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Sample records for chemical lumbar sympathectomy

  1. Long-term remission of primary erythermalgia with R1150W polymorphism in SCN9A after chemical lumbar sympathectomy.

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    Zhang, Long; Wang, Wen-hui; Li, Lin-feng; Dong, Guo-xiang; Zhao, Jun; Luan, Jing-yuan; Sun, Ting-ting

    2010-01-01

    Primary erythermalgia (PEM) is recalcitrant and long-term remission is difficult to achieve. Favorable results of treatment using carbamazepine or mexiletine have been identified in some PEM patients with SCN9A gene mutations. However, no therapeutic studies regarding patients without pathogenic SCN9A gene mutation have been reported. Here we present a PEM case with R1150W polymorphism in SCN9A and a five-year remission was achieved by chemical lumbar sympathectomy (CLS). A 15-year-old girl with severe PEM attacks in both feet and lower legs was treated with CLS and followed up for five years. The encoding exons and their flanking sequences in the SCN9A gene were amplified and sequenced. A 50% immediate pain reduction was achieved after CLS. Burning pain, erythema and swelling in the lower legs disappeared in four days, and all ulceration healed in a month. The patient resumed normal exercise five months after CLS. There were no relapses in the following five years. R1150W polymorphism in SCN9A was detected in the patient and her healthy father. Long-term remission was achieved after CLS in this PEM case with R1150W polymorphism in SCN9A. The effectiveness of CLS and phenotype/genotype of PEM should be further studied in larger samples.

  2. [Severe Raynaud's syndrome treated by lumbar sympathectomy].

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    Thomsen, Thomas Laden; Roeder, Ole

    2016-03-28

    Avoiding exposure of extremities to cold combined with pharmacologic treatment usually suffice in the attempt to suppress the related symptoms of Raynaud's syndrome. This case report describes a severe case of Raynaud's syndrome affecting the lower extremities of a 16-year-old female. She was referred to a centre of vascular surgery with severe vasospasms of the feet. After failed attempts of pharmacologic treatment, a laparoscopic lumbar sympathectomy was performed with no complications and a slight reduction of symptoms three years post-surgically.

  3. Early experience with endoscopic lumbar sympathectomy for plantar hyperhidrosis.

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    Singh, Sanjay; Kaur, Simranjit; Wilson, Paul

    2016-05-01

    We describe our endoscopic lumbar sympathectomy technique and our early experience using it to treat plantar hyperhidrosis. We reviewed 20 lumbar sympathectomies performed in our vascular unit for plantar hyperhidrosis in 10 patients from 2011 and 2014. Demographics and outcomes were analyzed and a review of the literature conducted. All procedures were carried out endoscopically with no intraoperative or postoperative morbidity. Plantar anhidrosis was achieved in all the patients, although two patients (20%) suffered a relapse. Unwanted side-effects occurred in the form of compensatory sweating in three patients (30%) and post-sympathectomy neuralgia in two patients (20%). None of the patients experienced sexual dysfunction. Management of plantar hyperhidrosis may be based upon a therapeutic ladder starting with conservative measures and working up to surgery depending on the severity of the disease. Minimally invasive (endoscopic) sympathectomy for the thoracic chain is well established, but minimally invasive sympathectomy for the lumbar chain is a relatively new technique. Endoscopic lumbar sympathectomy provides an effective, minimally invasive method of surgical management, but long-term data are lacking. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  4. Endoscopic Lumbar Sympathectomy for Women: Effect on Compensatory Sweat

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    de Paula Loureiro, Marcelo; de Campos, José Ribas Milanez; Kauffman, Paulo; Jatene, Fábio Biscegli; Weigmann, Sheila; Fontana, Aline

    2008-01-01

    INTRODUCTION Plantar hyperhidrosis is present in 50% of patients with hyperhidrosis. Thoracic sympathectomy is an important tool for the treatment of this condition, which is successful in about 60% of patients. For the remaining patients, lumbar sympathectomy is the procedure of choice. As new minimally invasive techniques have been developed, a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy. The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat. MATERIALS AND METHODS Thirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled. They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy (Group A) or no surgical intervention (Group B - control) groups. Quality-of-life modifications were assessed by specific questionnaires before and after surgery. In the same manner, direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss. Despite the lack of intervention, the control group was evaluated at similar timepoints. RESULTS In Group A, no major complications occurred in the peri-operative period. During the immediate post-operative period, three patients (20%) experienced prolonged pain (more than ten days). Eight patients suffered from worsened compensatory sweating (53.3%). In Group A, after lumbar sympathectomy, the quality of life significantly improved (psympathectomy resulted in significantly lower values of foot sweat (pre- vs. post-operative periods, psympathectomy diminishes plantar sweat and improves the quality of life of women with plantar hyperhidrosis. However, about half of the patients develop increased compensatory hyperhidrosis in other areas of the body. PMID:18438572

  5. Endoscopic lumbar sympathectomy for women: effect on compensatory sweat

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    Marcelo de Paula Loureiro

    2008-01-01

    Full Text Available INTRODUCTION: Plantar hyperhidrosis is present in 50% of patients with hyperhidrosis. Thoracic sympathectomy is an important tool for the treatment of this condition, which is successful in about 60% of patients. For the remaining patients, lumbar sympathectomy is the procedure of choice. As new minimally invasive techniques have been developed, a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy. The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat. MATERIALS AND METHODS: Thirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled. They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy (Group A or no surgical intervention (Group B - control groups. Quality-of-life modifications were assessed by specific questionnaires before and after surgery. In the same manner, direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss. Despite the lack of intervention, the control group was evaluated at similar timepoints. RESULTS: In Group A, no major complications occurred in the peri-operative period. During the immediate post-operative period, three patients (20% experienced prolonged pain (more than ten days. Eight patients suffered from worsened compensatory sweating (53.3%. In Group A, after lumbar sympathectomy, the quality of life significantly improved (p<0.05, intra-group comparison beyond that of the control group (p<0.05, inter-group comparison. Also, lumbar sympathectomy resulted in significantly lower values of foot sweat (pre- vs. post-operative periods, p<0.05; Group A vs. Group B, p<0.05. These patients also developed higher values of sweat measurements on specific points of their dorsal and abdominal regions after the procedure (p<0

  6. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome.

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    Straube, Sebastian; Derry, Sheena; Moore, R Andrew; Cole, Peter

    2013-09-02

    This review is an update of a review first published in Issue 2, 2003, which was substantially updated in Issue 7, 2010. The concept that many neuropathic pain syndromes (traditionally this definition would include complex regional pain syndromes (CRPS)) are "sympathetically maintained pains" has historically led to treatments that interrupt the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy ganglia of the sympathetic chain, while surgical ablation is performed by open removal or electrocoagulation of the sympathetic chain or by minimally invasive procedures using thermal or laser interruption. To review the evidence from randomised, double blind, controlled trials on the efficacy and safety of chemical and surgical sympathectomy for neuropathic pain, including complex regional pain syndrome. Sympathectomy may be compared with placebo (sham) or other active treatment, provided both participants and outcome assessors are blind to treatment group allocation. On 2 July 2013, we searched CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Relief Database. We reviewed the bibliographies of all randomised trials identified and of review articles and also searched two clinical trial databases, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform, to identify additional published or unpublished data. We screened references in the retrieved articles and literature reviews and contacted experts in the field of neuropathic pain. Randomised, double blind, placebo or active controlled studies assessing the effects of sympathectomy for neuropathic pain and CRPS. Two review authors independently assessed trial quality and validity, and extracted data. No pooled analysis of data was possible. Only one study satisfied our inclusion criteria, comparing percutaneous radiofrequency thermal lumbar sympathectomy with lumbar sympathetic neurolysis using phenol in 20 participants with CRPS. There was no comparison of

  7. Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis.

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    Rieger, Roman; Loureiro, Marcelo de Paula; Pedevilla, Sonja; de Oliveira, Ramon Antunes

    2011-01-01

    Palmoplantar hyperhidrosis is a common disease that leads to significant psychosocial strain for the affected person. Although the treatment of palmar symptoms with endoscopic thoracic sympathectomy (ETS) is clinically established, there are few data on the efficacy of an endoscopic lumbar sympathectomy (ELS) for the elimination of plantar symptoms. Especially the occurrence of unwanted side effects associated with sequential ETS and ELS has not been examined sufficiently. The study includes 130 patients, 8 men and 122 women, with severe palmoplantar hyperhidrosis who were already previously treated with ETS. An average of 28 months after the ETS, bilateral ELS was performed on all patients due to persistent severe plantar hyperhidrosis. After ELS the perioperative morbidity, elimination rate of the plantar hyperhidrosis, the frequency of unwanted side effects, and satisfaction with the result were evaluated. Follow-up examinations were carried out on 96 patients (74%) with a mean follow-up of 37 months (3-90 months). A total of 260 lumbar sympathectomies were successfully carried out endoscopically. Mortality was zero, intraoperative complications occurred in three (2.3%) patients and postoperative complications in six (4.6%). Plantar hyperhidrosis was eliminated in 93 patients (97%), 3 (3%) patients developed a one-sided recurrence. Seven patients (7%) developed minor compensatory sweating, and in 17 patients (18%) compensatory sweating that existed before the ELS was slightly increased. Transient postsympathectomy neuralgia was observed in 18 patients (19%), and none of the patients showed a sexual function disorder. Altogether, 77 patients (80%) were very satisfied with the postoperative result, and 16 (17%) were partially satisfied. The sesequential performance of ELS after ETS appears to be a safe, effective therapy option for patients with severe palmoplantar hyperhidrosis. However, more experience with a larger number of patients and longer follow

  8. [Monitoring by non-flowmeter vascular function tests following lumbar sympathectomy].

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    Becker, F; Davinroy, M

    1985-01-01

    Postoperative follow up examinations were conducted using vascular functional explorations (V.F.E.) including thermometry, Doppler, irrigraphy, digital plethysmography and tread mill. Immediate and long-term effects of lumbar sympathectomy have to be distinguished: the majority of hemodynamic variations noted are not due exclusively to lumbar sympathectomy, except for the iatrogenic development of vasomotor inertia (R.H.T. indifferent or negative) and perhaps values with time of the digital flow curve. Results of V.F.E. after lumbar sympathectomy are discussed in relation to three modalities and taking into account the efficacy and extent of the sympathetic chain resection. The question is raised as to the usefulness of lumbar sympathectomy when the pretreatment V.F.E. findings show hemodynamic elements of the type that would be expected after lumbar sympathectomy.

  9. [Adjuvant and individual application of lumbar sympathectomy at patient with arterial disease in lower limb].

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    Govedarski, V; Petrov, I; Zahariev, T; Nachev, G

    2010-01-01

    The first lumbar sympathectomy for treatment of arterial occlusive disease of the lower extremity was performed in 1924 by Julio Diez of Buenos Aires. The standart anatomy textbooks indicate, as a rule that the lumbar sympathetic trunk contains four or five ganglia. The overall anatomic denervation is important for achievement of an adequate sympathectomy of a given segment of an extremity. Criteria and indications for complete sympathetic block are still not clear. Exceptionally important for the improvement of the reology of the lower limbs is the option for a direct increase of the collaterals' debit which could be achieved by extensive profundoplasty. As an addition to the arterial reconstructions, the sympathectomy increases the passability of small vessel anastomosis and the recovery of traumatized arteries. Unilateral or bilateral lumbar sympathectomy is performed by retroperitonal access. From 01.01.2008 till 01.11.2008 in our clinic were performed 117 isolated and after arterial reconstruction lumbar sympathectomies.

  10. Management of Plantar Hyperhidrosis with Endoscopic Lumbar Sympathectomy.

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    Rieger, Roman

    2016-11-01

    Primary plantar hyperhidrosis is defined as excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle and reduction of health-related quality of life. Conservative therapy measures usually fail to provide sufficient relieve of symptoms and do not allow long-lasting elimination of hyperhidrosis. Endoscopic lumbar sympathectomy appears to be a safe and effective procedure for eliminating excessive sweating of the feet and improves quality of life of patients with severe plantar hyperhidrosis.

  11. Simpatectomia lombar por pneumoretroperitonioscopia (SLPR Retroperitoneal endoscopic lumbar sympathectomy

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    Wander Eduardo Sardinha

    2007-12-01

    aims at evaluating results of retroperitoneal endoscopic lumbar sympathectomy. METHODS: Thirty-one patients were submitted to retroperitoneal endoscopic lumbar sympathectomy (22 males and nine females, mean age of 48 years (41-70. Twenty patients had chronic peripheral arterial disease, with no possibility of revascularization, all presenting with necrosis or ulcer; seven patients had thromboangiitis obliterans, three had hypertensive ulcer, and one patient had secondary Raynaud phenomenon. Surgical procedures were performed by retroperitoneal endoscopic access, besides excision of ganglia L2-L4 of the lumbar sympathetic chain. RESULTS: There were no intraoperative complications, only the need of converting to open surgery due to technical difficulties. Mean operative time was 103 minutes and mean hospital stay was 2 days. CONCLUSION: Sympathectomy can be performed by retroperitoneal endoscopy using the advantages of a minimally invasive surgery.

  12. Totally videoscopic bilateral, simultaneous lumbar sympathectomy: original modification – preliminary report

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    Tomasz Stefaniak

    2010-03-01

    Full Text Available Introduction: Lumbar sympathectomy seems to be technically a much more demanding procedure than thoracic sympathectomy.Nevertheless, some patients require this particular procedure. In our centre, the operation is performed nosooner than 12 months after initial thoracic sympathectomy as a simultaneous bilateral retro-peritoneoscopic procedure.Aim: To evaluate early effectiveness of totally videoretroperitoneoscopic lumbar sympathectomy from a posteriorapproach.Material and methods: Between June 2008 and June 2009, there were 12 patients operated on for primary plantarhyperhidrosis in the Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Poland.A bilateral procedure was performed in 6 patients, and in 6 other cases (initial ones the procedure had to be split dueto too slow progress of the procedure (learning curve.Results: Mean operation time was 92.5 ±27.16 min (for 6 bilateral procedures and 84 ±20.17 min (for the initial12 unilateral procedures. There was no postoperative mortality. Morbidity involved post-sympathectomy syndromepresenting as moderate burning pain in the buttocks and thighs up to 4 weeks postoperatively. Postoperative stay was1 day in 7 cases and 2 days in 3 cases (due to long train travel awaiting the patient on his/her way home. In themajority of patients, early postoperative results were very good, expressed by both the subjective opinion of thepatient and gravimetric results. In one case dryness of the feet was so severe that the patient had to consult a dermatologist.Conclusions: We believe that videoretroperitoneoscopic lumbar sympathectomy from a posterior approach is a goodmethod of treatment for primary hyperhidrosis with plantar symptoms, but should be reserved for surgeonsexperienced in laparoscopic and retroperitoneoscopic surgery.

  13. Recovery of sympathetic nerve function after lumbar sympathectomy is slower in the hind limbs than in the torso.

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    Zheng, Zhi-Fang; Liu, Yi-Shu; Min, Xuan; Tang, Jian-Bing; Liu, Hong-Wei; Cheng, Biao

    2017-07-01

    Local sympathetic denervation by surgical sympathectomy is used in the treatment of lower limb ulcers and ischemia, but the restoration of cutaneous sympathetic nerve functions is less clear. This study aims to explore the recovery of cutaneous sympathetic functions after bilateral L2-4 sympathectomy. The skin temperature of the left feet, using a point monitoring thermometer, increased intraoperatively after sympathectomy. The cytoplasm of sympathetic neurons contained tyrosine hydroxylase and dopamine β-hydroxylase, visualized by immunofluorescence, indicated the accuracy of sympathectomy. Iodine starch test results suggested that the sweating function of the hind feet plantar skin decreased 2 and 7 weeks after lumbar sympathectomy but had recovered by 3 months. Immunofluorescence and western blot assay results revealed that norepinephrine and dopamine β-hydroxylase expression in the skin from the sacrococcygeal region and hind feet decreased in the sympathectomized group at 2 weeks. Transmission electron microscopy results showed that perinuclear space and axon demyelination in sympathetic cells in the L5 sympathetic trunks were found in the sympathectomized group 3 months after sympathectomy. Although sympathetic denervation occurred in the sacrococcygeal region and hind feet skin 2 weeks after lumbar sympathectomy, the skin functions recovered gradually over 7 weeks to 3 months. In conclusion, sympathetic functional recovery may account for the recurrence of hyperhidrosis after sympathectomy and the normalization of sympathetic nerve trunks after incomplete injury. The recovery of sympathetic nerve function was slower in the limbs than in the torso after bilateral L2-4 sympathectomy.

  14. Palmar hyperhidrosis - CT guided chemical percutaneous thoracic sympathectomy

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    Adler, O.B.; Engel, A.; Rosenberger, A. (Technion-Israel Inst. of Tech., Haifa (Israel). Dept. of Diagnostic Radiology); Dondelinger, R. (Centre Hospitalier, Luxembourg (Luxembourg). Dept. of Diagnostic Radiology)

    1990-10-01

    Palmar hyperhidrosis or excessive sweating of the hands causes, to those affected, emotional and physical disturbance and impediment in professional and social life. The cause is unknown. Sweat glands are innervated by the sympathic chain of the autonomous nervous system. The center of sympathic regulation of the upper extremities is located between the segments of D.2-D.9 of the spinal cord. Accepted treatment consists of surgery aimed to excise the third thoracic sympathic ganglion. CT guided chemical percutaneous thoracic sympathectomy presents an alternative, which in the event of failure does not prevent ensuing surgery. The preliminary experience with this procedure in 50 patients is presented and discussed. (orig./GDG).

  15. Percutaneous lumbar sympathectomy: A comparison of radiofrequency denervation versus phenol neurolysis

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    Haynsworth, R.F. Jr.; Noe, C.E. (Baylor Univ. Medical Center, Dallas, TX (USA))

    1991-03-01

    A new percutaneous approach to sympathectomy using radiofrequency denervation has seemed to offer longer duration and less incidence of postsympathetic neuralgia as compared to phenol sympathetic blocks. To compare these techniques, 17 patients underwent either phenol lumbar sympathetic blocks (n = 9) or radiofrequency denervation (n = 8). Duration of sympathetic block was followed by a sweat test and temperature measurements. Results indicate that 89% of patients in the phenol group showed signs of sympathetic blockade after 8 weeks, as compared to 12% in the radiofrequency group (P less than 0.05). Although the incidence of post sympathetic neuralgia appears to be less with radiofrequency denervation, further refinement of needle placement to ensure complete lesioning of the sympathetic chain will be required before the technique can offer advantages over current phenol techniques.

  16. [Experience in treatment of Raynaud's syndrome by chemical thoracic sympathectomy].

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    Zhao, Jun; Dong, Guo-xiang; Luan, Jing-yuan

    2003-11-25

    To summarize the experience in treatment of Raynaud's syndrome with chemical thoracic sympathectomy (CTS) guided by X ray. From March 2001 to December 2002,35 cases (66 limbs) of Raynaud's syndrome were treated by CTS. Guided by X ray, a needle was punctured through the back skin to the second or third thoracic sympathetic ganglion beside the thoracic vertebrae and 2 ml of 5% phenol was injected. The first CTS treatment produced an excellent effect on 32 limbs, good effect on 12 limbs, and no effect on 22 limbs with an effective rate of 66.7% (44/66). The same treatment was performed on the limbs without effect 1 - 2 days after the first treatment and produce excellent effect on 2 limbs, good effect on 6 limbs, and no effect on 14 limbs with an effective rate of 36.4% (8/22). The efficiency rate of the first hospitalization was 78.8%. The effective rate of treating primary Raynaud's disease by CTS was 88.5% and that of treating secondary one was 42.8%. 85% of the patients were followed up for 9 months on average with an efficiency rate of 61%. CTS is mini-invasive, cheap, easy to popularize, and a relatively ideal choice in treatment of Raynaud's syndrome. Complications can be minimum only if the operation is performed carefully.

  17. Lumbar sympathectomy under CT guidance: therapeutic option in critical limb ischaemia; la simpaticolisi TC guidata: alternativa terapeutica delle ischemie critiche

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    Pieri, Stefano; Agresti, Paolo [Az. Osp. S. Camillo-Forlanini, Roma (Italy). U.O. di radiologia vascolare ed interventistica; Ialongo, Pasquale; Fedeli, Stefano [Radiologia diagnostica Busi, Roma (Italy); Di Cesare, Fabio; Ricci, Guiseppe [Az. Osp. S. Camillo-Forlanini, Roma (Italy). Chirurgia vascolare

    2005-04-01

    Purpose: Lumbar sympathectomy is a complementary therapeutic option for patients with severe peripheral vascular occlusive disease presenting rest pain or gangrene and not eligible for surgical revascularisation. Traditional surgical sympathectomy was widely used in the past. However, due to its invasive character, it has increasingly been replaced by percutaneous techniques and, in some recent cases, by laparoscopic procedures. Percutaneous lumbar sympathectomy is a safe, cost-effective and widely available treatment option. We report our experience on 19 patients subjected to percutaneous sympathectomy under CT guidance. Materials and methods: Between 1998 and 2000, 19 patients underwent percutaneous sympathectomy under CT guidance. All patients had severe vascular disease of the lower extremities (Fontaine stage IV), with rest pain and gangrene. They were not eligible for surgical revascularization. Phenol was injected at the level of L2 and L4 using two 22 G needles (15 cm long). Signs of interrupted sympathetic activity usually occur 2'-15' after the procedure with warmth and flushing and dryness of the lower extremities. Results: Percutaneous sympathectomy under CT guidance is a simple, safe and well-tolerated procedure with a low rate of complications. Of the 19 patients, 9 (47.3%) showed clinical improvement, whereas 5 experienced a worsening of ischaemia in the month immediately following the procedure. Discussion: Results suggest that percutaneous lumbar sympathectomy causes a sympathetic blockade in patients with advanced vascular disease of the limb. CT guidance ensures a high level of precision in drug dosing, thus lowering the risk of complications. Although the results are demoralizing. the impossibility of achieving surgical revascularisation in advanced peripheral arteriosclerosis enhances the role of Ct-guided percutaneous sympathectomy in relieving rest pain and healing ulcers in order to postpone the amputation. [Italian] Scopo: La

  18. Comparative analysis of lower extremities tissue perfusion by the use of perfusion scintigraphy method after hyperbaric oxygenation and lumbar sympathectomy

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    Zoranović Uroš

    2009-01-01

    Full Text Available Background/Aim. Lumbar syphatectomy (LS increases pheripheral blood flow primarily by the arteriolar vasodilatation within the skin vascular net. Increase in tissue nutrition takes place only in the distal blood vessels of the skin. Nevertheless, in some patients sympathectomy brings about improvement in ischemic ulcerations healing. Hyperbaric oxigenation (HBO is a medical treatment in which a patient breathes 100% oxygen under pressure higher than atmospheric implemented in special units allowing the whole body be in a chamber. The aim of the study was to determine efficacy of the applied therapies for the treatment of inoperable occlusive lower extremities (LE arteries diseases according to the obtained results. Methods. The study included 30 patients divided into two groups (15 patients each in which stenosis level of the lower extremities arteries had been determined using aortography due to further treatment with HBO and LS. All the patients were clinically examined, their objective condition evaluation based on claudication distance, pain in rest, skin and skin adnexa atrophy, and temperature and LE functionality, as well as exposed to perfusion scintigraphy prior to the treatment and within 30 days after the treatment finishing. Results. Analyzing patients' status prior to and after the treatments applied the number of patients with obvious improvement was higher in those treated by HBO than those treated by LS. Measuring claudication distance revealed significantly greater changes in patients treated by HBO (from 178.57 m to 754.76 m than in those treated by LS (from 229 m to 253 m. Other clinical symptoms, such as parasthesia, status of the skin adnexes (hair, nails, skin colour and temperature were also improved after the treatment by HBO. Conclusion. The results obatined in this study confirm the advantages of HBO over LS in therapy of inoperable occlusive LE disease, so LS could be definitely abandoned as a choice for treating such

  19. [Experience in treatment of Raynaud's syndrome by chemical sympathectomy: 97 cases].

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    Han, Jin Tao; Zhao, Jun; Peng, Yong Guang

    2008-06-18

    To summarize the curative effect in treatment of Raynaud's syndrome with chemical thoracic sympathectomy (CTS) guided by X-ray since 2001. From March 2001 to August 2007, 97 patients with Raynaud's syndrome (186 limbs) were treated by CTS. Guided by X-ray, a needle was punctured through the back skin to the second thoracic sympathetic ganglion beside the thoracic vertebrae and 2 mL of 5% (v/v) phenol was injected. The first CTS treatment produced a good effect on 146 limbs with an effective rate of 78.5% (146/186). The same treatment was performed on the limbs with no effect 1-2 days after the first treatment and produced good effect on 13 limbs with an effective rate of 32.5% (13/40). The total effective rate of the patients who were hospitalized for the first time was 85.5% (159/186). Of the 97 patients, 78 patients (80.4%) were followed up for 47 months on an average with an effective rate of 69.5%. And the rate of complications was 11.4% for pheumothorax, and 3.9% for hydrothorax. Hyperalgesia on axillary region and anterior chest wall; Horner syndrome and sinus bradycardia were rare. CTS is minimally invasive and effective in treatment of Raynaud's syndrome.

  20. Capsaicin-induced corneal lesions in mice and the effects of chemical sympathectomy.

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    Shimizu, T; Izumi, K; Fujita, S; Koja, T; Sorimachi, M; Ohba, N; Fukuda, T

    1987-11-01

    Effects of chemical sympathectomy on corneal changes induced in mice by a s.c. injection of capsaicin were investigated. Pretreatment with a s.c. injection of 6-hydroxydopamine (6-OHDA) on the 1st and 2nd postnatal day or on the 14th and 15th postnatal day led to a marked suppression of the capsaicin-induced corneal lesions. This suppressive effect also was evident in case of administration after capsaicin treatment. Intraventricular injection of 6-OHDA had a slight, transient effect. DSP4 [N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine], another potent substance used for sympathetic denervation, had a suppressive effect similar to that of 6-OHDA. The concentration of capsaicin in tissues of the head was unaltered with 6-OHDA. The content of substance P (SP) in the ocular anterior segments was decreased, dose-dependently, with capsaicin administration. Neonatal administration of 6-OHDA decreased the rate of capsaicin-induced reduction of SP. However, this effect of 6-OHDA was too slight to explain the suppression of the corneal lesions, as the intensity score of lesions with a large dose of capsaicin after 6-OHDA was lower than that with a small dose of capsaicin without 6-OHDA, whereas SP content in the former was still much lower than that in the latter. On the other hand, the content of norepinephrine in the ocular tissues was decreased in the presence of 6-OHDA but not capsaicin. These results suggest that the corneal changes induced by capsaicin are largely inhibited by a decreased activity in the peripheral sympathetic system.

  1. Chemical sympathectomy restores baroreceptor-heart rate reflex and heart rate variability in rats with chronic nitric oxide deficiency.

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    Chaswal, M; Das, S; Prasad, J; Katyal, A; Fahim, M

    2015-01-01

    Nitric oxide (NO) plays a crucial role not only in regulation of blood pressure but also in maintenance of cardiac autonomic tone and its deficiency induced hypertension is accompanied by cardiac autonomic dysfunction. However, underlying mechanisms are not clearly defined. We hypothesized that sympathetic activation mediates hemodynamic and cardiac autonomic changes consequent to deficient NO synthesis. We used chemical sympathectomy by 6-hydroxydopamine to examine the influence of sympathetic innervation on baroreflex sensitivity (BRS) and heart rate variability (HRV) of chronic N(G)-nitro-L-arginine methyl ester (L-NAME) treated adult Wistar rats. BRS was determined from heart rate responses to changes in systolic arterial pressure achieved by intravenous administration of phenylephrine and sodium nitroprusside. Time and frequency domain measures of HRV were calculated from 5-min electrocardiogram recordings. Chronic L-NAME administration (50 mg/kg per day for 7 days orally through gavage) in control rats produced significant elevation of blood pressure, tachycardia, attenuation of BRS for bradycardia and tachycardia reflex and fall in time as well as frequency domain parameters of HRV. Sympathectomy completely abolished the pressor as well as tachycardic effect of chronic L-NAME. In addition, BRS and HRV improved after removal of sympathetic influence in chronic L-NAME treated rats. These results support the concept that an exaggerated sympathetic activity is the principal mechanism of chronic L-NAME hypertension and associated autonomic dysfunction.

  2. Chemical sympathectomy increases neutrophil-to-lymphocyte ratio in tumor-bearing rats but does not influence cancer progression.

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    Horvathova, Lubica; Tillinger, Andrej; Sivakova, Ivana; Mikova, Lucia; Mravec, Boris; Bucova, Maria

    2015-01-15

    The sympathetic nervous system regulates many immune functions and modulates the anti-tumor immune defense response, too. Therefore, we studied the effect of 6-hydroxydopamine induced sympathectomy on selected hematological parameters and inflammatory markers in rats with Yoshida AH130 ascites hepatoma. We found that chemically sympathectomized tumor-bearing rats had significantly increased neutrophil-to-lymphocyte ratio, leukocyte-to-lymphocyte ratio, and plasma levels of tumor necrosis factor alpha. Although our findings showed that sympathetic denervation in tumor-bearing rats led to increased neutrophil-to-lymphocyte ratio, that is an indicator of the disease progression, we found no significant changes in tumor growth and survival of sympathectomized tumor-bearing rats.

  3. Thoracic sympathectomy

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    Hashmonai, Moshe; Cameron, Alan E P; Licht, Peter B

    2016-01-01

    for current practice. METHODS: The literature was reviewed using the PubMed/Medline Database, and pertinent articles regarding the indications for thoracic sympathectomy were retrieved and evaluated. Old, historical articles were also reviewed as required. RESULTS AND CONCLUSIONS: Currently, thoracic......BACKGROUND: Thoracic sympathetic ablation was introduced over a century ago. While some of the early indications have become obsolete, new ones have emerged. Sympathetic ablation is being still performed for some odd indications thus prompting the present study, which reviews the evidence base...... cases of angina, arrhythmias and cardiomyopathy. Thoracic sympathetic ablation is indicated in several painful conditions: the early stages of complex regional pain syndrome, erythromelalgia, and some pancreatic and other painful abdominal pathologies. Although ischaemia was historically the major...

  4. Effects of infantile/prepubertal chronic estrogen treatment and chemical sympathectomy with guanethidine on developing cholinergic nerves of the rat uterus.

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    Richeri, Analía; Viettro, Lorena; Chávez-Genaro, Rebeca; Burnstock, Geoffrey; Cowen, Timothy; Brauer, M Mónica

    2002-06-01

    The innervation of the uterus is remarkable in that it exhibits physiological changes in response to altered levels in the circulating levels of sex hormones. Previous studies by our group showed that chronic administration of estrogen to rats during the infantile/prepubertal period provoked, at 28 days of age, an almost complete loss of norepinephrine-labeled sympathetic nerves, similar to that observed in late pregnancy. It is not known, however, whether early exposure to estrogen affects uterine cholinergic nerves. Similarly, it is not known to what extent development and estrogen-induced responses in the uterine cholinergic innervation are affected by the absence of sympathetic nerves. To address this question, in this study we analyzed the effects of infantile/prepubertal chronic estrogen treatment, chronic chemical sympathectomy with guanethidine, and combined sympathectomy and chronic estrogen treatment on developing cholinergic nerves of the rat uterus. Cholinergic nerves were visualized using a combination of acetylcholinesterase histochemistry and the immunohistochemical demonstration of the vesicular acetylcholine transporter (VAChT). After chronic estrogen treatment, a well-developed plexus of cholinergic nerves was observed in the uterus. Quantitative studies showed that chronic exposure to estrogen induced contrasting responses in uterine cholinergic nerves, increasing the density of large and medium-sized nerve bundles and reducing the intercept density of fine fibers providing myometrial and perivascular innervation. Estrogen-induced changes in the uterine cholinergic innervation did not appear to result from the absence/impairment of sympathetic nerves, because sympathectomy did not mimic the effects produced by estrogen. Estrogen-induced responses in parasympathetic nerves are discussed, considering the direct effects of estrogen on neurons and on changes in neuron-target interactions.

  5. LOW-FREQUENCY LOW INTENSITY MAGNETIC FIELD (50 Hz; 2,7 mT INFLUENCES ON HEMATOLOGICAL PARAMETERS FOLLOWING CHEMICAL SYMPATHECTOMY IN WISTAR RATS

    Directory of Open Access Journals (Sweden)

    Calin Maniu

    2007-08-01

    hydroxydopamine infusion with 25 mg/kg i.p. desipramine (Sigma to protect noradrenergic projections. 12 days after the operation, the hematological parameters (the total number of erythrocytes, hematocrit and hemoglobin level were evaluated. The sympathectomy-induced severe reduction in hematological parameters under low-frequency low intensity magnetic field exposure.

  6. Thoracic sympathectomy for peripheral vascular disease can lead to severe bronchospasm and excessive bronchial secretions

    Science.gov (United States)

    Goyal, Vikas Deep; Gupta, Bharti; Kumar, Sanjeev; Pal, Sanjay

    2015-01-01

    A 57-year-old male patient suffering from Buerger's disease presented with pre-gangrenous changes in right foot and ischemic symptoms in right hand. Computed tomographic angiography revealed diffuse distal disease not suitable for vascular bypass and angioplasty. Right lumbar sympathectomy was done using a retroperitoneal approach followed 1 year later by right thoracic sympathectomy using a transaxillary approach. Postoperatively, the patient had severe bronchospasm and excessive secretions in the respiratory tract resistant to theophylline and sympathomimetic group of drugs and without any clinical, laboratory and radiological evidence of infection. The patient was started on anticholinergics in anticipation that sympathectomy might have lead to unopposed cholinergic activity and the symptoms improved rapidly. The patient recovered well and was discharged on 10th post-operative day. PMID:25624604

  7. Thoracic sympathectomy for peripheral vascular disease can lead to severe bronchospasm and excessive bronchial secretions

    Directory of Open Access Journals (Sweden)

    Vikas Deep Goyal

    2015-01-01

    Full Text Available A 57-year-old male patient suffering from Buerger′s disease presented with pre-gangrenous changes in right foot and ischemic symptoms in right hand. Computed tomographic angiography revealed diffuse distal disease not suitable for vascular bypass and angioplasty. Right lumbar sympathectomy was done using a retroperitoneal approach followed 1 year later by right thoracic sympathectomy using a transaxillary approach. Postoperatively, the patient had severe bronchospasm and excessive secretions in the respiratory tract resistant to theophylline and sympathomimetic group of drugs and without any clinical, laboratory and radiological evidence of infection. The patient was started on anticholinergics in anticipation that sympathectomy might have lead to unopposed cholinergic activity and the symptoms improved rapidly. The patient recovered well and was discharged on 10 th post-operative day.

  8. CT 引导下胸交感神经化学阻断术治疗手多汗症的临床观察%CT -Guided Chemical Thoracic Sympathectomy for the Treatment of Palmar Hyperhidrosis:a Prospective Study of 26 Patients

    Institute of Scientific and Technical Information of China (English)

    杨红军; 邓兵梅; 程飚; 彭凯润; 武肖娜; 项薇

    2015-01-01

    目的:探讨 CT 引导下胸交感神经化学阻断术治疗手多汗症的临床疗效。方法:纳入手多汗症患者26例,参照多汗症量表评估其出汗严重程度。在 CT 引导下行胸交感神经化学阻断术,观察患者手术前后出汗评分、起效时间、并发症等指标。结果:本组患者术后手出汗明显减少,效果持久,其并发症轻微且多为一过性。结论:CT 引导下胸交感神经化学阻断术是治疗手多汗症安全、有效且实用的方法。%Objective: To assess the effect of CT-guided chemical thoracic sympathectomy treatment on patients with palmar hyperhidrosis. Methods: The study included 26 patients diagnosised as palmar hyperhidrosis and the severity of hyperhidrosis was measured by The Hyperhidrosis Disease Severity Scale (HDSS). All patients complet-ed a questionnaire including the following information: time to effect of thoracic sympathectomy, local or systemic complication, and severity of hyperhidrosis before and after thoracic sympathectomy. Results: There was a signifi-cant reduction in the severity of hyperhidrosis after performing thoracic sympathectomy. The side effects of treat-ment were slight and short. Conclusion: Treatment of palmar hyperhidrosis with thoracic sympathectomy was safe, effective and applicable.

  9. Robotic selective postganglionic thoracic sympathectomy for the treatment of hyperhidrosis

    National Research Council Canada - National Science Library

    Coveliers, Hans; Meyer, Mark; Gharagozloo, Farid; Wisselink, Willem; Rauwerda, Jan; Margolis, Marc; Tempesta, Barbara; Strother, Eric

    2013-01-01

    ... maneuverability in a confined space may facilitate the technique of selective sympathectomy (ramicotomy). We present a case series of patients undergoing selective postganglionic thoracic sympathectomy using robotic technology...

  10. Thoracoscopic Sympathectomy for Vasospastic Diseases

    Science.gov (United States)

    Sica, Giuseppe S.; Sileri, Pierpaolo; Gaspari, Achille L.

