy. A 41-year-old man was admitted to our clinic because of weakness in his right arm. Previous magnetic resonance imaging (MRI) examination revealed right posterolateral protrusion at the C6-7 level. At the initial assessment, atrophy of the right pectoralis major muscle was evident, and mild weakness of the right shoulder adductor, internal rotator, and flexor muscles was observed. Therefore, electrodiagnostic evaluation was performed, and a diagnosis of isolated LPN injury was made. Nerve injury was thought to have been caused by weightlifting exercises and traction injury. Lateral pectoral nerve injury can mimic cervical radiculopathy, and MRI examination alone may lead to misdiagnosis. Repeated physical examinations during the evaluation and treatment phase will identify the muscle atrophy that occurs 1 or more months after the injury.

How fast pain, numbness, and paresthesia resolves after lumbar nerve root decompression: a retrospective study of patient's self-reported computerized pain drawing.

Science.gov (United States)

Huang, Peng; Sengupta, Dilip K

2014-04-15

A single-center retrospective study. To compare the speed of recovery of different sensory symptoms, pain, numbness, and paresthesia, after lumbar nerve root decompression. Lumbar radiculopathy is characterized by different sensory symptoms like pain, numbness, and paresthesia, which may resolve at different rates after surgical decompression. Eighty-five cases with predominant lumbar radiculopathy treated surgically were reviewed. Oswestry Disability Index score, 36-Item Short Form Health Survey scores (Physical Component Summary and Mental Component Summary), and pain drawing at preoperative and at 6 weeks, 3 months, 6 months, and 1-year follow-up were reviewed. Recovery rate between different sensory symptoms were compared in all patients, and between the short-term compression (paresthesia; 28 (32.9%) had all these 3 component of sensory symptoms. Mean pain score improved fastest (55.3% at 6 wk); further resolution until 1 year was slow and not significant compared with each previous visit. Both numbness and paresthesia scores showed a trend of faster recovery during the initial 6-week period (20.5% and 24%, respectively); paresthesia recovery reached a plateau at 3 months postoperatively, but numbness continued a slow recovery until 1-year follow-up. Both Oswestry Disability Index score and Physical Component Summary scores (54.02 ± 1.87 and 26.29 ± 0.93, respectively, at baseline) improved significantly compared with each previous visits at 6 weeks and 3 months postoperatively, but further improvement was insignificant. Mental Component Summary showed a similar trend but smaller improvement. The short-term compression group had faster recovery of pain than the long-term compression group. In lumbar radiculopathy patients after surgical decompression, pain recovers fastest, in the first 6 weeks postoperatively, followed by paresthesia recovery that plateaus at 3 months postoperatively. Numbness recovers at a slower pace but continues until 1 year. 4.

Tophaceous gout causing lumbar stenosis: A case report.

Science.gov (United States)

Lu, Huigen; Sheng, Jianming; Dai, Jiaping; Hu, Xuqi

2017-08-01

Gout in the spine is very rare. The clinical symptoms of the spinal gout are various and lack of specificity. The authors report a case of spinal gout causing lumbar stenosis. We never find such wide-invasive spinal gouty lesion in the published studies. A 68-year-old male had low back pain radiating to bilateral lower limbs, accompanying with intermittent claudication that lasted for 3 months and aggravated 5 days ago. Spinal gout, lumbar stenosis. The patient underwent L2-L4 laminectomy, L2/3 L3/4 an d L4/5 discectomy and transforaminal lumbar interbody fusion with pedicle screw fixation. Dual-energy computed tomography detected extensive tophaceous deposits in L1/2 L2/3 L3/4 and L4/5 lumbar discs as well as the posterior column, especially L2-L3 and L4-L5 facet joints. During the surgery, we found a mass of chalky white material at the posterior column of L3 to L5 vertebral bodies, which also involved the intervertebral discs. Pathological examination confirmed the diagnosis of spinal gout. Although spinal gout is thought to be rare, the diagnosis should be considered if the patient had severe back pain and a history of gout. Dual-energy computed tomography is highly recommended for these patients.

Transforaminal epidural steroid injection for lumbosacral radiculopathy: preganglionic versus conventional approach

International Nuclear Information System (INIS)

Lee, Joon Woo; Kim, Sung Hyun; Choi, Ja Young

2006-01-01

The present study was undertaken to evaluate the effectiveness of transforaminal epidural steroid injection (TFESI) with using a preganglionic approach for treating lumbar radiculopathy when the nerve root compression was located at the level of the supra-adjacent intervertebral disc. The medical records of the patients who received conventional TFESI at our department from June 2003 to May 2004 were retrospectively reviewed. TFESI was performed in a total of 13 cases at the level of the exiting nerve root, in which the nerve root compression was at the level of the supra-adjacent intervertebral disc (the conventional TFESI group). Since June 2004, we have performed TFESI with using a preganglionic approach at the level of the supra-adjacent intervertebral disc (for example, at the neural foramen of L4-5 for L5 nerve root) if the nerve root compression was at the level of the supra-adjacent intervertebral disc. Using the inclusion criteria described above, 20 of these patients were also consecutively enrolled in our study (the preganglionic TFESI group). The treatment outcome was assessed using a 5-point patient satisfaction scale and by using a VAS (visual assessment scale). A successful outcome required a patient satisfaction scale score of 3(very good) or 4 (excellent), and a reduction on the VAS score of > 50% two weeks after performing TFESI. Logistic regression analysis was also performed. Of the 13 patients in the conventional TFESI group, nine showed satisfactory improvement two weeks after TFESI (69.2%). However, in the preganglionic TFESI group, 18 of the 20 patients (90%) showed satisfactory improvement, The difference between the two approaches in terms of TFESI effectiveness was of borderline significance (ρ = 0.056; odds ratio: 10.483). We conclude that preganglionic TFESI has the better therapeutic effect on radiculopathy caused by nerve root compression at the level of the supra-adjacent disc than does conventional TFESI, and the difference between

Transforaminal epidural steroid injection for lumbosacral radiculopathy: preganglionic versus conventional approach

Energy Technology Data Exchange (ETDEWEB)

Lee, Joon Woo; Kim, Sung Hyun; Choi, Ja Young [Seoul National University, Seoul (Korea, Republic of)] (and others)

2006-06-15

The present study was undertaken to evaluate the effectiveness of transforaminal epidural steroid injection (TFESI) with using a preganglionic approach for treating lumbar radiculopathy when the nerve root compression was located at the level of the supra-adjacent intervertebral disc. The medical records of the patients who received conventional TFESI at our department from June 2003 to May 2004 were retrospectively reviewed. TFESI was performed in a total of 13 cases at the level of the exiting nerve root, in which the nerve root compression was at the level of the supra-adjacent intervertebral disc (the conventional TFESI group). Since June 2004, we have performed TFESI with using a preganglionic approach at the level of the supra-adjacent intervertebral disc (for example, at the neural foramen of L4-5 for L5 nerve root) if the nerve root compression was at the level of the supra-adjacent intervertebral disc. Using the inclusion criteria described above, 20 of these patients were also consecutively enrolled in our study (the preganglionic TFESI group). The treatment outcome was assessed using a 5-point patient satisfaction scale and by using a VAS (visual assessment scale). A successful outcome required a patient satisfaction scale score of 3(very good) or 4 (excellent), and a reduction on the VAS score of > 50% two weeks after performing TFESI. Logistic regression analysis was also performed. Of the 13 patients in the conventional TFESI group, nine showed satisfactory improvement two weeks after TFESI (69.2%). However, in the preganglionic TFESI group, 18 of the 20 patients (90%) showed satisfactory improvement, The difference between the two approaches in terms of TFESI effectiveness was of borderline significance ({rho} = 0.056; odds ratio: 10.483). We conclude that preganglionic TFESI has the better therapeutic effect on radiculopathy caused by nerve root compression at the level of the supra-adjacent disc than does conventional TFESI, and the difference

Percutaneous full endoscopic lumbar foraminoplasty for adjacent level foraminal stenosis following vertebral intersegmental fusion in an awake and aware patient under local anesthesia: A case report.

Science.gov (United States)

Yamashita, Kazuta; Higashino, Kosaku; Sakai, Toshinori; Takata, Yoichiro; Hayashi, Fumio; Tezuka, Fumitake; Morimoto, Masatoshi; Chikawa, Takashi; Nagamachi, Akihiro; Sairyo, Koichi

2017-01-01

Percutaneous endoscopic surgery for the lumbar spine has become established in the last decade. It requires only an 8 mm skin incision, causes minimal damage to the paravertebral muscles, and can be performed under local anesthesia. With the advent of improved equipment, in particular the high-speed surgical drill, the indications for percutaneous endoscopic surgery have expanded to include lumbar spinal canal stenosis. Transforaminal percutaneous endoscopic discectomy has been used to treat intervertebral stenosis. However, it has been reported that adjacent level disc degeneration and foraminal stenosis can occur following intervertebral segmental fusion. When this adjacent level pathology becomes symptomatic, additional fusion surgery is often needed. We performed minimally invasive percutaneous full endoscopic lumbar foraminoplasty in an awake and aware 50-year-old woman under local anesthesia. The procedure was successful with no complications. Her radiculopathy, including muscle weakness and leg pain due to impingement of the exiting nerve, improved after the surgery. J. Med. Invest. 64: 291-295, August, 2017.

Field Medical Surveillance System User’s Manual

Science.gov (United States)

2000-12-14

Syndrome - Neck 69. 44. Spondylosis 70. 45. SpondylosisAVith Cord Impingement 71. 46. Spondylosis /No Cord Impingement 72. 47. Radiculopathy/Disc...Displacement 73. 48. Radiculopathy/Disc Displacement - Cervical 74. 49. Radiculopathy/Disc Displacement - Lumbar /Sa 75. 50. Radiculopathy/Disc Displacement...Somatic Dysfunction - Thoracic 161.Somatic Dysfunction - Lumbar 162.Somatic Dysfunction - Sacral 163.Somatic Dysfunction - Pelvic 164.Somatic

Pattern of cervical radiculopathy as diagnosed by electrodiagnostic studies

International Nuclear Information System (INIS)

Khan, O.J.; Ali, L.

2014-01-01

Objective: To determine the pattern of cervical radiculopathy presenting to a military care set up using electro diagnostic techniques. Study Design: Descriptive cross sectional study. Place and Duration of study: The study was conducted at the Armed Forces Institute of Rehabillitation Medicine Rawalpindi from July 2012 to December 2012. Subjects and Methods: Seventy-three patients who were diagnosed as cases of cervical radiculopathy on electro diagnostic testing were included in the study. Demographics and frequency of involvement of different levels were noted. Results: Of the total 73 patients, 51 (69.9%) were males and 22 (30.1%) females, with a men age of 48.01 +- 13.5 years. Left side predominated with 46.6% involvement whereas 39.7% of the patients had right sided radiculopathy and 13.7% had bilateral involvement. The most common radiculopathy encountered in this study was C7 which affected 25 (34.2%) patients, followed by C6 affecting 17 (23.3%) patients. Radicuolpathy affecting multiple upper segments like C5, C6 and C7 were a close third presenting in 15 (20.5%) patients. C8, TI radiculopathy of the lower segments was diagnosed in 13 (17.8%) patients whereas the lest common upper limp radiculopathy was C54, present in only 3 (4.1%) patients. Conclusion: Cervical radiculopathies affecting C7 and C6 roots were the most common ones encountered in our study, similar to international data. The cervical spine allows for greater movement and therefore is more prone to such developments. The reasons why C7 and C6 roots are most affected need to be studied further. (author)

Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms.

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Ekedahl, Harald; Jönsson, Bo; Annertz, Mårten; Frobell, Richard B

2018-04-01

To investigate the accuracy of 3 commonly used neurodynamic tests (slump test, straight-leg raise [SLR] test, femoral neurodynamic test) and 2 clinical assessments to determine radiculopathy (radiculopathy I, 1 neurologic sign; radiculopathy II, 2 neurologic signs corresponding to 1 specific nerve root) in detecting magnetic resonance imaging (MRI) findings (extrusion, subarticular nerve root compression, and foraminal nerve root compression). Validity study. Secondary care. We included subjects (N=99; mean age, 58y; 54% women) referred for epidural steroid injection because of lumbar radicular symptoms who had positive clinical and MRI findings. Positive clinical findings included the slump test (n=67), SLR test (n=50), femoral neurodynamic test (n=7), radiculopathy I (n=70), and radiculopathy II (n=33). Positive MRI findings included extrusion (n=27), subarticular nerve compression (n=14), and foraminal nerve compression (n=25). Not applicable. Accuracy of clinical tests in detecting MRI findings was evaluated using sensitivity, specificity, and receiver operating characteristics analysis with area under the curve (AUC). The slump test had the highest sensitivity in detecting extrusion (.78) and subarticular nerve compression (1.00), but the respective specificity was low (.36 and .38). Radiculopathy I was most sensitive in detecting foraminal nerve compression (.80) but with low specificity (.34). Only 1 assessment had a concurrent high sensitivity and specificity (ie, radiculopathy II) in detecting subarticular nerve compression (.71 and .73, respectively). The AUC for all tests in detecting extrusion, subarticular nerve compression, and foraminal nerve compression showed ranges of .48 to .60, .63 to .82, and .33 to .57, respectively. In general, the investigated neurodynamic tests or assessments for radiculopathy lacked diagnostic accuracy. The slump test was the most sensitive test, while radiculopathy II was the most specific test. Most interestingly, no

Clinical significance of the position of dorsal root ganglia in degenerative lumbar diseases. Correlation between anatomic study and imaging study with MRI

Energy Technology Data Exchange (ETDEWEB)

Seki, Masahiro; Kikuchi, Tomiichi [Fukushima Medical Coll., Matsuoka (Japan)

1995-06-01

In order to estimate the ralationship between the position of dorsal root ganglia (DRG) and radicular symptoms, anatomical study was done on 81 cadavers, and a clinical study with MRI was done on 20 cases of lumbar disc herniation and 20 of lumbar spondylosis with L{sub 5} radiculopathy. The position of DRG is not related to the occurrence of radicular symptoms in disc herniation, while in lumbar spondylosis proximally placed DRG are related to both of unilateral and bilateral occurrence of redicular symptoms. Unilateral occurrence of radicular symptoms is influenced by surrounding tissues of the nerve root, rather than the position of DRG. (author).

Clinical significance of the position of dorsal root ganglia in degenerative lumbar diseases. Correlation between anatomic study and imaging study with MRI

International Nuclear Information System (INIS)

Seki, Masahiro; Kikuchi, Tomiichi

1995-01-01

In order to estimate the ralationship between the position of dorsal root ganglia (DRG) and radicular symptoms, anatomical study was done on 81 cadavers, and a clinical study with MRI was done on 20 cases of lumbar disc herniation and 20 of lumbar spondylosis with L 5 radiculopathy. The position of DRG is not related to the occurrence of radicular symptoms in disc herniation, while in lumbar spondylosis proximally placed DRG are related to both of unilateral and bilateral occurrence of redicular symptoms. Unilateral occurrence of radicular symptoms is influenced by surrounding tissues of the nerve root, rather than the position of DRG. (author)

Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF

Science.gov (United States)

Phan, Kevin; Malham, Greg; Seex, Kevin; Rao, Prashanth J.

2015-01-01

Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life. Surgical interbody fusion of degenerative levels is an effective treatment option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity. The surgical options for interbody fusion of the lumbar spine include: posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF). The indications may include: discogenic/facetogenic low back pain, neurogenic claudication, radiculopathy due to foraminal stenosis, lumbar degenerative spinal deformity including symptomatic spondylolisthesis and degenerative scoliosis. In general, traditional posterior approaches are frequently used with acceptable fusion rates and low complication rates, however they are limited by thecal sac and nerve root retraction, along with iatrogenic injury to the paraspinal musculature and disruption of the posterior tension band. Minimally invasive (MIS) posterior approaches have evolved in an attempt to reduce approach related complications. Anterior approaches avoid the spinal canal, cauda equina and nerve roots, however have issues with approach related abdominal and vascular complications. In addition, lateral and OLIF techniques have potential risks to the lumbar plexus and psoas muscle. The present study aims firstly to comprehensively review the available literature and evidence for different lumbar interbody fusion (LIF) techniques. Secondly, we propose a set of recommendations and guidelines

A methodological approach for the biomechanical cause analysis of golf-related lumbar spine injuries.

Science.gov (United States)

Sim, Taeyong; Jang, Dong-Jin; Oh, Euichaul

2014-01-01

A new methodological approach employing mechanical work (MW) determination and relative portion of its elemental analysis was applied to investigate the biomechanical causes of golf-related lumbar spine injuries. Kinematic and kinetic parameters at the lumbar and lower limb joints were measured during downswing in 18 golfers. The MW at the lumbar joint (LJ) was smaller than at the right hip but larger than the MWs at other joints. The contribution of joint angular velocity (JAV) to MW was much greater than that of net muscle moment (NMM) at the LJ, whereas the contribution of NMM to MW was greater rather than or similar to that of JAV at other joints. Thus, the contribution of JAV to MW is likely more critical in terms of the probability of golf-related injury than that of NMM. The MW-based golf-related injury index (MWGII), proposed as the ratio of the contribution of JAV to MW to that of NMM, at the LJ (1.55) was significantly greater than those at other joints ( golf-related injuries around the lumbar spine. Therefore, both MW and MWGII should be considered when investigating the biomechanical causes of lumbar spine injuries.

Optimal imaging parameters to visualize lumbar spinal nerve roots in MRI

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Yamato, Hidetada; Takahashi, Toshiyuki; Funata, Tomonari; Nitta, Masaru; Nakazawa, Yasuo [Showa Univ., Tokyo (Japan). Hospital

2001-05-01

Radiculopathy due to lumber spine disorders is diagnosed mainly by radiculography. Recent advances in MRI have enabled non-invasive visualization of the lumbar nerve roots. Fifty normal volunteers were evaluated for optimal imaging angle to visualize the lumbar nerve roots and optimal imaging sequences. Results showed that in the coronal oblique plane, angles that visualized the nerve roots best were L4 17, L5 29.6, and S1 36.8. In the left sagittal oblique plane, the angles were L4 17.9, L5 21.4, and S1 12.6, and in the right sagittal oblique plane, L4 16.3, L5 19.4 and S1 12.6. SPGR showed the best results both in CNR values and visually. In summary, the optimal angle by which to visualize the lumbar spinal nerve roots increased as the roots became more caudal, except for S1 of the sagittal oblique plane, where individual variations were pronounced. SPGR was the best sequence for visualizing the nerve roots. (author)

[Discarthrosis with hyperalgic lumbar multileveled radicular syndrome].

Science.gov (United States)

Sardaru, D; Tiţu, Gabriela; Pendefunda, L

2012-01-01

The problems at the level of intervertebral discs are producing dysfunctions and important functional regression at the level of lumbar column, at a stage at which the patient could remain blocked in an anterior or lateral flexion position or producing an antalgic position of scoliosis that could incapacitate the patient to perform activities of daily living. The medical rehabilitation, in such cases, must seek not only the relief of local pain through different methods of obtaining it, but also the functional reeducation of the intervertebral articulations through specific analytical mobilization in order to achieve the biomechanical harmonization of the rachis. We report the case study of a 66 year-old patient who presented to our clinic for medical consult and physical therapy when he was diagnosed with discharthrosis, hyperalgic lumbar multileveled radiculopathy at L4-L5 and L5-S1. The lumbar x-ray showed osteophytes, disc narrowing at the level of L5-S1 and inter-apophysis arthrosis. The clinical examination revealed difficulty walking with pain in the right sacroiliac articulations and right sciatic emergence with plantar paraesthesia. The patient developed pain induced scoliosis on the right side that restricted the lumbar range of motion and prevented the right flexion blocking him into an left flexion, any attempt of straightening inducing pain. The condition was treated using specific analytical lumbar mobilization for the realignment of the vertebrae complex. In this case study, we found that functional reeducation in cases of pain induced deviations of the rachis of the column should be centered on the harmonization of inadequate pressure and position of the complex intervertebral articulations.

Kinetic magnetic resonance imaging analysis of lumbar segmental mobility in patients without significant spondylosis.

Science.gov (United States)

Tan, Yanlin; Aghdasi, Bayan G; Montgomery, Scott R; Inoue, Hirokazu; Lu, Chang; Wang, Jeffrey C

2012-12-01

The purpose of this study was to examine lumbar segmental mobility using kinetic magnetic resonance imaging (MRI) in patients with minimal lumbar spondylosis. Mid-sagittal images of patients who underwent weight-bearing, multi-position kinetic MRI for symptomatic low back pain or radiculopathy were reviewed. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, in all lumbar discs from L1-2 to L5-S1 were included for further analysis. Translational and angular motion was measured at each motion segment. The mean translational motion of the lumbar spine at each level was 1.38 mm at L1-L2, 1.41 mm at L2-L3, 1.14 mm at L3-L4, 1.10 mm at L4-L5 and 1.01 mm at L5-S1. Translational motion at L1-L2 and L2-L3 was significantly greater than L3-4, L4-L5 and L5-S1 levels (P lumbar spine was highest at L2-L3 (22.45 %) and least at L5/S1 (14.71 %) (P lumbar segmental mobility in patients without significant degenerative disc disease and found that translational motion was greatest in the proximal lumbar levels whereas angular motion was similar in the mid-lumbar levels but decreased at L1-L2 and L5-S1.

The Prevalence of Medial Epicondylitis Among Patients With C6 and C7 Radiculopathy

Science.gov (United States)

Lee, Aaron Taylor; Lee-Robinson, Ayse L.

2010-01-01

Background: Medial epicondylitis, or golfer’s/pitcher’s elbow, develops as a result of medial stress overload on the flexor muscles at the elbow and presents as pain at the medial epicondyle. Cervical radiculopathy has been associated with lateral epicondylitis, but few associations between the cervical spine and medial epicondylitis have been made. Researchers propose that there is an association, suggesting that the weakness and imbalance in the elbow flexor and extensor muscles from C6 and C7 radiculopathy allow for easy onset of medial epicondylitis. Hypothesis: Medial epicondylitis will present in over half the patients diagnosed with C6 and C7 radiculopathy. Methodology: A total of 102 patients initially presenting with upper extremity or neck symptoms were diagnosed with cervical radiculopathy. They were then examined for medial epicondylitis. Data were collected by referring to patient charts from February 2008 until June 2009. Results: Fifty-five patients were diagnosed with medial epicondylitis. Of these, 44 had C6 and C7 radiculopathy whereas 11 presented with just C6 radiculopathy. Conclusion: Medial epicondylitis presented with cervical radiculopathy in slightly more than half the patients. Weakening of the flexor carpi radialis and pronator teres and imbalance of the flexor and extensor muscles from the C6 and C7 radiculopathy allow for easy onset of medial epicondylitis. Patients with medial epicondylitis should be examined for C6 and C7 radiculopathy to ensure proper treatment. Physicians dealing with golfers, pitchers, or other patients with medial epicondylitis should be aware of the association between these 2 diagnoses to optimize care. PMID:23015956

Comparison of the therapeutic effect between a transforminal along with a caudal epidural injection, as well as two-level transforaminal epidural injections ina radiculopathy patient

International Nuclear Information System (INIS)

Hwang, Jung Han; Hwang, Cheol Mog; Cho, Young Jun; Kim, Keun Won; Kim, Young Joong; Seo, Jae Young; Lim, Seong Joo; Kang, Byeong Seong

2017-01-01

The aim of this study was to evaluate the therapeutic effect of a transforaminal epidural steroid injection (TFESI) along with a caudal epidural steroid injection (ESI), compared to two-level TFESIs in a multi-level radiculopathy patient. A total of 895 lumbar ESIs were performed in 492 patients with multi-level radiculopathy from January 2012 to January 2015. Before injections were performed, the initial Numeric Rating Scale (NRS) score was assessed in all patients, categorized into no pain (excellent), mild (good, NRS: 1-3), moderate (fair, NRS: 4-6), and severe pain (poor, NRS: 7-10). Therapeutic effects were examined for two groups: one-level TFESI along with caudal and ESI two-level TFESIs. Patient outcomes were assessed by NRS in a serial follow-up at one, three, and six months. One TFESI along with caudal ESI was performed in 274 patients and two TFESIs for 218. For the former group with one TFESI along with caudal ESI, excellent results were shown: 219 (79.9%) patients after one month, 200 (72.9%) after three, and 193 (70.4%) after six months. In the patient group with two TFESIs (n = 218) the outcomes were also very good: 152 (69.7%) after one month, 131 (60.0%) after three months, and 123 (56.4%) patients after six months. The therapeutic effect of one TFESI along with caudal ESI was better than two TFESIs in for one, threes, and six months (p < 0.01). Transforaminal epidural steroid with caudal epidural injection is a more effective tool for lumbosacral radiculopathy than two level transforaminal injections in multi-level radiculopathy patients

Comparison of the therapeutic effect between a transforminal along with a caudal epidural injection, as well as two-level transforaminal epidural injections ina radiculopathy patient

Energy Technology Data Exchange (ETDEWEB)

Hwang, Jung Han; Hwang, Cheol Mog; Cho, Young Jun; Kim, Keun Won; Kim, Young Joong; Seo, Jae Young; Lim, Seong Joo [Dept. of Diagnostic Radiology, Konyang University Hospital, Deajeon (Korea, Republic of); Kang, Byeong Seong [Dept. of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan (Korea, Republic of)

2017-01-15

The aim of this study was to evaluate the therapeutic effect of a transforaminal epidural steroid injection (TFESI) along with a caudal epidural steroid injection (ESI), compared to two-level TFESIs in a multi-level radiculopathy patient. A total of 895 lumbar ESIs were performed in 492 patients with multi-level radiculopathy from January 2012 to January 2015. Before injections were performed, the initial Numeric Rating Scale (NRS) score was assessed in all patients, categorized into no pain (excellent), mild (good, NRS: 1-3), moderate (fair, NRS: 4-6), and severe pain (poor, NRS: 7-10). Therapeutic effects were examined for two groups: one-level TFESI along with caudal and ESI two-level TFESIs. Patient outcomes were assessed by NRS in a serial follow-up at one, three, and six months. One TFESI along with caudal ESI was performed in 274 patients and two TFESIs for 218. For the former group with one TFESI along with caudal ESI, excellent results were shown: 219 (79.9%) patients after one month, 200 (72.9%) after three, and 193 (70.4%) after six months. In the patient group with two TFESIs (n = 218) the outcomes were also very good: 152 (69.7%) after one month, 131 (60.0%) after three months, and 123 (56.4%) patients after six months. The therapeutic effect of one TFESI along with caudal ESI was better than two TFESIs in for one, threes, and six months (p < 0.01). Transforaminal epidural steroid with caudal epidural injection is a more effective tool for lumbosacral radiculopathy than two level transforaminal injections in multi-level radiculopathy patients.

Hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level.

Science.gov (United States)

Ikeda, Osamu; Minami, Norihiko; Yamazaki, Masashi; Koda, Masao; Morinaga, Tatsuo

2015-03-01

We present a rare and interesting case of hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level suggesting a possible mechanism by which spinal subdural hematomas can arise. A 71-year-old man presented with persistent sciatic pain and intermittent claudication. Magnetic resonance imaging demonstrated a multilocular mass lesion that showed high signal intensity in both T1- and T2-weighted images, and was located both inside and outside of the spinal canal. Computed tomographic myelography showed a cap-shaped block of the dural tube at L5 and computed tomography with L5-S facet arthrography demonstrated cystic masses. The patient was diagnosed with lumbar radiculopathy caused by hemorrhagic facet cysts, and then progressed to surgical treatment. Surgery revealed that the cysts contained blood clots, and intraoperative findings that the inside of the dural tube appeared blackish and that the dural tube was tensely ballooned after removal of the cysts led us to explorative durotomy. The durotomy demonstrated concentrated old blood pooling both in the dorsal and ventral subdural space, and these spaces were subsequently drained. After surgery, his sciatic pain and intermittent claudication resolved. There was no evidence of cyst mass recurrence at 2 years of follow-up. We propose a newly described mechanism for the formation of spinal subdural hematomas. We recommend surgeons be alert to epidural lesions causing repeated acute compression of the dural tube, which can cause spinal subdural hematoma, and consider the possible coexistence of these lesions in diagnosis and strategic surgical decisions.

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

Science.gov (United States)

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.

Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors

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Kwon, Jong Won; Lee, Joon Woo; Kim, Sung Hyun; Kwack, Kyu-Sung [Seoul National University Bundang Hospital, Department of Radiology, Gyeonggi-do (Korea); Choi, Ja-Young; Moon, Sung Gyu; Jun, Woo Sun [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Yeom, Jin-Sup [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Gyeongi-Do (Korea); Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Gyeongi-Do (Korea); Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Gyeonggi-do (Korea); Seoul National University College of Medicine, Department of Radiology, Seoul (Korea)

2007-05-15

To verify the usefulness of a fluoroscopy guided cervical interlaminar epidural steroid injection (CIESI) in patients with neck pain and cervical radiculopathy and to evaluate outcome predictors. We retrospectively analyzed 91 patients from July 2004 to June 2005 in whom CIESI was initially performed for neck pain and cervical radiculopathy. Therapeutic effects were evaluated 2 weeks after the administration of CIESI, and CIESI effectiveness was graded using a five-point scale, namely, whether the pain had disappeared, was much improved, slightly improved, the same, or aggravated. We also used a visual analog scale (VAS) for the clinical evaluation. According to documentation and follow-up charts, we categorized treatments as effective or ineffective. Possible outcome predictors, namely, diagnosis (spinal stenosis vs herniated disc), primary symptoms (neck pain vs radiculopathy vs both), age, gender, and duration of pain (more or less than 6 months) were also analyzed. Fisher's exact test, the chi-square test, and multiple logistic regression analysis were used for the statistical analysis. After their medical records had been reviewed, 76 patients were included in this study. Inclusion criteria were: the availability of a cross-sectional image, such as a CT scan or an MR image, and a follow-up record after injection. The medical records of 76 patients (male:female = 41: 35) of mean age 53.1 years (range 32 years to 82 years) were reviewed. Two weeks after injection, 55 patients (72.4%) had experienced effective pain relief. Patients with herniated discs had significantly better results than patients with spinal stenosis (86.1% vs 60.0%) (P < 0.05). Other non-significant predictors of an improved outcome included: a symptom duration of <6 months, a young age, and the presence of cervical radiculopathy. Multiple regression analysis showed that the only factor that was significantly associated with outcome was the cause of the pain, i.e., herniated disc or

Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors

International Nuclear Information System (INIS)

Kwon, Jong Won; Lee, Joon Woo; Kim, Sung Hyun; Kwack, Kyu-Sung; Choi, Ja-Young; Moon, Sung Gyu; Jun, Woo Sun; Yeom, Jin-Sup; Kim, Hyun-Jib; Kang, Heung Sik

2007-01-01

To verify the usefulness of a fluoroscopy guided cervical interlaminar epidural steroid injection (CIESI) in patients with neck pain and cervical radiculopathy and to evaluate outcome predictors. We retrospectively analyzed 91 patients from July 2004 to June 2005 in whom CIESI was initially performed for neck pain and cervical radiculopathy. Therapeutic effects were evaluated 2 weeks after the administration of CIESI, and CIESI effectiveness was graded using a five-point scale, namely, whether the pain had disappeared, was much improved, slightly improved, the same, or aggravated. We also used a visual analog scale (VAS) for the clinical evaluation. According to documentation and follow-up charts, we categorized treatments as effective or ineffective. Possible outcome predictors, namely, diagnosis (spinal stenosis vs herniated disc), primary symptoms (neck pain vs radiculopathy vs both), age, gender, and duration of pain (more or less than 6 months) were also analyzed. Fisher's exact test, the chi-square test, and multiple logistic regression analysis were used for the statistical analysis. After their medical records had been reviewed, 76 patients were included in this study. Inclusion criteria were: the availability of a cross-sectional image, such as a CT scan or an MR image, and a follow-up record after injection. The medical records of 76 patients (male:female = 41: 35) of mean age 53.1 years (range 32 years to 82 years) were reviewed. Two weeks after injection, 55 patients (72.4%) had experienced effective pain relief. Patients with herniated discs had significantly better results than patients with spinal stenosis (86.1% vs 60.0%) (P < 0.05). Other non-significant predictors of an improved outcome included: a symptom duration of <6 months, a young age, and the presence of cervical radiculopathy. Multiple regression analysis showed that the only factor that was significantly associated with outcome was the cause of the pain, i.e., herniated disc or spinal

Mini-open lateral retroperitoneal lumbar spine approach using psoas muscle retraction technique. Technical report and initial results on six patients.

Science.gov (United States)

Aghayev, Kamran; Vrionis, Frank D

2013-09-01

The main aim of this paper was to report reproducible method of lumbar spine access via a lateral retroperitoneal route. The authors conducted a retrospective analysis of the technical aspects and clinical outcomes of six patients who underwent lateral multilevel retroperitoneal interbody fusion with psoas muscle retraction technique. The main goal was to develop a simple and reproducible technique to avoid injury to the lumbar plexus. Six patients were operated at 15 levels using psoas muscle retraction technique. All patients reported improvement in back pain and radiculopathy after the surgery. The only procedure-related transient complication was weakness and pain on hip flexion that resolved by the first follow-up visit. Psoas retraction technique is a reliable technique for lateral access to the lumbar spine and may avoid some of the complications related to traditional minimally invasive transpsoas approach.

Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures.

Science.gov (United States)

Sabo, Alex; Hatgis, Jesse; Granville, Michelle; Jacobson, Robert E

2017-12-19

Osteoporotic patients can present with either single or multiple fractures secondary to repeated falls and progressive osteoporosis. Multiple fractures often lead to additional spinal deformity and are a sign of more severe osteoporosis. In the thoracic spine, multiple fractures are associated with the development of gradual thoracic kyphosis but neurologic deficits are uncommon. In the lumbar spine, patients with multiple lumbar fractures have more constant lumbar pain, may have symptoms related to concurrent lumbar stenosis or degenerative scoliosis, and may present with radiculopathy, especially with fractures at L4 and L5. In a review of a series of patients with recurrent multiple lumbar fractures or 'cascading' fractures, it was found that all the patients were female, had severe osteoporosis, often untreated, had a previous history of multiple previous thoracic and lumbar fractures, and all had associated scoliotic spinal deformities ranging from 6 o to 50 o . It was found that if the curve progressed and the greater the degree of curvature, the more frequently subsequent multiple fractures developed, leading to recurrent acute episodes of pain. Forty percent also had additional sacral insufficiency fractures, an unusually high percentage. Biomechanically, the lumbar spine is both more mobile and supports a larger portion of the spinal load compared to the thoracic spine. The existence or worsening of a lumbar spinal deformity from degenerative lumbar scoliosis shifts the mechanical forces more to one side on already weakened osteoporotic lumbar vertebrae and sacrum, leading to an increased incidence of these fractures. Because of the chronic and uneven lower lumbar spinal load with severe vertebral osteoporosis in certain patients with repeat lumbar fractures and worsening degenerative lumbar scoliosis, there may be a rationale to add preventive vertebroplasty at adjacent vertebral endplates when treating acute recurrent lumbar fractures to decrease the

Diffusion-weighted imaging for pretreatment evaluation and prediction of treatment effect in patients undergoing CT-guided injection for lumbar disc herniation

Energy Technology Data Exchange (ETDEWEB)

Niu, Xiang Ke [Dept. of Radiology, Affiliated Hospital of Chengdu University, Chengdu (China); Bhetuwal, Anup; Yang, Han Feng [Schuan Key Laboratory of Medical Imaging and Dept. of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong (China)

2015-08-15

To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O{sub 2}-O{sub 3}) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O{sub 2}-O{sub 3} mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) x 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O{sub 2}-O{sub 3} therapy was determined. Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up. This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O{sub 2}-O{sub 3} injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.

Diffusion-weighted imaging for pretreatment evaluation and prediction of treatment effect in patients undergoing CT-guided injection for lumbar disc herniation

International Nuclear Information System (INIS)

Niu, Xiang Ke; Bhetuwal, Anup; Yang, Han Feng

2015-01-01

To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O 2 -O 3 ) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O 2 -O 3 mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) x 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O 2 -O 3 therapy was determined. Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up. This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O 2 -O 3 injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation

Cervical Stenosis, Myelopathy and Radiculopathy

Science.gov (United States)

... and rarely changes in bowel or bladder control. Cervical radiculopathy will manifest itself as pain traveling from the neck into a specific region ... physician feels that this is related to your cervical spine. If you have persistent pain, numbness or weakness in one of your arms ...

Prevention: Exercise

Medline Plus

Full Text Available ... Radiculopathy Herniated Lumbar Disc Herniated Cervical Disc Lumbar Degenerative Disc Disease Lumbar Spinal Stenosis Lumbar Spondylolisthesis Osteoarthritis Osteoporosis Spondylolysis ...

Lumbar spondylolysis: a review.

Science.gov (United States)

Leone, Antonio; Cianfoni, Alessandro; Cerase, Alfonso; Magarelli, Nicola; Bonomo, Lorenzo

2011-06-01

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

Lumbar spondylolysis: a review

International Nuclear Information System (INIS)

Leone, Antonio; Magarelli, Nicola; Bonomo, Lorenzo; Cianfoni, Alessandro; Cerase, Alfonso

2011-01-01

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

Lumbar spondylolysis: a review

Energy Technology Data Exchange (ETDEWEB)

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

2011-06-15

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

[Minimally invasive approach for cervical spondylotic radiculopathy].

Science.gov (United States)

Ding, Liang; Sun, Taicun; Huang, Yonghui

2010-01-01

To summarize the recent minimally invasive approach for cervical spondylotic radiculopathy (CSR). The recent literature at home and abroad concerning minimally invasive approach for CSR was reviewed and summarized. There were two techniques of minimally invasive approach for CSR at present: percutaneous puncture techniques and endoscopic techniques. The degenerate intervertebral disc was resected or nucleolysis by percutaneous puncture technique if CSR was caused by mild or moderate intervertebral disc herniations. The cervical microendoscopic discectomy and foraminotomy was an effective minimally invasive approach which could provide a clear view. The endoscopy techniques were suitable to treat CSR caused by foraminal osteophytes, lateral disc herniations, local ligamentum flavum thickening and spondylotic foraminal stenosis. The minimally invasive procedure has the advantages of simple handling, minimally invasive and low incidence of complications. But the scope of indications is relatively narrow at present.

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.

[Lumbar spondylosis].

Science.gov (United States)

Seichi, Atsushi

2014-10-01

Lumbar spondylosis is a chronic, noninflammatory disease caused by degeneration of lumbar disc and/or facet joints. The etiology of lumbar spondylosis is multifactorial. Patients with lumbar spondylosis complain of a broad variety of symptoms including discomfort in the low back lesion, whereas some of them have radiating leg pain or neurologenic intermittent claudication (lumbar spinal stenosis). The majority of patients with spondylosis and stenosis of the lumbosacral spine can be treated nonsurgically. Nonsteroidal anti-inflammatory drugs and COX-2 inhibitors are helpful in controlling symptoms. Prostaglandin, epidural injection, and transforaminal injection are also helpful for leg pain and intermittent claudication. Operative therapy for spinal stenosis or spondylolisthesis is reserved for patients who are totally incapacitated by their condition.

Imaging and outcome in severe complications of lumbar epidural anaesthesia: report of 16 cases

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Chiapparini, L.; Savoiardo, M. [Department of Neuroradiology, Istituto Nazionale Neurologico, Milano (Italy); Sghirlanzoni, A.; Pareyson, D. [Department of Neurology, Istituto Nazionale Neurologico, Milano (Italy)

2000-08-01

We reviewed the clinical and neuroradiological features in 16 patients with serious neurological complications of lumbar epidural anaesthesia. We observed acute, transient or permanent and delayed complications. Four patients had symptoms immediately after the procedure. One patient developed a subacute flaccid paraparesis. Two other patients had infectious spondylodiscitis at lumbar puncture level. Eight patients had a delayed progressive spastic paraparesis and were found to have subarachnoid cysts and irregularities of the surface of the spinal cord consistent with arachnoiditis; six of them had an extensive, complex syrinx within the cord. One patient had a severe lumbar polyradiculopathy, and MRI showed adhesive arachnoiditis involving the cauda equina. Although epidural anaesthesia is generally considered safe, rare but severe complications, such as radiculopathy, infectious disease, myelopathy from ischemia and arachnoiditis with a syrinx may occur. The patients with arachnoiditis had a relentless progression of the disease and a poor outcome: five are confined to a wheelchair, one is bedridden. Complications of epidural anaesthesia are easily recognised when they develop immediately; their relationship to the anaesthesia may be ignored or underestimated when they appear after a delay. Awareness of the possibility of delayed complications is important. (orig.)

Imaging and outcome in severe complications of lumbar epidural anaesthesia: report of 16 cases

International Nuclear Information System (INIS)

Chiapparini, L.; Savoiardo, M.; Sghirlanzoni, A.; Pareyson, D.

2000-01-01

We reviewed the clinical and neuroradiological features in 16 patients with serious neurological complications of lumbar epidural anaesthesia. We observed acute, transient or permanent and delayed complications. Four patients had symptoms immediately after the procedure. One patient developed a subacute flaccid paraparesis. Two other patients had infectious spondylodiscitis at lumbar puncture level. Eight patients had a delayed progressive spastic paraparesis and were found to have subarachnoid cysts and irregularities of the surface of the spinal cord consistent with arachnoiditis; six of them had an extensive, complex syrinx within the cord. One patient had a severe lumbar polyradiculopathy, and MRI showed adhesive arachnoiditis involving the cauda equina. Although epidural anaesthesia is generally considered safe, rare but severe complications, such as radiculopathy, infectious disease, myelopathy from ischemia and arachnoiditis with a syrinx may occur. The patients with arachnoiditis had a relentless progression of the disease and a poor outcome: five are confined to a wheelchair, one is bedridden. Complications of epidural anaesthesia are easily recognised when they develop immediately; their relationship to the anaesthesia may be ignored or underestimated when they appear after a delay. Awareness of the possibility of delayed complications is important. (orig.)

Mini-open transforaminal lumbar interbody fusion.

Science.gov (United States)

Tangviriyapaiboon, Teera

2008-09-01

To demonstrate the surgical technique and advantages of the mini-open transforaminal approach for lumbar interbody fusion (TLIF) combined with transpedicular screw fixation. Clinical and radiographic results were assessed to determine the clinical outcomes in twelve consecutive patients selected for minimally invasive access (mini-open technique) for TLIF in Prasat Neurological Institute. A retrospective analysis was performed on 12 patients (age range, 38-74 yr; mean, 54. 8 yr) who underwent mini-open transforaminal approach for lumbar interbody fusion (TLIF) combined with transpedicular screw fixation between September 2006 and June 2008. The titanium pedicle screws were introduced bilaterally through the 3.5 cm length, skin incisions with Spine Classics MLD- system retractor, autologous bone graft were inserted to perform TLIF in all patients. Eight patients were augmented anterior column support with titanium interbody cage, unilateral cage insertion in four patients and the others were inserted bilaterally interbody cages. Six patients presented with low back pain and associated radiculopathy, and six presented with low back pain only. Transforaminal lumbar interbody fusion was performed at L3-L4 in two patients, L4-L5 in four patients, L5-S1 in five patients, and two levels fusion in one patient. All patients were able to ambulate after spinal fusion. The patients were able to walk within 1.4 days (range 1-2 days). The hospital stay averaged 4.4 days (range 3-7 days). Periodic follow-up took place 1 to 21 months after surgery (mean, 7.4 months). The radiological fusion was archived in all nine patients who were operated on more than two months age. The other three patients who had been follow-up less than two months were probably fusion on the 1-month followed-up radiological examination. The use of mini-open technique for pedicle screw instrumentation with spinal fusion procedure provides excellent clinical results and may be an operation of choice for

Operative Outcomes for Cervical Myelopathy and Radiculopathy

Directory of Open Access Journals (Sweden)

J. G. Galbraith

2012-01-01

Full Text Available Cervical spondylotic myelopathy and radiculopathy are common disorders which can lead to significant clinical morbidity. Conservative management, such as physical therapy, cervical immobilisation, or anti-inflammatory medications, is the preferred and often only required intervention. Surgical intervention is reserved for those patients who have intractable pain or progressive neurological symptoms. The goals of surgical treatment are decompression of the spinal cord and nerve roots and deformity prevention by maintaining or supplementing spinal stability and alleviating pain. Numerous surgical techniques exist to alleviate symptoms, which are achieved through anterior, posterior, or circumferential approaches. Under most circumstances, one approach will produce optimal results. It is important that the surgical plan is tailored to address each individual's unique clinical circumstance. The objective of this paper is to analyse the major surgical treatment options for cervical myelopathy and radiculopathy focusing on outcomes and complications.

Lumbar vertebral haemangioma causing pathological fracture, epidural haemorrhage, and cord compression: a case report and review of literature.

Science.gov (United States)

Vinay, S; Khan, S K; Braybrooke, J R

2011-01-01

Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral column, occurring mostly in the thoracic spine. The vast majority of these are asymptomatic. Infrequently, these can turn symptomatic and cause neurological deficit (cord compression) through any of four reported mechanisms: (1) epidural extension; (2) expansion of the involved vertebra(e) causing spinal canal stenosis; (3) spontaneous epidural haemorrhage; (4) pathological burst fracture. Thoracic haemangiomas have been reported to be more likely to produce cord compression than lumbar haemangiomas. A forty-nine year old male with acute onset spinal cord compression from a pathological fracture in a first lumbar vertebral haemangioma. An MRI delineated the haemangioma and extent of bleeding that caused the cord compression. These were confirmed during surgery and the haematoma was evacuated. The spine was instrumented from T12 to L2, and a cement vertebroplasty was performed intra-operatively. Written consent for publication was obtained from the patient. The junctional location of the first lumbar vertebra, and the structural weakness from normal bone being replaced by the haemangioma, probably caused it to fracture under axial loading. This pathological fracture caused bleeding from the vascularized bone, resulting in cord compression.

Towards the causes of secondary post-traumatic deformations of thoracic and lumbar spine

Directory of Open Access Journals (Sweden)

Shulga А.Е.

2015-12-01

Full Text Available The purpose of the study is to analyze and systematize main causes of secondary spine deformations forming in patients who had operations due to thoracic and lumbar spine damages. Material and Methods. The analysis of poor surgical results of 155 patients previously operated due to various thoracic and lumbar spine damages has been conducted. All patients had complications associated with secondary spinal column deformations at various time after the intervention. Standard investigation included the analysis of patients' complaints, their previous history, somatic, neurological and orthopedic status. Results. The intensity of spinal column deformation was defined due to the character and level of primary trauma structurally characterized predominantly by unstable damages. However as it has been found in this research the main cause of this complicated pathology lied in the number of tactical and technical pitfalls of primary surgical treatment. Conclusion. Surgical operations due to secondary post-traumatic deformations in most cases are laborious and are accompanied by significant surgical trauma therefore systematization and analysis of the main causes of poor results of primary spine surgery may contribute to the preventive treatment of this type of pathology.

Progressive paralyzing sciatica revealing a pelvic pseudoaneurysm a year after hip surgery in a 12yo boy.

Science.gov (United States)

Boulouis, Grégoire; Shotar, Eimad; Dangouloff-Ros, Volodia; Janklevicz, Pierre-Henri; Boddaert, Nathalie; Naggara, Olivier; Brunelle, Francis

2016-01-01

Identifying extra spinal causes of a lumbar radiculopathy or polyneuropathy can be a tricky diagnosis challenge, especially in children. Among them, traumatic or iatrogenic pseudoaneurysms of iliac arteries have been seldom reported, in adults' series. The authors report an unusual case of progressive paralyzing left sciatica and lumbar plexopathy in a 12 years old boy, 12 months after a pelvic osteotomy for bilateral hip luxation secondary to osteochondritis dissecans. Spine MRI and pelvic CT angiography revealed a giant internal iliac artery pseudoaneurysm, enclosed in a chronic hematoma. The patient was successfully treated with endovascular coil embolization, and subsequent surgical hematoma evacuation. However, three months after treatment, neurological recovery was incomplete. This case highlights the importance of a rapid and extensive diagnosis work up of all causes of lower limb radiculopathies in children, including pelvic arteries lesions especially after pelvic surgery to avoid therapeutic delays that may jeopardize the chances of neurological recovery. Copyright © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Cost Effectiveness of OMT for Chronic Low Back Pain

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2018-06-14

Lumbar Radiculopathy; Lesion of Sciatic Nerve, Left Lower Limb; Lesion of Sciatic Nerve, Right Lower Limb; Lumbar Spinal Stenosis; Lumbar Spondylosis; Lumbago With Sciatica, Left Side; Lumbago With Sciatica, Right Side

Using the modified Delphi method to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy.

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Zang, Lei; Fan, Ning; Hai, Yong; Lu, S B; Su, Q J; Yang, J C; Du, Peng; Gao, Y J

2015-06-01

Although cervical radiculopathy is very common, there is no standard treatment for this condition, with little high-level evidence available to guide the treatment choice. Thus, this study aimed to review the current data on the management of cervical radiculopathy; and, further, to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy using the Delphi method. First, a systematic review of the previously established treatment guidelines and of articles related to cervical radiculopathy was conducted to establish a protocol for the clinical consensus of the treatment for cervical radiculopathy. Second, from February 2012 to June 2014, we performed a modified Delphi survey in which the current professional opinions from 30 experienced experts, representing almost all of the Chinese provinces, were gathered. Three rounds were performed, and consensus was defined as ≥70% agreement. Consensus of the treatments for cervical radiculopathy was reached on seven aspects, including the proportion of patients requiring only non-surgical therapies; the effectiveness of neck immobilization, physiotherapy, pharmacologic treatment; surgical indications; contraindications; surgery. The modified Delphi study conducted herein reached a consensus concerning several treatment issues for cervical radiculopathy. In the absence of high-level evidence, at present, these expert opinion findings will help guide health care providers to define the appropriate treatment in their regions. Items with no consensus provide excellent areas for future research.

Intradiscal corticosteroid injections in spondylotic cervical radiculopathy

International Nuclear Information System (INIS)

Fayad, Fouad; Rannou, Francois; Rahmani, Lamia; Lefevre-Colau, Marie-Martine; Nys, Alain; Poiraudeau, Serge; Ledoux, Michel; Revel, Michel; Drape, Jean L.; Chevrot, Alain

2007-01-01

The purpose of this study was to evaluate treatment outcomes with intradiscal injection of corticosteroids (IDIC) in cervical spondylotic radiculopathy. Twenty consecutive patients were treated with intradiscal injection of 25 mg of acetate of prednisolone under fluoroscopic control. All patients had previously received a nonsurgical treatment for at least 3 months without success. Outcomes were assessed 1, 3 and 6 months after IDIC. Radicular pain reduction as scored on a visual analogue scale (VAS 100-mm length) was statistically significant at 1 month (19.0±28.0 mm; p=0.008), 3 months (25.2±27.5 mm; p=0.002), and 6 months (24.6±28.4 mm; p=0.001). In all, 40% of treated patients described at least 50% pain improvement 6 months after treatment. Four patients had complete relief of radicular pain. In conclusion, IDIC should be an alternative in the nonsurgical management of cervical spondylotic radiculopathy. (orig.)

Iliacus Abscess with Radiculopathy Mimicking Herniated Nucleus ...

African Journals Online (AJOL)

2016-05-02

May 2, 2016 ... radiculopathy mimicking herniated nucleus pulposus: Aadditional diagnostic value of magnetic resonance imaging. Niger J Clin Pract. 2017;20:392-3. This is an open access article distributed under the terms of the Creative Commons. Attribution-Non Commercial-Share Alike 3.0 License, which allows ...

Lumbar stenosis: clinical case

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Pedro Sá

2014-08-01

Full Text Available Lumbar stenosis is an increasingly common pathological condition that is becoming more frequent with increasing mean life expectancy, with high costs for society. It has many causes, among which degenerative, neoplastic and traumatic causes stand out. Most of the patients respond well to conservative therapy. Surgical treatment is reserved for patients who present symptoms after implementation of conservative measures. Here, a case of severe stenosis of the lumbar spine at several levels, in a female patient with pathological and surgical antecedents in the lumbar spine, is presented. The patient underwent two different decompression techniques within the same operation.

[Conservative treatment of cervical radiculopathy with 5% lidocaine medicated plaster].

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Mattozzi, I

2015-02-01

Cervical radiculopathy is a mixed pain syndrome characterized by neuropathic, skeletal and myofascial pain. This condition is frequently found in developed countries and is a significant source of disability and a reason for frequent medical consultation. In our Pain Therapy Centre, cervical radiculopathy is initially treated with bi-weekly cycles of mesotherapy coupled, at least 15 days later, with physiotherapy to reach the complete mobilization of cervical spine. Cervical radiculopathy is a localized neuro-pathic pain and in agreement with international guidelines, we checked if patients treated topically with 5% lidocaine medicated plaster may benefit in improving pain management and in reducing the time necessary to start physiotherapy. A retrospective study was carried out on 60 patients, of which 30 were treated with mesotherapy and 30 were treated with 5% lidocaine medicated plaster. Data for a total of 30 days observation were collected from the patient medical records. In particular, besides medical history, intensity of pain, intensity of allodynia and pain were considered. For all analyzed parameters, both treatments were effective, but patients treated with 5% lidocaine medicated plaster showed faster control of the painful symptoms, an essential condition for an earlier rehabilitative treatment.