    1998-01-01

    Background: Vasospastic disorders (acrocyanosis, Raynaud's syndrome, causalgia) can arise from different etiologic factors, but the pathogenesis is always represented by an altered mechanism of vasal motility. Upper dorsal sympathectomy has been demonstrated to be an effective treatment for these disorders by decreasing peripheral resistances. Surgical technique has shown long-lasting results, and it can now be performed by endoscopic approach. Methods: Our experience with six cases of sympathectomy is illustrated. The indications, thoracoscopic technique, complications and longterm results are evaluated. Four women with Raynaud's syndrome and two men with causalgia were treated in this series. After an accurate preoperative evaluation, the second, third, fourth and fifth thoracic ganglia of the sympathetic chain were identified and excised. Results: All patients experienced relief of symptoms with very limited pain and discomfort. They did not require further medical therapy and are relapse-free at follow-up. Conclusions: We conclude that thoracoscopic sympathectomy can be considered an effective, safe and simple treatment for selected cases of vasospastic phenomenon. PMID:9876748

  11. CT guided Chemical Thoracic Sympathectomy for Raynaud′s phenomenon%CT引导定位下化学性胸交感神经节切除术治疗雷诺现象

    Institute of Scientific and Technical Information of China (English)

    赵军

    2008-01-01

    目的 探讨CT定位下化学性胸交感神经节切除术(chemical thoracic sympathectomy, CTS)治疗上肢雷诺现象的有效性和安全性. 方法 对10例雷诺现象,包括4例X线定位下CTS术后复发患者,在CT定位下经皮穿刺于T2或T3交感神经节处注射5%酚,每个点注射3 ml. 结果 治疗后效果优10条,良3条,改善4条,无效3条,治疗有效率为85.0%(17/20).原发性雷诺现象有效率为92.9%(13/14),继发性雷诺现象的有效率为66.7%(4/6),复发后治疗有效率为75.0%(6/8).未发生气胸. 结论 CT定位下CTS创伤小,有效率高,复发后再次治疗多数仍然有效,是目前治疗上肢雷诺现象较理想的方法.

  12. Blue toe syndrome treated with sympathectomy in a patient with acute renal failure caused by cholesterol embolization

    Directory of Open Access Journals (Sweden)

    Min-Gang Kim

    2013-12-01

    Full Text Available Blue toe syndrome is the most frequent manifestation of tissue ischemia caused by cholesterol embolization (CE, which can lead to amputation of affected lower extremities, if severe. However, any effective treatment is lacking. We experienced a case of spontaneously presenting blue toe syndrome and concomitant acute renal failure in a patient with multiple atherosclerotic risk factors. CE was confirmed by renal biopsy. Despite medical treatment including prostaglandin therapy and narcotics, the toe lesion progressed to gangrene with worsening ischemic pain. Therefore, we performed lumbar sympathectomy, which provided dramatic pain relief as well as an adequate blood flow to the ischemic lower extremities, resulting in healing of the gangrenous lesion and avoiding toe amputation. This is the first reported case of a patient with intractable ischemic toe syndrome caused by CE that was treated successfully by sympathectomy. Our observations suggest that sympathectomy may be beneficial in some patients with CE-associated blue toe syndrome.

  13. [Assessment of thoracic sympathectomy by transpleural posterolateral and thoracoscopic approach in surgical treatment of Raynaud's syndrome].

    Science.gov (United States)

    Czyzewski, Damian; Dobosz, Jolanta; Wojtacha, Jacek; Kozielski, Jerzy; Lipka, Mariusz; Lazar-Czyzewska, Barbara

    2004-01-01

    Operative treatment of patients with Raynaud's Syndrome is rarely used, and is recommended by most authors only in the case of disthrophic changes or so advanced symptoms, which disturb normal social and daily life. Recently, thoracoscopic sympathectomy is applied more frequently. The aim of this study was to assess the usefulness of thoracoscopic sympathectomy by the presentation of early and long-term outcome of 43 thoracic and eight lumbar sympathectomies performed in 41 patients with Raynaud's Syndrome. Transpleural posterio-lateral thoracotomy was performed 29 times in 27 patients, whereas thoracoscopic sympatectomy 14 times in 8 patients. Surgical techniques, early and long-term results were discussed. Based on early and long-term outcome, there were no significant differences between applied surgical techniques. Moreover, thoracoscopic sympathectomy was safe in the aspect of a short duration as well as good therapeutic and cosmetic effect of the procedure. It should be applied instead of others, so far used methods, with the exception of patients with massive pleural adhesions, which need thoracotomy.

  14. Unilateral Sympathectomy for Primary Palmar Hyperhidrosis.

    Science.gov (United States)

    Ravari, Hassan; Rajabnejad, Ataollah

    2015-12-01

    Primary palmar hyperhidrosis that arises mostly during puberty and early adolescence has a tremendous impact on the quality of life in patients. This study aimed to investigate the effectiveness of unilateral video-assisted thoracic sympathectomy for dominant hand in these patients. From July 2010 to June 2013, 52 patients with primary palmar hyperhidrosis underwent unilateral video-assisted thoracoscopic sympathectomy for dominant hand. We analyzed the outcomes regarding the resolution of symptoms, occurrence of complications, recurrence rate, and compensatory hyperhidrosis, and need of operation for opposite side. All patients were followed up from 6 to 42 months. Palmar hyperhidrosis was completely alleviated and absolute dryness was achieved in all patients at the same hand after the operation. Palmar hyperhidrosis in the opposite hand was cured to a complete dryness in 24 (46.15%) patients. No change happened in the opposite hand in 22 (42.3%) patients, but an increase was seen in 6 (11.53%) patients. Only seven (13.46%) patients needed to undergo contralateral sympathectomy. Compensatory hyperhidrosis occurred in 13 patients (25%) after unilateral sympathectomy. Another five patients (totally 18, 34.6%) were involved with compensatory hyperhidrosis after contralateral sympathectomy. It was mainly on the trunk in all 18 patients. Unilateral dominant side thoracoscopic sympathectomy for patients with primary palmar hyperhidrosis is an effective, safe, and minimally invasive procedure. Only a small number of patients will eventually require a contralateral sympathectomy in nondominant hand. Georg Thieme Verlag KG Stuttgart · New York.

  15. Chemical thoracic sympathectomy for Raynaud's phenomenon: Report of 73 cases%化学性胸交感神经节切除术治疗雷诺现象73例

    Institute of Scientific and Technical Information of China (English)

    赵军; 董国祥; 栾景源; 李天润; 翟国钧; 张龙; 韩金涛

    2006-01-01

    目的 探讨X线定位下化学性胸交感神经节切除术(chemical thoracic sympathectomy,CTS)治疗雷诺现象的疗效和并发症的防治.方法 2001年3月~2005年9月,我院73例(141条上肢)雷诺现象按照治疗时间顺序分2组(2001年3月~2002年12月为A组,2003年1月~2005年9月为B组).A组(35例67条上肢)在X线定位下经皮穿刺至T2或T3交感神经节处注射5%酚实施CTS.B组(38例74条上肢)在A组操作的基础上,在针尖抵达胸椎体后缘时注入局麻药2~3ml后再继续向前进针至交感神经节处注射5%酚实施CTS.结果 A组气胸发生率28.4%(19/67)显著高于B组的4.1%(3/74)(x2=15.773,P=0.000);A组有效率77.6%(52/67)显著低于B组的97.3%(72/74)(x2=12.851,P=0.000).腋下痛A组2条肢体,B组5条肢体(x2=0.411,P=0.521),窦性心动过缓A组1例,B组无(x2=0.002,P=0.967),Horner综合征2组各1例(均单侧)(x2=0.000,P=1.000).结论 CTS治疗雷诺现象疗效满意,气胸是CTS较常见的并发症,操作方法的改良可以有效降低气胸发生率并提高治疗有效率.

  16. Reversibility of Sympathectomy for Primary Hyperhidrosis.

    Science.gov (United States)

    Hynes, Conor F; Marshall, M Blair

    2016-11-01

    Endoscopic thoracic sympathectomy (ETS) is an effective treatment of primary hyperhidrosis of the face, upper extremities, and axillae. The major limitation is the side effect of compensatory sweating severe enough that patients request reversal in up to 10% of cases. When ETS is performed by cutting the sympathetic chain, reversal requires nerve grafting. However, for ETS done with clips, reversal is a simple thoracoscopic outpatient procedure of removing the clips. Subsequent reversal of the sympathectomy, ie, nerve regeneration, is successful in many cases. However, follow-up is short. Factors contributing to success rates require further study. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Percutaneous radiofrequency thermal lumbar sympathectomy and its clinical use

    NARCIS (Netherlands)

    J. Pernak (Jamina)

    1988-01-01

    textabstractPercutaneous radiofrequency thermolesion techniques are commonly used in the treatment of chronic pain in different pain syndromes. There are many reports describing techniques of percutaneous radiofrequency thermolesion for denervation of central & spinal nerves (Mullan 1963), 1965,

  18. Thoracic sympathectomy for upper extremity ischemia.

    Science.gov (United States)

    Hoexum, Frank; Coveliers, Hans M; Lu, Joyce J; Jongkind, Vincent; Yeung, Kakkhee K; Wisselink, Willem

    2016-12-01

    Thoracic sympathectomy is performed in the management of a variety of disorders of the upper extremity. To evaluate the contemporary results of thoracic sympathectomy for upper extremity ischemia a systematic review of the literature was conducted. We performed a PubMed, EMBASE and Cochrane search of the literature written in the English language from January 1975 to December 2015. All articles presenting original patient data regarding the effect of treatment on symptoms or on the healing of ulcers were eligible for inclusion. Individual analyses for Primary Raynaud's Disease (PRD) and Secondary Raynaud's Phenomenon (SRP) were performed. We included 6 prospective and 23 retrospective series with a total of 753 patients and 1026 affected limbs. Early beneficial effects of thoracic sympathectomy were noticed in 63-100% (median 94%) of all patients, in 73-100% (median 98%) of PRD patients and in 63-100% (median 94%) of SRP patients. The beneficial effect was noted to lessen over time. Long-term beneficial effects were reported in 13-100% (median 75%) of all patients, in 22-100% (median 58%) of PRD patients, and in 13-100% (median 79%) of SRD patients. Complete or improved ulcer healing was achieved in 33-100% and 25-67% respectively, of all patients. Thoracic sympathectomy can be beneficial in the treatment of upper extremity ischemia in select patients. Although the effect in patients with PRD will lessen over time, it may still reduce the severity of symptoms. In SRD, effects are more often long-lasting. In addition, thoracic sympathectomy may maximize tissue preservation or prevent amputation in cases of digital ulceration.

  19. Objective evaluation of plantar hyperhidrosis after sympathectomy

    Directory of Open Access Journals (Sweden)

    Nelson Wolosker

    2013-01-01

    Full Text Available OBJECTIVE: The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter. METHODS: From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years. RESULTS: Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5% patients after one year. Only two (2.5% patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%, and the proportion of stable patients decreased (32.5% to 22.50%. This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution. CONCLUSION: Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.

  20. Endoscopic thoracic sympathectomy for primary palmar hyperidrosis.

    Science.gov (United States)

    Prasad, Arun; Ali, Mudasir; Kaul, Sunil

    2010-08-01

    Primary hyperhidrosis is a disorder that is characterized by excessive sweating in disproportion to that required for thermoregulation. In most cases, this is aggravated by emotional factors and by heat. Hyperhidrosis can be seen in the palms of the hands, armpits, soles of the feet and face. The principal characteristic of this disease is the intense discomfort of patients, which affects their social and professional life. Treatment modalities include topical application of aluminum chloride, iontophoresis, anticholinergics, botulinum toxin injection, liposuction, excision of sweat glands, and thoracic sympathectomy. Between January 1998 and August 2007, a prospective study of endoscopic thoracic sympathectomies for palmar hyperhidrosis was undertaken based on case histories and a prospective pre- and postoperative questionnaire survey. The sample comprised of 322 patients with a mean age of 24 years. At Apollo Hospital, New Delhi, India, bilateral video-assisted thoracoscopic T3 level sympathectomies were performed in all cases. All patients had immediate cessation of palmar hyperhidrosis. The mean postoperative stay was 1.1 days. A questionnaire was completed based on their response to a telephone conversation or e-mail. A paired t test and Wilcoxon test was performed on these data and it showed significant improvement in quality of life. Compensatory sweating was found to be the most troublesome side effect for all patients. It was seen in 63% of the patients. This is similar to other reports of compensatory sweating; however, the figure decreases to 29% if we disregard the percentage of patients who reported only mild compensatory sweating. In view of the low morbidity and zero mortality rate of this surgical technique, we recommend it as a method of treatment for palmar hyperhidrosis. Thoracic sympathectomy eliminates palmar hyperhidrosis with minimal recurrence (1% in our series) and produces a high rate of patient satisfaction.

  1. Objective evaluation of plantar hyperhidrosis after sympathectomy

    Science.gov (United States)

    Wolosker, Nelson; Ishy, Augusto; Yazbek, Guilherme; de Campos, José Ribas Milanez; Kauffman, Paulo; Puech-Leão, Pedro; Jatene, Fábio Biscegli

    2013-01-01

    OBJECTIVE: The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter). METHODS: From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years). RESULTS: Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution. CONCLUSION: Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present. PMID:23644849

  2. [Thoracic sympathectomy in primary hyperhidrosis: patient satisfaction].

    Science.gov (United States)

    Galbis-Caravajal, José Marcelo; Sales-Badía, J Gabriel; Cuenca-Torres, María; Miquel-Miquel, Javier; Esturi-Navarro, Rafael; Ortega-Monzó, Carmen

    2006-05-01

    To evaluate satisfaction among patients who underwent thoracic sympathectomy for primary hyperhidrosis and the possible complications after a minimum of 14 months after surgery. We performed a retrospective study in 108 patients who underwent thoracic sympathectomy and who responded to all the questions asked in a telephone interview. The sample was composed of 21 men and 87 women, with a mean age of 29.73 years. In all patients, surgery was performed with general anesthesia in a single intervention. Special emphasis was placed on the degree of satisfaction (whether patients would recommend this type of surgery) and the possible negative effects or complications experienced by patients or attributed by them to the procedure. Patients were contacted a minimum of 14 months after the intervention. The most frequent complication was compensatory sweating (81.5%). Pain at the site of trocar insertion was reported by 6.5%. There were few immediate and long-term complications. The degree of satisfaction reached 90.7%. Video-assisted thoracic sympathectomy is safe and effective. Despite compensatory sweating, overall satisfaction was very high. However, satisfaction gradually decreased in the months after the intervention. Patients with hyperhidrosis with significant or principal axillary involvement could benefit from botulinic toxin administration as the first-line therapy.

  3. Thoracic sympathectomy for digital ischemia : A summary of evidence

    NARCIS (Netherlands)

    Coveliers, Hans M. E.; Hoexum, Frank; Nederhoed, Johanna H.; Wisselink, Willem; Rauwerda, Jan A.

    2011-01-01

    Background: Thoracic sympathectomy is used in the management of a variety of upper limb disorders. We have analyzed the evidence for thoracic sympathectomy in the management of digital ischemia. Methods: We reviewed the English literature between 1980 and 2010. Our analysis included reports with the

  4. Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results

    Directory of Open Access Journals (Sweden)

    Cina C

    2007-01-01

    Full Text Available Outline: We review the clinical features of hyperhidrosis and the range of treatments used for this condition. We describe in detail the technique of endoscopic sympathectomy. We summarize studies that have reported results of endoscopic sympathectomy. We present new data highlighting the difference in quality of life between patients with hyperhidrosis and controls.

  5. Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results

    OpenAIRE

    Cina C; Cina M; Clase C

    2007-01-01

    Outline: We review the clinical features of hyperhidrosis and the range of treatments used for this condition. We describe in detail the technique of endoscopic sympathectomy. We summarize studies that have reported results of endoscopic sympathectomy. We present new data highlighting the difference in quality of life between patients with hyperhidrosis and controls.

  6. Endoscopic thoracic sympathectomy in the treatment of upper limb hyperhidrosis.

    Science.gov (United States)

    Malone, P. S.; Cameron, A. E.; Rennie, J. A.

    1986-01-01

    The technique of endoscopic sympathectomy is described and its value in the treatment of upper limb hyperhidrosis is reported in an initial series of 7 patients (13 sympathectomies). It is recommended as the treatment of choice for this condition. Images Fig. 1 Fig. 2 PMID:3954316

  7. Psychosocial functioning of patients after endoscopic thoracic sympathectomy.

    Science.gov (United States)

    Vazquez, Lauren D; Staples, Nancy L; Sears, Samuel F; Klodell, Charles T

    2011-06-01

    Endoscopic thoracic sympathectomy is considered the treatment modality of choice for patients with disabling hyperhidrosis. However, the psychosocial impact of the intervention has not been systematically studied in American samples before and after sympathectomy. It is expected that the reduction of symptoms is associated with improved psychosocial functioning and quality of life. The aim of this study was to examine psychosocial functioning in patients with hyperhidrosis undergoing thoracic sympathectomy. Patients with hyperhidrosis undergoing evaluation for sympathectomy were recruited from Shands Hospital at the University of Florida. Fifty-one patients completed individual psychological assessment batteries prior to undergoing sympathectomy and at 1-month follow-up, measuring the constructs of health-related quality of life, anxiety, and depression. Repeated-measures analyses of variance revealed that 1 month after sympathectomy, patients reported significant improvements across the domains of physical quality of life (p=0.01), mental quality of life (p=0.005), trait anxiety (pSympathectomy resulted in increases in health-related quality of life, and decreases in anxiety and depression within 1 month post procedure. Results suggest that sympathectomy exists as an effective treatment choice for both medical and psychosocial outcomes in patients with hyperhidrosis. Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  8. Thoracic sympathectomy for digital ischemia : A summary of evidence

    NARCIS (Netherlands)

    Coveliers, Hans M. E.; Hoexum, Frank; Nederhoed, Johanna H.; Wisselink, Willem; Rauwerda, Jan A.

    Background: Thoracic sympathectomy is used in the management of a variety of upper limb disorders. We have analyzed the evidence for thoracic sympathectomy in the management of digital ischemia. Methods: We reviewed the English literature between 1980 and 2010. Our analysis included reports with the

  9. Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results

    Science.gov (United States)

    Cinà, C S; Cinà, M M; Clase, C M

    2007-01-01

    Outline: We review the clinical features of hyperhidrosis and the range of treatments used for this condition. We describe in detail the technique of endoscopic sympathectomy. We summarize studies that have reported results of endoscopic sympathectomy. We present new data highlighting the difference in quality of life between patients with hyperhidrosis and controls. PMID:19789674

  10. A single incision transaxillary thoracoscopic sympathectomy

    Directory of Open Access Journals (Sweden)

    Marić Nebojša

    2014-01-01

    Full Text Available Background/Aim. Primary hyperhidrosis causes are unknown. The disorder begins in early childhood. It intensifies in puberty and maturity. It is equally present in both sexes. The symptoms exacerbate when the body temperature rises and due to emotional stimuli affecting the sympathetic nerve system. The aim of this study was to demonstrate that videoassisted thoracoscopic surgery (VATS sympathectomy is a method for primary focal hyperhidrosis permanent treatment. The single incision method in properly selected patients maximizes the intervention effectiveness and minimizes aesthetic side effects. Methods. This prospective study analysed the findings in patients who had been operated on due to primary focal hyperhidrosis (face, palms, and armpits using a single small transaxilarry incision in the third inter-rib space at the level of the anterior axillary line with two 5 mm flexible ports. All the patients, with T2-T5 thoracoscopic sympathectomy of the sympathetic chain using a single small incision in the third inter-rib space in the anterior axillary line, were analysed in the period from September 2009 to November 2010 regarding the postoperative morbidity and outcomes of the operation (clinical evaluation and visual analogue scale with a view to assessing the effectiveness of the surgery conducted in this manner. Results. A total of 47 patients (18 men, 29 women, 18 to 48 years old (29 on average had underwent 94 bilateral video-assisted thoracoscopic sympathectomies. The sympathectomy was indicated in cases of facial blushing and sweating (6.38%, palmary sweating (34.04%, axillary sweating (14.89% or both palmary and axillary sweating (44.68%. The largest percentage of patients (98.6% had left the hospital the following day. The postoperative 30 day’s mortality was 0 and the conversion into open surgery was not necessary. As for complications, there had been an occurrence of partial pneumothorax in two patients treated by means of

  11. Video-Assisted Thoracic Sympathectomy for Hyperhidrosis.

    Science.gov (United States)

    Milanez de Campos, Jose Ribas; Kauffman, Paulo; Gomes, Oswaldo; Wolosker, Nelson

    2016-08-01

    By the 1980s, endoscopy was in use by some groups in sympathetic denervation of the upper limbs with vascular indications. Low morbidity, cosmetic results, reduction in the incidence of Horner syndrome, and the shortened time in hospital made video-assisted thoracic sympathectomy (VATS) better accepted by those undergoing treatment for hyperhidrosis. Over the last 25 years, this surgical procedure has become routine in the treatment of hyperhidrosis, leading to a significant increase in the number of papers on the subject in the literature.

  12. Thoracic sympathectomy: a review of current indications.

    Science.gov (United States)

    Hashmonai, Moshe; Cameron, Alan E P; Licht, Peter B; Hensman, Chris; Schick, Christoph H

    2016-04-01

    Thoracic sympathetic ablation was introduced over a century ago. While some of the early indications have become obsolete, new ones have emerged. Sympathetic ablation is being still performed for some odd indications thus prompting the present study, which reviews the evidence base for current practice. The literature was reviewed using the PubMed/Medline Database, and pertinent articles regarding the indications for thoracic sympathectomy were retrieved and evaluated. Old, historical articles were also reviewed as required. Currently, thoracic sympathetic ablation is indicated mainly for primary hyperhidrosis, especially affecting the palm, and to a lesser degree, axilla and face, and for facial blushing. Despite modern pharmaceutical, endovascular and surgical treatments, sympathetic ablation has still a place in the treatment of very selected cases of angina, arrhythmias and cardiomyopathy. Thoracic sympathetic ablation is indicated in several painful conditions: the early stages of complex regional pain syndrome, erythromelalgia, and some pancreatic and other painful abdominal pathologies. Although ischaemia was historically the major indication for sympathetic ablation, its use has declined to a few selected cases of thromboangiitis obliterans (Buerger's disease), microemboli, primary Raynaud's phenomenon and Raynaud's phenomenon secondary to collagen diseases, paraneoplastic syndrome, frostbite and vibration syndrome. Thoracic sympathetic ablation for hypertension is obsolete, and direct endovascular renal sympathectomy still requires adequate clinical trials. There are rare publications of sympathetic ablation for primary phobias, but there is no scientific basis to support sympathetic surgery for any psychiatric indication.

  13. Thoracic Sympathectomy for Severe Refractory Multivessel Coronary Artery Spasm.

    Science.gov (United States)

    Cardona-Guarache, Ricardo; Pozen, Jonah; Jahangiri, Arehzo; Koneru, Jayanthi; Shepard, Richard; Roberts, Charlotte; Abbate, Antonio; Cassano, Anthony

    2016-01-01

    Coronary artery spasm is a rare but potentially fatal disease. Herein, we report a case of recurrent ST-segment myocardial infarctions and ventricular fibrillation complicating severe multivessel coronary artery spasm successfully treated with bilateral thoracic surgical sympathectomy.

  14. Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans.

    Science.gov (United States)

    Moak, Jeffrey P; Eldadah, Basil; Holmes, Courtney; Pechnik, Sandra; Goldstein, David S

    2005-06-01

    Upper thoracic sympathectomy is used to treat several disorders. Sympathetic nerve fibers emanating from thoracic ganglia innervate the heart. Whether unilateral or bilateral upper thoracic sympathectomy affects cardiac sympathetic innervation in humans in vivo has been unclear. The purpose of this study was to assess whether thoracic sympathectomy decreases cardiac sympathetic innervation, as indicated by positron emission tomographic scanning after intravenous injection of the sympathoneural imaging agent 6-[18F]fluorodopamine. Nine patients with previous upper thoracic sympathectomies (four right-sided, one left-sided, four bilateral) underwent thoracic 6-[18F]fluorodopamine scanning between 1 and 2 hours after injection of the imaging agent. In each case, a low rate of entry of norepinephrine into the arm venous drainage (norepinephrine spillover) verified upper limb sympathectomy. Data were compared with those from the interventricular septum of patients with cardiac sympathetic denervation associated with pure autonomic failure and from normal volunteers. All four patients with bilateral sympathectomy had low septal myocardial 6-[18F]fluorodopamine-derived radioactivity (2,673 +/- 92 nCi-kg/cc-mCi at an average of 89 minutes after injection) compared with normal volunteers (3,634 +/- 311 nCi-kg/cc-mCi at 83 minutes, N = 22, P = .007) and higher radioactivity than in patients with pure autonomic failure (1,320 +/- 300 nCi-kg/cc-mCi at 83 minutes, N = 7, P = .003). Patients with unilateral sympathectomy had normal 6-[18F]fluorodopamine-derived radioactivity (3,971 +/- 337 nCi-kg/cc-mCi at 87 minutes). Bilateral upper thoracic sympathectomy partly decreases cardiac sympathetic innervation density.

  15. Thoracic sympathectomy and cardiopulmonary responses to exercise.

    Science.gov (United States)

    Inbar, Omri; Leviel, D; Shwartz, I; Paran, H; Whipp, B J

    2008-09-01

    The purpose was to study the effect of endoscopic thoracic sympathectomy (ETS) for palmar and/or axillary hyperhidrosis on physiological responses at rest, and during sub-maximal and maximal exercise in ten healthy patients (7 females and 3 males 18-40 years old) with idiopathic palmar and/or axillary hyperhidrosis. T2-T3 thoracoscopic sympathectomy was performed using a simplified one stage bilateral procedure. Physiological variables were recorded at rest and during sub-maximal (steady-state) and maximal treadmill exercise immediately prior to and 70 days (+/-7.5, SD) after bilateral ETS. Exercise performance capacity and peak VO(2) were not found to be different following bilateral ETS than prior to the ETS. However, heart rate was significantly reduced at rest (14%), at sub-maximal exercise (12.3%), and at peak exercise (5.7%), together with a significant increase in oxygen pulse (11.8, 12.7, and 7.8%, respectively). The rate pressure product (RPP) was also significantly reduced following the surgical procedure at all three study stages, while all other physiological variables measured remained unchanged. It is suggested that thoracic-sympathetic denervation affects the heart, sweating, and circulation of the respective denervated region but does not affect exercise performance or mechanical/physiologic efficiency, despite a significant reduction in heart rate (both at rest and during exercise). The latter was, most likely, fully compensated by an increase in stroke volume and less likely by an improved muscle O(2) extraction due to more efficient blood distribution, keeping the work-rate and oxygen uptake unaffected.

  16. Robotic selective postganglionic thoracic sympathectomy for the treatment of hyperhidrosis.

    Science.gov (United States)

    Coveliers, Hans; Meyer, Mark; Gharagozloo, Farid; Wisselink, Willem; Rauwerda, Jan; Margolis, Marc; Tempesta, Barbara; Strother, Eric

    2013-01-01

    The surgical management of hyperhidrosis is controversial. Robotic surgical systems with their high-definition magnified 3-dimensional view and increased maneuverability in a confined space may facilitate the technique of selective sympathectomy (ramicotomy). We present a case series of patients undergoing selective postganglionic thoracic sympathectomy using robotic technology. This study is a case series analysis of patients who underwent selective postganglionic thoracic sympathectomy from July 2006 to November 2011. The operation was performed on a video-assisted thoracoscopic surgery (VATS) platform. The robot was used for pleural dissection and division of the postganglionic sympathetic fibers and the communicating rami. The success of sympathectomy was assessed by intraoperative temperature measurement of the ipsilateral upper extremity, patient interviews, and scoring of the symptomatic nature of hyperhidrosis based on the Hyperhidrosis Disease Severity Scale. There were 110 sympathectomies performed in 55 patients (25 men, 30 women). Simultaneous bilateral sympathectomy was performed in all patients. Median age was 28 years (range, 16 to 65 years). There was no conversion to thoracotomy. Complications were minor and were seen in 5 of 55 patients (9%). There were no deaths. Median hospital stay was 1 day (range, 1 to 4 days). Of the 55 patients, 53 (96%) had sustained relief of their hyperhidrosis at a median follow-up of 24 months (range, 3 to 36 months), and compensatory sweating was seen in 4 patients (7.2%). Robotic thoracoscopic selective sympathectomy is an effective, feasible, and safe procedure with excellent relief of hyperhidrosis and low rates of compensatory sweating and complications. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Single incision thoracoscopic sympathectomy for palmar and axillary hyperhidrosis

    Directory of Open Access Journals (Sweden)

    Aram Baram

    2014-02-01

    Full Text Available Background: Primary hyperhidrosis is characterized by excessive sweating beyond physiological needs. It is a common disease (incidence 2.8% that causes intense discomfort for patients. In the last decade, advantages of Single-Incision Thoracoscopic Sympathectomy have become clear, particularly in decreasing morbidity of sympathectomy. Patients and methods: From January 2010 to December 2012, 39 patients (29 females and 10 males with primary palmar or axillary hyperhidrosis were treated by thoracoscopic sympathectomy. The age ranged from 18 to 40 years with a mean of 26.28 years. We used single incision thoracoscopic electrocoagulation through 10 mm incision for thoracic sympathetic chain (T2–T4. Results: The mean follow-up was 23.6 ± 14.2 months (range = 4–24 months. A total of 97.42% of patients were satisfied with the results. A total of 72.5% of patients had cure, one patient (2.5% and another patient (2.5% presented with recurrent axillary hyperhidrosis. The morbidity was 10.2% with no mortality. Percentage of compensatory sweating and gustatory sweating were 5.1% (p = .353 and 2.5% (p = .552, respectively. The result of sympathectomy in patients with both palmar and axillary hyperhidrosis was significantly better (17, 43.58% compared to palmar type (14, 35.89% or axillary type (7, 17.94%. Conclusion: Thoracoscopic sympathectomy is a simple, safe, and cost-effective therapy with good results and low complications.

  18. Single incision thoracoscopic sympathectomy for palmar and axillary hyperhidrosis

    Science.gov (United States)

    2014-01-01

    Background: Primary hyperhidrosis is characterized by excessive sweating beyond physiological needs. It is a common disease (incidence 2.8%) that causes intense discomfort for patients. In the last decade, advantages of Single-Incision Thoracoscopic Sympathectomy have become clear, particularly in decreasing morbidity of sympathectomy. Patients and methods: From January 2010 to December 2012, 39 patients (29 females and 10 males) with primary palmar or axillary hyperhidrosis were treated by thoracoscopic sympathectomy. The age ranged from 18 to 40 years with a mean of 26.28 years. We used single incision thoracoscopic electrocoagulation through 10 mm incision for thoracic sympathetic chain (T2–T4). Results: The mean follow-up was 23.6 ± 14.2 months (range = 4–24 months). A total of 97.42% of patients were satisfied with the results. A total of 72.5% of patients had cure, one patient (2.5%) and another patient (2.5%) presented with recurrent axillary hyperhidrosis. The morbidity was 10.2% with no mortality. Percentage of compensatory sweating and gustatory sweating were 5.1% (p = .353) and 2.5% (p = .552), respectively. The result of sympathectomy in patients with both palmar and axillary hyperhidrosis was significantly better (17, 43.58%) compared to palmar type (14, 35.89%) or axillary type (7, 17.94%). Conclusion: Thoracoscopic sympathectomy is a simple, safe, and cost-effective therapy with good results and low complications. PMID:26770711

  19. Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results.

    Science.gov (United States)

    Vannucci, Fernando; Araújo, José Augusto

    2017-04-01

    Sympathectomy and its variations have been performed in thoracic surgery for more than 100 years. However, its indications have undergone profound modifications in this period. Likewise, since then the surgical technique has also evolved dramatically up to the minimally invasive techniques worldwide accessible in present days. Currently, primary hyperhidrosis is, by far, the main indication for thoracic sympathectomy and this procedure is usually carried out thoracoscopically with excellent results. However, until today, hyperhidrosis is a part of thoracic surgery still surrounded by controversy, persisting as an open field over which some confusion still resides regarding its pathophysiology, terms definitions and operative approaches. The aim of this article is to provide a wide but easily comprehensible review of the theme, discussing and clarifying the major concepts with respect to its clinical presentation, all the presently available treatment options and strategies with their potential benefits and risks, the adequate patient selection for sympathectomy, as well as the postoperative clinical results.

  20. Peripheral Sympathectomy for Raynaud's Phenomenon: A Salvage Procedure

    Directory of Open Access Journals (Sweden)

    Wen-Her Wang

    2006-10-01

    Full Text Available We retrospectively reviewed the effectiveness of peripheral sympathectomy for severe Raynaud's phenomenon. In this study, a total of 14 digits from six patients with chronic digital ischemic change were included. All patients had pain, ulcer, or gangrenous change in the affected digits and were unresponsive to pharmacologic or other nonsurgical therapies. In all cases, angiography showed multifocal arterial lesions, so microvascular reconstruction was unfeasible. Peripheral sympathectomy was performed as a salvage procedure to prevent digit amputation. The results were analyzed according to reduction of pain, healing of ulcers, and prevention of amputation. In 12 of the 14 digits, the ulcers healed and amputation was avoided. In the other two digits, the ulcers improved and progressive gangrene was limited. As a salvage procedure for Raynaud's phenomenon recalcitrant to conservative treatment, peripheral sympathectomy improves perfusion to ischemic digits and enables amputation to be avoided.

  1. Feasibility of endoscopic transesophageal thoracic sympathectomy (with video).

    Science.gov (United States)

    Turner, Brian G; Gee, Denise W; Cizginer, Sevdenur; Konuk, Yusuf; Karaca, Cetin; Willingham, Field; Mino-Kenudson, Mari; Morse, Christopher; Rattner, David W; Brugge, William R

    2010-01-01

    Thoracoscopic sympathectomy is the preferred surgical treatment for patients with disabling palmar hyperhidrosis. Current methods require a transthoracic approach to permit ablation of the thoracic sympathetic chain. To develop a minimally invasive, transesophageal endoscopic technique for a sympathectomy in a swine model. Nonsurvival animal study. Animal trial at a tertiary care academic center. This study involved 8 healthy Yorkshire swine. After insertion of a double-channel gastroscope, a Duette Band mucosectomy device was used to create a small esophageal mucosal defect. A short, 5-cm submucosal tunnel was created by using the tip of the endoscope and biopsy forceps. Within the submucosal space, a needle-knife was used to incise the muscular esophageal wall and permit entry into the mediastinum and chest. The sympathetic chain was identified at the desired thoracic level and was ablated or transected. The animals were killed at the completion of the procedure. Feasibility of endoscopic transesophageal thoracic sympathectomy. The sympathetic chain was successfully ablated in 7 of 8 swine, as confirmed by gross surgical pathology and histology. In 1 swine, muscle fibers were inadvertently transected. On average, the procedure took 61.4+/-24.5 minutes to gain access to the chest, whereas the sympathectomy was performed in less than 3 minutes in all cases. One animal was killed immediately after sympathectomy, before the completion of the observation period, because of hemodynamic instability. Nonsurvival series, animal study. Endoscopic transesophageal thoracic sympathectomy is technically feasible, simple, and can be performed in a porcine model. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  2. Intrapleural analgesia after endoscopic thoracic sympathectomy.

    Science.gov (United States)

    Silva, Patrícia Gomes da; Cataneo, Daniele Cristina; Leite, Fernanda; Hasimoto, Erica Nishida; Barros, Guilherme Antonio Moreira de

    2011-12-01

    To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.

  3. Functional role of lumbar sympathetic nerves and supraspinal mechanism in the defecation reflex of the cat.

    Directory of Open Access Journals (Sweden)

    Takaki,Miyako

    1987-12-01

    Full Text Available The role of the lumbar sympathetic nerves and supraspinal mechanism in the defecation reflex was investigated in 30 adult cats and 6 kittens. One or two propulsive contractions, whose mean pressure evoked was more than about 90 cmH2O (adult cats and 50 cmH2O (kittens, were induced in the rectum of all animals by rectal distension. These propulsive contractions could be generated at the descending and the transverse colons. The removal of the supraspinal influence by spinal transection at T13 or removal of pelvic afferents to the supraspinal center by spinal transection at L abolished the propulsive contractions. Successive lumbar sympathectomy restored the contractions. Lumbar sympathectomy and the successive removal of the supraspinal influence did not affect the propulsive contractions. In both cases, the final exclusion of the sacral segments by pithing of the spinal cord abolished the propulsive contractions. These results suggest that the sacral excitatory reflex mediated via pelvic nerves and the lumbar inhibitory reflex mediated via lumbar sympathetic nerves can function during rectal distension in spinal cats and that the lumbar inhibitory reflex is suppressed by the supraspinal sympathetic inhibitory reflex activated by pelvic afferents in intact cats, as in guinea pigs, resulting in propulsive contractions.

  4. [Lumbar hernia].

    Science.gov (United States)

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

    2010-03-22

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

  5. Thoracic sympathectomy for digital ischemia: a summary of evidence.

    Science.gov (United States)

    Coveliers, Hans M E; Hoexum, Frank; Nederhoed, Johanna H; Wisselink, Willem; Rauwerda, Jan A

    2011-07-01

    Thoracic sympathectomy is used in the management of a variety of upper limb disorders. We have analyzed the evidence for thoracic sympathectomy in the management of digital ischemia. We reviewed the English literature between 1980 and 2010. Our analysis included reports with the clinical end points of relief, recurrence of symptoms or healing of ulcers, or both. Primary Raynaud disease (PRD) and secondary Raynaud phenomenon (SRP) were analyzed separately. An initial postoperative positive effect was reported in 92% of PRD patients and in 89% of SRP patients. Long-term beneficial effect was 58% for PRD and 89% for SRP. Ulcer healing or improvement was achieved in 95%. The available evidence suggests that thoracic sympathectomy has a role in the treatment of severe PRD and SRP, albeit with better results in SRP patients than in PRD patients. In case of digital ulceration, thoracic sympathectomy may maximize tissue preservation or prevent amputation. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  6. Does Ondansetron Modify Sympathectomy Due to Subarachnoid Anesthesia?

    DEFF Research Database (Denmark)

    Terkawi, Abdullah S; Mavridis, Dimitris; Flood, Pamela;

    2016-01-01

    BACKGROUND: Disagreement among many underpowered studies has led to an equivocal understanding of the efficacy of the 5-HT3 antagonist ondansetron in preventing the consequences of sympathectomy after subarachnoid anesthesia. The authors assessed the efficacy of ondansetron with respect to the ov...