Salvage of cervical motor radiculopathy using peripheral nerve transfer reconstruction.

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Afshari, Fardad T; Hossain, Taushaba; Miller, Caroline; Power, Dominic M

2018-05-10

Motor nerve transfer surgery involves re-innervation of important distal muscles using either an expendable motor branch or a fascicle from an adjacent functioning nerve. This technique is established as part of the reconstructive algorithm for traumatic brachial plexus injuries. The reproducible outcomes of motor nerve transfer surgery have resulted in exploration of the application of this technique to other paralysing conditions. The objective of this study is to report feasibility and increase awareness about nerve transfer as a method of improving upper limb function in patients with cervical motor radiculopathy of different aetiology. In this case series we report 3 cases with different modes of injury to the spinal nerve roots with significant and residual motor radiculopathy that have been successfully treated with nerve transfer surgery with good functional outcomes. The cases involved iatrogenic nerve root injury, tumour related root compression and degenerative root compression. Nerve transfer surgery may offer reliable reconstruction for paralysis when there has been no recovery following a period of conservative management. However the optimum timing of nerve transfer intervention is not yet identified for patients with motor radiculopathy.

Dimensions Underlying Measures of Disability, Personal Factors, and Health Status in Cervical Radiculopathy

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Halvorsen, Marie; Kierkegaard, Marie; Harms-Ringdahl, Karin; Peolsson, Anneli; Dedering, Åsa

2015-01-01

Abstract This cross-sectional study sought to identify dimensions underlying measures of impairment, disability, personal factors, and health status in patients with cervical radiculopathy. One hundred twenty-four patients with magnetic resonance imaging-verified cervical radiculopathy, attending a neurosurgery clinic in Sweden, participated. Data from clinical tests and questionnaires on disability, personal factors, and health status were used in a principal-component analysis (PCA) with oblique rotation. The PCA supported a 3-component model including 14 variables from clinical tests and questionnaires, accounting for 73% of the cumulative percentage. The first component, pain and disability, explained 56%. The second component, health, fear-avoidance beliefs, kinesiophobia, and self-efficacy, explained 9.2%. The third component including anxiety, depression, and catastrophizing explained 7.6%. The strongest-loading variables of each dimension were “present neck pain intensity,” “fear avoidance,” and “anxiety.” The three underlying dimensions identified and labeled Pain and functioning, Health, beliefs, and kinesiophobia, and Mood state and catastrophizing captured aspects of importance for cervical radiculopathy. Since the variables “present neck pain intensity,” “fear avoidance,” and “anxiety” had the strongest loading in each of the three dimensions; it may be important to include them in a reduced multidimensional measurement set in cervical radiculopathy. PMID:26091482

Biomechanical study of percutaneous lumbar diskectomy

International Nuclear Information System (INIS)

Li Yuan; Huang Xianglong; Shen Tianzhen; Hu Zhou; Hong Shuizong; Mei Haiying

2003-01-01

Objective: To investigate the stiffness of lumbar spine after the injury caused by percutaneous diskectomy and evaluate the efficiency of percutaneous lumbar diskectomy by biomechanical study. Methods: Four fresh lumbar specimens were used to analyse load-displacement curves in the intact lumbar spine and vertical disc-injured lumbar spine. The concepts of average flexibility coefficient (f) and standardized average flexibility coefficient (fs) were also introduced. Results: The load-displacement curves showed a good stabilization effect of the intact lumbar spine and disc-injured lumbar spine in flexion, extension, right and left bending. The decrease of anti-rotation also can be detected (P<0.05). Conclusion: In biomechanical study, percutaneous lumbar diskectomy is one of the efficiency methods to treat lumbar diac hernia

Sensory symptom profiles and co-morbidities in painful radiculopathy.

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Friederike Mahn

Full Text Available Painful radiculopathies (RAD and classical neuropathic pain syndromes (painful diabetic polyneuropathy, postherpetic neuralgia show differences how the patients express their sensory perceptions. Furthermore, several clinical trials with neuropathic pain medications failed in painful radiculopathy. Epidemiological and clinical data of 2094 patients with painful radiculopathy were collected within a cross sectional survey (painDETECT to describe demographic data and co-morbidities and to detect characteristic sensory abnormalities in patients with RAD and compare them with other neuropathic pain syndromes. Common co-morbidities in neuropathic pain (depression, sleep disturbance, anxiety do not differ considerably between the three conditions. Compared to other neuropathic pain syndromes touch-evoked allodynia and thermal hyperalgesia are relatively uncommon in RAD. One distinct sensory symptom pattern (sensory profile, i.e., severe painful attacks and pressure induced pain in combination with mild spontaneous pain, mild mechanical allodynia and thermal hyperalgesia, was found to be characteristic for RAD. Despite similarities in sensory symptoms there are two important differences between RAD and other neuropathic pain disorders: (1 The paucity of mechanical allodynia and thermal hyperalgesia might be explained by the fact that the site of the nerve lesion in RAD is often located proximal to the dorsal root ganglion. (2 The distinct sensory profile found in RAD might be explained by compression-induced ectopic discharges from a dorsal root and not necessarily by nerve damage. These differences in pathogenesis might explain why medications effective in DPN and PHN failed to demonstrate efficacy in RAD.

Comparison between effectiveness of Mechanical and Manual Traction combined with mobilization and exercise therapy in Patients with Cervical Radiculopathy.

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Bukhari, Syed Rehan Iftikhar; Shakil-Ur-Rehman, Syed; Ahmad, Shakeel; Naeem, Aamer

2016-01-01

Cervical radiculopathy is a common neuro-musculo-skeletal disorder causing pain and disability. Traction is part of the evidence based manual physical therapy management due to its mechanical nature, type of traction and parameters related to its applicability and are still to be explored more through research. Our objective was to determine the Effects of Mechanical versus Manual Traction in Manual Physical Therapy combined with segmental mobilization and exercise therapy in the physical therapy management of Patients with Cervical Radiculopathy. This randomized control trial was conducted at department of physical therapy and rehabilitation, Rathore Hospital Faisalabad, from February to July 2015. Inclusion criteria were both male and female patients with evident symptoms of cervical spine radiculopathy and age ranged between 20-70 years. The exclusion criteria were Patients with history of trauma, neck pain without radiculopathy, aged less than 20 and more than 70. A total of 72 patients with cervical radiculopathy were screened out as per the inclusion criteria, 42 patients were randomly selected and placed into two groups by toss and trial method, and only 36 patients completed the study, while 6 dropped out. The mechanical traction was applied in group A and manual traction in group B along with common intervention of segmental mobilization and exercise therapy in both groups for 6 weeks. The patient's outcomes were assessed by self reported NPRS and NDI at the baseline and after completion of 06 weeks exercise program at 3 days per week. The data was analyzed through SPSS version-21, and paired T test was applied at 95% level significance to determine the statistical deference between two groups. Clinically the group of patients treated with mechanical traction managed pain (mean pre 6.26, mean post 1.43), and disability (mean pre 24.43 and mean post 7.26) more effectively as compared with the group of patients treated with manual traction (Pain mean pre 6

Results of arthrospine assisted percutaneous technique for lumbar discectomy

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Mohinder Kaushal

2016-01-01

Full Text Available Background: Avaialable minimal invasive arthro/endoscopic techniques are not compatible with 30 degree arthroscope which orthopedic surgeons uses in knee and shoulder arthroscopy. Minimally invasive “Arthrospine assisted percutaneous technique for lumbar discectomy” is an attempt to allow standard familiar microsurgical discectomy and decompression to be performed using 30° arthroscope used in knee and shoulder arthroscopy with conventional micro discectomy instruments. Materials and Methods: 150 patients suffering from lumbar disc herniations were operated between January 2004 and December 2012 by indiginously designed Arthrospine system and were evaluated retrospectively. In lumbar discectomy group, there were 85 males and 65 females aged between 18 and 72 years (mean, 38.4 years. The delay between onset of symptoms to surgery was between 3 months to 7 years. Levels operated upon included L1-L2 (n = 3, L2-L3 (n = 2, L3-L4 (n = 8, L4-L5 (n = 90, and L5-S1 (n = 47. Ninety patients had radiculopathy on right side and 60 on left side. There were 22 central, 88 paracentral, 12 contained, 3 extraforaminal, and 25 sequestrated herniations. Standard protocol of preoperative blood tests, x-ray LS Spine and pre operative MRI and pre anaesthetic evaluation for anaesthesia was done in all cases. Technique comprised localization of symptomatic level followed by percutaneous dilatation and insertion of a newly devised arthrospine system devise over a dilator through a 15 mm skin and fascial incision. Arthro/endoscopic discectomy was then carried out by 30° arthroscope and conventional disc surgery instruments. Results: Based on modified Macnab's criteria, of 150 patients operated for lumbar discectomy, 136 (90% patients had excellent to good, 12 (8% had fair, and 2 patients (1.3% had poor results. The complications observed were discitis in 3 patients (2%, dural tear in 4 patients (2.6%, and nerve root injury in 2 patients (1.3%. About 90% patients

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.

Factors Associated With Work Ability in Patients Undergoing Surgery for Cervical Radiculopathy.

Science.gov (United States)

Ng, Eunice; Johnston, Venerina; Wibault, Johanna; Löfgren, Håkan; Dedering, Åsa; Öberg, Birgitta; Zsigmond, Peter; Peolsson, Anneli

2015-08-15

Cross-sectional study. To investigate the factors associated with work ability in patients undergoing surgery for cervical radiculopathy. Surgery is a common treatment of cervical radiculopathy in people of working age. However, few studies have investigated the impact on the work ability of these patients. Patients undergoing surgery for cervical radiculopathy (n = 201) were recruited from spine centers in Sweden to complete a battery of questionnaires and physical measures the day before surgery. The associations between various individual, psychological, and work-related factors and self-reported work ability were investigated by Spearman rank correlation coefficient, multivariate linear regression, and forward stepwise regression analyses. Factors that were significant (P work ability. Work ability was assessed using the Work Ability Index. The mean Work Ability Index score was 28 (SD, 9.0). The forward stepwise regression analysis revealed 6 factors significantly associated with work ability, which explained 62% of the variance in the Work Ability Index. Factors highly correlated with greater work ability included greater self-efficacy in performing self-cares, lower physical load on the neck at work, greater self-reported chance of being able to work in 6 months' time, greater use of active coping strategies, lower frequency of hand weakness, and higher health-related quality of life. Psychological, work-related and individual factors were significantly associated with work ability in patients undergoing surgery for cervical radiculopathy. High self-efficacy was most associated with greater work ability. Consideration of these factors by surgeons preoperatively may provide optimal return to work outcomes after surgery. 3.

Effect of aging and lumbar spondylosis on lumbar lordosis

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Francis Osita Okpala

2018-01-01

Full Text Available Background: Lumbar lordosis (LL, the anterior convexity of the lumbar spine in the mid-sagittal plane, gives the spine some resilience and helps in protecting it from compressive forces because some of the force is taken by the anterior longitudinal ligaments. In aging and lumbar spondylosis, the intervertebral discs undergo the same degenerative changes though at different rates, and in both, while some authors reported a straightening of LL, others reported no significant change. This morphologic information would hopefully influence therapeutic decision-making, particularly in lumbar spondylosis, which though usually asymptomatic, is a common cause of low back pain. Aim: The aim of the study was to investigate the effect of aging and lumbar spondylosis on LL. Subjects and Methods: Lumbosacral joint angle (LSJA, an angular measure of LL, was retrospectively measured in 252 normal and 329 spondylotic adolescent and adult supine lateral lumbosacral spine archival radiographs, and data were analyzed with IBM SPSS Statistics 23.0 (New York, USA. Results: Normal LSJA range was 5°–39°; the mean was 18.7° and showed insignificant variation with gender and aging. Spondylotic range was 5°–40° and the mean (20.8° differed from the normal mean by about 2°, which probably have inconsequential effect on the lumbar curvature, suggesting that the normal and spondylotic mean values are essentially equal. The spondylotic mean also showed insignificant variation with aging and inconsequential 1° gender difference in favor of females. Conclusion: LL is substantially maintained in aging and lumbar spondylosis.

Treatment of cervical radiculopathy: A review of the evolution and economics.

Science.gov (United States)

Ament, Jared D; Karnati, Tejas; Kulubya, Edwin; Kim, Kee D; Johnson, J Patrick

2018-01-01

The surgical treatment of cervical radiculopathy has centered around anterior cervical discectomy and fusion (ACDF). Alternatively, the posterior cervical laminoforaminotomy/microdiscectomy (PCF/PCM), which results in comparable outcomes and is more cost-effective, has been underutilized. Here, we compared the direct/indirect costs, reoperation rates, and outcome for ACDF and PCF vs. PCM using PubMed, Medline, and Embase databases. There were no significant differences between the re-operative rates of PCF/PCM (2% to 9.8%) versus ACDF (2% to 8%). Direct costs of ACDF were also significantly higher; the 1-year cost-utility analysis demonstrated that ACDF had $131,951/QALY while PCM had $79,856/QALY. PCF/PCM for radiculopathy are safe and more cost-effective vs. ACDF, and have similar clinical outcomes.

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

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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.

Cervical transforaminal epidural steroid injection for the management of cervical radiculopathy: a comparative study of particulate versus non-particulate steroids

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Lee, Joon Woo; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Gyeonggi-Do (Korea); Park, Kun Woo; Yeom, Jin S. [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Gyeonggi-Do (Korea); Chung, Sang-Ki; Kim, Ki-Jeong; Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Gyeonggi-do (Korea)

2009-11-15

To determine if a particulate steroid which has a risk for embolic infarct would be more effective than a non-particulate steroid for transforaminal epidural steroid injection (TFESI). The purpose of this study was (1) to compare the effect of cervical TFESI using particulate (e.g., triamcinolone) and non-particulate (e.g., dexamethasone) steroids and (2) to evaluate the effectiveness of cervical TFESI in general. From January 2006 to August 2008, 159 consecutive patients [male:female (M:F) 89:70; mean age 53 years, range 33-75 years] who underwent cervical TFESI were included in this non-randomized study. For cervical TFESI, triamcinolone was injected into 97 patients and dexamethasone into 62 patients. Short-term follow-up was conducted within 1 month. The outcome was classified as effective or ineffective. Fisher's exact test was used to analyze the difference of outcome according to the injected steroid (triamcinolone vs dexamethasone). Other possible outcome predictors, such as age, gender, duration of radiculopathy, predominant symptom, attack of radiculopathy, cause of radiculopathy, number of nerve root compression levels, previous operation, and failure of previous interlaminar epidural injection, were also analyzed. Cervical TFESI using triamcinolone (78/97, 80.4%) was slightly more effective than that using dexamethasone (43/62, 69.4%), which was not significant (P = 0.129). In general, cervical TFESIs were effective in 121 of 159 patients (76.1%) at short-term follow-up. The only significant outcome predictor was whether the patient had had a previous operation (6/13, 46/2%) or not (115/146, 78.8%) (P = 0.015). There was no significant difference between particulate or non-particulate steroid for the effect of cervical TFESI. Cervical TFESI was effective in managing cervical radiculopathy in general. (orig.)

Cervical transforaminal epidural steroid injection for the management of cervical radiculopathy: a comparative study of particulate versus non-particulate steroids

International Nuclear Information System (INIS)

Lee, Joon Woo; Kang, Heung Sik; Park, Kun Woo; Yeom, Jin S.; Chung, Sang-Ki; Kim, Ki-Jeong; Kim, Hyun-Jib

2009-01-01

To determine if a particulate steroid which has a risk for embolic infarct would be more effective than a non-particulate steroid for transforaminal epidural steroid injection (TFESI). The purpose of this study was (1) to compare the effect of cervical TFESI using particulate (e.g., triamcinolone) and non-particulate (e.g., dexamethasone) steroids and (2) to evaluate the effectiveness of cervical TFESI in general. From January 2006 to August 2008, 159 consecutive patients [male:female (M:F) 89:70; mean age 53 years, range 33-75 years] who underwent cervical TFESI were included in this non-randomized study. For cervical TFESI, triamcinolone was injected into 97 patients and dexamethasone into 62 patients. Short-term follow-up was conducted within 1 month. The outcome was classified as effective or ineffective. Fisher's exact test was used to analyze the difference of outcome according to the injected steroid (triamcinolone vs dexamethasone). Other possible outcome predictors, such as age, gender, duration of radiculopathy, predominant symptom, attack of radiculopathy, cause of radiculopathy, number of nerve root compression levels, previous operation, and failure of previous interlaminar epidural injection, were also analyzed. Cervical TFESI using triamcinolone (78/97, 80.4%) was slightly more effective than that using dexamethasone (43/62, 69.4%), which was not significant (P = 0.129). In general, cervical TFESIs were effective in 121 of 159 patients (76.1%) at short-term follow-up. The only significant outcome predictor was whether the patient had had a previous operation (6/13, 46/2%) or not (115/146, 78.8%) (P = 0.015). There was no significant difference between particulate or non-particulate steroid for the effect of cervical TFESI. Cervical TFESI was effective in managing cervical radiculopathy in general. (orig.)

Muscle activation timing and balance response in chronic lower back pain patients with associated radiculopathy.

Science.gov (United States)

Frost, Lydia R; Brown, Stephen H M

2016-02-01

Patients with chronic low back pain and associated radiculopathy present with neuromuscular symptoms both in their lower back and down their leg; however, investigations of muscle activation have so far been isolated to the lower back. During balance perturbations, it is necessary that lower limb muscles activate with proper timing and sequencing along with the lower back musculature to efficiently regain balance control. Patients with chronic low back pain and radiculopathy and matched controls completed a series of balance perturbations (rapid bilateral arm raise, unanticipated and anticipated sudden loading, and rapid rise to toe). Muscle activation timing and sequencing as well as kinetic response to the perturbations were analyzed. Patients had significantly delayed lower limb muscle activation in rapid arm raise trials as compared to controls. In sudden loading trials, muscle activation timing was not delayed in patients; however, some differences in posterior chain muscle activation sequencing were present. Patients demonstrated less anterior-posterior movement in unanticipated sudden loading trials, and greater medial-lateral movement in rise to toe trials. Patients with low back pain and radiculopathy demonstrated some significant differences from control participants in terms of muscle activation timing, sequencing, and overall balance control. The presence of differences between patients and controls, specifically in the lower limb, indicates that radiculopathy may play a role in altering balance control in these patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

Influence of Gluteus Maximus Inhibition on Upper Trapezius Overactivity in Chronic Mechanical Neck Pain with Radiculopathy

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Ghada Mohamed Koura

2017-03-01

Full Text Available Background: Mechanical neck pain is the most common type of neck pain and commonly to accompany with radiculopathy. Patients of neck pain exhibit greater activation of accessory muscles, (sternocleidomastoid, anterior scalene, and upper trapezius muscles and may also show changed patterns of motor control of other postural muscles as pelvic muscles for reducing activation of painful muscles of neck. Aim of the study: To determine if there is an association between gluteus maximus inhibition and overactivity of upper fibres of trapezius in patients with chronic mechanical neck pain with radiculopathy. Materials and Methods: Forty female patients participated in this study diagnosed as chronic mechanical neck pain with radiculopathy. Amplitude and onset of muscle activation were assessed by using the surface electromyography (EMG during prone hip extension test. Results: The results of this study demonstrated that there is no correlation between the amplitude of EMG activity of right and left gluteus maximus and the amplitude of EMG activity of right and left upper trapezius (P<0.05. Conclusion: It can be concluded that the overactivity of the upper trapezius muscle in patients with chronic mechanical neck pain with radiculopathy is not related to the inhibition of the gluteus maximus muscle during prone hip extension test.

Hypertrophy and pseudohypertrophy of the lower leg following chronic radiculopathy and neuropathy: imaging findings in two patients

International Nuclear Information System (INIS)

Beuckeleer, L. de; Schepper, A. de; Vanhoenacker, F.; Schepper, A. Jr. de; Seynaeve, P.

1999-01-01

Enlargement of the ipsilateral muscle compartment is an exceptional finding in patients with chronic radiculopathy, peripheral nerve injury, anterior horn cell diseases, or acquired peripheral neuropathy. We report radiographic, ultrasonographic, CT and MRI findings in a patient with chronic S1 radiculopathy and another with chronic neuropathy of the common fibular nerve (L4-S2), both presenting with painless enlargement of the calf muscles. (orig.)

Spondylectomy and lateral lumbar interbody fusion for thoracolumbar kyphosis in an adult with achondroplasia

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Miyazaki, Masashi; Kanezaki, Shozo; Notani, Naoki; Ishihara, Toshinobu; Tsumura, Hiroshi

2017-01-01

Abstract Rationale: Fixed thoracolumbar kyphosis with spinal stenosis in adult patients with achondroplasia presents a challenging issue. We describe the first case in which spondylectomy and minimally invasive lateral access interbody arthrodesis were used for the treatment of fixed severe thoracolumbar kyphosis and lumbar spinal canal stenosis in an adult with achondroplasia. Patient concerns: A 61-year-old man with a history of achondroplastic dwarfism presented with low back pain and radiculopathy and neurogenic claudication. Diagnoses: Plain radiographs revealed a high-grade thoracolumbar kyphotic deformity with diffuse degenerative changes in the lumbar spine. The apex was located at L2, the local kyphotic angle from L1 to L3 was 105°, and the anterior area was fused from the L1 to L3 vertebrae. MRI revealed significant canal and lateral recess stenosis secondary to facet hypertrophy. Interventions: We planned a front-back correction of the anterior and posterior spinal elements. We first performed anterior release at the fused part from L1 to L3 and XLIF at L3/4 and L4/5. Next, the patient was placed in the prone position. Spondylectomy at the L2 vertebra and posterior fusion from T10 to L5 were performed. Postoperative radiographs revealed L1 to L3 kyphosis of 32°. Outcomes: No complications occurred during or after surgery. Postoperatively, the patient's low back pain and neurological claudication were resolved. No worsening of kyphosis was observed 24 months postoperatively. Lessons: Circumferential decompression of the spinal cord at the apical vertebral level and decompression of lumbar canal stenosis were necessary. Front-back correction of the anterior and posterior spinal elements via spondylectomy and lateral lumbar interbody fusion is a reasonable surgical option for thoracolumbar kyphosis and developmental canal stenosis in patients with achondroplasia. PMID:29245270

TEST-RETEST RELIABILITY OF HAND GRIP STRENGTH MEASUREMENT USING A JAMAR HAND DYNAMOMETER IN PATIENTS WITH ACUTE AND CHRONIC CERVICAL RADICULOPATHY

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Ejazi G

2017-12-01

Full Text Available Background: To evaluate the test-retest reliability of Jamar hand held dynamometer for measuring handgrip strength (HGS in patients with acute and chronic cervical radiculopathy and to find out the difference in measurement of the handgrip strength between acute and chronic cervical radiculopathy. Methods: A prospective, observational and non-experimental, the comparative study design was used. A sample of 72 subjects (37 women and 35 men suffering from cervical radiculopathy were divided into two groups i.e., Group A(acute and Group B(chronic, handgrip strength was measured using Jamar hand held dynamometer on two occasions by the same rater with an interval of 7-days. Data collection was based on standard guidelines of American Society of Hand Therapists. Three gripping trials (measured in Kg with patient’s arm in standardized arm position were recorded. The data was analyzed from the mean score obtained from the sample. Result: One-way Analysis of Variance(ANOVA was used to evaluate test-retest reliability and Tukey-Kramer Multiple Comparison Test used to find the difference between handgrip strength among acute and chronic Cervical radiculopathy cases. Greater P-value (>0.05 in both testing session, as well as 95% of the confidence interval, shows the reliability of the instrument and lesser p-value (0.05 in female subjects shows no significant difference in handgrip strength between the two groups. Conclusion: Excellent test-retest reliability for hand grip strength measurement was measured in patients with acute and chronic cervical radiculopathy shows that the equipment could be used as an assessment tool for this patient and significant difference exists among male handgrip strength between acute and chronic cervical radiculopathy cases whereas no difference exists among female handgrip strength between acute and chronic cervical radiculopathy cases.

Hypertrophy and pseudohypertrophy of the lower leg following chronic radiculopathy and neuropathy: imaging findings in two patients

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Beuckeleer, L. de; Schepper, A. de [Department of Radiology, University Hospital Antwerp, Edegem (Netherlands); Vanhoenacker, F. [Department of Radiology, University Hospital Antwerp, Edegem (Netherlands)]|[Department of Radiology, AZ St. Maarten, Campus Duffel, Duffel (Belgium); Schepper, A. Jr. de [Department of Radiology, University Hospital Antwerp, Edegem (Netherlands)]|[Department of Radiology, AZ Middelheim, Antwerpen (Belgium); Seynaeve, P. [Department of Radiology, AZ Middelheim, Antwerpen (Belgium)

1999-04-01

Enlargement of the ipsilateral muscle compartment is an exceptional finding in patients with chronic radiculopathy, peripheral nerve injury, anterior horn cell diseases, or acquired peripheral neuropathy. We report radiographic, ultrasonographic, CT and MRI findings in a patient with chronic S1 radiculopathy and another with chronic neuropathy of the common fibular nerve (L4-S2), both presenting with painless enlargement of the calf muscles. (orig.) With 2 figs., 7 refs.

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

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Ding Zi-hai

2011-04-01

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

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

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Lu, Sheng; Chang, Shan; Zhang, Yuan-zhi; Ding, Zi-hai; Xu, Xin Ming; Xu, Yong-qing

2011-04-14

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

Value of physical tests in diagnosing cervical radiculopathy : a systematic review

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Thoomes, Erik J; van Geest, Sarita; van der Windt, Danielle A; Falla, Deborah; Verhagen, Arianne P; Koes, Bart W; Thoomes-de Graaf, Marloes; Kuijper, Barbara; Scholten-Peeters, Wendy Gm; Vleggeert-Lankamp, Carmen L

Background context In clinical practice, the diagnosis of cervical radiculopathy is based on information from the patient history, physical examination and diagnostic imaging. Various physical tests may be performed, but their diagnostic accuracy is unknown. Purpose To summarize and update the

Dimensions Underlying Measures of Disability, Personal Factors, and Health Status in Cervical Radiculopathy: A Cross-Sectional Study.

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Halvorsen, Marie; Kierkegaard, Marie; Harms-Ringdahl, Karin; Peolsson, Anneli; Dedering, Åsa

2015-06-01

This cross-sectional study sought to identify dimensions underlying measures of impairment, disability, personal factors, and health status in patients with cervical radiculopathy. One hundred twenty-four patients with magnetic resonance imaging-verified cervical radiculopathy, attending a neurosurgery clinic in Sweden, participated. Data from clinical tests and questionnaires on disability, personal factors, and health status were used in a principal-component analysis (PCA) with oblique rotation. The PCA supported a 3-component model including 14 variables from clinical tests and questionnaires, accounting for 73% of the cumulative percentage. The first component, pain and disability, explained 56%. The second component, health, fear-avoidance beliefs, kinesiophobia, and self-efficacy, explained 9.2%. The third component including anxiety, depression, and catastrophizing explained 7.6%. The strongest-loading variables of each dimension were "present neck pain intensity," "fear avoidance," and "anxiety." The three underlying dimensions identified and labeled Pain and functioning, Health, beliefs, and kinesiophobia, and Mood state and catastrophizing captured aspects of importance for cervical radiculopathy. Since the variables "present neck pain intensity," "fear avoidance," and "anxiety" had the strongest loading in each of the three dimensions; it may be important to include them in a reduced multidimensional measurement set in cervical radiculopathy.

Segmental and global lordosis changes with two-level axial lumbar interbody fusion and posterior instrumentation

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Melgar, Miguel A; Tobler, William D; Ernst, Robert J; Raley, Thomas J; Anand, Neel; Miller, Larry E; Nasca, Richard J

2014-01-01

Background Loss of lumbar lordosis has been reported after lumbar interbody fusion surgery and may portend poor clinical and radiographic outcome. The objective of this research was to measure changes in segmental and global lumbar lordosis in patients treated with presacral axial L4-S1 interbody fusion and posterior instrumentation and to determine if these changes influenced patient outcomes. Methods We performed a retrospective, multi-center review of prospectively collected data in 58 consecutive patients with disabling lumbar pain and radiculopathy unresponsive to nonsurgical treatment who underwent L4-S1 interbody fusion with the AxiaLIF two-level system (Baxano Surgical, Raleigh NC). Main outcomes included back pain severity, Oswestry Disability Index (ODI), Odom's outcome criteria, and fusion status using flexion and extension radiographs and computed tomography scans. Segmental (L4-S1) and global (L1-S1) lumbar lordosis measurements were made using standing lateral radiographs. All patients were followed for at least 24 months (mean: 29 months, range 24-56 months). Results There was no bowel injury, vascular injury, deep infection, neurologic complication or implant failure. Mean back pain severity improved from 7.8±1.7 at baseline to 3.3±2.6 at 2 years (p lordosis, defined as a change in Cobb angle ≤ 5°, was identified in 84% of patients at L4-S1 and 81% of patients at L1-S1. Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change. Conclusions/Clinical Relevance Two-level axial interbody fusion supplemented with posterior fixation does not alter segmental or global lordosis in most patients. Patients with postoperative change in lordosis greater than 5° have similarly favorable long-term clinical outcomes and fusion rates compared to patients with less than 5° lordosis change. PMID:25694920

Diffusion-weighted imaging and diffusion tensor imaging of asymptomatic lumbar disc herniation.

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Sakai, Toshinori; Miyagi, Ryo; Yamabe, Eiko; Fujinaga, Yasunari; N Bhatia, Nitin; Yoshioka, Hiroshi

2014-01-01

Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) were performed on a healthy 31-year-old man with asymptomatic lumbar disc herniation. Although the left S1 nerve root was obviously entrapped by a herniated mass, neither DWI nor DTI showed any significant findings for the nerve root. Decreased apparent diffusion coefficient (ADC) values and increased fractional anisotropy (FA) values were found. These results are contrary to those in previously published studies of symptomatic patients, in which a combination of increased ADC and decreased FA seem to have a relationship with nerve injury and subsequent symptoms, such as leg pain or palsy. Our results seen in an asymptomatic subject suggest that the compressed nerve with no injury, such as edema, demyelination, or persistent axonal injury, may be indicated by a combination of decreased ADC and increased FA. ADC and FA could therefore be potential tools to elucidate the pathomechanism of radiculopathy.

Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain

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Brooks, Benjamin K.; Southam, Samuel L.; Mlady, Gary W.; Logan, Jeremy; Rosett, Matthew [University of New Mexico School of Medicine, Department of Radiology, Albuquerque, NM (United States)

2010-07-15

To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain. The records of 2,555 patients who had undergone abdominal and pelvic CT in 2008 were reviewed electronically. In order to determine a true representation of the general population, we reviewed all indications for CT, excluding patients with a primary complaint of low back pain as the primary indication for imaging. Equal numbers of patients were separated into age groups by decade to ensure an even distribution of ages for statistical analysis. Patients older than 70 years were grouped together to provide case numbers comparable to those of the other decades. Logistic regression analysis was performed to evaluate the significance of the results. Three board-certified radiologists, including two musculoskeletal fellows and a radiology resident, retrospectively evaluated CT scans for lumbar spondylolysis, including unilateral and bilateral defects. Of the 2,555 cases evaluated, there were 203 positive cases of defects of the lumbar pars interarticularis. This corresponded to an overall prevalence of 8.0%. Prevalence per decade was fairly evenly distributed and ranged from 7.0%(ages 30-39 years) to 9.2% (ages 70 years and above). Prevalence of ages 20-49 years was 7.9%, and that of ages 50 years and older was 8.0%. Male to female ratio was 1.5:1. Logistic regression showed no significant increase in spondylolysis based on age. No significant increase in the prevalence of lumbar spondylolysis was demonstrated in patients older than 20 years. This suggests that the development of symptomatic lumbar pars defects do not occur in this population and should not be considered as a rare but potentially treatable cause of new onset low back pain in adults. This study demonstrated an overall prevalence of pars defects of 8

Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain.

Science.gov (United States)

Brooks, Benjamin K; Southam, Samuel L; Mlady, Gary W; Logan, Jeremy; Rosett, Matthew

2010-07-01

To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain. The records of 2,555 patients who had undergone abdominal and pelvic CT in 2008 were reviewed electronically. In order to determine a true representation of the general population, we reviewed all indications for CT, excluding patients with a primary complaint of low back pain as the primary indication for imaging. Equal numbers of patients were separated into age groups by decade to ensure an even distribution of ages for statistical analysis. Patients older than 70 years were grouped together to provide case numbers comparable to those of the other decades. Logistic regression analysis was performed to evaluate the significance of the results. Three board-certified radiologists, including two musculoskeletal fellows and a radiology resident, retrospectively evaluated CT scans for lumbar spondylolysis, including unilateral and bilateral defects. Of the 2,555 cases evaluated, there were 203 positive cases of defects of the lumbar pars interarticularis. This corresponded to an overall prevalence of 8.0%. Prevalence per decade was fairly evenly distributed and ranged from 7.0%( ages 30-39 years) to 9.2% (ages 70 years and above). Prevalence of ages 20-49 years was 7.9%, and that of ages 50 years and older was 8.0%. Male to female ratio was 1.5:1. Logistic regression showed no significant increase in spondylolysis based on age. No significant increase in the prevalence of lumbar spondylolysis was demonstrated in patients older than 20 years. This suggests that the development of symptomatic lumbar pars defects do not occur in this population and should not be considered as a rare but potentially treatable cause of new onset low back pain in adults. This study demonstrated an overall prevalence of pars defects of 8

Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain

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Brooks, Benjamin K.; Southam, Samuel L.; Mlady, Gary W.; Logan, Jeremy; Rosett, Matthew

2010-01-01

To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain. The records of 2,555 patients who had undergone abdominal and pelvic CT in 2008 were reviewed electronically. In order to determine a true representation of the general population, we reviewed all indications for CT, excluding patients with a primary complaint of low back pain as the primary indication for imaging. Equal numbers of patients were separated into age groups by decade to ensure an even distribution of ages for statistical analysis. Patients older than 70 years were grouped together to provide case numbers comparable to those of the other decades. Logistic regression analysis was performed to evaluate the significance of the results. Three board-certified radiologists, including two musculoskeletal fellows and a radiology resident, retrospectively evaluated CT scans for lumbar spondylolysis, including unilateral and bilateral defects. Of the 2,555 cases evaluated, there were 203 positive cases of defects of the lumbar pars interarticularis. This corresponded to an overall prevalence of 8.0%. Prevalence per decade was fairly evenly distributed and ranged from 7.0%(ages 30-39 years) to 9.2% (ages 70 years and above). Prevalence of ages 20-49 years was 7.9%, and that of ages 50 years and older was 8.0%. Male to female ratio was 1.5:1. Logistic regression showed no significant increase in spondylolysis based on age. No significant increase in the prevalence of lumbar spondylolysis was demonstrated in patients older than 20 years. This suggests that the development of symptomatic lumbar pars defects do not occur in this population and should not be considered as a rare but potentially treatable cause of new onset low back pain in adults. This study demonstrated an overall prevalence of pars defects of 8

[Case-control study on needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding for the treatment of low back pain caused by lumbar facet osteoarthritis].

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Lu, Di; Xu, Wei-xing; Ding, Wei-Guo; Guo, Qiao-Feng; Ma, Gou-ping; Zhu, Wei-min

2013-03-01

To study the clinical efficacy of needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding to treat low back pain caused by lumbar facet osteoarthritis. From July 2009 to June 2011, 60 patients with low back pain caused by lumbar facet osteoarthritis were reviewed,including 34 males and 26 females, ranging in age from 39 to 73 years old,averaged 61.9 years old; the duration of the disease ranged from 6 to 120 months, with a mean of 18.9 months. All the patients were divided into two groups, 30 patients (18 males and 12 females, ranging in age from 39 to 71 years old, needle-knife group) were treated with needle-knife to cut off medial branch of the lumbar posterior ramus under C -arm guiding and the other 30 patients(16 males and 14 females, ranging in age from 41 to 73 years old, hormone injection group) were treated with hormone injection in lumbar facet joint under C-arm guiding. The preoperative JOA scores and the scores at the 1st, 12th and 26th weeks after treatment were analyzed. Before treatment,the JOA scores between the two groups had no significant difference (P= 0.479); after 1 week of treatment, the JOA scores between the two groups had significant difference (P= 0.040), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (58.73+/-18.20)% in needle-knife group and (71.10+/-22.19)% in hormone injection group; after 12 weeks of treatment, the JOA scores between the two groups had no significant difference(P=0.569), and the improvement rate between the two groups had no significant difference,which were (50.09+/-19.33)% in the needle-knife group and (48.70+/-18.36)%) in the hormone injection group; after 26 weeks of treatment,the JOA scores between the two groups had significant difference (P=0.000), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (48.56+/-28.24)% in needle-knife group and (15

Partial Facetectomy for Lumbar Foraminal Stenosis

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Kevin Kang

2014-01-01

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

Computed tomography in the diagnosis of cervical disc herniation with radiculopathy

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Isu, Toyohiko; Iwasaki, Yoshinobu; Abe, Hiroshi; Miyasaka, Kazuo; Tashiro, Kunio [Hokkaido Univ., Sapporo (Japan). School of Medicine

1984-02-01

Computed tomography (CT) is an accurate method of diagnosing cervical disc herniation in patients with radiculopathy. We evaluated 7 patients for the treatment of radiculopathy. The CT features of lateral cervical disc herniation include: (1) plain CT reveals a soft tissue mass compatible with laterally herniated disc material within the intervertebral foramen; (2) plain CT shows a soft tissue mass, which implies a fragmented disc, in the lateral recess; (3) CT with the intravenous administration of the contrast medium shows no delineation of the nerve root in the intervertebral foramen; and (4) CT metrizamide myelography demonstrates the filling defect of the root sleeve and hypertrophy of the nerve root. In those seven patients, all CT examinations were interpreted as positive for lateral disc herniation. There was a good correlation between the results of the neurologic examination and the CT findings. We wish to stress the usefulness of CT in the diagnosis of lateral cervical disc herniation.

[Finite element analysis of lumbar pelvic and proximal femur model with simulate lumbar rotatory manipulation].

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Hu, Hua; Xiong, Chang-Yuan; Han, Guo-Wu

2012-07-01

To study the changes of displacement and stress in the model of lumbar pelvic and proximal femur during lumbar rotatory manipulation. The date of lumbar pelvic and proximal femur CT scan by Mimics 10.01 software was established a lumbar pelvic and proximal femur geometric model, then the model was modified with Geomagic 9, at last the modified model was imported into hypermesh 10 and meshed with tetrahedron, at the same time,add disc and ligaments. According to the principle of lumbar rotatory manipulation,the lumbar rotatory manipulation were decomposed. The mechanical parameters assigned into the three-dimensional finite element model. The changes of displacement and stress in the model of lunbar pelvic and proximal femur under the four conditions were calculated with Abaqus model of Hypermesh 10. 1) Under the same condition,the displacement order of lumbar was L1>L2>L3>L5 L5, anterior column > middle column > posterior column. 2) Under the different conditions, the displacement order of lumbar,case 3>case 1>case 4>case 2. 3) Under the same conditions, the displacement order of lumbar inter-vertebral disc from L1,2 to L5S1 was L1,2>L2,3>L3,4>L4,5>L5S1, as for the same inter-vertebral disc, the order was: second quadrant>third quadrant>first quadrant>fourth quadrant. 4) Under the different conditions,the displacement order of the inter-vertebral disc was L1,2>L2,3>L3,4>L4,5>L5S1, but to same inter-vertebral disc: case 3>case 4>case 1 >case 2. 5) There were apparent displacement and stress concentration in pelvis and hip during the manipulation. 1) The principles of lumbar rotation manipulation closely related to the relative displacement caused by rotation of various parts of lumbar pelvic and proximal femur model; 2) During the process of lumbar rotatory manipulation, the angle of lateral bending and flexion can not be randomly increased; 3) During the process of lumbar rotatory manipulation, all the conditions of lumbar pelvic and proximal femur must be

Distraction of facets with intraarticular spacers as treatment for lumbar canal stenosis: report on a preliminary experience with 21 cases.

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Goel, Atul; Shah, Abhidha; Jadhav, Madan; Nama, Santhosh

2013-12-01

The authors report their experience in treating 21 patients by using a novel form of treatment of lumbar degenerative disease that leads to canal stenosis. The surgery involved distraction of the facets using specially designed Goel intraarticular spacers and was aimed at arthrodesis of the spinal segment in a distracted position. The operation is based on the premise that subtle and longstanding facet instability, joint space reduction, and subsequent facet override had a profound and primary influence in the pathogenesis of degenerative lumbar canal stenosis. The surgical technique and the rationale for treatment are discussed. Between April 2006 and January 2011, 21 cases of lumbar degenerative disease resulting in characteristic lumbar canal stenosis were treated in the authors' department with the proposed technique. The patients were prospectively analyzed. There were 15 men and 6 women who ranged in age from 48 to 71 years (mean 58 years). Nine patients underwent 1-level and 12 patients underwent 2-level treatment. Surgery involved wide opening of the articular joint, denuding of the articular capsule/endplate cartilage, distraction of the facets, and forced impaction of Goel intraarticular spacers. Bone graft pieces obtained by sectioning the spinous processes were placed within and over the joint and in the midline over the adequately prepared host area of laminae. The Oswestry Disability Index and visual analog scale were used to clinically assess the patients before and after surgery and at follow-up. The alterations in the physical architecture of spinal canal and intervertebral foramen dimensions were evaluated before and after placement of the intrafacet implant and after at least 6 months of follow-up. All patients had varying degrees of relief from symptoms of local back pain and radiculopathy. Impaction of spacers within the facet joints resulted in an increase in the spinal canal and intervertebral root canal dimensions (mean 2.33 mm), reduction

Manual therapy and segmental stabilization in the treatment of cervical radiculopathy

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Rafael Souza Aquaroli

Full Text Available Abstract Introduction: Cervical radiculopathy (CR is one of the diseases that most affect the cervical spine, causing radicular symptoms in the ipsilateral limb. Conservative treatment aim recover of both mechanical and physiological functions through neural mobilization techniques, along with the activation of the deep neck flexors with cervical segmental stabilization, combining techniques of joint mobilization and manipulation, which seeks mobility improvement of crucial areas of the cervical spine. The objective of this study was to evaluate a multimodal treatment to enhance the outcomes of conservative care in patients diagnosed with CR. Methods: The sample consisted of 11 patients with CR, between 21 and 59 years old, 3 female and 8 male. It was recorded the Visual Analogue Scale (VAS for pain, the Functional Development of the Neck Pain and Disability Scale (NPDS and the goniometry during shoulder abduction. The intervention plan was composed by neural mobilization, intermittent cervical traction, pompages, stretching, myofascial inhibition techniques, manipulative techniques and cervical segmental stabilization exercises. After 12 weeks of treatment, subjects underwent a new evaluation process. Results: Before the treatment, subjects reported an average pain of 7 (± 1.48 in VAS, whose dropped to average 1.18 (± 1.99 (p < 0.01. Functional disability evaluated in NPDS was 36 (± 10.95 before treatment decreasing to 11.45 (± 9.8 (p < 0.01 after the treatment. Range of motion of the ipsilateral upper limb was restores by increasing from 9.2° (± 8.2 to 137° (± 24.4 (p < 0.01. Conclusion: The proposed treatment approach was effective, significantly improving the results of analgesia and functional disability a series of cases of patients diagnosed with cervical radiculopathy. {#}

Spondylectomy and lateral lumbar interbody fusion for thoracolumbar kyphosis in an adult with achondroplasia: A case report.

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Miyazaki, Masashi; Kanezaki, Shozo; Notani, Naoki; Ishihara, Toshinobu; Tsumura, Hiroshi

2017-12-01

Fixed thoracolumbar kyphosis with spinal stenosis in adult patients with achondroplasia presents a challenging issue. We describe the first case in which spondylectomy and minimally invasive lateral access interbody arthrodesis were used for the treatment of fixed severe thoracolumbar kyphosis and lumbar spinal canal stenosis in an adult with achondroplasia. A 61-year-old man with a history of achondroplastic dwarfism presented with low back pain and radiculopathy and neurogenic claudication. Plain radiographs revealed a high-grade thoracolumbar kyphotic deformity with diffuse degenerative changes in the lumbar spine. The apex was located at L2, the local kyphotic angle from L1 to L3 was 105°, and the anterior area was fused from the L1 to L3 vertebrae. MRI revealed significant canal and lateral recess stenosis secondary to facet hypertrophy. We planned a front-back correction of the anterior and posterior spinal elements. We first performed anterior release at the fused part from L1 to L3 and XLIF at L3/4 and L4/5. Next, the patient was placed in the prone position. Spondylectomy at the L2 vertebra and posterior fusion from T10 to L5 were performed. Postoperative radiographs revealed L1 to L3 kyphosis of 32°. No complications occurred during or after surgery. Postoperatively, the patient's low back pain and neurological claudication were resolved. No worsening of kyphosis was observed 24 months postoperatively. Circumferential decompression of the spinal cord at the apical vertebral level and decompression of lumbar canal stenosis were necessary. Front-back correction of the anterior and posterior spinal elements via spondylectomy and lateral lumbar interbody fusion is a reasonable surgical option for thoracolumbar kyphosis and developmental canal stenosis in patients with achondroplasia.

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

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

2015-07-01

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

A Hydatid Cyst of the Lumbar Spine: A Rare Cause of Paraplegia

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Suhail Ur Rehman

2017-05-01

Full Text Available Introduction Hydatid cyst is a zoonotic disease, affecting humans and other mammals worldwide. It is caused by tapeworms of the genus Echinococcus, which is most frequently encountered in the liver and lungs. Although involvement of the central nervous system and spine is rare, it can lead to severe neurological deficits due to direct compression. Case Presentation We report a case of intradural extramedullary hydatid cyst in the lumbar region with a sudden onset, causing progressive paraplegia and areflexia over the past 20 days. After surgical removal, the cyst was sent for histopathological examination. The results showed inner laminated membranes and an outer fibrous layer, surrounded by foreign-body giant cells. The primary objective during surgery was to avoid perforation of the cyst, thereby reducing the risk of systemic dissemination and local seeding of the parasite. During the postoperative period, there was a steady improvement in the neurological deficit, and the patient was discharged with anthelmintics to prevent any distant dissemination. Conclusions An accurate and precise diagnosis is necessary when dealing with cystic pathologies.

Digital tender point examination may be helpful in the evaluation of low back pain: clinical signs vs. magnetic resonance imaging

DEFF Research Database (Denmark)

Jensen, Ole Kudsk; Nielsen, Claus Vinther; Stengaard-Pedersen, Kristian

on MRI. After adjustment for age, sex and widespread pain, the number of TPs was still significantly reduced in patients with clinical radiculopathy. More than 8 and 11 TPs in men and women, respectively, made the diagnosis of radiculopathy less probable. The intensity of back pain, but not leg pain...... of the lumbar spine was performed. Associations were analyzed by linear regression analyses. Results: TPs were negatively associated with radiculopathy and with most degenerative manifestations on MRI, but the negative associations were primarily due to the presence of radiculopathy and/or nerve root compromise...... with and without degenerative changes and patients with and without radiculopathy, a TP count may help understanding LBP patients better, especially patients with normal or near normal MRI. Accordingly, digital TP examination may be a valuable supplemental tool in the clinical assessment of LBP patients....

Differentiating C8–T1 Radiculopathy from Ulnar Neuropathy: A Survey of 24 Spine Surgeons

Science.gov (United States)

Stoker, Geoffrey E.; Kim, Han Jo; Riew, K. Daniel

2013-01-01

Study Design Questionnaire. Objective To evaluate the ability of spine surgeons to distinguish C8–T1 radiculopathies from ulnar neuropathy. Methods Twenty-four self-rated “experienced” cervical spine surgeons completed a questionnaire with the following items. (1) If the ulnar nerve is cut at the elbow, which of the following would be numb: ulnar forearm, small and ring fingers; only the ulnar forearm; only the small and ring fingers; or none of the above? (2) Which of the following muscles are weak with C8–T1 radiculopathies but intact with ulnar neuropathy at the elbow: flexor digiti minimi brevis, flexor pollicis brevis, abductor digiti minimi, abductor pollicis brevis, adductor pollicis, opponens digiti minimi, opponens pollicis, medial lumbricals, lateral lumbricals, dorsal interossei, palmar interossei? Results Fifteen of 24 surgeons (63%) correctly answered the first question—that severing the ulnar nerve results in numbness of the fifth and fourth fingers. None correctly identified all four nonulnar, C8–T1-innervated options in the second question without naming additional muscles. Conclusion The ulnar nerve provides sensation to the fourth and fifth fingers and medial border of the hand. The medial antebrachial cutaneous nerve provides sensation to the medial forearm. The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve. By examining these five muscles, one can clinically differentiate cubital tunnel syndrome from C8–T1 radiculopathies. Although all participants considered themselves to be experienced cervical spine surgeons, this study reveals inadequate knowledge regarding the clinical manifestations of C8–T1 radiculopathies and cubital tunnel syndrome. PMID:24494175

Neurogenic muscle hypertrophy in a 12-year-old girl.

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Zutelija Fattorini, Matija; Gagro, Alenka; Dapic, Tomislav; Krakar, Goran; Marjanovic, Josip

2017-01-01

Muscular hypertrophy secondary to denervation is very rare, but well-documented phenomena in adults. This is the first report of a child with neurogenic unilateral hypertrophy due to S1 radiculopathy. A 12-year-old girl presented with left calf hypertrophy and negative history of low back pain or trauma. The serum creatinine kinase level and inflammatory markers were normal. Magnetic resonance imaging showed muscle hypertrophy of the left gastrocnemius and revealed a protruded lumbar disc at the L5-S1 level. The protruded disc abuts the S1 root on the left side. Electromyography showed mild left S1 radiculopathy. Passive stretching and work load might clarify the origin of neurogenic hypertrophy but there is still a need for further evidence. Clinical, laboratory, magnetic resonance imaging and electromyography findings showed that S1 radiculopathy could be a cause of unilateral calf swelling in youth even in the absence of a history of back or leg pain. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

CT-guided cervical interlaminar epidural steroid injection for cervical radiculopathy

International Nuclear Information System (INIS)

Chen Wei; Wu Chungen; Wu Chaoxian; Cheng Yongde

2009-01-01

Objective: To evaluate the safety and effectiveness of CT-guided cervical interlaminar epidural steroid injection for the treatment of cervical radiculopathy. Methods: CT-guided cervical interlaminar epidural steroid injection was performed in 32 patients with cervical radioculopathy, encountered during the period of Dec. 2006 to June 2008, as the patients failed to respond to the conservative treatment in 2 weeks. The clinical data and the imaging findings were retrospectively analyzed. Before and after the procedure, visual analogue scale (VAS) and Odom criteria were used to evaluate the pain of the patient. Results: Three months after the injection, improvement judged by Odom criteria was seen in 28 patients (87.5%), and the mean pain relief value of VAS was 5.88 ± 1.10. No significant difference in effective rate and in VAS score (P>0.05) was found between protrusion group and degenerative group, between the group with the course over 6 months and the group with the course below 6 months, also between the group receiving one injection and the group receiving the second injection. Conclusion: CT-guided fine needle (23 gauge) puncture epidural steroid (Decadron) 'target spot' injection is an ideal alternative for the treatment of cervical radiculopathy, especially for the patients who fails to respond to the conservative treatment. (authors)

High sensitive C-reactive protein-Effective tool in determining postoperative recovery in lumbar disc disease

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Tushar Narayan Rathod

2014-01-01

Full Text Available Background: It is common in medical practice to see patients having persistent pain and radiculopathy even after undergoing discectomy surgery. Inflammatory cytokines, such as interleukins are produced at the site of disc herniation and are now considered responsible for the pain perceived by the patient. This study has used high sensitive C-reactive protein (HSCRP assay for predicting inflammation around the nerve roots on very same principle, which has used HSCRP for predicting coronary artery diseases in current clinical practice. Thus, purpose of this study is to test whether HSCRP can stand as an objective tool to predict postoperative recovery in patients undergoing lumbar discectomy. That is, to study association between preoperative HSCRP blood level and postoperative recovery with the help of modified Oswestry Back Disability Score. Materials and Methods: A study group consisting of 50 cases of established lumbar disc disease and control group of 50 normal subjects, matched with the study group. Both the study and control groups were subjected to detailed evaluation with the help of modified Oswestry Low Back Pain Scale both pre and postoperatively at 3 months, 6 months and 1-year. The preoperative blood samples were analyzed to assess the HSCRP concentration. All the cases underwent surgery over a period of 1-year by the same surgeon. Results: The level of HSCRP in the study group was between 0.050- and 0.710 mg/dL and in the control group, 0.005-0.020 mg/dL. There was highly significant positive correlation between preoperative HSCRP level and postoperative score at P 10 points, while those with HSCRP level in the range of 0.470 ± 0.163 mg/dL, showed poor recovery (score improved < 10 points. Conclusion: HSCRP will serve as a good supplementary prognostic marker for operative decision making in borderline and troublesome cases of lumbar disc disease.

Operative techniques for cervical radiculopathy and myelopathy.

LENUS (Irish Health Repository)

Moran, C

2012-02-01

The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970\\'s. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review.

Effects of Lumbar Fusion Surgery with ISOBAR Devices Versus Posterior Lumbar Interbody Fusion Surgery on Pain and Disability in Patients with Lumbar Degenerative Diseases: A Meta-Analysis.

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Su, Shu-Fen; Wu, Meng-Shan; Yeh, Wen-Ting; Liao, Ying-Chin

2018-06-01

Purpose/Aim: Lumbar degenerative diseases (LDDs) cause pain and disability and are treated with lumbar fusion surgery. The aim of this study was to evaluate the efficacy of lumbar fusion surgery with ISOBAR devices versus posterior lumbar interbody fusion (PLIF) surgery for alleviating LDD-associated pain and disability. We performed a literature review and meta-analysis conducted in accordance with Cochrane methodology. The analysis included Group Reading Assessment and Diagnostic Evaluation assessments, Jadad Quality Score evaluations, and Risk of Bias in Non-randomized Studies of Interventions assessments. We searched PubMed, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, ProQuest, the Airiti Library, and the China Academic Journals Full-text Database for relevant randomized controlled trials and cohort studies published in English or Chinese between 1997 and 2017. Outcome measures of interest included general pain, lower back pain, and disability. Of the 18 studies that met the inclusion criteria, 16 examined general pain (802 patients), 5 examined lower back pain (274 patients), and 15 examined disability (734 patients). General pain, lower back pain, and disability scores were significantly lower after lumbar fusion surgery with ISOBAR devices compared to presurgery. Moreover, lumbar fusion surgery with ISOBAR devices was more effective than PLIF for decreasing postoperative disability, although it did not provide any benefit in terms of general pain or lower back pain. Lumbar fusion surgery with ISOBAR devices alleviates general pain, lower back pain, and disability in LDD patients and is superior to PLIF for reducing postoperative disability. Given possible publication bias, we recommend further large-scale studies.

Spondylodiscitis of the lumbar spine in a non-immunocompromised host caused by Yersinia enterocolitica O:9.

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Ellenrieder, Martin; Zautner, Andreas E; Podbielski, Andreas; Bader, Rainer; Mittelmeier, Wolfram

2010-04-01

Here presented is an extremely rare case of a spinal osteomyelitis (L5-S1) with epidural empyema in a non-immunocompromised 62-year-old man caused by Yersinia enterocolitica O:9. The infection occurred acutely and required immediate surgical treatment. Y. enterocolitica was cultured from the empyema fluid, wound swabs of the intervertebral disc L5-S1 and stool cultures. Following the surgical decompression and antibiotic treatment, the patient recovered completely, without neurological deficits. A review of the literature revealed only sparse cases of spondylodiscitis due to other Y. enterocolitica serogroups. To our knowledge, we report here the first case of a spondylodiscitis of the lumbar spine caused by Y. enterocolitica serovar O:9 in a non-immunocompromised patient.

Assessment of Lumbar Lordosis and Lumbar Core Strength in Information Technology Professionals.

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Mehta, Roma Satish; Nagrale, Sanket; Dabadghav, Rachana; Rairikar, Savita; Shayam, Ashok; Sancheti, Parag

2016-06-01

Observational study. To correlate lumbar lordosis and lumbar core strength in information technology (IT) professionals. IT professionals have to work for long hours in a sitting position, which can affect lumbar lordosis and lumbar core strength. Flexicurve was used to assess the lumbar lordosis, and pressure biofeedback was used to assess the lumbar core strength in the IT professionals. All subjects, both male and female, with and without complaint of low back pain and working for two or more years were included, and subjects with a history of spinal surgery or spinal deformity were excluded from the study. Analysis was done using Pearson's correlation. For the IT workers, no correlation was seen between lumbar lordosis and lumbar core strength (r=-0.04); however, a weak negative correlation was seen in IT people who complained of pain (r=-0.12), while there was no correlation of lumbar lordosis and lumbar core in IT people who had no complains of pain (r=0.007). The study shows that there is no correlation of lumbar lordosis and lumbar core strength in IT professionals, but a weak negative correlation was seen in IT people who complained of pain.

Weightlifter Lumbar Physiology Health Influence Factor Analysis of Sports Medicine.

Science.gov (United States)

Zhang, Xiangyang

2015-01-01

Chinese women's weightlifting project has been in the advanced world level, suggests that the Chinese coaches and athletes have many successful experience in the weight lifting training. Little weight lifting belongs to high-risk sports, however, to the lumbar spine injury, some young good athletes often due to lumbar trauma had to retire, and the national investment and athletes toil is regret things. This article from the perspective of sports medicine, weightlifting athletes training situation analysis and put forward Suggestions, aimed at avoiding lumbar injury, guarantee the health of athletes. In this paper, first of all to 50 professional women's weightlifting athletes doing investigation, found that 82% of the athletes suffer from lumbar disease symptoms, the reason is mainly composed of lumbar strain, intensity is too large, motion error caused by three factors. From the Angle of sports medicine and combined with the characteristics of the structure of human body skeleton athletes lumbar structural mechanics analysis, find out the lumbar force's two biggest technical movement, study, and regulate the action standard, so as to minimize lumbar force, for athletes to contribute to the health of the lumbar spine.

QUANTITATIVE SIZE ASSESSMENT OF THE LUMBAR SPINAL CANAL BY COMPUTED TOMOGRAPHY

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M. Midia Z. Miabi

2007-08-01

Full Text Available By determining normal ranges of spinal canal diameters we can make early diagnosis in persons who have lower diameters of spinal canal. These persons are predisposed to spinal canal stenosis that is a major cause of spinal radiculopathies. In different studies performed in several countries, minimum and maximum ranges of spinal canal diameters were different for each population. In this study, we tried to determine the mean values of normal spinal canal diameters and areas in Tabriz and its suburb. 39 healthy, young to mid-age cases were selected. Our study was focused on L3-L4 and L4-L5. The following parameters were measured: the area of cross-section of the vertebral body, the area of cross-section of the dural sac, interarticular diameter, interligamentous diameter, antero-posterior diameter of the lumbar canal, inter-pedicular diameter, and the area of cross-section of the vertebral canal. A correlation between the parameters studied and the height of subjects was significant for interligamentous diameter (for L3/L4 and L4/L5 and interarticular diameter (only at L3/L4, cross-section area of the vertebrae (both L3 and L4, cross-section area of vertebral canal (only at L5 level, area of dural sac (at L3/L4 and L4. It was suggested that these diameters and areas should be interpreted as a unction of height of the subject. Most of diameters studied had smaller means than those in previous studies. This can be attributed to differences between populations and it can be interpreted as predisposition to spinal canal stenosis in our population.

Computed tomography as the primary radiological examination of lumbar spine

Energy Technology Data Exchange (ETDEWEB)

Ilkko, E.; Laehde, S.

1988-10-01

A series of 235 patients examined by lumbar CT because of sciatica or other low back disorder was studied. The need of additional examinations and correlations to surgical findings were evaluated. Inadequate information was the cause of additional examination, mostly myelography in 20 patients (8,5%). It was concluded that lumbar CT is a suitable first examination of the lumbar spine in sciatica and low back pain. The indications to complementary myelography and its benefit are discussed.

Computed tomography as the primary radiological examination of lumbar spine

International Nuclear Information System (INIS)

Ilkko, E.; Laehde, S.

1988-01-01

A series of 235 patients examined by lumbar CT because of sciatica or other low back disorder was studied. The need of additional examinations and correlations to surgical findings were evaluated. Inadequate information was the cause of additional examination, mostly myelography in 20 patients (8,5%). It was concluded that lumbar CT is a suitable first examination of the lumbar spine in sciatica and low back pain. The indications to complementary myelography and its benefit are discussed. (orig.) [de

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 CORSETS CAN DECREASE LUMBAR MOTION IN GOLF SWING

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Koji Hashimoto

2013-03-01

Full Text Available Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K., full golf swings were monitored without a corset (WOC, with a soft corset (SC, and with a hard corset (HC, with each subject taking 3 swings. Changes in the angle between the pelvis and the thorax (maximum range of motion and angular velocity in 3 dimensions (lumbar rotation, flexion-extension, and lateral tilt were analyzed, as was rotation of the hip joint. Peak changes in lumbar extension and rotation occurred just after impact with the ball. The extension angle of the lumbar spine at finish was significantly lower under SC (38° or HC (28° than under WOC (44° conditions (p < 0.05. The maximum angular velocity after impact was significantly smaller under HC (94°/sec than under SC (177°/sec and WOC (191° /sec conditions, as were the lumbar rotation angles at top and finish. In contrast, right hip rotation angles at top showed a compensatory increase under HC conditions. Wearing a lumbar corset while swinging a golf club can effectively decrease lumbar extension and rotation angles from impact until the end of the swing. These effects were significantly enhanced while wearing an HC

The influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination during weightlifting.

Science.gov (United States)

Hu, Boyi; Ning, Xiaopeng

2015-01-01

Lumbar muscle fatigue is a potential risk factor for the development of low back pain. In this study, we investigated the influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination patterns during weightlifting. Each of the 15 male subjects performed five repetitions of weightlifting tasks both before and after a lumbar extensor muscle fatiguing protocol. Lumbar muscle electromyography was collected to assess fatigue. Trunk kinematics was recorded to calculate lumbar-pelvic continuous relative phase (CRP) and CRP variability. Results showed that fatigue significantly reduced the average lumbar-pelvic CRP value (from 0.33 to 0.29 rad) during weightlifting. The average CRP variability reduced from 0.17 to 0.15 rad, yet this change ws statistically not significant. Further analyses also discovered elevated spinal loading during weightlifting after the development of lumbar extensor muscle fatigue. Our results suggest that frequently experienced lumbar extensor muscle fatigue should be avoided in an occupational environment. Lumbar extensor muscle fatigue generates more in-phase lumbar-pelvic coordination patterns and elevated spinal loading during lifting. Such increase in spinal loading may indicate higher risk of back injury. Our results suggest that frequently experienced lumbar muscle fatigue should be avoided to reduce the risk of LBP.

Prevention: Exercise

Medline Plus

Full Text Available ... Back Pain SI Joint Pain Other Scoliosis Back Pain and Emotional Distress Muscle Spasms Pinched Nerve Discitis Degenerative Conditions Bulge vs Herniation Cervical Stenosis, Myelopathy, and Radiculopathy Herniated Lumbar Disc Herniated ...

Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

International Nuclear Information System (INIS)

Lee, Kwang Lae; Yim, Yoon Myung; Lim, Oh Kyung; Park, Ki Deok; Choi, Chung Hwan; Lee, Ju Kang

2009-01-01

Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Lee, Kwang Lae; Yim, Yoon Myung; Lim, Oh Kyung; Park, Ki Deok; Choi, Chung Hwan; Lee, Ju Kang [Gachon University of Medicine and Science, Incheon (Korea, Republic of)

2009-12-15

Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial.

NARCIS (Netherlands)

B. Kuijper (Barbara); J.T. Tans; A. Beelen (Anita); F. Nollet (Frans); M. de Visser (Marianne)

2009-01-01

textabstractOBJECTIVE: To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy. DESIGN: Randomised controlled trial. SETTING: Neurology outpatient clinics in three Dutch hospitals. PARTICIPANTS: 205 patients

Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion.

Science.gov (United States)

Rothenfluh, Dominique A; Mueller, Daniel A; Rothenfluh, Esin; Min, Kan

2015-06-01

Several risk factors and causes of adjacent segment disease have been debated; however, no quantitative relationship to spino-pelvic parameters has been established so far. A retrospective case-control study was carried out to investigate spino-pelvic alignment in patients with adjacent segment disease compared to a control group. 45 patients (ASDis) were identified that underwent revision surgery for adjacent segment disease after on average 49 months (7-125), 39 patients were selected as control group (CTRL) similar in the distribution of the matching variables, such as age, gender, preoperative degenerative changes, and numbers of segments fused with a mean follow-up of 84 months (61-142) (total n = 84). Several radiographic parameters were measured on pre- and postoperative radiographs, including lumbar lordosis measured (LL), sacral slope, pelvic incidence (PI), and tilt. Significant differences between ASDis and CTRL groups on preoperative radiographs were seen for PI (60.9 ± 10.0° vs. 51.7 ± 10.4°, p = 0.001) and LL (48.1 ± 12.5° vs. 53.8 ± 10.8°, p = 0.012). Pelvic incidence was put into relation to lumbar lordosis by calculating the difference between pelvic incidence and lumbar lordosis (∆PILL = PI-LL, ASDis 12.5 ± 16.7° vs. CTRL 3.4 ± 12.1°, p = 0.001). A cutoff value of 9.8° was determined by logistic regression and ROC analysis and patients classified into a type A (∆PILL lordosis mismatch. In type A spino-pelvic alignment, 25.5 % of patients underwent revision surgery for adjacent segment disease, whereas 78.3 % of patients classified as type B alignment had revision surgery. Classification of patients into type A and B alignments yields a sensitivity for predicting adjacent segment disease of 71 %, a specificity of 81 % and an odds ratio of 10.6. In degenerative disease of the lumbar spine a high pelvic incidence with diminished lumbar lordosis seems to predispose to adjacent segment disease. Patients with such pelvic incidence-lumbar

National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy

DEFF Research Database (Denmark)

Kjær, Per; Kongsted, Alice; Hartvigsen, Jan

2017-01-01

PURPOSE: To summarise recommendations about 21 selected non-surgical interventions for recent onset (pain (NP) and cervical radiculopathy (CR) based on two guidelines from the Danish Health Authority. METHODS: Two multidisciplinary working groups formulated...

Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial

NARCIS (Netherlands)

Kuijper, Barbara; Tans, Jos Th J.; Beelen, Anita; Nollet, Frans; de Visser, Marianne

2009-01-01

Objective To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy. Design Randomised controlled trial. Setting Neurology outpatient clinics in three Dutch hospitals. Participants 205 patients with symptoms and

Neuromuscular ultrasound imaging in low back pain patients with radiculopathy.

Science.gov (United States)

Frost, Lydia R; Brown, Stephen H M

2016-02-01

Patients suffering from chronic low back pain with associated radiculopathy (LBP-R), or sciatica, experience neuromuscular symptoms in the lower back and leg; however, research to date has focussed solely on the lower back. To expand neuromuscular research of LBP-R patients into the lower limb, using ultrasound imaging. Case control study comparing LBP-R patients to matched healthy controls. LBP-R patients with disc bulge or herniation (L3/L4 to L5/S1) resulting in unilateral radiculopathy (n = 17) and healthy matched controls (n = 17) were recruited. High-resolution ultrasound imaging was used to investigate sciatic nerve structure, as well as the quality (relative magnitude of fat/fibrosis infiltration) and contraction (muscle thickening) of associated musculature in the lower back (paraspinals) and lower limb (biceps femoris, gastrocnemius, soleus). LBP-R patients had swollen sciatic nerves (increased cross sectional area), but this was not associated with evidence of reduced lower limb muscle quality. As compared to controls, LBP-R patients demonstrated less soleus muscle thickening during submaximal contraction; however, there were no impairments in the hamstring or lower back musculature. Ultrasound imaging was an effective method to detect sciatic nerve swelling in mild to moderately affected LBP-R patients. Nerve swelling was not associated with poorer muscle quality, nor consistently impaired muscle contraction. Copyright © 2015 Elsevier Ltd. All rights reserved.

Lumbar disc excision through fenestration

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Sangwan S

2006-01-01

Full Text Available Background : Lumbar disc herniation often causes sciatica. Many different techniques have been advocated with the aim of least possible damage to other structures while dealing with prolapsed disc surgically in the properly selected and indicated cases. Methods : Twenty six patients with clinical symptoms and signs of prolapsed lumbar intervertebral disc having radiological correlation by MRI study were subjected to disc excision by interlaminar fenestration method. Results : The assessment at follow-up showed excellent results in 17 patients, good in 6 patients, fair in 2 patients and poor in 1 patient. The mean preoperative and postoperative Visual Analogue Scores were 9.34 ±0.84 and 2.19 ±0.84 on scale of 0-10 respectively. These were statistically significant (p value< 0.001, paired t test. No significant complications were recorded. Conclusion : Procedures of interlaminar fenestration and open disc excision under direct vision offers sufficient adequate exposure for lumbar disc excision with a smaller incision, lesser morbidity, shorter convalescence, early return to work and comparable overall results in the centers where recent laser and endoscopy facilities are not available.

Brain meningioma with initial manifestation similar to cervical radiculopathy: a case report

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Huang YH

2014-06-01

Full Text Available Yu-Hsuan Huang,1,* Chang-Zern Hong,2,* Wei-Ting Wu,1 Kun-Ta Li,3 Li-Wei Chou1,4¹Department of Physical Medicine and Rehabilitation, China Medical University Hospital, 2Department of Physical Therapy, Hungkuang University, 3Department of Emergency Medicine, China Medical University Hospital, 4School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan*These authors contributed equally to this workAbstract: Meningiomas are the most common benign brain tumors, and are characterized by slow growth and a long asymptomatic period. Once the tumor becomes symptomatic, the various presentations may be related to the location and compression of adjacent structures. Meningioma is primarily treated through surgical intervention, and thus earlier diagnosis is likely to result in better prognosis. The symptoms of the meningioma may mimic other diseases, making precise diagnosis difficult, which will then delay treatment. We report a case of brain meningioma that showed initial signs and symptoms similar to cervical radiculopathy. The symptoms extended gradually, and the ultimate diagnosis of meningioma was confirmed based on brain-image studies. After brain-tumor excision, postoperation radiotherapy, and aggressive rehabilitation, the patient was able to perform better in daily activities.Keywords: hemiplegia, menigioma, paresthesia, radiculopathy, rehabilitation

Post-surgical functional recovery, lumbar lordosis, and range of motion associated with MR-detectable redundant nerve roots in lumbar spinal stenosis.

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Chen, Jinshui; Wang, Juying; Wang, Benhai; Xu, Hao; Lin, Songqing; Zhang, Huihao

2016-01-01

T1- and T2-weighted magnetic resonance images (MRI) can reveal lumbar redundant nerve roots (RNRs), a result of chronic compression and nerve elongation associated with pathogenesis of cauda equina claudication (CEC) in degenerative lumbar canal stenosis (DLCS). The study investigated effects of lumbar lordosis angle and range of motion on functional recovery in lumbar stenosis patents with and without RNRs. A retrospective study was conducted of 93 lumbar spinal stenosis patients who underwent decompressive surgery. Eligible records were assessed by 3 independent blinded radiologists for presence or absence of RNRs on sagittal T2-weighted MR (RNR and non-RNR groups), pre- and post-operative JOA score, lumbar lordosis angle, and range of motion. Of 93 total patients, the RNR group (n=37, 21/37 female) and non-RNR group (n=56; 31/56 female) had similar preoperative conditions (JOA score) and were not significantly different in age (mean 64.19 ± 8.25 vs. 62.8 ± 9.41 years), symptom duration (30.92 ± 22.43 vs. 28.64 ± 17.40 months), or follow-up periods (17.35 ± 4.02 vs. 17.75 ± 4.29 mo) (all p>0.4). The non-RNR group exhibited significantly better final JOA score (p=0.015) and recovery rate (p=0.002). RNR group patients exhibited larger lumbar lordosis angles in the neutral position (p=0.009) and extension (p=0.021) and larger range of motion (p=0.008). Poorer surgical outcomes in patients with RNRs indicated that elevated lumbar lordosis angle and range of motion increased risks of RNR formation, which in turn may cause poorer post-surgical recovery, this information is possibly useful in prognostic assessment of lumbar stenosis complicated by RNRs. Copyright © 2015 Elsevier B.V. All rights reserved.

Effects of Artcure Diffusional Patch application on pain and functional status in lumbar disc herniation patients: a prospective randomized controlled study.

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Uğurlu, Mahmut; Aksekili, Mehmet Atıf Erol; Alkan, Berat Meryem; Kara, Halil; Çağlar, Ceyhun

2017-06-12

The aim of this study was to assess the efficacy of the Artcure Diffusional Patch, which contains a mixture of 6 herbal oils (oleum thymi, oleum limonis, oleum nigra, oleum rosmarini, oleum chamomilla, oleum lauriexpressum) and has a hypoosmolar lipid structure, in the conservative treatment of lumbar disc herniation patients and to show the advantages and/or possibility of using this as an alternative method to surgery. Of the 120 patients enrolled, 79 clinically diagnosed patients were included in the study. Clinical evaluations were performed on patients who had findings of protrusion or extrusion in their magnetic resonance results. The treatment group was treated with the Artcure Diffusional Patch while the control group received a placebo transdermal diffusional patch. The functional state of patients was measured using the Oswestry Disability Index and pain intensity was measured with a visual analog scale as primary outcomes. Secondary outcomes of the study were Lasegue's sign, the femoral stretching test, and paravertebral muscle spasm. The treatment group showed a dramatic recovery in the first month following the application in regards to Oswestry Disability Index scores and visual analog scale values. The patients treated with the Artcure Diffusional Patch showed a statistically significant difference in recovery as compared to the control group. These findings suggest that the Artcure Diffusional Patch may be an alternative for the conservative treatment of lumbar disc herniation with radiculopathy.

Low back pain, radiculopathy, and bilateral proximal hamstring ruptures: a case report.

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Deren, Matthew E; DeFroda, Steven F; Mukand, Nita H; Mukand, Jon A

2015-12-01

Low back pain (LBP) is a common complaint in the United States, with an incidence of 6.3%-15.4% and yearly recurrence in 54%-90% of patients.1 Trends show more frequent diagnostic testing, opioid use, and surgical intervention as the incidence of LBP increases.2 LBP is defined as pain at and near the lumbosacral region that can vary with physical activity and time. LBP is usually related to pathology of muscles, ligaments, spinal column joints, nerve roots, and the spinal cord. During the assessment of LBP, practitioners must also consider less common causes of pain in that region. For instance, patients with indolent or nighttime pain may have infectious or malignant processes. Referred pain from injuries to pelvic musculature or abdominal contents should be considered, especially following a traumatic event. One of these injuries, which can present as acute low back pain, is rupture of the proximal hamstring tendon. On rare occasion, concomitant LBP, radiculopathy, and hamstring injuries can occur;. This diagnostic challenge is described in the following case.

Deformation Measurement Of Lumbar Vertebra By Holographic Interferometry

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Matsumoto, Toshiro; Kojima, Arata; Ogawa, Ryoukei; Iwata, Koichi; Nagata, Ryo

1988-01-01

The mechanical properties of normal lumbar vertebra and one with the interarticular part cut off to simulate hemi-spondylolysis were measured by the double exposure holographic interferometry. In the normal lumbar vertebra, displacement due to the load applied to the inferior articular process was greater than that of superior articular process under the same load. The interarticular part was subjected to the high stress. From these points, one of the valuable data to consider the cause of spondylolysis was obtained.

Clinical tests to diagnose lumbar spondylolysis and spondylolisthesis: A systematic review.

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Alqarni, Abdullah M; Schneiders, Anthony G; Cook, Chad E; Hendrick, Paul A

2015-08-01

The aim of this paper was to systematically review the diagnostic ability of clinical tests to detect lumbar spondylolysis and spondylolisthesis. A systematic literature search of six databases, with no language restrictions, from 1950 to 2014 was concluded on February 1, 2014. Clinical tests were required to be compared against imaging reference standards and report, or allow computation, of common diagnostic values. The systematic search yielded a total of 5164 articles with 57 retained for full-text examination, from which 4 met the full inclusion criteria for the review. Study heterogeneity precluded a meta-analysis of included studies. Fifteen different clinical tests were evaluated for their ability to diagnose lumbar spondylolisthesis and one test for its ability to diagnose lumbar spondylolysis. The one-legged hyperextension test demonstrated low to moderate sensitivity (50%-73%) and low specificity (17%-32%) to diagnose lumbar spondylolysis, while the lumbar spinous process palpation test was the optimal diagnostic test for lumbar spondylolisthesis; returning high specificity (87%-100%) and moderate to high sensitivity (60-88) values. Lumbar spondylolysis and spondylolisthesis are identifiable causes of LBP in athletes. There appears to be utility to lumbar spinous process palpation for the diagnosis of lumbar spondylolisthesis, however the one-legged hyperextension test has virtually no value in diagnosing patients with spondylolysis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Side effects after diagnostic lumbar puncture and lumbar iohexol myelography

International Nuclear Information System (INIS)

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

1987-01-01

A prospective, controlled study was performed to compare side effect incidences after lumbar iohexol myelography (n=97) and diagnostic lumbar puncture (n=85). No significant side effect incidence differences (iohexol vs. controls) were found regarding number of patients with any side effect (63 vs. 73%), headache (44 vs. 54%), nausea, dizziness, visual, auditory, or psychic symptoms. Early-onset headache occurred significantly more often in the iohexol group (16 vs 5%), while postural headache occurred most frequently after lumbar puncture (25 vs. 41%). These results suggest that apart from the slight early-onset headache, most side effets after lumbar iohexol myelography are related to the puncture per se, not to the contrast agent. (orig.)

Influence of Lumbar Lordosis on the Outcome of Decompression Surgery for Lumbar Canal Stenosis.

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Chang, Han Soo

2018-01-01

Although sagittal spinal balance plays an important role in spinal deformity surgery, its role in decompression surgery for lumbar canal stenosis is not well understood. To investigate the hypothesis that sagittal spinal balance also plays a role in decompression surgery for lumbar canal stenosis, a prospective cohort study analyzing the correlation between preoperative lumbar lordosis and outcome was performed. A cohort of 85 consecutive patients who underwent decompression for lumbar canal stenosis during the period 2007-2011 was analyzed. Standing lumbar x-rays and 36-item short form health survey questionnaires were obtained before and up to 2 years after surgery. Correlations between lumbar lordosis and 2 parameters of the 36-item short form health survey (average physical score and bodily pain score) were statistically analyzed using linear mixed effects models. There was a significant correlation between preoperative lumbar lordosis and the 2 outcome parameters at postoperative, 6-month, 1-year, and 2-year time points. A 10° increase of lumbar lordosis was associated with a 5-point improvement in average physical scores. This correlation was not present in preoperative scores. This study showed that preoperative lumbar lordosis significantly influences the outcome of decompression surgery on lumbar canal stenosis. Copyright © 2017 Elsevier Inc. All rights reserved.

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;

[Randomized controlled trials of needle knife therapy combined with rotation traction manipulation for the treatment of cervical spondylotic radiculopathy].

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Zhou, Zhong-Liang; Su, Guo-Hong; Zheng, Bao-Zhu; Zuo, Yu-Zhu; Wei, Fu-Liang

2016-09-25

To compare the therapeutic effects between needle knife therapy combined with rotation traction manipulation and rotation traction manipulation for the treatment of cervical spondylotic radiculopathy. From November 2013 to June 2015, 80 patients with cervical spondylotic radiculopathy meeting the inclusion criteria were divided into two groups randomly:the control group in which 39 patients were treated with rotation traction manipulation, and the treatment group in which 41 patients were treated with needle knife combined with rotation traction manipulation. The patients in the control group were treated once dayly for 2 weeks, which was 1 course. The patients in the treatment group were treated with needle knife firstly once a week for 2 weeks, which was 1 course;then were treated with the same methods as the patients in the control group. The symptoms, signs score and the therapeutic effects of the two groups before and after treatment were observed. After treatment, symptoms and signs scores declined in both groups( P knife combined with rotation traction manipulation is an effective method for the treatment of cervical spondylotic radiculopathy, which is better than using manipulation method simply. Needle knife therapy has follow advantages:improving local blood circulation, reducing local content of pain substance, increasing production of substances resisting pain, opening channels and collaterals, and make body reaching new static and dynamic balance on the new foundation.

Solitary osteochondroma arising in lumbar spinous process: Case report

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Khaled Hadhri

2016-12-01

Full Text Available Solitary osteochondromas rarely occur in the axial skeleton. Those tumors mostly arise on the posterior elements of the cervical column causing various symptoms especially when developing within the spinal canal. Exophytic lumbar variety is uncommon presenting with palpable mass or spinal deformity. We report a 20-year-old man presenting with a solid painless mass at the lower lumbar region. Radiological examinations revealed an exophytic lesion arising in the third lumbar spinous process appearing to be a solitary osteochondroma. The lesion was treated by en-bloc resection; histopathological examination confirmed the diagnosis of osteochondroma with no evidence of recurrence at the end of 2-year follow up.

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy.

NARCIS (Netherlands)

Rubinstein, S.M.; Pool, J.J.; van Tulder, M.W.; Riphagen, II; de Vet, H.C.W.

2007-01-01

Clinical provocative tests of the neck, which position the neck and arm inorder to aggravate or relieve arm symptoms, are commonly used in clinical practice in patients with a suspected cervical radiculopathy. Their diagnostic accuracy, however, has never been examined in a systematic review. A

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

International Nuclear Information System (INIS)

Acevedo Gonzalez, Juan Carlos; Jimenez Hakim, Enrique; Rodriguez, Jose Maria; Hakim Daccach, Fernando; Quinonez, German; Rodriguez Munera, Andres

2004-01-01

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

Analysis and treatment of surgical complications after percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis

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Guang HAN

2016-04-01

Full Text Available Objective To analyze the causes of surgical complications after treatment of lumbar disc herniation (LDH and lumbar intervertebral foraminal stenosis by percutaneous transforaminal endoscopic discectomy (PTED.  Methods From December 2009 to December 2014, 286 patients with LDH (N = 201 and lumbar intervertebral foraminal stenosis (N = 85 were confirmed by X-ray, CT or MRI and treated by PTED in our hospital. Visual Analogue Scale (VAS was used to evaluate the degree of pain in each paitent before and after operation. The curative effect was evaluated by Macnab score. Surgical complications were recorded to find out the causes and methods to prevent them.  Results All cases were followed up for 3 months, and the VAS score decreased significantly compared with preoperation [1.00 (0.00, 1.05 vs 8.50 (7.75, 9.25; Z = 2.825, P = 0.050]. According to Macnab score, the rate of excellent and good functional recovery was 95.45% (273/286. Procedure-related complications included nerve injury in 8 cases (2.80%, hemorrhage at the operation site and hematoma formation around nerve root in 6 cases (2.10%, rupture of dural sac in one case (0.35%, muscle cramps in 3 cases (1.05%, surgical infection in one case (0.35%, postoperative recurrence in 4 cases (1.40%. All patients with complications were cured after symptomatic treatment. Conclusions The overall effect of percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis is satisfactory, which has a low incidence rate of postoperative complications. Some tips can effectively reduce the rate of surgical complications such as preoperative evaluation, precise performance, careful hemostasis, shortening the operation time and postoperatively symptomatic treatment, etc. DOI: 10.3969/j.issn.1672-6731.2016.04.007

Foot drop caused by lumbar degenerative disease: clinical features, prognostic factors of surgical outcome and clinical stage.

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Kun Liu

Full Text Available OBJECTIVE: The purpose of this study was to analyze the clinical features and prognostic factors of surgical outcome of foot drop caused by lumbar degenerative disease and put forward the clinical stage. METHODS: We retrospectively reviewed 135 patients with foot drop due to lumbar degenerative disease. The clinical features and mechanism were analyzed. Age, sex, duration of palsy, preoperative muscle strength of tibialis anterior (TA, sensation defect of affected lower limb, affected foot, diagnosis and compressed nerve roots were recorded and compared with surgical outcome. RESULTS: Foot drop was observed in 8.1% of all inpatients of lumbar degenerative disease. L5 nerve root compression was observed in 126 of all 135 patients (93.3%. Single, double and triple roots compression was observed respectively in 43, 83, and 9 patients (31.9%, 61.5%, and 6.6%. But there was no significant relationship between preoperative muscle strength of TA and the number of compressed roots. The muscle strength of TA was improved in 113 (83.7% patients after surgery, but it reached to >=4 in only 21 (15.6% patients. Improvement of the muscle strength of TA was almost stable at the 6-month follow-up. At the last follow-up, the muscle strength of TA was 1, 2, 3, 4, 5 respectively in 28, 24, 62, 13, 8 patients. Multivariate logistic regression showed duration of palsy (p=0.0360, OR=2.543, preoperative muscle strength of TA (p=0.0064, OR=5.528 and age (p=0.0309, OR=3.208 were factors that influenced recovery following an operation. CONCLUSIONS: L5 nerve root was most frequently affected. The muscle strength of TA improved in most patients after surgery, but few patients can get a good recovery from foot drop. Patients of shorter duration of palsy, better preoperative muscle strength of TA and younger age showed a better surgical outcome.

The Effect of Pregabalin and Metformin on Subacute and Chronic Radiculopathy

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Behnaz Ansari

2018-01-01

Full Text Available Background: Radicular pain is one of the most common forms of chronic pain in the world, which has challenges about effective medical therapy. The aim of this study was to evaluate the effect of pregabalin (PGB and metformin (Met on subacute and chronic radiculopathy. Materials and Methods: This double-blind prospective clinical trial was performed on 71 patients with subacute and chronic cervical and lumbosacral radiculopathy. Group A was treated with PGB 75 mg daily while Group B was treated with PGB 75 mg daily and Met 500 mg daily for 3 months. Finally, the pain score in both groups was evaluated based on visual analog scale (VAS and numerical scale pain. Results: The results showed a significant reduction in VAS and pain severity in both groups but this reduction in the terms of VAS (47.79% vs. 46.48%, P = 0.125 and pain severity (47.1% vs. 39.2%, P = 0.264 was more in treated patients with PGB and Met as compared to PGB group while total pain experience (53.5% vs. 49.1%, P = 0.464 and interference with daily function (57.1% vs. 50.61%, P = 0.726 were more in patients treated with PGB alone. Conclusion: Our results showed that PGB and PGB + Met reduced pain intensity and interference with daily function while we did not observe significant differences between two groups. PGB alone would have the potentiality to become a simple and economic means to decrease radicular pain.

Caudal lumbar vertebral fractures in California Quarter Horse and Thoroughbred racehorses.

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Collar, E M; Zavodovskaya, R; Spriet, M; Hitchens, P L; Wisner, T; Uzal, F A; Stover, S M

2015-09-01

To gain insight into the pathophysiology of equine lumbar vertebral fractures in racehorses. To characterise equine lumbar vertebral fractures in California racehorses. Retrospective case series and prospective case-control study. Racehorse post mortem reports and jockey injury reports were retrospectively reviewed. Vertebral specimens from 6 racehorses affected with lumbar vertebral fractures and 4 control racehorses subjected to euthanasia for nonspinal fracture were assessed using visual, radiographic, computed tomography and histological examinations. Lumbar vertebral fractures occurred in 38 Quarter Horse and 29 Thoroughbred racehorses over a 22 year period, primarily involving the 5th and/or 6th lumbar vertebrae (L5-L6; 87% of Quarter Horses and 48% of Thoroughbreds). Lumbar vertebral fractures were the third most common musculoskeletal cause of death in Quarter Horses and frequently involved a jockey injury. Lumbar vertebral specimens contained anatomical variations in the number of vertebrae, dorsal spinous processes and intertransverse articulations. Lumbar vertebral fractures examined in 6 racehorse specimens (5 Quarter Horses and one Thoroughbred) coursed obliquely in a cranioventral to caudodorsal direction across the adjacent L5-L6 vertebral endplates and intervertebral disc, although one case involved only one endplate. All cases had evidence of abnormalities on the ventral aspect of the vertebral bodies consistent with pre-existing, maladaptive pathology. Lumbar vertebral fractures occur in racehorses with pre-existing pathology at the L5-L6 vertebral junction that is likely predisposes horses to catastrophic fracture. Knowledge of these findings should encourage assessment of the lumbar vertebrae, therefore increasing detection of mild vertebral injuries and preventing catastrophic racehorse and associated jockey injuries. © 2014 EVJ Ltd.

Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

African Journals Online (AJOL)

Background and Objective: There are various postulated possible causes of surgically symptomatic prolapsed intervertebral discs in the lumbar and sacral regions. They may be acting singularly or collectively. Yet, these factors, which could vary in different environments, have not been satisfactorily confirmed. The intention ...

Ból kręgosłupa szyjnego w przebiegu radikulopatii = The cervical spine pain in radiculopathy

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Jakub Litak

2017-02-01

²Department of Human Anatomy  Medical University of Lublin     Key words: cervical discopathy, radiculopathy, neck pain         Abstrakt Bóle kręgosłupa szyjnego stanowią poważny problem diagnostyczny w praktyce lekarskiej . Są najczęstszą przyczyną zgłaszania się do lekarza i mają znaczący wymiar ekonomiczny. W związku z rozwojem cywilizacyjnym, stresem , siedzącym trybem życia i ograniczeniem aktywności procesy  degeneracyjno - wytwórcze w kręgosłupie szyjnym stają się bardziej powszechne. Radikulopatia szyjna jest neurologicznym stanem wywołanym kompresją lub uszkodzeniem korzeni nerwowych szyjnego odcinka kręgosłupa. Stan ten generuje ból w obrębie szyi  nie rzadko promieniuje do obręczy barkowej i kończyn górnych. Postępowanie diagnostyczne jest procesem wieloetapowym. Wywiad i badanie fizykalne pełnia znaczącą rolę a badania obrazowe uzupełniają pełną diagnozę. Farmakoterapia i ograniczenie obciążeń redukują ból w ostrej fazie. W przypadku nieskuteczności leczenia zachowawczego , przewlekłego bólu czy tez postępujących deficytów neurologicznych przeprowadzenie zabiegu operacyjnego obarczającego uciśnięte struktury nerwowe staje się jedynym słusznym postępowaniem .   Słowa kluczowe: szyjna dyskopatia, radikulopatia, ból kręgosłupa szyjnego     Abstract The cervical spine pain represents serious diagnostic medical problem .It is the most common reason for visiting the doctor and has economic dimension . According to Development of Civilization , stress , sitting lifestyle and limitation of physical  activity  Degenerative and Osteoarthritic  syndromes become more common. Cervical radiculopathy  is a neurological condition caused by compression or damage of the nerve roots of the cervical spine.  This leads to the occurrence of the neck pain  radiating  to the shoulders and upper extremities. Diagnostic path is a multistage process. Medical interview and physical examination

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

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

2014-05-01

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

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

Sagittal lumbar and pelvic alignment in the standing and sitting positions.

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Endo, Kenji; Suzuki, Hidekazu; Nishimura, Hirosuke; Tanaka, Hidetoshi; Shishido, Takaaki; Yamamoto, Kengo

2012-11-01

The sitting position has become the most common posture in today's workplace. In relation to this position, kinematic analysis of the lumbar spine is helpful in understanding the causes of low back pain and its prevention. In this study, we investigated the relationship between sagittal lumbar alignment and pelvic alignment in the standing and sitting positions for 50 healthy adults. Lumbar lordotic angle (LLA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured on lateral lumbar spine standing and sitting radiographs. Regarding changes from the standing to sitting positions, average LLA, SS, and PT were -16.6° (-49.8 %), -18.7° (-50.3 %), and 18.3° (284.8 %), respectively (P position, lumbar lordosis was reduced and pelvic rotation became posterior. This study showed that LLA decreased by approximately 50 % and PT increased by approximately 25 % in the sitting position compared with the standing position. No significant gender differences were observed for LLA, SS, and PT in the standing position. In the sitting position, however, LLA and SS were markedly larger for women.

Technological advances and changing indications for lumbar puncture in neurological disorders.

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Costerus, Joost M; Brouwer, Matthijs C; van de Beek, Diederik

2018-03-01

Technological advances have changed the indications for and the way in which lumbar puncture is done. Suspected CNS infection remains the most common indication for lumbar puncture, but new molecular techniques have broadened CSF analysis indications, such as the determination of neuronal autoantibodies in autoimmune encephalitis. New screening techniques have increased sensitvity for pathogen detection and can be used to identify pathogens that were previously unknown to cause CNS infections. Evidence suggests that potential treatments for neurodegenerative diseases, such as Alzheimer's disease, will rely on early detection of the disease with the use of CSF biomarkers. In addition to being used as a diagnostic tool, lumbar puncture can also be used to administer intrathecal treatments as shown by studies of antisense oligonucleotides in patients with spinal muscular atrophy. Lumbar puncture is generally a safe procedure but complications can occur, ranging from minor (eg, back pain) to potentially devastating (eg, cerebral herniation). Evidence that an atraumatic needle tip design reduces complications of lumbar puncture is compelling, and reinforces the need to change clinical practice. Copyright © 2018 Elsevier Ltd. All rights reserved.

Does Lordotic Angle of Cage Determine Lumbar Lordosis in Lumbar Interbody Fusion?

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Hong, Taek-Ho; Cho, Kyu-Jung; Kim, Young-Tae; Park, Jae-Woo; Seo, Beom-Ho; Kim, Nak-Chul

2017-07-01

Retrospective, radiological analysis. To determine that 15° lordotic angle cages create higher lumbar lordosis in open transforaminal lumbar interbody fusion (TLIF) than 4° and 8° cages. Restoration of lumbar lordosis is important to obtain good outcome after lumbar fusion surgery. Various shapes and angles of cages in interbody fusion have been used; however, it is not proved that lordotic angle of cages determine lumbar lordosis. Sixty-seven patients were evaluated after TLIF using 15° cages and screw instrumentation. For comparison, TLIF using 4° lordotic angle cages in 65 patients and 8° cages in 49 patients were analyzed. Lumbar lordosis angles, segmental lordosis angles, disc height, and bony union rate were measured on the radiographs. The lumbar lordosis was 31.1° preoperatively, improved to 42.9° postoperatively, and decreased to 36.4° at the last follow-up in the 15° group. It was 35.8° before surgery, corrected to 41.5° after surgery, and changed to 33.6° at the last follow-up in the 4° group. In the 8° group, it was 32.7° preoperatively, improved to 39.1° postoperatively, and decreased to 34.5° at the last follow-up. These changes showed statistical significances (P lordosis at L4-5 was 6.6° before surgery, 13.1° after surgery, and 9.8° at the last follow-up in the 15° group. It was 6.9°, 9.5°, and 6.2° in the 4° group and 6.7°, 9.8°, and 8.1° in the 8° group, respectively (P lordosis after TLIF. Cages with sufficient lordotic angle showed better restoration of lumbar lordosis and prevention of loss of correction. 4.

Solitary osteochondroma arising in lumbar spinous process: Case report.

Science.gov (United States)

Hadhri, Khaled; Tebourbi, Anis; Saidi, Mehdi; Kooli, Mondher

2016-12-01

Solitary osteochondromas rarely occur in the axial skeleton. Those tumors mostly arise on the posterior elements of the cervical column causing various symptoms especially when developing within the spinal canal. Exophytic lumbar variety is uncommon presenting with palpable mass or spinal deformity. We report a 20-year-old man presenting with a solid painless mass at the lower lumbar region. Radiological examinations revealed an exophytic lesion arising in the third lumbar spinous process appearing to be a solitary osteochondroma. The lesion was treated by en-bloc resection; histopathological examination confirmed the diagnosis of osteochondroma with no evidence of recurrence at the end of 2-year follow up. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Overload pain but root differentiation discomfort in the lumbar spine

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Joanna Siminska

2017-06-01

Full Text Available Lumbar pain syndromes of the spine can also be referred to as the pain of the cross. These ailments have now become epidemics of our time. In literature, these pain are referred to as localized ailments that are located in the lumbar, lumbosacral, and cross-iliac areas. Cross pains are a very general term because there are a multitude of factors that cause lumbar disc herniation. This problem poses great diagnostic difficulties. [4]. The nature of these ailments is often difficult to pinpoint by the patient, but it can be the pain that describes patients from blunt, piercing, biting, baking, to those that are termed cold feeling. Keep in mind that the location of the lumbar pain symptoms varies. Patients report pain that is located throughout the lumbar-sacral area or only on one side of the spine, or occurs only in the area of the hip joints. These complaints often radiate along the lower limb. They are often the result of a lack of proper spine prevention: they contribute to this poor body posture, improper sleep positioning, as well as lack of coping skills, as well as a bad diet. In daily life, it is important to remember to do your daily activities in the correct position as well as to use prevention to avoid pain in the lumbar area.

Ikkekirurgisk behandling af lumbal nerverodspåvirkning

DEFF Research Database (Denmark)

Andersen, Mikkel Østerheden; Andresen, Andreas K; Lorenzen, Marianne Dyrby

2017-01-01

evidence is found regarding non-surgical treatment of patients with lumbar radiculopathy. Physiotherapy, in the form of group sessions, seems to have the best level of evidence. However, evidence is still very limited and of poor quality. No evidence has been found with regards to acupuncture...

Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck-arm pain.

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Tampin, Brigitte; Slater, Helen; Hall, Toby; Lee, Gabriel; Briffa, Noelle Kathryn

2012-12-01

The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were compared to healthy control (HC) subjects and a positive control group comprising patients with fibromyalgia (FM). Quantitative sensory testing (QST) of thermal and mechanical detection and pain thresholds, pain sensitivity and responsiveness to repetitive noxious mechanical stimulation was performed in the maximal pain area, the corresponding dermatome and foot of 23 patients with painful C6 or C7 cervical radiculopathy, 8 patients with NSNAP in a C6/7 dermatomal pain distribution, 31 HC and 22 patients with FM. For both neck-arm pain groups, all QST parameters were within the 95% confidence interval of HC data. Patients with cervical radiculopathy were characterised by localised loss of function (thermal, mechanical, vibration detection Ppain area and dermatome (thermal detection, vibration detection, pressure pain sensitivity Ppain groups demonstrated increased cold sensitivity in their maximal pain area (Ppain groups differed from patients with FM, the latter characterised by a widespread gain of function in most nociceptive parameters (thermal, pressure, mechanical pain sensitivity Ppain characteristics between the 2 neck-arm pain groups, distinct sensory profiles were demonstrated for each group. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Lumbar Nerve Root Occupancy in the Foramen in Achondroplasia

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Modi, Hitesh N.; Song, Hae-Ryong; Yang, Jae Hyuk

2008-01-01

Lumbar stenosis is common in patients with achondroplasia because of narrowing of the neural canal. However, it is unclear what causes stenosis, narrowing of the central canal or foramina. We performed a morphometric analysis of the lumbar nerve roots and intervertebral foramen in 17 patients (170 nerve roots and foramina) with achondroplasia (eight symptomatic, nine asymptomatic) and compared the data with that from 20 (200 nerve roots and foramina) asymptomatic patients without achondroplasia presenting with low back pain without neurologic symptoms. The measurements were made on left and right parasagittal MRI scans of the lumbar spine. The foramen area and root area were reduced at all levels from L1 to L5 between the patients with achondroplasia (Groups I and II) and the nonachondroplasia group (Group III). The percentage of nerve root occupancy in the foramen between Group I and Group II as compared with the patients without achondroplasia was similar or lower. This implied the lumbar nerve root size in patients with achondroplasia was smaller than that of the normal population and thus there is no effective nerve root compression. Symptoms of lumbar stenosis in achondroplasia may be arising from the central canal secondary to degenerative disc disease rather than a true foraminal stenosis. Level of Evidence: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18259829

Gossypiboma complicated with paraspinal abscess and lumbar sinus: An uncommon complication of posterior lumbar spinal surgery

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Sahoo, Ranjan Kumar; Tripathy, Pradipta; Das, Pulin Bihari; Mohapatra, Debahuti

2017-01-01

A 42-year-old female presented with the complaint of purulent discharging sinus over posterior lumbar area following one month of lumbar spinal surgery for prolapsed intervertebral disc. Gossypiboma complicated with paraspinal abscess and sinus track formation over posterior lumbar area was diagnosed in magnetic resonance imaging which was confirmed in re- exploration of lumbar spinal operative site.

Posterior epidural disc fragment masquerading as spinal tumor: Review of the literature.

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Park, Taejune; Lee, Ho Jun; Kim, Jae Seong; Nam, Kiyeun

2018-03-09

Posterior epidural lumbar disc fragment is infrequent because of anatomical barriers, and it is difficult to diagnose posterior epidural lumbar disc fragment because of its rare incidence and the ambiguity of radiologic evaluations. And it is difficult to differentiate it from other diseases such as spinal tumors. Differential diagnosis of posterior epidural lumbar disc fragment is clinically important because its diagnosis can affect treatment and prognosis. To investigate the incidence, anatomical concern, etiology, symptom, diagnostic tool, management and prognosis of posterior epidural lumbar disc fragment, we reviewed articles including case report. We performed a search of all clinical studies of posterior epidural lumbar disc fragment published to date. The following keywords were searched: Posterior epidural lumbar disc fragment, disc migration, posterior epidural disc, extradural migration, dorsal epidural migration, sequestrated disc, and disc fragment. We identified 40 patients of posterior epidural lumbar disc fragment from 28 studies. The most common presentation of posterior epidural lumbar disc fragment was sudden onset radiculopathy (70.0%), followed by cauda equina syndrome (27.5%). The most frequently used diagnostic modality was magnetic resonance imaging (MRI), conducted in 36 cases (90.0%), and followed by computed tomography in 14 cases (35.0%). After the imaging studies, the preoperative diagnoses were 45.0% masses, 20.0% lesions, and 12.5% tumors. Characteristic MRI findings in posterior epidural lumbar disc fragment are helpful for diagnosis; it typically displays low signals on T1-weighted images and high signals on T2-weighted images with respect to the parent disc. In addition, most of the disc fragments show peripheral rim enhancement on MRI with gadolinium administration. Electrodiagnostic testing is useful for verifying nerve damage. Surgical treatment was performed in all cases, and neurologic complications were observed in 12.5%. As

RADIOLOGICAL STUDY OF HUMAN LUMBAR VERTEBRAL CANAL IN VIDHARBHA REGION

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Shruti

2015-06-01

Full Text Available Increase in number of patients suffering from backache all over world needs changing health polices and cost benefit analysis, it is important to look at diseases causing low back pain and for this study of radiological structure of lumbar vertebral canal is undertaken. AIMS : To reveal the radiological feature of Human lumbar vert ebral canal. METHOD AND MATERIAL : 50 - xray of lumbar canal was collected from orthopedic department of government medical college, Nagpur. STATISTICAL ANALYSIS : Data is presented in mean ± standard deviation and categorical variable are presented in percen tage. Comparison with previous study is done. RESULT : M aximum measurement as greater in male than female of same age group. CONCLUSION : T he present study and previous studies are compared and the non - significant result is found.

Comprehensive comparing percutaneous endoscopic lumbar discectomy with posterior lumbar internal fixation for treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis

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Sun, Yapeng; Zhang, Wei; Qie, Suhui; Zhang, Nan; Ding, Wenyuan; Shen, Yong

2017-01-01

Abstract The study was to comprehensively compare the postoperative outcome and imaging parameter characters in a short/middle period between the percutaneous endoscopic lumbar discectomy (PELD) and the internal fixation of bone graft fusion (the most common form is posterior lumbar interbody fusion [PLIF]) for the treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis after a previous lumbar internal fixation surgery. In this retrospective case-control study, we collected the medical records from 11 patients who received PELD operation (defined as PELD group) for and from 13 patients who received the internal fixation of bone graft fusion of lumbar posterior vertebral lamina decompression (defined as control group) for the treatment of the lumbar disc prolapse combined with stable retrolisthesis at Department of Spine Surgery, the Third Hospital of Hebei Medical University (Shijiazhuang, China) from May 2010 to December 2015. The operation time, the bleeding volume of perioperation, and the rehabilitation days of postoperation were compared between 2 groups. Before and after surgery at different time points, ODI, VAS index, and imaging parameters (including Taillard index, inter-vertebral height, sagittal dislocation, and forward bending angle of lumbar vertebrae) were compared. The average operation time, the blooding volume, and the rehabilitation days of postoperation were significantly less in PELD than in control group. The ODI and VAS index in PELD group showed a significantly immediate improving on the same day after the surgery. However, Taillard index, intervertebral height, sagittal dislocation in control group showed an immediate improving after surgery, but no changes in PELD group till 12-month after surgery. The forward bending angle of lumbar vertebrae was significantly increased and decreased in PELD and in control group, respectively. PELD operation was superior in terms of operation time, bleeding volume, recovery period

CHANGES IN RADIOGRAPHIC PARAMETERS AFTER MINIMALLY INVASIVE LUMBAR INTERBODY FUSION

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Emiliano Vialle

2015-12-01

Full Text Available Objective : This study aims to evaluate changes in lumbosacral parameters after minimally invasive lumbar interbody fusion. The secondary aim was to evaluate whether interbody cage shape (crescent shaped or rectangular would influence the results. Method : Retrospective analysis of 70 patients who underwent one or two level lumbar interbody fusion through a minimally invasive posterolateral approach. This included midline preservation and unilateral facetectomy. Pre- and postoperative (three to six months postoperative radiographs were used for measuring lumbar lordosis (LL, segmental lordosis (SL at the level of interbody fusion, and sacral slope (SS. Further analyses divided the patients into Roussouly lumbar subgroups. Results : LL was significantly reduced after surgery (59o:39o, p=0.001 as well as the SS (33.8o:31.2o, p=0.05. SL did not change significantly (11.4:11.06, p=0.85. There were no significant differences when comparing patients who received crescent shaped cage (n=27 and rectangular cage (n=43. Hypolordotic patients (Roussouly types 1 and 2 had radiographic improvement in comparison to normolordotic and hyperlordotic groups (types 3 and 4. Conclusion : Minimally invasive lumbar interbody fusion caused reduction in lumbosacral parameters. Cage shape had no influence on the results.