  7. Predictors of outcome following endoscopic thoracic sympathectomy.

    Science.gov (United States)

    Bell, David; Jedynak, Justin; Bell, Roger

    2014-01-01

    Endoscopic thoracic sympathectomy (ETS) provides definitive management for primary focal hyperhidrosis and facial blushing. These conditions are debilitating and not uncommon, but many clinicians avoid ETS due to the risk of complications, particularly compensatory sweating (CS). This retrospective cohort study aimed to evaluate the degree of symptom resolution, patient satisfaction and adverse reactions after ETS and to identify subgroups of patients more likely to achieve a satisfactory outcome. From 2004 to 2010, 210 patients underwent ETS performed by a single surgeon. These patients responded to a questionnaire regarding levels of satisfaction, symptom resolution and complications encountered, particularly CS. Palmar hyperhidrosis (97%) and scalp/facial hyperhidrosis (93%) demonstrated greater degrees of symptom resolution than axillary hyperhidrosis (71%) and facial blushing (71%) (P < 0.001). Rates of severe CS were lowest in patients with palmar hyperhidrosis (8%) and highest in patients with axillary (26%) and scalp/facial (44.5%) hyperhidrosis (P = 0.0003). The probability of experiencing no CS was highest at young ages and decreased with age (P = 0.0006). Satisfaction rates also fell as age increased (P = 0.004). Satisfaction rates were highest in patients with palmar (90%) and lowest in patients with scalp/facial (52%) hyperhidrosis (P < 0.02). Patient satisfaction following ETS is highest among younger patients and those undergoing the procedure for palmar hyperhidrosis. Dissatisfaction arises from failure to achieve the desired aim as well as the development of severe CS, which is more common in older patients and those undergoing ETS for axillary and scalp/facial hyperhidrosis. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

  8. Thoracoscopic sympathectomy for primary palmar and axillary hyperhidrosis

    Institute of Scientific and Technical Information of China (English)

    姚学权

    2004-01-01

    Objective:Open thoracic sympathectomy has been established as a routine treatment for patients with primary hyperhidrosis. Recently, thoracoscopic techniques have allowed surgeons to offer these patients a permanent solution with minimal surgical trauma. Methods:From June 1996 to July 2002, 78 thoracoscopic sympathectomies(TS) were performed. There were 28 males and 50 females with a mean age of 22.4 years (range, 14 to 48 years). The procedures were performed with the patients under general anesthesia using a double- lumen endotracheal tube. In palmar hyperhidrosis the second thoracic sympathetic oanglia are destroyed by electrocautery. In axillary hyperhidrosis the second to fourth oanglion are cut off. Each lung was reinflated on completion of the sympathectomy, and residual pneumothorax aspirated before closure of the incisions. No placement of chest tubes was performed in the operating. Results:All sympathectomies were completed thoracoscopically. The symptoms disappeared completely in all patients immediately after the operation. Their hands were dry and warm when they waked up from anaesthesia. There was no surgical mortality. Median operation time for a bilateral procedure is 28 min. (range, 8 - 90 min). The average hospital stay was 5.5 days. The mean follow- up time was 43.8 months (range, 3 - 73months). Compensatory hyperhidrosis was found in 41.03% (32/78) of patients, but the symptoms were not serve enough to interfere with lifestyle, and were not required further treatment. In all 78 patients had a satisfactory result, without recurrence of palmar or axillary hyperhidrosis. Conclusions: Thoracoscopic sympathectomy is the most effective and minimally invasive treatment for palmar and axillary hyperhydrosis.

  9. Feasibility of endoscopic transumbilical thoracic sympathectomy in a porcine model.

    Science.gov (United States)

    Zhang, Jixue; Zhu, Lihuan; Yang, Shengsheng; Chen, Long; Li, Dazhou; Zheng, Heping; Chen, Weisheng

    2013-07-01

    Thoracoscopic sympathectomy is an effective treatment for palmar hyperhidrosis. Current methods are associated with risks of chronic neuropathic pain and a visible chest scar. We developed a novel surgical technique for the performance of sympathectomy by embryonic natural orifice transumbilical endoscopic surgery with a flexible endoscope in a porcine model. Transumbilical flexible endoscopic thoracic sympathectomies were performed in seven farm pigs (three acute and four 4-week survivals). Under general anaesthesia, animals were intubated and mechanically ventilated with a dual lumen endotracheal tube through tracheostomy. A newly developed long transabdominal trocar was placed through the umbilicus. After insertion of a gastroscope through this trocar, a small incision was created on both sides of the diaphragm by a needle-knife. Then the gastroscope was inserted into the thoracic cavity, and the sympathetic chain was identified at the desired thoracic level and ablated. Operation time, safety and feasibility were recorded in all animals. The transumbilical thoracic sympathectomies were successfully completed in all pigs with a mean operation time of 66.7 ± 9.4 min. Intraoperative bleeding occurred in one pig during the electrosurgical incision of diaphragm tissue, which was successfully controlled by hot biopsy forceps. No other acute intraoperative complications were observed in any cases. In the acute group, the length of the diaphragm incision ranged from 4 to 5 mm in three pigs. In the survival group, the animals recovered promptly from surgery. In three pigs, a small pneumothorax was found in the postoperative chest X-ray, but all of them were completely resolved with conservative treatment. Autopsy showed all bilateral T3 sympathetic chains were successfully ablated and no evidence of vital structure injury or diaphragmatic hernia. Transumbilical flexible endoscopic thoracic sympathectomy is technically feasible, simple and safe in a porcine model. This

  10. Effects of simulated weightlessness and sympathectomy on maximum VO2 of male rats

    Science.gov (United States)

    Woodman, C. R.; Stump, C. S.; Beaulieu, S. M.; Rahman, Z.; Sebastian, L. A.

    1989-01-01

    The effects of simulated weightlessness (hind-limb suspension) and chemical sympathectomy (by repeated injections with guanethidine sulfate) on the maximum oxygen consumption (VO2 max) of female rats were investigated in rats assigned for 14 days to one of three groups: a head-down hind-limb suspension, a horizontal suspension with hind limbs weight bearing, or the caged control. The VO2 max values were assessed by having rats run on a treadmill enclosed in an airtight chamber. The hind-limb-suspended sympathectomized rats were found to exhibit shorter run times and lower mechanical efficiencies, compared to their presuspension values or the values from saline-injected suspended controls. On the other hand, the suspended sympathectomized rats did not demonstrate a decrease in the VO2 max values that was observed in saline-injected controls.

  11. Azygos lobe: a difficulty in video-assisted thoracic sympathectomy.

    Science.gov (United States)

    Kauffman, Paulo; Wolosker, Nelson; de Campos, José Ribas Milanez; Yazbek, Guilherme; Jatene, Fábio Biscegli

    2010-06-01

    The presence of an azygos lobe (AL) may make it difficult or even impossible to use video-assisted thoracic sympathectomy if the surgeon is unprepared to deal with this anatomical anomaly. Seven hyperhidrosis patients with an AL from a total of 1,876 individuals who underwent video-assisted thoracic sympathectomy are presented. The surgical technique and clinical evolution are described. For these 7 patients, the surgical intervention could be performed using thoracoscopy. Only 1 patient required postoperative pleural drainage. Another patient presented atelectasis in part of the AL, which was resolved through respiratory physiotherapy. For all of them, the operation was completely successful. We concluded that it is possible to successfully perform VATS in the presence of an AL. Previous knowledge of the presence of AL is useful, so that surgeons are not taken by surprise during the operation. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Left thoracic sympathectomy in a premature infant with long QT syndrome and heart failure.

    Science.gov (United States)

    Surendran, Sushitha; Kumar, Thittamaranahalli K S; Knott-Craig, Christopher J

    2017-01-01

    Left thoracic sympathectomy has been shown to be an effective treatment for adults with long QT syndrome who are refractory to medical therapy. We report the successful use of left thoracic sympathectomy for the management of a 10-week-old premature baby with long QT syndrome and heart failure from a large ventricular septal defect and patent ductus arteriosus.

  13. Minimal Access Posterior Approach for Extrapleural Thoracic Sympathectomy: A Cadaveric Study and Cases.

    Science.gov (United States)

    Raskin, Jeffrey S; Liu, Jesse J; Sun, Hai; Nemecek, Andrew; Balaji, Seshadri; Raslan, Ahmed M

    2016-09-01

    Operatively, video-assisted thoracoscopic sympathectomy (VATS) involves pleural entry and poses risk in small children and patients with pulmonary disease. A conventional posterior sympathectomy is more invasive than VATS. We investigated a cadaveric feasibility study of a minimal access posterior approach for endoscopic extrapleural sympathectomy and discuss this minimal approach in children with cardiac sympathectomy. A posterior endoscopic extrapleural approach for thoracic sympathectomy was performed using lightly embalmed cadavers; surgical corridor depth, width, and associated pleural violation were recorded. Two pediatric cases undergoing secondary prevention for breakthrough cardiac dysrhythmias using this approach are discussed: case 1, a 9-year-old girl with refractory long QT syndrome; and case 2, a 13-year-old boy with hypertrophic cardiomyopathy. The cadaveric study supported 100% identification of a craniocaudal-oriented sympathetic chain using an 18-mm tubular retractor, and a 10% pleural violation rate. There were no clinically significant pneumothoracies in either proof of concept cases. Minimal access posterior extrapleural sympathectomy is feasible to expose the sympathetic chain in the thoracic region with good visualization using either endoscopic or microscopic magnification. Single-position bilateral thoracic sympathectomy can be performed in pediatric patients with life-threatening ventricular arrhythmias. Based on the cadaveric study and the 2 preliminary cases, we believe that a posterior minimal access approach allows safe and effective access to the thoracic sympathetic chain for causes requiring sympathectomy using single positioning, with minimal risk of pneumothorax or Horner syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Sympathetic radiofrequency neurolysis for unilateral lumbar hyperhidrosis: a case report.

    Science.gov (United States)

    Aşik, Züleyha Soytürk; Orbey, Başak Ceyda; Aşik, Ibrahim

    2008-07-01

    Patients with hyperhidrosis suffer from physical, social and mental discomfort which often cannot be treated sufficiently using conservative measures. A new percutaneous approach to sympathectomy using radiofrequency denervation has seemed to offer longer duration of action and less incidence of post sympathetic neuralgia. This article reports the authors' experience with sympathetic RF neurolysis in a 35 year old male with right unilateral lumbar hyperhidrosis. Under scopy guided localization of the lumbar spine sympathetic blockade with local anesthetics to L2-5 vertebral levels were performed as a diagnostic block. Lesion effectiveness is monitored by bilateral feet skin temperature measurement. Clinical effects produced by the first sympathetic ganglion block were sustained for 1 week and then RF neurolysis of lumbar sympathetic ganglion was performed to the same levels for a longer effect. The procedure was accomplished within 30 minutes and the patient was discharged within 2 hours after the procedure. Hyperhidrosis was relieved after the procedure and there were no postsympathectomy neuralgia and sexual dysfunction. The patient obtained improvement of lumbar hyperhidrosis at his first month of follow- up and was satisfied with the outcome. In conclusion, RF neurolysis of lumbar sympathetic ganglions is a safe and effective palliative procedure with minimal invasiveness for relieving excessive sweat secretion in patients with localized hyperhidrosis.

  15. [Comparative estimation of the results of open and endoscopic thoracic sympathectomy in the treatment of Raynaud's phenomenon].

    Science.gov (United States)

    Miminoshvili, O I; Perepelitsa, S V; Shapovalov, I N

    2010-10-01

    Comparative analysis of thoracic sympathectomy efficacy, performed for Raynaud's phenomenon (RP), was accomplished, concerning application either endoscopic or open method. In 62 patients, suffering RP, open or endoscopic thoracic sympathectomy was done in surgical and vascular departments in 1997-2007 yrs. In 32 (51.61%) patients there was performed endoscopic thoracic sympathectomy, in 30 (48.39%)--upper thoracic sympathectomy, using extrapleural supraclavicular access, according to V. N. Klimenko. Immediate results of upper thoracic sympathectomy did not differ trustworthy depending on any method or access. Late follow-up results of upper thoracic sympathectomy were worse than immediate results by 28%--in endoscopic variant and by 43% --in the open one. The positive results rate after endoscopic thoracic sympathectomy have exceeded that after conducting the open one by 15.18%.

  16. Long-term cardiopulmonary function after thoracic sympathectomy: comparison between the conventional and simplified techniques.

    Science.gov (United States)

    Ponce González, Miguel Angel; Serdá, Gabriel Juliá; Rodriguez Suarez, Pedro; Perez-Peñate, Gregorio; Freixinet Gilart, Jorge; Cabrera Navarro, Pedro

    2010-02-01

    We sought to compare the long-term effects of conventional and simplified thoracic sympathectomy on cardiopulmonary function. We performed a prospective and randomized study of 32 patients with diagnoses of primary hyperhidrosis who were candidates for either conventional or simplified thoracic sympathectomy. Patients were randomized according to the type of procedure: conventional thoracic sympathectomy (18 patients) and simplified thoracic sympathectomy (14 patients). Before surgical intervention, forced spirometry, body plethysmography, measurement of the diffusing capacity of the lung for carbon monoxide (DLCO), and exercise tests were carried out in all patients. These evaluations were performed again 1 year after the procedure to assess the long-term effects of sympathectomy. Lung function tests revealed a significant decrease in forced expiratory volume in 1 second (FEV(1)) and forced expiratory flow between 25% and 75% of vital capacity (FEF(25%-75%)) in both groups (FEV(1) of -6.3% and FEF(25%-75%) of -9.1% in the conventional thoracic sympathectomy group and FEV(1) of -3.5% and FEF(25%-75%) of -12.3% in the simplified thoracic sympathectomy group). DLCO and heart rate at rest and maximal values after exercise were also significantly reduced in both groups (DLCO of -4.2%, DLCO corrected by alveolar volume of -6.1%, resting heart rate of -11.8 beats/min, and maximal heart rate of -9.5 beats/min in the conventional thoracic sympathectomy group and DLCO of -3.9%, DLCO corrected by alveolar volume of -5.2%, resting heart rate of -10.7 beats/min, and maximal heart rate of -17.6 beats/min in the simplified thoracic sympathectomy group). Airway resistance increased significantly in the group of patients undergoing conventional thoracic sympathectomy (+13%). Despite all these changes, the patients remained asymptomatic. No significant differences were found between the conventional and simplified thoracic sympathectomy groups. Simplified and conventional thoracic

  17. Lumbar lordosis.

    Science.gov (United States)

    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.

  18. Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity.

    Science.gov (United States)

    Cruz, Jorge; Sousa, João; Oliveira, Antonio G; Silva-Carvalho, Luis

    2009-03-01

    Endoscopic thoracic sympathectomy is performed to treat primary hyperhidrosis. The second and third sympathetic thoracic ganglia excised also innervate the heart. Some studies have shown decreased heart rate but have not been conclusive regarding other cardiac effects of sympathectomy. We studied the cardiac autonomic effects of endoscopic thoracic sympathectomy in a group of patients with primary hyperhidrosis. Heart rate variability is a simple, noninvasive electrocardiographic marker reflecting the activity and balance of the sympathetic and vagal components of the autonomous nervous system. We performed a prospective study in 38 patients with primary hyperhidrosis with 24-hour Holter recordings obtained before endoscopic thoracic sympathectomy and 6 months later. We found statistically significant differences (P sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity. These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.

  19. Perfusion Index: An Indicator of Success During Endoscopic Thoracic Sympathectomy for Hyperhidrosis.

    Science.gov (United States)

    Jeng, Eric I-Hun; Gravenstein, Nikolaus; Klodell, Charles T

    2017-08-01

    Endoscopic thoracic sympathectomy (ETS) is indicated for refractory hyperhidrosis. The pulse oximetry-derived perfusion index (PI) quantifies pulsatile blood flow at the oximeter. Thoracic sympathectomy increases blood flow; thus we postulate it will reliably increase PI. We evaluated the ipsilateral finger PI as a predictor of successful sympathectomy during ETS. After institutional review board approval and informed consent, 100 adult patients undergoing bilateral ETS were studied. Finger and earlobe pulse oximetry probes were placed. Hemodynamic variables and PI were continuously monitored. PI data were collected before and every minute after sympathectomy for 5 minutes and then at 10 minutes. We defined a successful sympathectomy by at least a 50% increase of the PI on the ipsilateral arm. A repeated measures analysis of variance was conducted to determine overall model significance (p ≤ 0.05). Left sympathectomy was associated with a mean 240% increase in PI (p thoracic sympathectomy. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Evaluating the Efficacy of Endoscopic Thoracic Sympathectomy for Generalized Social Anxiety Disorder with Blushing Complaints

    Science.gov (United States)

    Súarez, Claudio; Palacios, Estela; Palacios, Fernanda; Matus, Patricia

    2011-01-01

    Objective: No study has yet compared the efficacy of endoscopic thoracic sympathectomy for treating facial blushing with other treatment or no treatment. We conducted a prospective, observational, open-label, clinical study to compare endoscopic thoracic sympathectomy for blushing with generalized social anxiety disorder versus sertraline treatment and no treatment. Method: Three-hundred and thirty consecutive patients seeking treatment for their blushing were assessed by psychiatric interview and patient-rated scales. The Brief Social Phobia Scale was the primary outcome measure. Patients meeting Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria for generalized social anxiety disorder, scoring 20 points or more in the Brief Social Phobia Scale and 19 points or more in the Social Phobia Inventory were considered eligible and followed up for a mean of 11 months (range 1–64) after endoscopic thoracic sympathectomy or initiation of sertraline. Results: At baseline, 97 percent of the endoscopic thoracic sympathectomy-treated group, 87 percent of the sertraline-treated group, and 78 percent of the nontreated group rated their blushing as being “severe” or “extreme.” At follow up, 16 percent of endoscopic thoracic sympathectomy-treated patients, 32 percent of sertraline-treated patients, and 57 percent of untreated patients reported this degree of blushing. At endpoint, Brief Social Phobia Scale total scores exhibited a greater decline with either treatment than with no treatment. Nonetheless, in comparison to no treatment, only the results obtained with endoscopic thoracic sympathectomy achieved statistical significance (p=0.003). Compensatory sweating occurred in 99 percent of patients who underwent endoscopic thoracic sympathectomy. High degrees of satisfaction with treatment were reported by 89 percent of patients undergoing endoscopic thoracic sympathectomy and by 59 percent of patients taking medication. Conclusion

  1. Sympathectomy for glaucoma: Its rise and fall (1898-1910).

    Science.gov (United States)

    Feibel, Robert M

    2015-01-01

    The influence of the sympathetic nervous system upon intraocular pressure (IOP) has been a subject of great interest since 1727, when the first experimental ocular sympathetic paralysis was produced in dogs. By the middle of the 19th century, it was known that excision of the superior cervical sympathetic ganglion lowered, and that electrical stimulation of the sympathetic nerve trunk raised IOP in various animals. From these observations, it was thought that excision of this ganglion could replace or supplement the available operations for glaucoma of which iridectomy was the most popular. Iridectomy was acknowledged to be of great value in acute and subacute glaucoma, but less useful in chronic glaucoma. Iridectomy, however, was associated with major surgical complications and long-term failure, so that there was considerable appeal of an extraocular operation that avoided the risks of intraocular surgery. Beginning in 1898, cervical sympathectomy became a widely performed operation around the world, with most surgeons enthusiastic about its results, at least initially, and many publications from 1898 to 1905 claimed excellent results for various types of glaucoma. Opponents of the procedure emphasized that the effect on IOP was transient, and that the published reports of successful results were poorly documented. The popularity of sympathectomy gradually diminished and by 1910 it was abandoned. I discuss the reasons why cervical sympathectomy received such initial enthusiasm but was then questioned and discarded. These included bias from the surgeons promoting this surgery; the placebo effect; short follow-up; inaccurate, subjective, and variable measures of the surgical results; and the development of more effective procedures such as filtering surgery and cyclodialysis.

  2. Endoscopic thoracic sympathectomy: at what level should you perform surgery?

    Science.gov (United States)

    Weksler, Benny; Luketich, James D; Shende, Manisha R

    2008-05-01

    Several interventions are possible on the sympathetic chain and the nomenclature has been confusing. The authors propose a uniform nomenclature for each procedure, mainly, sympathectomy for resection or ablation of the ganglion, sympathicotomy for the transaction of the chain, ramicotomy for the procedure preserving the chain and ganglia and severing the rami, and finally, sympathetic block for clipping above and below the ganglia. They recommend intervention on the T2 ganglia for facial hyperhidrosis and rubor, on the T3 ganglia for palmar hyperhidrosis, and on the T3 and T4 ganglia for axillary hyperhidrosis.

  3. Skin depigmentation: could it be a complication caused by thoracic sympathectomy?

    Science.gov (United States)

    Westphal, Fernando L; de Campos, José R M; Ribas, Jonas; de Lima, Luís C; Lima Netto, José C; da Silva, Márcia S; Westphal, Danielle C

    2009-10-01

    Primary hyperhidrosis is an idiopathic disorder, and its definitive treatment is obtained through thoracic sympathectomy. However, this procedure is not exempt from complications and compensatory sweating is the main inconvenience described. In this article, 2 patients were submitted to video-assisted thoracoscopic sympathectomy, and after approximately 8 months they noticed depigmentation of the region corresponding to the blockage of sympathetic stimulus. This fact could be explained by the possible effect of the nervous system on the melanocytes of human skin. Thus, patients with primary hyperhidrosis, who are candidates for thoracic sympathectomy and have brown skin, must be made aware of this possible complication.

  4. The effect of lumber sympathectomy. Evaluation of using {sup 99m}Tc-MAA

    Energy Technology Data Exchange (ETDEWEB)

    Tachihara, Hiromasa; Akaba, Noritake; Shimada, Takao [Jikei Univ., Tokyo (Japan). School of Medicine

    1996-05-01

    Lumbar sympathectomy (LST) remains even now an effective treatment especially for severe ischemic symptoms, such as ulcerous necrosis of skin, in chronic obstructive disease of artery. The efficacy of LST is evaluated not only by a comparative study of the clinical effect of treatment, but also by a through evaluation of functional change in the sympathetic nerves occurring after LST. In the present investigation, we used a nuclear medical test with {sup 99m}Tc-MAA, and calculated the rate of arteriovenous shunt in the lower extremities from the dilation of subcutaneous arteriovenous anastomosis (AVAs) caused by LST. We then evaluated the effect of LST based on this rate. The present study consisted of 26 patients with Buerger`s disease treated in our department in the period from 1977 to 1995. The patients were examined by the nuclear medical test before and after LST. From the results of the shunt rate in 23 patients (a total of 69 limbs), except for three patients whose test was not successful, we investigated the prolonged effect of LST. It was concluded that: measurement of the rate of arteriovenous shunt in the lower extremities with {sup 99m}Tc-MAA was useful for the quantitative evaluation of LST efficacy, L{sub 2-4} LST, the standard procedure performed, led to stable and prolonged sympathetic blockage of long-duration, and although the effect of LST has not yet been clarified in many respects, the findings suggested that a difference exists in the action of sympathetic blockage (collapse) by LST between diabetic neuropathy and Buerger`s disease. (author)

  5. Lumbar spine CT scan

    Science.gov (United States)

    CAT scan - lumbar spine; Computed axial tomography scan - lumbar spine; Computed tomography scan - lumbar spine; CT - lower back ... your breath for short periods of time. The scan should take only 10 to 15 minutes.

  6. Needlescopic video-assisted thoracic surgery for reversal of thoracic sympathectomy.

    Science.gov (United States)

    Wong, Randolph H L; Ng, Calvin S H; Wong, Jasper K W; Tsang, Susanna

    2012-03-01

    Thoracic sympathectomy is a commonly performed surgical procedure for the treatment of palmar hyperhidrosis. However, one major complication of such a procedure is compensatory truncal hyperhidrosis. We describe an extreme case of compensatory truncal hyperhidrosis and anhidrosis over the head and neck region which led to a heatstroke. Bilateral reoperative needlescopic video-assisted thoracic surgery was performed for the reversal of thoracic sympathectomy with an interposition intercostal nerve graft. The patient's truncal hyperhidrosis resolved gradually over 1 month following the reversal procedure.

  7. [Upper thoracic sympathectomy in treatment of upper limb ischaemia in distal lesions of the arterial bed].

    Science.gov (United States)

    Alukhanian, O A; Martirosian, Kh G; Aristov, D S; Kurganskiĭ, O V

    2013-01-01

    Analysed herein was efficacy of 76 videothoracoscopic upper chest sympathectomies performed for upper limb ischaemia in a total of 61 patients. Of these, 15 patients were found to suffer bilateral lesions. The findings of clinical follow up and instrumental examinations (laser Doppler flowmetry, rheovasography, measuring transcranial oxygen tension in tissues) made it possible to draw a conclusion on efficacy of upper chest sympathectomy in distal lesions of the vascular bed of the upper extremities.

  8. Intraoperative prediction of compensatory sweating for thoracic sympathectomy.

    Science.gov (United States)

    Fujita, Takeo; Mano, Masayuki; Nishi, Hideyuki; Shimizu, Nobuyoshi

    2005-09-01

    Postoperative compensatory sweating (PCS) is an important problem impacting on quality of life for patients after endoscopic thoracic sympathectomy (ETS). The present study investigated whether intraoperative palmar temperature and blood flow are useful for assessing PCS after ETS. Retrospectively, results were evaluated for ETS in 27 consecutive patients with primary palmar hyperhidrosis between 1996 and 2002. For all patients, bilateral nerve conduction to the palms was interrupted. The relationship between the range of PCS and intraoperative changes in palmar temperature and blood flow was investigated. PCS developed in all cases. After completion of ETS, mean blood flow and temperature increased respectively. Significant correlations were found between the range of PCS and increases in palmar temperature (p<0.05) and blood flow (p<0.05). Intraoperative monitoring of increases in palmar temperature and blood flow may be useful in patients with primary hyperhidrosis, to predict the range of PCS after ETS.

  9. Modeling of safe window for percutaneous thoracic sympathectomy.

    Science.gov (United States)

    Lee, Do Won; Hong, Jung Min; Hwang, Boo Young; Kim, Tae Kyun; Kim, Eun Soo

    2015-06-01

    Despite the many benefits of percutaneous thoracic sympathectomy, it also has serious complications such as pneumothorax. This study was conducted in order to determine the safe percutaneous entering window and angles for the needle during T2 and T3 thoracic sympathectomy avoiding pneumothorax. Transverse section of CT images that crosses at the middle of the T2 or T3 vertebral body was selected. Medial and lateral imaginary lines were drawn from the dorsoventrally midpoint on the lateral surface of the vertebral body (v) to the skin. The medial one was drawn to the skin medially as much as possible tangent to the vertebral body (vM). The lateral one was drawn to the skin tangent to parietal pleura (vL). c was defined as the point where the midsagittal line meets the skin. The distance cM and cL, the angle aM and aL made between the midsagittal line and vM or vL lines were measured. To determine the relations between patients' covariates and measured data, mixed-effect population analysis was performed for the cL, aL, and vL. In males, the mean values of cL were 85.3 and 79.2 mm for T2 and T3, respectively. In females, they were 71.5 and 63.7 mm for T2 and T3, respectively. Population analysis revealed that cL was best described with age, weight, gender covariates, and interindividual variability. The aL was best described with BMI and gender covariates. The covariates' relationship and interindividual variability resulting from the mixed-effect analysis enhanced individual prediction for safe widows.

  10. Does surgical sympathectomy improve clinical outcomes in patients with refractory angina pectoris?

    Science.gov (United States)

    Holland, Luke C; Navaratnarajah, Manoraj; Taggart, David P

    2016-04-01

    A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In patients with angina pectoris refractory to medical therapy, does surgical sympathectomy improve clinical outcomes? A total of 528 papers were identified using the search protocol described, of which 6 represented the best evidence to answer the clinical question. There were 5 case series and 1 prospective cohort study. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 5 of the case series demonstrated an improvement in symptoms, exercise tolerance or quality of life in patients undergoing surgical sympathectomy. An early case series investigating an open approach had a high morbidity and mortality rate, but the 4 other series used a minimally invasive technique and had low morbidity and zero perioperative mortality rates. The cohort study compared surgical sympathectomy with transmyocardial laser revascularization (TMR) and concluded TMR to be superior. However, this study looked only at unilateral sympathectomy, whereas all 5 case series focused on bilateral surgery. We conclude that the best currently available evidence does suggest that patients report an improvement in their symptoms and quality of life following surgical sympathectomy, but the low level of this evidence does not allow for a statistically proved recommendation. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  11. Acquired lumbar spinal stenosis.

    Science.gov (United States)

    Deasy, JoAnn

    2015-04-01

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

  12. Prophylactic left thoracic sympathectomy to prevent electrical storms in CPVT patients needing ICD placement.

    Science.gov (United States)

    Moray, Amol; Kirk, Edwin P; Grant, Peter; Camphausen, Christoph

    2011-11-01

    Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), a life threatening arrhythmia induced by sympathetic stimulation in susceptible individuals is often refractory to antiarrhythmic agents. First line of treatment, beta-blockers can be ineffective in up to 50% with implantable cardioverter-defibrillator (ICD) placement for refractory cases. Paradoxically ICD can be arryhthmogenic from shock-associated sympathetic stimulation, initiating more shocks and "electrical storms". This has led to the use of more effective beta blockade offered by left sympathectomy, now performed by minimally invasive video assisted thoracoscopic surgery (VATS). Sympathectomy has been traditionally performed long after ICD placement, after the patient has experienced multiple shocks, thus necessitating two procedures. We report simultaneous ICD insertion and thoracoscopic sympathectomy in a 10 year-old boy with CPVT, and suggest it as a better approach than sequential procedures. To our knowledge this is first such reported case.

  13. Congenital Lumbar Hernia

    Directory of Open Access Journals (Sweden)

    Sanjay Sharma

    2008-01-01

    Full Text Available Lumbar hernia is a rare hernia. It constitutes less than one percent of all abdominal hernias. It can becongenital or acquired. Acquired can occur either spontaneously or after surgery or trauma. Only 300cases of lumbar hernia are reported till date. We report a case of congenital lumbar hernia in one month oldmale baby

  14. Single-port vasoview sympathectomy for palmar hyperhidrosis: a clinical update.

    Science.gov (United States)

    Ng, Calvin S H; Lau, Rainbow W H; Wong, Randolph H L; Ho, Anthony M H; Wan, Song

    2014-01-01

    Thoracic sympathectomy remains an effective method for treatment of palmar hyperhidrosis refractory to other conservative forms of management. The procedure has become more acceptable following the introduction of the minimally invasive technique using video-assisted thoracic surgery (VATS). More recently, single-port VATS has gained popularity as an alternative approach to performing sympathectomy. We report on our experience and early results of single-port bilateral VATS sympathectomy using the Vasoview(®) (Maquet Inc., Rastatt, Germany) device at our institute. All patients who underwent VATS sympathectomy for primary palmar hyperhidrosis between June 2011 and March 2012 were recruited into this prospective study. Patients' demographics and intraoperative and postoperative outcomes were collected. Effectiveness of the procedure, postoperative pain, duration of hospital stay, and complications were also measured. Sixteen patients underwent Vasoview bilateral VATS sympathectomy for severe palmar hyperhidrosis. Mean age was 23.8 years (range, 17-36 years), and mean operative time to complete the bilateral procedure was 56 minutes (range, 42-81 minutes). The procedure was successfully completed in all patients without the need to enlarge the incision or convert. Postoperatively, there was no mortality and no residual palmar hyperhidrosis. Mean postoperative stay was 0.9 days (range, 0.7-1.9 days). The mean visual analog pain score at discharge was 1.8 (range, 1.2-3.4). Single-port Vasoview sympathectomy for treatment of severe palmar hyperhidrosis is technically feasible and safe with satisfactory immediate and early results. Intermediate and long-term follow-up is required to monitor recurrence or late complications. Future studies are warranted to compare Vasoview single-port and other minimal invasive VATS approaches.

  15. Severe compensatory hyperhidrosis following thoracic sympathectomy successfully treated with low doses of botulinum toxin A.

    Science.gov (United States)

    Santana-Rodríguez, Norberto; Clavo, Bernardino; Calatayud-Gastardi, Joaquín; García-Castellano, José Manuel; Ponce-González, Miguel A; Olmo-Quintana, Vicente; Llontop, Pedro; Alvarez-Prats, Alejandro; Yordi, Nagib Atallah; Ruíz-Caballero, José Antonio

    2012-12-01

    Compensatory hyperhidrosis is an adverse effect of thoracic sympathectomy that can be debilitating, which is why an efficient treatment is demanded. Botulinum toxin is an emerging treatment, not well known yet. We report two cases of compensatory hyperhidrosis following thoracic sympathectomy which were both treated with low doses of botulinum toxin A. The patients, a male and a female, noted a high level of satisfaction with the abolishment of sweating that was maintained up to 10 months. We consider that low doses of botulinum toxin A is a well tolerated, safe and effective treatment for compensatory hyperhidrosis and should be offered as an alternative treatment.

  16. A New Device of Needlescopic Thoracic Sympathectomy Through a Skin Incision.

    Science.gov (United States)

    Yamamoto, Hidehiro; Okada, Masayoshi

    2017-05-01

    We describe a new technique of performing sympathectomy with a new device. A single skin incision 3 mm long was made in the armpit. The device enables complete resection of the sympathetic segment through a single skin incision, whereas sympathectomy is limited by the use of the conventional needle technique. Even if sympathetic nerves and blood vessels were overlapping, separation of the two organs was performed safely. This device increases the possibility of planning surgical procedures for patients with difficult anatomies. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Efficacy of bilateral thoracoscopic sympathectomy in a patient with catecholaminergic polymorphic ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Katsunori Okajima, MD

    2016-02-01

    Full Text Available A 27-year-old woman with frequent implantable cardioverter defibrillator (ICD shocks related to catecholaminergic polymorphic ventricular tachycardia (VT experienced aborted sudden death due to incessant polymorphic VT despite the administration of beta-blockers, verapamil, and flecainide. Catheter ablation failed to suppress the polymorphic VT. Based on the temporary efficacy of the local anesthetic administered at the left and right cervical sympathetic nerves to suppress VT under an isoproterenol infusion, stepwise, bilateral thoracoscopic sympathectomy was performed. Postoperatively, no further VT or syncopal episodes were documented under ICD telemetry. Bilateral thoracoscopic sympathectomy may be an alternative for patients with drug-refractory catecholaminergic polymorphic VT.

  18. Efficacy of bilateral thoracoscopic sympathectomy in a patient with catecholaminergic polymorphic ventricular tachycardia

    Science.gov (United States)

    Okajima, Katsunori; Kiuchi, Kunihiko; Yokoi, Kiminobu; Teranishi, Jin; Aoki, Kosuke; Shimane, Akira; Nakamura, Yoshihide; Kimura, Motoko; Horikawa, Yoshio; Yoshida, Masato; Maniwa, Yoshimasa

    2015-01-01

    A 27-year-old woman with frequent implantable cardioverter defibrillator (ICD) shocks related to catecholaminergic polymorphic ventricular tachycardia (VT) experienced aborted sudden death due to incessant polymorphic VT despite the administration of beta-blockers, verapamil, and flecainide. Catheter ablation failed to suppress the polymorphic VT. Based on the temporary efficacy of the local anesthetic administered at the left and right cervical sympathetic nerves to suppress VT under an isoproterenol infusion, stepwise, bilateral thoracoscopic sympathectomy was performed. Postoperatively, no further VT or syncopal episodes were documented under ICD telemetry. Bilateral thoracoscopic sympathectomy may be an alternative for patients with drug-refractory catecholaminergic polymorphic VT. PMID:26949433

  19. Compensatory hyperhidrosis following thoracic sympathectomy: a biophysical rationale.

    Science.gov (United States)

    Cramer, Matthew N; Jay, Ollie

    2012-02-01

    A side-effect of endoscopic thoracic sympathectomy (ETS) is compensatory hyperhidrosis (CH), characterized by excessive sweating from skin areas with intact sudomotor function. The physiological mechanism of CH is unknown, but may represent an augmented local sweat rate from skin areas with uninterrupted sympathetic innervation based on evaporative heat balance requirements. For a given combination of activity and climate, the same absolute amount of evaporation (if any) is needed to balance the rate of metabolic heat production both pre- and post-ETS. However, the rate of local sweating per unit of skin surface area with intact sudomotor activity must be greater post-ETS as evaporation must be derived from a smaller skin surface area. Under conditions with high evaporative requirements, greater degradations in sweating efficiency associated with an increased dripping of sweat should also occur post-ETS, further pronouncing the sweat rate required for heat balance. In conclusion, in addition to the potential role of psychological stimuli for increased sudomotor activity, the existence of CH post-ETS can be described by the interplay between fundamental thermoregulatory physiology and altered heat balance biophysics and does not require a postoperative alteration in physiological control.

  20. Cardiopulmonary effects following endoscopic thoracic sympathectomy for primary hyperhidrosis.

    Science.gov (United States)

    Cruz, Jorge M; Fonseca, Manuel; Pinto, Fausto J; Oliveira, Antonio G; Carvalho, L Silva

    2009-09-01

    Endoscopic thoracic sympathectomy (ETS) is performed for the treatment of primary hyperhidrosis (PH). The second and third sympathetic thoracic ganglions excised in ETS also innervate the heart and lung. In the present work we studied the cardiopulmonary effects of ETS in a group of patients with PH. We performed a prospective study in 38 patients with severe PH. Pulmonary function, echocardiographic assessment of left ventricular function and myocardial contractility and maximal, symptom-limited, incremental exercise tests were evaluated 2 weeks before, and 6 months after ETS. Data were analysed with the paired t-test. Differences were considered significant when p<0.05. In pulmonary function tests, we found a statistically significant decrease forced expiratory flow in small airways and an increase of residual volume, a significant decrease in heart rate and ejection fraction, a significant decrease of 'rest' and 'peak' heart rate, and a significant increase of oxygen pulse (O2 pulse) and oxygen peak uptake (VO2 peak) after ETS (p<0.05). These cardiopulmonary effects observed 6 months after ETS in the treatment of patients with PH are all in normal ranges and are not relevant in cardiopulmonary function. We concluded that ETS in patients with PH is a safe procedure. Patients must be informed about these cardiopulmonary effects before the operation.

  1. Embryonic NOTES thoracic sympathectomy for palmar hyperhidrosis: results of a novel technique and comparison with the conventional VATS procedure.

    Science.gov (United States)

    Zhu, Li-Huan; Chen, Long; Yang, Shengsheng; Liu, Daoming; Zhang, Jixue; Cheng, Xianjin; Chen, Weisheng

    2013-11-01

    To avoid the disadvantages of chronic pain and chest wall paresthesia associated with video-assisted thoracic surgery (VATS) procedures, we developed a novel surgical technique for performing sympathectomy by embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) with a flexible endoscope. In this study, we compared the outcomes of E-NOTES with conventional VATS thoracic sympathectomy on palmar hyperhidrosis. From January 2010 to April 2011, a total of 66 patients with severe palmar hyperhidrosis were treated with thoracic sympathectomy in our department. Thirty-four transumbilical thoracic sympathectomies were performed via a 5-mm umbilicus incision with ultrathin gastroscope, then compared with 32 conventional needlescopic thoracic sympathectomies. Retrospective statistical analysis of a prospectively collected group of patients was performed. There was no significant difference with regard to gender, mean age, body mass index, and length of hospital stay between the two groups. The operative time for E-NOTES thoracic sympathectomy was longer than that of VATS thoracic sympathectomy (56.4 ± 10.8 vs. 40.3 ± 6.5 min, p sympathectomy reported successful treatment of their palmar hyperhidrosis. Compensatory hyperhidrosis was noticed in 7 (20.1 %) and 6 (18.8 %) patients in the E-NOTES and VATS groups, respectively (p > 0.05). Postoperative pain and paresthesia were significantly reduced in the E-NOTES group at each time interval, and the aesthetic effect of the incision was superior in the E-NOTES group. Transumbilical-diaphragmatic thoracic sympathectomy is a safe and efficacious alternative to the conventional approach. This novel procedure can further reduce postoperative pain and chest wall paresthesia as well as afford maximum cosmetic benefits by hiding the surgical incision in the umbilicus.

  2. Comparison of only T3 and T3-T4 sympathectomy for axillary hyperhidrosis regarding treatment effect and compensatory sweating.

    Science.gov (United States)

    Yuncu, Gökhan; Turk, Figen; Ozturk, Gökhan; Atinkaya, Cansel

    2013-08-01

    Patients diagnosed with axillary hyperhidrosis can face psychosocial issues that can ultimately hinder their quality of life both privately and socially. The routine treatment for axillary hyperhidrosis is T3-T4 sympathectomy, but compensatory sweating is a serious side effect that is commonly seen with this approach. This study was designed to evaluate whether a T3 sympathectomy was effective for the treatment of axillary hyperhidrosis and whether this treatment led to less compensatory sweating than T3-T4 sympathectomies among our 60-patient population. One hundred and twenty endoscopic thoracic sympathectomies were performed on 60 patients who had axillary hyperhidrosis. The sympathectomies were accomplished by means of a single-lumen endotracheal tube and a single port. The axillary hyperhidrosis patients were randomly divided into two groups with 17 patients in Group 1 undergoing T3-T4 sympathectomies and 43 in Group 2 undergoing only T3 sympathectomies. We analysed the data associated with the resolution of axillary hyperhidrosis, the degree of patient satisfaction with the surgical outcome and the quality of life in parallel with compensatory sweating after the procedure as reported by the patient and confirmed by the examiner. Moreover, the results were compared statistically. No statistically significant difference was observed between the groups based on age (P=0.56), gender (P=0.81), duration of the surgery (P=0.35) or postoperative satisfaction levels (P=0.45). However, the incidence and degree of compensatory sweating were lower in the T3 group than the T3-T4 group at the 1-year follow-up (P=0.008). T3 sympathectomy was as effective as T3-T4 sympathectomy for the treatment of axillary hyperhidrosis based on the patients' reported postoperative satisfaction, and the T3 group demonstrated lower compensatory sweating at the 1-year follow-up.

  3. Influence of sympathectomy in humans on the rhythmicity of 6-sulphatoxymelatonin urinary excretion

    DEFF Research Database (Denmark)

    Møller, Morten; Osgaard, Ole; Grønbech-Jensen, Michael

    2006-01-01

    The amount of 6-sulphatoxymelatonin, the chief metabolite of melatonin, in the urine was measured in nine patients, who were subjected to bilateral sympathectomy at the second thoracic ganglionic level for treatment of hyperhidrosis of the palms. All patients showed before surgery a normal 6...

  4. Bilateral Single-Port Sympathectomy: Long-Term Results and Quality of Life

    Science.gov (United States)

    Ibrahim, Mohsen; Menna, Cecilia; Ciccone, Anna Maria; D'Andrilli, Antonio; Maurizi, Giulio; Pomes, Leda Marina; Cassiano, Francesco; Venuta, Federico; Rendina, Erino A.

    2013-01-01

    Object. Video-assisted thoracoscopic sympathectomy is a safe, effective, and minimally invasive procedure for primary hyperhidrosis. This study aims to evaluate long-term results and patients' quality of life and investigate potential variables responsible for compensatory sweating after one-stage bilateral single-port thoracoscopic sympathectomy. Methods. Between 2005 and 2011, 260 consecutive bilateral thoracoscopic sympathectomies were performed in 130 patients for primary palmar and axillary hyperidrosis through one-port access. Residual pain, postoperative complications, recurrence of symptoms, heart rate adjustment, and quality of life were analyzed. Multivariate analysis was performed. Results. No operative mortality and conversion to open surgery were recorded. Mean operative time was 38 ± 5 minutes. Mean hospital stay was 1.1 ± 0.6 days. Eight patients (6%) had unilateral pneumothorax. Twenty-five cases (19%) were complicated by compensatory sweating. Winter and fall were identified as protective factors for compensatory sweating occurrence. Decreased heart rate was observed 1 year after surgery and permanently over the time. No recurrence during the follow-up period (31.5 months) was observed and 90% of patients showed improved quality of life. Conclusions. One-stage bilateral miniuniportal thoracoscopic sympathectomy is a valid and safe treatment for primary hyperhidrosis, achieving definitive and esthetic results, with excellent patients' satisfaction. Compensatory sweating may potentially occur in a season-dependent manner. PMID:24383050

  5. Transumbilical thoracic sympathectomy with an ultrathin flexible endoscope in a series of 38 patients.

    Science.gov (United States)

    Zhu, Li-Huan; Wang, Wen; Yang, Shengsheng; Li, Dazhou; Zhang, Zhijian; Chen, Shengping; Cheng, Xianjin; Chen, Long; Chen, Weisheng

    2013-06-01

    The newest trend in the field of thoracic surgery, thoracic natural orifice transluminal endoscopic surgery (NOTES), is still in the early stages of development and limited to animal experiments. Transumbilical endoscopic surgery could work as a viable intermediate step before pure NOTES. We describe our experiences performing transumbilical-diaphragmatic thoracic sympathectomy with an ultrathin flexible endoscope for palmar and axillary hyperhidrosis in human patients. From April 2010 to January 2012, a total of 38 patients underwent transumbilical-diaphragmatic thoracic sympathectomy. Through the incision in the umbilicus, a newly developed long trocar was inserted into the abdominal cavity. An ultrathin endoscope was introduced through the long trocar and then passed through the rigid incision made in the left and right diaphragm and into the thoracic cavity. The ganglion was ablated at the desired thoracic level. Sympathectomy was performed successfully in all patients. Mean operation time was 68 ± 16 (range, 48-107) minutes. There was no mortality and no conversion to open surgery during the operation of any patient. At a median follow-up of 11 (range, 4-12) months after surgery, no diaphragmatic hernia was observed. The rate of palmar hyperhidrosis and axillary hyperhidrosis resolution was 100 and 75 %, respectively. Transumbilical endoscopic thoracic sympathectomy is technically feasible and safe, which has the possible advantages of pure NOTES and can be performed in routine clinical practice.

  6. The effect of upper dorsal thoracoscopic sympathectomy on the total amount of body perspiration.

    Science.gov (United States)

    Kopelman, D; Assalia, A; Ehrenreich, M; Ben-Amnon, Y; Bahous, H; Hashmonai, M

    2000-01-01

    Thoracoscopic T2-T3 sympathectomy is the treatment of choice for primary palmar hyperhidrosis (PPH); however, compensatory hyperhidrosis (CH) is a disturbing sequela of this operation, the mechanism of which is poorly understood. This study was conducted to evaluate the effect of heat stress on total body perspiration after thoracoscopic T2-T3 sympathectomy, and determine its correlation with CH. A total of 17 patients with PPH who underwent bilateral T2-T3 sympathectomy were subjected to heat stress induced by a 10-min sauna bath (ambient temperature 70 degrees C), 1 day before and 1 month after surgery. The naked body weight was recorded before and immediately following the sauna bath, and the patients were followed up to assess whether CH had developed and the degree of its severity. Postoperatively, the amount of perspiration increased in 13 patients and decreased in 1. The amount of perspiration induced by the sauna bath ranged from 60 to 480 g, with a mean value of 185.29 +/- 125.80 g, before the operation, and from 60 to 540 g, with a mean value of 265.88 +/- 154.05 g, after the operation (P = 0.0113). There was no correlation between the degree of alteration in total body perspiration and the development of CH. Performing thoracoscopic T2-T3 sympathectomy for PPH affects the total body sweating response to heat; however, the development of CH does not correlate with this alteration.

  7. Long-term results of thoracic sympathectomy for primary hyperhidrosis.

    Science.gov (United States)

    Stefaniak, Tomasz J; Ćwigoń, Marta

    2013-05-01

    The side effects following thoracic sympathectomy for primary hyperhidrosis include pain and compensatory/ reflex sweating. The aim of the study was the evaluation of the results of the endoscopic sympathicotomy with clips with emphasis on the frequency of side effects following the operation. Two-hundred-eighty-three patients were qualified to thoracic T3-T4 sympathicotomy with clips. In all cases bilateral procedure in prone position with CO2 insufflation was performed. The subjective intensity of disease was evaluated by VAS scale (0--no sweating; 10--maximal possible sweating) while the recurrence of the sweating in primary localization, intensity and dynamics of compensatory and plantar sweating were evaluated post-operatively. Follow-up data were obtained during office visits 3, 12 and 36 months after surgery. The overall follow-up response was 74.6%. There was no mortality. Perioperative morbidity included 6 cases of pneumothorax. The mean duration of surgery was 57 minutes bilaterally. The postoperative intercostal pain was present in all patients (100%) with mean duration of 21.88 days but in 72.6% of cases it did not demand any medication as early as 48 hours after surgery. Strong or very strong compensatory sweating was observed in 17.5% of cases 3 months after ETS, in 14.1% after 12 months and in 23.6% after 36 months. Thoracic sympathicotomy with clips is a safe treatment that provides satisfactory longterm results. The incidence of side-effects (intercostal pain, compensatory sweating) is high and does not change with time in most of the cases.

  8. Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Villaça Leão

    Full Text Available CONTEXT: Essential hyperhidrosis is a frequent disorder causing significant functional impairment. The advent and development of video-assisted thoracoscopic techniques now allows thoracic sympathectomy to be carried out precisely and safety with good results and minimal morbidity. OBJECTIVE: To assess the impact of video-assisted thoracic sympathectomy in patients diagnosed as presenting severe and disabling hyperhidrosis. TYPE OF STUDY: This was a longitudinal study of the clinical course of all hyperhidrosis cases selected for surgery between May 1999 and January 2003. SETTING: Division of Thoracic Surgery, Universidade Federal de São Paulo (UNIFESP. PARTICIPANTS: 743 patients with surgery indicated due to palmar hyperhidrosis (49.8%, palmar-axillary hyperhidrosis (38.1%, craniofacial hyperhidrosis (8.9% or isolated axillary hyperhidrosis (2.8%. PROCEDURES: Video-thoracoscopic sympathectomy was performed, isolating the second thoracic ganglion (T2 in all patients, with additional sympathectomy of T3 and T4 if necessary. MAIN MEASUREMENTS:The clinical course was followed up via questionnaires, phone calls, letters and statements. Simple questions were asked regarding the disappearance of symptoms and presence and intensity of compensatory sweating. RESULTS: The surgery was regarded as efficient in all cases of palmar hyperhidrosis. In the craniofacial hyperhidrosis cases, partial recurrence of the symptoms occurred in 2 cases (3.0%. Partial recurrence or persistence of symptoms occurred in 20% of the patients with predominantly axillary symptomatology. The compensatory sweating was considered disagreeable or uncomfortable by about 30% of the patients, but it only reached the level of regretting the operation for 3% of them. This occurred more frequently in patients with axillary hyperhidrosis. Ten cases of complications occurred. CONCLUSION: Thoracoscopic sympathectomy provides very good results in most patients, with a very low complication

  9. Comparison between high and low levels thoracic sympathectomy for the treatment of palmar and axillary primary hyperhidrosis: systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    GILMAR FELISBERTO JÚNIOR

    Full Text Available ABSTRACT Primary hyperhidrosis (PH is a condition that has a great impact on affected individuals' quality of life, regardless of its location. Its surgical treatment is done through thoracic sympathectomy performed by videothoracoscopy. Standardization of the technique includes section of the sympathetic trunk at different levels, according to the site of symptoms. The aim of this review is to evaluate the efficacy of thoracic sympathectomy through a systematic literature review comparing sympathectomy at different levels of the sympathetic chain.

  10. [Neurolitic block of the lumbar sympathetic chain improves chronic pain in a patient with critical lower limb ischemia].

    Science.gov (United States)

    Barreto Junior, Elton Pereira de Sá; Nascimento, Jedson Dos Santos; de Castro, Anita Perpetua Carvalho Rocha

    2016-01-23

    Sympathectomy is one of the therapies used in the treatment of chronic obstructive arterial disease (COAD). Although not considered as first-line strategy, it should be considered in the management of pain difficult to control. This clinical case describes the evolution of a patient with inoperable COAD who responded properly to the lumbar sympathetic block. A female patient, afro-descendant, 69 years old, ASA II, admitted to the algology service due to refractory ischemic pain in the lower limbs. The patient had undergone several surgical procedures and conservative treatments without success. Vascular surgery considered the case as out of therapeutic possibility, unless limb amputation. At that time, sympathectomy was indicated. After admission to the operating room, the patient was monitored, positioned and sedated. The blockade was performed with the aid of radioscopy, bilaterally, at L2-L3-L4 right and L3 left levels. On the right side, at each level cited, 3mL of absolute alcohol with 0.25% bupivacaine were injected without vasoconstrictor, and on the left side only local anesthetic. The procedure was performed uneventfully. The patient was discharged with complete remission of the pain. Neurolitic block of the lumbar sympathetic chain is an effective and safe treatment option for pain control in patients with critical limb ischemia patients in whom the only possible intervention would be limb amputation. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  11. Laparoscopic lumbar hernia repair.

    Science.gov (United States)

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

    2006-04-01

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

  12. Long term compensatory sweating results after sympathectomy for palmar and axillary hyperhidrosis

    Science.gov (United States)

    Menna, Cecilia; Andreetti, Claudio; Ciccone, Anna Maria; D’Andrilli, Antonio; Maurizi, Giulio; Poggi, Camilla; Rendina, Erino Angelo

    2016-01-01

    Background Endoscopic thoracic sympathectomy is currently the best treatment for primary upper extremity hyperhidrosis, but the potential for adverse effects, particularly the development of compensatory sweating, is a concern and often precludes surgery as a definitive therapy. This study aims to evaluate long-term results of two-stage unilateral versus one-stage bilateral thoracoscopic sympathectomy. Methods From November 1995 to February 2011, 261 patients with severe palmar and/or axillary hyperhidrosis underwent endoscopic sympathectomy with a follow-up of at least 4 years. One-hundred and twenty-six patients received one-stage bilateral, single port video-assisted thoracoscopic sympathectomy (one-stage group) and 135 patients underwent two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of four months between the procedures (two-stage group). Results The mean postoperative follow-up period was 7.2 years (range, 4–9 years). Sixteen patients (12.7%) in the one-stage group and 15 patients (11.1%) in the two-stage group suffered from bradycardia (P=0.15). Recurrences occurred in three patients (2.4%) in the one-stage group and one (0.7%) in the two-stage group (P=0,09). Facial flushing or hyperthermia occurred in eight patients (6.3%) in the one-stage group and 11 (8.1%) of the two-stage group. Compensatory sweating occurred in 27 patients (21.4%) in the one-stage group and six patients (4.4%) in the two-stage group (P=0.0001). However, compensatory sweating recovered in five patients (83.3%) in the two-stage group versus nine (33.35%) in one-stage group during the follow-up period (Log-rank test P=0.016; HR, 7.196; 95% CI, 1.431–36.20). An improvement in postoperative quality of life (QoL) scores was observed in at least 90% of patients at three years after surgery in the one-stage group and at least 95% of patients in the two-stage group (P=0.001). Conclusions Compensatory sweating seems to improve during

  13. Twenty months of evolution following sympathectomy on patients with palmar hyperhidrosis: sympathectomy at the T3 level is better than at the T2 level

    Directory of Open Access Journals (Sweden)

    Guilherme Yazbek

    2009-01-01

    Full Text Available OBJECTIVE: To compare two surgical techniques (denervation levels for sympathectomy using video-assisted thoracoscopy to treat palmar hyperhidrosis in the long-term. METHODS: From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis, incidence and severity of compensatory hyperhidrosis and its evolution over time, and quality of life. RESULTS: Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. Twenty months later, all patients in both groups presented some degree of compensatory hyperhidrosis but with less severity in the T3 group (p = 0.007. Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen starting from the first postoperative evaluation but without any difference between the groups. This improvement was maintained until the end of the follow-up. CONCLUSION: Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis with less severity. Nevertheless, the improvement in quality of life was similar between the groups.

  14. One-year follow-up period after transumbilical thoracic sympathectomy for hyperhidrosis: outcomes and consequences.

    Science.gov (United States)

    Zhu, Li-Huan; Du, Quan; Chen, Long; Yang, Shengsheng; Tu, Yuanrong; Chen, Shengping; Chen, Weisheng

    2014-01-01

    Thoracic sympathectomy is considered the most effective method to treat palmar hyperhidrosis. We developed a novel approach for thoracic sympathectomy in patients with palmar hyperhidrosis through the umbilicus, using an ultrathin gastroscope. The aim of this study was to evaluate the continuing efficacy and patient satisfaction of this innovative surgery. All procedures were performed under general anesthesia and the patients were intubated with a dual-lumen endotracheal tube. After a 5-mm umbilical incision, the muscular parts of the diaphragmatic dome were incised with a needle-knife and the nasal gastroscope was advanced into the thoracic cavity. The sympathetic chain was identified at the desired thoracic level and ablated with hot biopsy forceps. All patients were followed up for at least 1 year after the procedure through clinic visits or telephone/e-mail interviews. From April 2010 to August 2011, a total of 35 patients underwent a transumbilical thoracic sympathectomy. Fifty-seven percent were male patients, with a mean age of 21.2 years (range, 16-33 years). The success rate after 12 months was 97.1% (34 of 35) for isolated palmar hyperhidrosis and 72.2% (13 of 18) for axillary hyperhidrosis. Compensatory sweating was reported in 28.6% of patients at the 1-year follow-up evaluation. There was no mortality, no diaphragmatic hernia, and no Horner syndrome was observed. Quality of life related to hyperhidrosis improved substantially in 27 (77.1%) patients, and improved in 4 (11.4%) patients at 12 months after surgery. A total of 94.3% of patients were satisfied with the excellent cosmetic results of the surgical incision. Transumbilical thoracic sympathectomy is an efficacious alternative to the conventional approach. This technique avoided the chronic pain and chest wall paresthesia associated with the chest incision. In addition, this novel procedure afforded maximum cosmetic benefits. Copyright © 2014 The American Association for Thoracic Surgery

  15. [Video-assisted thoracic sympathectomy - the results from a center outpatient surgery program].

    Science.gov (United States)

    R Velho, Tiago; Junqueira, Nádia; Sena, André; Guerra, Nuno; Caldeira, João; Gallego, Javier; Nobre, Ângelo

    2016-01-01

    The outpatient surgery program from our department has started in 2014 to improve patient access to surgery and to reduce the surgical waitlist. Focused on the thoracic surgery, the most common intervention is the surgical treatment of primary hyperhidrosis by thoracic sympathectomy by video-assisted thoracoscopic surgery (VATS). It is performed according to the patient's symptoms, with section or application of surgical clips between R2-R5. Retrospective study including all the patients submitted to thoracic sympathectomy by video- -assisted thoracoscopy surgery from our department's outpatient surgery program from January 2014 to January 2016. In our outpatient program we performed 198 thoracic sympathectomy by VATS. The mean age of the patients was 32,8 years old. 63,6% of the patients were females and 36.4% were males. From the 198 endoscopic thoracic sympathectomy performed, 181 (91,4%) were performed bilatellary with section between R3-R5, 12 (6,1%) were performed with the application of surgical clips in R2-R4 and 3 (1.5%) could not be performed due to the presence of pleuropulmonary adhesions. One of the patients was re-operated due to recurrent symptoms and another patients had surgery to remove the surgical clips (bilaterally in R2) due to exaggerated abdominal compensatory hyperhidrosis. Three patients had pneumothorax. The surgical treatment of primary hyperhidrosis was the most frequent procedure in our outpatient surgery program. The procedure without the use of a thoracic drainage allowed its inclusion in the outpatient surgery program. Excluding 3 patients, all the patients were discharged within 12 hours after the surgery. The good results and the reduction of the surgical waitlist encourage the cardiothoracic outpatient surgery program.

  16. Lumbar stenosis: clinical case

    Directory of Open Access Journals (Sweden)

    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.

  17. Nonintubated Needlescopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis: A Randomized Controlled Trial.

    Science.gov (United States)

    Chen, Jian-Feng; Lin, Min; Chen, Ping; Quan, Du; Li, Xu; Lai, Fan-Cai; Tu, Yuan-Rong

    2016-08-01

    Conventional endoscopic thoracic sympathectomy (ETS) is usually performed with 5-mm thoracoscope under general anesthesia with endotracheal intubation. Needlescopic thoracic sympathectomy under total intravenous anesthesia without intubation has rarely been attempted. This randomized controlled trial assesses the feasibility and safety of this minimally invasive therapeutic procedure in managing primary palmar hyperhidrosis. From July 2012 to July 2014, 221 patients with severe primary palmar hyperhidrosis underwent bilateral ETS and were randomly allocated to group A or group B. Patients in group A (n=108) underwent nonintubated ETS using a needle endoscope, whereas those in group B (n=113) underwent traditional transaxillary single-port ETS using a 5-mm thoracoscope. ETS was successfully performed in all patients. The palms of all patients became dry and warm immediately after surgery. The mean resuscitation time was significantly shorter in nonintubated patients than in intubated patients (Pthoracic sympathectomy is a safe, effective, and minimally invasive therapeutic procedure, which has the advantages of a smaller incision with less pain, shorter resuscitation time, and better cosmetic results.

  18. [Outpatient or short-stay videothoracoscopy-assisted thoracic sympathectomy: anesthesia in 445 cases].

    Science.gov (United States)

    Tejedor, A; Anglada, M T; Pons, M; Callejas, M A; Gomar, C

    2010-11-01

    To demonstrate the safety of outpatient or short-stay bilateral videothoracoscopy-assisted thoracic sympathectomy. The medical records of 445 who underwent bilateral videothoracoscopy-assisted thoracic sympathectomy were reviewed; the same protocols were used to guide these outpatient or short-stay procedures in all cases. Intravenous anesthesia was provided. An orotracheal tube allowed for carrying out the sympathectomy procedure during short periods of apnea. A 2% lidocaine solution was infused through the thoracic drains, which were removed soon after surgery. Data on intraoperative respiratory variables, pain, and intra- and postoperative complications were gathered. The data for patients undergoing the procedure on an outpatient or short-stay basis were compared. No significant differences in demographic or perioperative variables were found between the 2 groups. In 3.6% of the patients in the series, there was a record of a postoperative pulmonary complication: 4 therapeutic minithoracotomies; 1 subcutaneous emphysema without radiologic changes; 9 residual pneumothoraces, 2 requiring pleural drainage; 1 chylothorax; and 1 delayed hemothorax. With the exception of the late-developing hemothorax, all complications were diagnosed and treated in the immediate postoperative period. In the outpatient surgery group, unplanned admissions because of patient refusal to leave occurred in 6.5% of the cases. The low incidence of complications, and especially the finding that complications are detected in the early recovery period, indicate that this procedure can be performed on an outpatient basis.

  19. Surgical thoracic sympathectomy induces structural and biomechanical remodeling of the thoracic aorta in a porcine model.

    Science.gov (United States)

    Angouras, Dimitrios C; Dosios, Theodosios J; Dimitriou, Constantinos A; Chamogeorgakis, Themistocles P; Rokkas, Chris K; Manos, Themistoklis A; Sokolis, Dimitrios P

    2012-01-01

    Sympathetic innervation exerts marked effects on vascular smooth muscle cells, including a short-term homeostatic (vasoconstrictor) and a direct trophic action promoting differentiation. However, the role of sympathetic nervous system in long-term structural and functional modulation of the aortic wall is yet undefined. Six Landrace pigs underwent bilateral thoracic sympathectomy from the stellate to T8 ganglion, whereas 10 pigs underwent sham operation. Animals were sacrificed 3 mo postoperatively. Histometrical examination was performed on specimens from the thoracic (TA) and abdominal aorta (AA) utilizing an image-processing system. A uniaxial tensile tester was utilized for biomechanical evaluation; parameters of extensibility, strength, and stiffness of aortic tissue were calculated. Structural aortic remodeling of sympathectomized animals was observed, including increased inner aortic diameter in TA (15.3 ± 0.4 versus 10.4 ± 0.2 mm, P sympathectomy, TA was equally extensible but manifested augmented strength (1344 ± 73 versus 1071 ± 52 kPa, P = 0.004) and stiffness (6738 ± 478 versus 5026 ± 273 kPa, P = 0.003), in accordance with extracellular matrix protein accumulation in that region. Differences in the AA were non-significant. Chronic thoracic sympathetic denervation causes significant structural and biomechanical remodeling of the thoracic aorta. Possible clinical implications for patients undergoing thoracic sympathectomy or chronically treated with sympathetic blockers require further investigation. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Cardiac Autonomic Changes After Thoracic Sympathectomy: A Prospective, Randomized Study.

    Science.gov (United States)

    Fiorelli, Alfonso; Messina, Giovanni; Chiodini, Paolo; Costanzo, Saveria; Viggiano, Andrea; Monda, Marcellino; Vicidomini, Giovanni; Santini, Mario

    2017-01-01

    We evaluated whether cardiac autonomic changes could be associated with different extent of sympathetic nerve resection in the management of essential palmar hyperhidrosis. Sixty patients with essential palmar hyperhidrosis were randomly allocated to undergo excision of T3 ganglia (sympathicectomy group; n = 30) or to interruption of sympathetic chain at the T2 to T3 level with ganglion sparing (sympathicotomy group; n = 30). Time and frequency domains were measured with a 24-Holter monitor during daytime, nighttime, and 24-hour periods at different interval points (7 days before operation; 24 hours; and 1, 3, and 6 months later), and the differences were statistically compared. Clinical outcomes were also evaluated. Twenty-eight of 30 patients of the sympathectomy and 29 of 30 patients of the sympathicotomy group completed the study. In both groups, we observed a significant increase (p 50 ms; high frequency; and a significant decrease (p sympathectomy group than in the sympathicotomy group. Clinical outcomes were similar between the two groups. Endoscopic thoracic sympathectomy caused a shift of sympathovagal balance toward parasympathetic tone that seems to be associated with the extent of denervation. This trial was registered at clinicaltrials.gov as NCT02733497. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Radiofrequency upper thoracic sympathectomy in the treatment of critical upper limb ischemia--a case series.

    Science.gov (United States)

    Gabrhelik, Tomas; Stehlik, Daniel; Adamus, Milan; Zalesak, Bohumil; Michalek, Pavel

    2013-06-01

    Patients with significant medical and social problems resulting from impaired perfusion of the upper limbs caused by micro- or macro-angiopathy are now frequent in clinical practice. Vasospastic disease of the upper limbs of combined origin is a difficult condition to treat by conservative methods and therapeutic strategies are usually multidisciplinary. In addition to standard pharmacotherapy, treatment may involve regional anaesthesia, thoracoscopic or radiofrequency sympathectomy and surgical treatment of defects, including plastic surgery. This paper describes our successful work in the treatment of upper limb critical ischemia using radiofrequency upper thoracic sympathectomy. In three case reports we present the results of radiofrequency thermolysis applied to treat patients with chronic defects of the hand and fingers. These patients were diagnosed with upper limb critical ischemia of combined origin, standard conservative treatment methods failed and surgical intervention was originally not indicated, however, radiofrequency thermolysis proved to be beneficial. Radiofrequency thoracic sympathectomy could improve peripheral perfusion of the upper limbs and thereby contribute to healing of chronic defects, reduction of pain and improvement in the quality of life of the patients.

  2. Minimally invasive thoracoscopic sympathectomy for palmar hyperhidrosis via a transaxillary single-port approach.

    Science.gov (United States)

    Georghiou, Georgios P; Berman, Marius; Bobovnikov, Viacheslav; Vidne, Bernardo A; Saute, Milton

    2004-09-01

    The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 months, range 6-18 months) and value of transaxillary single-port thoracic sympathectomy using a thoracoscope with an operating channel for the treatment of hyperhidrosis. Between December 1992 and October 2002, 176 consecutive patients (94 men, 82 women, mean age 21 years) with hyperhidrosis underwent thoracoscopic sympathectomy via a 12-mm single-port approach. Data on postoperative morbidity and outcome were analyzed to validate the technique. Mean operative time per side was 9 min; there was no conversion to an open procedure. Ninety-five percent of the patients were discharged the next day. Thirty-day mortality was zero. Complications included unilateral transient Horner's syndrome (n=1), residual pneumothorax requiring chest drainage from the port entry (n=4), and segmental atelectasis of the lung (n=4) which was treated conservatively. Complete relief of symptoms was observed in all patients at the 6-month follow-up; 45% experienced compensatory hyperhidrosis. Single-port thoracoscopic sympathectomy produces excellent medical and cosmetic results in patients with hyperhidrosis, and is associated with a short hospital stay and a low risk of complications. Overall satisfaction is high. A few patients may experience compensatory symptoms.

  3. Incidence and Frequency of Endoscopic Sympathectomy for the Treatment of Hyperhidrosis Palmaris in Taiwan

    Directory of Open Access Journals (Sweden)

    Dachen Chu

    2010-03-01

    Full Text Available Hyperhidrosis palmaris (HP is a rather common disease in Taiwan. Taiwan is a leading nation in terms of the surgical treatment of this disease using thoracic endoscopic sympathectomy. However, the currently available epidemiological information regarding HP is insufficient. To date, the incidence of HP and the percentage of patients treated surgically have not been reported. We investigated the incidence of HP treated in 2004 by sampling Taiwan's National Health Insurance database. Patients who were diagnosed with HP during 2004 were identified by International Classification of Diseases, 9th Clinical Modification code 780.8 from a database of about 22 million beneficiaries, and were followed to 2006. Those who had been diagnosed as HP in 2002 or 2003 were excluded. Patients who underwent surgery were identified by the treatment codes 83026C (dorsal sympathectomy and 83085B (transendoscopic dorsal sympathectomy, TES. Factors included in the analysis included age, sex, time of operation and hospitalization for surgery. In total, 15,839 patients with HP were identified. The incidence was 7.2 per 10,000 beneficiaries. The study sample included 7,603 males with an incidence of 6.9 per 10,000 beneficiaries, and 8,236 females with an incidence of 7.4 per 10,000 beneficiaries. The incidence was highest among patients aged 20–29 years old. The incidence decreased with increasing age (Mantel-Haenszel χ2 test for trend, p < 0.001, and 3,755 cases (23.7% received an operation, of which 1,733 were male (22.8% of all male patients and 2,022 were female (24.6% of all female patients (p = 0.009. Of these, 99.3% underwent transendoscopic dorsal sympathectomy, and 94.7% underwent surgery within 1 month of the initial diagnosis. Males underwent surgery sooner than females (p = 0.004. Adjusted multivariate logistic regression analysis showed that patients aged 20–29 were more likely to undergo surgery than the other age groups (odds ratio: 2.28; 95

  4. Uniportal versus biportal video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis

    Institute of Scientific and Technical Information of China (English)

    CHEN Yong-bing; YE Wu; YANG Wen-tao; SHI Li; GUO Xu-feng; XU Zhong-hua; QIAN Yong-yue

    2009-01-01

    Background Video-assisted thoracoscopic sympathectomy had replaced open surgery. The aim of this study was to compare the outcomes of using a single port and two pods to perform video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Methods Between April 2006 and February 2008, 20 cases underwent video-assisted thoracoscopic sympathectomy through one port (uniportal group) and 25 cases through two pods (biportal group). The variables including the operating time, hospital stay, pain scores, postoperative complications, incidence of symptom recurrence and patient satisfaction were compared. The mean postoperative follow-up period was 11.5 months (range, 3-25 months). Results The hands of all patients were warm and dry after operation. No conversion to open surgery was necessary, and no operative mortality was recorded in either group. The mean inpatient pain scores were significantly higher in the biportal group (1.2±0.6) than that in the uniportal group (0.8±0.5, p=0.025). For the first three weeks after operation, four out of 20 (20%) patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 (32%) cases in the biportal group (P=0.366). Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics. Our mean operative time (bilateral sympathectomy) in the uniportal group ((39.5±10.0) minutes) was shorter than that in biportal group ((49.7±10.6) minutes, P=0.02). There were no significant differences between two groups in terms of the mean hospital stay, compensatory sweating, and patient satisfaction. Two patients in the biportal group and three in the uniportal group experienced a unilateral pneumothorax. None of them required chest drainage. No patient experienced Homer's syndrome, and no recurrent symptoms were observed in either groupsConclusions Both uniportal and biportal video-assisted thoracoscopic sympathectomy are effective, safe, and minimally

  5. Lumbar corsets can decrease lumbar motion in golf swing

    National Research Council Canada - National Science Library

    Hashimoto, Koji; Miyamoto, Kei; Yanagawa, Takashi; Hattori, Ryo; Aoki, Takaaki; Matsuoka, Toshio; Ohno, Takatoshi; Shimizu, Katsuji

    2013-01-01

    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...

  6. [Transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis: a novel surgical approach].

    Science.gov (United States)

    Lin, Min; Tu, Yuan-rong; Lai, Fan-cai; Li, Xu; Chen, Jian-feng; Luo, Rong-gang; Lin, Jian-bo

    2013-11-05

    To evaluate the cosmetic effect and safety of transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis (PH). Retrospective study was conducted for 326 PH cases undergoing transaxillary concealing single incision endoscopic thoracic bilateral sympathectomy during January 2009 and March 2011. All operations were successfully performed without severe complication and mortality. No conversion into open technique was necessary. The mean unilateral operative duration was 5.8 (5-8) min. It was calculated from the time of skin incision to the application of dressing over wound. The mean follow-up period was 25 (8-38) months. All patients achieved excellent cosmetic effects with undetectable incision. Transaxillary concealing single incision endoscopic thoracic sympathectomy is a safe and effective procedure for treating primary PH. Incision is undetectable with excellent cosmetic effect. It is worthy of wider popularization.

  7. Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis†

    Science.gov (United States)

    Ibrahim, Mohsen; Menna, Cecilia; Andreetti, Claudio; Ciccone, Anna Maria; D'Andrilli, Antonio; Maurizi, Giulio; Poggi, Camilla; Vanni, Camilla; Venuta, Federico; Rendina, Erino Angelo

    2013-01-01

    OBJECTIVES Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy. METHODS From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group). RESULTS The mean postoperative follow-up period was 12.5 (range: 1–24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/moderate pain (P = 0.8482). The mean operative time was 38 ± 5 min in the one-stage group and 39 ± 8 min in the two-stage group (P = 0.199). Pneumothorax occurred in 8 (6%) patients of the one-stage group and in 11 (8%) of the two-stage group. Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner's syndrome. CONCLUSIONS Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis. PMID:23442937

  8. Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis.

    Science.gov (United States)

    Ibrahim, Mohsen; Menna, Cecilia; Andreetti, Claudio; Ciccone, Anna Maria; D'Andrilli, Antonio; Maurizi, Giulio; Poggi, Camilla; Vanni, Camilla; Venuta, Federico; Rendina, Erino Angelo

    2013-06-01

    Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy. From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group). The mean postoperative follow-up period was 12.5 (range: 1-24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/moderate pain (P = 0.8482). The mean operative time was 38 ± 5 min in the one-stage group and 39 ± 8 min in the two-stage group (P = 0.199). Pneumothorax occurred in 8 (6%) patients of the one-stage group and in 11 (8%) of the two-stage group. Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner's syndrome. Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis.

  9. SACRALISATION OF LUMBAR VERTEBRAE

    Directory of Open Access Journals (Sweden)

    Sangeeta Wazir

    2014-06-01

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

  10. Lateral Lumbar Interbody Fusion

    Science.gov (United States)

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

    2015-01-01

    The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques. PMID:26713134

  11. Incarcerated inferior lumbar (Petit's) hernia.

    Science.gov (United States)

    Astarcioğlu, H; Sökmen, S; Atila, K; Karademir, S

    2003-09-01

    Petit's hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh reinforcement repair.