Oriental Medical Treatment of Lumbar Spinal Stenosis

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Hae-Yeon Lee

2003-12-01

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

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

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Feng-Chun Kao

2014-04-01

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

Lumbar lordosis.

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Been, Ella; Kalichman, Leonid

2014-01-01

Lumbar lordosis is a key postural component that has interested both clinicians and researchers for many years. Despite its wide use in assessing postural abnormalities, there remain many unanswered questions regarding lumbar lordosis measurements. Therefore, in this article we reviewed different factors associated with the lordosis angle based on existing literature and determined normal values of lordosis. We reviewed more than 120 articles that measure and describe the different factors associated with the lumbar lordosis angle. Because of a variety of factors influencing the evaluation of lumbar lordosis such as how to position the patient and the number of vertebrae included in the calculation, we recommend establishing a uniform method of evaluating the lordosis angle. Based on our review, it seems that the optimal position for radiologic measurement of lordosis is standing with arms supported while shoulders are flexed at a 30° angle. There is evidence that many factors, such as age, gender, body mass index, ethnicity, and sport, may affect the lordosis angle, making it difficult to determine uniform normal values. Normal lordosis should be determined based on the specific characteristics of each individual; we therefore presented normal lordosis values for different groups/populations. There is also evidence that the lumbar lordosis angle is positively and significantly associated with spondylolysis and isthmic spondylolisthesis. However, no association has been found with other spinal degenerative features. Inconclusive evidence exists for association between lordosis and low back pain. Additional studies are needed to evaluate these associations. The optimal lordotic range remains unknown and may be related to a variety of individual factors such as weight, activity, muscular strength, and flexibility of the spine and lower extremities. Copyright © 2014 Elsevier Inc. All rights reserved.

Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization

International Nuclear Information System (INIS)

Maleux, G.; Wilms, G.; Vermylen, J.

2002-01-01

Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma. (orig.)

Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization

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Maleux, G.; Wilms, G. [Department of Radiology, University Hospitals, Leuven (Belgium); Vermylen, J. [Department of Internal Medicine-Vascular Diseases, University Hospitals, Leuven (Belgium)

2002-06-01

Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma. (orig.)

Enlargement of lumbar spinal canal in lumbar degenerative spondylolisthesis. Evaluation with three-dimensional computed tomography

International Nuclear Information System (INIS)

Kunishi, Yoshihiko

2003-01-01

A number of clinical studies have demonstrated that enlargement of the lumbar spinal canal is one of the effective surgical procedures for the treatment of the lumbar degenerative spondylolisthesis and provides a good result. In the present study, we have evaluated the long-term outcome of the enlargement of the lumbar canal without fusion in thirty eight patients with lumbar degenerative spondylolisthesis using three-dimensional computed tomography (3D-CT) The improvement rate was excellent in 80% of the patients (mean improvement ratio, 83%) according to the Japanese Orthopedic Association scoring system. We found that the sufficient enlargement of the canal was obtained by the surgery and maintained for a long period of time. The results from 3D-CT suggested that a round shape was maintained in the canal after the surgery because of pressures of the dura mater against to the bony canal. None of patients showed lumbar instability. In conclusion, enlargement of lumbar canal without fusion is useful for the treatment of lumbar degenerative spondylolisthesis, and the enlarged canal has been maintained for a long period of time after the surgery. The results demonstrated the clinical utility of 3D-CT to evaluate the preoperative and postoperative shape of the spine. (author)

Revision and simplification of the boarding previous minimum of the lumbar column

International Nuclear Information System (INIS)

Lazannec, JY; Del Vecchio, R; Ramare, S; Saillant, G

2001-01-01

This paper describes the boarding retroperineal previous minimum, which provides access at any level discal and vertebral between T12 and S1. It is carried out a technique of dissection retroperineal that facilitates the renal and duodenum-pancreatic mobilization to consent to the face previous left of the whole lumbar column and of the thoracic-lumbar union. They were carried out careful anatomical dissections in fresh cadavers and preserved to determine the topography and the anatomical relationships of interest and this way to develop a sure boarding and easily reproducible. Special attention has been paid to the description of the lumbar veins and the anastomosis between the vein renal left and the hemiacigos system for the exhibition of the expensive left anterolateral of T12 and L1. A series of 94 patients is reported with lesions caused by traumas or degenerative processes. For all the lumbar levels, even in-patient with antecedents of surgery intraperitoneal, the boarding minimum retroperitoneal, was safe for the kidneys, ureters, spleen, hypo gastric plexus and duodenum-pancreatic union. Better cosmetic results are reported, decrease of the time surgical, scarce bled intraoperatory and easiness for the decortications and placement of implants. The previous boarding minimum retro peritoneal of the column developed starting from the boarding classic retroperineals, offers significant advantages on the endoscopic techniques, which require sophisticated machinery and they are technically plaintiffs. The exhibition of all the lumbar levels, as well as the reduction maneuvers and placement of implants, they can be carried out with easiness without causing muscular damage

NEUROMUSCULAR CONTROL IN LUMBAR DISORDERS

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Ville Leinonen

2004-03-01

Full Text Available Impaired motor and sensory functions have been associated with low back pain (LBP. This includes disturbances in a wide range of sensorimotor control e.g. sensory dysfunctions, impaired postural responses and psychomotor control. However, the physiological mechanisms, clinical relevance and characteristics of these findings in different spinal pathologies require further clarification. The purposes of this study were to investigate postural control, lumbar muscle function, movement perception and associations between these findings in healthy volunteers (n=35, patients with lumbar disc herniation (n=20 and lumbar spinal stenosis (LSS, n=26. Paraspinal muscle responses for sudden upper limb loading and muscle activation during flexion-extension movement and the lumbar endurance test were measured by surface electromyography (EMG. Postural stability was measured on a force platform during two- and one-footed standing. Lumbar movement perception was assessed in a motorised trunk rotation unit in the seated position. In addition, measurements of motor-(MEP and somatosensory evoked potentials (SEP and needle EMG examination of lumbar multifidus muscles were performed in the LSS patients. Clinical and questionnaire data were also recorded. A short latency paraspinal muscle response (~50 ms for sudden upper limb loading was observed. The latency of the response was shortened by expectation (p=0.017. The response latency for unexpected loading was similar in healthy persons and disc herniation patients but the latency was not shortened by expectation in the patients (p = 0.014. Also impaired postural control (p < 0.05 and lumbar movement perception (p = 0.012 were observed in disc herniation patients. The impaired lumbar movement perception (p=0.054 and anticipatory muscle activation (p = 0.043 tended to be restored after successful surgery but postural control had still not recovered after 3 months of follow-up. The majority of LSS patients were unable

Bay11-7082 attenuates neuropathic pain via inhibition of nuclear factor-kappa B and nucleotide-binding domain-like receptor protein 3 inflammasome activation in dorsal root ganglions in a rat model of lumbar disc herniation

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Zhang AL

2017-02-01

Full Text Available Ailiang Zhang, Kun Wang, Lianghua Ding, Xinnan Bao, Xuan Wang, Xubin Qiu, Jinbo Liu Spine Surgery, Third Affiliated Hospital of Soochow University, Changzhou, People’s Republic of China Abstract: Lumbar disc herniation (LDH is an important cause of radiculopathy, but the underlying mechanisms are incompletely understood. Many studies suggested that local inflammation, rather than mechanical compression, results in radiculopathy induced by LDH. On the molecular and cellular level, nuclear factor-kappa B (NF-κB and nucleotide-binding domain-like receptor protein 3 (NLRP3 inflammasome have been implicated in the regulation of neuroinflammation formation and progression. In this study, the autologous nucleus pulposus (NP was implanted in the left L5 dorsal root ganglion (DRG to mimic LDH in rats. We investigated the expression of NF-κB and the components of NLRP3 inflammasome in the DRG neurons in rats. Western blotting and immunofluorescence for the related molecules, including NLRP3, apoptosis-associated speck-like protein containing caspase-1 activator domain (ASC, caspase-1, interleukin (IL-1β, IL-18, IκBα, p-IκBα, p65, p-p65, and calcitonin gene-related peptide (CGRP were examined. In the NP-treated group, the activations of NLRP3, ASC, caspase-1, IL-1β, IL-18, p-IκBα, and p-p65 in DRG neurons in rats were elevated at 1 day after surgery, and the peak occurred at 7 days. Treatment with Bay11-7082, an inhibitor of the actions of IKK-β, was able to inhibit expression and activation of the molecules (NLRP3, ASC, caspase-1, IL-1β, IL-18, p-IκBα, and p-p65 and relieve the pain in rats. Our study shows that NF-κB and NLRP3 inflammasome are involved in the maintenance of NP-induced pain, and that Bay11-7082 could alleviate mechanical allodynia and thermal hyperalgesia by inhibiting NF-κB and NLRP3 inflammasome activation. Keywords: pain, NLRP3, NF-κB, dorsal root ganglion, nucleus pulposus

Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up.

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Peolsson, Anneli; Söderlund, Anne; Engquist, Markus; Lind, Bengt; Löfgren, Håkan; Vavruch, Ludek; Holtz, Anders; Winström-Christersson, Annelie; Isaksson, Ingrid; Öberg, Birgitta

2013-02-15

Prospective randomized study. To investigate differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program. No earlier studies have evaluated the effectiveness of a structured physiotherapy program or postoperative physical rehabilitation after ACDF for patients with magnetic resonance imaging-verified nerve compression due to cervical disc disease. Our prospective randomized study included 63 patients with radiculopathy and magnetic resonance imaging-verified nerve root compression, who were randomized to receive either ACDF in combination with physiotherapy or physiotherapy alone. For 49 of these patients, an independent examiner measured functional outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning before treatment and at 3-, 6-, 12-, and 24-month follow-ups. There were no significant differences between the 2 treatment alternatives in any of the measurements performed (P = 0.17-0.91). Both groups showed improvements over time in neck muscle endurance (P ≤ 0.01), manual dexterity (P ≤ 0.03), and right-handgrip strength (P = 0.01). Compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery. 2.

Effect of Lumbar Lordosis on the Adjacent Segment in Transforaminal Lumbar Interbody Fusion: A Finite Element Analysis.

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Zhao, Xin; Du, Lin; Xie, Youzhuan; Zhao, Jie

2018-06-01

We used a finite element (FE) analysis to investigate the biomechanical changes caused by transforaminal lumbar interbody fusion (TLIF) at the L4-L5 level by lumbar lordosis (LL) degree. A lumbar FE model (L1-S5) was constructed based on computed tomography scans of a 30-year-old healthy male volunteer (pelvic incidence,= 50°; LL, 52°). We investigated the influence of LL on the biomechanical behavior of the lumbar spine after TLIF in L4-L5 fusion models with 57°, 52°, 47°, and 40° LL. The LL was defined as the angle between the superior end plate of L1 and the superior end plate of S1. A 150-N vertical axial preload was imposed on the superior surface of L3. A 10-N/m moment was simultaneously applied on the L3 superior surface along the radial direction to simulate the 4 basic physiologic motions of flexion, extension, lateral bending, and torsion in the numeric simulations. The range of motion (ROM) and intradiscal pressure (IDP) of L3-L4 were evaluated and compared in the simulated cases. In all motion patterns, the ROM and IDP were both increased after TLIF. In addition, the decrease in lordosis generally increased the ROM and IDP in all motion patterns. This FE analysis indicated that decreased spinal lordosis may evoke overstress of the adjacent segment and increase the risk of the pathologic development of adjacent segment degeneration; thus, adjacent segment degeneration should be considered when planning a spinal fusion procedure. Copyright © 2018. Published by Elsevier Inc.

Aspergillus Spondylitis involving the Cervico-Thoraco-Lumbar Spine in an Immunocompromised Patient: a Case Report

International Nuclear Information System (INIS)

Son, Jeong-Min; Jee, Won-Hee; Jung, Chan-Kwon; Kim, Sang-Il; Ha, Kee-Yong

2007-01-01

Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient. spergillosis is a rare cause of spondylitis, and early diagnosis by MR imaging and adequate treatment are essential for a good outcome. Although the MR findings of bacterial spondylitis have been fully described, the findings of aspergillus spondylitis have been rarely described, and to the best of our knowledge multilevel involvement of cervico-thoraco-lumbar spine has not been previously reported. Here, we report the MR imaging findings of aspergillus spondylitis involving the cervico-thoraco-lumbar spine in a liver transplant recipient. In conclusion, aspergillus spondylitis should be considered in the differential diagnosis of immunocompromised patients with MR findings resembling those of tuberculous spondylitis

Complications in posterior lumbar interbody fusion

OpenAIRE

Kreuzer, Rolf-Peter

2010-01-01

From 1993 to 2000, 220 consecutive patients with unstable degenerative spondylolisthesis were studied after posterior lumbar interbody fusion (PLIF) using different types of grafts and pedicle screw systems. In a retrospective review the author detail the associated complications and their correlation with perioperative factors. The causes, strategies for their avoidance, and the clinical course of these complications are also disscused. The study group was composed of 136 women and 84 men...

Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

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Kanthila Mahesha

2017-01-01

Full Text Available Background: Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy. Percutaneous endoscopic discectomy is the least invasive procedure for lumbar disc prolapse. The aim of this study was to analyze the clinical outcome, quality of life, neurologic function, and complications. Materials and Methods: One hundred patients with lumbar disc prolapse who were treated with percutaneous endoscopic discectomy from May 2012 to January 2014 were included in this retrospective study. Clinical followup was done at 1 month, 3 months, 6 months, 1 year, and at yearly interval thereafter. The outcome was assessed using modified Macnab′s criteria, visual analog scale, and Oswestry Disability Index. Results: The mean followup period was 2 years (range 18 months - 3 years. Transforaminal approach was used in 84 patients, interlaminar approach in seven patients, and combined approach in nine patients. An excellent outcome was noted in ninety patients, good outcome in six patients, fair result in two patients, and poor result in two patients. Minor complications were seen in three patients, and two patients had recurrent disc prolapse. Mean hospital stay was 1.6 days. Conclusions: Percutaneous endoscopic lumbar discectomy is a safe and effective procedure in lumbar disc prolapse. It has the advantage that it can be performed on a day care basis under local anesthesia with shorter length of hospitalization and early return to work thus improving the quality of life earlier. The low complication rate makes it the future of disc surgery. Transforaminal approach alone is sufficient in majority of cases, although 16% of cases required either percutaneous interlaminar approach or combined approach. The procedure definitely has a learning curve, but it is acceptable with adequate preparations.

CT-findings in pain syndromes originated from thoraco-lumbar junction

International Nuclear Information System (INIS)

Dimitrov, I.; Karadjova, M.; Malchanova, V.

2007-01-01

The thoraco-lumbar junction syndrome imitates, as far as clinical symptoms are concerned, low back pain, caused by disc protrusion in the lower lumbar vertebral segments. It is manifested by referred pain in the area, innervated by posterior and anterior primary rami (dorsal and ventral rami), belonging to thoraco-lumbar junction vertebral segments (Th11-L2). Eighty one patients with clinically diagnosed thoraco-lumbar junction syndrome underwent CT-investigations, that aimed establishing pathological processes, leading to this clinical symptomatology. 148 vertebral levels were examined. In 67 patients we scanned two consecutive levels to find the type of change of the zygapophyseal joints. We found facet tropism (asymmetry) in 72 patients (88.8%) or in 117 levels (79.6%), degenerated faced joints in 63 patients (77.8%), pathology of the intervertebral disc - in 33 patients (43.1%) including 5 patients (6.2%) with disc prolapse. When investigating on two subsequent segments (Th11-Th12 and Th12-L1) sudden anatomical change in orientation of facets occurred in 55 patients (82%). Our findings support the hypothesis of the facet-joint origin of this ailment. (authors)

Sciatica due to pelvic hematoma: case report

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Kocaman Umit

2016-12-01

Full Text Available Sciatica is defined as pain in the sciatic nerve distribution. The most common reason of sciatica is radiculopathy due to lumbar disc hernia. Other causes can be congenital, acquired, infectious, neoplastic, or inflammatory. The piriformis syndrome is another cause. The pain starts in an insidious manner when the cause of sciatica is an extraspinal tumor. It is intermittent at first but a constant and progressive pain that does not decrease with position or rest gradually develops in all patients. The possibility of an intraabdominal or pelvic mass should always be considered and the relevant tests requested when the cause of the sciatica cannot be explained. We present an 83-year-old male who presented with non-traumatic and non-vascular lumbosacral plexopathy due to a large hematoma in the left adductor muscle following the use of warfarin sodium.

Lumbar Scoliosis Combined Lumbar Spinal Stenosis and Herniation Diagnosed Patient Was Treated with “U” Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy

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Binbin Wu

2017-01-01

Full Text Available The objective was to report a case of a 63-year-old man with a history of low back pain (LBP and left leg pain for 2 years, and the symptom became more serious in the past 5 months. The patient was diagnosed with lumbar scoliosis combined with lumbar spinal stenosis (LSS and lumbar disc herniation (LDH at the level of L4-5 that was confirmed using Computerized Topography and Magnetic Resonance Imaging. The surgical team preformed a novel technique, “U” route transforaminal percutaneous endoscopic lumbar discectomy (PELD, which led to substantial, long-term success in reduction of pain intensity and disability. After removing the osteophyte mass posterior to the thecal sac at L4-5, the working channel direction was changed to the gap between posterior longitudinal ligament and thecal sac, and we also removed the herniation and osteophyte at L3-4 with “U” route PELD. The patient’s symptoms were improved immediately after the surgical intervention; low back pain intensity decreased from preoperative 9 to postoperative 2 on a visual analog scale (VAS recorded at 1 month postoperatively. The success of the intervention suggests that “U” route PELD may be a feasible alternative to treat lumbar scoliosis with LSS and LDH patients.

Lumbar lordosis in female collegiate dancers and gymnasts.

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Ambegaonkar, Jatin P; Caswell, Amanda M; Kenworthy, Kristen L; Cortes, Nelson; Caswell, Shane V

2014-12-01

Postural deviations can predispose an individual to increased injury risk. Specifically, lumbar deviations are related to increased low back pain and injury. Dancers and gymnasts are anecdotally suggested to have exaggerated lumbar lordosis and subsequently may be at increased risk of lumbar pathologies. Our objective was to examine lumbar lordosis levels in dancers and gymnasts. We examined lumbar lordosis in 47 healthy collegiate females (17 dancers, 29 gymnasts; mean age 20.2 ± 1.6 yrs) using 2-dimensional sagittal plane photographs and the Watson MacDonncha Posture Analysis instrument. Participants' lordosis levels were cross-tabulated and a Mann-Whitney U-test compared lumbar lordosis between groups (plordosis deviations. The distribution of lordosis was similar across groups (p=0.22). Most dancers and gymnasts had moderate or marked lumbar lordosis. The extreme ranges of motion required during dancing and gymnastics may contribute to the participants' high lumbar lordosis. Instructors should be aware that there may be links between repetitive hyperextension activities and lumbar lordosis levels in dancers and gymnasts. Thus, they should proactively examine lumbar lordosis in their dancers and gymnasts. How much age of training onset, regimens, survivor bias, or other factors influence lumbar lordosis requires study. Longitudinal studies are also needed to determine if lumbar lordosis levels influence lumbar injury incidence in dancers and gymnasts.

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

International Nuclear Information System (INIS)

Shoda, Motoi; Kuno, Shigehiko; Inoue, Tatsushi

2009-01-01

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

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

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Surendra Mohan Tuli

2011-01-01

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

Lumbar Disc Herniation in a Patient With Congenital Vertebral Body Anomaly: A Case Report

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Atabey, Cem; Topuz, Ali Kivanc; Velioğlu, Murat; Demircan, Mehmet Nusret

2014-01-01

Lumbar disc herniation is characterized with low back and leg pain resulting from the degenerated lumbar disc compressing the spinal nerve root. The etiology of degenerative spine is related to age, smoking, microtrauma, obesity, disorders of familial collagen structure, occupational and sports-related physical activity. However, disc herniations induced by congenital lumbar vertebral anomalies are rarely seen. Vertebral fusion defect is one of the causes of congenital anomalies. The pathogenesis of embryological corpus vertebral fusion anomaly is not fully known. In this paper, a 30-year-old patient who had the complaints of low back and right leg pain after falling from a height is presented. She had right L5-S1 disc herniation that had developed on the basis of S1 vertebra corpus fusion anomaly in Lumbar computed tomography. This case has been discussed in the light of literature based on evaluations of Lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). This case is unique in that it is the first case with development of lumbar disc herniation associated with S1 vertebral corpus fusion anomaly. Congenital malformations with unusual clinical presentation after trauma should be evaluated through advanced radiological imaging techniques. PMID:25620987

Simple prediction method of lumbar lordosis for planning of lumbar corrective surgery: radiological analysis in a Korean population.

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Lee, Chong Suh; Chung, Sung Soo; Park, Se Jun; Kim, Dong Min; Shin, Seong Kee

2014-01-01

This study aimed at deriving a lordosis predictive equation using the pelvic incidence and to establish a simple prediction method of lumbar lordosis for planning lumbar corrective surgery in Asians. Eighty-six asymptomatic volunteers were enrolled in the study. The maximal lumbar lordosis (MLL), lower lumbar lordosis (LLL), pelvic incidence (PI), and sacral slope (SS) were measured. The correlations between the parameters were analyzed using Pearson correlation analysis. Predictive equations of lumbar lordosis through simple regression analysis of the parameters and simple predictive values of lumbar lordosis using PI were derived. The PI strongly correlated with the SS (r = 0.78), and a strong correlation was found between the SS and LLL (r = 0.89), and between the SS and MLL (r = 0.83). Based on these correlations, the predictive equations of lumbar lordosis were found (SS = 0.80 + 0.74 PI (r = 0.78, R (2) = 0.61), LLL = 5.20 + 0.87 SS (r = 0.89, R (2) = 0.80), MLL = 17.41 + 0.96 SS (r = 0.83, R (2) = 0.68). When PI was between 30° to 35°, 40° to 50° and 55° to 60°, the equations predicted that MLL would be PI + 10°, PI + 5° and PI, and LLL would be PI - 5°, PI - 10° and PI - 15°, respectively. This simple calculation method can provide a more appropriate and simpler prediction of lumbar lordosis for Asian populations. The prediction of lumbar lordosis should be used as a reference for surgeons planning to restore the lumbar lordosis in lumbar corrective surgery.

Genotypic and antimicrobial characterisation of Propionibacterium acnes isolates from surgically excised lumbar disc herniations

DEFF Research Database (Denmark)

Rollason, Jess; McDowell, Andrew; Albert, Hanne B

2013-01-01

The anaerobic skin commensal Propionibacterium acnes is an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised...... from each of 64 patients with lumbar disc herniation. P. acnes and other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence of P. acnes in their excised herniated disc tissue. Using recA and mAb typing methods...... isolate collection (63%) suggests that the role of P. acnes in lumbar disc herniation should not be readily dismissed....

Methamphetamine Related Radiculopathy: Case Series and Review of Literature

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Mohsen Foroughipour

2013-06-01

Full Text Available Background: Peripheral nervous injury and neuromuscular complications from methamphetamine abuse has not been reported. The mechanism is not yet identified. Methods: Eight patients with lower extremity weakness following methamphetamine abuse were reported during December 2009 to May 2010. Results: Patients presented with lower extremity weakness. All patients were co-abusers of methamphetamine and opioids. Other clinical manifestations comprised of distal paresthesia of the lower extremities with progression to proximal portions, with minimal sensory involvement in the distal of the lower extremities. Electrodiagnostic findings were consistent with lumbosacral Radiculopathy. Vital signs were unremarkable and all laboratory tests were within normal limits. Follow-up examination after three months showed improvement of weakness in 3 patients. Conclusion: For patients with a history of illicit drug abuse and acute neuromuscular weakness, methamphetamine or heroin toxicity should be taken into account. Hence, urine morphine and amphetamine/ methamphetamine tests should be performed and serum lead and thallium levels should be evaluated. In addition, rhabdomyolysis and myoglobinuria should be worked up.

A case of lumbar pain after intraoperative radiotherapy

International Nuclear Information System (INIS)

Shimizu, Wakako; Ogino, Takashi; Murakami, Koji; Nawano, Shigeru; Moriyama, Noriyuki; Ryu, Munemasa; Kawano, Nariaki

1996-01-01

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

Which level is responsible for gluteal pain in lumbar disc hernia?

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Fang, Guofang; Zhou, Jianhe; Liu, Yutan; Sang, Hongxun; Xu, Xiangyang; Ding, Zihai

2016-08-22

There are many different reasons why patients could be experiencing pain in the gluteal area. Previous studies have shown an association between radicular low back pain (LBP) and gluteal pain (GP). Studies locating the specific level responsible for gluteal pain in lumbar disc hernias have rarely been reported. All patients with lumbar disc herniation (LDH) in the Kanghua hospital from 2010 to 2014 were recruited. All patients underwent a lumbar spine MRI to clarify their LDH diagnosis, and patients were allocated to a GP group and a non-GP group. To determine the cause and effect relationship between LDH and GP, all of the patients were subjected to percutaneous endoscopic lumbar discectomy (PELD). A total of 286 cases were included according to the inclusive criteria, with 168 cases in the GP group and 118 cases in the non-GP group. Of these, in the GP group, 159 cases involved the L4/5 level and 9 cases involved the L5/S1 level, while in the non-GP group, 43 cases involved the L4/5 level and 48 cases involved the L5/S1 level. PELD was performed in both groups. Gluteal pain gradually disappeared after surgery in all of the patients. Gluteal pain recrudesced in a patient with recurrent disc herniation (L4/5). As a clinical finding, gluteal pain is related to low lumbar disc hernia. The L4/5 level is the main level responsible for gluteal pain in lumbar disc hernia. No patients with gluteal pain exhibited involvement at the L3/4 level.

Cumulative occupational lumbar load and lumbar disc disease – results of a German multi-center case-control study (EPILIFT

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Michaelis Martina

2009-05-01

Full Text Available Abstract Background The to date evidence for a dose-response relationship between physical workload and the development of lumbar disc diseases is limited. We therefore investigated the possible etiologic relevance of cumulative occupational lumbar load to lumbar disc diseases in a multi-center case-control study. Methods In four study regions in Germany (Frankfurt/Main, Freiburg, Halle/Saale, Regensburg, patients seeking medical care for pain associated with clinically and radiologically verified lumbar disc herniation (286 males, 278 females or symptomatic lumbar disc narrowing (145 males, 206 females were prospectively recruited. Population control subjects (453 males and 448 females were drawn from the regional population registers. Cases and control subjects were between 25 and 70 years of age. In a structured personal interview, a complete occupational history was elicited to identify subjects with certain minimum workloads. On the basis of job task-specific supplementary surveys performed by technical experts, the situational lumbar load represented by the compressive force at the lumbosacral disc was determined via biomechanical model calculations for any working situation with object handling and load-intensive postures during the total working life. For this analysis, all manual handling of objects of about 5 kilograms or more and postures with trunk inclination of 20 degrees or more are included in the calculation of cumulative lumbar load. Confounder selection was based on biologic plausibility and on the change-in-estimate criterion. Odds ratios (OR and 95% confidence intervals (CI were calculated separately for men and women using unconditional logistic regression analysis, adjusted for age, region, and unemployment as major life event (in males or psychosocial strain at work (in females, respectively. To further elucidate the contribution of past physical workload to the development of lumbar disc diseases, we performed lag

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

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

2012-03-01

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

The activL® Artificial Disc: a next-generation motion-preserving implant for chronic lumbar discogenic pain

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Yue, James J; Garcia, Rolando; Miller, Larry E

2016-01-01

Degeneration of the lumbar intervertebral discs is a leading cause of chronic low back pain in adults. Treatment options for patients with chronic lumbar discogenic pain unresponsive to conservative management include total disc replacement (TDR) or lumbar fusion. Until recently, only two lumbar TDRs had been approved by the US Food and Drug Administration − the Charité Artificial Disc in 2004 and the ProDisc-L Total Disc Replacement in 2006. In June 2015, a next-generation lumbar TDR received Food and Drug Administration approval − the activL® Artificial Disc (Aesculap Implant Systems). Compared to previous-generation lumbar TDRs, the activL® Artificial Disc incorporates specific design enhancements that result in a more precise anatomical match and allow a range of motion that better mimics the healthy spine. The results of mechanical and clinical studies demonstrate that the activL® Artificial Disc results in improved mechanical and clinical outcomes versus earlier-generation artificial discs and compares favorably to lumbar fusion. The purpose of this report is to describe the activL® Artificial Disc including implant characteristics, intended use, surgical technique, postoperative care, mechanical testing, and clinical experience to date. PMID:27274317

Reproduction of the lumbar lordosis

DEFF Research Database (Denmark)

Andreasen, Marianne Løgtholt; Langhoff, Lotte; Jensen, Tue Secher

2007-01-01

OBJECTIVE: This study investigates whether it is possible to reproduce the lumbar lordosis in the upright position during magnetic resonance imaging (MRI) by positioning the patient supine with straightened lower extremities and investigates intra- and interexaminer reliability of measurements...... of the lumbar lordosis on radiographs and MRI. METHODS: This was an observational study, which included an intra- and interexaminer reliability study. The lumbar lordosis was measured digitally on radiographs taken from 22 patients in an upright standing position, and 22 MRI scans of the same patients lying...... supine with straightened lower extremities. These measurements were compared statistically. Intra- and interexaminer reliability was calculated applying the Bland and Altman method. RESULTS: The lumbar lordosis in the standing position was reproduced in the straightened supine position with a median...

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

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Hey Hwee Weng

2010-01-01

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

Lower thoracic degenerative spondylithesis with concomitant lumbar spondylosis.

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Hsieh, Po-Chuan; Lee, Shih-Tseng; Chen, Jyi-Feng

2014-03-01

. The average Nurick scale score improved from 3.75 before the operation to 2 after the operation. Lower thoracic degenerative spondylolisthesis is a rare disease, which may occur concomitantly with lumbar spondylosis and confuse clinicians. Diagnosis should be made properly, especially because symptoms/signs cannot be explained purely on the basis of the available images. Micromotion due to facet joint laxity and disc degeneration was believed as the cause of progressive myelopathy. Posterior decompression with fixation/fusion procedure was appropriate for the treatment of thoracic spondylolisthesis secondary to thoracic disc degeneration. Copyright © 2013 Elsevier B.V. All rights reserved.

Treatment of cervical radiculopathy by anterior cervical discectomy and cage fusion

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Osman A Mohamed

2012-01-01

Full Text Available Introduction: Since the pioneering days of the anterior cervical approach introduced by Cloward et al. in the early 1950s, anterior cervical discectomy and fusion (ACDF has been the standard procedure for most discogenic and degenerative cervical spinal lesions. Although traditional interbody fusion using iliac bone can maintain the patency of the neuroforamen and ensure solid fusion, selection of patients, and of surgical procedure for ACDF is a continuous challenge. Aim: The aim of this study was to assess the results of cervical discectomy and fusion with cervical cages in treatment of cervical radiculopathy clinically and radiologically. Materials and Methods: Eighteen patients suffering from cervical radiculopathy were operated upon using this technique. They were 15 males and 3 females. Clinical and radiological assessment, visual analog scale (VAS for neck and arm and modified Oswestery neck disability index (NDI were done preoperatively and at 4 weeks, 3, 6, and 12 months postoperatively. Polyetheretherketone (Peek cages filled with iliac bone graft were used after cervical discectomy. The levels operated upon were C 5-6 in 16 patients and C4-5 in 2 patients. Results: Marked clinical improvement as regard arm and neck pain, and NDI was observed. The pre and post operative mean and standard deviations (SD of the various scores were as follows. VAS for pain in arm reduced from mean of 8 (SD 1.76 to mean 0.4 (SD 0.4, VAS for neck pain reduced from mean of 3.5 (SD 1.58 to mean of 0.8 (SD 0.47, and NDI from mean of 20.2 (SD 0.89 to 2.1(SD 1.05. Fusion occurred in all patients. Subjectively 79% of the patients reported marked improvement in neck pain, and 95% reported marked reduction in arm pain. Conclusion: Anterior cervical discectomy and cage fusion resulted in high fusion rate with minimal preservation of lordosis.

Two cases of congenital defects within transverse processes of lumbar spine

International Nuclear Information System (INIS)

Malawski, S.; Sokolski, B.

1993-01-01

Two cases of congenital defects of transverse processes of lumbar spine causing lumbalgia are described. The first one was produced by direct contact of the elongated processes with subsequent pseudoarthrosis. Hypertrophied processes caused stenosis around intervertebral foramen and irritated posterior neural branch in the second case. Surgical resection of the hypertrophied transverse processes has brought the cure. (author)

Transforaminal Percutaneous Endoscopic Discectomy and Foraminoplasty after Lumbar Spinal Fusion Surgery.

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Wu, Jian-Jun; Chen, Hui-Zhen; Zheng, Changkun

2017-07-01

The most common causes of pain following lumbar spinal fusions are residual herniation, or foraminal fibrosis and foraminal stenosis that is ignored, untreated, or undertreated. The original surgeon may advise his patient that nothing more can be done in his opinion that the nerve was visually decompressed by the original surgery. Post-operative imaging or electrophysiological assessment may be inadequate to explain all the reasons for residual or recurrent symptoms. Treatment of failed lumbar spinal fusions by repeat traditional open revision surgery usually incorporates more extensive decompression causing increased instability and back pain. The authors, having limited their practice to endoscopic surgery over the last 10 years, report on their experience gained during that period to relieve pain by transforaminal percutaneous endoscopic revision of lumbar spinal fusions. To assess the effectiveness of transforaminal percutaneous endoscopic discectomy and foraminoplasty in patients with pain after lumbar spinal fusion. Retrospective study. Inpatient surgery center. Sixteen consecutive patients with pain after lumbar spinal fusions presenting with back and leg pain that had supporting imaging diagnosis of foraminal stenosis and/or residual/recurrent disc herniation, or whose pain complaint was supported by relief from diagnostic and therapeutic injections, were offered percutaneous transforaminal endoscopic discectomy and foraminoplasty over a repeat open procedure. Each patient sought consultation following a transient successful, partially successful or unsuccessful open lumbar spinal fusions treatment for disc herniation or spinal stenosis. Endoscopic foraminoplasty was also performed to either decompress the bony foramen in the case of foraminal stenosis, or to allow for endoscopic visual examination of the affected traversing and exiting nerve roots in the axilla. The average follow-up time was 30.3 months, minimum 12 months. Outcome data at each visit

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

International Nuclear Information System (INIS)

Mou Ling

2009-01-01

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

Lumbar disc arthroplasty: indications, biomechanics, types, and radiological criteria

International Nuclear Information System (INIS)

Baur-Melnyk, A.; Reiser, M.F.; Birkenmaier, C.

2006-01-01

Lumbar total disc replacement (TDR) was developed to treat a painful degenerative lumbar motion segment while avoiding the disadvantages of fusion surgery, such as adjacent segment instabilities. Early clinical results with TDR have shown a significant reduction in low back pain and a significant improvement in disability scores. When compared to fusion, the results with TDR tend to be superior in the short-term follow-up and initial rehabilitation is faster. The radiological assessment is an integral part of the preoperative work-up. Plain X-rays of the lumbar spine should be complemented by flexion - extension views in order to assess residual segmental mobility. Computed tomography is used to exclude osteoarthritis of the zygapophyseal joints, Baastrup's disease (kissing spines) and other sources of low back pain. Magnetic resonance imaging is useful to exclude substantial disc protrusions; it allows for the detection of disc dehydration and bone marrow edema in the case of activated spondylochondrosis. If osteoporosis is suspected, an osteodensitometry of the lumbar spine should be performed. Postoperative plain X-rays should include antero-posterior and lateral views as well as flexion - extension views in the later postoperative course. Measurements should determine the disc space height in the lateral view, the segmental and total lumbar lordosis as well as the segmental mobility in the flexion - extension views. The ideal position of a TDR is exactly central in the ap-view and close to the dorsal border of the vertebral endplates in the lateral view. Malpositioning may cause segmental hyperlordosis and unbalanced loading of the endplates with the risk of implant subsidence and migration. (orig.) [de

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

International Nuclear Information System (INIS)

Juhng, Seon Kwan; Koplyay, Peter; Jeffrey Carr, J.; Lenchik, Leon

2001-01-01

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

Cobb Angle Changes in Thoracic and Lumbar Spine Fractures ...

African Journals Online (AJOL)

The annual incidence of spinal column fracture is 350 per million populations. with Motor vehicular accident being the major single cause of spine injuries. The victims are predominantly young and male. The aim of this study to evaluate the clinical outcome of conservative treatment of closed thoracic and lumbar spine ...

Structural and clinikal displays of discogenic radiculopathy in combination with haemangioma of spine

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Fomina AM

2010-12-01

Full Text Available The work presents the examination results of 104 patients with the symptoms of lumbosacral compressive radiculopathy. The intensity of pain syndrome at rest, in physical exertion and at night was assessed by visual analogue and verbal assessment scales. Magnetic resonance tomography was used to examine the condition of vertebral bodies, degenerative changes of invertebral discs and the size and location of invertebral disc extrusion. The results of the study has led to the conclusion that disc syndrome in combination with spinal hemangioma is accompanied in most cases by lower limb chronic venous insufficiency, urination disorders and has no direct influence on pain intensity

Transforaminal Percutaneous Endoscopic Discectomy for Lumbar Disc Herniation in Parkinson's Disease: A Case-Control Study.

Science.gov (United States)

Kapetanakis, Stylianos; Giovannopoulou, Eirini; Charitoudis, George; Kazakos, Konstantinos

2016-08-01

A case-control study. To investigate the effectiveness of transforaminal percutaneous endoscopic discectomy (TPED) in Parkinson's disease (PD). Patients with PD frequently suffer from radiculopathy and low back pain. Additionally, they demonstrate higher complication rates after open spine surgery. However, the clinical outcome of minimally invasive techniques for lumbar discectomy, such as TPED, have not been established for this population. Patients diagnosed with lumbar disc hernia were divided into Group A (11 patients diagnosed with PD), and Group B (10 patients as the control, non-PD group). All patients underwent TPED. Indexes of visual analogue scale (VAS) for leg pain and Oswestry disability index (ODI) were assessed right before surgery and at six weeks, three months, six months and one year post-surgery. At the baseline visit, groups did not differ significantly with age (p=0.724), gender (p=0.835), level of operation (p=0.407), ODI (p=0.497) and VAS (p=0.772). Parkinson's patients had higher scores in ODI at every visit, but the outcome was statistically significant only at 3 months (p=0.004) and one year (p=0.007). Similarly, VAS measurements were higher at each time point, with the difference being significant at 3 (p<0.001), 6 (0.021), and 12 (p<0.001) months after surgery. At the end of a year of follow up, ODI was reduced by 49.6% (±16.7) in Group A and 59.2% (±8.0) in Group B (p=0.111), translating to a 79.5% (±13.0) and 91.5% (±4.1) average improvement in daily functionality (p=0.024). VAS was reduced by 59.1 mm (±11.8) in Group A and 62.2 mm (±7.4) in Group B (p=0.485), leading to an 85.3 % (±4.0) and 91.9% (±2.6) general improvement in leg pain (p<0.001). Our data indicate that TPED led to satisfactory improvement in leg pain and daily living in PD patients a year after surgery.

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.

Comprehensive comparing percutaneous endoscopic lumbar discectomy with posterior lumbar internal fixation for treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis: A retrospective case-control study.

Science.gov (United States)

Sun, Yapeng; Zhang, Wei; Qie, Suhui; Zhang, Nan; Ding, Wenyuan; Shen, Yong

2017-07-01

The study was to comprehensively compare the postoperative outcome and imaging parameter characters in a short/middle period between the percutaneous endoscopic lumbar discectomy (PELD) and the internal fixation of bone graft fusion (the most common form is posterior lumbar interbody fusion [PLIF]) for the treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis after a previous lumbar internal fixation surgery.In this retrospective case-control study, we collected the medical records from 11 patients who received PELD operation (defined as PELD group) for and from 13 patients who received the internal fixation of bone graft fusion of lumbar posterior vertebral lamina decompression (defined as control group) for the treatment of the lumbar disc prolapse combined with stable retrolisthesis at Department of Spine Surgery, the Third Hospital of Hebei Medical University (Shijiazhuang, China) from May 2010 to December 2015. The operation time, the bleeding volume of perioperation, and the rehabilitation days of postoperation were compared between 2 groups. Before and after surgery at different time points, ODI, VAS index, and imaging parameters (including Taillard index, inter-vertebral height, sagittal dislocation, and forward bending angle of lumbar vertebrae) were compared.The average operation time, the blooding volume, and the rehabilitation days of postoperation were significantly less in PELD than in control group. The ODI and VAS index in PELD group showed a significantly immediate improving on the same day after the surgery. However, Taillard index, intervertebral height, sagittal dislocation in control group showed an immediate improving after surgery, but no changes in PELD group till 12-month after surgery. The forward bending angle of lumbar vertebrae was significantly increased and decreased in PELD and in control group, respectively.PELD operation was superior in terms of operation time, bleeding volume, recovery period, and financial

Intervertebral Disc Characteristic on Progressive Neurological Deficit

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Farid Yudoyono

2017-09-01

Full Text Available Objective: To examine the intervertebral disc characteristic on magnetic resonance imaging (MRI in lumbar herniated disc (LHD patients with progressive neurological deficit. Methods: Patients were collected retrospectively from Dr. Hasan Sadikin General Hospital Database from 2011–2013 with LHD, had neurological deficit such as radiculopathy and cauda equine syndrome for less than four weeks with a positive sign confirmed by neurological examination and confirmatory with MRI examination. Results: A total of 14 patients with lumbar herniated disc disease (10 males, 4 females suffered from progressive neurological deficit with an average age of (52.07±10.9 years old. Early disc height was 9.38±0.5 mm and progressive neurological deficit state disc height was 4.03±0.53 mm, which were significantly different statisticaly (p<0.01. Symptoms of radiculopathy were seen in 11 patients and cauda equine syndrome in three patients. Modic changes grade 1 was found in five patients, grade 2 in eight patients,grade 3 in one patient, Pfirmman grade 2 in eleven patients and grade 3 in three patients. Thecal sac compression 1/3 compression was seen in four patients and 2/3 compression in ten patients. Conclusions: Neurosurgeon should raise concerns on the characteristic changes of intervertebral disc in magnetic resonance imaging examination to avoid further neural injury in lumbar herniated disc patients.

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

Energy Technology Data Exchange (ETDEWEB)

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)

Lumbar interspinous bursitis in active polymyalgia rheumatica.

Science.gov (United States)

Salvarani, Carlo; Barozzi, Libero; Boiardi, Luigi; Pipitone, Nicolò; Bajocchi, Gian Luigi; Macchioni, Pier Luigi; Catanoso, Mariagrazia; Pazzola, Giulia; Valentino, Massimo; De Luca, Carlo; Hunder, Gene G

2013-01-01

To evaluate the inflammatory involvement of lumbar interspinous bursae in patients with polymyalgia rheumatica (PMR) using magnetic resonance imaging (MRI). Ten consecutive, untreated new patients with PMR and pain in the shoulder and pelvic girdles were investigated. Seven patients with spondyloarthritis (4 with psoriatic spondyloarthrits, one with entheropatic spondyloarthritis, and 2 with ankylosing spondylitis) as well as 2 patients with spinal osteoarthritis and 2 patients with rheumatoid arthritis with lumbar pain served as controls. MRI of lumbar spine was performed in all PMR patients and controls. Nine patients (5 PMR patients and 4 controls) also had MRI of the thoracic spine. MRI evidence of interspinous lumbar bursitis was found in 9/10 patients with PMR and in 5/11 controls. A moderate to marked (grade ≥2 on a semiquantitative 0-3 scale) lumbar bursitis occurred significantly more frequently in patients with PMR than in control patients (60% vs. 9%, p=0.020). In most of the patients and controls lumbar bursitis was found at the L3-L5 interspaces. Only 2 patients had bursitis at a different level (one patient had widespread lumbar bursitis, and one control at L2-L4). No interspinous bursitis was demonstrated by MRI of the thoracic spine in patients and controls. Inflammation of lumbar bursae may be responsible for the low back pain reported by patients with PMR. The prominent inflammatory involvement of bursae including those of the lumbar spine supports the hypothesis that PMR may be a disorder affecting predominantly extra-articular synovial structures.

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

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Manchikanti L

2012-08-01

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

The Neandertal vertebral column 2: The lumbar spine.

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Gómez-Olivencia, Asier; Arlegi, Mikel; Barash, Alon; Stock, Jay T; Been, Ella

2017-05-01

Here we provide the most extensive metric and morphological analysis performed to date on the Neandertal lumbar spine. Neandertal lumbar vertebrae show differences from modern humans in both the vertebral body and in the neural arch, although not all Neandertal lumbar vertebrae differ from modern humans in the same way. Differences in the vertebral foramen are restricted to the lowermost lumbar vertebrae (L4 and L5), differences in the orientation of the upper articular facets appear in the uppermost lumbar vertebrae (probably in L1 and L2-L3), and differences in the horizontal angle of the transverse process appear in L2-L4. Neandertals, when compared to modern humans, show a smaller degree of lumbar lordosis. Based on a still limited fossil sample, early hominins (australopiths and Homo erectus) had a lumbar lordosis that was similar to but below the mean of modern humans. Here, we hypothesize that from this ancestral degree of lumbar lordosis, the Neandertal lineage decreased their lumbar lordosis and Homo sapiens slightly increased theirs. From a postural point of view, the lower degree of lordosis is related to a more vertical position of the sacrum, which is also positioned more ventrally with respect to the dorsal end of the pelvis. This results in a spino-pelvic alignment that, though different from modern humans, maintained an economic postural equilibrium. Some features, such as a lower degree of lumbar lordosis, were already present in the middle Pleistocene populations ancestral to Neandertals. However, these middle Pleistocene populations do not show the full suite of Neandertal lumbar morphologies, which probably means that the characteristic features of the Neandertal lumbar spine did not arise all at once. Copyright © 2017 Elsevier Ltd. All rights reserved.

Side effects after ambulatory lumbar iohexol myelography

International Nuclear Information System (INIS)

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

1989-01-01

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

Lumbar kinematic variability during gait in chronic low back pain and associations with pain, disability and isolated lumbar extension strength.

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Steele, James; Bruce-Low, Stewart; Smith, Dave; Jessop, David; Osborne, Neil

2014-12-01

Chronic low back pain is a multifactorial condition with many dysfunctions including gait variability. The lumbar spine and its musculature are involved during gait and in chronic low back pain the lumbar extensors are often deconditioned. It was therefore of interest to examine relationships between lumbar kinematic variability during gait, with pain, disability and isolated lumbar extension strength in participants with chronic low back pain. Twenty four participants with chronic low back pain were assessed for lumbar kinematics during gait, isolated lumbar extension strength, pain, and disability. Angular displacement and kinematic waveform pattern and offset variability were examined. Angular displacement and kinematic waveform pattern and offset variability differed across movement planes; displacement was highest and similar in frontal and transverse planes, and pattern variability and offset variability higher in the sagittal plane compared to frontal and transverse planes which were similar. Spearman's correlations showed significant correlations between transverse plane pattern variability and isolated lumbar extension strength (r=-.411) and disability (r=.401). However, pain was not correlated with pattern variability in any plane. The r(2) values suggested 80.5% to 86.3% of variance was accounted for by other variables. Considering the lumbar extensors role in gait, the relationship between both isolated lumbar extension strength and disability with transverse plane pattern variability suggests that gait variability may result in consequence of lumbar extensor deconditioning or disability accompanying chronic low back pain. However, further study should examine the temporality of these relationships and other variables might account for the unexplained variance. Copyright © 2014 Elsevier Ltd. All rights reserved.

Sacral Myeloid Sarcoma Manifesting as Radiculopathy in a Pediatric Patient: An Unusual Form of Myeloid Leukemia Relapse

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Joana Ruivo Rodrigues

2018-01-01

Full Text Available Myeloid sarcoma (MS, granulocytic sarcoma or chloroma, is defined as a localized extramedullary mass of blasts of granulocytic lineage with or without maturation, occurring outside the bone marrow. MS can be diagnosed concurrently with acute myeloid leukemia (AML or myelodysplastic syndrome (MDS. The authors report a case of sacral MS occurring as a relapse of myeloid leukemia in a 5-year-old girl who was taken to the emergency department with radiculopathy symptoms.

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

LENUS (Irish Health Repository)

Kelly, Joseph

2012-02-03

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

Factors associated with lumbar disc hernia recurrence after microdiscectomy.

Science.gov (United States)

Camino Willhuber, G; Kido, G; Mereles, M; Bassani, J; Petracchi, M; Elizondo, C; Gruenberg, M; Sola, C

Lumbar disc hernias are a common cause of spinal surgery. Hernia recurrence is a prevalent complication. To analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution. Lumbar microdiscectomies between 2010 and 2014 were analysed, patients with previous surgeries, extraforaminales and foraminal hernias were excluded. Patients with recurrent hernia were the case group and those who showed no recurrence were the control group. 177 patients with lumbar microdiscectomy, of whom 30 experienced recurrence (16%), and of these 27 were reoperated. Among the risk factors associated with recurrence, we observed a higher rate of disc height, higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes; we observed no differences in sex, body mass index or age. Previous studies show increased disc height and young patients as possible factors associated with recurrence. In our series we found that the higher rate of disc height, the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Cerebrospinal Fluid Lumbar Tapping Utilization for Suspected Ventriculoperitoneal Shunt Under-Drainage Malfunctions.

Science.gov (United States)

Lee, Jong-Beom; Ahn, Ho-Young; Lee, Hong-Jae; Yang, Ji-Ho; Yi, Jin-Seok; Lee, Il-Woo

2017-01-01

The diagnosis of shunt malfunction can be challenging since neuroimaging results are not always correlated with clinical outcomes. The purpose of this study was to evaluate the efficacy of a simple, minimally invasive cerebrospinal fluid (CSF) lumbar tapping test that predicts shunt under-drainage in hydrocephalus patients. We retrospectively reviewed the clinical and radiological features of 48 patients who underwent routine CSF lumbar tapping after ventriculoperitoneal shunt (VPS) operation using a programmable shunting device. We compared shunt valve opening pressure and CSF lumbar tapping pressure to check under-drainage. The mean pressure difference between valve opening pressure and CSF lumbar tapping pressure of all patients were 2.21±24.57 mmH 2 O. The frequency of CSF lumbar tapping was 2.06±1.26 times. Eighty five times lumbar tapping of 41 patients showed that their VPS function was normal which was consistent with clinical improvement and decreased ventricle size on computed tomography scan. The mean pressure difference in these patients was -3.69±19.20 mmH 2 O. The mean frequency of CSF lumbar tapping was 2.07±1.25 times. Fourteen cases of 10 patients revealed suspected VPS malfunction which were consistent with radiological results and clinical symptoms, defined as changes in ventricle size and no clinical improvement. The mean pressure difference was 38.07±23.58 mmH 2 O. The mean frequency of CSF lumbar tapping was 1.44±1.01 times. Pressure difference greater than 35 mmH 2 O was shown in 2.35% of the normal VPS function group (2 of 85) whereas it was shown in 64.29% of the suspected VPS malfunction group (9 of 14). The difference was statistically significant ( p =0.000001). Among 10 patients with under-drainage, 5 patients underwent shunt revision. The causes of the shunt malfunction included 3 cases of proximal occlusion and 2 cases of distal obstruction and valve malfunction. Under-drainage of CSF should be suspected if CSF lumbar tapping

MANAGEMENT OF LUMBAR SPINAL CANAL STENOSIS

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Mukhergee G. S

2016-06-01

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

Radiographical analysis concernig the etiology of degenerative spondylolisthesis of the lumbar spine

International Nuclear Information System (INIS)

Ihara, Koichiro

1989-01-01

The purpose of this article is to evaluate radiographically degenerative spondylolisthesis of the lumbar spine, with the main focus on the configuration of posterior elements. A comparative study between 49 cases of degenerative spondylolisthesis and 99 cases of other lumbar disorders was performed, using 13 radiographical parameters. The results clearly indicate the posterior elements of degenerative spondylolisthesis shifted horizontally and sagittally to allow slipping. This was due to the weak bony hook mechanism. Furthermore, almost all facet joints were morphologically classified as sagittal or intermediate type. Another meaningful difference was the alignment of the lumbar spine which showed an increase in both lordosis and lumbosacral angle. On the other hand, the level of Jacoby's line was almost the same in both groups. These characteristic configurations could be the cause of listhesis, although further study should be carried out to elucidate whether they are present at the non-listhetic stage. (author)

Radiographical analysis concernig the etiology of degenerative spondylolisthesis of the lumbar spine

Energy Technology Data Exchange (ETDEWEB)

Ihara, Koichiro [Yamaguchi Univ., Ube (Japan). School of Medicine

1989-12-01

The purpose of this article is to evaluate radiographically degenerative spondylolisthesis of the lumbar spine, with the main focus on the configuration of posterior elements. A comparative study between 49 cases of degenerative spondylolisthesis and 99 cases of other lumbar disorders was performed, using 13 radiographical parameters. The results clearly indicate the posterior elements of degenerative spondylolisthesis shifted horizontally and sagittally to allow slipping. This was due to the weak bony hook mechanism. Furthermore, almost all facet joints were morphologically classified as sagittal or intermediate type. Another meaningful difference was the alignment of the lumbar spine which showed an increase in both lordosis and lumbosacral angle. On the other hand, the level of Jacoby's line was almost the same in both groups. These characteristic configurations could be the cause of listhesis, although further study should be carried out to elucidate whether they are present at the non-listhetic stage. (author).

Fuerza lumbar en jugadores de hockey hierba

OpenAIRE

Til Pérez, Lluís; Barceló Peiró, Oriol; Pomés Díes, Teresa; Martínez Navas, Roberto; Galilea Ballarini, Pedro; Bellver Vives, Montserrat

2007-01-01

Introducción: El dolor lumbar tiene una alta prevalencia entre los deportistas, se ha relacionado con déficits en la fuerza extensora lumbar, y el hecho de padecerlo representa un obstáculo importante para la práctica de deportes de alta intensidad. Método: Se ha medido la fuerza lumbar en 2 grupos de practicantes de hockey hierba mediante máquina MedX® y un test de resistencia isométrico lumbar. Resultados: Entre ambos grupos los resultados han sido muy homogéneos....

Biomechanical effect of altered lumbar lordosis on intervertebral lumbar joints during the golf swing: a simulation study.

Science.gov (United States)

Bae, Tae Soo; Cho, Woong; Kim, Kwon Hee; Chae, Soo Won

2014-11-01

Although the lumbar spine region is the most common site of injury in golfers, little research has been done on intervertebral loads in relation to the anatomical-morphological differences in the region. This study aimed to examine the biomechanical effects of anatomical-morphological differences in the lumbar lordosis on the lumbar spinal joints during a golf swing. The golf swing motions of ten professional golfers were analyzed. Using a subject-specific 3D musculoskeletal system model, inverse dynamic analyses were performed to compare the intervertebral load, the load on the lumbar spine, and the load in each swing phase. In the intervertebral load, the value was the highest at the L5-S1 and gradually decreased toward the T12. In each lumbar spine model, the load value was the greatest on the kypholordosis (KPL) followed by normal lordosis (NRL), hypolordosis (HPL), and excessive lordosis (EXL) before the impact phase. However, results after the follow-through (FT) phase were shown in reverse order. Finally, the load in each swing phase was greatest during the FT phase in all the lumbar spine models. The findings can be utilized in the training and rehabilitation of golfers to help reduce the risk of injury by considering individual anatomical-morphological characteristics.

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

OpenAIRE

GUO, SHUGUANG; SUN, JUNYING; TANG, GENLIN

2013-01-01

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

[Epidemiology investigation and biomechanics analyses for the correlation between sacroiliac joint disorder and lumbar intervertebral disc degeneration].

Science.gov (United States)

Shi, Ning-Ning; Shen, Guo-Quan; He, Shui-Yong; Guo, Ru-Bao

2014-07-01

To study the correlation between lumber disc degeneration and sacroiliac joint disorder, in order to provides a new understanding concepts and therapeutic approach for the prevention and treatment of chronic intractable low back pain. From August 2009 to October 2010,129 cases with lumbar disc herniation were studied with epidemiological methods. Among them, 61 patients with L4, disc herniation included 37 males and 24 females, ranging in aged from 20 to 75 years old, duration of the disease ranged from 1 to 144 months; The other 68 patients with L5S1 disc herniation included 32 males and 36 females,ranging in aged froml8 to 76 years old,duration of the disease ranged from 0.5 to 240 months. The clinical data, symptoms and signs,X-ray characteristics of lumbar spine and pelvis of the patients were investigated by epidemiological. The risk of lumbar disc herniation was calculated with case-control study; independent variables were screened with single factor analysis; the risk factors for lumbar disc herniation were determined with logistic regression analysis, and biomechanics analyses were taken. Among 129 patients with lumbar disc herniation, 88 cases associated with sacroiliac joint disorders, sacroiliac joint disorder was a risk factor of lumbar disc herniation (OR = 4.61, P = 0.00); 47 cases associated with sacroiliac joint disorders in 61 patients with L4,5 disc herniation, iliac crest uneven caused by iliac rotational displacement was a high risk factor of L4,5 disc herniation (OR = 11.27, P = 0.00); 41 cases associated with sacroiliac joint disorders in 68 patients with L5S1 disc herniation, lumbar sacral angle abnormalities caused by sacral tilt shift was a high risk factor L5S1 disc herniation (OR = 2.31, P = 0.03). Lumbar disc herniation and sacroiliac joint disorder are two of fallot, the two factors affect each other and there is a causal relationship. They are common exists in low back pain.

Postoperative dysesthesia in lumbar three-column resection osteotomies.

Science.gov (United States)

Zhang, Zhengfeng; Wang, Honggang; Zheng, Wenjie

2016-08-01

Three-column lumbar spinal resection osteotomies including pedicle subtraction osteotomy (PSO), vertebral column resection (VCR), and total en bloc spondylectomy (TES) can potentially lead to dorsal root ganglion (DRG) injury which may cause postoperative dysesthesia (POD). The purpose of retrospective study was to describe the uncommon complication of POD in lumbar spinal resection osteotomies. Between January 2009 and December 2013, 64 patients were treated with lumbar three-column spinal resection osteotomies (PSO, n = 31; VCR, n = 29; TES, n = 4) in investigator group. POD was defined as dysesthetic pain or burning dysesthesia at a proper DRG innervated region, whether spontaneous or evoked. Non-steroidal antiinflammatory drugs, central none-opioid analgesic agent, neuropathic pain drugs and/or intervertebral foramen block were selectively used to treat POD. There were 5 cases of POD (5/64, 7.8 %), which consisted of 1 patient in PSO (1/31, 3.2 %), 3 patients in PVCR (3/29, 10.3 %), and 1 patient in TES (1/4, 25 %). After the treatment by drugs administration plus DRG block, all patients presented pain relief with duration from 8 to 38 days. A gradual pain moving to distal end of a proper DRG innervated region was found as the beginning of end. Although POD is a unique and rare complication and maybe misdiagnosed as nerve root injury in lumbar spinal resection osteotomies, combination drug therapy and DRG block have an effective result of pain relief. The appearance of a gradual pain moving to distal end of a proper DRG innervated region during recovering may be used as a sign for the good prognosis.

Posterior Lumbar Subcutaneous Edema on Spine Magnetic Resonance Images: What Is the Cause?

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Han, Ga Jin; Lee, In Sook; Han, In Ho; Lee, Jung Sub [Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of); Moon, Tae Yong [Dept. of Radiology, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of); Song, Jong Woon [Dept. of Radiology, Inje University Haeundae Paik Hospital, Busan (Korea, Republic of)

2013-04-15

Posterior lumbar subcutaneous (PLS) edema on spine magnetic resonance (MR) images is a common incidental, though neglected finding. This study was undertaken to investigate the relations between PLS edema and pathologic conditions. Between January and December 2009, 138 patients with PLS edema, but without a spinal tumor or a history of recent surgery or trauma, and 80 infectious spondylitis patients without PLS edema were enrolled in this retrospective study. Available medical records and lumbar spine MR images were evaluated. The degree of edema was quantified using an arbitrary scoring system. Further, the correlations between the degree of edema and age, sex, body mass index (BMI), degeneration of posterior spinal structures (PSS) and infectious spondylitis were analyzed. Of the 93 cases with a calculable BMI, 61 (66%) had a BMI of > 23 kg/m2. Correlations between the degree of edema and sex, age and BMI grade were all statistically non-significant. Thirty-three cases (24%) had an underlying disease, such as heart problem, diabetes mellitus, liver cirrhosis, chronic renal failure, extra-spinal tumor or connective tissue disorder. The numbers of cases with infectious spondylitis and an idiopathic condition was 61 (44%) and 44 (32%), respectively. The grade of infectious spondylitis was not found to be significantly associated with the degree of edema (p = 0.084). In cases with an idiopathic condition, the correlation between the degree of edema and PSS degeneration was statistically significant (p = 0.042). Radiologists should not disregard PLS edema, because it is related to an underlying disease and thus may be of clinical significance.

Posterior Lumbar Subcutaneous Edema on Spine Magnetic Resonance Images: What Is the Cause?

International Nuclear Information System (INIS)

Han, Ga Jin; Lee, In Sook; Han, In Ho; Lee, Jung Sub; Moon, Tae Yong; Song, Jong Woon

2013-01-01

Posterior lumbar subcutaneous (PLS) edema on spine magnetic resonance (MR) images is a common incidental, though neglected finding. This study was undertaken to investigate the relations between PLS edema and pathologic conditions. Between January and December 2009, 138 patients with PLS edema, but without a spinal tumor or a history of recent surgery or trauma, and 80 infectious spondylitis patients without PLS edema were enrolled in this retrospective study. Available medical records and lumbar spine MR images were evaluated. The degree of edema was quantified using an arbitrary scoring system. Further, the correlations between the degree of edema and age, sex, body mass index (BMI), degeneration of posterior spinal structures (PSS) and infectious spondylitis were analyzed. Of the 93 cases with a calculable BMI, 61 (66%) had a BMI of > 23 kg/m2. Correlations between the degree of edema and sex, age and BMI grade were all statistically non-significant. Thirty-three cases (24%) had an underlying disease, such as heart problem, diabetes mellitus, liver cirrhosis, chronic renal failure, extra-spinal tumor or connective tissue disorder. The numbers of cases with infectious spondylitis and an idiopathic condition was 61 (44%) and 44 (32%), respectively. The grade of infectious spondylitis was not found to be significantly associated with the degree of edema (p = 0.084). In cases with an idiopathic condition, the correlation between the degree of edema and PSS degeneration was statistically significant (p = 0.042). Radiologists should not disregard PLS edema, because it is related to an underlying disease and thus may be of clinical significance.

Diffusion-weighted magnetic resonance imaging of symptomatic nerve root of patients with lumbar disk herniation

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Eguchi, Yawara; Ohtori, Seiji; Yamashita, Masaomi; Yamauchi, Kazuyo; Suzuki, Munetaka; Orita, Sumihisa; Kamoda, Hiroto; Arai, Gen; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Ochiai, Nobuyasu; Kishida, Shunji; Inoue, Gen; Takahashi, Kazuhisa [Chiba University, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba (Japan); Masuda, Yoshitada; Ochi, Shigehiro; Kikawa, Takashi [Chiba University Hospital, Department of Radiology, Chiba (Japan); Toyone, Tomoaki [Teikyo University Chiba Medical Center, Department of Orthopaedic Surgery, Chiba (Japan); Takaso, Masashi [Kitasato University, Department of Orthopaedic Surgery, School of Medicine, Sagamihara City, Kanagawa (Japan); Aoki, Yasuchika [Chiba Rosai Hospital, Department of Orthopedic Surgery, Ichihara, Chiba (Japan)

2011-09-15

Diffusion-weighted imaging (DWI) can provide valuable structural information that may be useful for evaluating pathological changes of the lumbar nerve root. Diffusion-weighted magnetic resonance (MR) neurography has recently been introduced as an alternative way to visualize nerves, but to date, quantitative DWI and MR neurography have not been applied to evaluate the pathology of lumbar nerve roots. Our purpose was to visualize lumbar nerve roots and to analyze their morphology by MR neurography, and to measure the apparent diffusion coefficient (ADC) of lumbar nerve roots compressed by herniated disks using 1.5-T MR imaging. Ten consecutive patients (median age, 48.0 and range, 20-72 years) with monoradicular symptoms caused by a lumbar herniated disk and 14 healthy volunteers were studied. Regions of interests were placed on the lumbar roots at dorsal root ganglia (DRG) and distal spinal nerves on DWI to quantify mean ADC values. The spinal nerve roots were also visualized by MR neurography. In the patients, mean ADC values were significantly greater in the compressed DRG and distal spinal nerves than in intact nerves. MR neurography also showed abnormalities such as nerve swelling at and below the compression in the symptomatic nerve root. Increased ADC values were considered to be because of edema and Wallerian degeneration of compressed nerve roots. DWI is a potential tool for analysis of the pathophysiology of lumbar nerve roots compressed by herniated disks. (orig.)

Diffusion-weighted magnetic resonance imaging of symptomatic nerve root of patients with lumbar disk herniation

International Nuclear Information System (INIS)

Eguchi, Yawara; Ohtori, Seiji; Yamashita, Masaomi; Yamauchi, Kazuyo; Suzuki, Munetaka; Orita, Sumihisa; Kamoda, Hiroto; Arai, Gen; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Ochiai, Nobuyasu; Kishida, Shunji; Inoue, Gen; Takahashi, Kazuhisa; Masuda, Yoshitada; Ochi, Shigehiro; Kikawa, Takashi; Toyone, Tomoaki; Takaso, Masashi; Aoki, Yasuchika

2011-01-01

Diffusion-weighted imaging (DWI) can provide valuable structural information that may be useful for evaluating pathological changes of the lumbar nerve root. Diffusion-weighted magnetic resonance (MR) neurography has recently been introduced as an alternative way to visualize nerves, but to date, quantitative DWI and MR neurography have not been applied to evaluate the pathology of lumbar nerve roots. Our purpose was to visualize lumbar nerve roots and to analyze their morphology by MR neurography, and to measure the apparent diffusion coefficient (ADC) of lumbar nerve roots compressed by herniated disks using 1.5-T MR imaging. Ten consecutive patients (median age, 48.0 and range, 20-72 years) with monoradicular symptoms caused by a lumbar herniated disk and 14 healthy volunteers were studied. Regions of interests were placed on the lumbar roots at dorsal root ganglia (DRG) and distal spinal nerves on DWI to quantify mean ADC values. The spinal nerve roots were also visualized by MR neurography. In the patients, mean ADC values were significantly greater in the compressed DRG and distal spinal nerves than in intact nerves. MR neurography also showed abnormalities such as nerve swelling at and below the compression in the symptomatic nerve root. Increased ADC values were considered to be because of edema and Wallerian degeneration of compressed nerve roots. DWI is a potential tool for analysis of the pathophysiology of lumbar nerve roots compressed by herniated disks. (orig.)

Minimally Invasive Transforaminal Lumbar Interbody Fusion and Unilateral Fixation for Degenerative Lumbar Disease.

Science.gov (United States)

Wang, Hui-Wang; Hu, Yong-Cheng; Wu, Zhan-Yong; Wu, Hua-Rong; Wu, Chun-Fu; Zhang, Lian-Suo; Xu, Wei-Kun; Fan, Hui-Long; Cai, Jin-Sheng; Ma, Jian-Qing

2017-08-01

To evaluate the clinical effect of the minimally invasive transforaminal lumbar interbody fusion combined with posterolateral fusion and unilateral fixation using a tubular retractor in the management of degenerative lumbar disease. A retrospective analysis was conducted to analyze the clinical outcome of 58 degenerative lumbar disease patients who were treated with minimally invasive transforaminal lumbar interbody fusion combined with posterolateral fusion and unilateral fixation during December 2012 to January 2015. The spine was unilaterally approached through a 3.0-cm skin incision centered on the disc space, located 2.5 cm lateral to the midline, and the multifidus muscles and longissimus dorsi were stripped off. After transforaminal lumbar interbody fusion and posterolateral fusion the unilateral pedicle screw fixation was performed. The visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI), and the MacNab score were applied to evaluate clinical effects. The operation time, peri-operative bleeding, postoperative time in bed, hospitalization costs, and the change in the intervertebral height were analyzed. Radiological fusion based on the Bridwell grading system was also assessed at the last follow-up. The quality of life of the patients before and after the operation was assessed using the short form-36 scale (SF-36). Fifty-eight operations were successfully performed, and no nerve root injury or dural tear occurred. The average operation time was 138 ± 33 min, intraoperative blood loss was 126 ± 50 mL, the duration from surgery to getting out of bed was 46 ± 8 h, and hospitalization cost was 1.6 ± 0.2 ten thousand yuan. All of the 58 patients were followed up for 7-31 months, with an average of 14.6 months. The postoperative VAS scores and ODI score were significantly improved compared with preoperative data (P degenerative lumbar disease, and the short-term clinical outcome is satisfactory

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

International Nuclear Information System (INIS)

Kido, Kenji; Kawai, Shinya; Oda, Hirotane; Saika, Minoru; Uminaga, Yasuo; Takano, Shinichi; Akiho, Yasushi

1986-01-01

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

[Renal angiomyolipoma rupture as a cause of lumbar pain: report of one case].

Science.gov (United States)

Cifuentes, Melissa; Calleja, Félix; Hola, José; Daviú, Antonio; Jara, Danilo; Vallejos, Humberto

2008-08-01

Renal angiomyolipoma is a benign tumor formed by smooth muscle, adipose tissue and blood vessels. It is commonly found incidentally and its clinical manifestations are pain and abdominal mass or spontaneous tumor rupture with retroperitoneal bleeding. The clinical presentation of a hemorrhagic shock secondary to a retroperitoneal hematoma is uncommon. We report a 40 year-old male who presented to the emergency room with lumbar pain and deterioration of hemodynamic parameters. The CT scan showed a left renal injury associated to an expansive retroperitoneal process. The abdominal exploration, vascular control of the renal pedicle and nephrectomy allowed a successful outcome.

Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery.

Science.gov (United States)

van Helvoirt, Hans; Apeldoorn, Adri T; Knol, Dirk L; Arts, Mark P; Kamper, Steven J; van Tulder, Maurits W; Ostelo, Raymond W

2016-04-27

Prospective cohort study. Although lumbar radiculopathy is regarded as a specific diagnosis, the most effective treatment strategy is unclear. Commonly used treatments include transforaminal epidural steroid injections (TESIs) and Mechanical Diagnosis & Therapy (MDT), but no studies have investigated the effectiveness of this combination. MDT differentiates pain centralization (C) from non-centralization (NC), which indicates good vs. poor prognostic validity respectively. The main aims were 1) to determine changes in Mechanical Diagnosis and Therapy (MDT) pain response classifications after transforaminal epidural steroid injections (TESIs) in candidates for lumbar herniated disc surgery and 2) to evaluate differences in short and long term outcomes for patients with different pain response classifications. Candidates for lumbar herniated disc surgery were assessed with a MDT protocol and their pain response classified as centralizing or peripheralizing. For this study,only patients were eligible who showed a peripheralizing pain response at intake. All patients then received TESIs and were reassessed and classified using the MDT protocol, into groups according to pain response (resolved, centralizing, peripheralizing with less pain and peripheralising with severe pain). After receiving targeted treatment based on pain response after TESIs, ranging from advice, MDT or surgery, follow-up assessments were completed at discharge and at 12 months. The primary outcomes were disability (Roland-Morris Disability Questionnaire [RMDQ] for Sciatica), pain severity in leg (visual analogue scale [VAS], 0-100) and global perceived effect (GPE). Linear mixed-models were used to determine between-groups differences in outcome. A total of 77 patients with lumbar disc herniation and peripheralizing symptoms were included. Patients received an average of 2 (SD 0.7) TESIs. After TESIs, 17 patients (22%) were classified as peripheralizing with continuing severe pain.These patients

Adjacent segment disease in degenerative pathologies with posterior instrumentation

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Ana Guadalupe Ramírez Olvera

2015-03-01

Full Text Available OBJECTIVE: To establish the real incidence of adjacent segment disease after fusion, and to identify the levels and predisposing factors for the pathology, as well as the functional results. METHODS: a retrospective case series study with level of evidence IIB, in a sample of 179 patients diagnosed with stenosis of the lumbar spine, spondylolisthesis and degenerative scoliosis, submitted to surgery in the period 2005 to December 2013, with posterior instrumentation and posterolateral fusion, with follow-up from 2007 until May 2014, in which the symptomology and radiographic findings were evaluated, to establish the diagnosis and treatment. RESULTS: the study included 179 patients diagnosed with stenosis of the lumbar spine (n=116, isthmic and degenerative spondylolisthesis (n=50 and degenerative scoliosis (n=13; during the study, 20 cases of adjacent level segment were identified, 80% of which were treated surgically with extension of the instrumentation, while 20% were treated conservatively with NSAIDs and therapeutic blocks. CONCLUSION: An incidence of 11% was found, with an average of 3.25 years in diagnosis and treatment, a prevalence of females and diagnosis of stenosis of the lumbar canal on posterior instrumentation, a predominance of levels L4-L5; 80% were treated with extension of the instrumentation. The complications were persistent radiculopathy, infection of the surgical wound, and one death due to causes not related to the lumbar pathology.

Remote cerebellar hemorrhage after lumbar spinal surgery

International Nuclear Information System (INIS)

Cevik, Belma; Kirbas, Ismail; Cakir, Banu; Akin, Kayihan; Teksam, Mehmet

2009-01-01

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

Lumbar dorsal ramus syndrome.

Science.gov (United States)

Bogduk, N

1980-11-15

Low back pain, referred pain in the lower limbs, and spasm of the back, gluteal, and hamstring muscles are clinical features which can be induced in normal volunteers by stimulating structures which are innervated by the lumbar dorsal rami. Conversely, they can be relieved in certain patients by selective interruption of conduction along dorsal rami. These facts permit the definition of a lumbar dorsal ramus syndrome, which can be distinguished from the intervertebral disc syndrome and other forms of low back pain. The distinguishing feature is that, in lumbar dorsal ramus syndrome, all the clinical features are exclusively mediated by dorsal rami and do not arise from nerve-root compression. The pathophysiology, pathology, and treatment of this syndrome are described. Recognition of this syndrome, and its treatment with relatively minor procedures, can obviate the need for major surgery which might otherwise be undertaken.

Manejo del síndrome doloroso lumbar Management of lumbar syndrome

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Rafael Rivas Hernández

2010-03-01

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

Radiographical analysis concernig the etiology of degenerative spondylolisthesis of the lumbar spine

Energy Technology Data Exchange (ETDEWEB)

Ihara, Koichiro (Yamaguchi Univ., Ube (Japan). School of Medicine)

1989-12-01

The purpose of this article is to evaluate radiographically degenerative spondylolisthesis of the lumbar spine, with the main focus on the configuration of posterior elements. A comparative study between 49 cases of degenerative spondylolisthesis and 99 cases of other lumbar disorders was performed, using 13 radiographical parameters. The results clearly indicate the posterior elements of degenerative spondylolisthesis shifted horizontally and sagittally to allow slipping. This was due to the weak bony hook mechanism. Furthermore, almost all facet joints were morphologically classified as sagittal or intermediate type. Another meaningful difference was the alignment of the lumbar spine which showed an increase in both lordosis and lumbosacral angle. On the other hand, the level of Jacoby's line was almost the same in both groups. These characteristic configurations could be the cause of listhesis, although further study should be carried out to elucidate whether they are present at the non-listhetic stage. (author).

The activL® Artificial Disc: a next-generation motion-preserving implant for chronic lumbar discogenic pain

Directory of Open Access Journals (Sweden)

Yue JJ

2016-05-01

Full Text Available James J Yue,1 Rolando Garcia Jr,2 Larry E Miller3 1Department of Orthopaedic Surgery, Yale School of Medicine, New Haven, CT, 2Orthopedic Care Center, Miami, FL, 3Miller Scientific Consulting, Inc., Asheville, NC, USA Abstract: Degeneration of the lumbar intervertebral discs is a leading cause of chronic low back pain in adults. Treatment options for patients with chronic lumbar discogenic pain unresponsive to conservative management include total disc replacement (TDR or lumbar fusion. Until recently, only two lumbar TDRs had been approved by the US Food and Drug Administration - the Charité Artificial Disc in 2004 and the ProDisc-L Total Disc Replacement in 2006. In June 2015, a next-generation lumbar TDR received Food and Drug Administration approval - the activL® Artificial Disc (Aesculap Implant Systems. Compared to previous-generation lumbar TDRs, the activL® Artificial Disc incorporates specific design enhancements that result in a more precise anatomical match and allow a range of motion that better mimics the healthy spine. The results of mechanical and clinical studies demonstrate that the activL® Artificial Disc results in improved mechanical and clinical outcomes versus earlier-generation artificial discs and compares favorably to lumbar fusion. The purpose of this report is to describe the activL® Artificial Disc including implant characteristics, intended use, surgical technique, postoperative care, mechanical testing, and clinical experience to date. Keywords: activL® Artificial Disc, artificial disc, degenerative disc disease, discogenic, implant, lumbar, motion preservation, pain

Sensitivity of lumbar spine loading to anatomical parameters

DEFF Research Database (Denmark)

Putzer, Michael; Ehrlich, Ingo; Rasmussen, John

2016-01-01

Musculoskeletal simulations of lumbar spine loading rely on a geometrical representation of the anatomy. However, this data has an inherent inaccuracy. This study evaluates the in uence of dened geometrical parameters on lumbar spine loading utilizing ve parametrized musculoskeletal lumbar spine ...... lumbar spine model for a subject-specic approach with respect to bone geometry. Furthermore, degeneration processes could lead to computational problems and it is advised that stiffness properties of discs and ligaments should be individualized....

49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

Science.gov (United States)

2010-10-01

...-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section..., the lumbar spine assembly shall flex by an amount that permits the rigid thoracic spine to rotate from...

The reasons for delay lumbar puncture

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MH. Lotfi

2017-04-01

Full Text Available Early diagnosis of meningitis and encephalitis and prompt initiation of appropriate therapy is vital and any delay will lead to high mortality and serious and permanent morbidity. The main purpose of this study was to evaluate the management of 220 patients with suspected central nervous system (CNS infections (meningitis and encephalitis to determine the percentage of patients’ suspected CNS infection undergo lumbar puncture in acceptable time (in accordance with conventional algorithms. In this descriptive study, patients with suspected CNS infections admitted to Bu-Ali and Qods hospitals, in the period July 2013 to December 2015 were studied. Information of 220 patients was collected. Continuous variables were summarized as means ± standard deviation and categorical variables as frequencies and percentages. Lumbar puncture (LP in patients was delayed in 200 cases (91%. Most common causes of delay in performing LP were prolongation of the process of determining patient needs to puncture, satisfying patients, CT scan delay and the delay in allowing LP by neurologist. In this study, delaying LP rate was higher than other studies. It seems certain pattern in assistants’ visits for counseling. CT requests and neurologic consultation before LP performed for all adult patients.

Lumbar spondylolysis in the adolescent athlete.

Science.gov (United States)

Lawrence, Kevin J; Elser, Tim; Stromberg, Ryan

2016-07-01

Spondylolysis is a common occurrence for adolescent athletes who have low back pain. The injury involves a defect in the pars interarticularis, occurring as a result of repeated hyperextension and rotation. Clinical findings might include tightness of the hip flexors and hamstrings, weakness of the abdominals and gluteals, and an excessive lordotic posture. The validity of several clinical tests were compared alongside magnetic resonance imaging, but were not able to distinguish spondylolysis from other causes of low back pain. Medical referral should be arranged so that medical imaging and diagnostic testing can be completed to insure a proper diagnosis. Initial intervention includes rest from sport, which may vary from 2 weeks to 6 months. Bracing is also used to help minimize lumbar lordosis and lumbar extension. Exercises that focus on stabilization and spine neutral position should be incorporated in physical therapy intervention. Avoiding end ranges is important while performing exercises to minimize the translational and rotational stresses on the spine. Surgical interventions have also been recommended for athletes who have had persistent low back pain for more than six months with no relief from rest and bracing. Copyright © 2016 Elsevier Ltd. All rights reserved.

Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain.

NARCIS (Netherlands)

Windt, D.A.W.M. van der; Simons, E.; Riphagen, I.I.; Ammendolia, C.; Verhangen, A.P.; Laslett, M.; Devillé, W.; Deyo, R.A.; Bouter, L.M.; Vet, H.C.W. de; Aertgeerts, B.

2010-01-01

Background: Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care

Lumbar Vertebral Canal Diameters in Adult Ugandan Skeletons ...

African Journals Online (AJOL)

Background: Normal values of lumbar vertebral canal diameters are useful in facilitating diagnosis of lumbar vertebral canal stenosis. Various studies have established variation on values between different populations, gender, age, and ethnic groups. Objectives: To determine the lumbar vertebral canal diameters in adult ...

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

OpenAIRE

Bogduk, N

1980-01-01

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

Assessment of lumbar spinal canal stenosis by magnetic resonance phlebography

International Nuclear Information System (INIS)

Manaka, Masakazu; Komagata, Masashi; Endo, Kenji; Imakiire, Atsuhiro

2003-01-01

There is evidence to suggest that cauda equina intermittent claudication is caused by local circulatory disturbances in the cauda equina as well as compression of the cauda equina. We evaluated the role of magnetic resonance phlebography (MRP) in identifying circulatory disturbances of the vertebral venous system in patients with lumbar spinal canal stenosis. Extensive filling defects of the anterior internal vertebral venous plexus were evident in patients with lumbar spinal canal stenosis (n=53), whereas only milder abnormalities were noted in patients with other lumber diseases (n=16) and none in normal subjects (n=13). The extent of the defect on MRP correlated with the time at which intermittent claudication appeared. In patients with lumber spinal canal stenosis, extensive defects of the internal vertebral venous plexus on MRP were noted in the neutral spine position, but the defect diminished with anterior flexion of the spine. This phenomenon correlated closely with the time at which intermittent claudication appeared. Our results highlight the importance of MRP for assessing the underlying mechanism of cauda equina intermittent claudication in patients with lumbar spinal canal stenosis and suggest that congestive venous ischemia is involved in the development of intermittent claudication in these patients. (author)

The shape of the human lumbar vertebral canal

OpenAIRE

Zarzur,Edmundo

1996-01-01

Literature on the anatomy of the human vertebral column characterizes the shape of the lumbar vertebral canal as triangular. The purpose of the present study was to determine the precise shape of the lumbar vertebral canal. Ten lumbar vertebral columns of adult male cadavers were dissected. Two transverse sections were performed in the third lumbar vertebra. One section was performed at the level of the lower border of the ligamenta flava, and the other section was performed at the level of t...

Computed Tomography of the lumbar facet joints

International Nuclear Information System (INIS)

Choi, Mi Ryoung; Kim, Yung Soon; Lee, Joo Hyuk; Jeon, Hae Sang; Kim, Dae Yung

1989-01-01

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

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

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Friedly Janna L

2012-03-01

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

REHABILITATION THERAPY VERSUS DRUG THERAPY IN PATIENTS WITH LUMBAR DISC DEGENERATION

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BROSCATEAN, Emanuela-Flavia

2013-12-01

Full Text Available Lumbar disc degeneration is a disorder whose clinical manifestations are represented by episodic pain in the lumbar spine, without lumbar blockage and minor muscle contraction. Because lumbalgia caused by lumbar disc degeneration is not always very high intensity pain, the easiest to apply treatment is drug therapy. The aim of this study was to analyze the potential role of rehabilitation treatment in the recovery of patients and the prevention of complications compared to drug therapy alone. The study included 28 patients (17 women and 11 men aged between 23-60 years, assigned to two groups: 20 patients who received rehabilitation treatment (consisting of massage, kinesiotherapy, hydrokinesiotherapy, electrotherapy and medication and 8 patients who received drug treatment consisting of anti-inflammatory and analgesic drugs. The treatment duration was 10 days. For the evaluation of pain, the visual analogue scale was used, for the degree of disability, the Oswestry questionnaire, and for joint mobility and muscle strength, articular and muscular testing. At the end of treatment, the study group compared to the control group had a statistically significant result for pain (p=0.001, as well as for the Oswestry score (p=0.030. The mean age of the patients was 35.51±3.026, which shows an increased incidence among young adults. A possible connection between the development of the disease in women and age less than 45 years was also investigated, but the result was not statistically significant, p=0.22. Our data suggest the fact that rehabilitation treatment plays an important role in the reduction of pain and the improvement of the quality of life of patients with lumbar disc degeneration by decreasing the degree of disability. In the future, it can be proposed to monitor patients with lumbar disc degeneration over a longer time period in order to see the effects of kinetic rehabilitation programs in relation to the delay of chronicization. As

Adaptation of muscles of the lumbar spine to sudden imbalance in patients with lower back pain caused by military training.

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Gao, Ying; Shi, Jian-guo; Ye, Hong; Liu, Zhi-rong; Zheng, Long-bao; Ni, Zhi-ming; Fan, Liang-quan; Wang, Jian; Hou, Zhen-hai

2014-11-01

This study aims to investigate the effects of sudden load changes (expected and unexpected imbalance) on the activity of muscles of the lumbar spine and their central motor control strategy in military personnel with or without chronic low back pain (LBP). Bilateral sudden imbalance was examined (2 × 2 factorial design). The 117th PLA Hospital, Hangzhou, China Twenty-one male subjects with lower back pain and 21 male healthy control subjects were active members of the Nanjing Military Region land forces. Independent variables: LBP vs. healthy controls and imbalance anticipation (expected and unexpected imbalance). rapid reaction time (RRT) and intensity of rapid reaction (IRR) of bilateral lumbar (L3-L4) erector spinae (ES), lumbar (L5-S1) multifidus (MF), and abdominal external oblique muscles. Results Under expected or unexpected sudden imbalance conditions, subjects with LBP demonstrated significantly greater IRR than healthy controls in ipsilateral and contralateral ES and MF, respectively (P imbalance prolonged RRT of selected trunk muscles in patients with chronic LBP. The activation amplitude increased. The results may provide a theoretical basis for a study on the pathogenesis of chronic LBP.

Lumbar myelography with iohexol

International Nuclear Information System (INIS)

Nestvold, K.; Sortland, O.

1988-01-01

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

Idiopathic and normal lateral lumbar curves: muscle effects interpreted by 12th rib length asymmetry with pathomechanic implications for lumbar idiopathic scoliosis

Directory of Open Access Journals (Sweden)

Theodoros B. Grivas

2016-10-01

congenitally lengthened, induced mechanically, or both. Several small muscles are attached to the 12th ribs. We focus attention here on the largest of these muscles namely, QL. It has attachments to the pelvis, 12th ribs and transverse processes of lumbar vertebrae as origins and as insertions. Given increased muscle activity on the lumbar curve convexity and similar to the interpretations of earlier workers outlined above, we suggest two hypotheses, relatively increased activity of the right QL muscle causes the LLCs (first hypothesis; or counteracts the lumbar curvature as part of the body’s attempt to compensate for the curvature (second hypothesis. These hypotheses may be tested by electrical stimulation studies of QL muscles in subjects with lumbar IS by revealing respectively curve worsening or correction. We suggest that one mechanism leading to relatively increased length of the right 12 ribs is mechanotransduction in accordance with Wolff’s and Pauwels Laws.

PARAMETRIC MODEL OF LUMBAR VERTEBRA

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CAPPETTI Nicola

2010-11-01

Full Text Available The present work proposes the realization of a parametric/variational CAD model of a normotype lumbar vertebra, which could be used for improving the effectiveness of actual imaging techniques in informational augmentation of the orthopaedic and traumatological diagnosis. In addition it could be used for ergonomic static and dynamical analysis of the lumbar region and vertebral column.

Clinical evaluation and surgical decision making for patients with lumbar discogenic pain and facet syndrome

International Nuclear Information System (INIS)

Tessitore, Enrico; Molliqaj, Granit; Schatlo, Bawarjan; Schaller, Karl

2015-01-01

In industrialized countries, more than two thirds of the population suffers from low back pain (LBP) in their lifetime. LBP associated with lumbar disc herniation, stenosis, and instability is a well-known and documented entity. On the other hand, the lumbar discogenic pain and facet syndrome are difficult to be clearly identified, and they are not always detectable by imaging. This article describes the causes of these painful syndromes, which are typically without radicular component, explains the modern diagnostic procedures, and provides guidelines for surgical decision making

Clinical evaluation and surgical decision making for patients with lumbar discogenic pain and facet syndrome

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Tessitore, Enrico, E-mail: enrico.tessitore@hcuge.ch [Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva (Switzerland); Molliqaj, Granit, E-mail: granitmolliqaj@gmail.com [Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva (Switzerland); Schatlo, Bawarjan, E-mail: schatlo@gmail.com [Department of Neurosurgery, Georg-August University, University of Medicine Gottingen, 37075 Gottingen (Germany); Schaller, Karl, E-mail: karl.schaller@hcuge.ch [Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva (Switzerland)

2015-05-15

In industrialized countries, more than two thirds of the population suffers from low back pain (LBP) in their lifetime. LBP associated with lumbar disc herniation, stenosis, and instability is a well-known and documented entity. On the other hand, the lumbar discogenic pain and facet syndrome are difficult to be clearly identified, and they are not always detectable by imaging. This article describes the causes of these painful syndromes, which are typically without radicular component, explains the modern diagnostic procedures, and provides guidelines for surgical decision making.

Comparison Between Posterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases: A Systematic Review and Meta-Analysis.

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Lan, Tao; Hu, Shi-Yu; Zhang, Yuan-Tao; Zheng, Yu-Chen; Zhang, Rui; Shen, Zhe; Yang, Xin-Jian

2018-04-01

To compare the efficacy and safety in the management of lumbar diseases performed by either posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). Interbody fusion is considered the "gold standard" in the treatment of lumbar degenerative diseases. Both PLIF and TLIF have been advocated, and it remains controversial as to the best operative technique. The electronic databases including Embase, PubMed, and Cochrane library were searched to identify relevant studies up to September 2017. The primary outcomes were fusion rate, complications, and clinical satisfaction. The secondary outcomes were length of hospitalization, operation time, blood loss, postoperative visual analog scale, Oswestry Disability Index, and Japanese Orthopaedic Association Score. Data analysis was conducted with RevMan 5.3 software. A total of 16 studies involving 1502 patients (805 patients in PLIF group and 697 in TLIF group) were included in the meta-analysis. The pooled analysis showed that there was no significant difference in terms of fusion rate (P > 0.05) and clinical satisfaction (P > 0.05) between the 2 groups. TLIF was superior to PLIF with significantly lower incidence of nerve root injury (P 0.05) and graft malposition (P > 0.05). PLIF required significant longer operation time (P degenerative lumbar diseases. However, TLIF was superior to PLIF with shorter operation time, less blood loss, and lower incidence of nerve root injury and dural tear. There is no significant difference between both groups regarding wound infection and graft malposition. Copyright © 2018 Elsevier Inc. All rights reserved.

Monoradiculopathy and secondary segmental instability caused by postoperative pars interarticularis fracture: a case report.

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Kaner, Tuncay; Tutkan, Ibrahim

2009-04-01

Instability can develop after lumbar spinal surgery. What is also known as secondary segmental instability is one of the important causes of failed back syndrome. In this paper, we described a 45-year-old female patient who was diagnosed with secondary segmental instability caused by left L3 pars interarticularis fracture after a high lumbar disc surgery and was subsequently treated with re-operation. We evaluated the clinical course, diagnosis, and treatment methods for secondary segmental instability caused by postoperative pars interarticularis fracture. Furthermore, we emphasized the importance of preserving the pars interarticularis during upper lumbar disc surgeries in order to avoid a potential stress fracture.

Facetal distraction as treatment for single- and multilevel cervical spondylotic radiculopathy and myelopathy: a preliminary report.

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Goel, Atul; Shah, Abhidha

2011-06-01

The authors discuss their successful preliminary experience with 36 cases of cervical spondylotic disease by performing facetal distraction using specially designed Goel cervical facet spacers. The clinical and radiological results of treatment are analyzed. The mechanism of action of the proposed spacers and the rationale for their use are evaluated. Between 2006 and February 2010, 36 patients were treated using the proposed technique. Of these patients, 18 had multilevel and 18 had single-level cervical spondylotic radiculopathy and/or myelopathy. The average follow-up period was 17 months with a minimum of 6 months. The Japanese Orthopaedic Association classification system, visual analog scale (neck pain and radiculopathy), and Odom criteria were used to monitor the clinical status of the patient. The patients were prospectively analyzed. The technique of surgery involved wide opening of the facet joints, denuding of articular cartilage, distraction of facets, and forced impaction of Goel cervical facet spacers into the articular cavity. Additionally, the interspinous process ligaments were resected, and corticocancellous bone graft from the iliac crest was placed and was stabilized over the adjoining laminae and facets after adequately preparing the host bone. Eighteen patients underwent single-level, 6 patients underwent 2-level, and 12 patients underwent 3-level treatment. The alterations in the physical architecture of spine and canal dimensions were evaluated before and after the placement of intrafacet joint spacers and after at least 6 months of follow-up. All patients had varying degrees of relief from symptoms of pain, radiculopathy, and myelopathy. Analysis of radiological features suggested that the distraction of facets with the spacers resulted in an increase in the intervertebral foraminal dimension (mean 2.2 mm), an increase in the height of the intervertebral disc space (range 0.4-1.2 mm), and an increase in the interspinous distance (mean 2

L5 radiculopathy due to sacral stress fracture

International Nuclear Information System (INIS)

Aylwin, Anthony; Saifuddin, Asif; Tucker, Stuart

2003-01-01

We report the case of a 70-year-old man who presented with a history of left buttock pain with radiation into the left leg in an L5 distribution. MRI of the lumbar spine revealed a left sacral stress fracture with periosteal reaction involving the left L5 nerve root anterior to the sacral ala. With spontaneous healing of the fracture, the patient's symptoms resolved completely. (orig.)

Management of Lumbar Conditions in the Elite Athlete.

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Hsu, Wellington K; Jenkins, Tyler James

2017-07-01

Lumbar disk herniation, degenerative disk disease, and spondylolysis are the most prevalent lumbar conditions that result in missed playing time. Lumbar disk herniation has a good prognosis. After recovery from injury, professional athletes return to play 82% of the time. Surgical management of lumbar disk herniation has been shown to be a viable option in athletes in whom nonsurgical measures have failed. Degenerative disk disease is predominately genetic but may be accelerated in athletes secondary to increased physiologic loading. Nonsurgical management is the standard of care for lumbar degenerative disk disease in the elite athlete. Spondylolysis is more common in adolescent athletes with back pain than in adult athletes. Nonsurgical management of spondylolysis is typically successful. However, if surgery is required, fusion or direct pars repair can allow the patient to return to sports.

Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

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ICHINOSE, Daisuke; TOCHIGI, Satoru; TANAKA, Toshihide; SUZUKI, Tomoya; TAKEI, Jun; HATANO, Keisuke; KAJIWARA, Ikki; MARUYAMA, Fumiaki; SAKAMOTO, Hiroki; HASEGAWA, Yuzuru; TANI, Satoshi; MURAYAMA, Yuichi

2018-01-01

A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy. PMID:29479039

Lumbar spondylolysis: A report of four cases from two generations of a family.

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Yurube, Takashi; Kakutani, Kenichiro; Okamoto, Koji; Manabe, Michihiko; Maeno, Koichiro; Yoshikawa, Masaho; Sha, Norihide; Kuroda, Ryosuke; Nishida, Kotaro

2017-01-01

Spondylolysis is a major cause of back pain in children and adolescents. The prevalence of spondylolysis depends on the sex, race, and congenital abnormality. These biases suggest hereditary predisposition as an etiology of spondylolysis. However, no conclusive evidence still exists regarding the inheritance for spondylolysis. Herein, we report rare cases with familial occurrence of lumbar spondylolysis. In two generations of a Japanese family, three brothers including identical twins complained of back pain related to sports activities. Clinical, radiographic, and computed tomographic examinations identified spondylolysis at L4 and L5 in all these boys. The father experienced long-term back pain and had spondylolisthesis at L4-L5 and healed spondylolysis at L5. The daughter and mother did not show any lumbar spondylolysis. The frequent development of spondylolysis at L4, a rarely affected segment, in four of six family members (66.7%) support that lumbar spondylolysis has an underlying genetic etiology, primarily autosomal dominant inheritance.

Preliminary experience with lumbar facet distraction and fixation as treatment for lumbar spinal stenosis

OpenAIRE

Grasso, Giovanni; Landi, Alessandro

2017-01-01

Objectives: To assess the properties of facet fixation with the Facet Wedge system in patients affected by lumbar spinal stenosis (LSS). Summary of Background Data: Implant of intra-articular spacers is an emerging technique for lumbar degenerative disease. Methods: This study included forty patients (Group 1) with symptomatic LSS in whom intra-articular spacers have been implanted along with microdecompression (MD) of the neural structures. Group 1 has been compared with a homogeneous ...

Clinical effect of acupuncture on cervical spondylotic radiculopathy: results of a case series.

Science.gov (United States)

Nakajima, Miwa; Inoue, Motohiro; Itoi, Megumi; Kitakoji, Hiroshi

2013-12-01

To observe the effectiveness of acupuncture applied to the cervical region of patients with upper extremity radicular symptoms due to cervical spondylotic radiculopathy (CSR). 15 subjects diagnosed with CSR and with upper extremity pain and/or paraesthesiae for 13.1±18.0 months were selected. The 15 patients had 16 affected limbs and scored a total of 17 symptom scores of pain and/or paraesthesiae. All patients were treated with acupuncture once a week for 4 weeks at up to 10 sites in the cervical paraspinal region centred on the affected area. The severity of the symptoms was recorded using a visual analogue scale (VAS) and functional evaluation was conducted using a Neck Disability Index (NDI). A significant reduction over time was seen for both mean VAS (pCSR.

Effect of Lumbar Disc Degeneration and Low-Back Pain on the Lumbar Lordosis in Supine and Standing

DEFF Research Database (Denmark)

Hansen, Bjarke B; Bendix, Tom; Grindsted, Jacob

2015-01-01

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To examine the influence of low-back pain (LBP) and lumbar disc degeneration (LDD) on the lumbar lordosis in weight-bearing positional magnetic resonance imaging (pMRI). SUMMARY OF BACKGROUND DATA: The lumbar lordosis increases with a change...... of position from supine to standing and is known as an essential contributor to dynamic changes. However, the lordosis may be affected by disc degeneration and pain. METHODS: Patients with LBP >40 on a 0 to 100 mm Visual Analog Scale (VAS) both during activity and rest and a sex and age-decade matching...... control group without LBP were scanned in the supine and standing position in a 0.25-T open MRI unit. LDD was graded using Pfirrmann's grading-scale. Subsequently, the L2-to-S1 lumbar lordosis angle (LA) was measured. RESULTS: Thirty-eight patients with an average VAS of 58 (±13.8) mm during rest and 75...

Ipsilateral atrophy of the psoas major muscle in patients with lumbar disc herniation

International Nuclear Information System (INIS)

Makino, Takahiro; Hosono, Noboru; Mukai, Yoshihiro; Miwa, Toshitada; Fuji, Takeshi

2009-01-01

We measured the cross-sectional area (CSA) of the psoas major muscles of 48 male patients under 50 years of age with unilateral sciatica caused by a single-level lumbar disc herniation. Patients who had multi-level disc lesions, lumbar canal stenosis, spondylolisthesis, scoliosis>5deg, or a history of lumbar surgery or hip joint disease were excluded. Mean age at surgery was 33 years old. Two orthopedic surgeons measured the CSA independently and blindly on magnetic resonance images in which the spinal canal had been blacked out. The CSA ratio (pain-positive side/pain-negative side) was 0.99 at L3/4, 0.98 at L4/5, and 1.00 at L5/S. There was a statistically significant difference between the CSA of the psoas major muscle on the painful side and the unaffected side at L4/5 (p=0.02). There was no correlation between the CSA ratio and the angle in the straight leg raising test, the duration of symptoms, or the size of the disc herniation. The atrophy of the psoas major muscle observed on the pain-positive side in lumbar disc herniation patients may be attributable to disuse of the affected leg. (author)

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

OpenAIRE

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...

Retroperitoneal hemorrhage from an unrecognized puncture of the lumbar right segmental artery during lumbar chemical sympathectomy: diagnosis and management.

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Shin, Ho-Jin; Choi, Yun-Mi; Kim, Hye-Jin; Lee, Sun-Jae; Yoon, Seok-Hyun; Kim, Kyung-Hoon

2014-12-01

Lumbar chemical sympathectomy has been performed using fluoroscopic guidance for needle positioning. An 84 year old woman with atherosclerosis obliterans was referred to the pain clinic for intractable cold allodynia of her right foot. A thermogram showed decreased temperature of both feet compared with temperatures above both ankles. The patient agreed to undergo lumbar chemical sympathectomy using fluoroscopy after being informed of the associated risks of nerve injury, hemorrhage, infection, transient back pain, and transient hypotension. During the procedure and three hours afterward, no abnormal signs or symptoms were found except an increase in right leg temperature. The patient was ambulatory after the procedure. However, one day after undergoing lumbar chemical sympathectomy, she visited our emergency department for abdominal discomfort and postural dizziness. Her blood pressure was 80/50 mmHg, and flank tenderness was noted. Retroperitoneal hemorrhage from the second right lumbar segmental artery was shown on computed tomography and angiography. Vital signs were stabilized immediately after embolization into the right lumbar segmental artery. Copyright © 2014 Elsevier Inc. All rights reserved.

Radiographic Results of Single Level Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease: Focusing on Changes of Segmental Lordosis in Fusion Segment

OpenAIRE

Kim, Sang-Bum; Jeon, Taek-Soo; Heo, Youn-Moo; Lee, Woo-Suk; Yi, Jin-Woong; Kim, Tae-Kyun; Hwang, Cheol-Mog

2009-01-01

Background To assess the radiographic results in patients who underwent transforaminal lumbar interbody fusion (TLIF), particularly the changes in segmental lordosis in the fusion segment, whole lumbar lordosis and disc height. Methods Twenty six cases of single-level TLIF in degenerative lumbar diseases were analyzed. The changes in segmental lordosis, whole lumbar lordosis, and disc height were evaluated before surgery, after surgery and at the final follow-up. Results The segmental lordosi...

Clinical evaluation of an allogeneic bone matrix containing viable osteogenic cells in patients undergoing one- and two-level posterolateral lumbar arthrodesis with decompressive laminectomy.

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Musante, David B; Firtha, Michael E; Atkinson, Brent L; Hahn, Rebekah; Ryaby, James T; Linovitz, Raymond J

2016-05-27

Trinity Evolution® cellular bone allograft (TE) possesses the osteogenic, osteoinductive, and osteoconductive elements essential for bone healing. The purpose of this study is to evaluate the radiographic and clinical outcomes when TE is used as a graft extender in combination with locally derived bone in one- and two-level instrumented lumbar posterolateral arthrodeses. In this retrospective evaluation, a consecutive series of subject charts that had posterolateral arthrodesis with TE and a 12-month radiographic follow-up were evaluated. All subjects were diagnosed with degenerative disc disease, radiculopathy, stenosis, and decreased disc height. At 2 weeks and at 3 and 12 months, plain radiographs were performed and the subject's back and leg pain (VAS) was recorded. An evaluation of fusion status was performed at 12 months. The population consisted of 43 subjects and 47 arthrodeses. At 12 months, a fusion rate of 90.7 % of subjects and 89.4 % of surgical levels was observed. High-risk subjects (e.g., diabetes, tobacco use, etc.) had fusion rates comparable to normal patients. Compared with the preoperative leg or back pain level, the postoperative pain levels were significantly (p < 0.0001) improved at every time point. There were no adverse events attributable to TE. Fusion rates using TE were higher than or comparable to fusion rates with autologous iliac crest bone graft that have been reported in the recent literature for posterolateral fusion procedures, and TE fusion rates were not adversely affected by several high-risk patient factors. The positive results provide confidence that TE can safely replace autologous iliac crest bone graft when used as a bone graft extender in combination with locally derived bone in the setting of posterolateral lumbar arthrodesis in patients with or without risk factors for compromised bone healing. Because of the retrospective nature of this study, the trial was not registered.

Influences of posterior-located center of gravity on lumbar extension strength, balance, and lumbar lordosis in chronic low back pain.

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Kim, Dae-Hun; Park, Jin-Kyu; Jeong, Myeong-Kyun

2014-01-01

In patients with chronic low back pain, the center of gravity (COG) is abnormally located posterior to the center in most cases. The purpose of this study was to examine the effects of posterior-located COG on the functions (lumbar extension strength, and static and dynamic balance) and structure (lumbar lordosis angle and lumbosacral angle) of the lumbar spine. In this study, the COG of chronic low back pain patients who complained of only low back pain were examined using dynamic body balance equipment. A total of 164 subjects participated in the study (74 males and 90 females), and they were divided into two groups of 82 patients each. One group (n=82) consisted of patients whose COG was located at the center (C-COG); the other group (n=82) consisted of patients whose COG was located posterior to the center (P-COG). The following measures assessed the lumber functions and structures of the two groups: lumbar extension strength, moving speed of static and dynamic COGs, movement distance of the static and dynamic COGs, lumbar lordosis angle, and lumbosacral angle. The measured values were analyzed using independent t-tests. The group of patients with P-COG showed more decreases in lumbar extension strength, lumbar lordosis angle, and lumbosacral angle compared to the group of patients with C-COG. Also this group showed increases in moving speed and movement distance of the static COG. However, there were no differences in moving speed and movement distance of the dynamic COG between the two groups. These findings suggest that chronic LBP patients with P-COG have some disadvantages to establish lumbar extension strength and static and dynamic balance, which require specific efforts to maintain a neutral position and to control posture.