  12. Comparison of only T3 and T3–T4 sympathectomy for axillary hyperhidrosis regarding treatment effect and compensatory sweating

    Science.gov (United States)

    Yuncu, Gökhan; Turk, Figen; Ozturk, Gökhan; Atinkaya, Cansel

    2013-01-01

    OBJECTIVES Patients diagnosed with axillary hyperhidrosis can face psychosocial issues that can ultimately hinder their quality of life both privately and socially. The routine treatment for axillary hyperhidrosis is T3–T4 sympathectomy, but compensatory sweating is a serious side effect that is commonly seen with this approach. This study was designed to evaluate whether a T3 sympathectomy was effective for the treatment of axillary hyperhidrosis and whether this treatment led to less compensatory sweating than T3–T4 sympathectomies among our 60-patient population. METHODS One hundred and twenty endoscopic thoracic sympathectomies were performed on 60 patients who had axillary hyperhidrosis. The sympathectomies were accomplished by means of a single-lumen endotracheal tube and a single port. The axillary hyperhidrosis patients were randomly divided into two groups with 17 patients in Group 1 undergoing T3–T4 sympathectomies and 43 in Group 2 undergoing only T3 sympathectomies. We analysed the data associated with the resolution of axillary hyperhidrosis, the degree of patient satisfaction with the surgical outcome and the quality of life in parallel with compensatory sweating after the procedure as reported by the patient and confirmed by the examiner. Moreover, the results were compared statistically. RESULTS No statistically significant difference was observed between the groups based on age (P = 0.56), gender (P = 0.81), duration of the surgery (P = 0.35) or postoperative satisfaction levels (P = 0.45). However, the incidence and degree of compensatory sweating were lower in the T3 group than the T3–T4 group at the 1-year follow-up (P = 0.008). CONCLUSIONS T3 sympathectomy was as effective as T3–T4 sympathectomy for the treatment of axillary hyperhidrosis based on the patients’ reported postoperative satisfaction, and the T3 group demonstrated lower compensatory sweating at the 1-year follow-up. PMID:23644731

  13. Randomized trial - oxybutynin for treatment of persistent plantar hyperhidrosis in women after sympathectomy

    Directory of Open Access Journals (Sweden)

    Altair da Silva Costa Jr

    2014-02-01

    Full Text Available OBJECTIVE: Hyperhidrosis is a common disease, and thoracoscopic sympathectomy improves its symptoms in up to 95% of cases. Unfortunately, after surgery, plantar hyperhidrosis may remain in 50% of patients, and compensatory sweating may be observed in 70%. This clinical scenario remains a challenge. Our objective was to evaluate the effectiveness of oxybutynin in the treatment of persistent plantar hyperhidrosis and compensatory sweating and its effects on quality of life in women after thoracoscopic sympathectomy. METHOD: We conducted a prospective, randomized study to compare the effects of oxybutynin at 10 mg daily and placebo in women with persistent plantar hyperhidrosis. The assessment was performed using a quality-of-life questionnaire for hyperhidrosis and sweating measurement with a device for quantifying transepidermal water loss. Clinicaltrials.gov: NCT01328015. RESULTS: Sixteen patients were included in each group (placebo and oxybutynin. There were no significant differences between the groups prior to treatment. After oxybutynin treatment, there was a decrease in symptoms and clinical improvement based on the quality-of-life questionnaire (before treatment, 40.4 vs. after treatment, 17.5; p = 0.001. The placebo group showed modest improvement (p = 0.09. The outcomes of the transepidermal water loss measurements in the placebo group showed no differences (p = 0.95, whereas the oxybutynin group revealed a significant decrease (p = 0.001. The most common side effect was dry mouth (100% in the oxybutynin group vs. 43.8% in the placebo group; p = 0.001. CONCLUSION: Oxybutynin was effective in the treatment of persistent plantar hyperhidrosis, resulting in a better quality of life in women who had undergone thoracoscopic sympathectomy.

  14. Randomized trial - oxybutynin for treatment of persistent plantar hyperhidrosis in women after sympathectomy

    Science.gov (United States)

    da Silva Costa, Altair; Leão, Luiz Eduardo Villaça; Succi, José Ernesto; Perfeito, Joao Aléssio Juliano; Filho, Adauto Castelo; Rymkiewicz, Erika; Filho, Marco Aurelio Marchetti

    2014-01-01

    OBJECTIVE: Hyperhidrosis is a common disease, and thoracoscopic sympathectomy improves its symptoms in up to 95% of cases. Unfortunately, after surgery, plantar hyperhidrosis may remain in 50% of patients, and compensatory sweating may be observed in 70%. This clinical scenario remains a challenge. Our objective was to evaluate the effectiveness of oxybutynin in the treatment of persistent plantar hyperhidrosis and compensatory sweating and its effects on quality of life in women after thoracoscopic sympathectomy. METHOD: We conducted a prospective, randomized study to compare the effects of oxybutynin at 10 mg daily and placebo in women with persistent plantar hyperhidrosis. The assessment was performed using a quality-of-life questionnaire for hyperhidrosis and sweating measurement with a device for quantifying transepidermal water loss. Clinicaltrials.gov: NCT01328015. RESULTS: Sixteen patients were included in each group (placebo and oxybutynin). There were no significant differences between the groups prior to treatment. After oxybutynin treatment, there was a decrease in symptoms and clinical improvement based on the quality-of-life questionnaire (before treatment, 40.4 vs. after treatment, 17.5; p = 0.001). The placebo group showed modest improvement (p = 0.09). The outcomes of the transepidermal water loss measurements in the placebo group showed no differences (p = 0.95), whereas the oxybutynin group revealed a significant decrease (p = 0.001). The most common side effect was dry mouth (100% in the oxybutynin group vs. 43.8% in the placebo group; p = 0.001). CONCLUSION: Oxybutynin was effective in the treatment of persistent plantar hyperhidrosis, resulting in a better quality of life in women who had undergone thoracoscopic sympathectomy. PMID:24519200

  15. Retention of the Eosinopenic Response After Bilateral Sympathectomy in the Dog

    Science.gov (United States)

    1951-09-11

    ARMY MEDICAL RESEARCH LABs„ F0RT KNOX9 KY» (REPORT NO* 65) RETENTION OF THE E05IN0PENSC RESPONSE AFTER BILATERAL SYMPATHECTOMY IN THE DOS NELSON...OP THE EOSBSOPENlC RESPONSE AFTER BILATERAL SIMPATHEGTOMT IN THE DOG OBJECT To determine If removal of the thoracic and abdominal sympathetic...Bilateral removal of th© thoracic and abdominal sympathetic chains in the dog does not prevent the marked decrease in th© circulating ©ösinöphils

  16. Our experience of the thoracoscopic sympathectomy in case of the periferial arteries diseases

    Directory of Open Access Journals (Sweden)

    Nikolay Krotov

    2010-07-01

    Full Text Available Investigated the results of thoracoscopic sympathectomy at 107patients with peripheral arteries diseases. The best results inpost operation period observed in patients with Raynaud’sdisease and syndrome, which efficacy reached up to 100%. Inthe long follow up period efficacy of operation observed 100%and 90% accordingly. At obliterating endarteritis and anatherosclerosis we fought followed preservation of the basicfunctions of the extremities. In conclusion in postoperativeperiod this parameter was 73.2% and 62.5% accordingly and inthe long follow up period extremities could be saved 62% and25% accordingly.

  17. Lumbar hernia: a diagnostic dilemma.

    Science.gov (United States)

    Ahmed, Syed Tausif; Ranjan, Rajeeva; Saha, Subhendu Bikas; Singh, Balbodh

    2014-04-15

    Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Hence the diagnosis can be easily missed. This leads to delay in the treatment causing increased morbidity. We report a case of lumbar hernia in a middle-aged woman. It was misdiagnosed as lipoma by another surgeon. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Clinical and MRI findings were correlated to reach the diagnosis. We also highlight the types, the process of diagnosis and the surgical repair of lumbar hernias. We wish to alert our fellow surgeons to keep the differential diagnosis of the lumbar hernia in mind before diagnosing any lumbar swelling as lipoma.

  18. Epidurography in lumbar spondylolisthesis

    Energy Technology Data Exchange (ETDEWEB)

    Johansen, J.G.; Hauge, O.

    1982-04-01

    Seventeen patients with lytic lumbar spondylolisthesis (Meyerding grade I-II) and radicular symptoms were examined by epidurography in addition to radiculomyelography before surgical treatment. Epidurography is considered more suitble than radiculomyelogrphy for assessing this condition because narrowing of the epidural space and compression of the nerve roots, due to osteofibrous changes at the lysis, are more consistently demonstrated.

  19. Variant lumbar pedicle

    Energy Technology Data Exchange (ETDEWEB)

    Whelan, M.A.; Feldman, F.

    1982-01-01

    Three cases of aplastic and/or hypoplastic lumbar pedicle are presented and discussed. The importance of plain films, especially the 45/sup 0/ posterior oblique, for making the diagnosis is emphasized. The incidence and embryology of abnormalities of the pedicle are reviewed and the radiological features used to differentiate these congenital abnormalities from neoplasm and trauma are described.

  20. [Trans-areola single port endoscopic thoracic sympathectomy for the treatment of palmar hyperhidrosis: a new surgical approach].

    Science.gov (United States)

    Tu, Yuan-rong; Lai, Fan-cai; Li, Xu; Lin, Min; Duan, Hong-bing; Fu, Cheng-guo; Zhan, Hua-hui; Zheng, Yi-wen

    2011-11-29

    To evaluate the cosmetic effects and safety profiles of trans-areola single port endoscopic thoracic sympathectomy. A retrospective study was conducted for 45 males and 7 females with palmar hyperhidrosis undergoing trans-areola single port endoscopic thoracic bilateral sympathectomy during April and June 2011. All operations were successfully performed without severe morbidity and mortality. No conversion to open technique was necessary. The mean unilateral operative duration was 6 minutes (range: 5 - 8). The time was calculated from the time of skin incision to that of dressing application over wound. The mean hospitalization duration was 2.2 days (range: 2 - 3). The mean follow-up period was 2.8 months (range: 1 - 7). All patients achieved excellent cosmetic effects. No incision scar was found. Trans-areola single port endoscopic thoracic sympathectomy is a safe and effective therapeutic procedure for primary palmar hyperhidrosis. The incision is undetectable with excellent cosmetic effects. The trans-areola route is a new ideal and promising approach for endoscopic thoracic sympathectomy.

  1. Single-Port Endoscopic Thoracic Sympathectomy with Monitored Anesthesia Care: A More Promising Procedure for Palmar Hyperhidrosis.

    Science.gov (United States)

    Ning, Ye; Wang, Yanan; Tao, Xiandong; Tang, Hua; Jiang, Jingjing; Li, Yonghua; Sun, Guangyuan; Xue, Lei; Zhao, Xuewei

    2015-09-01

    Thoracic sympathectomy is considered the most effective method to treat palmar hyperhidrosis. We presented a novel procedure for thoracic sympathectomy treating palmar hyperhidrosis which could be performed under monitored anesthesia care. The aim of this study was to evaluate the continuing efficacy and safety of this innovative surgery. From May 2011 to May 2014, we performed the single-port endoscopic thoracic sympathectomy (ETS) with a flexible thoracoscopy in 32 patients under monitored anesthesia care. All patients were followed up until today. Under monitored anesthesia, all patients were awake during the procedure. A proper sedation and local anesthesia make it possible for patients to communicate with surgeons. The symptoms disappeared immediately when the sympathectomy was done. No surgical complications occurred during the procedure. All patients were discharged from the hospital on the first morning of postoperative day. Compared with the traditional approach, the advantages of less operative costs, fewer hospital days, and better recovery were suggested. Single-port ETS with flexible thoracoscopy under monitored anesthesia is a promising procedure for palmar hyperhidrosis.

  2. Minimally invasive thoracic sympathectomy for palmar hyperhidrosis via a single unilateral incision approach by the pleura videoscope.

    Science.gov (United States)

    Yang, Yunhai; Zeng, Liping; An, Zhou; Wang, Luming; Hu, Jian

    2014-05-01

    Palmar hyperhidrosis is a common disease that causes intense significant embarassment for patients. Bilateral single-port thoracoscopic sympathectomy is an effective surgical treatment with high success rates and improvement in quality of life. In order to reduce surgical invasion and to seek better cosmetic results, we describe a novel protocol for thoracic sympathectomy in the treatment of palmar hyperhidrosis. Between January 2012 and September 2012, bilateral thoracic sympathectomy was performed through the anterior mediastinal pleura using the pleural videoscope with a single unilateral skin incision in 10 men and 6 women. In total, 16 patients were cured, and the skin temperature increased by a mean of 2.7±0.6°C. The average operation time was 67.9±15.8 minutes, with a postoperative hospital stay of 1.9±0.6 days and operative bleeding of less than 20 mL. All operations were successful, with no severe complications or perioperative mortality. Follow-up of 9.8±2.3 months (range, 7-14 months) showed that palmar sweating improved in all patients, and the effective rate was 100%. A single unilateral incision for two-sided thoracic sympathectomy through the anterior mediastinal pleura is an effective, feasible, safe, and minimally invasive procedure with excellent cosmetic results.

  3. Efficacy of cervicothoracic sympathectomy versus conservative management in patients suffering from incapacitating Raynaud's syndrome after frost bite.

    Science.gov (United States)

    Khan, Mohammad Iqbal; Tariq, Mohammad; Rehman, Ahmed; Zafar, Afsheeen; Sheen, Salman Najam

    2008-01-01

    Raynaud's syndrome is a known complication of cold injuries. Stress, smoking and metabolic diseases may further aggravate the disease course. The purpose of this study was to determine the efficacy of Cervico-thoracic sympathectomy as compared to conservative management in severe Raynaud's syndrome after frostbite. This non-randomized controlled trial was conducted at Railway Hospital, Rawalpindi and Islamic International Medical Complex, Islamabad between January 1999 and June 2006. All patients sustained severe cold trauma in the mountain ridges of Himalayas in Kashmir. In all cases, an informed consent was obtained from patients and families. All operations performed were free of charges. Out of the total 48 patients who developed incapacitating Raynaud's syndrome of the upper limbs after frost bite, 17 patients underwent thoracic sympathectomy through anterior supraclavicular route. Remaining 31 patients were treated conservatively and were placed in the control group. Data was collected on pre-designed proforma and assessed using SPSS (version 11). Chi-square test was applied to assess the effectiveness of the two treatment modalities. All operated cases initially showed improvement in symptoms and incapacitation. Among sympathectomised patients, 11 patients became symptom free and 3 patients showed mild but improved symptoms. Two patients after initial transient improvement developed incapacitating symptoms requiring further treatment, one patient developed gangrene ofdistal phalanx nine month after sympathectomy requiring amputation of the finger. Frequency of attacks and duration between the attacks reduced in all operated patients of cervical sympathectomy (p treatment in patients having severe Raynaud's disease of upper limbs secondary to frost bite.

  4. The Role of Lumbar Sympathetic Nerves in Regulation of Blood Flow to Skeletal Muscle during Anaphylactic Hypotension in Anesthetized Rats.

    Directory of Open Access Journals (Sweden)

    Jie Song

    Full Text Available During hypovolemic shock, skeletal muscle blood flow could be redistributed to vital organs via vasoconstriction in part evoked by activation of the innervating sympathetic nerve activity. However, it is not well known whether this mechanism operates during anaphylactic shock. We determined the femoral artery blood flow (FBF and lumbar sympathetic nerve activity (LSNA mainly regulating the hindquater muscle blood flow during anaphylactic hypotension in anesthetized rats. Anesthetized Sprague-Dawley rats were randomly allocated to the following groups (n = 7/group: (1 non-sensitized, (2 anaphylaxis, (3 anaphylaxis-lumbar sympathectomy (LS and (4 anaphylaxis-sinoaortic denervation (SAD groups. Anaphylaxis was induced by an intravenous injection of the ovalbumin antigen to the sensitized rats. The systemic arterial pressure (SAP, heart rate (HR, central venous pressure (CVP, FBF and LSNA were continuously measured. In the anaphylaxis group, LSNA and HR increased, while SAP and FBF decreased after antigen injection. In the anaphylaxis-SAD group, LSNA did not significantly change during the early phase, but the responses of SAP and FBF were similar to those in the anaphylaxis group. In the anaphylaxis-LS group, both FBF and SAP decreased similarly to the anaphylaxis group during anaphylactic hypotension. These results indicated that LSNA increased via baroreceptor reflex, but this sympathoexcitation or LS did not affect antigen-induced decreases in FBF or SAP. Lumbar sympathetic nerves are not involved in regulation of the blood flow to the hindlimb or systemic blood pressure during anaphylactic hypotension in anesthetized rats.

  5. Lumbar facet syndromes.

    Science.gov (United States)

    Beresford, Zach M; Kendall, Richard W; Willick, Stuart E

    2010-01-01

    Low back pain is a common presenting complaint to sports medicine providers. The lumbar spine is a complex anatomic structure with multiple potential pain generators. Epidemiologic studies have shown that the intervertebral disc is the most common pain generator in all patients with low back pain. The facet joints may account for 15%-40% of low back pain. It can be challenging at times to establish a firm diagnosis of facet pain. Facet pain can have different presentations, and pain emanating from other lumbopelvic structures can present similarly as facet joint pain. This article reviews the anatomy and biomechanics of the lumbar facet joints, presenting symptoms and physical examination findings seen with facet pain. We also will discuss diagnostic and treatment paradigms that are helpful to the clinician treating low back pain in athletes.

  6. Lumbar-sacral dysplasias

    Energy Technology Data Exchange (ETDEWEB)

    Schumacher, M.; Thron, A.

    1984-09-01

    By means of some selected examples, the myelographic and CT characteristics are presentated of different lumbar-sacral dysplasias. The advantage of the different methods of examination (CT, CT myelography and myelography) and the improved presentation of pathological-anatomical details by means of a combination of these methods in the diagnosis of hyperplasia of the filum terminale, diastematomyelia, tethered conus, intracorporal and anterior sacral meningocele have been shown.

  7. Electrodiagnosis of lumbar radiculopathy.

    Science.gov (United States)

    Barr, Karen

    2013-02-01

    The evaluation of patients with suspected lumbar radiculopathy is one of the most common reasons patients are referred for electrodiagnostic testing. The utility of this study depends on the expertise of the physician who plans, performs, and completes the study. This article reviews the strengths and weaknesses of electrodiagnosis to make this diagnosis, as well as the clinical reasoning of appropriate study planning. The current use of electrodiagnostic testing to determine prognosis and treatment outcomes is also discussed.

  8. Pre-emptive local analgesia in video-assisted thoracic surgery sympathectomy.

    Science.gov (United States)

    Fiorelli, Alfonso; Vicidomini, Giovanni; Laperuta, Paolo; Busiello, Luigi; Perrone, Anna; Napolitano, Filomena; Messina, Gaetana; Santini, Mario

    2010-03-01

    Our goal is to determine whether infiltration with a short-acting local anaesthetic such as lidocaine before the surgical incision has a pre-emptive effect on postoperative pain intensity and on incidence of paraesthesia in patients undergoing standard thoracoscopic sympathectomy for palmar hyperhidrosis. This prospective study includes a consecutive series of 18 patients undergoing bilateral standard thoracoscopic sympathectomy for palmar hyperhidrosis during January 2005-December 2007. Each patient enrolled in the study was randomised to receive pre-incisional lidocaine with epinephrine infiltration of the wounds on the one side, and normal saline solution on the other. The identical surgery was performed on each side to allow patients to act as their own controls. Then, the side which received local analgesia was compared with the control side with regard to pain control and paraesthesia after 4, 24 and 168 h postoperatively. The patients and investigators were both blinded concerning the side randomised to receive pre-emptive local analgesia (PLA). We found that patients reported significantly less pain on the side treated with pre-emptive local anaesthesia in contrast to the control side 4 and 24h after surgery (p=0.001 and p=0.004, respectively). However, that difference decreased with time and was no longer significant 168 h following surgery (p=0.156). Regarding the paraesthesia, the incidence was higher in the control side than the PLA side at 4, 24 and 168 h postoperatively, but the difference was not statistically significant. A total of 17 of 18 (94%) patients noted a change in palmar hyperhidrosis status after surgery. Our study shows that the pre-injection of local anaesthetic before standard thoracoscopic sympathectomy suppresses the local pain mediators, hence resulting in significantly less pain in the first postoperative 24 h but not thereafter. The clinical impact of the procedure is the possibility of early discharge to home and early return to

  9. [Changes in palmar skin blood flow, perfusion index and temperature during endoscopic thoracic sympathectomy].

    Science.gov (United States)

    Asano, Maiko; Tanaka, Motoshige; Kusaka, Hitomi; Sakai, Masato; Minami, Toshiaki

    2010-12-01

    In endoscopic thoracic sympathectomy (ETS), it is required to perform accurate cautery of the sympathetic trunk. Monitoring of palmar skin blood flow and temperature has been used to assess the efficacy of ETS. This study investigated whether Perfusion Index (PI) is useful in assessing palmar skin blood flow and temperature in ETS. We studied 5 patients (1 man, 4 women) with palmar hyperhidrosis who had undergone a total of 10 ETS procedures. We measured skin blood flow, temperature and PI during ETS and evaluated the results. Significant correlations were found between increases in skin blood flow and PI after ETS in cases with the palmar skin temperature just before ETS of below 35 degrees C. In these cases, we can substitute increases in PI with increases in skin blood flow during ETS.

  10. Pulmonary edema following lumbar puncture

    Directory of Open Access Journals (Sweden)

    Gupta D

    1977-01-01

    Full Text Available In a boy of 17 years with disseminated tuberculosis, sudden onset of pulmonary edema following lumbar puncture is described. Possible pat ho-mechanisms have been discussed. The link bet-ween the lumbar puncture and the development of pulmonary edema is not casual.

  11. Transareolar Single-Port Needlescopic Thoracic Sympathectomy Under Intravenous Anesthesia Without Intubation: A Randomized Controlled Trial.

    Science.gov (United States)

    Chen, Jianfeng; Du, Quan; Lin, Min; Lin, Jianbo; Li, Xu; Lai, Fancai; Tu, Yuanrong

    2016-12-01

    Transareolar single-port needlescopic thoracic sympathectomy under intravenous anesthesia without intubation has rarely been attempted in managing primary palmar hyperhidrosis (PPH). The objective of this study is to evaluate the feasibility and safety of this minimally invasive technique. From May 2012 to May 2015, 168 male patients with severe PPH underwent single-port endoscopic thoracic sympathectomy (ETS) and were randomly allocated to groups A or B. Patients in group A underwent nonintubated transareolar ETS with a 2-mm needle endoscope, while those in group B underwent intubated transaxillary ETS with a 5-mm thoracoscope. All procedures were performed successfully. The palms of all patients became dry and warm immediately after surgery. The mean resuscitation time was significantly shorter in nonintubated patients than in intubated patients. Postoperative sore throat occurred in 4 patients in group A and in 32 patients in group B (P < .01). The mean incision length was significantly shorter in group A than in group B. The mean postoperative pain scores were markedly higher in group B than in group A. The mean cost of anesthesia was considerably lower in nonintubated patients than in intubated patients. The mean cosmetic scores were higher in group A than in group B (P < .01). Nonintubated transareolar single-port ETS with a needle endoscope is a safe, effective, and minimally invasive therapeutic procedure, which allows a smaller incision with less pain and excellent cosmetic results. This novel procedure can be performed in a routine clinical practice for male patients with severe PPH.

  12. Patient Satisfaction after Thoracoscopic Sympathectomy for Palmar Hyperhidrosis: Do Method and Level Matter?

    Science.gov (United States)

    Cheng, Amy; Johnsen, Hege; Chang, Michael Y

    2015-01-01

    Context: Although surgery is widely recognized as the best treatment for palmar hyperhidrosis (PH), the decision to perform a sympathicotomy, sympathectomy, or clipping of the thoracic sympathetic chain is based on surgeon preference. Objective: We investigated the outcomes of patients who underwent surgical intervention for PH with regard to method used and level of sympathetic chain interrupted. Design: This was a retrospective medical chart review. Patients who underwent thoracoscopic intervention for PH were mailed questionnaires regarding their presenting and postoperative symptoms and satisfaction 6 months to 15 years after their procedure. Analyses were performed to investigate whether the surgical method applied affected these outcomes. Results: A total of 635 patients underwent bilateral thoracoscopic procedures for PH between April 1995 and February 2010, and 210 (33%) responded to the questionnaires. Sixteen surgeons performed 108 sympathicotomies, 83 sympathectomies, and 19 ligations with titanium clips for PH. Mean follow-up was 5.5 years. Overall palmar success was 85.4% and was not affected by the surgical method. The rate of compensatory hyperhidrosis was significantly lower if the operative level did not include the R2 ganglion (66.7% vs 80.6%, p = 0.028). Nevertheless, 76.2% of patients were satisfied with the results, and 85.7% would repeat the procedure if given the option to do it again. Conclusion: Most patients reported relief of their PH and were satisfied with surgical intervention, regardless of method used. Although postoperative compensatory hyperhidrosis was common, this did not appear to affect overall patient satisfaction. The inclusion of rib level 2 ganglion resulted in a significantly increased incidence of compensatory hyperhidrosis. PMID:26517433

  13. Myocardial Microvascular Responsiveness During Acute Cardiac Sympathectomy Induced by Thoracic Epidural Anesthesia.

    Science.gov (United States)

    Bulte, Carolien S E; Boer, Christa; Hartemink, Koen J; Kamp, Otto; Heymans, Martijn W; Loer, Stephen A; de Marchi, Stefano F; Vogel, Rolf; Bouwman, R Arthur

    2017-02-01

    To evaluate the effect of acute cardiac sympathectomy by thoracic epidural anesthesia on myocardial blood flow and microvascular function. A prospective observational study. The study was conducted in a tertiary teaching hospital. Ten patients with a mean age of 48 years (range 22-63 years) scheduled for thoracic surgery. Myocardial contrast echocardiography was used to study myocardial blood flow and microvascular responsiveness at rest, during adenosine-induced hyperemia, and after sympathetic stimulation by the cold pressor test. Repeated measurements were performed without and with thoracic epidural anesthesia. An increased myocardial blood volume was observed with thoracic epidural anesthesia compared to baseline (from 0.08±0.02 to 0.10±0.03 mL/mL; p = 0.02). No difference existed in resting myocardial blood flow between baseline conditions and epidural anesthesia (0.85±0.24 v 1.03±0.27 mL/min/g, respectively). Hyperemia during thoracic epidural anesthesia increased myocardial blood flow to 4.31±1.07 mL/min/g (p = 0.0008 v baseline) and blood volume to 0.17±0.04 mL/mL (p = 0.005 baseline). After sympathetic stimulation, no difference in myocardial blood flow parameters was observed CONCLUSIONS: Acute cardiac sympathectomy by thoracic epidural anesthesia increased the blood volume in the myocardial capillary system. Also, thoracic epidural anesthesia increased hyperemic myocardial blood flow, indicating augmented endothelial-independent vasodilator capacity of the myocardium. Copyright © 2017. Published by Elsevier Inc.

  14. Thoracoscopic sympathectomy for palmar hyperhidrosis and Raynaud's phenomenon of the upper limb and excessive facial blushing: a five year experience

    Science.gov (United States)

    Rajesh, Y; Pratap, C; Woodyer, A

    2002-01-01

    Primary hyperhidrosis of the palms, face, and axillae has a strong negative impact on social and professional life. A retrospective analysis of 40 laparoscopic transaxillary thoracic sympathectomies performed in a district general hospital over a five year period was undertaken in order to determine the effectiveness of this procedure. A postal questionnaire was sent to all patients to assess the benefit from the operation; postoperative pain and time off work were collated. Immediate failure was noted in three patients, of whom two later underwent successful reoperation. Recurrence was noted in three patients (8%). Though immediate complications were minimal, the major long term postoperative morbidity was compensatory hyperhidrosis on the back, chest, and thigh (77%) along with gustatory sweating over the face (22%). Thoracoscopic sympathectomy is a safe, effective, and minimally invasive surgical treatment for hyperhidrosis, Raynaud's phenomenon of the upper limb, and excessive facial blushing; however, the chance of long term compensatory hyperhidrosis is high. PMID:12496327

  15. A novel approach to treat women patients with palmar hyperhidrosis: transumbilical thoracic sympathectomy with an ultrathin gastroscope.

    Science.gov (United States)

    Chen, Weisheng; Chen, Long; Zhu, Lihuan; Yang, Shengsheng; Feng, Xuegang; Zhang, Jixue; Cheng, Xianjin; Liu, Daoming; Wang, Wen

    2013-12-01

    Primary palmar hyperhidrosis is very common in women. Video-assisted thoracic sympathectomy is recognized as an effective treatment for patients with severe hyperhidrosis, which has usually been performed with more than 2 skin incisions. We developed a novel approach for thoracic sympathectomy in women with palmar hyperhidrosis through the umbilicus using an ultrathin gastroscope. The approach requires only 1 tiny incision, which is hidden in the umbilicus. Under general anesthesia, patients were intubated with a dual-lumen endotracheal tube. Through the incision in the umbilicus, a newly developed long trocar was inserted into the abdominal cavity. After insertion of the ultrathin gastroscope through this trocar, a small incision was created on the both sides of diaphragm by a needle knife. The endoscope was introduced into the thoracic cavity through the incision made in the left or right diaphragm. The sympathetic chain was identified at the desired thoracic level and ablated. From January 10, 2010, to November 30, 2011, 25 women underwent transumbilical-diaphragmatic thoracic sympathectomy. The mean operating room time for the entire bilateral procedure was 56.9 ± 6.9 minutes. There were no significant postoperative complications. The symptoms disappeared in all patients. Compensatory sweating was reported in 56%. All of the patients were satisfied with the surgical results and the cosmetic outcome of the incision. Transumbilical thoracic sympathectomy with the ultrathin flexible endoscope was a safe and effective option for women with severe palmar hyperhidrosis that provided excellent cosmetic outcomes. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Predictors of Long-Term Outcome of Thoracic Sympathectomy in Patients with Complex Regional Pain Syndrome Type 2.

    Science.gov (United States)

    Alkosha, Hazem M; Elkiran, Yasser M

    2016-08-01

    Long-term results of sympathectomy in patients with complex regional pain syndrome (CRPS) type 2 varies widely among studies due to nonspecific or vague criteria of diagnosis and absence of outcome predictors that help good patient selection. The objective was to determine the predictors of long-term outcome of sympathectomy in patients with upper limb CRPS type 2. A retrospective cohort, in which those who underwent thoracic sympathectomy for upper limb CRPS type 2 from 2007 to 2014, were included. Demographic and clinical data of patients, in addition to stellate ganglion block (SGB) details and percent of pain relief at the end of follow-up, were collected and used for statistical analysis. Our study included 53 patients, with a mean age of 47 ± 7 years, and 60% females. Using bivariate correlations; age, sex, nerve injured, type of injury, and occupation were not significantly correlated to outcome. Multiple linear regression analysis of correlated variables revealed that duration of pain relief after SGB and degree of sympathetic overactivity were positive predictors (β = 0.286, P = 0.027, and β = 0.257, P = 0.003, respectively), whereas presence of allodynia was a negative predictor (β = -0.280, P = 0.041) of the final pain relief. Final pain relief was better in those patients who experienced extended relief of their pain >2 days after SGB (P = 0.001, Kruskal Wallis test). Thoracic sympathectomy may prove more effective than reported in carefully selected CRPS patients with prominent sympathetic overactivity, no or early allodynia, and pain relief >2 days after SGB. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. An unexpected lumbar lesion

    Directory of Open Access Journals (Sweden)

    Laura Beard

    2016-01-01

    Full Text Available This case report details an interesting case of suspected spinal bifida in an obstetric patient who presented for an elective cesarean section. A large scarred/dimpled area, surrounded by significant hair growth in the region of the lumbar spine had been missed in multiple antenatal and preoperative assessments and was recognized on the day of the surgery as the patient was being prepared for spinal anesthesia. The patient was uncertain regarding the pathology of the lesion, and all investigations relating to this had been undertaken in Pakistan where she lived as a child. General anesthesia was undertaken because magnetic resonance imaging had not been performed and tethering of the spinal cord could not be ruled out clinically. The patient suffered from significant blood loss intra and postoperatively, requiring a two unit blood transfusion. She was discharged after 5 days in the hospital. This case highlights the need for thorough examination in all obstetric patients presenting to the preoperative clinic, focusing on the airway, vascular access, and lumbar spine. Patients may not always disclose certain information due to a lack of understanding, embarrassment, forgetfulness, or language barriers. Significant aspects of their care may have been undertaken abroad and access to these notes is often limited. Preoperative detection of the lesion would have allowed further investigation and imaging of the lesion and enabled more comprehensive discussions with the patient regarding anesthetic options and risk.

  18. Eight years experience in the management of median arcuate ligament syndrome by decompression, celiac ganglion sympathectomy, and selective revascularization.

    Science.gov (United States)

    Sultan, Sherif; Hynes, Niamh; Elsafty, Naisrin; Tawfick, Wael

    2013-11-01

    We aim to review an 8-year experience of median arcuate ligament syndrome (MALS) with chronic gastrointestinal ischemia (CGI) and evaluate clinical outcomes of arcuate ligament decompression, celiac sympathectomy, and selective revascularization. Between December 2002 and March 2012, of 25 patients referred with symptoms of CGI, 11 patients (10 women and 1 man) had clinical signs of abdominal angina and radiological evidence of MALS. Mean age was 50 ± 20.4 years. Median symptom duration was 34 months. All patients had median arcuate decompression and celiac sympathectomy. In all, 8 did not require revascularization, 2 had retrograde celiac and/or superior mesenteric artery (SMA) stenting, and 1 had SMA bypass. There was no mortality. The 30-day morbidity was 9%. Mean follow-up was 60 months. Eight patients noted complete relief of abdominal pain, and 1 reported some improvement. The MALS is not solely a vascular compression syndrome. The neurological component requires careful celiac plexus sympathectomy in addition to arcuate ligament decompression.

  19. Evaluating the Efficacy of Endoscopic Thoracic Sympathectomy for Generalized Social Anxiety Disorder with Blushing Complaints: A Comparison with Sertraline and No Treatment—Santiago de Chile 2003–2009

    OpenAIRE

    Jadresic, Enrique; Súarez, Claudio; Palacios, Estela; Palacios, Fernanda; Matus, Patricia

    2011-01-01

    Objective: No study has yet compared the efficacy of endoscopic thoracic sympathectomy for treating facial blushing with other treatment or no treatment. We conducted a prospective, observational, open-label, clinical study to compare endoscopic thoracic sympathectomy for blushing with generalized social anxiety disorder versus sertraline treatment and no treatment.

  20. The imaging of lumbar spondylolisthesis

    Energy Technology Data Exchange (ETDEWEB)

    Butt, S. [Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex HA7 4LP (United Kingdom); Saifuddin, A. [Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex HA7 4LP (United Kingdom) and Institute of Orthopaedics and Musculo-Skeletal Sciences, University College, London (United Kingdom)]. E-mail: asaifuddin@aol.com

    2005-05-01

    Lumbar spondylolisthesis is a common finding on plain radiographs. The condition has a variety of causes which can be differentiated on the basis of imaging findings. As the treatment is dependent upon the type of spondylolisthesis, it is important for the radiologist to be aware of these features. We present a pictorial review of the imaging features of lumbar spondylolisthesis and explain the differentiating points between different groups of this disorder. The relative merits of the different imaging techniques in assessing lumbar spondylolisthesis are discussed.

  1. 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...... 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......: The findings of this study show that lumbar lordosis in the upright position can be reproduced by positioning the patient supine with straightened lower extremities....

  2. LUMBAR CORSETS CAN DECREASE LUMBAR MOTION IN GOLF SWING

    Directory of Open Access Journals (Sweden)

    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

  3. [Intradural lumbar disk hernia].

    Science.gov (United States)

    Alonso-Bartolomé, P; Canga, A; Vázquez-Barquero, A; García-Valtuille, R; Abascal, F; Cerezal, L

    2001-04-01

    Intradural disc herniation is a rare complication of degenerative disc disease. A correct diagnosis of this process is frequently difficult. If this entity is not preoperatively diagnosed and is omitted at surgery, severe neurologic sequels may be provoked. We report a case of a pathologically proven intradural disc herniation preoperatively diagnosed by MR imaging. Clinically, it was manifested by sudden onset of right leg ciatalgia and progressive right lower extremity weakness. The patient also referred a one-month history of sexual dysfunction. MR imaging revealed interruption of the low signal of the anulus fibrosus and of the posterior longitudinal ligament at L2-L3 level and a voluminous disc fragment migrated in the dural sac that showed rim enhancement with gadolinium.The clinical, neuroradiological, and surgical management of lumbar intradural disc herniation are reviewed.

  4. 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

  5. Lumbar peritoneal shunt

    Directory of Open Access Journals (Sweden)

    Yadav Yad

    2010-01-01

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

  6. Thoracoscopic sympathectomy of T2 and T3 ganglions for palmar hyperhydrosis

    Directory of Open Access Journals (Sweden)

    Toolabi K

    2008-05-01

    Full Text Available Background: Hyperhydrosis, excessive sweating, can profoundly affect the quality of life of the patient, with severe impairment of daily activities, social relationships and occupational activities. The purpose of this study was to evaluate the outcome of thoracoscopic sympathectomy in patients with palmar hyperhydrosis.Methods: In a clinical trial at Imam Khomeini, Milad and Velenjak Hospitals from 2003 to 2006, 33 patients older than five years of age with palmar hyperhydrosis underwent thoracoscopic sympathectomy of T2 and T3 ganglions. The variables regarding operation duration, length of hospital stay and early post-op complications were recorded. In addition, the quality of life of the patients was evaluated using the DLQI questionnaire, while the satisfaction of the patients was evaluated using the visual analogue scale before, immediately after and six months after the operation.Results: The mean age of the patients was 23 years and 63.6% of our patients were female. The sites of hyperhydrosis were hand, foot and armpit in 72.7% of the patients. In 90.91% of the cases, disease onset occurred during childhood and 78.79% of the patients had a family history of hyperhydrosis. Hyperhydrosis impaired function and had social, interpersonal and emotional effects in 72.7% of the cases. The mean duration of the operation was 40.3 minutes and the mean hospital stay was 1.45 days. The most common early post-op complications were atelectasis (7.57%, short-term pulmonary complications (3.03% and pleural effusion (3.03%. Compensatory hyperhydrosis occurred in 60% of the cases, while 18.75% experienced gustatory sweating. Palms were reported to be totally dry immediately after and six months after the operation in 81.82% of the cases, while 18.18% reported acceptable levels of perspiration. The mean level of satisfaction immediately after and six months after the procedure was 0.81. All patients felt improvement in all aspects of their lives

  7. [Video-thoracoscopic sympathectomy in the treatment of Raynaud's disease and palmar hyperhidrosis].

    Science.gov (United States)

    Trignano, M; Boatto, R; Mastino, G P; Ferrandu, T; Padula, G; Loi, V; Pala, C

    2000-01-01

    Raynaud's syndrome is a clinical entity characterised by episodic vascular spasm, digital ischemia in response to cold or emotional stimuli and hyperhidrosis. Many patients suffering from Raynaud's syndrome are successfully treated using medical therapy alone. Those patients who do not respond to medical treatment undergo surgery but the indications continue to be a source of controversy. A modern approach to thoracic sympathectomy requires a video-assisted technique. The aim of this study is to attempt to use mini-invasive type surgery to treat Raynaud's disease and hyperhidrosis in order to evaluate the real efficacy of thoracic sympathectomy in a large number of patients. The results of this method were compared for the two different pathologies in question. The methodology used by this study is based on instrumental and clinical tests performed before and after surgery on treated patients using a comparative criterion and with a minimum 5-year follow-up. The pre- and postoperative diagnostic tests were performed by the vascular surgery laboratory and using a C.W. Doppler and a reflected light photoplethysmograph. Capillaroscopy and laboratory evaluations relating to secondary Raynaud's disease were carried out by internist type structures. The patients enrolled in the study responded to the following criteria: primary Raynaud's disease, palmar hyperhidrosis and associated syndromes. The population came from a mixed sociodemographic background, albeit within a strictly regional zone (Sardinia). A total of 42 patients were studied. The surgical technique used consisted of the ablation of thoracic ganglia from the 2nd to the 4th. The results showed a resolution of symptoms in 95% of patients treated for hyperhidrosis, whereas a 50% recidivation rate was observed in patients with Raynaud's disease alone, although symptoms were less intense. The results for Raynaud's disease were more disappointing, but it is important to remember that surgery is the ultimate choice

  8. Percutaneous T2 and T3 Radiofrequency Sympathectomy for Complex Regional Pain Syndrome Secondary to Brachial Plexus Injury: A Case Series

    Science.gov (United States)

    Phui, Vui Eng; Nizar, Abd Jalil; Yeo, Sow Nam

    2013-01-01

    Complex regional pain syndrome secondary to brachial plexus injury is often severe, debilitating and difficult to manage. Percuteneous radiofrequency sympathectomy is a relatively new technique, which has shown promising results in various chronic pain disorders. We present four consecutive patients with complex regional pain syndrome secondary to brachial plexus injury for more than 6 months duration, who had undergone percutaneous T2 and T3 radiofrequency sympathectomy after a diagnostic block. All four patients experienced minimal pain relief with conservative treatment and stellate ganglion blockade. An acceptable 6 month pain relief was achieved in all 4 patients where pain score remained less than 50% than that of initial score and all oral analgesics were able to be tapered down. There were no complications attributed to this procedure were reported. From this case series, percutaneous T2 and T3 radiofrequency sympathectomy might play a significant role in multi-modal approach of CRPS management. PMID:24156009

  9. Excision of sympathetic ganglia and the rami communicantes with histological confirmation offers better early and late outcomes in Video assisted thoracoscopic sympathectomy

    Directory of Open Access Journals (Sweden)

    Sivalingam Sivakumar

    2008-08-01

    Full Text Available Abstract Background Video-Assisted Thoracoscopic Sympathectomy (VATS is an established minimally invasive procedure for thoracic sympathetic blockade in patients with hyperhidrosis, facial flushing and intractable angina. Various techniques using clips, diathermy and excision are used to perform sympathectomy. We present our technique of excision of the sympathetic chain with histological proof and the analysis of the early and late outcomes. Methods We evaluated 200 procedures in 100 consecutive patients, who underwent Video Assisted Thoracoscopic Sympathectomy by a single surgeon in our centre between September 1996 to March 2007. All patients had maximum medical therapy prior to surgery and were divided into 3 groups based on indications, Group 1(hyperhidrosis: 48 patients, Group 2 (facial flushing: 26 patients and Group 3(intractable angina: 26 patients. The demography and severity of symptoms for each group were analysed. The endpoints were success rate, 30 day mortality, complications and patient's satisfaction. Results 99 patients had bilateral VATS sympathectomy and 1 had unilateral sympathectomy. The conversion rate to open was 1(1%. All patients had successful removal of ganglia proven histologically with no perioperative mortality in our series. The complications included pneumothorax (5%, acute coronary syndrome (2%, transient Horner's syndrome (1%, transient paraesthesia (1%, wound infection (4%, compensatory hyperhidrosis (18%, residual flushing (3% and wound pain (5%. There were five late deaths in the intractable angina group at a mean follow up of 36.7 months. Overall success rates of abolishing the symptoms were 96.3%, 87.5% and 95.2% for Group 1, 2 and 3 respectively. Conclusion Excision of the sympathetic chain with histological confirmation during VATS sympathectomy is a safe and effective method in treating hyperhidrosis, facial flushing and intractable angina with good long term results and satisfaction.

  10. Excision of sympathetic ganglia and the rami communicantes with histological confirmation offers better early and late outcomes in Video assisted thoracoscopic sympathectomy

    Science.gov (United States)

    Rathinam, Sridhar; Nanjaiah, Prakash; Sivalingam, Sivakumar; Rajesh, Pala B

    2008-01-01

    Background Video-Assisted Thoracoscopic Sympathectomy (VATS) is an established minimally invasive procedure for thoracic sympathetic blockade in patients with hyperhidrosis, facial flushing and intractable angina. Various techniques using clips, diathermy and excision are used to perform sympathectomy. We present our technique of excision of the sympathetic chain with histological proof and the analysis of the early and late outcomes. Methods We evaluated 200 procedures in 100 consecutive patients, who underwent Video Assisted Thoracoscopic Sympathectomy by a single surgeon in our centre between September 1996 to March 2007. All patients had maximum medical therapy prior to surgery and were divided into 3 groups based on indications, Group 1(hyperhidrosis: 48 patients), Group 2 (facial flushing: 26 patients) and Group 3(intractable angina: 26 patients). The demography and severity of symptoms for each group were analysed. The endpoints were success rate, 30 day mortality, complications and patient's satisfaction. Results 99 patients had bilateral VATS sympathectomy and 1 had unilateral sympathectomy. The conversion rate to open was 1(1%). All patients had successful removal of ganglia proven histologically with no perioperative mortality in our series. The complications included pneumothorax (5%), acute coronary syndrome (2%), transient Horner's syndrome (1%), transient paraesthesia (1%), wound infection (4%), compensatory hyperhidrosis (18%), residual flushing (3%) and wound pain (5%). There were five late deaths in the intractable angina group at a mean follow up of 36.7 months. Overall success rates of abolishing the symptoms were 96.3%, 87.5% and 95.2% for Group 1, 2 and 3 respectively. Conclusion Excision of the sympathetic chain with histological confirmation during VATS sympathectomy is a safe and effective method in treating hyperhidrosis, facial flushing and intractable angina with good long term results and satisfaction. PMID:18700966

  11. Endoscopic thoracic sympathectomy%内窥镜胸交感神经链切断术

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To review our experience with endoscopic thoracicsympathectomy. Methods Retrospectively analyze the prognosis of 58 patients with hyperhidrosis treated with endoscopic thoracic sympathectomy, review the literatures and summarize the application of the operation. Result All patients were successfully cured, Complications were pneumothorax(4 cases), compensative sweat(2 cases), inte rcostal neuralgia(1 cases). Conclusion Endoscopic thoracic s ympathectomy, which is simple and safe, can be used to treat hyperhidrosis, cau salgia, Raynaud's disease, angina pectoris and social phobia.%目的 总结内窥镜胸交感神经链切断术治疗多汗症的经验。 方法 回顾性分析内窥镜胸交感神经链切断术治疗58例多汗症的结果,复习文献,总结此手术的临床应用。 结果 58例均治愈;出现气胸4例、代偿性多汗2例、肋间神经痛1例。 结论 内窥镜胸交感神经链切断术比较安全,除多汗症外还可用于雷诺病、灼性神经痛、社会恐怖症和心绞痛的治疗。

  12. Video-Assisted Thoracoscopic Sympathectomy for Palmar Hyperhidrosis: A Meta-Analysis of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Wenxiong Zhang

    Full Text Available Video-assisted thoracoscopic sympathectomy (VTS is effective in treating palmar hyperhidrosis (PH. However, it is no consensus over which segment should undergo VTS to maximize efficacy and minimize the complications of compensatory hyperhidrosis (CH. This study was designed to compare the efficiency and side effects of VTS of different segments in the treatment of PH.A comprehensive search of PubMed, Ovid MEDLINE, EMBASE, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar was performed to identify studies comparing VTS of different segments for treatment of PH. The data was analyzed by Revman 5.3 software and SPSS 18.0.A total of eight randomized controlled trials (RCTs involving 1200 patients were included. Meta-analysis showed that single segment/low segments VTS could reduce the risk of moderate/severe CH compared with multiple segments/high segments. The risk of total CH had a similar trend. In the subgroup analysis of single segment VTS, no significant differences were found between T2/T3 VTS and other segments in postoperative CH and degree of CH. T4 VTS showed better efficacy in limiting CH compared with other segments.T4 appears to be the best segment for the surgical treatment of PH. Our findings require further validation in more high-quality, large-scale randomized controlled trials.

  13. Is gender a predictive factor for satisfaction among patients undergoing sympathectomy to treat palmar hyperhidrosis?

    Directory of Open Access Journals (Sweden)

    Nelson Wolosker

    2010-01-01

    Full Text Available Video-assisted thoracic sympathectomy (VATS is currently the procedure of choise for the definitive treatment of primary hyperhidrosis because it is an effective, safe, and minimally invasive method. The aim of VATS treatment is to improve the quality of life through the reduction of excessive sudoresis. The purpose of this study was to assess the quality of life after VATS for treating palmar hyperhidrosis according to gender. METHODS: A total of 1044 patients who submitted to the surgical treatment for palmar hyperhidrosis from June 2000 to February 2008 were retrospectively evaluated. The patients were divided into two groups according to gender [719 (68.8% females and 325 (31.2% males]. RESULTS: There are no statistically significant differences between genders with regard to the quality of life in palmar hyperhidrosis patients (p = 0.726. In the interview that was performed 30 days after surgery, the quality of life in the two groups had improved, with no statistical difference between the groups. CONCLUSION: Patients with palmar hyperhidrosis present with an improvement in the quality of life after VATS regardless of gender.

  14. A Prospective Cohort Study on Quality of Life after Endoscopic Thoracic Sympathectomy for Primary Hyperhidrosis.

    Science.gov (United States)

    Dharmaraj, B; Kosai, N R; Gendeh, H; Ramzisham, A R; Das, S

    2016-01-01

    Hyperhidrosis is an excessive sweating disorder affecting quality of life. Endoscopic thoracic sympathectomy (ETS), introduced by Kux in 1951, is currently the gold standard surgical treatment for primary hyperhidrosis. 75% of patients with primary hyperhidrosis have seen improvement in quality of life within 30 days after surgery. Compensatory hyperhidrosis and pneumothorax (up to 75%) have been reported in patients after surgery. This study evaluates the functional status, self- esteem, compensatory hyperhidrosis and quality of life among patient with primary hyperhidrosis before and after undergoing ETS. Fifty (n=50) patients between the ages 18 to 30, with primary hyperhidrosis were recruited. Patients answered the quality of life questionnaire and Rosenberg self-esteem questionnaire prior to surgery and 30 days post surgery on follow up. Any post-operative complications were documented. Telephone interviews were held for patients who were unable to attend the clinics for follow-up. Forty six patients (92%) had symptomatic relieve within 30 days of surgery. The incidence of compensatory sweating was 78% (39 patients), with 6 patients developing severe hyperhidrosis. Two patients who did not experience symptomatic relieve, developed compensatory hyperhidrosis. Pneumothorax was documented in 8 patients (16%), with 6 patients requiring chest tubes. Significant improvement in quality of life and self-esteem was seen among patients after surgery. ETS has shown to significantly improve the quality of life and self-esteem of patients with primary hyperhidrosis within 30 days of surgery. However, the rate of compensatory hyperhidrosis still remains high (78%) which requires a long term evaluation.

  15. Is Gender a Predictive Factor for Satisfaction among Patients Undergoing Sympathectomy to Treat Palmar Hyperhidrosis?

    Science.gov (United States)

    Wolosker, Nelson; Munia, Marco Antonio Soares; Kauffman, Paulo; de Campos, José Ribas Milanez; Yazbek, Guilherme; Puech-Leão, Pedro

    2010-01-01

    Video-assisted thoracic sympathectomy (VATS) is currently the procedure of choise for the definitive treatment of primary hyperhidrosis because it is an effective, safe, and minimally invasive method. The aim of VATS treatment is to improve the quality of life through the reduction of excessive sudoresis. The purpose of this study was to assess the quality of life after VATS for treating palmar hyperhidrosis according to gender. METHODS: A total of 1044 patients who submitted to the surgical treatment for palmar hyperhidrosis from June 2000 to February 2008 were retrospectively evaluated. The patients were divided into two groups according to gender [719 (68.8%) females and 325 (31.2%) males]. RESULTS: There are no statistically significant differences between genders with regard to the quality of life in palmar hyperhidrosis patients (p = 0.726). In the interview that was performed 30 days after surgery, the quality of life in the two groups had improved, with no statistical difference between the groups. CONCLUSION: Patients with palmar hyperhidrosis present with an improvement in the quality of life after VATS regardless of gender. PMID:20613933

  16. Video-Assisted Thoracoscopic Sympathectomy for Palmar Hyperhidrosis: A Meta-Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Zhang, Wenxiong; Yu, Dongliang; Jiang, Han; Xu, Jianjun; Wei, Yiping

    2016-01-01

    Objectives Video-assisted thoracoscopic sympathectomy (VTS) is effective in treating palmar hyperhidrosis (PH). However, it is no consensus over which segment should undergo VTS to maximize efficacy and minimize the complications of compensatory hyperhidrosis (CH). This study was designed to compare the efficiency and side effects of VTS of different segments in the treatment of PH. Methods A comprehensive search of PubMed, Ovid MEDLINE, EMBASE, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar was performed to identify studies comparing VTS of different segments for treatment of PH. The data was analyzed by Revman 5.3 software and SPSS 18.0. Results A total of eight randomized controlled trials (RCTs) involving 1200 patients were included. Meta-analysis showed that single segment/low segments VTS could reduce the risk of moderate/severe CH compared with multiple segments/high segments. The risk of total CH had a similar trend. In the subgroup analysis of single segment VTS, no significant differences were found between T2/T3 VTS and other segments in postoperative CH and degree of CH. T4 VTS showed better efficacy in limiting CH compared with other segments. Conclusions T4 appears to be the best segment for the surgical treatment of PH. Our findings require further validation in more high-quality, large-scale randomized controlled trials. PMID:27187774

  17. [Lateral lumbar disk hernia].

    Science.gov (United States)

    Monod, A; Desmoineaux, P; Deburge, A

    1990-01-01

    Lateral lumbar disc herniations (L.D.H.) develop in the foramen, and compress the nerve root against the overlying vertebral pedicle. In our study of L.D.H. from the clinical, radiographical, and therapeutical aspects, we reviewed 23 cases selected from the 590 patients treated for discal herniation from 1984 to 1987. The frequency of L.D.H. in this series was 3.8 per cent. The clinical pattern brings out some suggestive signs of L.D.H. (frequency of cruralgia, a seldom very positive Lasegue's test, the paucity of spinal signs, non impulsive pain). Saccoradiculography and discography rarely evidenced the L.D.H.. The T.D.M. was the investigation of choice on condition that it was correctly used. When the image was doubtful, disco-CT confirmation should be proceeded too. This latter method of investigation enabled the possibility of sequestration to be explored. 14 patients were treated by chemonucleolysis, with 9 successful outcomes. The 5 failures were cases where chemonucleolysis should not have been indicated, mainly due to associated osseous stenosis. 9 patients underwent immediate surgery with good results in each case.

  18. [Lumbar stabilization exercises].

    Science.gov (United States)

    Vásquez-Ríos, Jorge Rodrigo; Nava-Bringas, Tania Inés

    2014-01-01

    Antecedentes: el ejercicio es la intervención con mayor grado de evidencia de eficacia para el tratamiento del dolor crónico de la espalda baja, con beneficio superior en términos de dolor y funcionalidad, en comparación con cualquiera otra intervención. Existe una amplia variedad de ejercicios diseñados; sin embargo, actualmente los llamados ejercicios de estabilización lumbar adquiririeron una popularidad creciente entre los clínicos que están en contacto con enfermedades de la columna. Sin embargo, existe controversia en cuanto a la prescripción adecuada de los mismos y los múltiples protocolos publicados. Objetivo: analizar la bibliografía científica acerca del uso y prescripción de estos ejercicios para favorecer la mejor toma de decisiones enlos clínicos y diseñar, con base a la evidencia, el programa más adecuado para cada paciente. Conclusión: se encontró que este programa es una herramienta esencial en el tratamiento del dolor de espalda baja, en la etapa terapéutica y en la preventiva.

  19. NEUROMUSCULAR CONTROL IN LUMBAR DISORDERS

    Directory of Open Access Journals (Sweden)

    Ville Leinonen

    2004-03-01

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

  20. Evaluating the efficacy of endoscopic thoracic sympathectomy for generalized social anxiety disorder with blushing complaints: a comparison with sertraline and no treatment-santiago de chile 2003-2009.

    Science.gov (United States)

    Jadresic, Enrique; Súarez, Claudio; Palacios, Estela; Palacios, Fernanda; Matus, Patricia

    2011-11-01

    No study has yet compared the efficacy of endoscopic thoracic sympathectomy for treating facial blushing with other treatment or no treatment. We conducted a prospective, observational, open-label, clinical study to compare endoscopic thoracic sympathectomy for blushing with generalized social anxiety disorder versus sertraline treatment and no treatment. Three-hundred and thirty consecutive patients seeking treatment for their blushing were assessed by psychiatric interview and patient-rated scales. The Brief Social Phobia Scale was the primary outcome measure. Patients meeting Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria for generalized social anxiety disorder, scoring 20 points or more in the Brief Social Phobia Scale and 19 points or more in the Social Phobia Inventory were considered eligible and followed up for a mean of 11 months (range 1-64) after endoscopic thoracic sympathectomy or initiation of sertraline. At baseline, 97 percent of the endoscopic thoracic sympathectomy-treated group, 87 percent of the sertraline-treated group, and 78 percent of the nontreated group rated their blushing as being "severe" or "extreme." At follow up, 16 percent of endoscopic thoracic sympathectomy-treated patients, 32 percent of sertraline-treated patients, and 57 percent of untreated patients reported this degree of blushing. At endpoint, Brief Social Phobia Scale total scores exhibited a greater decline with either treatment than with no treatment. Nonetheless, in comparison to no treatment, only the results obtained with endoscopic thoracic sympathectomy achieved statistical significance (p=0.003). Compensatory sweating occurred in 99 percent of patients who underwent endoscopic thoracic sympathectomy. High degrees of satisfaction with treatment were reported by 89 percent of patients undergoing endoscopic thoracic sympathectomy and by 59 percent of patients taking medication. Endoscopic thoracic sympathectomy was associated to a

  1. 腔镜胸交感神经手术的进展%Progress of thoracic sympathectomy

    Institute of Scientific and Technical Information of China (English)

    张杨杨; 葛文; 周嘉; WIHLM Jean-marie

    2014-01-01

    胸交感神经手术是治疗许多交感神经相关疾病的有效方法。现阶段这一手术多用于治疗多汗症(手足多汗症,头面多汗症,腋汗症等)和面部潮红。1920年Kotzareff首先应用胸交感神经切除术治疗手汗症并获得成功。目前绝大多数胸外科医师所采用的方式是常规胸腔镜交感神经手术(endoscopic thoracic sympathectomy, ETS)。近年来,ETS方式得到了进一步的改良和提高,本文对ETS的各种方式进行总结和讨论。%Summary thoracic sympathetic procedure is an effective method to treat many sympathetic nerve-related diseases. Currently the procedure is usually used to treat hyperhidrosis (palmar and plantar hyperhidrosis, craniofacial hyperhidrosis,axillary hyperhidrosis,etc.)and facial blushing. In 1920,Kotzareff became the first one who applied thoracic sympathectomy to treat palmar and plantar hyperhidrosis and succeed. Nowadays,the conventional Endoscopic Thoracic Sympathectomy(ETS)are adopted by most thoracic surgeons. In recent years,this surgery has been further improved. Regarding this,the article made summary and discussion on various ways of thoracic sympathectomy.

  2. [Anesthetic effect and safety of ultrasound-guided thoracic paravertebral blockade in sympathectomy for palmar hyperhidrosis: a randomized controlled trial].

    Science.gov (United States)

    Xu, Jin-Dong; Yu, Li-Na; Zhao, Da-Qiang; Xie, Liang; Zhou, Hai-Yu; Wang, Sheng

    2016-12-20

    To explore the anesthetic effect and safety of ultrasound-guided thoracic paravertebral blockade in video-assisted thoracoscopic sympathectomy for treatment of palmar hyperhidrosis. A total of 120 patients undergoing video-assisted thoracoscopic sympathectomy for moderate or severe hyperhidrosis were randomized to receive ultrasound-guided thoracic paravertebral blockade (group A, n=60) or general anesthesia with tracheal intubation (group B, n=60). In both groups routine monitoring and radial artery catheterization were used. The patients in group A were given oxygen inhalation via a nasal tube after thoracic paravertebral blockade, and those in group B had intratracheal intubation. Blood gas analyses were conducted 5 min before and 5 min after the operation and the clinical outcomes and complications were recorded in each group. All the patients completed the operations safely and none of the patients with thoracic paravertebral blockade required conversion to general anesthesia. Significant differences were recorded between groups A and B in anesthetic preparation time (6.26∓2.09 vs 46.32∓15.76 min), awakening time (6.26∓2.09 vs 46.32∓15.76 min), and mean hospitalization expense (6355.54∓426.00 vs 8932.25∓725.98 RMB Yuan). Compared with those in group B, the patients in group A showed a significantly lower rate of postoperative throat discomfort (0% vs 100%), a shorter monitoring time (2 h vs 12 h), and faster recovery time for food intake (2 h vs 6 h). The parameters of artery blood gas analysis both before and after the operation were similar between the two groups, but the postoperative variations differed significantly between the two groups in pH value and PaCO2 but not in PaO2. Ultrasound-guided thoracic paravertebral blockade is safe and effective in video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis and is associated with less complications and better postoperative recovery.

  3. Thoracic sympathectomy at the level of the fourth and fifth ribs for the treatment of axillary hyperhidrosis.

    Science.gov (United States)

    Boscardim, Paulo César Buffara; Oliveira, Ramon Antunes de; Oliveira, Allan Augusto Ferrari Ramos de; Souza, Juliano Mendes de; Carvalho, Roberto Gomes de

    2011-01-01

    To describe the clinical results and the degree of satisfaction of patients submitted to thoracic sympathectomy at the level of the fourth and fifth ribs (R4-R5) for the treatment of axillary hyperhidrosis. We included 118 patients diagnosed with axillary hyperhidrosis and having undergone axillary sympathectomy at the R4-R5 level between March of 2003 and December of 2007 at the Paraná Federal University Hospital de Clínicas, located in the city of Curitiba, Brazil. All procedures were carried out by the same surgeon. Data regarding the resolution of axillary hyperhidrosis and the degree of patient satisfaction with the surgical outcome, as well as compensatory hyperhidrosis in the early and late postoperative periods (after 7 days and after 12 months, respectively), were collected. Of the 118 patients evaluated, 99 (83.9%) and 81 (68.6%) showed complete resolution of the symptoms in the early and late postoperative periods, respectively. Compensatory hyperhidrosis occurred in 49 patients (41.5%) in the early postoperative period and in 77 (65.2%) in the late postoperative period. Of those 77, 55 (71.4%) categorized the compensatory hyperhidrosis as mild. In the early postoperative period, 110 patients (93.2%) were satisfied with the surgical results, and 104 (88.1%) remained so in the late postoperative period. Sympathectomy at the R4-R5 level is efficient in the resolution of primary axillary hyperhidrosis. The degree of patient satisfaction with the long-term surgical results is high. Mild compensatory hyperhidrosis is the main side effect associated with this technique.

  4. Transumbilical thoracic sympathectomy: a single-centre experience of 148 cases with up to 4 years of follow-up†.

    Science.gov (United States)

    Zhu, Li-Huan; Chen, Weisheng; Chen, Long; Yang, Shengsheng; Lu, Zhao-Tong

    2016-01-01

    Thoracic sympathectomy is considered as the most effective method to treat palmar hyperhidrosis (PH). Here, we report our experience of transumbilical thoracic sympathectomy with an ultrathin flexible endoscope for PH in a series of 148 patients with up to 4 years of follow-up. A prospective database was used in this retrospective analysis of 148 patients (61 males, 87 females, with a mean age of 21.3 years) with PH who were operated on by the same surgeon in a single institution from April 2010 to March 2014. All procedures were performed under general anaesthesia involving intubation with a double-lumen endotracheal tube. Demographic, postoperative and long-term data of patients were recorded and statistical analyses were performed. All patients were followed up at least 6 months post procedure through clinic visits or telephone/e-mail interviews. The procedure was performed successfully in 148 of the 150 patients. Two patients had to be converted to conventional thoracoscopic procedure because of severe pleural adhesions. The mean operating time was 43 min (ranging from 39 to 107 min) and the mean postoperative length of stay was 1 day (range 1-4 days). All patients were interviewed 6-48 months after surgery and no diaphragmatic hernia or syndrome was observed. The rate of resolution of PH and axillary hyperhidrosis was 98 and 74.6%, respectively. Compensatory sweating was reported in 22.3% of patients. Almost all of the patients were satisfied with the surgical results and the cosmetic outcome of the incision. This preliminary human experience suggested that transumbilical thoracic sympathectomy was a safe and efficacious alternative to the conventional approach. This technique avoided the chronic pain and chest wall paraesthesia that are associated with the chest incision. In addition, this novel procedure afforded maximum cosmetic benefits. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio

  5. Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow.

    Science.gov (United States)

    Li, Xu; Tu, Yuan-Rong; Lin, Min; Lai, Fan-Cai; Chen, Jian-Feng; Miao, Hui-Weng

    2009-02-01

    Limiting the extent of sympathectomy in palmar hyperhidrosis was recently recognized as an effective method to minimize the incidence and severity of troublesome compensatory sweating. However, the levels at which transection should be performed remain controversial. In this study, we proposed that the level of ablation varies and should be adjusted for each individual patient. Guided by palmar skin temperature and laser Doppler blood flow, we try to find the correct target level in each case. Fifty patients with severe primary palmar hyperhidrosis received bilateral endoscopic thoracic sympathectomy. Different levels of transection from T4 to T2 were performed step by step until the successful extirpation was implied by the intraoperative monitoring. The results of the operations were studied. All patients were followed up and evaluated for symptom resolution, postoperative complication, levels of satisfaction, and severity of compensatory sweating. Of a total of 100 lateral procedures, 76 laterals (76%) ended the procedure at the T4 level, 23 laterals (23%) ended the procedure at the T3 level, and 1 lateral (1%) ended the procedure at the T2 level. The postoperative complication was minor, and no Horner's syndrome was detected. The rate of symptom resolution was 100% and no recurrence was found. The satisfaction rate was 92%, and the incidence of mild, moderate, and severe compensatory sweating were 12%, 8%, and 6%, respectively. Concerning the sympathectomy for palmar hyperhidrosis, there is a possibility that the level of the transection varies and should be adjusted for each individual patient. Intraoperative monitoring of temperature and blood flow may be a useful tool in establishing a kind of standardized reference for finding the correct target level.

  6. Preoperative education for lumbar surgery for radiculopathy

    OpenAIRE

    Louw, A; Louw, Q; L. Crous

    2009-01-01

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

  7. Segmentalliverincarcerationthrougha recurrent incisional lumbar hernia

    Institute of Scientific and Technical Information of China (English)

    Nikolaos S. Salemis; Konstantinos Nisotakis; Stavros Gourgiotis; Efstathios Tsohataridis

    2007-01-01

    BACKGROUND: Lumbar hernia is a rare congenital or acquired defect of the posterior abdominal wall. The acquired type is more common and occurs mainly as an incisional defect after lfank surgery. Incarceration or strangulation of hernia contents is uncommon. METHOD: Segmental liver incarceration through a recurrent incisional lumbar defect was diagnosed in a 58 years old woman by magnetic resonance imaging. RESULTS: The patient underwent an open repair of the com-plicated hernia. An expanded polytetralfouoroethylene (e-PTFE) mesh was fashioned as a sublay prosthesis. She had an uncomplicated postoperative course. Follow-up examinations revealed no evidence of recurrence. CONCLUSIONS: Although lumbar hernia rarely results in incarceration or strangulation, early repair is necessary because of the risks of complications and the increasing dififculty in repairment as it enlarges. Surgical repair is often dififcult and challenging.

  8. [Congenital lumbar hernia and bilateral renal agenesis].

    Science.gov (United States)

    Barrero Candau, R; Garrido Morales, M

    2007-04-01

    We report a new case of congenital lumbar hernia. This is first case reported of congenital lumbar hernia and bilateral renal agenesis. We review literature and describe associated malformations reported that would be role out in every case of congenital lumbar hernia.

  9. CHEMICALS

    CERN Document Server

    Medical Service

    2002-01-01

    It is reminded that all persons who use chemicals must inform CERN's Chemistry Service (TIS-GS-GC) and the CERN Medical Service (TIS-ME). Information concerning their toxicity or other hazards as well as the necessary individual and collective protection measures will be provided by these two services. Users must be in possession of a material safety data sheet (MSDS) for each chemical used. These can be obtained by one of several means : the manufacturer of the chemical (legally obliged to supply an MSDS for each chemical delivered) ; CERN's Chemistry Service of the General Safety Group of TIS ; for chemicals and gases available in the CERN Stores the MSDS has been made available via EDH either in pdf format or else via a link to the supplier's web site. Training courses in chemical safety are available for registration via HR-TD. CERN Medical Service : TIS-ME :73186 or service.medical@cern.ch Chemistry Service : TIS-GS-GC : 78546

  10. Bilateral single-port thoracoscopic sympathectomy with the VasoView (R) device in the treatment of palmar and axillary hyperhidrosis

    NARCIS (Netherlands)

    Bouma, Wobbe; Klinkenberg, Theo J.; Mariani, Massimo A.

    2011-01-01

    Primary or essential hyperhidrosis is a disorder characterized by excessive sweating beyond physiological needs. It is a common disease (with an incidence of up to 2.8%) that causes intense discomfort for patients. Video-assisted thoracoscopic bilateral sympathectomy is an effective surgical treatme

  11. Bilateral single-port thoracoscopic sympathectomy with the VasoView (R) device in the treatment of palmar and axillary hyperhidrosis

    NARCIS (Netherlands)

    Bouma, Wobbe; Klinkenberg, Theo J.; Mariani, Massimo A.

    Primary or essential hyperhidrosis is a disorder characterized by excessive sweating beyond physiological needs. It is a common disease (with an incidence of up to 2.8%) that causes intense discomfort for patients. Video-assisted thoracoscopic bilateral sympathectomy is an effective surgical

  12. Simpatectomia cervicotoracica por videotoracoscopia: experiência inicial Thoracoscopic cervicodorsal sympathectomy: initial results

    Directory of Open Access Journals (Sweden)

    Paulo Kauffman

    1998-08-01

    Full Text Available O objetivo do presente trabalho é avaliar os resultados iniciais obtidos com a simpatectomia cervicotorácica videotoracoscópica. De outubro de 1995 a outubro de 1997 foram realizados 24 procedimentos em 14 pacientes: dez homens e quatro mulheres, com idades que variaram de 16 a 56 anos, média de 30 anos. Indicações para a operação foram: hiperidrose palmar em dez pacientes, isquemia de mão em três e causalgia em um. Nos casos de hiperidrose, a ressecção da cadeia simpática incluiu T2 e T3. Nos portadores de isquemia e causalgia também o gânglio estrelado foi ressecado. Vinte e três das 24 extremidades mostraram excelente resposta imediata à simpatectomia. Somente uma extremidade de paciente com hiperidrose permaneceu inalterada devido a procedimento incompleto, tendo sido desnervada pela mesma técnica em reoperação posterior, com bom resultado. Pneumotórax residual pós-operatório ocorreu em uma paciente com resolução espontânea. Treze pacientes tiveram seguimento que variou de dois a 18 meses, com média de 11 meses. Não houve mortalidade nessa série, e a principal complicação tardia observada nos pacientes operados por hiperidrose foi a hiperidrose compensatória, que ocorreu, em grau variado, nos nove pacientes com seguimento, sendo que em 30% deles esta manifestação foi significativa. Concluímos tratar-se de procedimento simples, seguro, eficiente e de melhor aceitação por parte dos pacientes do que a operação convencional.This report analyzes the initial results of thoracoscopic cervicodorsal sympathectomy. From October 1995 to October 1997, 24 procedures were accomplished in 14 patients. Ten were males and four were females ranging in age from 16 to 56 (mean 30. Surgical indications were: palmar hyperhidrosis in ten, ischemia of the hand in three and causalgia in one. Resection of the sympathetic chain in hyperhidrosis included T2 and T3. In those with ischemia and causalgia the stellate ganglion was

  13. Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing.

    Science.gov (United States)

    Smidfelt, K; Drott, C

    2011-12-01

    The purpose of this study was to clarify the long-term effects, side-effects and overall satisfaction rates of endoscopic thoracic sympathectomy (ETS) used in the treatment of hyperhidrosis and facial blushing. Some 3015 patients had bilateral ETS from 1989 to 1998. A questionnaire follow-up was used. Some of the patients had participated in a previous follow-up study, and the answers in both surveys were compared. A total of 1700 patients responded (56·4 per cent); mean(s.d.) follow-up was 14·6(2·4) years. The best result was achieved for palmar hyperhidrosis (95·6 per cent) compared with axillary hyperhidrosis (68·9 per cent), facial hyperhidrosis (83 per cent) and facial blushing (72·8 per cent) (P < 0·001). Compensatory sweating, the main side-effect, was present in 80·0 per cent. Some 6·5 per cent were dissatisfied and 13·5 per cent regretted having the procedure. Patients with palmar hyperhidrosis were more satisfied (86·6 per cent) than those with axillary hyperhidrosis (66·0 per cent), facial hyperhidrosis (74 per cent) or facial blushing (73·5 per cent) (P < 0·001). Women were more satisfied than men (85·4 versus 71·4 per cent; P < 0·001). The procedure regret rate rose from 7·8 per cent in the first survey to 13·5 per cent in the present one. ETS had an excellent and lasting effect on palmar hyperhidrosis. The effect on facial and axillary hyperhidrosis and facial blushing was less rewarding. The procedure regret rate increased over time. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  14. Nonintubated Transareolar Endoscopic Thoracic Sympathectomy with a Flexible Endoscope: Experience of 58 Cases.

    Science.gov (United States)

    Chen, Jianfeng; Lin, Jianbo; Tu, Yuanrong; Lin, Min; Li, Xu; Lai, Fancai

    2016-01-01

    Natural orifice transluminal endoscopic surgery (NOTES) has recently become a hot spot in the field of minimally invasive surgery. But, most of the procedures are still in the early stages of development and limited to animal experiments. Transareolar endoscopic surgery could work as a viable intermediate step before thoracic NOTES. Under intravenous anesthesia without endotracheal intubation, transareolar endoscopic thoracic sympathectomy (ETS) with a flexible endoscope has rarely been attempted. The objective of this study is to evaluate the feasibility and safety of this novel minimally invasive technique in managing primary palmar hyperhidrosis (PPH). From June 2012 to July 2014, a total of 58 male patients with severe PPH underwent transareolar ETS by use of a flexible endoscope. Under intravenous anesthesia without endotracheal intubation, a flexible endoscope was introduced through the incision on the edge of the areola into the thoracic cavity. The thoracic sympathetic chain was ablated at the level of the fourth rib. All procedures were successfully performed with a mean operating time of 33.6 ± 8.3 min. All patients regained consciousness rapidly and none of them complained about sore throat after surgery. There were no operative mortality and conversion to open procedure. The symptoms of all patients disappeared as soon as the sympathetic chain was cut off. Fifty six patients (96.6%) were discharged from the hospital on the first postoperative day. The postoperative complications were minor, and no patients developed Horner's syndrome. At 3 months postoperatively, there was no obvious surgical scar on the chest wall, and none of the patients complained about postoperative pain. Compensatory hyperhidrosis (CH) appeared in 19 patients. No recurrent symptoms were observed in our study. One year follow-up revealed an excellent cosmetic result and degree of satisfaction. Nonintubated transareolar ETS with a flexible endoscope is a safe, effective and

  15. Comparison of T2 and T3 sympathectomy for compensatory sweating on palmar hyperhidrosis

    Science.gov (United States)

    Turkyilmaz, Atila; Karapolat, Sami; Seyis, Kubra Nur; Tekinbas, Celal

    2017-01-01

    Abstract Background: An otherwise successfully performed endoscopic thoracic sympathectomy (ETS) to treat palmar hyperhidrosis (PH) often has a serious side effect: compensatory sweating (CS). This side effect occurs in other parts of the body to a disturbing extent. The objective of this study is to determine whether there is a relationship between the level of ETS performed on patients with PH, and the occurrence and severity of postoperational CS. Methods: Between January 2014 and January 2015, ETS procedures were performed on 25 randomly selected consecutive subjects (group A) at T2 level, and on another 25 subjects (group B) at T3 level, who all felt severely handicapped due to PH. All subjects were assessed in terms of their demographic characteristics including gender and age, as well as postoperative complications, short-term results, side effects, recurrence of symptoms, and long-term results. Results: The symptoms disappeared in all subjects in short-term, and no recurrence was seen in their short or long-term follow-ups. At the end of year one, CS developed at a rate of 12% in group A and 8% in group B, particularly in their back and abdominal regions. The overall satisfaction with the procedure in year one was 96% in group A and 100% in group B. Conclusion: When an ETS performed at T2 or T3 level for PH involves only the interruption of the sympathetic chain, with a limitation on the range of dissection and avoidance of any damage to ganglia, sweating is stopped completely. No recurrence of PH is encountered, and CS develops only at low rates and severities. PMID:28422886

  16. Endoscopic thoracic sympathectomy for primary hyperhidrosis: a 16-year follow up in a single UK centre.

    Science.gov (United States)

    Askari, Alan; Kordzadeh, Ali; Lee, Gui Han; Harvey, Michael

    2013-06-01

    Since the introduction of Endoscopic Thoracic Sympathectomy ( ETS ) by Kux in 1951, the procedure has been performed for treatment of primary hyperhidrosis (PH) of the upper limb. Despite its initial success and minimally invasive nature, the long-term results are yet to be established. The aim of this study is to evaluate the outcome of patients after ETS with particular emphasis on patient satisfaction and its effectiveness over a 16-year period. A patient survey of fifty-one (n = 51) patients who had ETS for PH of palms from 1995 to 2011 was conducted. The data on age, sex, site of the PH, family history, trigger, hospital stay, relief from symptoms, complications, refractory sweating and overall satisfaction with the procedure was analysed with SAS software version 9.1.3. The mean follow-up was 77 months (range, 6-189 months) with equal gender distribution (n = 24 males Vs n = 27 females) and mean age of 19 (range, 13-64 years). The hereditary prevalence was 55%. Forty-six patients (90.2%) reported an immediate (≤24 h) and four patients (7.8%) reported a delay (>24 h) in relief of symptoms. To the best of our knowledge this is longest duration of follow-up reported in the literature. Copyright © 2012 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  17. Lumbar discography: an update.