Sacral Stress Fracture following the Bone Union of Lumbar Spondylolysis

Directory of Open Access Journals (Sweden)

Tatsuro Sasaji

2016-01-01

Full Text Available While 22 articles have reported on sacral stress fractures, it is a rare injury and its etiology is not well known. We present the case of a 16-year-old male who presented with low back pain in 2015. He was a high school soccer player with a previous history of a bilateral L5 lumbar spondylolysis in 2014. The patient refrained from soccer and wore a brace for six months. Two months after restarting soccer, he again complained of low back pain. After 1 year, a lumbar spine computed tomography revealed the bone union of the spondylolysis. At his first visit to our hospital, his general and neurological conditions were normal and laboratory data were within the normal range. Sacral coronal magnetic resonance imaging (MRI of the left sacral ala revealed an oblique lineal signal void surrounding bone marrow edema. Based on his symptoms, sports history, and MRI, he was diagnosed with a sacral stress fracture. He again refrained from soccer; his low back pain soon improved, and, after 1 year, the abnormal signal change had disappeared on sacral MRI. Recurrent low back pain case caused by a sacral stress fracture occurring after the bone union of lumbar spondylolysis is uncommon.

Epidural versus intravenous steroids application following percutaneous endoscopic lumbar discectomy.

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Hu, Annan; Gu, Xin; Guan, Xiaofei; Fan, Guoxin; He, Shisheng

2018-05-01

Retrospectively study.The purpose of this study was to compare the effects of intraoperative epidural steroids and single dose intravenous steroids following a percutaneous endoscopic lumbar discectomy (PELD).Inflammatory irritation of dorsal root ganglia or sensory nerve roots may cause postoperative pain. Epidural steroids have been applied after a lumbar discectomy for more than 20 years. Epidural steroid application after a PELD is easier to perform and safer because the operations are under observation of the scope.We retrospectively reviewed the medical records of patients with lumbar intervertebral disc herniation who had undergone transforaminal PELD at our department. There are 60 patients in epidural steroid group, intravenous steroid group, and control group, respectively. Visual analog scores (VAS) and the Oswestry Disability Index (ODI) were collected. Successful pain control is defined as 50% or more reduction in back and leg pain (VAS scores).VAS scores (back and leg) and ODI showed a significant decrease in all groups when comparing pre- and postoperatively. Epidural steroid group had a significant improvement in successful pain control compared with the control group at 2 weeks of follow-up. VAS scores (leg) in the epidural steroid group showed a significant decrease compared with the intravenous steroids group at 1, 3, and 7 days after the surgery, but this difference had no statistical significance at 1, 6, and 12 months of follow-up. All groups did not show a significant difference in ODI at 1, 6, and 12 months follow-up.Epidural application of steroid has a better effect on controlling the postoperative pain of PELD in the short term. The epidural application of steroid did not show a tendency to cause infection.

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

DEFF Research Database (Denmark)

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

2009-01-01

STUDY DESIGN: A prospective clinical study. OBJECTIVES: To investigate the predictive value of the lumbar extension test for outcome after surgical treatment of lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: Studies have indicated that aggravation of the symptoms from LSS by extension...... of the lumbar spine has predictive value for the outcome after decompression. The aim of this study was to investigate this theory in a larger group of patients. METHODS: One hundred forty-six consecutive patients surgically treated for LSS were included in the study. The clinical condition was recorded before...... has no predictive value for the outcome after surgical treatment of LSS....

Interventional Radiology Management of a Ruptured Lumbar Artery Pseudoaneurysm after Cryoablation and Vertebroplasty of a Lumbar Metastasis

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Giordano, Aldo Victor; Arrigoni, Francesco, E-mail: arrigoni.francesco@gmail.com [Ospedale San Salvatore, Department of Radiology (Italy); Bruno, Federico [University of L’Aquila, Department of Biotechnological and Applied Clinical Sciences (Italy); Carducci, Sergio; Varrassi, Marco; Zugaro, Luigi [Ospedale San Salvatore, Department of Radiology (Italy); Barile, Antonio; Masciocchi, Carlo [University of L’Aquila, Department of Biotechnological and Applied Clinical Sciences (Italy)

2017-05-15

We describe the management of a complication (a lumbar artery pseudoaneurysm and its rupture) after combined procedure (cryoablation and vertebroplasty) on a lumbar (L2) metastasis from renal cell carcinoma. Review of the literature is also presented with discussion about the measures to be taken to prevent these types of complications.

ISASS Policy Statement – Lumbar Artificial Disc

Science.gov (United States)

Garcia, Rolando

2015-01-01

Purpose The primary goal of this Policy Statement is to educate patients, physicians, medical providers, reviewers, adjustors, case managers, insurers, and all others involved or affected by insurance coverage decisions regarding lumbar disc replacement surgery. Procedures This Policy Statement was developed by a panel of physicians selected by the Board of Directors of ISASS for their expertise and experience with lumbar TDR. The panel's recommendation was entirely based on the best evidence-based scientific research available regarding the safety and effectiveness of lumbar TDR. PMID:25785243

Gonadal dose reduction in lumbar spine radiography

International Nuclear Information System (INIS)

Moilanen, A.; Kokko, M.L.; Pitkaenen, M.

1983-01-01

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

Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

Directory of Open Access Journals (Sweden)

Koshi Ninomiya

2014-01-01

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

General practitioners' willingness to request plain lumbar spine radiographic examinations

International Nuclear Information System (INIS)

Ryynaenen, Olli-Pekka; Lehtovirta, Jukka; Soimakallio, Seppo; Takala, Jorma

2001-01-01

Objectives: To examine general practitioners' attitudes to plain lumbar spine radiographic examinations. Design: A postal questionnaire consisting of questions on background data and doctors' opinions about plain lumbar spine radiographic examinations, as well as eight vignettes (imaginary patient cases) presenting indications for lumbar radiography, and five vignettes focusing on the doctors' willingness to request lumbar radiography on the basis of patients' age and duration of symptoms. The data were analysed according to the doctor's age, sex, workplace and the medical school of graduation. Setting: Finland. Subjects: Six hundred and fifteen randomly selected physicians working in primary health care (64% of original target group). Results: The vignettes revealed that the use of plain lumbar radiographic examination varied between 26 and 88%. Patient's age and radiation protection were the most prominent factors influencing doctors' decisions to request lumbar radiographies. Only slight differences were observed between the attitudes of male and female doctors, as well as between young and older doctors. Doctors' willingness to request lumbar radiographies increased with the patient's age in most vignettes. The duration of patients' symptoms had a dramatic effect on the doctor's decision: in all vignettes, doctors were more likely to request lumbar radiography when patient's symptoms had exceeded 4 weeks. Conclusions: General practitioners commonly use plain lumbar spine radiographic examinations, despite its limited value in the diagnosis of low back pain. Further consensus and medical education is needed to clarify the indications for plain lumbar radiographic examination

A CLINICAL STUDY OF OPERATIVE TREATMENT FOR LUMBAR INTERVERTEBRAL DISC PROLAPSE

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Anilkumar S. D

2016-09-01

Full Text Available BACKGROUND Amongst painful diseases, sciatica occupies a foremost place by reason of its prevalence, its production by a great variety of conditions, the great disablement it may produce and its tending to relapse all of which have led to its recognition as one of the great scourges of humanity. Intervertebral disc prolapse is the important and common cause of low back pain and sciatica. Here, the subject of laminectomy and discectomy in the treatment of proven intervertebral disc prolapse in the lower lumbar region is reviewed and its results examined. AIM OF STUDY This study was undertaken in order to evaluate the following objectives. PRIMARY Analysis of clinical parameters and per operative findings of lumbar intervertebral disc prolapse. SECONDARY Analysis of clinical parameters and surgical outcome in lumbar intervertebral disc prolapse with respect to improvement in pain and neurological status. MATERIALS AND METHODS The study was undertaken in 22 patients who attended the Orthopaedic Department of Mount Zion Medical College, Adoor, between August 2014 to July 2015. All of them were suffering from a prolapsed lumbar vertebral disc as shown by clinical examination and investigations. Lumbar laminectomy and discectomy constituted the operative procedure for all of them. RESULTS In acute onset cases and cases with short duration, results were good. By six months, 80% of patients recorded of good pain relief, 80% of patients returned to work within six 6 months, 60% of patients showed good neurological recovery by 6 months. Laminectomy and discectomy in proven cases of lumbar intervertebral disc prolapse is a rewarding procedure. LT definitely relieved pain in all cases and improved morbidity and neurological deficits in most of the cases. CONCLUSION 1. Laminectomy and discectomy is an effective method of treatment in herniation of lumbar intervertebral disc. 2. The procedure is ideally done in those with the disc prolapse proved with the

Computed Tomography of the lumbar facet joints

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

1989-08-15

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

Pelvic Hydatid Disease: CT and MRI Findings Causing Sciatica

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Sanal, Hatice Tuba; Kocaoglu, Murat; Bulakbasi, Nail; Yildirim, Duzgun [Gulhane Military Medical School, Department of Radiology, 06018, Ankara (Turkmenistan)

2007-12-15

Pelvic masses, especially hydatid disease, rarely present with sciatica. We present the computed tomography (CT) and the magnetic resonance imaging (MRI) findings of a 49-year-old female patient with presacral hydatid disease, who was evaluated for her sciatica. We also want to emphasize the importance of assessing the pelvis of patients with symptoms and clinical findings that are inconsistent and that cannot be satisfactorily explained by the spinal imaging findings. isc herniation in the lumbar spine is a well-known etiology of back pains and sciatica, but whenever disc herniation of the lumbar spine is excluded by the employed imaging modalities, then the pelvis should be examined for other possible etiologies of nerve compression. We describe here a patient, who was complaining of sciatica, with no abnormal findings in her lumbar spinal magnetic resonance imaging (MRI). The cause of her sciatica was found to be associated with a pelvic hydatid cyst compressing the lumbosacral nerve plexus. In conclusion, if no pathology is evident for the lumbar discal structures, in connection with the cause of sciatica and lumbar back pains, then the pelvis should also be examined for the possible etiologies of compression of the lumbosacral nerve plexus. Whenever a multiseptated cyst is come across in a patient of an endemic origin with a positive history for hydatid disease like surgery, indicating recurrence, hydatid cyst is the most likely diagnosis.

Pelvic Hydatid Disease: CT and MRI Findings Causing Sciatica

International Nuclear Information System (INIS)

Sanal, Hatice Tuba; Kocaoglu, Murat; Bulakbasi, Nail; Yildirim, Duzgun

2007-01-01

Pelvic masses, especially hydatid disease, rarely present with sciatica. We present the computed tomography (CT) and the magnetic resonance imaging (MRI) findings of a 49-year-old female patient with presacral hydatid disease, who was evaluated for her sciatica. We also want to emphasize the importance of assessing the pelvis of patients with symptoms and clinical findings that are inconsistent and that cannot be satisfactorily explained by the spinal imaging findings. isc herniation in the lumbar spine is a well-known etiology of back pains and sciatica, but whenever disc herniation of the lumbar spine is excluded by the employed imaging modalities, then the pelvis should be examined for other possible etiologies of nerve compression. We describe here a patient, who was complaining of sciatica, with no abnormal findings in her lumbar spinal magnetic resonance imaging (MRI). The cause of her sciatica was found to be associated with a pelvic hydatid cyst compressing the lumbosacral nerve plexus. In conclusion, if no pathology is evident for the lumbar discal structures, in connection with the cause of sciatica and lumbar back pains, then the pelvis should also be examined for the possible etiologies of compression of the lumbosacral nerve plexus. Whenever a multiseptated cyst is come across in a patient of an endemic origin with a positive history for hydatid disease like surgery, indicating recurrence, hydatid cyst is the most likely diagnosis

The hybrid assistive limb (HAL) for Care Support successfully reduced lumbar load in repetitive lifting movements.

Science.gov (United States)

Miura, Kousei; Kadone, Hideki; Koda, Masao; Abe, Tetsuya; Kumagai, Hiroshi; Nagashima, Katsuya; Mataki, Kentaro; Fujii, Kengo; Noguchi, Hiroshi; Funayama, Toru; Kawamoto, Hiroaki; Sankai, Yoshiyuki; Yamazaki, Masashi

2018-05-03

Work-related low back pain is a serious socioeconomic problem. This study examined whether HAL for Care Support, which is a newly developed wearable robot, would decrease lumbar fatigue and improve lifting performance during repetitive lifting movements. Eighteen healthy volunteers (11 men, 7 women) performed repetitive stoop lifting movements of a cardboard box weighing 12 kg as many times as possible. The first lifting trial was executed without HAL for Care Support, and the second was with it. We evaluated the VAS of lumbar fatigue as the lumbar load and the number of lifts and the lifting time as lifting performance. Without HAL for Care Support, the mean VAS of lumbar fatigue, the number of lifts and lifting time were 68 mm, 60 and 230 s; with HAL for Care Support, they were 51 mm, 87 and 332 s, respectively. Both lifting performance measures were significantly improved by using HAL for Care Support (Fig. 2). A power analysis showed that there was sufficient statistical power for the VAS of lumbar fatigue (0.99), the number of lifts (0.92), and lifting time (0.93). All participants performed their repetitive lifting trials safely. There were no adverse events caused by using HAL for Care Support. In conclusion, the HAL for Care Support can decrease lumbar load and improve the lifting performance during repetitive stoop lifting movements in healthy adults. Copyright © 2018. Published by Elsevier Ltd.

Tractography of lumbar nerve roots: initial results

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Balbi, Vincent; Budzik, Jean-Francois; Thuc, Vianney le; Cotten, Anne [Hopital Roger Salengro, Service de Radiologie et d' Imagerie musculo-squelettique, Lille Cedex (France); Duhamel, Alain [Universite de Lille 2, UDSL, Lille (France); Bera-Louville, Anne [Service de Rhumatologie, Hopital Roger Salengro, Lille (France)

2011-06-15

The aims of this preliminary study were to demonstrate the feasibility of in vivo diffusion tensor imaging (DTI) and fibre tracking (FT) of the lumbar nerve roots, and to assess potential differences in the DTI parameters of the lumbar nerves between healthy volunteers and patients suffering from disc herniation. Nineteen patients with unilateral sciatica related to posterolateral or foraminal disc herniation and 19 healthy volunteers were enrolled in this study. DTI with tractography of the L5 or S1 nerves was performed. Mean fractional anisotropy (FA) and mean diffusivity (MD) values were calculated from tractography images. FA and MD values could be obtained from DTI-FT images in all controls and patients. The mean FA value of the compressed lumbar nerve roots was significantly lower than the FA of the contralateral nerve roots (p=0.0001) and of the nerve roots of volunteers (p=0.0001). MD was significantly higher in compressed nerve roots than in the contralateral nerve root (p=0.0002) and in the nerve roots of volunteers (p=0.04). DTI with tractography of the lumbar nerves is possible. Significant changes in diffusion parameters were found in the compressed lumbar nerves. (orig.)

Tractography of lumbar nerve roots: initial results

International Nuclear Information System (INIS)

Balbi, Vincent; Budzik, Jean-Francois; Thuc, Vianney le; Cotten, Anne; Duhamel, Alain; Bera-Louville, Anne

2011-01-01

The aims of this preliminary study were to demonstrate the feasibility of in vivo diffusion tensor imaging (DTI) and fibre tracking (FT) of the lumbar nerve roots, and to assess potential differences in the DTI parameters of the lumbar nerves between healthy volunteers and patients suffering from disc herniation. Nineteen patients with unilateral sciatica related to posterolateral or foraminal disc herniation and 19 healthy volunteers were enrolled in this study. DTI with tractography of the L5 or S1 nerves was performed. Mean fractional anisotropy (FA) and mean diffusivity (MD) values were calculated from tractography images. FA and MD values could be obtained from DTI-FT images in all controls and patients. The mean FA value of the compressed lumbar nerve roots was significantly lower than the FA of the contralateral nerve roots (p=0.0001) and of the nerve roots of volunteers (p=0.0001). MD was significantly higher in compressed nerve roots than in the contralateral nerve root (p=0.0002) and in the nerve roots of volunteers (p=0.04). DTI with tractography of the lumbar nerves is possible. Significant changes in diffusion parameters were found in the compressed lumbar nerves. (orig.)

Side effects after lumbar iohexol myelography

International Nuclear Information System (INIS)

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

1990-01-01

Side effects of iohexol lumbar myelography have been analyzed with respect to the influence of the type of radiological abnormality, sex and age in a group of 200 patients. Headache, postural headache, nausea and back/leg pain were significantly more frequent in patients without definite radiological abnormalities. Postural headache, nausea, dizziness and mental symptoms were more frequent in women, while headache, postural headache, nausea, dizziness, minor mental symptoms (i.e. anxiety or depression) and pain became less frequent with age. This pattern is similar to that reported after lumbar puncture. Young women without definite clinical signs of nerve root lesions probably have the greatest risk of experiencing side effects after iohexol lumbar myelography. (orig.)

ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

OpenAIRE

Léo, Jefferson Coelho de; Léo, Álvaro Coelho de; Cardoso, Igor Machado; Jacob Júnior, Charbel; Batista Júnior, José Lucas

2015-01-01

Objective:To associate spinopelvic parameters, pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with the axial location of lumbar disc herniation.Methods:Retrospective study, which evaluated imaging and medical records of 61 patients with lumbar disc herniation, who underwent surgery with decompression and instrumented lumbar fusion in only one level. Pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with simple lumbopelvic lateral radiographs, which included the ...

Comparison of erector spinae and hamstring muscle activities and lumbar motion during standing knee flexion in subjects with and without lumbar extension rotation syndrome.

Science.gov (United States)

Kim, Si-hyun; Kwon, Oh-yun; Park, Kyue-nam; Kim, Moon-Hwan

2013-12-01

The aim of this study was to compare the activity of the erector spinae (ES) and hamstring muscles and the amount and onset of lumbar motion during standing knee flexion between individuals with and without lumbar extension rotation syndrome. Sixteen subjects with lumbar extension rotation syndrome (10 males, 6 females) and 14 healthy subjects (8 males, 6 females) participated in this study. During the standing knee flexion, surface electromyography (EMG) was used to measure muscle activity, and surface EMG electrodes were attached to both the ES and hamstring (medial and lateral) muscles. A three-dimensional motion analysis system was used to measure kinematic data of the lumbar spine. An independent-t test was conducted for the statistical analysis. The group suffering from lumbar extension rotation syndrome exhibited asymmetric muscle activation of the ES and decreased hamstring activity. Additionally, the group with lumbar extension rotation syndrome showed greater and earlier lumbar extension and rotation during standing knee flexion compared to the control group. These data suggest that asymmetric ES muscle activation and a greater amount of and earlier lumbar motion in the sagittal and transverse plane during standing knee flexion may be an important factor contributing to low back pain. Copyright © 2013 Elsevier Ltd. All rights reserved.

High-Force Versus Low-Force Lumbar Traction in Acute Lumbar Sciatica Due to Disc Herniation: A Preliminary Randomized Trial.

Science.gov (United States)

Isner-Horobeti, Marie-Eve; Dufour, Stéphane Pascal; Schaeffer, Michael; Sauleau, Erik; Vautravers, Philippe; Lecocq, Jehan; Dupeyron, Arnaud

This study compared the effects of high-force versus low-force lumbar traction in the treatment of acute lumbar sciatica secondary to disc herniation. A randomized double blind trial was performed, and 17 subjects with acute lumbar sciatica secondary to disc herniation were assigned to high-force traction at 50% body weight (BW; LT50, n = 8) or low force traction at 10% BW (LT10, n = 9) for 10 sessions in 2 weeks. Radicular pain (visual analogue scale [VAS]), lumbo-pelvic-hip complex motion (finger-to-toe test), lumbar-spine mobility (Schöber-Macrae test), nerve root compression (straight-leg-raising test), disability (EIFEL score), drug consumption, and overall evaluation of each patient were measured at days 0, 7, 1, 4, and 28. Significant (P sciatica secondary to disc herniation who received 2 weeks of lumbar traction reported reduced radicular pain and functional impairment and improved well-being regardless of the traction force group to which they were assigned. The effects of the traction treatment were independent of the initial level of medication and appeared to be maintained at the 2-week follow-up. Copyright © 2016. Published by Elsevier Inc.

Therapeutic efficacy of hydro-kinesiotherapy Programs in lumbar spondylosis

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Ana-Maria BOTEZAN

2015-12-01

Full Text Available Lumbar spondylarthrosis is a degenerative disease that affects the joint structures of the lumbar spine. In the course of time, numerous studies on the role of hydro-kinesiotherapy in the treatment of lumbar spondylosis have been conducted. The aim of this research is motivated by the significantly high number of patients with chronic pain in the lumbar spine due to lumbar spondylosis, as well as by the negative impact on their quality of life through the impairment of the activities of daily living. The prospective longitudinal study was carried out at the Clinical Rehabilitation Hospital Cluj-Napoca. The study included 35 patients with chronic low back pain and mobility limitation in the lumbar spine. The patients were assigned to two groups: the study group formed by 20 patients and the control group consisting of 15 patients aged between 40-70 years. The treatment of the patients included in the study was performed over a two week period and consisted of a hydro-kinesiotherapy program, for the patients of the study group, the duration of a treatment session being 40 minutes. Both the subjects of the study group and of the control group also benefited from sedative massage of the lumbosacral spine, kinesiotherapy, laser therapy of the lumbar spine. The patients were evaluated using Schober’s test, the Visual Analogue Scale, the Oswestry index. These evaluation methods were applied to the patients of both groups at the beginning of the rehabilitation programs and after two weeks. The results of the study demonstrated the therapeutic efficacy of the medical rehabilitation programs that included hydro-kinesiotherapy programs. The patients of both groups had improvements through a decrease of lumbar pain, an increase in lumbar spine mobility, as well as in the patients’ ability to organize themselves in the activities of daily living. However, the patients of the study group, with a hydro-kinesiotherapy program performed for two weeks, had

Effect of levomepromazine on EEG and on clinical side effects after lumbar myelography with metrizamide

International Nuclear Information System (INIS)

Standnes, B.; Oftedal, S.-I.; Weber, H.

1982-01-01

In patients with lumbago-sciatica levomepromazine is a potent supplement to analgetics in pain treatment. The hypothesis that neuroleptics increase the risk of epileptic seizures after metrizamide myelography was not comfirmed in a series of 77 patients, 26 with and 51 without levomepromazine medication, before and after lumbar metrizamide myelography. No differences existed between the groups with regard to the appearance of EEG abnormalities such as slow waves or spikes. Mild side effects were more frequent in the levomepromazine group, except nausea and vomiting. Lumbar metrizamide epidurography in 30 patients did not cause any abnormal EEG. (Auth.)

Effect of levomepromazine on EEG and on clinical side effects after lumbar myelography with metrizamide

Energy Technology Data Exchange (ETDEWEB)

Standnes, B.; Oftedal, S.I.; Weber, H. (Ullevaal Sykehus, Oslo (Norway))

1982-01-01

In patients with lumbago-sciatica levomepromazine is a potent supplement to analgesics in pain treatment. The hypothesis that neuroleptics increase the risk of epileptic seizures after metrizamide myelography was not comfirmed in a series of 77 patients, 26 with and 51 without levomepromazine medication, before and after lumbar metrizamide myelography. No differences existed between the groups with regard to the appearance of EEG abnormalities such as slow waves or spikes. Mild side effects were more frequent in the levomepromazine group, except nausea and vomiting. Lumbar metrizamide epidurography in 30 patients did not cause any abnormal EEG.

New physical examination tests for lumbar spondylolisthesis and instability: low midline sill sign and interspinous gap change during lumbar flexion-extension motion.

Science.gov (United States)

Ahn, Kang; Jhun, Hyung-Joon

2015-04-22

Lumbar spondylolisthesis (LS) and lumbar instability (LI) are common disorders in patients with low back or lumbar radicular pain. However, few physical examination tests for LS and LI have been reported. In the study described herein, new physical examination tests for LS and LI were devised and evaluated for their validity. The test for LS was designated "low midline sill sign", and that for LI was designated "interspinous gap change" during lumbar flexion-extension motion. The validity of the low midline sill sign was evaluated in 96 patients with low back or lumbar radicular pain. Validity of the interspinous gap change during lumbar flexion-extension motion was evaluated in 73 patients with low back or lumbar radicular pain. The sensitivity, specificity, and positive and negative predictive values of the two tests were also investigated. The sensitivity and specificity of the low midline sill sign for LS were 81.3% and 89.1%, respectively. Positive and negative predictive values of the test were 78.8% and 90.5%, respectively. The sensitivity and specificity of the interspinous gap change test for LI were 82.2% and 60.7%, respectively. Positive and negative predictive values of the test were 77.1% and 68.0%, respectively. The low midline sill sign and interspinous gap change tests are effective for the detection of LS and LI, and can be performed easily in an outpatient setting.

Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation in surgical treatment for single-segment lumbar spinal tuberculosis

OpenAIRE

Zeng, Hao; Wang, Xiyang; Zhang, Penghui; Peng, Wei; Zhang, Yupeng; Liu, Zheng

2015-01-01

Objective: The aim of this study is to determine the feasibility and efficacy of surgical management of single-segment lumbar spinal tuberculosis (TB) by using single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation.Methods: Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reco...

Intervertebral Fusion with Mobile Microendoscopic Discectomy for Lumbar Degenerative Disc Disease.

Science.gov (United States)

Xu, Bao-Shan; Liu, Yue; Xu, Hai-Wei; Yang, Qiang; Ma, Xin-Long; Hu, Yong-Cheng

2016-05-01

The aim of this article is to introduce a technique for lumbar intervertebral fusion that incorporates mobile microendoscopic discectomy (MMED) for lumbar degenerative disc disease. Minimally invasive transforaminal lumbar interbody fusion is frequently performed to treat degenerative diseases of the lumbar spine; however, the scope of such surgery and vision is limited by what the naked eye can see through the expanding channel system. To expand the visual scope and reduce trauma, we perform lumbar intervertebral fusion with the aid of a MMED system that provides a wide field through freely tilting the surgical instrument and canals. We believe that this technique is a good option for treating lumbar degenerative disc disease that requires lumbar intervertebral fusion. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

OpenAIRE

Lee, Su-Keon; Lee, Seung-Hwan; Song, Kyung-Sub; Park, Byung-Moon; Lim, Sang-Youn; Jang, Geun; Lee, Beom-Seok; Moon, Seong-Hwan; Lee, Hwan-Mo

2016-01-01

Background To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondyloli...

The top 100 classic papers in lumbar spine surgery.

Science.gov (United States)

Steinberger, Jeremy; Skovrlj, Branko; Caridi, John M; Cho, Samuel K

2015-05-15

Bibliometric review of the literature. To analyze and quantify the most frequently cited papers in lumbar spine surgery and to measure their impact on the entire lumbar spine literature. Lumbar spine surgery is a dynamic and complex field. Basic science and clinical research remain paramount in understanding and advancing the field. While new literature is published at increasing rates, few studies make long-lasting impacts. The Thomson Reuters Web of Knowledge was searched for citations of all papers relevant to lumbar spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each paper. The most cited paper was found to be the classic paper from 1990 by Boden et al that described magnetic resonance imaging findings in individuals without back pain, sciatica, and neurogenic claudication showing that spinal stenosis and herniated discs can be incidentally found when scanning patients. The second most cited study similarly showed that asymptomatic patients who underwent lumbar spine magnetic resonance imaging frequently had lumbar pathology. The third most cited paper was the 2000 publication of Fairbank and Pynsent reviewing the Oswestry Disability Index, the outcome-measure questionnaire most commonly used to evaluate low back pain. The majority of the papers originate in the United States (n=58), and most were published in Spine (n=63). Most papers were published in the 1990s (n=49), and the 3 most common topics were low back pain, biomechanics, and disc degeneration. This report identifies the top 100 papers in lumbar spine surgery and acknowledges those individuals who have contributed the most to the advancement of the study of the lumbar spine and the body of knowledge used to guide evidence-based clinical decision making in lumbar spine surgery today. 3.

Single photon emission computed tomography in lumbar degenerative spondylolisthesis

International Nuclear Information System (INIS)

Ito, S.; Muro, T.; Eisenstein, S.

1998-01-01

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

Optimizing Residents' Performance of Lumbar Puncture

DEFF Research Database (Denmark)

Henriksen, Mikael Johannes Vuokko; Wienecke, Troels; Thagesen, Helle

2018-01-01

Background: Lumbar puncture is often associated with uncertainty and limited experience on the part of residents; therefore, preparatory interventions can be essential. There is growing interest in the potential benefit of videos over written text. However, little attention has been given...... to whether the design of the videos impacts on subsequent performance. Objective: To investigate the effect of different preparatory interventions on learner performance and self-confidence regarding lumbar puncture (LP). Design: Randomized controlled trial in which participants were randomly assigned to one...... of three interventions as preparation for performing lumbar puncture: 1) goal- and learner-centered video (GLV) presenting procedure-specific process goals and learner-centered information; 2) traditional video (TV) providing expert-driven content, but no process goals; and 3) written text (WT...

Axial loaded MRI of the lumbar spine

Energy Technology Data Exchange (ETDEWEB)

Saifuddin, A. E-mail: asaifuddin@aol.com; Blease, S.; MacSweeney, E

2003-09-01

Magnetic resonance imaging is established as the technique of choice for assessment of degenerative disorders of the lumbar spine. However, it is routinely performed with the patient supine and the hips and knees flexed. The absence of axial loading and lumbar extension results in a maximization of spinal canal dimensions, which may in some cases, result in failure to demonstrate nerve root compression. Attempts have been made to image the lumbar spine in a more physiological state, either by imaging with flexion-extension, in the erect position or by using axial loading. This article reviews the literature relating to the above techniques.

Lumbar supports for prevention and treatment of low back pain

DEFF Research Database (Denmark)

Van Tulder, M W; Jellema, P; van Poppel, M N

2000-01-01

BACKGROUND: Lumbar supports are used in the treatment of low back pain patients to make the impairment and disability vanish or decrease. Lumbar supports are also used to prevent the onset of low back pain (primary prevention) or to prevent recurrences of a low back pain episode (secondary...... 1999, and the Embase database up to September 1998. We also screened references given in relevant reviews and identified controlled trials, and used Science Citation Index to identify additional controlled trials. SELECTION CRITERIA: Controlled clinical trials that reported on any type of lumbar...... types of treatment or no intervention. No evidence was found on the effectiveness of lumbar supports for secondary prevention. The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment, while it is still unclear if lumbar...

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

Science.gov (United States)

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

2016-07-22

Spinal sagittal imbalance is a widely acknowledged problem, but there is insufficient knowledge regarding its occurrence. In some patients with lumbar disc herniation (LDH), their symptom is similar to spinal sagittal imbalance. The aim of this study is to illustrate the spinopelvic sagittal characteristics and identity the role of spinal musculature in the mechanism of sagittal imbalance in patients with LDH. Twenty-five adults with spinal sagittal imbalance who initially came to our clinic for treatment of LDH, followed by posterior discectomy were reviewed. The horizontal distance between C7 plumb line-sagittal vertical axis (C7PL-SVA) greater than 5 cm anteriorly with forward bending posture is considered as spinal sagittal imbalance. Radiographic parameters including thoracic kyphotic angle (TK), lumbar lordotic angle (LL), pelvic tilting angle (PT), sacral slope angle (SS) and an electromyography(EMG) index 'the largest recruitment order' were recorded and compared. All patients restored coronal and sagittal balance immediately after lumbar discectomy. The mean C7PL-SVA and trunk shift value decreased from (11.6 ± 6.6 cm, and 2.9 ± 6.1 cm) preoperatively to (-0.5 ± 2.6 cm and 0.2 ± 0.5 cm) postoperatively, while preoperative LL and SS increased from (25.3° ± 14.0° and 25.6° ± 9.5°) to (42.4° ± 10.2° and 30.4° ± 8.7°) after surgery (P imbalance caused by LDH is one type of compensatory sagittal imbalance. Compensatory mechanism of spinal sagittal imbalance mainly includes a loss of lumbar lordosis, an increase of thoracic kyphosis and pelvis tilt. Spinal musculature plays an important role in spinal sagittal imbalance in patients with LDH.

Magnetic Resonance Imaging (MRI): Lumbar Spine (For Parents)

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Magnetic Resonance Imaging (MRI): Lumbar Spine KidsHealth / For Parents / Magnetic Resonance Imaging (MRI): Lumbar Spine What's in this article? ...

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

Science.gov (United States)

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.

Treatment and outcome of herniated lumbar intervertebral disk in a ...

African Journals Online (AJOL)

The goal of treatment in cases of lumbar disk herniation is to return the patient to .... instability during surgery on the lumbar spine for the treatment of reherniation ... H. H. Failure within one year following subtotal lumbar discectomy. J Bone ...

LUMBAR LORDOSIS IN ASYMPTOMATICS SUBJECTS AND PATIENTS WITH CHRONIC LOW BACK PAIN

Directory of Open Access Journals (Sweden)

S.J MOUSAVI

2003-12-01

Full Text Available Introduction: The relationship between the degree of lumbar lordosis and chronic and purpose low back pain (LBP has long been speculated, but there is discrepancy in findings of previous researchers. The purpose of this of this study was to drtermin differences between lumbar lordosis in asymptomatic and LBP subjects. Matherials: Lumbar lordosis of 420 patients with chronic LBP and 420 asymptomatic subjects was measured by two examiner. A flexible ruler was used to measure lumbar lodosis in all subjects. Results: The averagr degree of lumbar lordosis for all subjects was 37±13°. Females had greater lumbar lordosis (42 ±15° than males (32±100 and elderly subjects had lesser lumbar lordosis than younger and middle aged subjects. Conclussoion: The degree of lumbar lordosis was not differet between normal subjects and those with LBP. It seems that effects of lumbar lordosis on LBP and treatment programs need to be reevaluated.

[A woman with a postoperative lumbar swelling].

Science.gov (United States)

Hulshof, Hanna M; Elsenburg, Patric H J M; Frequin, Stephan T F M

2013-01-01

A 65-year-old woman had developed a large lumbar swelling in a period of four weeks following lumbar laminectomy. An MRI-scan revealed a large fluid collection, which had formed from the spinal canal. The diagnosis 'liquorcele', a rare complication of spine surgery, was established.

Analysis of Patients with Myelopathy due to Benign Intradural Spinal Tumors with Concomitant Lumbar Degenerative Diseases Misdiagnosed and Erroneously Treated with Lumbar Surgery.

Science.gov (United States)

Lu, Kang; Wang, Hao-Kuang; Liliang, Po-Chou; Yang, Chih-Hui; Yen, Cheng-Yo; Tsai, Yu-Duan; Chen, Po-Yuan; Chye, Cien-Leong; Wang, Kuo-Wei; Liang, Cheng-Loong; Chen, Han-Jung

2017-09-01

When a cervical or thoracic benign intradural spinal tumor (BIST) coexists with lumbar degenerative diseases (LDD), diagnosis can be difficult. Symptoms of BIST-myelopathy can be mistaken as being related to LDD. Worse, an unnecessary lumbar surgery could be performed. This study was conducted to analyze cases in which an erroneous lumbar surgery was undertaken in the wake of failure to identify BIST-associated myelopathy. Cases were found in a hospital database. Patients who underwent surgery for LDD first and then another surgery for BIST removal within a short interval were studied. Issues investigated included why the BISTs were missed, how they were found later, and how the patients reacted to the unnecessary lumbar procedures. Over 10 years, 167 patients received both surgeries for LDD and a cervical or thoracic BIST. In 7 patients, lumbar surgery preceded tumor removal by a short interval. Mistakes shared by the physicians included failure to detect myelopathy and a BIST, and a hasty decision for lumbar surgery, which soon turned out to be futile. Although the BISTs were subsequently found and removed, 5 patients believed that the lumbar surgery was unnecessary, with 4 patients expressing regrets and 1 patient threatening to take legal action against the initial surgeon. Concomitant symptomatic LDD and BIST-associated myelopathy pose a diagnostic challenge. Spine specialists should refrain from reflexively linking leg symptoms and impaired ability to walk to LDD. Comprehensive patient evaluation is fundamental to avoid misdiagnosis and wrong lumbar surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Magnetic resonance imaging of normal lumbar intervertebral discs

International Nuclear Information System (INIS)

Al-Hadidi, Maher T.; Badran, Darwish H.; Abu-Ghaida, Jamal H.; Al-Hadidi, A.

2001-01-01

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

49 CFR 572.85 - Lumbar spine flexure.

Science.gov (United States)

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine flexure. 572.85 Section 572.85... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) ANTHROPOMORPHIC TEST DEVICES 9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected to continuously applied force in accordance with paragraph (b...

Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion--systematic review and meta-analysis.

Science.gov (United States)

Phan, Kevin; Thayaparan, Ganesha K; Mobbs, Ralph J

2015-01-01

To assess the clinical and radiographic outcomes and complications of anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF). A systematic literature search was conducted from six electronic databases. The relative risk and weighted mean difference (WMD) were used as statistical summary effect sizes. Fusion rates (88.6% vs. 91.9%, P = 0.23) and clinical outcomes were comparable between ALIF and TLIF. ALIF was associated with restoration of disk height (WMD, 2.71 mm, P = 0.01), segmental lordosis (WMD, 2.35, P = 0.03), and whole lumbar lordosis (WMD, 6.33, P = 0.03). ALIF was also associated with longer hospitalization (WMD, 1.8 days, P = 0.01), lower dural injury (0.4% vs. 3.8%, P = 0.05) but higher blood vessel injury (2.6% vs. 0%, P = 0.04). ALIF and TLIF appear to have similar success and clinical outcomes, with different complication profiles. ALIF may be associated with superior restoration of disk height and lordosis, but requires further validation in future studies.

Complications of CT guided lumbar sympathicolysis: own experience and review of literature

International Nuclear Information System (INIS)

Ernst, S.; Heindel, W.; Fischbach, R.; Langen, H.J.; Krahe, T.; Gawenda, M.; Neubauer, S.

1998-01-01

Aim: To review the complications of CT guided lumbar sympathicolysis (CTLS) on the basis of our own experience and the available literature. Methods: 241 CTLS were performed by a standard technique according to Haaga's method. Clinical follow-up revealed 4 serious complications; these were analysed and compared with published cases. Results: Amongst our patients there were three fibrotic ureter stenoses and one retroperitoneal abscess. Analysis of the serious complications described in the literature indicates that introduction of CT guided lumbar sympathicolysis has reduced the severity and frequency of complications as compared with surgical and 'blind' procedures. With CTLS, no deaths due to the procedure have been reported in the literature. The results indicate that damage to the ureters can be caused by substances used for the neurolysis. (orig./MG) [de

Evaluation of lumbar disc lesions in teen-agers using magnetic resonance imaging

International Nuclear Information System (INIS)

Urakado, Misao; Naruo, Masakuni; Koyanagi, Eiichi; Taoka, Yuuji; Shiiba, Mutuo; Ryouki, Yoshihiro; Kitazono, Tooru; Kato, Yoshiyuki

1993-01-01

The peridiscal and nuclear (nucleus pulposus and inner layer of annulus fibrosus) signal intensities in 500 discs of teen-age patients were compared with common degenerative lumbar disc disease. Images were taken with a 7 mm slice thickness and T 2 weighted (TE 80∼90 mS, TR 2000∼2200 mS) midsagittal imaging. Clear correlation between these intensities was found. The signal intensity primarily decreased in the peridiscal tissues and secondarily decreased in the nucleus pulposus and inner layer of annulus fibrosus. These findings suggest that peridiscal disorders cause degenerative changes of the nucleus pulposus. Additionally, in the early degenerative stage of the teen-age lumbar disc, a decrease of nuclear signal intensity indicated that degenerative changes originated from the anterior portion and extended posteriorly. (author)

Predictors of clinical outcome following lumbar disc surgery

DEFF Research Database (Denmark)

Hebert, Jeffrey J; Fritz, Julie; Koppenhaver, S.L.

2016-01-01

scheduled for first time, single-level lumbar discectomy. Participants underwent a standardized preoperative evaluation including real-time ultrasound imaging assessment of lumbar multifidus function, and an 8-week postoperative rehabilitation programme. Clinical outcome was defined by change in disability....... CONCLUSIONS: Information gleaned from the clinical history and physical examination helps to identify patients more likely to succeed with lumbar disc surgery. While this study helps to inform clinical practice, additional research confirming these results is required prior to confident clinical...

When a patient goes home: Meaningful lessons in designing for the patient experience of Cervical Radiculopathy and Stroke paralysis

DEFF Research Database (Denmark)

Nielsen, Lasse Nørgaard; Poulsen, Sven Døfler; Coxon, Ian Robert

2013-01-01

Presented in this paper are remarkably powerful learning experiences from two researchers in two separate studies. One dealing with the lived experience of patients suffering paralysis from stroke or brain haemorrhage and the other studying patients with Cervical Radiculopathy. Both cases originate......) of home rehabilitation for people with these conditions. In this paper we not only share our practical experiences and lessons learned in pushing the boundaries of researching human experience but also how it deeply affected us as researchers in achieving the illusive, 'experience of understanding' - what...

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

Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical spondylotic radiculopathy subjects?

Science.gov (United States)

Moustafa, Ibrahim Moustafa; Diab, Aliaa Attiah Mohamed; Hegazy, Fatma A; Harrison, Deed E

2017-01-01

To test the hypothesis that improvement of cervical lordosis in cervical spondylotic radiculopathy (CSR) will improve cervical spine flexion and extension end range of motion kinematics in a population suffering from CSR. Thirty chronic lower CSR patients with cervical lordosis lordosis (p lordosis in the study group was associated with significant improvement in the translational and rotational motions of the lower cervical spine. This finding provides objective evidence that cervical flexion/extension is partially dependent on the posture and sagittal curve orientation. These findings are in agreement with several other reports in the literature; whereas ours is the first post treatment analysis identifying this relationship.

Repair of the spondylolysis in lumbar spine

International Nuclear Information System (INIS)

Matta Ibarra, Javier; Arrieta Maria, Victor; Torres Romero Fernando; Ramirez Cabrales, Vladimir

2005-01-01

The objective is to present the surgical experience in the repair of the spondylolysis in lumbar spine. Background: Spodylolysis is an important cause of low back pain in young adults and is responsible for high grade of incapacity. Classically, patients with surgical indications with Spondylolysis have been treated with vertebral arthrodesis arthrodesis, with the following functional lost of the intervened segment and biomechanical overload of the upper contiguous segment. There are not previous reports about repairing of lysis in national literature and international references in this technique are scarce. Materials and methods: Eight patients within 2002-2004 were operated, a direct repairing of the lyses by in situ, fusion and interfragmental osteosynthesis with AO 3.5 mm titanium cortical screws with autogenous bone grafts was achieved. The casuistic was analyzed depending on clinical presentation, consolidation, mobility and vitality of the disc in imaginology studies. Results: During the follow-up a firm fusion in all cases, mobility and vitality preservation of the L5-S1 intervertebral disc was detected. There was neither infection nor neurological deficit. Recommendations: Repairing of spondylolysis in lumbar column, in young symptomatic patients without or with mild lystesis (grade I) and without associated disc damage, is a safe surgical technique

Computed tomography in lumbar canal stenosis

International Nuclear Information System (INIS)

Ohta, Shu; Baba, Itsushi; Ishida, Akihisa; Sumida, Tadayuki; Sasaki, Seishu

1984-01-01

Preoperative CT was done in 39 patients with lumbar canal stenosis. Marked symmetrical narrowing of the whole vertebral canal was seen in the group with nervous symptoms in the cauda equina. Deformed bilateral intervertebral joints were seen in the group with both nervous symptoms in the cauda equina and radicular sciatica. The lateral recess on the affected side was markedly narrowed by the projection of the upper and lower joints and herniation. In the group with radicular sciatica, the vertebral canal itself was not so narrowed, but the unilateral intervertebral joint was extremely deformed, causing a narrowing of the lateral recess. There were large differences in the angle of the left and right intervertebral joints. (Namekawa, K)

Morphometric study of the lumbar spinal canal in the Korean population.

Science.gov (United States)

Lee, H M; Kim, N H; Kim, H J; Chung, I H

1995-08-01

The anatomic dimensions of the vertebral body and spinal canal of the lumbar spine were analyzed in Koreans. To determine the normal dimension of the lumbar spinal canal in Koreans, to determine whether there are any racial differences in the morphometry of the lumbar spinal canal, and to provide criteria for diagnosing spinal stenosis in the Far Eastern Asian. Some radiologic and anatomic studies have been conducted regarding the size of the lumbar spinal canal of whites and blacks in western and African countries. One-thousand-eight-hundred measurements were performed on the transverse and sagittal diameters of vertebral bodies and spinal canals using complete sets of 90 lumbar vertebrae. The mean mid-sagittal diameter of the lumbar spinal canal in the Korean population was less than that measured in white and African populations, but there was no significant differences between the Korean, white, and African populations regarding the transverse diameter of the lumbar spinal canal. The mid-sagittal diameter of the lumbar spinal canal is narrowest in the Far Eastern Asian population; the radiologic criteria of spinal stenosis should be reconsidered for these people.

The role of cumulative physical work load in lumbar spine disease: risk factors for lumbar osteochondrosis and spondylosis associated with chronic complaints

OpenAIRE

Seidler, A; Bolm-Audorff, U; Heiskel, H; Henkel, N; Roth-Kuver, B; Kaiser, U; Bickeboller, R; Willingstorfer, W; Beck, W; Elsner, G

2001-01-01

OBJECTIVES—To investigate the relation with a case-control study between symptomatic osteochondrosis or spondylosis of the lumbar spine and cumulative occupational exposure to lifting or carrying and to working postures with extreme forward bending.
METHODS—From two practices and four clinics were recruited 229 male patients with radiographically confirmed osteochondrosis or spondylosis of the lumbar spine associated with chronic complaints. Of these 135 had additionally had acute lumbar disc...

Lumbar spinal stenosis

DEFF Research Database (Denmark)

Lønne, Greger; Fritzell, Peter; Hägg, Olle

2018-01-01

BACKGROUND: Decompression surgery for lumbar spinal stenosis (LSS) is the most common spinal procedure in the elderly. To avoid persisting low back pain, adding arthrodesis has been recommended, especially if there is a coexisting degenerative spondylolisthesis. However, this strategy remains con...

General practitioners' willingness to request plain lumbar spine radiographic examinations

Energy Technology Data Exchange (ETDEWEB)

Ryynaenen, Olli-Pekka E-mail: ollipekka.ryynanen@uku.fi; Lehtovirta, Jukka; Soimakallio, Seppo; Takala, Jorma

2001-01-01

Objectives: To examine general practitioners' attitudes to plain lumbar spine radiographic examinations. Design: A postal questionnaire consisting of questions on background data and doctors' opinions about plain lumbar spine radiographic examinations, as well as eight vignettes (imaginary patient cases) presenting indications for lumbar radiography, and five vignettes focusing on the doctors' willingness to request lumbar radiography on the basis of patients' age and duration of symptoms. The data were analysed according to the doctor's age, sex, workplace and the medical school of graduation. Setting: Finland. Subjects: Six hundred and fifteen randomly selected physicians working in primary health care (64% of original target group). Results: The vignettes revealed that the use of plain lumbar radiographic examination varied between 26 and 88%. Patient's age and radiation protection were the most prominent factors influencing doctors' decisions to request lumbar radiographies. Only slight differences were observed between the attitudes of male and female doctors, as well as between young and older doctors. Doctors' willingness to request lumbar radiographies increased with the patient's age in most vignettes. The duration of patients' symptoms had a dramatic effect on the doctor's decision: in all vignettes, doctors were more likely to request lumbar radiography when patient's symptoms had exceeded 4 weeks. Conclusions: General practitioners commonly use plain lumbar spine radiographic examinations, despite its limited value in the diagnosis of low back pain. Further consensus and medical education is needed to clarify the indications for plain lumbar radiographic examination.

Imaging of thoracic and lumbar spinal extradural arachnoid cysts: report of two cases

International Nuclear Information System (INIS)

Rimmelin, A.; Clouet, P.L.; Salatino, S.; Kehrli, P.; Maitrot, D.; Stephan, M.; Dietemann, J.L.

1997-01-01

Extradural arachnoid cysts are uncommon expanding lesions in the spinal canal which may communicate with the subarachnoid space. Usually in the lower thoracic spine, they may cause symptoms by compressing the spinal cord or nerve roots. We report cases of thoracic and lumbar arachnoid cysts studied by cystography, myelography, CT and MRI. These techniques showed extradural cystic lesions containing cerebrospinal fluid, with variable communication with the subarachnoid space, causing anterior displacement and flattening of the spinal cord. (orig.)

Hepatocellular Carcinoma Supplied by the Right Lumbar Artery

International Nuclear Information System (INIS)

Miyayama, Shiro; Yamashiro, Masashi; Okuda, Miho; Yoshie, Yuichi; Sugimori, Natsuki; Igarashi, Saya; Nakashima, Yoshiko; Matsui, Osamu

2010-01-01

This study evaluated the clinical features of hepatocellular carcinoma (HCC) supplied by the right lumbar artery. Eleven patients with HCC supplied by the right lumbar artery were treated with chemoembolization. The patients' medical records were retrospectively analyzed. All patients underwent 6.7 ± 3.7 (mean ± SD) chemoembolization sessions, and the hepatic arterial branches were noted as being attenuated. The right inferior phrenic artery (IPA) was also embolized in 10 patients. The interval between initial chemoembolization and chemoembolization of the lumbar artery supply was 53.2 ± 26.9 months. Mean tumor diameter was 3.1 ± 2.4 cm and was located at the surface of S7 and S6. The feeding-branch arose proximal to the bifurcation of the dorsal ramus and muscular branches (n = 8) or from the muscular branches (n = 3) of the right first (n = 10) or second lumbar artery (n = 1). The anterior spinal artery originated from the tumor-feeding lumbar artery in one patient. All feeders were selected, and embolization was performed after injection of iodized oil and anticancer drugs (n = 10) or gelatin sponge alone in a patient with anterior spinal artery branching (n = 1). Eight patients died from tumor progression 10.1 ± 4.6 months later, and two patients survived 2 and 26 months, respectively. The remaining patient died of bone metastases after 32 months despite liver transplantation 10 months after chemoembolization. The right lumbar artery supplies HCC located in the bare area of the liver, especially in patients who undergo repeated chemoembolization, including chemoembolization by way of the right IPA. Chemoembolization by way of the right lumbar artery may be safe when the feeder is well selected.

Physiological pattern of lumbar disc height

International Nuclear Information System (INIS)

Biggemann, M.; Frobin, W.; Brinckmann, P.

1997-01-01

Purpose of this study is to present a new method of quantifying objectively the height of all discs in lateral radiographs of the lumbar spine and of analysing the normal craniocaudal sequence pattern of lumbar disc heights. Methods: The new parameter is the ventrally measured disc height corrected for the dependence on the angle of lordosis by normalisation to mean angles observed in the erect posture of healthy persons. To eliminate radiographic magnification, the corrected ventral height is related to the mean depth of the cranially adjoining vertebra. In this manner lumbar disc heights were objectively measured in young, mature and healthy persons (146 males and 65 females). The craniocaudal sequence pattern was analysed by mean values from all persons and by height differences of adjoining discs in each individual lumbar spine. Results: Mean normative values demonstrated an increase in disc height between L1/L2 and L4/L5 and a constant or decreasing disc height between L4/L5 and L5/S1. However, this 'physiological sequence of disc height in the statistical mean' was observed in only 36% of normal males and 55% of normal females. Conclusion: The radiological pattern of the 'physiological sequence of lumbar disc height' leads to a relevant portion of false positive pathological results especially at L4/L5. An increase of disc height from L4/L5 to L5/S1 may be normal. The recognition of decreased disc height should be based on an abrupt change in the heights of adjoining discs and not on a deviation from a craniocaudal sequence pattern. (orig.) [de

Return to Golf After Lumbar Fusion.

Science.gov (United States)

Shifflett, Grant D; Hellman, Michael D; Louie, Philip K; Mikhail, Christopher; Park, Kevin U; Phillips, Frank M

Spinal fusion surgery is being increasingly performed, yet few studies have focused on return to recreational sports after lumbar fusion and none have specifically analyzed return to golf. Most golfers successfully return to sport after lumbar fusion surgery. Case series. Level 4. All patients who underwent 1- or 2-level primary lumbar fusion surgery for degenerative pathologies performed by a single surgeon between January 2008 and October 2012 and had at least 1-year follow-up were included. Patients completed a specifically designed golf survey. Surveys were mailed, given during follow-up clinic, or answered during telephone contact. A total of 353 patients met the inclusion and exclusion criteria, with 200 responses (57%) to the questionnaire producing 34 golfers. The average age of golfers was 57 years (range, 32-79 years). In 79% of golfers, preoperative back and/or leg pain significantly affected their ability to play golf. Within 1 year from surgery, 65% of patients returned to practice and 52% returned to course play. Only 29% of patients stated that continued back/leg pain limited their play. Twenty-five patients (77%) were able to play the same amount of golf or more than before fusion surgery. Of those providing handicaps, 12 (80%) reported the same or an improved handicap. More than 50% of golfers return to on-course play within 1 year of lumbar fusion surgery. The majority of golfers can return to preoperative levels in terms of performance (handicap) and frequency of play. This investigation offers insight into when golfers return to sport after lumbar fusion surgery and provides surgeons with information to set realistic expectations postoperatively.