    Science.gov (United States)

    Anderson, Mark W

    2004-01-01

    and then come back to reinject more contrast into the disk in question. As radiologists, we tend to focus on the technical aspects of a procedure and the anatomic/morphologic information it provides. However, it cannot be emphasized enough that when performing lumbar discography, the assessment of the patient's pain response during the injection is the most important component of the procedure, and requires not only technical skills, but an understanding of how best to avoid some of the pitfalls that can lead to inaccurate results.

  18. A lumbar disc surgery predictive score card.

    Science.gov (United States)

    Finneson, B E

    1978-06-01

    A lumbar disc surgery predictive score card or questionnaire has been developed to assess potential candidates for excision of a herniated lumbar disc who have not previously undergone lumbar spine surgery. It is not designed to encompass patients who are being considered for other types of lumbar spine surgery, such as decompressive laminectomy or fusion. In an effort to make the "score card" usable by almost all physicians who are involved in lumbar disc surgery, only studies which have broad acceptance and are generally employed are included. Studies which have less widespread use such as electromyogram, discogram, venogram, special psychologic studies (MMPI, pain drawings) have been purposely excluded.

  19. Expanded level of sympathetic chain removal does not increase the incidence or severity of compensatory hyperhidrosis after endoscopic thoracic sympathectomy.

    Science.gov (United States)

    Gunn, Tyler M; Davis, Diane M; Speicher, James E; Rossi, Nicholas P; Parekh, Kalpaj R; Lynch, William R; Iannettoni, Mark D

    2014-12-01

    Compensatory hyperhidrosis is a common devastating adverse effect after endoscopic thoracic sympathectomy for patients undergoing surgical treatment of primary hyperhidrosis. We sought to determine whether a correlation existed in our patient population between the level and extent of sympathetic chain resection and the subsequent development of compensatory hyperhidrosis. All patients undergoing endoscopic thoracic sympathectomy in the T2-T3, T2-T4, T2-T5, or T2-T6 levels for palmar or axillary hyperhidrosis at the University of Iowa Hospital and Clinics (n = 97) from January 2004 to January 2013 were retrospectively reviewed. Differences in the preoperative patient characteristics were not statistically significant among the patients receiving T2-T3, T2-T4, T2-T5, or T2-T6 level resections. Of the 97 included patients, 28 (29%) experienced transient compensatory hyperhidrosis and 4 (4%) complained of severe compensatory hyperhidrosis and required additional treatment. No operative mortalities occurred, and the morbidity was similar among the groups. Most patients had successful outcomes after undergoing extensive resection without changes in the incidence of compensatory hyperhidrosis. Therefore, we recommend performing complete and adequate resection for relief of symptoms in patients with primary hyperhidrosis. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  20. Expanded Level of Sympathetic Chain Removal Does Not Increase Incidence or Severity of Compensatory Hyperhidrosis Following Endoscopic Thoracic Sympathectomy

    Science.gov (United States)

    Gunn, Tyler M.; Davis, Diane M.; Speicher, James E.; Rossi, Nicholas P.; Parekh, Kalpaj R.; Lynch, William R.; Iannettoni, Mark D.

    2015-01-01

    Objective Compensatory hyperhidrosis is a common devastating adverse effect following endoscopic thoracic sympathectomy for patients undergoing surgical treatment of primary hyperhidrosis. We sought to determine if there was a correlation in our patient population between the level and extent of sympathetic chain resection and the subsequent development of compensatory hyperhidrosis. Methods All patients undergoing endoscopic thoracic sympathectomy in the T2-3, T2-4, T2-5, or T2-6 levels for palmar or axillary hyperhidrosis at the University of Iowa Hospital and Clinics (n=97) between January 2004 and January 2013 were retrospectively reviewed. Results Differences in preoperative patient characteristics were not statistically significant between patients receiving either T2-3, T2-4, T2-5, or T2-6 level resections. Of the ninety-seven patients included in this study, twenty-eight patients (29%) experienced transient compensatory hyperhidrosis and four patients (4%) complained of severe compensatory hyperhidrosis and required further treatment. There were no operative mortalities and morbidity was similar amongst the groups. Conclusions Most patients had successful outcomes after undergoing extensive resection without change in incidence of compensatory hyperhidrosis. Therefore, we recommend performing a complete and adequate resection for relief of symptoms in patients with primary hyperhidrosis. PMID:25131173

  1. Differences between objective efficacy and perceived efficacy in patients with palmar hyperhidrosis treated with either botulinum toxin or endoscopic thoracic sympathectomy.

    Science.gov (United States)

    Alvarez, M A; Ruano, J; Gómez, F J; Casas, E; Baamonde, C; Salvatierra, A; Moreno, J C

    2013-03-01

    Moderate to severe palmar hyperhidrosis can disturb people's work and social and emotional lives. Botulinum toxin and sympathectomy are currently considered the most effective treatment options but few studies have analysed the concordance between efficacy and patient satisfaction in comparisons of these two types of treatments. To assess the relation between efficacy and the satisfaction of patients with palmar hyperhidrosis treated with either botulinum toxin or endoscopic thoracic sympathectomy. This retrospective, observational study included all patients treated with either botulinum toxin or endoscopic thoracic sympathectomy in a single reference hospital in 2005-2010. Information was obtained from computerized medical records and a telephone survey about patients' educational and socio-economic level, awareness of treatment options, pre- and post-treatment severity of palmar hyperhidrosis, satisfaction and associated side effects. Predictors of efficacy and patient satisfaction with each treatment were analysed with ordinal and multinomial logistic regression models. Patients who underwent sympathectomy had more severe palmar hyperhidrosis but efficacy and patient satisfaction were greater compared with patients given botulinum toxin. The severity of the compensatory palmar hyperhidrosis was predictive of less satisfaction after sympathectomy. In the group treated with botulinum toxin, low socio-economic status, lack of information about treatment options, fewer sessions and a shorter anhidrotic effect were associated with less satisfaction. In studies of expectations regarding the outcome of palmar hyperhidrosis treatment, doctors should consider the factors that determine patient satisfaction in relation to the treatment options. © 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.

  2. Lumbar myelography with Omnipaque (iohexol)

    Energy Technology Data Exchange (ETDEWEB)

    Lilleaas, F.; Bach-Gansmo, T.; Weber, H.

    1986-07-01

    Lumbar myelography with iohexol (Omnipaque) was performed in 103 consecutive adult patients with low back pain or sciatica. The patients were observed for 48 h with registration of possible adverse reactions. Mild or moderate transient side effects were recorded in 24 patients. No serious adverse reactions were noted, and EEG recorded in 25 patients showed no changes.

  3. Chondroblastoma of the lumbar vertebra

    Energy Technology Data Exchange (ETDEWEB)

    Leung, L.Y.J.; Shu, S.J.; Chan, M.K.; Chan, C.H.S. [Dept. of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (Hong Kong)

    2001-12-01

    Chondroblastoma of the vertebra is a very rare condition. To our knowledge fewer than 20 cases have been reported in the world literature. We report a 54-year-old man with chondroblastoma of the fifth lumbar vertebra. The clinical and radiological aspects of the tumor are discussed, emphasizing the presence of an extraosseous mass suggestive of locally aggressive behavior. (orig.)

  4. 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.

  5. Lumbar disc excision through fenestration

    Directory of Open Access Journals (Sweden)

    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.

  6. Case report and review of lumbar hernia.

    Science.gov (United States)

    Walgamage, Thilan B; Ramesh, B S; Alsawafi, Yaqoob

    2015-01-01

    Lumbar hernias are uncommon and about 300 cases have been reported till date. They commonly occur due to trauma, surgery and infection. They are increasingly being reported after motor vehicle collision injuries. However, spontaneous lumbar hernias are rare and are reported infrequently. It is treated with different surgical approaches and methods. We report a case of primary spontaneous lumbar hernia which was repaired by transperitonial laparoscopic approach using Vypro (polypropylene/polyglactin) mesh and covered with a peritoneal flap.

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Ding Zi-hai

    2011-04-01

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

  9. [Bilateral thoracoscopic sympathectomy in treatment of palmar and axillary hyperhydrosis - a summary of 22 cases. A role for one day surgery in thoracic surgery?].

    Science.gov (United States)

    Kocsis, Akos; Agócs, László; Kostic, Szilárd; Lévay, Bernadett; Török, Klára; Rényi-Vámos, Ferenc

    2012-10-01

    The procedure of the ETS is carried out by two ports, a videothoracoscop and a diathermy instrument are introduced into the pleural cavity. After the identification of the sympathetic chain, the relevant ganglia are divided or excised. 22 patient underwent bilateral video assisted thoracoscopic T2-T4 sympathectomy in a half-way sitting position for palmar and axillary hyperhydrosis between December 2008 and January 2011. 5 male and 17 female patients with a mean age of 39.9 years, (19-63) underwent the above procedure. The mean operation time was 36 minutes, (30-61 minutes). No postoperative complications were detected. The authors believe that two port VATS sympathectomy is a safe and effective method for the treatment of hyperhydrosis even as one day surgical procedure.

  10. Indication of posterior lumbar interbody fusion for lumbar disc herniation.

    Science.gov (United States)

    Satoh, Iwao; Yonenobu, Kazuo; Hosono, Noboru; Ohwada, Tetsuo; Fuji, Takeshi; Yoshikawa, Hideki

    2006-04-01

    To examine whether lumbar disc herniation with massive extrusion and/or segmental instability can be an indicator for spinal fusion or not, by comparing the outcome of posterior lumbar interbody fusion (PLIF) and discectomy alone. One hundred seventy-four patients with PLIF and 177 patients with discectomy were retrospectively analyzed. We hypothesized two criteria for fusion: massive herniation and segmental instability. The patients were divided into four groups according to our original criteria: group F-F (n = 96) consisted of the patients who fulfilled the criteria for fusion and underwent PLIF; group nF-F (n = 78) consisted of those who did not fulfill the criteria but had PLIF; group F-nF (n = 30) consisted of those who fulfilled the criteria but underwent discectomy; group nF-nF (n = 147) comprised those who did not fulfill the criteria and underwent discectomy. Each patient was evaluated clinically and radiologically at 5 years after operation. Groups F-F and nF-F had significantly superior results on low back pain compared with group F-nF (F-F vs F-nF, P < 0.05; nF-F vs F-nF, P < 0.01). The frequency of additional operation at the involved level was significantly higher in group F-nF (10.0%) than in group F-F (2.0%) (P < 0.05). Postoperative instability of the adjacent segment developed in 15 cases (8.6%) in groups F-F and nF-F and in 3 cases (1.7%) in groups F-nF and nF-nF (P < 0.01). Lumbar disc herniation with massive herniation or segmental instability can be well treated with PLIF.

  11. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations.

    Science.gov (United States)

    Herbst, F; Plas, E G; Függer, R; Fritsch, A

    1994-01-01

    OBJECTIVE: This evaluated the long-term outcome after endoscopic thoracic sympathectomy (ETS) from below D1 to D4, using a single-site access technique for primary hyperhidrosis of the upper limbs. SUMMARY BACKGROUND DATA: Primary hyperhidrosis of the upper limbs is a distressing and often socially disabling condition. Endoscopic thoracic sympathectomy is considered the treatment of choice, causing minimal morbidity and high initial success rates. However, data regarding long-term results are scarce. METHODS: Two hundred seventy of 323 patients (83.7%), in whom 480 sympathectomies were performed, answered a questionnaire after a mean of 14.6 years postoperatively regarding the early postoperative result, side effects, and complications caused by the operation and long-term results with particular emphasis on patient satisfaction. RESULTS: There was no postoperative mortality and no major complications requiring surgical reintervention. A majority of the patients (98.1%) were relieved, and 95.5% were satisfied initially. Permanent side effects included compensatory sweating in 67.4%, gustatory sweating in 50.7% and Horner's trias in 2.5%. However, patient satisfaction declined over time, although only 1.5% recurred. This left only 66.7% satisfied, and a 26.7% partially satisfied. Compensatory and gustatory sweating were the most frequently stated reasons for dissatisfaction. Individuals operated for axillary hyperhidrosis without palmar involvement were significantly less satisfied (33.3% and 46.2%, respectively). PMID:8024363

  12. Relationship between anxiety, depression and quality of life with the intensity of reflex sweating after thoracoscopic sympathectomy for treatment of primary hyperhidrosis

    Directory of Open Access Journals (Sweden)

    LUCIARA IRENE DE NADAI DIAS

    Full Text Available ABSTRACT Objective: to compare the intensity of reflex sweating with the degree of anxiety and its interference in the quality of life of patients undergoing Thoracoscopic (VATS sympathectomy in the pre- and postoperative period. Methods: we evaluated 54 patients with a mean age of 26 years (16-49 years undergoing sympathectomy in the R3-R4 level. We applied two questionnaires at three different times: "Quality of life in patients with primary hyperhidrosis" and "Scale for anxiety and depression". Results: of the patients studied, 93% showed significant improvement in quality of life 30 days after surgery, the effects remaining after six months. There were no postoperative complications. The patient's level of anxiety is highly correlated with the intensity of reflex sweating after 30 and 180 days. Conclusion: Thoracoscopic sympathectomy improves quality of life of patients with primary hyperhidrosis, even with the emergence of reflex sweating. Anxiety directly relates to the intensity of reflex sweating, without compromising the degree of patient satisfaction.

  13. Evaluation of the effectiveness of thoracic sympathectomy in the treatment of primary hyperhidrosis of hands and armpits using the measurement of skin resistance.

    Science.gov (United States)

    Misiak, Piotr; Jabłoński, Sławomir; Rzepkowska-Misiak, Beata; Piskorz, Lukasz; Brocki, Marian; Wcisło, Szymon; Smigielski, Jacek; Kordiak, Jacek

    2012-08-01

    Hyperhidrosis is excessive sweating beyond the needs of thermoregulation. It is disease which mostly affects young people, often carrying a considerable amount of socio-economic implications. Thoracic sympathectomy is now considered to be the "gold standard" in the treatment of idiopathic hyperhidrosis of hands and armpits. Assessment of early effectiveness of thoracic sympathectomy using skin resistance measurements performed before surgery and in the postoperative period. A group of 20 patients with idiopathic excessive sweating of hands and the armpit was enrolled in the study. Patients underwent two-stage thoracic sympathectomy with resection of Th2-Th4 ganglions. The skin resistance measurements were made at six previously designated points on the day of surgery and the first day after the operation. In all operated patients we obtained complete remission of symptoms on the first day after the surgery. Inhibition of sweating was confirmed using the standard starch iodine (Minor) test. At all measurement points we obtained a statistically significant increase of skin resistance, assuming p resistance in all cases is a good method of assessing the effectiveness of the above surgery in the early postoperative period.

  14. Effects of cervical sympathectomy on vasospasm induced by meningeal haemorrhage in rabbits Efeitos da simpatectomia cervical sobre o vasoespasmo induzido por hemorragia meníngea em coelhos

    Directory of Open Access Journals (Sweden)

    Antônio Tadeu de Souza Faleiros

    2006-09-01

    Full Text Available This study investigates the role of cervical sympathectomy in the prevention of acute vasospasm induced by meningeal haemorrhage in rabbits. Sixteen adult English Norfolk rabbits were divided into 2 experimental groups: bilateral cervical sympathectomy of the superior sympathetic ganglion (SSSG, n=8, and bilateral SSSG and sympathectomy of the inferior sympathetic ganglion (SISG, n=8. Other 24 animals were used as controls. Basilar artery diameter was evaluated by angiography. SSSG protected the animals against developing cerebral vasospasm; SSSG associated with SISG did not increase this effect.Este estudo investiga o papel da simpatectomia cervical na prevenção do vasoespasmo agudo induzido por hemorragia meníngea em coelhos. Para tanto, foram utilizados 16 coelhos adultos da raça Norfolk inglesa, divididos em 2 grupos experimentais: simpatectomia cervical bilateral do gânglio simpático cervical superior (SSSG, n=8 e SSSG associada a simpatectomia cervical bilateral do gânglio simpático cervical inferior (SISG, n=8. Outros 24 animais foram usados como controles. Os diâmetros das artérias basilares foram avaliados por medições após angiografias. SSSG protegeu os animais contra o vasoespasmo; SSSG associada a SISG não aumentou este efeito.

  15. Remote cerebellar hemorrhage after lumbar spinal surgery

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

    2009-04-15

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

  16. Genetic association studies in lumbar disc degeneration

    DEFF Research Database (Denmark)

    Eskola, Pasi J; Lemmelä, Susanna; Kjaer, Per

    2012-01-01

    Low back pain is associated with lumbar disc degeneration, which is mainly due to genetic predisposition. The objective of this study was to perform a systematic review to evaluate genetic association studies in lumbar disc degeneration as defined on magnetic resonance imaging (MRI) in humans....

  17. Primary lumbar hernia: A rarely encountered hernia

    Directory of Open Access Journals (Sweden)

    Sharada Sundaramurthy

    2016-01-01

    Conclusion: A surgeon may encounter a primary lumbar hernia perhaps once in his lifetime making it an interesting surgical challenge. Sound anatomical knowledge and adequate imaging are indispensable. Inspite of advances in minimally invasive surgery, it cannot be universally applied to patients with lumbar hernia and management requires a more tailored approach.

  18. [Neonatal occlusion due to a lumbar hernia].

    Science.gov (United States)

    Hunald, F A; Ravololoniaina, T; Rajaonarivony, M F V; Rakotovao, M; Andriamanarivo, M L; Rakoto-Ratsimba, H

    2011-10-01

    A Petit lumbar hernia is an uncommon hernia. Congenital forms are seen in children. Incarceration may occur as an unreducible lumbar mass, associated with bilious vomiting and abdominal distention. Abdominal X-ray shows sided-wall bowel gas. In this case, reduction and primary closure must be performed as emergency repair.

  19. Percutaneous treatment of cervical and lumbar herniated disc

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, A., E-mail: akelekis@med.uoa.gr; Filippiadis, D.K., E-mail: dfilippiadis@yahoo.gr

    2015-05-15

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4–6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75–94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine.

  20. Hernia discal lumbar: Tratamiento conservador

    OpenAIRE

    López-Sastre Núñez, Antonio; Candau Pérez, Ernesto

    1999-01-01

    Existe una gran demanda de patología lumbar crónica y aguda que debe de tratarse conjuntamente entre el especialista en Rehabilitación y el Cirujano de columna vertebral. En este trabajo se detallan las posibilidades del tratamiento conservador antes de optar por la cirugía. Se realiza una revisión bibliográfica de los resultados conservadores del tratamiento de la lumbociática de origen discal comparando aquellos estudios publicados con validez estadística. Se detallan las modernas pautas de...

  1. Lumbar Epidural Varix Mimicking Disc Herniation.

    Science.gov (United States)

    Bursalı, Adem; Akyoldas, Goktug; Guvenal, Ahmet Burak; Yaman, Onur

    2016-07-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method.

  2. Lumbar pedicle cortical bone trajectory screw

    Institute of Scientific and Technical Information of China (English)

    Song Tengfei; Wellington K Hsu; Ye Tianwen

    2014-01-01

    Objective The purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory (CBT) screw fixation technique,a new fixation technique for lumbar surgery.Data sources The data analyzed in this review are mainly from articles reported in PubMed published from 1994 to 2014.Study selection Original articles and critical reviews relevant to CBT technique and lumbar pedicle fixation were selected.Results CBT technique was firstly introduced as a new fixation method for lumbar pedicle surgery in 2009.The concepts,morphometric study,biomechanical characteristics and clinical applications of CBT technique were reviewed.The insertional point of CBT screw is located at the lateral point of the pars interarticularis,and its trajectory follows a caudocephalad path sagittally and a laterally directed path in the transverse plane.CBT technique can be used for posterior fixation during lumbar fusion procedures.This technique is a minimally invasive surgery,which affords better biomechanical stability,fixation strength and surgical safety.Therefore,CBT technique has the greatest benefit in lumbar pedicle surgery for patients with osteoporosis and obesity.Conclusion CBT technique is a better alternative option of lumbar pedicle fixation,especially for patients with osteoporosis and obesity.

  3. Postvagotomy acid secretion and mucosal blood flow during beta-adrenoceptor stimulation and universal chemical sympathectomy in dogs

    DEFF Research Database (Denmark)

    Hovendal, C P

    1983-01-01

    The aim of the present study was to examine the effect of beta-adrenoceptor stimulation, alpha blockade, and elimination of the adrenergic nerve function on mucosal blood flow and acid secretion in parietal-cell-vagotomized (PCV) gastric fistula dogs. Isoprenaline inhibited pentagastrin-stimulate......The aim of the present study was to examine the effect of beta-adrenoceptor stimulation, alpha blockade, and elimination of the adrenergic nerve function on mucosal blood flow and acid secretion in parietal-cell-vagotomized (PCV) gastric fistula dogs. Isoprenaline inhibited pentagastrin......-stimulated gastric acid secretion via the beta 1 receptors non-competitively. The effect of isoprenaline was more pronounced after vagotomy than before vagotomy and significantly more pronounced than the effect on parasympathomimetically stimulated (bethanechol) gastric acid secretion. The animals were subjected...

  4. 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.

  5. 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.

  6. Lumbar hernia: a short historical survey.

    Science.gov (United States)

    Cavallaro, Antonino; De Toma, Giorgio; Cavallaro, Giuseppe

    2012-01-01

    Lumbar hernia is a rare form of abdominal hernia, which has been recognized later along the early development of the modern surgery. it has been, on many occasions, the object of heavy debate regarding its anatomical background and as well its etiology. The authors reports the historical aspects of this rare pathology, focusing on the earliest descriptions of hernia arising in lumbar regions, on the first reports of surgical repair, and on the anatomical description of the lumbar weakness areas, that are currently named Petit's triangle and Grynfeltt and Lesshaft's triangle.

  7. Minimal Invasive Decompression for Lumbar Spinal Stenosis

    Directory of Open Access Journals (Sweden)

    Victor Popov

    2012-01-01

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

  8. Lumbar herniated disc: spontaneous regression

    Science.gov (United States)

    Yüksel, Kasım Zafer

    2017-01-01

    Background Low back pain is a frequent condition that results in substantial disability and causes admission of patients to neurosurgery clinics. To evaluate and present the therapeutic outcomes in lumbar disc hernia (LDH) patients treated by means of a conservative approach, consisting of bed rest and medical therapy. Methods This retrospective cohort was carried out in the neurosurgery departments of hospitals in Kahramanmaraş city and 23 patients diagnosed with LDH at the levels of L3−L4, L4−L5 or L5−S1 were enrolled. Results The average age was 38.4 ± 8.0 and the chief complaint was low back pain and sciatica radiating to one or both lower extremities. Conservative treatment was administered. Neurological examination findings, durations of treatment and intervals until symptomatic recovery were recorded. Laségue tests and neurosensory examination revealed that mild neurological deficits existed in 16 of our patients. Previously, 5 patients had received physiotherapy and 7 patients had been on medical treatment. The number of patients with LDH at the level of L3−L4, L4−L5, and L5−S1 were 1, 13, and 9, respectively. All patients reported that they had benefit from medical treatment and bed rest, and radiologic improvement was observed simultaneously on MRI scans. The average duration until symptomatic recovery and/or regression of LDH symptoms was 13.6 ± 5.4 months (range: 5−22). Conclusions It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically. This condition must be taken into account during decision making for surgical intervention in LDH patients devoid of indications for emergent surgery. PMID:28119770

  9. Possibilities of balneotherapy in treatment of subjective symptoms of chronic low back pain (lumbar syndrome)

    OpenAIRE

    Batsialou Ioanna

    2002-01-01

    Introduction Chronic low back pain is a degenerative rheumatic disease and is characterized by various symptoms and clinical signs. Balneotherapy Balneotherapy represents a therapy by various hot or warm baths in natural mineral waters of specific physical and chemical characteristics. When used externally, they have mechanical, chemical and thermic effects. Balneotherapy of lumbar syndrome includes: individual baths, swimming in the pool, hydrokinesitherapy, underwater massage, underwater ex...

  10. GUIDELINES FOR TREATMENT OF DEGENERATIVE LUMBAR SPONDYLOLISTHESIS

    Directory of Open Access Journals (Sweden)

    CARMEN YOSSALETH BRICEÑO-GONZÁLEZ

    Full Text Available ABSTRACT Objectives: To determine the standard of treatment of degenerative lumbar spondylolisthesis in its different clinical presentations in UMAE Dr. Victorio de la Fuente Narváez. Methods: Six cases found in the literature were presented to 36 experts in spine surgery, along with treatment options, to thereby obtain a standard prescription for the treatment of degenerative lumbar spondylolisthesis. Analytical observational cross-sectional descriptive study. Results: It was found that the treatment of choice in cases of degenerative lumbar spondylolisthesis with axial symptoms is conservative. The surgical treatment of choice for both stable and unstable patients with radiculopathy and/or claudication is decompression + posterolateral graft + transpedicular instrumentation + discectomy (graft. Conclusions: We managed to define the degenerative lumbar spondylolisthesis treatment guidelines in our unit, which can serve as a basis for the development of a clinical practice guide.

  11. Lumbar Epidural Varix Mimicking Perineural Cyst

    Science.gov (United States)

    Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent

    2013-01-01

    Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots. PMID:23741553

  12. Posteroanterior versus anteroposterior lumbar spine radiology

    Energy Technology Data Exchange (ETDEWEB)

    Tsuno, M.M.; Shu, G.J. (Cleveland Chiropractic College, Los Angeles, CA (USA))

    1990-03-01

    The posteroanterior view of the lumbar spine has important features including radiation protection and image quality; these have been studied by various investigators. Investigators have shown that sensitive tissues receive less radiation dosage in the posteroanterior view of the spine for scoliosis screening and intracranial tomography without altering the image quality. This paper emphasizes the importance of the radiation safety aspect of the posteroanterior view and shows the improvement in shape distortion in the lumbar vertebrae.

  13. Fem Modelling of Lumbar Vertebra System

    Directory of Open Access Journals (Sweden)

    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.

  14. Unilateral sequential endoscopic thoracic sympathectomy for palmar hyperhidrosis: a proposed technique to overcome compensatory hyperhidrosis and improve plantar hyperhidrosis.

    Science.gov (United States)

    Youssef, Tamer; Soliman, Mosaad

    2015-05-01

    Although endoscopic thoracic sympathectomy (ETS) offers permanent cure of palmar hyperhidrosis (PH), compensatory hyperhidrosis (CH) often complicates the procedure. We analyzed the outcomes of a 2-month interval for unilateral sequential ETS (S-ETS) in comparison with simultaneous bilateral ETS (B-ETS), notably regarding CH and associated plantar hyperhidrosis, in treating patients with PH. Four hundred seven patients with intractable PH were randomly assigned into two groups: the B-ETS group (204 patients) and the S-ETS group (203 patients). Three hundred sixty-four patients completed the study. Complication rates were comparable for both groups. No patient died perioperatively, and no conversion was necessary. Treatment success on follow-up was 97.2% for S-ETS and 96.7% for B-ETS. The incidence of CH was decreased substantially from 131 (71.1%) patients in the B-ETS group to 22 (12.2%) patients in the S-ETS group (Psympathectomies were effective, safe, and minimally invasive methods for treatment of PH, unilateral sequential ETS appeared to be a more optimal technique in terms of reduction of CH to a minimum and improvement of associated plantar hyperhidrosis.

  15. Monitoring of peripheral vascular condition using a log-linearized arterial viscoelastic index during endoscopic thoracic sympathectomy.

    Science.gov (United States)

    Hirano, Hiroki; Horiuchi, Tetsuya; Hirano, Harutoyo; Kurita, Yuichi; Ukawa, Teiji; Nakamura, Ryuji; Saeki, Noboru; Yoshizumi, Masao; Kawamoto, Masashi; Tsuji, Toshio

    2013-01-01

    This paper proposes a novel technique to support the monitoring of peripheral vascular conditions using biological signals such as electrocardiograms, arterial pressure values and pulse oximetry plethysmographic waveforms. In this approach, a second-order log-linearized model (referred to here as a log-linearized peripheral arterial viscoelastic model) is used to describe the non-linear viscoelastic relationship between blood pressure waveforms and photo-plethysmographic waveforms. The proposed index enables estimation of peripheral arterial wall stiffness changes induced by sympathetic nerve activity. The validity of the method is discussed here based on the results of peripheral vascular condition monitoring conducted during endoscopic thoracic sympathectomy (ETS). The results of ETS monitoring showed significant changes in stiffness variations between the periods before and during the procedures observed (p < 0.01) as well as during and after them (p < 0.01), so that it was confirmed that sympathetic nerve activity is drastically decreased in the area around the monitoring site after the thoracic sympathetic nerve trunk on the monitoring side is successfully blocked. In addition, no change was observed in the values of the proposed index during the ETS procedure on the side opposite that of the monitoring site. The experimental results obtained clearly show the proposed method can be used to assess changes in sympathetic nerve activity during ETS.

  16. Preoperative education for lumbar surgery for radiculopathy

    Directory of Open Access Journals (Sweden)

    A. Louw

    2009-02-01

    Full Text Available To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptiveand inferential statistical tests. Results showed that 100% of the patients and 99% of therapists view preoperative education to be an important component for lumbar surgery for radiculopathy. The most important factors identifiedfor inclusion in preoperative educational programs were reason for surgery, risks associated with surgery, limitations following surgery and more education regarding pain. The preferred method of education delivery was verbal one-on-one education. This study demonstrates that there is a demand for preoperative education for patients who had lumbar surgery.

  17. Scoliosis secondary to lumbar osteoid osteoma

    Science.gov (United States)

    Zhang, Haiping; Niu, Xingbang; Wang, Biao; He, Simin; Hao, Dingjun

    2016-01-01

    Abstract Rationale: Lumbar osteoid osteoma has a low incidence, which could easily lead to scoliosis. Patient concerns: Scoliosis secondary to lumbar osteoid osteoma could be easily misdiagnosed when patients do not complain of obvious symptoms. Diagnoses: We reported a case of a 9-year-old boy with back deformity that was firstly diagnosed with scoliosis at the local hospital. After prescribed with orthosis, the patient experienced aggravating pain that could not be relieved with painkillers. After he admitted to our hospital for further medical advice, he was prescribed to complete radiological examinations. Considering his radiological examination results and his medical history, correct diagnosis of lumbar osteoid osteoma was made. Interventions: Surgical intervention of posterior lesion resection was conducted after diagnosis. Intra-operative frozen pathology indicated features of osteoid osteoma. As the lesion involved inferior articular process of L5, which could cause lumbar instability after lesion resection, internal fixation was conducted at L4-S1 segment, and posterolateral bone fusion was also conducted at L5-S1 segment. Outcomes: Three months after operation, the patient showed marked improvement of scoliosis deformity and great relief of lumbar pain. Lessons subsections: Although spine osteoid osteoma is clinically rare, it shall not be overlooked when young patients present with scoliosis first. Radiological results including computed tomography and magnetic resonance imaging shall be taken carefully as reference when making diagnosis. Surgical intervention of lesion resection could well improve scoliosis and relieve lumbar pain. PMID:27893671

  18. A Comparative Study of Lateral Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spondylolisthesis

    Science.gov (United States)

    Hughes, Alexander P.; Sama, Andrew A.; Girardi, Federico P.; Lebl, Darren R.; Cammisa, Frank P.

    2015-01-01

    Study Design Level 4 retrospective review. Purpose To compare the radiographic and clinical outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) with posterior segmental spinal instrumentation (SSI) for degenerative lumbar spondylolisthesis. Overview of Literature Both PLIF and LLIF have been performed for degenerative spondylolisthesis with good results, but no study has directly compared these two techniques so far. Methods The electronic medical and radiographic records of 78 matched patients were analyzed. In one group, 39 patients underwent PLIF with SSI at 41 levels (L3-4/L4-5), while in the other group, 39 patients underwent the LLIF procedure at 48 levels (L3-4/L4-5). Radiological outcomes such as restoration of disc height and neuroforaminal height, segmental lumbar lordosis, total lumbar lordosis, incidence of endplate fracture, and subsidence were measured. Perioperative parameters were also recorded in each group. Clinical outcome in both groups was assessed by the short form-12, Oswestry disability index and visual analogue scale scores. The average follow-up period was 16.1 months in the LLIF group and 21 months in the PLIF group. Results The restoration of disc height, foraminal height, and segmental lumbar lordosis was significantly better in the LLIF group (p<0.001). The duration of the operation was similar in both groups, but the average blood loss was significantly lower in the LLIF group (p<0.001). However, clinical outcome scores were similar in both groups. Conclusions Safe, effective interbody fusion can be achieved at multiple levels with neuromonitoring by the lateral approach. LLIF is a viable treatment option in patients with new onset symptoms due to degenerative spondylolisthesis who have had previous lumbar spine surgery, and it results in improved sagittal alignment and indirect foraminal decompression. PMID:26435782

  19. Long-term results of a randomized controlled trial of T2 versus T2-T3 ablation in endoscopic thoracic sympathectomy for palmar hyperhidrosis.

    Science.gov (United States)

    Ong, Wilson; Lee, Alvin; Tan, Wee Boon; Lomanto, Davide

    2016-03-01

    Despite good short-term results and patient satisfaction with endoscopic thoracic sympathectomy (ETS), there has been much debate on the level of sympathectomy for treatment of palmar hyperhidrosis (PH) in terms of long-term clinical outcomes. The aim of the study was to analyze the long-term recurrence and compensatory hyperhidrosis (CH) rates of ETS, comparing single-level T2 against multi-level T2-T3 ablation in single patients. Patients who had undergone treatment for PH with unilateral T2 and contralateral T2-T3 ablation in ETS were retrospectively reviewed. They were subjected to telephone interview using standardized set of interview script and questionnaire with a scoring system similar to hyperhidrosis disease severity scale. All patients were evaluated for comparison of symptom resolution, site and severity of CH, and satisfaction rates. To compare between T2 and T2-T3, the level of sympathectomy on one side is matched to the ipsilateral recurrence of PH and CH occurrence. Twenty-two patients with a mean age of 36.5 years could be reached. The mean follow-up was 8 years (range 38-153 months). The global recurrence rate for PH is 18%. CH was observed in 20 (91%) patients, and trunk compensation was the most common (18/22-82%), followed by lower limb (14/22-64%) and axilla (10/22-45%). Overall, 72.8% (16) of the patients were satisfied with the operation. Among the six patients who were not satisfied, two patients reported recurrence of symptoms, while four patients experienced some form of compensation. There was no absolute difference in the severity of sweating bilaterally for patients who reported recurrence of PH. The site and severity of CH were also bilaterally symmetrical for all patients. There was no difference in recurrence rates and CH between single-level (T2) and multi-level (T2-T3) ETSs in the long term.

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

    Directory of Open Access Journals (Sweden)

    Surendra Mohan Tuli

    2011-01-01

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

  1. An update on the management of chronic lumbar discogenic pain.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2015-09-01

    Lumbar degenerative disc disease without disc herniation, also known as discogenic pain, is an elusive diagnosis of chronic low back pain. Lumbar provocation discography and fusion surgery have been frequently utilized for several decades as the gold standards for the diagnosis and treatment of symptomatic lumbar discogenic pain, though controversial, based on conjecture, rather than evidence. In addition to lumbar fusion, various other operative and nonoperative modalities of treatments are available in managing chronic lumbar discogenic pain. This review provides an updated assessment of the management of chronic lumbar discogenic pain with a critical look at the many modalities of treatments that are currently available.