Three-dimensional motion analysis of the lumbar spine during "free squat" weight lift training.

Science.gov (United States)

Walsh, James C; Quinlan, John F; Stapleton, Robert; FitzPatrick, David P; McCormack, Damian

2007-06-01

Heavy weight lifting using a squat bar is a commonly used athletic training exercise. Previous in vivo motion studies have concentrated on lifting of everyday objects and not on the vastly increased loads that athletes subject themselves to when performing this exercise. Athletes significantly alter their lumbar spinal motion when performing squat lifting at heavy weights. Controlled laboratory study. Forty-eight athletes (28 men, 20 women) performed 6 lifts at 40% maximum, 4 lifts at 60% maximum, and 2 lifts at 80% maximum. The Zebris 3D motion analysis system was used to measure lumbar spine motion. Exercise was performed as a "free" squat and repeated with a weight lifting support belt. Data obtained were analyzed using SAS. A significant decrease (P free squat or when lifting using a support belt in any of the groups studied. Weight lifting using a squat bar causes athletes to significantly hyperextend their lumbar spines at heavier weights. The use of a weight lifting support belt does not significantly alter spinal motion during lifting.

Relationship between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation.

Science.gov (United States)

Taspinar, Ferruh; Taspinar, Betul; Ozkan, Yasemin; Afsar, Emrah; Gul, Canan; Durmaz, Elif Dilara

2016-06-17

Lumbar disc herniation leads to disability by restricting of patients' lives and reducing their quality of life. This situation causes a decrease in motivation of patients by triggering depressive mood. Therefore, the aim of the study was investigation of correlation between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation. Totally forty-seven patients (24 male and 23 female patients) diagnosed lumbar disc herniation was included in this study. Maslach II Burnout Inventory (MBI) and Fear Avoidance Beliefs Questionnaire (FABQ) for determining of levels of burnout and fear avoidance level were used, respectively. It was observed that MBI and FABQ scores of the patients were 50.78 ± 10.07 and 36.61 ± 13.91, respectively. Moderate level correlation was found between FABQ and MBI total scores (r= 0.49, p= 0.00). Fear avoidance beliefs of patients with chronic back pain can affect level of burnout syndrome. Therefore, symptoms of burnout syndrome and fear avoidance beliefs of patients should be considered in evaluation and treatment process.

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...

Rescue Implantation of Expandable Cages for Severe Osteolysis and Cage Dislocation in the Lumbosacral Junction.

Science.gov (United States)

Schatlo, Bawarjan; Rohde, Veit; Solomiichuk, Volodymyr; von Eckardstein, Kajetan; Behm, Timo

2017-11-01

Osteolysis and implant loosening are commonly encountered problems after spinal instrumentation. In a patient who had previously undergone a posterior lumbar interbody fusion procedure, fusion did not occur, and a secondary cage dislocation led to an impingement of the L5 nerve root with severe radiculopathy. Revision surgery was performed. Intraoperatively, osteolysis was found to be so severe that conventional cages did not fill the void to allow for sufficient anterior column support. We used expandable transforaminal lumbar interbody fusion cages and implanted them bilaterally to replace the dislodged posterior lumbar interbody fusion cages. Clinical follow-up was uneventful. Imaging performed at 1 year showed satisfactory cage position and fusion. We propose the use of cages with the ability of ventral distraction in similar rescue interventions with cage dislocation and bone resorption. This may prevent a second surgery via a ventral approach. Copyright © 2017 Elsevier Inc. All rights reserved.

Morphometric and Histological Study of Osteophytes in Human Cadaveric Lumbar Vertebrae

OpenAIRE

Ashwini Aithal Padur; Naveen Kumar; Swamy Ravindra Shanthakumar; Arijit Bishnu

2017-01-01

Introduction: Osteophytes are bony outgrowth on the vertebral column. Its prevalence in the lumbar region and clinical importance mandates to conduct a detailed study of lumbar osteophytes in the cadaveric vertebral column. Aim: The present study was conducted to study the detailed features of lumbar osteophytes and document its prevalence, morphometric and histological structure. Materials and Methods: This was an observational study in which frequency of occurrence of lumbar osteophyt...

Investigation of the load on the lumbar region in nursing technique's movements - relation between twist and surface electromyogram.

Science.gov (United States)

Maekawa, Yasuko; Shiozaki, Akira; Majima, Yukie

2009-01-01

This study measured the twist angle of the lumbar region and the surface electromyogram (EMG) and examined their mutual relation to elucidate the degree and influence of factors of "twist" in nursing techniques as a cause of lower back pain. Using a goniometer (two-way angle and twist sensors) and an EMG(SX230; DKH Co., Ltd.), we conducted measurements by affixing the goniometer on the lumbar vertebral column and EMG sensor at four points of right and left sides of L2 and L4 (of the erector muscle of the spine). The measured nursing techniques were three common methods of "transferring a patient from bed to wheelchair," which is said to impart a heavy load on the lumbar region. Results show that the correlation value between the twist angle rate and mean energy is likely to be greater, suggesting that the magnitude of the load on the lumbar region should be related to the twist speed rather than to the twist angle of the movement itself.

Assessment of changes in spine curvatures and the sensations caused in three different types of working seats

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Caique de Melo do Espírito Santo

2017-08-01

Full Text Available Abstract Aims This study aimed to evaluate the changes in the spine curvatures and the sensations caused by different types of seats: standard, ischial support and salli. Methods The analyzes were performed by the kinematics and scales of discomfort and pain in 14 healthy subjects. The data collection occurred in three days, one day for each type of seat. The subjects answered questionnaires and were assessed for placement of kinematic markers used to measure the thoracic, thoraco-lumbar and lumbar angles. Each trial was conducted in a sixty-minute period on each chair. Results and conclusions The results showed that the salli seat type causes larger lumbar angles, which is consistent with the maintenance of lumbar lordosis. Likewise, the salli seat showed smaller thoraco-lumbar angle, which is consistent with smaller inferior thoracic kyphosis. Paradoxically, the ischial support seat produced less discomfort and pain than salli type. And finally, the longer the sitting position was the higher the score on the discomfort scale.

Transforaminal Lumbar Puncture: An Alternative Technique in Patients with Challenging Access.

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Nascene, D R; Ozutemiz, C; Estby, H; McKinney, A M; Rykken, J B

2018-05-01

Interlaminar lumbar puncture and cervical puncture may not be ideal in all circumstances. Recently, we have used a transforaminal approach in selected situations. Between May 2016 and December 2017, twenty-six transforaminal lumbar punctures were performed in 9 patients (25 CT-guided, 1 fluoroscopy-guided). Seven had spinal muscular atrophy and were referred for intrathecal nusinersen administration. In 2, CT myelography was performed via transforaminal lumbar puncture. The lumbar posterior elements were completely fused in 8, and there was an overlying abscess in 1. The L1-2 level was used in 2; the L2-3 level, in 10; the L3-4 level, in 12; and the L4-5 level, in 2 procedures. Post-lumbar puncture headache was observed on 4 occasions, which resolved without blood patching. One patient felt heat and pain at the injection site that resolved spontaneously within hours. One patient had radicular pain that resolved with conservative treatment. Transforaminal lumbar puncture may become an effective alternative to classic interlaminar lumbar puncture or cervical puncture. © 2018 by American Journal of Neuroradiology.

Lumbar lordosis and sacral slope in lumbar spinal stenosis: standard values and measurement accuracy.

Science.gov (United States)

Bredow, J; Oppermann, J; Scheyerer, M J; Gundlfinger, K; Neiss, W F; Budde, S; Floerkemeier, T; Eysel, P; Beyer, F

2015-05-01

Radiological study. To asses standard values, intra- and interobserver reliability and reproducibility of sacral slope (SS) and lumbar lordosis (LL) and the correlation of these parameters in patients with lumbar spinal stenosis (LSS). Anteroposterior and lateral X-rays of the lumbar spine of 102 patients with LSS were included in this retrospective, radiologic study. Measurements of SS and LL were carried out by five examiners. Intraobserver correlation and correlation between LL and SS were calculated with Pearson's r linear correlation coefficient and intraclass correlation coefficients (ICC) were calculated for inter- and intraobserver reliability. In addition, patients were examined in subgroups with respect to previous surgery and the current therapy. Lumbar lordosis averaged 45.6° (range 2.5°-74.9°; SD 14.2°), intraobserver correlation was between Pearson r = 0.93 and 0.98. The measurement of SS averaged 35.3° (range 13.8°-66.9°; SD 9.6°), intraobserver correlation was between Pearson r = 0.89 and 0.96. Intraobserver reliability ranged from 0.966 to 0.992 ICC in LL measurements and 0.944-0.983 ICC in SS measurements. There was an interobserver reliability ICC of 0.944 in LL and 0.990 in SS. Correlation between LL and SS averaged r = 0.79. No statistically significant differences were observed between the analyzed subgroups. Manual measurement of LL and SS in patients with LSS on lateral radiographs is easily performed with excellent intra- and interobserver reliability. Correlation between LL and SS is very high. Differences between patients with and without previous decompression were not statistically significant.

Use of CT scanning for the study of posterior lumbar intervertebral articulations

Energy Technology Data Exchange (ETDEWEB)

Hermanus, N.; de Becker, D.; Baleriaux, D.; Hauzeur, J.P.

1983-01-01

CT scan is peculiarly effective in the study of architectural pathologies of the column; it appears that a number of etiological factors of low back pain are involved and they are often related. Indeed, dis herniation, for instance, is frequently associated with facetal asymmetry, the first signs of arthroses and ligamentous calcification after treatment. The three vertebral axes must be evaluated, one discal and two facetal, the slightest defect in one of which can affect the two others. Moreover, in view of the complexity of the innervation, the entire lumbar column from L1 to L5 S1 must be investigated: it is not uncommonly that low sciatica is caused by a more cranial lumbar pathology. This systematic study promotes better understanding of the etiology of low back pain and suggests a stet judicious therapeutic attitude.

Clinical outcomes of two minimally invasive transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases.

Science.gov (United States)

Tian, Yonghao; Liu, Xinyu

2016-10-01

There are two modified TLIF, including MIS-TLIF and TLIF through Wiltse approach (W-TLIF). Although both of the two minimally invasive surgical procedures can be effective in the treatment for lumbar degenerative diseases, no comparative analysis has been made so far regarding their clinical outcomes. To compare the clinical outcomes of MIS-TLIF and W-TLIF for the treatment for single-segment degenerative lumbar diseases. Ninety-seven patients with single-segment degenerative lumbar disorders were included in this study. Forty-seven underwent MIS-TLIF surgery (group A). For group B, fifty patients underwent W-TLIF. The Japanese Orthopedic Association (JOA) score, the visual analog scale (VAS) of low back pain (LBP) and leg pain, MRI score and atrophy rate of CSA, interbody fusion rate were assessed during the postoperative follow-up. Incision length, blood loss, operative time, CPK, and postoperative incision pain VAS were better in group A (P degenerative disease. MIS-TLIF has less blood loss, shorter surgical incision, and less lower postoperative back pain, while W-TLIF is less expensive for hospital stay with lower exposure to X-rays.

[THE ALTERNATIVE MODEL IN TRAINING FOR OPERATION MANAGEMENT ON LUMBAR SPINE].

Science.gov (United States)

Zakondyrin, D E

2015-01-01

The authors proposed to use a lumbar part of calf carcass as a new biological model for training of basic practical skills in order to perform the neurosurgical operative interventions on the spine. The proximity of anatomico-surgical parameters of given model and human cavader lumbar spine was estimated. The study proved the possibility of use of lumbar part of calf carcass for training techniques of transpedicular fixation and microdiskectomy in lumbar part.

Fem Modelling of Lumbar Vertebra System

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Rimantas Kačianauskas

2014-02-01

Full Text Available The article presents modeling of human lumbar vertebra and it‘sdeformation analysis using finite elements method. The problemof tissue degradation is raised. Using the computer aided modelingwith SolidWorks software the models of lumbar vertebra(L1 and vertebra system L1-L4 were created. The article containssocial and medical problem analysis, description of modelingmethods and the results of deformation test for one vertebramodel and for model of 4 vertebras (L1-L4.

Effect of intervertebral disc disease on scoliosis in the lumbar spine

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Wojcik Gustaw

2014-09-01

Full Text Available Lumbar intervertebral discopathy is a common clinical problem and a significant cause of low back pain. Usually it is associated with overload and damage to the intervertebral disc, which directly relates to the instability of the motion segment. Renal normal anatomy between tissues within the spinal canal is a cause of the reflex curvature of the spine, the goal is to increase the volume of the spinal channel and reduce the compression of the nerve tissue. Knee-jerk reaction to pain is an non physiological change of the setting of the spine in the frontal plane.

Application of percutaneous endoscopic RF/holmium laser lumbar discectomy in the lumbar disc herniation (attach 160 cases reported)

International Nuclear Information System (INIS)

Zhao Zhengxu; Hu Tongzhou; He Jun; Jiang Zenghui; Wang Weiqi; Lin Hang

2010-01-01

Objective: To evaluate the efficacy of endoscopic discectomy for the lumbar disc herniation and to determine the prognostic factors affecting surgical outcome. Methods: In the group of 160 cases, posterolateral and trans-interlaminar endoscopic Ho: YAG laser and radio frequency-assisted disc excisions were performed under local anesthesia. Results: In 160 patients with post-surgical follow-up period was 15 months on average (7 ∼ 24 months). Based on the MacNab criteria, there were 117 cases in which result was excellent, in 19 cases good, in 12 cases fair, and in 12 cases poor, and successful rate was 85%. Conclusion: Percutaneous endoscopy lumbar discectomy is effective for recurrent disc herniation in the selected. In applies in particular to the traditional open surgery of lumbar disc herniation in patients with recurrent. (authors)

Lumbar Morel-Lavallée lesion: Case report and review of the literature.

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Zairi, F; Wang, Z; Shedid, D; Boubez, G; Sunna, T

2016-06-01

The Morel-Lavallée lesion (MLL) is a rarely reported closed degloving injury, in which shearing forces have lead to break off subcutaneous tissues from the underlying fascia. Lumbar MLL have been rarely reported to date, explaining that patients are frequently misdiagnosed. While patients could be treated conservatively or with non-invasive procedures, delayed diagnosis may require open surgery for its cure. Indeed, untreated lesions can cause pain, infection or growing subcutaneous mass that can be confused with a soft tissue tumor. We report the clinical and radiological features of a 45-year old man with voluminous lumbar MLL initially misdiagnosed. We also reviewed the relevant English literature to summarize the diagnostic tools and the main therapeutic options. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Coexisting lumbar spondylosis in patients undergoing TKA: how common and how serious?

Science.gov (United States)

Chang, Chong Bum; Park, Kun Woo; Kang, Yeon Gwi; Kim, Tae Kyun

2014-02-01

Information on the coexistence of lumbar spondylosis and its influence on overall levels of pain and function in patients with advanced knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA) would be valuable for patient consultation and management. The purposes of this study were to document the prevalence and severity of coexisting lumbar spondylosis in patients with advanced knee OA undergoing TKA and to determine whether the coexisting lumbar spondylosis at the time of TKA adversely affects clinical scores in affected patients before and 2 years after TKA. Radiographic lumbar spine degeneration and lumbar spine symptoms including lower back pain, radiating pain at rest, and radiating pain with activity were assessed in 225 patients undergoing TKA. In addition, the WOMAC score and the SF-36 scores were evaluated before and 2 years after TKA. Potential associations of radiographic lumbar spine degeneration and lumbar spine symptom severities with pre- and postoperative WOMAC subscales and SF-36 scores were examined. All 225 patients had radiographic degeneration of the lumbar spine, and the large majority (89% [200 of 225]) had either moderate or severe spondylosis (72% and 17%, respectively). A total of 114 patients (51%) had at least one moderate or severe lumbar spine symptom. No association was found between radiographic severity of lumbar spine degeneration and pre- and postoperative clinical scores. In terms of lumbar spine symptoms, more severe symptoms were likely to adversely affect the preoperative WOMAC and SF-36 physical component summary (PCS) scores, but most of these adverse effects improved by 2 years after TKA with the exception of the association between severe radiating pain during activity and a poorer postoperative SF-36 PCS score (regression coefficient = -5.41, p = 0.015). Radiographic lumbar spine degeneration and lumbar spine symptoms are common among patients with advanced knee OA undergoing TKA. Severe lumbar spine symptoms

Angiogenesis in the degeneration of the lumbar intervertebral disc

OpenAIRE

David, Gh; Ciurea, AV; Iencean, SM; Mohan, A

2010-01-01

The goal of the study is to show the histological and biochemical changes that indicate the angiogenesis of the intervertebral disc in lumbar intervertebral disc hernia and the existence of epidemiological correlations between these changes and the risk factors of lumbar intervertebral disc hernia, as well as the patient's quality of life (QOL). We have studied 50 patients aged between 18 and 73 years old, who have undergone lumbar intervertebral disc hernia surgery, making fibroblast growth ...

Critical analysis of extra peritoneal antero-lateral approach for lumbar plexus

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Roberto Sérgio Martins

2011-08-01

Full Text Available Lesions of lumbar plexus are uncommon and descriptions of surgical access are derived from vertebral spine approaches. METHOD: The extraperitoneal anterolateral approach to the lumbar plexus was performed in six adult fresh cadavers. The difficulties on dissection were related. RESULTS: An exposure of all distal elements of lumbar plexus was possible, but a cranial extension of the incision was needed to reach the iliohypogastric nerve in all cases. Ligation of vessels derived from common iliac artery was necessary for genitofemoral and obturator nerves exposure in two cases. The most proximal part of the lumbar roots could be identified only after dissection and clipping of most lumbar vessels. CONCLUSION: The extraperitoneal anterolateral approach allows appropriate exposure of terminal nerves of lumbar plexus laterallly to psoas major muscle. Cranial extension of the cutaneous incision may be necessary for exposure of iliohypogastric nerve. Roots exposure increases the risk of vascular damage.

FUNCTIONAL DISABILITY, SAGITTAL ALIGNMENT AND PELVIC BALANCE IN LUMBAR SPONDYLOLISTHESIS

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Luis Muñiz Luna

2016-03-01

Full Text Available ABSTRACT Objectives: To demonstrate the recovery of lumbar sagittal pelvic alignment and sagittal pelvic balance after surgical reduction of lumbar spondylolisthesis and establish the benefits of the surgery for reduction and fixation of the lumbar spondylolisthesis with 360o circumferential arthrodesis for 2 surgical approaches by clinical and functional evaluation. Method: Eight patients with lumbar spondylolisthesis treated with surgical reduction and fixation of listhesis and segmental circumferential fusion with two surgical approaches were reviewed. They were evaluated before and after treatment with Oswestry, Visual Analogue for pain and Odom scales, performing radiographic measurement of lumbar sagittal alignment and pelvic sagittal balance with the technique of pelvic radius. Results: Oswestry scales and EVA reported improvement of symptoms after treatment in 8 cases; the Odom scale had six outstanding cases reported. The lumbar sagittal alignment presented a lumbosacral lordosis angle and a lumbopelvic lordosis angle reduced in 4 cases and increased in 4 other cases; pelvic sagittal balance increased the pelvic angle in 4 cases and decreased in 3 cases and the sacral translation of the hip axis to the promontory increased in 6 cases. Conclusion: The surgical procedure evaluated proved to be useful by modifying the lumbar sagittal alignment and the pelvic balance, besides reducing the symptoms, enabling the patient to have mobility and movement and the consequent satisfaction with the surgery.

Morphometric and Histological Study of Osteophytes in Human Cadaveric Lumbar Vertebrae

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Ashwini Aithal Padur

2017-10-01

Full Text Available Introduction: Osteophytes are bony outgrowth on the vertebral column. Its prevalence in the lumbar region and clinical importance mandates to conduct a detailed study of lumbar osteophytes in the cadaveric vertebral column. Aim: The present study was conducted to study the detailed features of lumbar osteophytes and document its prevalence, morphometric and histological structure. Materials and Methods: This was an observational study in which frequency of occurrence of lumbar osteophytes was studied in 40 cadaveric vertebral columns over a period of four years. The lumbar part of the vertebral columns was dissected and examined meticulously. The occurrence of lumbar osteophytes with their vertebral levels and morphometric measurements were recorded. A small excision of the osteophyte was processed histologically to study its microscopic details using routine Haematoxylin & Eosin stain. Results: Lumbar osteophytes were present in 4 specimens (10%. They were mostly found on the right side of the vertebral bodies. Histopathological examination of the osteophytes revealed degenerative osteophytic cartilage and fibrillation overlying the trabecular bone enclosing fatty marrow spaces containing haematopoietic elements. Conclusion: Lumbar osteophytes were found in 10% of the specimens studied and it is assumed that these cadaveric reports deserve further attention given their potential clinical implications. Knowledge regarding occurrence and incidence of osteophytes is essential for management of common degenerative changes of the vertebral column.

ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

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Jefferson Coelho de Léo

2015-09-01

Full Text Available Objective:To associate spinopelvic parameters, pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with the axial location of lumbar disc herniation.Methods:Retrospective study, which evaluated imaging and medical records of 61 patients with lumbar disc herniation, who underwent surgery with decompression and instrumented lumbar fusion in only one level. Pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with simple lumbopelvic lateral radiographs, which included the lumbar spine, the sacrum and the proximal femur. The affected segment was identified as the level and location of lumbar disc herniation in the axial plane with MRI scans.Results:Of 61 patients, 29 (47.5% had low lumbar lordosis; in this group 24 (82.8% had central disc herniation, 4 (13.8% had lateral recess disc herniation and 1 (3.4% had extraforaminal disc herniation (p<0.05. Of the 61 patients, 18 (29.5% had low sacral slope; of this group 15 (83.3% had central disc herniation and 3 (16.7% had disc herniation in lateral recess (p<0.05.Conclusions:There is a trend towards greater load distribution in the anterior region of the spine when the spine has hypolordotic curve. This study found an association between low lordosis and central disc herniation, as well as low sacral slope and central disc herniation.

Magnetic Resonance Imaging Quantification of Lumbar Spinal Canal Stenosis in Symptomatic Subjects

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Siddarth Ragupathi

2017-10-01

Full Text Available Introduction: Low backache is a common condition to occur in the middle age. It is mainly caused by the degeneration of the intervertebral disc which forms the main support to the vertebral column. Lumbar spinal canal stenosis results in the compression of spinal cord and nerves at the level of lumbar vertebra. Aim: The purpose of this study is to measure the spinal canal dimensions and correlate with the clinical symptoms to establish a radiological criterion based on MRI for diagnosis of lumbar canal stenosis. This study is done to improve the diagnostic accuracy of lumbar spinal canal stenosis. Materials and Methods: Two hundred subjects with complaints of low backache without a traumatic history underwent Magnetic Resonance Imaging (MRI after assessment of pain by two methods: 1. Oswestry Disability Index (ODI scoring and 2. Wong Baker Facial Expression scale. All the images were qualitatively analyzed to obtain the MRI grading for central canal at various levels from L1 to S1 vertebra after making sure that the neural foramina is not involved. Anteroposterior (AP and transverse diameter of spinal canal at intervertebral disc and upper part of vertebral body levels and spinal canal area are measurements that are taken. Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented on mean±SD (min-max and results on categorical measurements are presented in number (%. Significance is assessed at 5% level of significance. Results: The spinal canal diameter measured along its AP and transverse direction is found to be correlating with the severity of low backache complained by the patient. Comparing the two methods of clinical assessment, ODI scoring was found to be more significant. Conclusion: The spinal canal measurements can be used as a radiologic criterion for diagnosis of acquired lumbar spinal canal stenosis. This will improve the diagnostic accuracy. However

Dual photon absorptiometry in lumbar vertebrae

International Nuclear Information System (INIS)

Roos, B.O.; Hansson, T.H.; Skoeldborn, H.

1980-01-01

In connection with determination of the bone mineral content in the third lumbar vertebra by dual photon absorptiometry, the fat in the adipose capsules of the kidneys is assumed to cause erroneous positioning of the baseline, leading to overestimation of the bone mineral content. The bone mineral content in L3 was measured in situ (BMC 1 ) and vitro (BMC 2 ) in 14 cadavers. The difference between BMC 1 and BMC 2 was significantly greater than zero, the median value being 0.32 g/cm at the confidence level of 94.4 per cent. It is concluded that at correlation between bone mineral content and compressive strength in vitro, the in vivo strength is overestimated by about 250 N. (Auth.)

Kinematics of the lumbar spine : clinical significance of lateral X-rays of the lumbar spine in anteflexion and retroflexion in healthy individuals, in cases of symptomatic herniated lumbar disc diseases and of spondylolisthesis

NARCIS (Netherlands)

M.W. Berfelo

1989-01-01

textabstractAbout half of the population of the Netherlands suffers at some stage in their life from low back pain (Haanen, 1984) ; clinical examination of the lumbar spine is a matter of daily routine. X-Rays of the lumbar spine are taken in order to detect morphological changes that may be

Hybrid dynamic stabilization: a biomechanical assessment of adjacent and supraadjacent levels of the lumbar spine.

Science.gov (United States)

Mageswaran, Prasath; Techy, Fernando; Colbrunn, Robb W; Bonner, Tara F; McLain, Robert F

2012-09-01

The object of this study was to evaluate the effect of hybrid dynamic stabilization on adjacent levels of the lumbar spine. Seven human spine specimens from T-12 to the sacrum were used. The following conditions were implemented: 1) intact spine; 2) fusion of L4-5 with bilateral pedicle screws and titanium rods; and 3) supplementation of the L4-5 fusion with pedicle screw dynamic stabilization constructs at L3-4, with the purpose of protecting the L3-4 level from excessive range of motion (ROM) and to create a smoother motion transition to the rest of the lumbar spine. An industrial robot was used to apply continuous pure moment (± 2 Nm) in flexion-extension with and without a follower load, lateral bending, and axial rotation. Intersegmental rotations of the fused, dynamically stabilized, and adjacent levels were measured and compared. In flexion-extension only, the rigid instrumentation at L4-5 caused a 78% decrease in the segment's ROM when compared with the intact specimen. To compensate, it caused an increase in motion at adjacent levels L1-2 (45.6%) and L2-3 (23.2%) only. The placement of the dynamic construct at L3-4 decreased the operated level's ROM by 80.4% (similar stability as the fusion at L4-5), when compared with the intact specimen, and caused a significant increase in motion at all tested adjacent levels. In flexion-extension with a follower load, instrumentation at L4-5 affected only a subadjacent level, L5-sacrum (52.0%), while causing a reduction in motion at the operated level (L4-5, -76.4%). The dynamic construct caused a significant increase in motion at the adjacent levels T12-L1 (44.9%), L1-2 (57.3%), and L5-sacrum (83.9%), while motion at the operated level (L3-4) was reduced by 76.7%. In lateral bending, instrumentation at L4-5 increased motion at only T12-L1 (22.8%). The dynamic construct at L3-4 caused an increase in motion at T12-L1 (69.9%), L1-2 (59.4%), L2-3 (44.7%), and L5-sacrum (43.7%). In axial rotation, only the placement of

A lumbar body support (KBS 2000) alters lumbar muscle recruitment ...

African Journals Online (AJOL)

random order) either a flat conventional mattress or a LBS placed on top of the ... mirrored these changes and were higher in patients only when lying on the flat ... While studies have examined the effect of lumbar support on LBP during sitting ... measured using a 4-channel EMG and customised software programme (EM8 ...

NONFUSION STABILIZATION IN THE DEGENERATIVE LUMBAR SPINE DISEASES

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Matjaž Voršič

2009-04-01

Conclusions Cosmic is a posterior dynamic nonfusion pedicle screw-rod system for the stabilization of the lumbar vertebral column. It represents the new step in the development of the spinal instrumentation and can efficiently replace the spondylodesis in the treatment of painful degenerative diseases of the lumbar spine.

The Influence of Pelvic Incidence and Lumbar Lordosis Mismatch on Development of Symptomatic Adjacent Level Disease Following Single-Level Transforaminal Lumbar Interbody Fusion.

Science.gov (United States)

Tempel, Zachary J; Gandhoke, Gurpreet S; Bolinger, Bryan D; Khattar, Nicolas K; Parry, Philip V; Chang, Yue-Fang; Okonkwo, David O; Kanter, Adam S

2017-06-01

Annual incidence of symptomatic adjacent level disease (ALD) following lumbar fusion surgery ranges from 0.6% to 3.9% per year. Sagittal malalignment may contribute to the development of ALD. To describe the relationship between pelvic incidence-lumbar lordosis (PI-LL) mismatch and the development of symptomatic ALD requiring revision surgery following single-level transforaminal lumbar interbody fusion for degenerative lumbar spondylosis and/or low-grade spondylolisthesis. All patients who underwent a single-level transforaminal lumbar interbody fusion at either L4/5 or L5/S1 between July 2006 and December 2012 were analyzed for pre- and postoperative spinopelvic parameters. Using univariate and logistic regression analysis, we compared the spinopelvic parameters of those patients who required revision surgery against those patients who did not develop symptomatic ALD. We calculated the predictive value of PI-LL mismatch. One hundred fifty-nine patients met the inclusion criteria. The results noted that, for a 1° increase in PI-LL mismatch (preop and postop), the odds of developing ALD requiring surgery increased by 1.3 and 1.4 fold, respectively, which were statistically significant increases. Based on our analysis, a PI-LL mismatch of >11° had a positive predictive value of 75% for the development of symptomatic ALD requiring revision surgery. A high PI-LL mismatch is strongly associated with the development of symptomatic ALD requiring revision lumbar spine surgery. The development of ALD may represent a global disease process as opposed to a focal condition. Spine surgeons may wish to consider assessment of spinopelvic parameters in the evaluation of degenerative lumbar spine pathology. Copyright © 2017 by the Congress of Neurological Surgeons

The association of spinal osteoarthritis with lumbar lordosis

Science.gov (United States)

2010-01-01

Background Careful review of published evidence has led to the postulate that the degree of lumbar lordosis may possibly influence the development and progression of spinal osteoarthritis, just as misalignment does in other joints. Spinal degeneration can ensue from the asymmetrical distribution of loads. The resultant lesions lead to a domino- like breakdown of the normal morphology, degenerative instability and deviation from the correct configuration. The aim of this study is to investigate whether a relationship exists between the sagittal alignment of the lumbar spine, as it is expressed by lordosis, and the presence of radiographic osteoarthritis. Methods 112 female subjects, aged 40-72 years, were examined in the Outpatients Department of the Orthopedics' Clinic, University Hospital of Heraklion, Crete. Lumbar radiographs were examined on two separate occasions, independently, by two of the authors for the presence of osteoarthritis. Lordosis was measured from the top of L1 to the bottom of L5 as well as from the top of L1 to the top of S1. Furthermore, the angle between the bottom of L5 to the top of S1was also measured. Results and discussion 49 women were diagnosed with radiographic osteoarthritis of the lumbar spine, while 63 women had no evidence of osteoarthritis and served as controls. The two groups were matched for age and body build, as it is expressed by BMI. No statistically significant differences were found in the lordotic angles between the two groups Conclusions There is no difference in lordosis between those affected with lumbar spine osteoarthritis and those who are disease free. It appears that osteoarthritis is not associated with the degree of lumbar lordosis. PMID:20044932

Lumbar disc herniation in patients with chronic backache.

Science.gov (United States)

Ali, Asghar; Khan, Shahbaz Ali; Aurangzeb, Ahsan; Ahmed, Ehtisham; Ali, Gohar; Muhammad, Gul; Mehmood, Shakir

2013-01-01

Low back pain with or without lower extremity pain is the most common problem among chronic pain disorders with significant economic, social, and health impact. This study was conducted to determine the frequency of lumbar disc herniation and its different levels, among patients with chronic backache. This cross sectional study was conducted in the department of Neurosurgery, Ayub Medical College Abbottabad from January 2011 to January 2013. All the patients presenting with chronic low backache of either gender above the age 14 years were included in the study. Magnetic resonance imaging (MRI) was done in all the patients included in the study to look for lumbar disc herniation. A total of 477 patients with chronic low backache were included in the study out of which 274 (57.4%) were males. Age of the patients ranged from 19 to 75 (39.92 +/- 12.31) years. Out of 477 patients 38 (7.9%) had significant radiological evidence of disc prolapse at lumbar vertebral levels, with 26 (9.5%) males and 12 (5.9%) females. Among these 38 patients with inter-vertebral disc, 20 (52.6%) of patients had disc herniation at L5-S1, 15 (39.5%) at L4-L5, 2 (5.26%) cases at L3-L4 level and only one case (2.6%) had the involvement of L2-L3 level. No cases of L1-L2 disc prolapse were found. Patients with chronic backache can have inter-vertebral lumbar disc prolapsed disease. Middle age group are more affected by lumbar disc disease especially at the lower lumbar regions.

Bone mineral density of lumbar spine and femur in acromegaly

International Nuclear Information System (INIS)

Huebsch, P.; Kotzmann, H.; Svoboda, T.; Kainberger, F.M.; Bankier, A.; Seidl, G.

1993-01-01

Acromegaly is regarded as a cause for secondary osteoporosis, whereas recent papers suggest that growth hormone increases bone mineral density (BMD). In 16 patients with active acromegaly we found an increased BMD compared to normal controls in the lumbar spine and the proximal femur by means of dual energy X-ray absoptiometry. This increase in BMD was statistically significant in the femoral neck and in Ward's triangle (P=0.05). Moreover, no signs of osteoporosis were found radiologically. (orig.) [de

An empirical study of preferred settings for lumbar support on adjustable office chairs.

Science.gov (United States)

Coleman, N; Hull, B P; Ellitt, G

1998-04-01

The preferred settings for lumbar support height and depth of 43 male and 80 female office workers were investigated. All subjects were equipped with identical modern office chairs with foam-padded backrests adjustable in both height and depth. Measurements of lumbar support settings were recorded in the workplace, outside of working hours, on four different occasions, over a 5 week period. Preferred lumbar support height and depth settings extended to both extremes of the adjustment range. The mean preferred height setting was 190 mm above the compressed seat surface. The mean depth setting (horizontal distance from front of seat to lumbar support point) was 387 mm. A regression model examining the effects of standing height, Body Mass Index (BMI) and gender on mean preferred lumbar support height showed a significant relationship between preferred height and BMI. Higher lumbar supports were chosen by subjects with greater BMIs. Gender and standing height were not associated with preferred lumbar support height settings. Preferred lumbar support depth was not significantly associated with standing height, gender or BMI. Older subjects were more likely to readjust their lumbar support from a disrupted position than younger subjects, indicating that older users are more sensitive to the position of their lumbar support. Subjects who reported recent back pain or discomfort that they believed to be associated with their chair or office work were found to set their lumbar support significantly closer to the front of the seat, probably to ensure greater support for their back. Based on the evidence that a high proportion of users do make adjustments to the height and depth of their lumbar support, and the finding that different groups of users, with different physical characteristics, adjust the position of their lumbar support in distinct and predictable ways, the researchers conclude that office chairs with traditional padded fixed-height lumbar supports are unlikely

Ultrasound-guided lumbar puncture in pediatric patients: technical success and safety.

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Pierce, David B; Shivaram, Giri; Koo, Kevin S H; Shaw, Dennis W W; Meyer, Kirby F; Monroe, Eric J

2018-06-01

Disadvantages of fluoroscopically guided lumbar puncture include delivery of ionizing radiation and limited resolution of incompletely ossified posterior elements. Ultrasound (US) allows visualization of critical soft tissues and the cerebrospinal fluid (CSF) space without ionizing radiation. To determine the technical success and safety of US-guided lumbar puncture in pediatric patients. A retrospective review identified all patients referred to interventional radiology for lumbar puncture between June 2010 and June 2017. Patients who underwent lumbar puncture with fluoroscopic guidance alone were excluded. For the remaining procedures, technical success and procedural complications were assessed. Two hundred and one image-guided lumbar punctures in 161 patients were included. Eighty patients (43%) had previously failed landmark-based attempts. One hundred ninety-six (97.5%) patients underwent lumbar puncture. Five procedures (2.5%) were not attempted after US assessment, either due to a paucity of CSF or unsafe window for needle placement. Technical success was achieved in 187 (95.4%) of lumbar punctures attempted with US guidance. One hundred seventy-seven (90.3%) were technically successful with US alone (age range: 2 days-15 years, weight range: 1.9-53.1 kg) and an additional 10 (5.1%) were successful with US-guided thecal access and subsequent fluoroscopic confirmation. Three (1.5%) cases were unsuccessful with US guidance but were subsequently successful with fluoroscopic guidance. Of the 80 previously failed landmark-based lumbar punctures, 77 (96.3%) were successful with US guidance alone. There were no reported complications. US guidance is safe and effective for lumbar punctures and has specific advantages over fluoroscopy in pediatric patients.

Contribution of hamstring fatigue to quadriceps inhibition following lumbar extension exercise.

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Hart, Joseph M; Kerrigan, D Casey; Fritz, Julie M; Saliba, Ethan N; Gansneder, Bruce; Ingersoll, Christopher D

2006-01-01

The purpose of this study was to determine the contribution of hamstrings and quadriceps fatigue to quadriceps inhibition following lumbar extension exercise. Regression models were calculated consisting of the outcome variable: quadriceps inhibition and predictor variables: change in EMG median frequency in the quadriceps and hamstrings during lumbar fatiguing exercise. Twenty-five subjects with a history of low back pain were matched by gender, height and mass to 25 healthy controls. Subjects performed two sets of fatiguing isometric lumbar extension exercise until mild (set 1) and moderate (set 2) fatigue of the lumbar paraspinals. Quadriceps and hamstring EMG median frequency were measured while subjects performed fatiguing exercise. A burst of electrical stimuli was superimposed while subjects performed an isometric maximal quadriceps contraction to estimate quadriceps inhibition after each exercise set. Results indicate the change in hamstring median frequency explained variance in quadriceps inhibition following the exercise sets in the history of low back pain group only. Change in quadriceps median frequency explained variance in quadriceps inhibition following the first exercise set in the control group only. In conclusion, persons with a history of low back pain whose quadriceps become inhibited following lumbar paraspinal exercise may be adapting to the fatigue by using their hamstring muscles more than controls. Key PointsA neuromuscular relationship between the lumbar paraspinals and quadriceps while performing lumbar extension exercise may be influenced by hamstring muscle fatigue.QI following lumbar extension exercise in persons with a history of LBP group may involve significant contribution from the hamstring muscle group.More hamstring muscle contribution may be a necessary adaptation in the history of LBP group due to weaker and more fatigable lumbar extensors.

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

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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.

Fine needle diagnosis in lumbar osteomyelitis

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Joshi, K.B.; Brinker, R.A.

1983-01-01

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

Tearing of the left iliac vessels in lumbar surgery revealed by multiphase post-mortem CT-angiography (MPMCTA).

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Vilariño Villaverde, Raquel; Bruguier, Christine; Zerlauth, Jean-Baptiste; De Froidmont, Sébastien; Grabherr, Silke

2016-05-01

Lumbar surgery is regularly applied in cases of discal hernia and acquired lumbar stenosis. In this report, we present a case of a laceration in the left common iliac artery and iliac vein during a lumbar surgery and discuss the literature concerning this kind of event. In the present case, the surgical procedure was followed by a sudden decrease in blood pressure, and the surgeon discovered an intra-abdominal haemorrhage that led to the patient's death. Postmortem investigation confirmed the intra-abdominal haemorrhage and revealed a laceration of the proximal portion of the left common iliac artery and left iliac vein. The source of bleeding could be detected especially thanks to multi-phase postmortem CT angiography (MPMCTA), which was performed prior to autopsy. We also found a haemorrhagic path through the intervertebral disc between the L4-L5 vertebrae, caused by the surgeon's instrument (pituitary rongeur). To date, a few cases have been described of iatrogenic death resulting from a tear in the iliac vessels during lumbar surgery, but not from the postmortem perspective. Such investigations have recently been modernized thanks to the introduction of forensic imaging. In particular, MPMCTA offers new possibilities in postmortem investigations and can be considered the new gold standard for investigating deaths related to medical intervention. Here we describe the first case of a death during lumbar surgery using this new method. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

DESCRIPTIVE STUDY ON SAGITTAL LUMBAR SPINE CHANGES IN STUDENTS OF THE FEDERAL EDUCATIONAL SYSTEM OF FLORIANÓPOLIS.

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Group, Susane; Santos, Saray Giovana Dos; Moro, Antônio Renato Pereira

2010-01-01

The purpose of this study was to assess the prevalence of sagittal lumbar spine postural abnormalities and associated factors among students in the federal educational system in Florianópolis. 288 adolescents (156 males and 132 females), aged from 15 to 18 years, who were students in the federal educational system in Florianópolis, Santa Catarina, were evaluated. To gather data, photogrammetry was used following a specific protocol for postural assessment, and a questionnaire was used to identify the prevalence and frequency of pain, and the activities that triggered the problem. In the data analysis, descriptive statistics, Student's t-test for independent samples, chi-square test and Poisson's regression were used, with the significance level set at p<0.05 for all the tests. The prevalence of low back pain was 49.3%, with weekly frequency in 43.1% of the sample. The prevalence of deviation was 53.8%, and 90.9% corresponded to rectification of lumbar curvature, and this affected males more frequently. A significant difference in lumbar angle was found between the sexes; higher prevalence ratios of postural deviations were found in the male group. The prevalences of low back pain and lumbar postural deviation were high, but the relationship between these variables did not present significance. The main causes of the lumbar pain were sports practice or vigorous activities and remaining in a seated position for extended periods of time.

The hybrid assisted limb (HAL) for Care Support, a motion assisting robot providing exoskeletal lumbar support, can potentially reduce lumbar load in repetitive snow-shoveling movements.

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Miura, Kousei; Kadone, Hideki; Koda, Masao; Abe, Tetsuya; Endo, Hirooki; Murakami, Hideki; Doita, Minoru; Kumagai, Hiroshi; Nagashima, Katsuya; Fujii, Kengo; Noguchi, Hiroshi; Funayama, Toru; Kawamoto, Hiroaki; Sankai, Yoshiyuki; Yamazaki, Masashi

2018-03-01

An excessive lumbar load with snow-shoveling is a serious problem in snowfall areas. Various exoskeletal robots have been developed to reduce lumbar load in lifting work. However, few studies have reported the attempt of snow-shoveling work using exoskeletal robots. The purpose of the present study was to test the hypothesis that the HAL for Care Support robot would reduce lumbar load in repetitive snow-shoveling movements. Nine healthy male volunteers performed repetitive snow-shoveling movements outdoors in a snowfall area for as long as possible until they were fatigued. The snow-shoveling trial was performed under two conditions: with and without HAL for Care Support. Outcome measures were defined as the lumbar load assessed by the VAS of lumbar fatigue after the snow-shoveling trial and the snow-shoveling performance, including the number of scoops, and snow shoveling time and distance. The mean of VAS of lumbar fatigue, the number of scoops, and snow-shoveling time and distance without HAL for Care Support were 75.4 mm, 50.3, 145 s, and 9.6 m, while with HAL for Care Support were 39.8 mm, 144, 366 s, and 35.4 m. The reduction of lumbar fatigue and improvement of snow-shoveling performance using HAL for Care Support were statistically significant. There was no adverse event during snow-shoveling with HAL for Care Support. In conclusion, the HAL for Care Support can reduce lumbar load in repetitive snow-shoveling movements. Copyright © 2017 Elsevier Ltd. All rights reserved.

Other Causes of Leg Pain

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... are visible just under the surface of the skin Spinal stenosis —narrowing in the spine, causing pressure on the nerves and spine, with resulting numbness and pain Lumbar disease Osteoarthritis QUESTIONS TO ASK YOUR HEALTH CARE PROVIDER Does my medical history raise my risk for P.A.D.? Do ...

Correlation between facet tropism and lumbar degenerative disease: a retrospective analysis.

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Gao, Tian; Lai, Qi; Zhou, Song; Liu, Xuqiang; Liu, Yuan; Zhan, Ping; Yu, Xiaolong; Xiao, Jun; Dai, Min; Zhang, Bin

2017-11-22

The aim of this study was to investigate the correlation between facet tropism and spinal degenerative diseases, such as degenerative lumbar spondylolisthesis, degenerative lumbar scoliosis, and lumbar disc herniation. This study retrospectively analysed clinical data from the Department of Orthopaedics at The First Affiliated Hospital of Nanchang University. Ninety-two patients were diagnosed with lumbar spondylolisthesis, 64 patients with degenerative scoliosis, and 86 patients with lumbar disc herniation between 1 October 2014 and 1 October 2016. All patients were diagnosed using 3.0 T magnetic resonance imaging and underwent conservative or operative treatment. Facet tropism was defined as greater than a ten degree between the facet joint angles on both sides. For L3-L4 degenerative lumbar spondylolisthesis, one out of six cases had tropism compared to seven out of the 86 controls (p = 0.474). At the L4-L5 level, 17/50 cases had tropism compared to 4/42 cases in the control group (p = 0.013). At the L5-S1 level, 18/36 cases had tropism compared to 7/56 controls (p = 0.000). For degenerative lumbar scoliosis at the L1-L5 level, 83/256 cases had tropism as compared to 36/256 controls (p = 0.000). For L3-L4 lumbar disc herniation two out of eight cases had tropism compared to 14/78 controls (p = 0.625). At the L4-L5 level, 19/44 cases had tropism compared to four out of 42 controls (p = 0.001). At the L5-S1 level, 24/34 cases had tropism compared to 10/52 controls (p = 0.000). At the L4-5 and L5-S1 levels, facet tropism is associated with degenerative spondylolisthesis. In the degenerative lumbar scoliosis group, the number of case with facet tropism was significantly higher than that of the control group. Facet tropism was associated with lumbar disc herniation at the L4-5 and L5-S1 levels. Overall, in these three lumbar degenerative diseases, facet tropism is a common phenomenon.

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

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2010-10-01

...) ANTHROPOMORPHIC TEST DEVICES 6-Year-Old Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The lumbar spine, abdomen, and pelvis consist of... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine, abdomen, and pelvis assembly and...

Intracranial haemorrhage following lumbar myelography: case report and review of the literature

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Suess, O.; Stendel, R.; Baur, S.; Schilling, A.; Brock, M.

2000-01-01

We describe a subacute intracranial subdural haematoma following lumbar myelography. This rare but potentially life-threatening complication has been reported both after lumbar myelography and following lumbar puncture for spinal anaesthesia. We review 16 previously reported cases of intracranial haemorrhage following lumbar myelography, and discuss the pathogenesis. In all reported cases post-puncture headache was the leading symptom and should therefore be regarded as a warning sign. (orig.)

The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis.

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Chun, Se-Woong; Lim, Chai-Young; Kim, Keewon; Hwang, Jinseub; Chung, Sun G

2017-08-01

Clinicians regard lumbar lordotic curvature (LLC) with respect to low back pain (LBP) in a contradictory fashion. The time-honored point of view is that LLC itself, or its increment, causes LBP. On the other hand, recently, the biomechanical role of LLC has been emphasized, and loss of lordosis is considered a possible cause of LBP. The relationship between LLC and LBP has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP. This study aimed to (1) determine the difference in LLC in those with and without LBP and (2) investigate confounding factors that might affect the association between LLC and LBP. Systematic review and meta-analysis. The inclusion criteria consisted of observational studies that included information on lumbar lordotic angle (LLA) assessed by radiological image, in both patients with LBP and healthy controls. Studies solely involving pediatric populations, or addressing spinal conditions of nondegenerative causes, were excluded. A systematic electronic search of Medline, Embase, Cochrane Library, CINAHL, Scopus, PEDro, and Web of Science using terms related to lumbar alignment and Boolean logic was performed: (lumbar lordo*) or (lumbar alignment) or (sagittal alignment) or (sagittal balance). Standardized mean differences (SMD) and 95% confidence intervals (CI) were estimated, and chi-square and I 2 statistics were used to assess within-group heterogeneity by random effects model. Additionally, the age and gender of participants, spinal disease entity, and the severity and duration of LBP were evaluated as possible confounding factors. A total of 13 studies consisting of 796 patients with LBP and 927 healthy controls were identified. Overall, patients with LBP tended to have smaller LLA than healthy controls. However, the studies were heterogeneous. In the meta-regression analysis, the factors of age, severity of LBP, and spinal disease entity were revealed to contribute

Clostridium difficile colitis in patients undergoing lumbar spine surgery.

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Skovrlj, Branko; Guzman, Javier Z; Silvestre, Jason; Al Maaieh, Motasem; Qureshi, Sheeraz A

2014-09-01

Retrospective database analysis. To investigate incidence, comorbidities, and impact on health care resources of Clostridium difficile infection after lumbar spine surgery. C. difficile colitis is reportedly increasing in hospitalized patients and can have a negative impact on patient outcomes. No data exist on estimates of C. difficile infection rates and its consequences on patient outcomes and health care resources among patients undergoing lumbar spine surgery. The Nationwide Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on International Classification of Diseases, Ninth Revision, Clinical Modification, procedural codes for lumbar spine surgery for degenerative diagnoses. Baseline patient characteristics were determined and multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality. The incidence of C. difficile infection in patients undergoing lumbar spine surgery is 0.11%. At baseline, patients infected with C. difficile were significantly older (65.4 yr vs. 58.9 yr, Pinfection. Small hospital size was associated with decreased odds (odds ratio [OR], 0.5; Pinfection. Uninsured (OR, 1.62; Pinfection. C. difficile increased hospital length of stay by 8 days (Pdifficile infection after lumbar spine surgery carries a 36.4-fold increase in mortality and costs approximately $10,658,646 per year to manage. These data suggest that great care should be taken to avoid C. difficile colitis in patients undergoing lumbar spine surgery because it is associated with longer hospital stays, greater overall costs, and increased inpatient mortality. 3.

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

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Burnett Angus F

2008-11-01

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

Lumbar puncture in patients using anticoagulants and antiplatelet agents

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Renan Domingues

2016-08-01

Full Text Available ABSTRACT The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks.

Multiple-level lumbar spondylolysis and spondylolisthesis.

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Liu, Xinyu; Wang, Lianlei; Yuan, Suomao; Tian, Yonghao; Zheng, Yanping; Li, Jianmin

2015-03-01

Lumbar spondylolysis and isthmic spondylolisthesis occur most commonly at only one spinal level. The authors report on 13 cases of lumbar spondylolysis with spondylolisthesis at multiple levels. During July 2007-March 2012, multiple-level spondylolysis associated with spondylolisthesis was diagnosed in 13 patients (10 male, 3 female) at Qilu Hospital of Shandong University. The mean patient age was 43.5 ± 14.6 years. The duration of low-back pain was 11.7 ± 5.1 months. Spondylolysis occurred at L-2 in 2 patients, L-3 in 4 patients, L-4 in all patients, and L-5 in 5 patients. Spondylolysis occurred at 3 spinal levels in 3 patients and at 2 levels in 10 patients. All patients had spondylolisthesis at 1 or 2 levels. Japanese Orthopaedic Association and visual analog scale scores were used to evaluate preoperative and postoperative neurological function and low-back pain. All patients underwent pedicle screw fixation and interbody fusion or direct pars interarticularis repair. Both low-back pain scores improved significantly after surgery (p spondylolysis and spondylolisthesis occurred more often in men. Most multiplelevel lumbar spondylolysis occurred at 2 spinal levels and was associated with sports, trauma, or heavy labor. Multiplelevel lumbar spondylolysis occurred mostly at L3-5; associated spondylolisthesis usually occurred at L-4 and L-5, mostly at L-4. The treatment principle was the same as that for single-level spondylolisthesis.

Does football cause an increase in degenerative disease of the lumbar spine?

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Gerbino, Peter G; d'Hemecourt, Pierre A

2002-02-01

Degenerative disease of the lumbar spine is exceedingly common. Whether any specific activity increases the likelihood of developing degenerative disc disease (DDD) or facet degeneration (FD) has enormous implications. Within the field of occupational medicine there are specific activities, occupations, and morphologic characteristics that have been related to low back pain. Several specific risk factors have been conclusively linked to low back pain, and in particular DDD and FD. Within the sport of American football, there has long been the feeling that many athletes have or will develop low back pain, DDD, and FD. Proving that certain risk factors present in football will predictably lead to an increase in LBP, DDD, and FD is more difficult. At this time, it can be said that football players, in general, increase their risk of developing low back pain, DDD, and FD as their years of involvement with their sport increase. Because specific spine injuries like fracture, disc herniation, and spondylolysis are more frequent in football players, the resulting DDD and FD are greater than that of the general population. The weightlifting and violent hyperextension that are part of American football are independent risk factors for degenerative spine disease.

The use of CT scanning for the study of posterior lumbar intervertebral articulations

International Nuclear Information System (INIS)

Hermanus, N.; Becker, D. de; Baleriaux, D.; Hauzeur, J.P.

1983-01-01

CT scan is peculiarly effective in the study of architectural pathologies of the column; it appears that a number of etiological factors of low back pain are involved and they are often related. Indeed, dis herniation, for instance, is frequently associated with facetal asymmetry, the first signs of arthroses and ligamentous calcification after treatment. The three vertebral axes must be evaluated, one discal and two facetal, the slightest defect in one of which can affect the two others. Moreover, in view of the complexity of the innervation, the entire lumbar column from L1 to L5 S1 must be investigated: it is not uncommonly that low sciatica is caused by a more cranial lumbar pathology. This systematic study promotes better understanding of the etiology of low back pain and suggests a stet judicious therapeutic attitude. (orig.)

Short-term outcome of fluoroscopic-guided steroid injection therapy of lumber facet cyst-induced radicular pain

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Kwon, Mi Ri; Kwon, Jong Won; Lee, Jong Seo; Kim, Eu Sang [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2015-04-15

To determine the short-term effect of fluoroscopic-guided steroid injection therapy of lumbar facet cyst-induced radicular pain. Seventeen patients with radiculopathy due to lumbar synovial cysts, who were treated with fluoroscopically guided injection, were retrospectively evaluated. All plain radiographic images and MR images before the therapy were reviewed. Five patients underwent only the facet joint injection, whereas twelve patients underwent the facet joint injection with perineural injection therapy. The clinical course of pain was evaluated on the first follow-up after therapy. Effective pain relief was achieved in 11 (64.7%) of the 17 patients. Among 12 patients who underwent facet joint injection with perineural injection, 9 patients (75%) had an effective pain relief. Of 5 patients, 2 (40%) patients only took the facet joint injection and had an effective pain relief. Fluoroscopic-guided steroid injection therapy shows a good short-term effect in patients with symptomatic lumbar facet joint synovial cysts.

Differences between clinical "snap-shot" and "real-life" assessments of lumbar spine alignment and motion - What is the "real" lumbar lordosis of a human being?

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Dreischarf, Marcel; Pries, Esther; Bashkuev, Maxim; Putzier, Michael; Schmidt, Hendrik

2016-03-21

The individual lumbar lordosis and lumbar motion have been identified to play an important role in pathogenesis of low back pain and are essential references for preoperative planning and postoperative evaluation. The clinical "gold-standard" for measuring lumbar lordosis and its motion are radiological "snap-shots" taken while standing and during upper-body flexion and extension. The extent to which these clinically assessed values characterise lumbar alignment and its motion in daily life merits discussion. A non-invasive measurement-system was employed to measure lumbar lordosis and lumbar motion in 208 volunteers (age: 20-74yrs; ♀/♂: 115/93). For an initial short-term measurement, comparable with the clinical "snap-shot", lumbar lordosis and its motion were assessed while standing and during flexion and extension. Subsequently, volunteers were released to their daily lives while wearing the device, and measurements were performed during the following 24h. The average lumbar lordosis during 24h (8.0°) differed significantly from the standardised measurement while standing (33.3°). Ranges of motion were significantly different throughout the day compared to standing measurements. The influence of the factors age and gender on lordosis and its motion resulted in conflicting results between long- and short-term-measurements. In conclusion, results of short-term examinations differ considerably from the average values during real-life. These findings might be important for surgical planning and increase the awareness of the biomechanical challenges that spinal structures and implants face in real-life. Furthermore, long-term assessments of spinal alignment and motion during daily life can provide valid data on spinal function and can reveal the importance of influential factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Radiographic Morphometry of the Lumbar Spine in Munich Miniature Pigs†

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Engelke, Elisabeth C; Post, Christina; Pfarrer, Christiane D; Sager, Martin; Waibl, Helmut R

2016-01-01

The incidence of human spinal column disease remains high, and animal models still play important roles in prophylactic, diagnostic, and therapeutic research. Because of their similar size to humans, pigs remain an important spine model. For pigs to serve as a model for the human spine, basic similarities and differences must be understood. In this study, morphometric data of the lumbar spine of Munich miniature pigs (Troll) were recorded radiologically, evaluated, and compared with recorded human data. Whereas humans have a constant number of 5 lumbar vertebrae, Munich minipigs had 5 or 6 lumbar vertebrae. Compared with their human counterparts, the lumbar vertebral bodies of the minipigs were remarkably larger in the craniocaudal (superior–inferior) direction and considerably smaller in the dorsoventral and laterolateral directions. The porcine vertebral canal was smaller than the human vertebral canal. The spinal cord extended into the caudal part of the porcine lumbar vertebral canal and thus did not terminate as cranial, as seen in humans. The lumbar intervertebral spaces of the pig were narrower in craniocaudal direction than human intervertebral spaces. These differences need to be considered when planning surgical actions, not only to avoid pain and irreversible damage to the minipigs but also to achieve accurate scientific results. PMID:27177570

Lumbar hernia: A commonly misevaluated condition of the bilateral costoiliac spaces

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Yiji Suh

2017-09-01

Full Text Available Lumbar hernias develop through the weakening of the posterolateral abdominal wall associated with the Petit's triangle or the Grynfeltt-Lesshaft triangle. Clinicians are generally unfamiliar with the presentation of lumbar hernias, which frequently leads to misdiagnosis and delay of treatment. Prompt failure to diagnose and surgically correct lumbar hernias have resulted in increased morbidity. This review addresses the anatomical and clinical concepts associated with the bilateral costoiliac spaces, which may be implicated in the increased prevalence of left-sided hernias. Knowledge of the contents and boundaries of this enclosure can aid the physician in diagnosis. We explore the intraperitoneal and retroperitoneal diseases that present at the lumbocostal space, including lumbar hernias, which can be classified as congenital, acquired, traumatic, or iatrogenic in origin. In an evaluation, imaging is crucial for assessing musculofascial layer disruptions and hernia contents. Open and laparoscopic surgery, as well retromuscular lumbar hernia repair, are options to explore in surgical intervention, particularly if there are challenges in preliminary pain management. Keywords: Lumbar hernia, Costoiliac spaces, Petit's triangle, Grvnfeltt-lesshaft triangle, Lumbocostovertebral syndrome

Congenital absence of the lumbar facet joint associated with bilateral spondylolysis of the fifth lumbar vertebra.

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Wang, Zhuo; Sakakibara, Toshihiko; Kasai, Yuichi

2013-01-01

A 14-year-old boy presented with a rare case of congenital absence of lumbar facet joint manifesting as low back pain. Physical examination showed no neurological or hematologic abnormalities. Radiography revealed absence of a facet joint on the right side of L4-5. Computed tomography and three-dimensional computed tomography revealed absence of the facet joint on the right side of L4-5 and spondylolysis on both sides of L5. Pain subsided after conservative treatment. This is an extremely rare case of congenital absence of lumbar facet joint associated with bilateral spondylolysis.

Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation in surgical treatment for single-segment lumbar spinal tuberculosis.

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Zeng, Hao; Wang, Xiyang; Zhang, Penghui; Peng, Wei; Liu, Zheng; Zhang, Yupeng

2015-01-01

The aim of this study is to determine the feasibility and efficacy of surgical management of single-segment lumbar spinal tuberculosis (TB) by using single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. The mean follow-up was 36.9 months (range: 24-62 months). The kyphotic angle ranged from 15.2-35.1° preoperatively, with an average measurement of 27.8°. The American Spinal Injury Association (ASIA) score system was used to evaluate the neurological deficits and erythrocyte sedimentation rate (ESR) used to judge the activity of TB. Spinal TB was completely cured in all 17 patients. There was no recurrent TB infection. The postoperative kyphotic angle was 6.6-10.2°, 8.1° in average, and there was no significant loss of the correction at final follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation can be a feasible and effective method the in treatment of single-segment lumbar spinal TB.

Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction.

Science.gov (United States)

Mellor, F E; Thomas, P; Breen, A

2014-08-01

Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy. Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) ( n  = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA). The effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography. The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm 2 which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm 2 ), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm 2 ) is lower than for four view functional radiography (7.34 Gy cm 2 ). Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm 2 ) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data. Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased.

Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction

International Nuclear Information System (INIS)

Mellor, F.E.; Thomas, P.; Breen, A.

2014-01-01

Purpose: Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy. Methods: Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) (n = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA). Results and conclusion: The effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography. The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm 2 which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm 2 ), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm 2 ) is lower than for four view functional radiography (7.34 Gy cm 2 ). Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm 2 ) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data. Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased

LUMBAR LORDOSIS IN ASYMPTOMATICS SUBJECTS AND PATIENTS WITH CHRONIC LOW BACK PAIN

OpenAIRE

S.J MOUSAVI; MOHAMMAD REZA NOURBAKHSH

2003-01-01

Introduction: The relationship between the degree of lumbar lordosis and chronic and purpose low back pain (LBP) has long been speculated, but there is discrepancy in findings of previous researchers. The purpose of this of this study was to drtermin differences between lumbar lordosis in asymptomatic and LBP subjects. Matherials: Lumbar lordosis of 420 patients with chronic LBP and 420 asymptomatic subjects was measured by two examiner. A flexible ruler was used to measure lumbar l...

Diagnosis of Lumbar Foraminal Stenosis using Diffusion Tensor Imaging.

Science.gov (United States)

Eguchi, Yawara; Ohtori, Seiji; Suzuki, Munetaka; Oikawa, Yasuhiro; Yamanaka, Hajime; Tamai, Hiroshi; Kobayashi, Tatsuya; Orita, Sumihisa; Yamauchi, Kazuyo; Suzuki, Miyako; Aoki, Yasuchika; Watanabe, Atsuya; Kanamoto, Hirohito; Takahashi, Kazuhisa

2016-02-01

Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed during nerve conduction studies. Computed tomography and magnetic resonance imaging indicated bilateral L5 lumbar foraminal stenosis. DTI imaging was done. The extraforaminal values were decreased and tractography was interrupted in the foraminal region. Bilateral L5 vertebral foraminal stenosis was treated by transforaminal lumbar interbody fusion and the pain in both legs disappeared. The case indicates the value of DTI for diagnosing vertebral foraminal stenosis.

Overpowering posterior lumbar instrumentation and fusion with hyperlordotic anterior lumbar interbody cages followed by posterior revision: a preliminary feasibility study.

Science.gov (United States)

Kadam, Abhijeet; Wigner, Nathan; Saville, Philip; Arlet, Vincent

2017-12-01

OBJECTIVE The authors' aim in this study was to evaluate whether sagittal plane correction can be obtained from the front by overpowering previous posterior instrumentation and/or fusion with hyperlordotic anterior lumbar interbody fusion (ALIF) cages in patients undergoing revision surgery for degenerative spinal conditions and/or spinal deformities. METHODS The authors report their experience with the application of hyperlordotic cages at 36 lumbar levels for ALIFs in a series of 20 patients who underwent revision spinal surgery at a single institution. Included patients underwent staged front-back procedures: ALIFs with hyperlordotic cages (12°, 20°, and 30°) followed by removal of posterior instrumentation and reinstrumentation from the back. Patients were divided into the following 2 groups depending on the extent of posterior instrumentation and fusion during the second stage: long constructs (≥ 6 levels with extension into thoracic spine and/or pelvis) and short constructs (lumbar lordosis increased from 44.3° to 59.8° (p lumbar levels that have pseudarthrosis from the previous posterior spinal fusion. Meticulous selection of levels for ALIF is crucial for safely and effectively performing this technique.

[Lumbar spinal angiolipoma].

Science.gov (United States)

Isla, Alberto; Ortega Martinez, Rodrigo; Pérez López, Carlos; Gómez de la Riva, Alvaro; Mansilla, Beatriz

2016-01-01

Spinal angiolipomas are fairly infrequent benign tumours that are usually located in the epidural space of the thoracic column and represent 0.14% to 1.3% of all spinal tumours. Lumbar angiolipomas are extremely rare, representing only 9.6% of all spinal extradural angiolipomas. We report the case of a woman who complained of a lumbar pain of several months duration with no neurological focality and that had intensified in the last three days without her having had any injury or made a physical effort. The MR revealed an extradural mass L1-L2, on the posterior face of the medulla, decreasing the anteroposterior diameter of the canal. The patient symptoms improved after surgery. Total extirpation of the lesion is possible in most cases, and the prognosis is excellent even if the lesion is infiltrative. For this reason, excessively aggressive surgery is not necessary to obtain complete resection. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

Oblique lumbar spine radiographs: importance in young patients

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Libson, E.; Bloom, R.A.; Dinari, G.; Robin, G.C.

1984-04-01

Spondylolysis is a direct precursor of spondylolisthesis and can lead to crippling back pain. Of 1,743 patients surveyed, including 936 who were asymptomatic and 807 with back pain, 165 (including 91 who were asymptomatic and 74 with back pain) had spondylolysis, which was seen only on oblique lumbar views in 20% of cases. Because of the high false-negative rate of AP and lateral views, oblique views are essential in children and young adults. As spondylolysis is rare above L3, radiographs can be limited to L3-S1. Significantly less spondylolysis was seen in persons older than 30 with back pain usually caused by disk degeneration.

Oblique lumbar spine radiographs: importance in young patients

International Nuclear Information System (INIS)

Libson, E.; Bloom, R.A.; Dinari, G.; Robin, G.C.

1984-01-01

Spondylolysis is a direct precursor of spondylolisthesis and can lead to crippling back pain. Of 1,743 patients surveyed, including 936 who were asymptomatic and 807 with back pain, 165 (including 91 who were asymptomatic and 74 with back pain) had spondylolysis, which was seen only on oblique lumbar views in 20% of cases. Because of the high false-negative rate of AP and lateral views, oblique views are essential in children and young adults. As spondylolysis is rare above L3, radiographs can be limited to L3-S1. Significantly less spondylolysis was seen in persons older than 30 with back pain usually caused by disk degeneration

MRI of the lumbar spine. Technical aspect. T2-weighted fat saturation coronal dynamic MRI of the lumbar spine

International Nuclear Information System (INIS)

Clarisse, J.; Francke, J.P.; Leclet, H.; Bourgeois, Ph.; Chastanet, P.; Cotten, A.

1998-01-01

Assess the feasibility of 'dynamic' MRI of the lumbar spine and study the parameters of a single MRI sequence favorable for simultaneous imaging of the meningeal space and the epidural and foraminal venous system. Favor a decline in the number of sacco-radiculograms. Clinical assessment in the following circumstances: discordant clinical and and radiographic findings, difficulty in interpreting single or multiple disc-root conflicts, preoperative work-up in cases of narrow or stenotic lumbar canal. Dynamic MRI of the lumbar spine is possible if the hypothesis that the hyper-lordosis obtained in the supine position creates an anatomic and radiographic situation identical to the hyper-lordosis induced by the upright position is accepted. The 'radiculo-phlebographic' sequence gives images of the root sheaths and the epidural, foraminal and extra-foraminal veins simultaneously, particularly in the coronal plane. (authors)

A systematic review of preoperative predictors for postoperative clinical outcomes following lumbar discectomy.

Science.gov (United States)

Wilson, Courtney A; Roffey, Darren M; Chow, Donald; Alkherayf, Fahad; Wai, Eugene K

2016-11-01

Sciatica is often caused by a herniated lumbar intervertebral disc. When conservative treatment fails, a lumbar discectomy can be performed. Surgical treatment via lumbar discectomy is not always successful and may depend on a variety of preoperative factors. It remains unclear which, if any, preoperative factors can predict postsurgical clinical outcomes. This review aimed to determine preoperative predictors that are associated with postsurgical clinical outcomes in patients undergoing lumbar discectomy. This is a systematic review. This systematic review of the scientific literature followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. MEDLINE and PubMed were systematically searched through June 2014. Results were screened for relevance independently, and full-text studies were assessed for eligibility. Reporting quality was assessed using a modified Newcastle-Ottawa Scale. Quality of evidence was assessed using a modified version of Sackett's Criteria of Evidence Support. No financial support was provided for this study. No potential conflict of interest-associated biases were present from any of the authors. The search strategy yielded 1,147 studies, of which a total of 40 high-quality studies were included. There were 17 positive predictors, 20 negative predictors, 43 non-significant predictors, and 15 conflicting predictors determined. Preoperative predictors associated with positive postoperative outcomes included more severe leg pain, better mental health status, shorter duration of symptoms, and younger age. Preoperative predictors associated with negative postoperative outcomes included intact annulus fibrosus, longer duration of sick leave, worker's compensation, and greater severity of baseline symptoms. Several preoperative factors including motor deficit, side and level of herniation, presence of type 1 Modic changes and degeneration, age, and gender had non-significant associations with postoperative clinical

A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice.

Science.gov (United States)

Daniels, Clinton J; Wakefield, Pamela J; Bub, Glenn A; Toombs, James D

2016-12-01

The purpose of this narrative review was to describe the most common spinal fusion surgical procedures, address the clinical indications for lumbar fusion in degeneration cases, identify potential complications, and discuss their relevance to chiropractic management of patients after surgical fusion. The PubMed database was searched from the beginning of the record through March 31, 2015, for English language articles related to lumbar fusion or arthrodesis or both and their incidence, procedures, complications, and postoperative chiropractic cases. Articles were retrieved and evaluated for relevance. The bibliographies of selected articles were also reviewed. The most typical lumbar fusion procedures are posterior lumbar interbody fusion, anterior lumbar interbody fusion, transforaminal interbody fusion, and lateral lumbar interbody fusion. Fair level evidence supports lumbar fusion procedures for degenerative spondylolisthesis with instability and for intractable low back pain that has failed conservative care. Complications and development of chronic pain after surgery is common, and these patients frequently present to chiropractic physicians. Several reports describe the potential benefit of chiropractic management with spinal manipulation, flexion-distraction manipulation, and manipulation under anesthesia for postfusion low back pain. There are no published experimental studies related specifically to chiropractic care of postfusion low back pain. This article describes the indications for fusion, common surgical practice, potential complications, and relevant published chiropractic literature. This review includes 10 cases that showed positive benefits from chiropractic manipulation, flexion-distraction, and/or manipulation under anesthesia for postfusion lumbar pain. Chiropractic care may have a role in helping patients in pain who have undergone lumbar fusion surgery.

3-dimensional reconstructions of computer tomograms of the lumbar spine

International Nuclear Information System (INIS)

Kern, A.; Waggershauser, T.; Zendel, W.; Astinet, A.; Felix, R.; Hansen, K.; Lanksch, W.R.

1991-01-01

In this study, 50 patients were examined by a Siemens 'Somatom Plus'; continuous 2 mm sections between the third lumbar and first sacral vertebra were obtained. All these imaging procedures were suitable for the diagnosis of osteochondrosis and chondrosis. Spondylosis was diagnosed more frequently on 3-D CT. Spondyloarthrosis, with narrowing of the invertebral foramina and root canals is shown particularly well by 3-D CT, since the entire extent of these structures can be seen. 3-D surface reconstruction of the lumbar spine is useful in the diagnosis of lumbar spondyloarthrosis with narrowing of the root canals and of the spinal canal. This method of axial CT is superior to conventional radiography of the lumbar spine in the usual two planes. (orig./GDG) [de

?Lumbar Degenerative Kyphosis? Is Not Byword for Degenerative Sagittal Imbalance: Time to Replace a Misconception

OpenAIRE

Lee, Chang-Hyun; Chung, Chun Kee; Jang, Jee-Soo; Kim, Sung-Min; Chin, Dong-Kyu; Lee, Jung-Kil

2017-01-01

Lumbar degenerative kyphosis (LDK) is a subgroup of the flat-back syndrome and is most commonly caused by unique life styles, such as a prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Unfortunately, LDK has been used as a byword for degenerative sagittal imbalance, and this sometimes causes confusion. The aim of this review was to evaluate the exact territory of LDK, and to introduce another appropriate term for degenerative sagittal...

Painful lumbar spondylolysis among pediatric sports players: a pilot MRI study.

Science.gov (United States)

Sairyo, Koichi; Sakai, Toshinori; Mase, Yasuyoshi; Kon, Tamiyo; Shibuya, Isao; Kanamori, Yasuo; Kosugi, Tatsuo; Dezawa, Akira

2011-11-01

For children and adolescents who are very active athletes, fresh lumbar spondylolysis is the main pathologic cause of lower back pain (LBP). However, regarding the terminal-stage spondylolysis (pars defect), there have been few studies to clarify the pathomechanism of LBP. The purpose of this study is to clarify the cause of LBP associated with pars defects in athletes. This is the first report showing a possible pathomechanism of LBP in active athletes with painful pars defect. Six pediatric athletes (5 boys and 1 girl) below 18 years old with painful bilateral lumbar spondylolysis were evaluated. In all cases, spondylolysis was identified as terminal stage (pseudoarthrosis) on CT scan. To evaluate the inflammation around the pars defects, short time inversion recovery (STIR) MRI was performed along with the sagittal section. Fluid collection, which is an indicator of inflammatory events, was evaluated in 12 pars defects as well as in 12 cranial and caudal adjoining facet joints. Inflammation (i.e., fluid collection) was observed in all 12 pars defects in six subjects at the pseudoarthrotic pars defects. In terms of facet joints, 7 of 12 (58%) pars defects showed fluid collection at the cranial and/or caudal adjoining joints on STIR MRI. The present study showed that inflammation was always present at the pars defects and in some cases at the adjoining facet joints. Thus, it is not difficult to understand how, during sports activity, inflammation may first occur at the pseudoarthrotic site and then spread to the adjoining facet joints. This mechanism could cause LBP associated with terminal-stage (pseudoarthrotics) spondylolysis in athletes.

Influence of age, BMI, gender and lumbar level on T1ρ magnetic resonance imaging of lumbar discs in healthy asymptomatic adults

Energy Technology Data Exchange (ETDEWEB)

Guebitz, Raphael [Asklepios Hospital Altona, Hamburg (Germany). Dept. of Radiology and Neuroradiology; Lange, Tobias; Gosheger, Georg [University Hospital Muenster (Germany). Dept. of Orthopaedics and Tumor Orthopaedics; Heindel, Walter; Allkemper, Thomas [University Hospital Muenster (Germany). Dept. of Clinical Radiology; Stehling, Christoph [Sankt-Barbara Hospital Ham-Heessen, Hamm (Germany). Clinic for Radiology and Neuroradiology; Gerss, Joachim [Muenster Univ. (Germany). Inst. of Biostatistics and Clinical Research; Kanthak, Christian [Fraunhofer MEVIS, Bremen (Germany). Inst. for Medical Image Computing; Schulte, Tobias L. [Bochum Univ. St. Josef Hospital (Germany). Dept. of Orthopaedics and Trauma Surgery

2018-02-15

To assess the T1ρ range of lumbar intervertebral discs in healthy asymptomatic individuals at 1.5 T and to investigate the influence of age, body mass index (BMI), gender, and lumbar level on T1ρ relaxation. In a prospective study, a total of 81 volunteers aged 20 - 80 years were included in this study and divided into three age groups (A: 20 - 39y; B: 40 - 59y; C: 60 - 80y). All of the volunteers underwent magnetic resonance imaging (MRI) at 1.5 T with acquisition of sagittal T1ρ images. The calculated T1ρ relaxation times were correlated with age, BMI, gender, and lumbar level relative to the total disc, the annulus fibrosus, and the nucleus pulposus. Age had a significant influence on T1ρ relaxation times at all lumbar levels, with increasing age being associated with reduced relaxation times. There was also a significant difference between age groups A vs. C and B vs. C (P = 0.0008 and P = 0.0149, respectively). No significant differences in T1ρ relaxation time were observed between men and women (P > 0.05). BMI showed a significant negative correlation with T1ρ relaxation times (P < 0.0001). Analysis of the lumbar level revealed a significant decrease in relaxation times from L1/2 to L5 / S1 (P = 0.0013). Increasing age correlated significantly with advanced lumbar disc degeneration in asymptomatic individuals, particularly in those aged 60 or older. Increasing BMI correlated significantly with increasing degeneration. The lower discs showed more degeneration than the upper ones.

Influence of age, BMI, gender and lumbar level on T1ρ magnetic resonance imaging of lumbar discs in healthy asymptomatic adults

International Nuclear Information System (INIS)

Guebitz, Raphael; Lange, Tobias; Gosheger, Georg; Heindel, Walter; Allkemper, Thomas; Stehling, Christoph; Gerss, Joachim; Kanthak, Christian; Schulte, Tobias L.

2018-01-01

To assess the T1ρ range of lumbar intervertebral discs in healthy asymptomatic individuals at 1.5 T and to investigate the influence of age, body mass index (BMI), gender, and lumbar level on T1ρ relaxation. In a prospective study, a total of 81 volunteers aged 20 - 80 years were included in this study and divided into three age groups (A: 20 - 39y; B: 40 - 59y; C: 60 - 80y). All of the volunteers underwent magnetic resonance imaging (MRI) at 1.5 T with acquisition of sagittal T1ρ images. The calculated T1ρ relaxation times were correlated with age, BMI, gender, and lumbar level relative to the total disc, the annulus fibrosus, and the nucleus pulposus. Age had a significant influence on T1ρ relaxation times at all lumbar levels, with increasing age being associated with reduced relaxation times. There was also a significant difference between age groups A vs. C and B vs. C (P = 0.0008 and P = 0.0149, respectively). No significant differences in T1ρ relaxation time were observed between men and women (P > 0.05). BMI showed a significant negative correlation with T1ρ relaxation times (P < 0.0001). Analysis of the lumbar level revealed a significant decrease in relaxation times from L1/2 to L5 / S1 (P = 0.0013). Increasing age correlated significantly with advanced lumbar disc degeneration in asymptomatic individuals, particularly in those aged 60 or older. Increasing BMI correlated significantly with increasing degeneration. The lower discs showed more degeneration than the upper ones.

Mechanisms of action of lumbar supports : a systematic review

NARCIS (Netherlands)

van Poppel, M N; de Looze, M P; Koes, B W; Smid, T; Bouter, L M

2000-01-01

STUDY DESIGN: A systematic review and meta-analysis of studies on the putative mechanisms of action of lumbar supports in lifting activities. OBJECTIVE: To summarize the evidence bearing on the putative mechanisms of action of lumbar supports. SUMMARY OF BACKGROUND DATA: A restriction of trunk

Mechanisms of action of lumbar supports: a sytematic review

NARCIS (Netherlands)

van Poppel-Bruinvels, M.N.M.; de Looze, M.P.; Koes, B.W.; Smid, T.; Bouter, L.M.

2000-01-01

Study Design. A systematic review and meta-analysis of studies on the putative mechanisms of action of lumbar supports in lifting activities. Objective. To summarize the evidence bearing on the putative mechanisms of action of lumbar supports. Summary of Background Data. A restriction of trunk

Is it possible to preserve lumbar lordosis after hybrid stabilization? Preliminary results of a novel rigid-dynamic stabilization system in degenerative lumbar pathologies.

Science.gov (United States)

Formica, Matteo; Cavagnaro, Luca; Basso, Marco; Zanirato, Andrea; Felli, Lamberto; Formica, Carlo

2015-11-01

To evaluate the results of a novel rigid-dynamic stabilization technique in lumbar degenerative segment diseases (DSD), expressly pointing out the preservation of postoperative lumbar lordosis (LL). Forty-one patients with one level lumbar DSD and initial disc degeneration at the adjacent level were treated. Circumferential lumbar arthrodesis and posterior hybrid instrumentation were performed to preserve an initial disc degeneration above the segment that has to be fused. Clinical and spino-pelvic parameters were evaluated pre- and postoperatively. At 2-year follow-up, a significant improvement of clinical outcomes was reported. No statistically significant difference was noted between postoperative and 2-year follow-up in LL and in disc/vertebral body height ratio at the upper adjacent fusion level. When properly selected, this technique leads to good results. A proper LL should be achieved after any hybrid stabilization to preserve the segment above the fusion.

RELIABILITY AND VALIDITY OF SUBJECTIVE ASSESSMENT OF LUMBAR LORDOSIS IN CONVENTIONAL RADIOGRAPHY.

Science.gov (United States)

Ruhinda, E; Byanyima, R K; Mugerwa, H

2014-10-01

Reliability and validity studies of different lumbar curvature analysis and measurement techniques have been documented however there is limited literature on the reliability and validity of subjective visual analysis. Radiological assessment of lumbar lordotic curve aids in early diagnosis of conditions even before neurologic changes set in. To ascertain the level of reliability and validity of subjective assessment of lumbar lordosis in conventional radiography. A blinded, repeated-measures diagnostic test was carried out on lumbar spine x-ray radiographs. Radiology Department at Joint Clinical Research Centre (JCRC), Mengo-Kampala-Uganda. Seventy (70) lateral lumbar x-ray films were used for this study and were obtained from the archive of JCRC radiology department at Butikiro house, Mengo-Kampala. Poor observer agreement, both inter- and intra-observer, with kappa values of 0.16 was found. Inter-observer agreement was poorer than intra-observer agreement. Kappa values significantly rose when the lumbar lordosis was clustered into four categories without grading each abnormality. The results confirm that subjective assessment of lumbar lordosis has low reliability and validity. Film quality has limited influence on the observer reliability. This study further shows that fewer scale categories of lordosis abnormalities produce better observer reliability.

Recurrent acute low back pain secondary to lumbar epidural calcification

Energy Technology Data Exchange (ETDEWEB)

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

2007-06-15

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

Recurrent acute low back pain secondary to lumbar epidural calcification

International Nuclear Information System (INIS)

Ziade, M.; Zufferey, P.; So, A.K.L.

2007-01-01

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

Embolization of Isolated Lumbar Artery Injuries in Trauma Patients

International Nuclear Information System (INIS)

Sofocleous, Constantinos T.; Hinrichs, Clay R.; Hubbi, Basil; Doddakashi, Satish; Bahramipour, Philip; Schubert, Johanna

2005-01-01

Purpose. The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. Methods. All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. Results. In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men) suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. Conclusions. In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery

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

Science.gov (United States)

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.

Assessment of Efficacy of Transforaminal Epidural Steroid Injection for Management of Low Back Pain with Unilateral Radiculopathy in Industrial Workers: A Randomized Control Trial

Directory of Open Access Journals (Sweden)

Piyali Mondal

2018-01-01

Full Text Available Introduction: Disability related to chronic Low Back Pain (LBP is a multi-factorial phenomenon, associated with high social and health costs, with a prevalence ranging from 11 to 76%. Significant and long-lasting pain relief can be achieved with transforaminal epidural steroid injection. Surgery is indicated for those patients with progressive neurological deficits or severe LBP refractory to conservative measures. Aim: To evaluate the efficacy of transforaminal epidural steroid injection through pelvic angle measurement, pain and disability measurements in patients with LBP and radiculopathy. Materials and Methods: This prospective randomized controlled study was conducted in Department of Pain in ESI institute of pain management for the industrial workers at Kolkata, India between October 2015 and September 2016. Sixty patients aged between 18 to 60 years, who attended pain clinic with complaints of LBP with unilateral radiculopathy due to lumber disc herniation were included in this trial. Patients were divided into 2 groups (30 patients in each group; Group I: Test group received single transforaminal epidural steroid injection with deposteroid (20 mg and 0.25% bupivacaine (total 2 ml together with oral medications and exercises at day 0. Group II: Control group received only medications and exercises on day 0/visit 1. Each patient was followed up for one month at visit 2. Each patient was assessed with Numeric Rating Scale (NRS for pain intensity and modified Oswestry Disability Index (ODI for measurement for disability and pelvic angle measurement on affected side. Results: During study period, 60 confirmed patients were included in the analysis. NRS for pain intensity measurement between visit 1(V1 and 2 (V2, showed significant improvement (p-value is < 0.001 in group I. ODI scores between 2 visits showed better outcome in group I. Pelvic angle measurement of affected limb on second visit in both groups as compared to first visit, showed

Does change in isolated lumbar extensor muscle function correlate with good clinical outcome? A secondary analysis of data on change in isolated lumbar extension strength, pain, and disability in chronic low back pain.

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Steele, James; Fisher, James; Perrin, Craig; Conway, Rebecca; Bruce-Low, Stewart; Smith, Dave

2018-01-12

Secondary analysis of data from studies utilising isolated lumbar extension exercise interventions for correlations among changes in isolated lumbar extension strength, pain, and disability. Studies reporting isolated lumbar extension strength changes were examined for inclusion criteria including: (1) participants with chronic low back pain, (2) intervention ≥ four weeks including isolated lumbar extension exercise, (3) outcome measures including isolated lumbar extension strength, pain (Visual Analogue Scale), and disability (Oswestry Disability Index). Six studies encompassing 281 participants were included. Correlations among change in isolated lumbar extension strength, pain, and disability. Participants were grouped as "met" or "not met" based on minimal clinically important changes and between groups comparisons conducted. Isolated lumbar extension strength and Visual Analogue Scale pooled analysis showed significant weak to moderate correlations (r = -0.391 to -0.539, all p Disability Index pooled analysis showed significant weak correlations (r = -0.349 to -0.470, all p disability, isolated lumbar extension strength changes were greater for those "met" compared with those "not met" (p disability. This study shows significant correlations between increases in isolated lumbar extension strength and reductions in pain and disability. Strengthening of the lumbar extensor musculature could be considered an important target for exercise interventions.

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

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Rapp, Steven M; Miller, Larry E; Block, Jon E

2011-01-01

Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF) system is a minimally invasive fusion device that accesses the lumbar (L4-S1) intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date.

Does team lifting increase the variability in peak lumbar compression in ironworkers?

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Faber, Gert; Visser, Steven; van der Molen, Henk F; Kuijer, P Paul F M; Hoozemans, Marco J M; Van Dieën, Jaap H; Frings-Dresen, Monique H W

2012-01-01

Ironworkers frequently perform heavy lifting tasks in teams of two or four workers. Team lifting could potentially lead to a higher variation in peak lumbar compression forces than lifts performed by one worker, resulting in higher maximal peak lumbar compression forces. This study compared single-worker lifts (25-kg, iron bar) to two-worker lifts (50-kg, two iron bars) and to four-worker lifts (100-kg, iron lattice). Inverse dynamics was used to calculate peak lumbar compression forces. To assess the variability in peak lumbar loading, all three lifting tasks were performed six times. Results showed that the variability in peak lumbar loading was somewhat higher in the team lifts compared to the single-worker lifts. However, despite this increased variability, team lifts did not result in larger maximum peak lumbar compression forces. Therefore, it was concluded that, from a biomechanical point of view, team lifting does not result in an additional risk for low back complaints in ironworkers.

Lumbar punction: comparison between an atraumatic and a traumatic punction needle

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Tina Bregant

2017-03-01

Full Text Available Background: Lumbar puncture is a standardized, routine diagnostic procedure in the diagnosis of neurological diseases. Post-duarl puncture headache (PDPH is a common complication which occurs in 10 to 30 % of patients. Although the incidence of PDPH is much lower with the use of small, non-cutting needles, neurologists in Slovenia routinely use the classical traumatic spinal needles.Methods: In the article we provide an overview of a research concerned with the use of traumatic and atraumatic needles in the procedure with the emphasis on complications of the lumbar puncture. We present American and European recommendations for lumbar puncture procedure.Conclusions: International recommendations for neurologists advise the use of atraumatic spinal needles for lumbar puncture. We recommend to Slovenian neurologists to start using the atraumatic needles for elective lumbar punctures and hence provide neurological patients with better quality and cheaper long-term care.

Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease.

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Wu, Haiting; Pang, Qingjiang; Jiang, Guoqiang

2017-10-01

Objective To compare the medium-term clinical and radiographic outcomes of Dynesys dynamic stabilization and posterior lumbar interbody fusion (PLIF) for treatment of multisegmental lumbar degenerative disease. Methods Fifty-seven patients with multisegmental lumbar degenerative disease underwent Dynesys stabilization (n = 26) or PLIF (n = 31) from December 2008 to February 2010. The mean follow-up period was 50.3 (range, 46-65) months. Clinical outcomes were evaluated using a visual analogue scale (VAS) and the Oswestry disability index (ODI). Radiographic evaluations included disc height and range of motion (ROM) of the operative segments and proximal adjacent segment on lumbar flexion-extension X-rays. The intervertebral disc signal change was defined by magnetic resonance imaging, and disc degeneration was classified by the Pfirrmann grade. Results The clinical outcomes including the VAS score and ODI were significantly improved in both groups at 3 months and the final follow-up, but the difference between the two was not significant. At the final follow-up, the disc height of stabilized segments in both groups was significantly increased; the increase was more notable in the Dynesys than PLIF group. The ROM of stabilized segments at the final follow-up decreased from 6.20° to 2.76° and 6.56° to 0.00° in the Dynesys and PLIF groups, respectively. There was no distinct change in the height of the proximal adjacent segment in the two groups. The ROM of the proximal adjacent segment in both groups increased significantly at the final follow-up; the change was significantly greater in the PLIF than Dynesys group. Only one case of adjacent segment degeneration occurred in the PLIF group, and this patient underwent a second operation. Conclusions Both Dynesys stabilization and PLIF can improve the clinical and radiographic outcomes of multisegmental lumbar degenerative disease. Compared with PLIF, Dynesys stabilization can maintain the mobility of the

Is lumbar lordosis related to low back pain development during prolonged standing?

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Sorensen, Christopher J; Norton, Barbara J; Callaghan, Jack P; Hwang, Ching-Ting; Van Dillen, Linda R

2015-08-01

An induced-pain paradigm has been used in back-healthy people to understand risk factors for developing low back pain during prolonged standing. The purposes of this study were to (1) compare baseline lumbar lordosis in back-healthy participants who do (Pain Developers) and do not (Non-Pain Developers) develop low back pain during 2 h of standing, and (2) examine the relationship between lumbar lordosis and low back pain intensity. Cross-sectional. First, participants stood while positions of markers placed superficial to the lumbar vertebrae were recorded using a motion capture system. Following collection of marker positions, participants stood for 2 h while performing light work tasks. At baseline and every 15 min during standing, participants rated their low back pain intensity on a visual analog scale. Lumbar lordosis was calculated using marker positions collected prior to the 2 h standing period. Lumbar lordosis was compared between pain developers and non-pain developers. In pain developers, the relationship between lumbar lordosis and maximum pain was examined. There were 24 (42%) pain developers and 33 (58%) non-pain developers. Lumbar lordosis was significantly larger in pain developers compared to non-pain developers (Mean difference = 4.4°; 95% Confidence Interval = 0.9° to 7.8°, Cohen's d = 0.7). The correlation coefficient between lumbar lordosis and maximum pain was 0.46 (P = 0.02). The results suggest that standing in more lumbar lordosis may be a risk factor for low back pain development during prolonged periods of standing. Identifying risk factors for low back pain development can inform preventative and early intervention strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Evaluation of the risk of mediastinal or retroperitoneal injuries caused by dorso-lumbar pedicle screws].

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Hernigou, P; Germany, W

1998-09-01

Within an anatomical and a clinical study, the authors employed computerized tomographic scans to evaluate the risks of anterior surrounding tissues injuries during screw insertion. CT scans of 20 patients suffering from cardiac disease were reviewed retrospectively. Scans through the thoracic and lumbar spine were obtained using 6 mm slice thickness. These examinations were performed with intravenous contrast medium. Measurements of vessel diameters and distance of the soft tissues situated directly anterior to the spine were done. A retrospective study of 61 pedicle screws implanted for spine fractures evaluated the penetration of the anterior vertebral cordex with X rays and CT scans. Computerized tomographic scans of the thoracic and lumbar spine of the 20 patients in the control group confirmed proximity of the posterior mediastinal structures to the anterior vertebral cortex. Many structures of the posterior mediastinum were within five millimeters of the anterior vertebral cortex and thus were at risk: aorta, azygos vein, vena cava, parietal pleura and lungs. The theoretical risk of unrecognized screw penetrations evaluated on geometric shape of the anterior vertebral body is as high as 21 per cent when screw position is only seen with an antero posterior and a lateral X Ray. In the other group, computerized tomographic scans showed that 30 per cent of the implanted screws were outside the boundaries of the anterior thoracic spine. Two orthogonal incidences do not enable determination of whether the extremity of the screw is slightly outside the anterior cortex of the vertebral body. However the geometric shape of the anterior vertebral body enables peroperative definition of a safety zone on two orthogonal incidences. Even if a breach of a few millimeters of the anterior cortical boundaries of the vertebral body may not initially damage the adjacent soft-tissue structures, chronic irritation may result in late damages of these structures. The use of

Imaging of sciatica; A short historical review and the present situation. Bildediagnostikk ved isjas; En kort historisk oversikt og status presens

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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

General anesthesia versus segmental thoracic or conventional lumbar spinal anesthesia for patients undergoing laparoscopic cholecystectomy

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Yousef, Gamal T.; Lasheen, Ahmed E.

2012-01-01

Background: Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. Objective: This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery an...

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

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Rapp SM

2011-08-01

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

Intrathecal volume changes in lumbar spinal canal stenosis following extension and flexion: An experimental cadaver study.

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Teske, Wolfram; Schwert, Martin; Zirke, Sonja; von Schulze Pellengahr, Christoph; Wiese, Matthias; Lahner, Matthias

2015-01-01

The spinal canal stenosis is a common disease in elderly. The thecal sac narrowing is considered as the anatomical cause for the disease. There is evidence that the anatomical proportions of the lumbar spinal canal are influenced by postural changes. The liquor volume shift during these postural changes is a valuable parameter to estimate the dynamic qualities of this disease. The aim of this human cadaver study was the determination of intrathecal fluid volume changes during the lumbar flexion and the extension. A special measuring device was designed and built for the study to investigate this issue under controlled conditions. The measuring apparatus fixed the lumbar spine firmly and allowed only flexion and extension. The dural sac was closed water tight. The in vitro changes of the intrathecal volumes during the motion cycle were determined according to the principle of communicating vessels. Thirteen human cadaver spines from the Institute of Anatomy were examined in a test setting with a continuous adjustment of motion. The diagnosis of the lumbar spinal stenosis was confirmed by a positive computer tomography prior testing. The volume changes during flexion and extension cycles were measured stepwise in a 2 degree distance between 18° flexion and 18° extension. Three complete series of measurements were performed for each cadaver. Two specimens were excluded because of fluid leaks from further investigation. The flexion of the lumbar spine resulted in an intrathecal volume increase. The maximum volume effects were seen in the early flexion positions of 2° and 4°. The spine reclination resulted in a volume reduction. The maximum extension effect was seen between 14° and 16°. According to our results, remarkable volume effects were seen in the early movements of the lumbar spine especially for the flexion. The results support the concept of the spinal stenosis as a dynamic disease and allow a better understanding of the pathophysiology of this

Lumbar spondylolysis: A report of four cases from two generations of a family

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Yurube, Takashi; Kakutani, Kenichiro; Okamoto, Koji; Manabe, Michihiko; Maeno, Koichiro; Yoshikawa, Masaho; Sha, Norihide; Kuroda, Ryosuke; Nishida, Kotaro

2017-01-01

Spondylolysis is a major cause of back pain in children and adolescents. The prevalence of spondylolysis depends on the sex, race, and congenital abnormality. These biases suggest hereditary predisposition as an etiology of spondylolysis. However, no conclusive evidence still exists regarding the inheritance for spondylolysis. Herein, we report rare cases with familial occurrence of lumbar spondylolysis. In two generations of a Japanese family, three brothers including identical twins complai...

Incidental durotomy in lumbar spine surgery - incidence, risk factors and management

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Adam D.

2015-03-01

Full Text Available Incidental durotomy is a common complication of lumbar spine operations for degenerative disorders. Its incidence varies depending on several risk factors and regarding the intra and postoperative management, there is no consensus. Our objective was to report our experience with incidental durotomy in patients who were operated on for lumbar disc herniation, lumbar spinal stenosis and revision surgeries. Between 2009 and 2012, 1259 patients were operated on for degenerative lumbar disorders. For primary operations, the surgical approach was mino-open, interlamar, uni- or bilateral, as for recurrences, the removal of the compressive element was intended: the epidural scar and the disc fragment. 863 patients (67,7% were operated on for lumbar disc herniation, 344 patients (27,3% were operated on for lumbar spinal stenosis and 52 patients (5% were operated for recurrences. The operations were performed by neurosurgeons with the same professional degree but with different operative volume. Unintentional durotomy occurred in 20 (2,3% of the patients with herniated disc, in 14 (4,07% of the patients with lumbar spinal stenosis and in 12 (23% of the patients who were operated on for recurrences. The most frequent risk factors were: obesity, revised surgery and the physician’s low operative volume. Intraoperative dural fissures were repaired through suture (8 cases, by applying muscle, fat graft or by applying curaspon, tachosil. There existed 4 CSF fistulas which were repaired at reoperation. Incidental dural fissures during operations for degenerative lumbar disorders must be recognized and immediately repaired to prevent complications such as CSF fistula, osteodiscitis and increased medical costs. Preventing, identifying and treating unintentional durotomies can be best achieved by respecting a neat surgical technique and a standardized treatment protocol.

Caudal epidural injections for lumbar prolapsed inter vertebral disc: assessment with urdu version of oswestry disability index

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Pasha, I.F.; Qureshi, M.A.; Farooq, M.

2014-01-01

Background/Aims: Oswestry Disability index is an established tool for assessment of Spinal Disability. It has been translated into many languages and but not to Urdu. The aim of this prospective observational study was translation, application and validation of Urdu version of the Oswestry Disability Index (Urdu ODI) for our specific cultural background. Methods: Urdu version of ODI was developed and applied for outcome assessment in 50 patients, suffering from lumbar prolapsed inter vertebral discs and treated with caudal epidural steroid injection. All patients having mechanical low backache with radiculopathy and single level disc prolapse at L-4-5 or L5- S 1 on Magnetic Resonance Imaging (MRI) were included in the study. Single Steroid Injection with local anesthetic was injected into sacral caudal epidural space through sacral hiatus. A Performa was made for each patient and records were kept in a custom built Microsoft access database. Outcome was assessed using Urdu ODI and validation by comparing with Numeric rating Scale 0-10 at each visit. Results: Fifty patients received caudal epidural injections, 23 (46%) were male and 27 (54%) were female. The mean age was 34 years, with the range being 21-55. Low mechanical backache with right sided radiculopathy was in 29 (58%) and left sided in 21 (42%) patients. The commonest involved disc was L4-S in 28 (56%) and L5-S1 in 22 (44%) patients Pain was assessed with Numeric Rating Scale (NRS) of ten points. This was mean 7.35, range 9-6 at presentation and mean improvement was 4.15 with range 5-3 at fist week, 3.80 with range 5-2 at first month and 3.05 with range 4-1 after six months. Functional disability assessment was done using Urdu ODI. The mean Urdu ODI at the time of presentation was 66.23% with range 81%-48%. The mean functional status was found to be 38.64% with range 26%-45% at the end of the first week, 43.65% with range 31%-48% after one month and 44.85% with range 28%-48% after six months. So there was

Congenital lumbar vertebrae agenesis in a lamb.

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Farajli Abbasi, Mohammad; Shojaei, Bahador; Azari, Omid

2017-01-01

Congenital agenesis of lumbar vertebrae was diagnosed in a day-old female lamb based on radiology and clinical examinations. There was no neurological deficit in hindlimb and forelimb associated with standing disability. Radiography of the abdominal region revealed absence of lumbar vertebrae. Necropsy confirmed clinical and radiographic results. No other anomaly or agenesis was seen macroscopically in the abdominal and thoracic regions as well as vertebral column. Partial absence of vertebral column has been reported in human and different animal species, as an independent occurrence or associated with other organs anomalies. The latter has been designated as caudal regression syndrome. Vertebral agenesis may arise from irregularity in the differentiation of somites to the sclerotome or sclerotome to the vertebral primordium. Most of the previously reported cases of agenesis were related to the lumbosacral region, lonely or along with other visceral absences. This case was the first report of congenital agenesis of lumbar vertebrae in a lamb.

Biomechanical implications of lumbar spinal ligament transection.

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Von Forell, Gregory A; Bowden, Anton E

2014-11-01

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

Cauda Equina Syndrome Due to Lumbar Disc Herniation: a Review of Literature.

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Kapetanakis, Stylianos; Chaniotakis, Constantinos; Kazakos, Constantinos; Papathanasiou, Jannis V

2017-12-20

Cauda equina syndrome (CES) is a rare neurologic condition that is caused by compression of the cauda equina. Cauda equina consists of spinal nerves L2-L5, S1-S5 and the coccygeal nerve. The compression of these nerve roots can be caused mainly by lumbar disc herniation (45% of all causes). The diagnosis consists of two critical points: a) detailed history and physical examination and b) MRI or CT. The gold standard of the treatment of this syndrome is the surgical approach in combination with the timing of onset of symptoms. The surgery as an emergency situation is recommended in the fi rst 48 hours of onset of symptoms. Any delay in diagnosis and treatment leads to a poor prognosis of CES.

Efficacy of different bone volume expanders for augmenting lumbar fusions.

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Epstein, Nancy E

2008-01-01

A wide variety of bone volume expanders are being used in performing posterolateral lumbar noninstrumented and instrumented lumbar fusions. This article presents a review of their efficacy based on fusion rates, complications, and outcomes. Lumbar noninstrumented and instrumented fusions frequently use laminar autografts and different bone graft expanders. This review presents the utility of multiple forms/ratios of DBMs containing allografts. It also discusses the efficacy of artificial bone graft substitutes, including HA and B-TCP. Dynamic x-ray and/or CT examinations were used to document fusion in most series. Outcomes were variously assessed using Odom's criteria or different outcome questionnaires (Oswestry Questionnaire, SF-36, Dallas Pain Questionnaire, and/or Low Back Pain Rating Scale). Performing noninstrumented and instrumented lumbar posterolateral fusions resulted in comparable fusion rates in many series. Similar outcomes were also documented based on Odom's criteria or the multiple patient-based questionnaires. However, in some studies, the addition of spinal instrumentation increased the reoperation rate, operative time, blood loss, and cost. Various forms of DBMs, applied in different ratios to autografts, effectively supplemented spinal fusions in animal models and patient series. beta-Tricalcium phosphate, which is used to augment autograft fusions addressing idiopathic scoliosis or lumbar disease, also proved to be effective. Different types of bone volume expanders, including various forms of allograft-based DBMs, and artificial bone graft substitutes (HA and B-TCP) effectively promote posterolateral lumbar noninstrumented and instrumented fusions when added to autografts.

Spinal CT scan, 2. Lumbar and sacral spines

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

1982-08-01

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

Endoscopic anatomy and features of lumbar discectomy by Destandau technique

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Keyvan Mostofi

2017-03-01

Full Text Available Minimally invasive spine surgery prevents alteration of paraspinal muscles and avoids traditional open surgery, so in the majority of cases, recovery is much quicker and patients have less back pain after surgery. The authors describe an endoscopic approach to lumbar disc herniation by the Destandau's method originated in Bordeaux. Destandau designed ENDOSPINE for discectomy will be inserted, and the procedure will continue using endoscopy. The Endoscopic approach to lumbar disc herniation by Destandau's method offers a convenient access to lumbar disc herniation with less complications and negligible morbidity. It gives maximum exposure to the disc space with maximal angles and minimal cutaneous incision. Contrary to other minimally invasive approaches, the visual field in discectomy by Destandau technique is broad and depending on the workability of ENDOSPINE an adequate access to lumbar disc herniation is possible.

Anterior cervical discectomy and fusion for the management of axial neck pain in the absence of radiculopathy or myelopathy

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Riew, K Daniel; Ecker, Erika; Dettori, Joseph R.

2010-01-01

Study design: Systematic review Study rationale: Anterior cervical discectomy and fusion (ACDF) is a proven, effective treatment for relieving neck pain due to degenerative conditions of the cervical spine. Since most patients also present with radiculopathy or myelopathy, little is known as to the effectiveness of ACDF to relieve pain and improve function in patients without radicular or myelopathic symptoms. Objective: To examine the clinical outcome in patients undergoing (ACDF) for axial neck pain without radicular or myelopathic symptoms. Methods: A systematic review was undertaken for articles published up to March 2010. Electronic databases and reference lists of key articles were searched to identify studies evaluating ACDF for the treatment of axial neck pain only. Radiculopathy and myelopathy, patients who suffered severe trauma, or with tumor/metastatic disease or infection were excluded. Two independent reviewers assessed the strength of evidence using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results: No comparative studies were identified. Three case series met our inclusion criteria and were evaluated. All studies showed a mean improvement of pain of at least 50% approximately 4-years following surgery. Functional outcomes improved between 32% and 52% from baseline. Most patients reported satisfaction with surgery, 56% in one study and 79% in another. Complications varied among studies ranging from 1% to 10% and included pseudoarthrosis (9%), nonunion and revision (3%) and screw removal (1%). Conclusion: There is low evidence suggesting that patients with axial neck pain without radicular or myelopathic symptoms may receive some improvement in pain and function following ACDF. However, whether this benefit is greater than nontreatment or other treatments cannot be determined with the present literature. PMID:22956927