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

    Directory of Open Access Journals (Sweden)

    Tevfik Yilmaz

    2014-01-01

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

  3. MR-guided lumbar sympathicolysis

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-06-01

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

  4. MRI after successful lumbar discectomy

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Kelft, E. van de [Department of Neurosurgery, University of Antwerp, Edegem (Belgium); Biltjes, I.G.G.M. [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Hasselt, B.A.A.M. van [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Hauwe, L. van den [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Parizel, P.M. [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Schepper, A.M.A. de [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium)

    1996-05-01

    Our aim was to establish the normal range of MRI findings after successful lumbar discectomy. We prospectively examined 34 consecutive patients with an excellent clinical outcome by MRI 6 weeks and 6 months after surgery. All examinations included sagittal and axial spin-echo (SE) T1-weighted images before and after intravenous gadolinium-DTPA and fast SE T2-weighted images. Contrast enhancement along the surgical tract was seen in all patients 6 weeks and 6 months after surgery. After 6 months minimal or no mass effect on the dural sac by epidural scar was seen. In 20 % of patients there was recurrent disc herniation, with mass effect. Enhancing nerve roots were seen in 20 % of patients 6 weeks postoperatively, and half of these were associated with recurrent disc herniation at the same side. None of these patients still showed nerve root enhancement 6 months after surgery. Postoperative MRI studies must be interpreted with great care since the features described in the failed back surgery syndrome are also found, to some extent, in asymptomatic postoperative patients. (orig.). With 7 figs., 2 tabs.

  5. Lumbar lordosis in female collegiate dancers and gymnasts.

    Science.gov (United States)

    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.

  6. A Change in Lumbar Sagittal Alignment After Single-level Anterior Lumbar Interbody Fusion for Lumbar Degenerative Spondylolisthesis With Normal Sagittal Balance.

    Science.gov (United States)

    Kim, Chi Heon; Chung, Chun Kee; Park, Sung Bae; Yang, Seung Heon; Kim, Jung-Hee

    2017-08-01

    Retrospective analysis. The object is to assess the correlation between whole lumbar lordosis (LL) and the segmental angle (SA) after single-level anterior lumbar interbody fusion for degenerative lumbar spondylolisthesis. The restoration of the SA at lower lumbar spine is meaningful, considering it contributes approximately 60% of LL, and revision surgery due to flat back or adjacent segment pathology was necessary decades after the initial surgery. However, little is known about the change of whole lumbar curvature after single-level lower lumbar fusion surgery, especially for balanced spine. We included 41 consecutive patients (M:F=9:32; mean age, 59.8±9.3 y) with a single-level anterior lumbar interbody fusion surgery for low-grade degenerative spinal spondylolisthesis, with C7 plumb line of sagittal alignment was influenced by single SA. Therefore, obtaining adequate segmental lordosis is desirable considering the effect on the whole spine for a long time.

  7. Tractography of lumbar nerve roots: initial results

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  8. Minimally invasive procedures on the lumbar spine

    Science.gov (United States)

    Skovrlj, Branko; Gilligan, Jeffrey; Cutler, Holt S; Qureshi, Sheeraz A

    2015-01-01

    Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology and surgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine. PMID:25610845

  9. A musculoskeletal model for the lumbar spine.

    Science.gov (United States)

    Christophy, Miguel; Faruk Senan, Nur Adila; Lotz, Jeffrey C; O'Reilly, Oliver M

    2012-01-01

    A new musculoskeletal model for the lumbar spine is described in this paper. This model features a rigid pelvis and sacrum, the five lumbar vertebrae, and a rigid torso consisting of a lumped thoracic spine and ribcage. The motion of the individual lumbar vertebrae was defined as a fraction of the net lumbar movement about the three rotational degrees of freedom: flexion-extension lateral bending, and axial rotation. Additionally, the eight main muscle groups of the lumbar spine were incorporated using 238 muscle fascicles with prescriptions for the parameters in the Hill-type muscle models obtained with the help of an extensive literature survey. The features of the model include the abilities to predict joint reactions, muscle forces, and muscle activation patterns. To illustrate the capabilities of the model and validate its physiological similarity, the model's predictions for the moment arms of the muscles are shown for a range of flexion-extension motions of the lower back. The model uses the OpenSim platform and is freely available on https://www.simtk.org/home/lumbarspine to other spinal researchers interested in analyzing the kinematics of the spine. The model can also be integrated with existing OpenSim models to build more comprehensive models of the human body.

  10. Economic impact of minimally invasive lumbar surgery

    Science.gov (United States)

    Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

    2015-01-01

    Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures. PMID:25793159

  11. 77例手-脚汗症经电视胸腔镜胸交感神经切断术的疗效分析%The effect of endoscopic thoracic sympathectomy of 77 cases with palma-plantar hyperhidrosis

    Institute of Scientific and Technical Information of China (English)

    陈国祥; 华平; 陈炬; 熊利华; 潘德强

    2010-01-01

    目的 探讨用电视胸腔镜外科技术治疗手-脚汗症的效果.方法 2006年1月至2009年1月经电视胸腔镜手术治疗手-脚汗症77例,其中因合并腋下多汗而行T2~T4切断术52例(A组),未合并腋下多汗而行T2~T3切断术25例(B组).结果 术后手汗及腋下多汗均消失,脚底无汗者7例,脚底多汗减少者34例,脚底多汗无明显变化者32例,脚底多汗增多者4例.A组与B组术后脚底多汗改变差异无统计学意义(P>0.05).结论 每侧单孔电视胸腔镜手术治疗手-脚汗症创伤更小,患者更易于接受.胸交感神经切断术后部分患者脚底多汗可减轻或消失.切断T2~T4与切断T2~T3对脚汗症的影响无差别.%Objective To analyse the effect of endoscopic thoracic sympathectomy of palma-plantar hyperhidrosis. Methods Between January 2006 and January 2009,77 cases with palma-plantar hyperhidrosis were operated by thoracoscope. Fifty-two cases of palma-axillary-plantar hyperhidrosis were performed sympathectomy of T2-T4 and 25 cases of palma-plantar were performed sympathectomy of T2-T3.Bilateral procedures were completed in the same position. Results After operation palmar hyperhidrosis and armpits hyperhidrosis all were cured. Of soles, 7 cases were completely dry, 34 cases nearly dry, 32 cases unchanged and 4 cases worse. There was no significant difference in the change of plantar hyperhidrosis between sympathectomy of T2-T3 and T2-T4 (P > 0.05). Conclusions Bilateral single port for endoscopic thoracic sympathectomy produces slighter trauma and patients easily accept it. Plantar sweating can be relieved or nearly relieved in partial patients after thoracic sympathectomy. There is no difference in the effect of plantar hyperhidrosis between sympathectomy of T2-T3 and T2-T4.

  12. [Experimental Subarachnoid hemmorrhage in dogs--effect of various drugs and sympathectomy on cerebral arterial spasm (author's transl)].

    Science.gov (United States)

    Noda, S

    1975-09-01

    Adult mongrel dogs were used. The posterior communicating artery was punctured with a fine needle and subarachnoid hemorrhage was produced, which simulated aneurysmal rupture in human. The cerebral basal arteries were constricted remarkably after the puncture. However this vasospasm disappeared in about 60-120 minutes. After this restoration, the vessels began to be constricted again and reduced their diameter in greater degree with lapse of time. Effect of various drugs and sympathectomy on the experimental spasm induced by this method were studied utilizing the magnified vertebral angiography. The drugs used were papverine, isoxuprine, methysergide, phentolamine and propranolol. One of these drugs was given to each dog into the vertebral artery 15 minutes after the puncture of the artery for study of the early spasm, and the same procedure was carried out 24 hours after the late spasm. Vertebral arteriograms were taken immediately after and at 5, 10 and 30 minutes after injection of the drug. Diameter changes of the cerebral basal arteries were measured on the film. Smooth muscle relaxtants, papaverine and isoxsuprine, were effective on relieving the early and the late spasm. An antiserotonin agent, methysergide, relieved slightly the early spasm, but it had no effect on the late spasm. Phentolamine, that is an adrenergic blocking agent, relieved the early spam remarkably, but it was less effective on the late spam. A beta adrenergic blocking agent, propranolol, was effective on relieving neither the early nor the late spasm. Two weeks after the removal of the bilateral upper cervical ganglia, subarachnoid hemorrhage was produced by the smae method as mentioned above in four dogs. Arteriograms taken 24 hours after puncture of the posterior communicating artery in these dogs showed vasoconstriction as same as in the non-sympathectomized dogs. From these experimental results, it was suggested that an etiological difference in the early and the late spasm may exist

  13. Endoscopic thoracic sympathectomy for upper limb ischemia. A 16 year follow-up in a single center.

    Science.gov (United States)

    Coveliers, Hans; Hoexum, Frank; Rauwerda, Jan A; Wisselink, Willem

    2016-10-01

    The aim of our study was to evaluate the long term results of Endoscopic Thoracic Sympathectomy (ETS) in the management of upper limb ischemia (ULI). We retrospectively reviewed the records of all consecutive patients who underwent ETS for ULI between January 1994 and May 2009. A standardized questionnaire was used to evaluate the long term success, morbidity and overall patient satisfaction. Thirty-five patients (20 female, mean age 49 years (range 23-79)) underwent bilateral (n = 9) and unilateral (n = 27) ETS procedures, respectively. Six patients had Primary (idiopathic) Raynaud Disease. Twenty-nine patients had upper limb ischemia secondary to systemic disorders (n = 12), embolic disease (n = 10), occlusion of the arteries of the arm (n = 5) or hypothenar hammer syndrome (n = 2). Tissue loss at time of surgery was present in nineteen patients. Short term beneficial effects were reported by 12 patients (63%). Eleven of the 35 patients experienced a total of 13 complications or adverse events, whereof 11 were minor or transient. Limb salvage was unsuccessful in three patients because of major amputations (n = 2) or severe functional impairment (n = 1). Necrotectomies or minor amputations without functional impairment were performed in 9 patients. Medium or long term follow up (mean 98 months (range 18-198) was available in 19 out of 22 living patients(86%). Long term beneficial effects were reported by 10 (53%). Overall patient satisfaction was 56%. Compensatory sweating was experienced by 11 patients (58%). Although the long term efficacy of ETS in our study was moderate (53%), due to its low invasiveness ETS is a valuable option in the management of ULI. Copyright © 2016. Published by Elsevier Ltd.

  14. Effect of Lumbar Progressive Resistance Exercise on Lumbar Muscular Strength and Core Muscular Endurance in Soldiers.

    Science.gov (United States)

    Mayer, John M; Childs, John D; Neilson, Brett D; Chen, Henian; Koppenhaver, Shane L; Quillen, William S

    2016-11-01

    Low back pain is common, costly, and disabling for active duty military personnel and veterans. The evidence is unclear on which management approaches are most effective. The purpose of this study was to assess the effectiveness of lumbar extensor high-intensity progressive resistance exercise (HIPRE) training versus control on improving lumbar extension muscular strength and core muscular endurance in soldiers. A randomized controlled trial was conducted with active duty U.S. Army Soldiers (n = 582) in combat medic training at Fort Sam Houston, Texas. Soldiers were randomized by platoon to receive the experimental intervention (lumbar extensor HIPRE training, n = 298) or control intervention (core stabilization exercise training, n = 284) at one set, one time per week, for 11 weeks. Lumbar extension muscular strength and core muscular endurance were assessed before and after the intervention period. At 11-week follow-up, lumbar extension muscular strength was 9.7% greater (p = 0.001) for HIPRE compared with control. No improvements in core muscular endurance were observed for HIPRE or control. Lumbar extensor HIPRE training is effective to improve isometric lumbar extension muscular strength in U.S. Army Soldiers. Research is needed to explore the clinical relevance of these gains. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  15. The lumbar lordosis below Harrington instrumentation for scoliosis.

    Science.gov (United States)

    Swank, S M; Mauri, T M; Brown, J C

    1990-03-01

    This retrospective study evaluates lumbar lordosis in 43 patients before and after Harrington instrumentation into the lumbar spine. The authors measured overall lumbar lordosis, lordosis of unfused lumbar levels, and sagittal vertical axis. Lordosis decreased progressively in lower levels of fusion. The increase in lordosis below the fusion did not compensate for the overall loss of lordosis. The sagittal vertical axis moved forward, producing a subtle, asymptomatic form of flat back syndrome.

  16. Percutaneous upper thoracic radiofrequency sympathectomy in Raynaud phenomenon: a comparison of T2/T3 procedure versus T2 lesion with phenol application.

    Science.gov (United States)

    Gabrhelik, Tomas; Michalek, Pavel; Adamus, Milan; Berta, Emil

    2009-01-01

    Percutaneous radiofrequency (RF) thoracic sympathectomy is an alternative method to surgical procedures for the treatment of acral ischemia in Raynaud phenomenon. The procedure is indicated if conservative therapy fails to provide sufficient relief. The aim of this study was to compare classic T2 and T3 RF thermolesioning with a less invasive procedure at the level of T2 only. Fifty adult patients, American Society of Anesthesiologists (ASA) classification I to III, were randomly assigned to 1 of 2 groups. T2 and T3 thoracic RF thermolesion was performed in 1 group, whereas T2 thermolesion with local application of 0.5 mL of 6% phenol was delivered in the second group. Changes in cold perception, pain, and quality of life were assessed using a questionnaire. Blood circulation in the upper extremity was evaluated using infrared thermography. Patients were observed for a period of 3 months. A significant decrease in pain according to visual analog scale (P Thoracic RF upper sympathectomy is an effective method in the treatment of resistant forms of Raynaud phenomenon. A single-shot procedure at the level of T2 may be preferable because of the shorter procedure duration of this technique.

  17. Evaluation and Treatment of Lumbar Facet Cysts.

    Science.gov (United States)

    Boody, Barrett S; Savage, Jason W

    2016-12-01

    Lumbar facet cysts are a rare but increasingly common cause of symptomatic nerve root compression and can lead to radiculopathy, neurogenic claudication, and cauda equina syndrome. The cysts arise from the zygapophyseal joints of the lumbar spine and commonly demonstrate synovial herniation with mucinous degeneration of the facet joint capsule. Lumbar facet cysts are most common at the L4-L5 level and often are associated with spondylosis and degenerative spondylolisthesis. Advanced imaging studies have increased diagnosis of the cysts; however, optimal treatment of the cysts remains controversial. First-line treatment is nonsurgical management consisting of oral NSAIDs, physical therapy, bracing, epidural steroid injections, and/or cyst aspiration. Given the high rate of recurrence and the relatively low satisfaction with nonsurgical management, surgical options, including hemilaminectomy or laminotomy to excise the cyst and decompress the neural elements, are typically performed. Recent studies suggest that segmental fusion of the involved levels may decrease the risks of cyst recurrence and radiculopathy.

  18. Traumatic lumbar hernia: report of a case.

    Science.gov (United States)

    Torer, Nurkan; Yildirim, Sedat; Tarim, Akin; Colakoglu, Tamer; Moray, Gokhan

    2008-12-01

    Traumatic lumbar hernias are very rare. Here, we present a case of secondary lumbar hernia. A 44-year-old man sustained a crushing injury. On admission, ecchymotic, fluctuating swelling was present on his left flank with normal vital signs. Subcutaneous intestinal segments were revealed at his left flank on abdominal CT. Emergency laparotomy revealed a 10-cm defect on the left postero-lateral abdominal wall. The splenic flexure was herniated through the defect. Herniated segments was reduced, the defect was repaired with a polypropylene mesh graft. There was also a serosal tear and an ischemic area 3mm wide on the splenic flexure and was repaired primarily. The patient had an uneventful recovery. Most traumatic lumbar hernias are caused by blunt trauma. Trauma that causes abdominal wall disruption also may cause intraabdominal organ injury. Abdominal CT is useful in the diagnosis and allows for diagnosis of coexisting organ injury. Emergency laparotomy should be performed to repair possible coexisting injuries.

  19. Lumbar hernia repaired using a new technique.

    Science.gov (United States)

    Di Carlo, Isidoro; Toro, Adriana; Sparatore, Francesca; Corsale, Giuseppe

    2007-01-01

    Lumbar hernia is uncommon and occurs in Grynfeltt's triangle on the left side, more frequently in men than in women. Acquired lumbar hernias are the result of iliac crest bone harvest or blunt trauma and seat belt injuries in road accidents. Many surgical options have been reported for repairing this hernia through primary closure of the defect or through use of aponeurotic or prosthetic materials. The Dowd technique is the technique most often used. The authors describe a patient with posttraumatic inferior triangle lumbar hernia who underwent laparoscopy and, 10 days later, laparotomy. Both procedures failed. Finally, a novel lumbotomic surgical approach was used, involving the Dowd technique and prosthetic mesh. The patient was free of recurrence 3 months after the procedure.

  20. 49 CFR 572.115 - Lumbar spine and pelvis.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine and pelvis. 572.115 Section 572.115... 50th Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to those for the SID dummy as set forth in § 572.42 except that...

  1. 49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine, abdomen, and pelvis. 572.9 Section... Percentile Male § 572.9 Lumbar spine, abdomen, and pelvis. (a) The lumbar spine, abdomen, and pelvis consist... minutes after the release. (d) When the abdomen is subjected to continuously applied force in accordance...

  2. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY...-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis...

  3. Relationship between New Osteoporotic Vertebral Fracture and Instrumented Lumbar Arthrodesis

    OpenAIRE

    Kim, Bung-Hak; Choi, Dong-Hyuk; Jeon, Seong-Hun; Choi, Yong-Soo

    2010-01-01

    Study Design Retrospective study. Purpose To evaluate the relationship between a new osteoporotic vertebral fracture and instrumented lumbar arthrodesis. Overview of Literature In contrast to the growing recognition of the importance of adjacent segment disease after lumbar arthrodesis, relatively little attention has been paid to the relationship between osteoporotic vertebral fractures and instrumented lumbar arthrodesis. Methods Twenty five patients with a thoracolumbar vertebral fracture ...

  4. Laparoscopic lumbar hernia repair in a child with lumbocostovertebral syndrome.

    Science.gov (United States)

    Jones, Sarah L; Thomas, Iona; Hamill, James

    2010-02-01

    Lumbocostovertebral syndrome is the association of a congenital lumbar hernia with rib and vertebral anomalies. We report the first case of a laparoscopic repair of a lumbar hernia in a child with lumbocostovertebral syndrome. Laparoscopic lumbar hernia repair appears to be safe and feasible in children.

  5. Lumbar posture and muscular activity while sitting during office work.

    Science.gov (United States)

    Mörl, Falk; Bradl, Ingo

    2013-04-01

    Field study, cross-sectional study to measure the posture and sEMG of the lumbar spine during office work for a better understanding of the lumbar spine within such conditions. There is high incidence of low back pain in office workers. Currently there is little information about lumbar posture and the activity of lumbar muscles during extended office work. Thirteen volunteers were examined for around 2h of their normal office work. Typical tasks were documented and synchronised to a portable long term measuring device for sEMG and posture examination. The correlation of lumbar spine posture and sEMG was tested statistically. The majority of time spent in office work was sedentary (82%). Only 5% of the measured time was undertaken in erect body position (standing or walking). The sEMG of the lumbar muscles under investigation was task dependent. A strong relation to lumbar spine posture was found within each task. The more the lumbar spine was flexed, the less there was activation of lumbar muscles (P postures. Because of very low activation of lumbar muscles while sitting, the load is transmitted by passive structures like ligaments and intervertebral discs. Due to the viscoelasticity of passive structures and low activation of lumbar muscles, the lumbar spine may incline into de-conditioning. This may be a reason for low back pain. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Lumbar degenerative kyphosis: radiologic analysis and classifications.

    Science.gov (United States)

    Jang, Jee-Soo; Lee, Sang-Ho; Min, Jun-Hong; Han, Kyoung-Mi

    2007-11-15

    Retrospective study of a consecutive patient series. To review the radiographic classification of patients with sagittal imbalance due to lumbar degenerative kyphosis (LDK) and to determine correlation between thoracic and lumbar curve. Lumbar degenerative kyphosis is one of the common spinal deformities in Asian countries, especially Korea and Japan. However, there have been few studies regarding the classification and treatment of this disease. Seventy-eight patients with LDK were analyzed and classified according to the standing lateral whole spine findings. Total lumbar lordosis (L1-S1), thoracic kyphosis (T5-T12), sacral slope, thoracolumbar angle (T11-L1), and sagittal vertical axis (SVA) were measured on the lateral view of the whole spine. Spinal curve deformities were classified into 2 groups according to the thoracolumbar (T-L) junction angle: flat or lordotic angle (Group 1; N = 53) and kyphotic angle (Group 2; N = 25). In Group 1, significant correlations between the thoracic and lumbar curves (r = 0.772, P sagittal thoracic compensated group. In contrast, In Group 2, no correlation was found between the thoracic and lumbar curves in the decompensated group (r = 0.179, P = 0.391), but we found a significant correlation between lordosis and sacral slope (r = 0.442, P = 0.027). By this result, Group 2 was classified as sagittal thoracic decompensated group. There was significant difference in SVA between 2 groups (P = 0.020). The angle of the thoracolumbar junction is an important parameter in determining whether a sagittal thoracic compensatory mechanism exists in LDK. We assumed that existence of a compensatory mechanism in the proximal spine is central to the determination of the fusion levels in the treatment of LDK.

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

    OpenAIRE

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

    2015-01-01

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

  8. Comparison of electromyographic activities of lumbar iliocostalis and lumbar multifidus muscles during stabilization exercises in prone, quadruped, and sitting positions

    OpenAIRE

    Kelly, Marie; Jacobs, Dee; Wooten, Mary E.; Edeer, Ayse Ozcan

    2016-01-01

    [Purpose] The purposes of this study were: 1) describe a hierarchy of electromyographic activity production, using percentage maximum voluntary contraction of lumbar iliocostalis and lumbar multifidus muscles during prone, quadruped and sitting exercises; and 2) identify optimal recruitment exercises for both lumbar iliocostalis as a global multi-segmental stabilizer and lumbar multifidus as a segmental stabilizer. [Subjects] Twelve healthy volunteers (six male and six female) aged 24 to 45 p...

  9. 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...

  10. Mini-open anterior lumbar interbody fusion.

    Science.gov (United States)

    Gandhoke, Gurpreet S; Ricks, Christian; Tempel, Zachary; Zuckerbraun, Brian; Hamilton, D Kojo; Okonkwo, David O; Kanter, Adam S

    2016-07-01

    In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure. The video can be found here: https://youtu.be/r3bC4_vu1hQ .

  11. Lumbar vertebral pedicles: radiologic anatomy and pathology

    Energy Technology Data Exchange (ETDEWEB)

    Patel, N.P.; Kumar, R.; Kinkhabwala, M.; Wengrover, S.I.

    1988-01-01

    With the advancement of high-resolution computed tomography (CT) scanning the spine has added new knowledge to the various conditions affecting the pedicles. We wish to review the entire spectrum of pedicular lesions: the embryology, normal anatomy, normal variants, pitfalls, congenital anomalies, and pathological conditions are discussed. Different imaging modalities involving CT, isotope bone scanning, and Magnetic Resonance Imaging (MRI) are used to complement plain films of the lumbar spine. This subject review is an excellent source for future reference to lumbar pedicular lesions. 27 references.

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

    National Research Council Canada - National Science Library

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

    ..., 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...

  13. Lymphocoele: a rare and little known complication of anterior lumbar surgery.

    Science.gov (United States)

    Schizas, Constantin; Foko'o, Noël; Matter, Maurice; Romy, Sebastien; Munting, Everard

    2009-07-01

    Lymphocoele is a rare and little known complication with only a handful of reports available. We report two cases of lymphocoele after anterior lumbar surgery that have occurred in two different centres and discuss diagnosis and management options. The first case is that of a 53-year-old male patient undergoing two level anterior lumbar interbody fusion (ALIF) for disabling back pain due to disc degeneration in the context of an old spondylodiscitis. He developed a large fluid mass postoperatively. Fluid levels of creatinin were low and intravenous urography ruled out a urinoma suggesting the diagnosis of a lymphocoele. Following two unsuccessful drainage attempts he underwent a laparoscopic marsupialization. The second case was that of a 32-year-old female patient developing a large fluid mass following a L5 corpectomy for a burst fracture. She was treated successfully with insertion of a vacuum drain during 7 days. Lymphocoele is a rare complication but should be suspected if fluid collects postoperatively following anterior lumbar spine procedures. Chemical analysis of the fluid can help in diagnosis. Modern treatment consists of laparoscopic marsupialization. Lymph vessel anatomy should be borne in mind while exposing the anterior lumbar spine.

  14. [Relationship between lumbosacral multifidus muscle and lumbar disc herniation].

    Science.gov (United States)

    Chen, Wei-ye; Wang, Kuan; Yuan, Wei-an; Zhan, Hong-sheng

    2016-06-01

    As a common disease in clinical, the treatment of lumbar disc herniation (LDH) focused on local intervertebral disc, such as surgery and other interventional therapy treatment, but postoperative complications and recurrence rate has been a difficult problem in the field of profession. With the development of spine biomechanics and anatomy, researches on lumbar herniation also increased. Researchers discovered that the incidence and prognosis of LDH were inseparable with local muscle and soft tissue. As the deep paraspinal muscles, multifidus muscle plays an important role to make lumbar stability. Its abnormal function could reduce the stable of lumbar spine, and the chronic lumbar disease could also lead to multifidus muscle atrophy.

  15. Percutaneous fusion of lumbar facet with bone allograft

    Directory of Open Access Journals (Sweden)

    Félix Dolorit Verdecia

    2015-03-01

    Full Text Available OBJECTIVE: To assess the evolution of the cases treated with percutaneous facet fusion with bone allograft in lumbar facet disease. METHOD: Between 2010 and 2014, 100 patients (59 women and 41 men diagnosed with lumbar facet disease underwent surgery. RESULTS: The lumbar facet fusion with bone allograft shows good clinical results, is performed on an outpatient basis, and presents minimal complications and rapid incorporation of the patient to the activities of daily living. CONCLUSIONS: The lumbar facet fusion with bone allograft appears to be an effective treatment for lumbar facet disease.

  16. Congenital lumbar hernia associated to lumbar costovertebral syndrome. A case report.

    Directory of Open Access Journals (Sweden)

    Zoe Quintero Delgado

    2005-11-01

    Full Text Available Reported the case of a born patient of color of white skin, 6 years old, of pregnancy and normal childbirth that it was valued in the Service of Surgery of the Pediatric Hospital ¨Paquito González Cueto¨ because it presented increase of volume in both lumbar regions, without another associate sintomatology. Congenital bilateral lumbar hernia associated to syndrome lumbocostovertebral, strange affection in the pediatric age.

  17. Effect of pelvic tilt on lumbar spine geometry.

    Science.gov (United States)

    Delisle, A; Gagnon, M; Sicard, C

    1997-12-01

    The purpose of this study was to use a noninvasive method to determine the effect of pelvic tilt on the lumbar spine geometry in the sagittal plane. Five healthy male subjects were instructed in performing active forward and backward pelvic tilt manoeuvres in the standing position. The lumbar spine geometry (severity of lordosis, pelvis and lumbar vertebrae orientations) was estimated with a lumbar spine geometric model. The voluntary backward pelvic tilt succeeded in reducing the depth of the lumbar spine curvature, but the forward tilt did not change it. Both pelvic tilt manoeuvres influenced the absolute orientations of the lower lumbar vertebrae and the relative orientations of some lumbar vertebrae. Interestingly, the L5/S1 joint showed was little affected by the pelvic tilt manoeuvres.

  18. Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation.

    Science.gov (United States)

    Ozturk, Bulent; Gunduz, Osman Hakan; Ozoran, Kursat; Bostanoglu, Sevinc

    2006-05-01

    We investigated the effects of continuous lumbar traction in patients with lumbar disc herniation on clinical findings, and size of the herniated disc measured by computed tomography (CT). In this prospective, randomized, controlled study, 46 patients with lumbar disc herniation were included, and randomized into two groups as the traction group (24 patients), and the control group (22 patients). The traction group was given a physical therapy program and continuous lumbar traction. The control group was given the same physical therapy program without traction, for the same duration of time. Data for the clinical symptoms and signs were collected before and after the treatment together with calculation of a herniation index, from the CT images that showed the size of the herniated disc material. In the traction group, most of the clinical findings significantly improved with treatment. Size of the herniated disc material in CT decreased significantly only in the traction group. In the traction group the herniation index decreased from 276.6+/-129.6 to 212.5+/-84.3 with treatment (p0.05). Patients with greater herniations tended to respond better to traction. In conclusion, lumbar traction is both effective in improving symptoms and clinical findings in patients with lumbar disc herniation and also in decreasing the size of the herniated disc material as measured by CT.

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

    Institute of Scientific and Technical Information of China (English)

    Fan Yuan-zhi; Wu Yao-chi

    2014-01-01

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

  20. Lumbar Puncture for First Simple Febrile Seizure

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-01-01

    Full Text Available Compliance with American Academy of Pediatrics consensus statement recommendations regarding lumbar puncture for infants 6-18 months of age with a first simple febrile seizure was investigated by a retrospective review of 704 infants evaluated in the pediatric emergency medicine division at Children’s Hospital Boston, MA, Oct 1995-Oct 2006.

  1. Multiple lumbar arachnoid cysts. Case report.

    Science.gov (United States)

    Pappalardo, S; Cassarino, A; Braidotti, P

    1986-09-01

    Arachnoid cysts are a rare cause of compression of the contents of the lumbar spinal canal; in the literature only about 100 cases are reported. The various methods of diagnosis are discussed in the light of a recent case observed by the authors.

  2. FUNCTIONAL PATHOLOGY OF LUMBAR SPINAL STENOSIS

    NARCIS (Netherlands)

    PENNING, L

    1992-01-01

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

  3. A case of inferior lumbar hernia

    Directory of Open Access Journals (Sweden)

    Vidhyasagar M. Sharma

    2013-02-01

    Full Text Available In this article we report a case of inferior lumbar hernia. The patient underwent preperitoneal meshplasty. The patient is well on follow up with no recurrence. The relevant literature has been reviewed and management discussed in brief. [Int J Res Med Sci 2013; 1(1.000: 33-35

  4. 经单孔胸腔镜手术治疗手汗症%Thoracoscopic sympathectomy through single operation hole for palmar hyperhidrosis

    Institute of Scientific and Technical Information of China (English)

    熊健宪; 赖政洪; 肖骏琦; 罗志方; 李章红

    2011-01-01

    [ Objective ] The aim of this study was to evaluate the safety and efficiency of the surgical technique of thoracoscopic sympathectomy to destroy the thoracic sympathetic ganglia from singe Operation hole for Palmar hyperhidrosis. [Methods] From 2006 to June 2010, 74 patiens suffering from palmar hyperhidrosis underwent video-assisted thoracoscopic sympathectomy under general anesthesia using a double-lumen endotracheal tube. The light pole and coagulation bar were used through singe operation hole. [ Results ] The symptoms disappeared completely in all patients immediately after operation. There were no patients with Honer's syndrome and deaths. The average operation time(both side) was (38.52+9.24) min. The mean follow-up was 16 months (range: 8 to 24 months). There were no recurrence cases. [Conclusions] Thoracoscopic sympathectomy through singe operation hole is a simple, effective and safe minimally invasive treatment for palmar hyperhidrosis.%目的 评价经单孔胸腔镜胸交感神经链切除术治疗手汗症的安全性和有效性.方法 自2006年~2010年6月,74倒手汗症患者采用双腔气管插管全麻,在电视胸腔镜下,光源杆及电凝棒经胸壁单孔操作,行双侧胸交感神经切断术治疗手汗症.结果 74例患者术后手掌多汗症状消失,无Honer's综合征及死亡病例.平均手术时间(38.52±9.24)rnin,随访8~24个月,无病例复发.结论 经单孔腔镜胸胸交感神经节切除是一种简单、安全有效的治疗手汗症的微创手术.

  5. 腋下单孔交感链切断术治疗手汗症%Transaxillary uniportal thoracoscopic sympathectomy in treatment of palmar hyperhidrosis

    Institute of Scientific and Technical Information of China (English)

    徐沁孜; 孙威; 付向宁; 汤应雄

    2011-01-01

    目的 探讨胸腔镜经腋下单孔T、T交感神经链切断术治疗手汗症的治疗效果和技术要点.方法 2008年5月至2010年8月采用胸腔镜经腋下单孔T、T交感神经链切断术治疗手汗症患者36例,通过分析临床指标,评价该术式的有效性、安全性.结果 均通过腋下单孔完成手术,无延长及增加切口者.术后单侧气胸1例,无Horne's综合征及其他严重并发症.36例手汗症状均完全缓解,轻度代偿性多汗13例(36.1%),中度2例(5.56%),无重度代偿性多汗.结论 胸腔镜经腋下单孔T、T交感链切断术治疗手汗症是一种安全、有效、微创的手术方式.%Objective To discuss the clinical efficacy, complications and technical points of transaxillary uniportal T3 ,T4 thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis. Methods The clinical data of 16 patients, who underwent transaxillary uniportal T3, T4 thoracoscopy sympathectomy from May 2008 to March 2010,were studied to assess the efficacy and safety of this procedure.Results The transaxillary uniportal thoracoscopy sypathectomy was performed uneventfully in all patients. No extended or extra incisions were done. One had unilateral pneumothorax postoperatively. Symptoms of palmar hyperhidrosis of all 16 patients were totally relieved with no Homer' s syndrome or other severe complications. Mild compensatory sweating appeared in 13 (36. 1% ), moderate in 2 (5.56%), and severe in none. Conclusion Transaxillary uniportal T3, T4 thoracoscopic sympathectomy is a safe, effective, minimally invasive procedure in the treatment of palmar hyperhidrosis.

  6. Problems of posterior lumbar interbody fusion (PLIF) for the rheumatoid spondylitis of the lumbar spine.

    Science.gov (United States)

    Inaoka, Masahiro; Tada, Koichi; Yonenobu, Kazuo

    2002-03-01

    We performed posterior lumbar interbody fusion (PLIF) on 7 patients with rheumatoid spondylitis (RA) of the lumbar spine with severe low-back pain and/or cauda equina symptoms, and evaluated the effectiveness of PLIF for the lumbar spinal instability in RA secondary to destruction of the anterior elements, including vertebral endplates and the apophyseal joint. The subjects were 7 patients with classic RA, 2 men and 5 women, mean age 65 years old, and the mean duration of RA was 21 years. All had severe low-back pain and difficulty with walking. According to the ARA classification, the patients were at stage 3 or worse and in class 3. Diagnostic imaging including magnetic resonance imaging (MRI), tomography, myelography, and computed tomographic myelography (CTM) of the lumbar spine clearly delineated pathology, destruction of the vertebral endplate, subluxation, and cauda compression which can be well treated with PLIF. We performed L4/5PLIF (5 cases), L3/4 and L4/5 PLIF (2 cases), and posterior fixation with instruments for anterior column repair and stabilization and posterior decompression. Autografts (all cases) and Brantigan IF cage (2 cases) were used. Stable fixation of the lumbar spine was achieved after surgery, and improvement in gait and activities of daily living were achieved through the relief of low-back pain and radicular pain; the mean duration of follow-up was 22 months. Postoperative, plain radiography, CT, and MRI revealed the enlargement of the lumbar canal and fusion and incorporation of grafted bone, but in some cases, collapse of graft, migration of pedicle screw, instability of adjacent level, and collapse of adjacent vertebra were noted. PLIF with spinal instruments is a preferred treatment for rheumatoid spondylitis of the lumbar spine, but in the mutilating type of RA with severe osteoporosis, PLIF in combination with a long fixation system and/or augmentation of the vertebral bodies might be needed.

  7. Transumbilical thoracic sympathectomy for hyperhidrosis: one year follow-up%经脐胸交感神经切断术1年随访

    Institute of Scientific and Technical Information of China (English)

    杨胜生; 朱立桓; 陈龙; 张吉学; 刘道明; 冯学刚; 程先进; 李达周; 陈炜生

    2013-01-01

    Objective To summarize the one year follow-up clinical result of patients undergoing endoscopic transumbilical thoracic sympathectomy and to assess the related factors influencing the outcome.Methods A total of 38 patients (17 males,22 females) with a mean age of 22 years old underweut transumbilical thoracic sympathectomy from April 2010 to August 2011.Of these,16 patients suffered concomitant palmar and axillary hyperhidrosis and 22 palmar hyperhydrosis alone.The following parameters were evaluated:clinical improvement,satisfaction,changes in quality of life,and compensatory sweating and gustatory sweating.Results The operation was aceomplished successfully in all 38 patents with a mean operation time of 47 min (40-86 min).35 patients were followed up for 1.0-1.6years (mean 1.2 years).The rate of palmar hyperhidrosis (PH) and axillary hyperhidrosis (AH) resolution was 100% and 81.3%,respectively,and recurred in 1 patient.Postoperative complications were noticed in 12 patients,including compensatory sweating in 10 cases and pneomothorax in 2 cases.The post-operative pain lasts less than 2 days in all patients.There was no Horner syndrome and no diaphragmatic hernia was observed.Conclusion Endoscopic transumbilical thoracic sympathectomy is a safe and efficacious alternative to the conventional approach.%目的 回顾性总结经脐胸交感神经切断术(transumbilical thoracic sympathectomy,TTS)1年随访结果,评估采用TTS技术的手术效果.方法 2010年4月至2011年8月,38例手汗症患者接受经脐胸交感神经切断术,男17例,女21例;年龄14 ~35岁,平均22岁.单纯手汗22例,手汗合并腋汗16例.从治愈率、疼痛持续时间、术后满意率以及并发症发生率等方面进行随访.结果 38例手术均成功完成,手术40 ~86 min,平均47 min;术中无严重并发症发生.35例随访1.0~1.6年,平均1,2年.所有手汗症均达到临床治愈,腋汗治愈率81.3%(13/16例),总复发1例(2.9%);代偿性出汗10

  8. The Effect of an Adjustable Hinged Operating Table on Lumbar Lordosis during Lumbar Surgery.

    Science.gov (United States)

    Sebastian, Arjun; Ahmed, Amin; Vernon, Brian; Nguyen, Emily C; Aleem, Ilyas; Clarke, Michelle J; Currier, Bradford L; Anderson, Paul; Bydon, Mohamad; Nassr, Ahmad

    2017-07-24

    Prospective observational study OBJECTIVES.: Quantify the amount of lumbar lordosis achieved on a hinged operative table in neutral, flexion, and extension. Hinged operative tables may allow surgeons to adjust lumbar spine positioning intraoperatively. The amount of lumbar lordosis in neutral, flexion, and extension positions has not been quantified prospectively using a hinged table. Thirty patients undergoing elective lumbar surgery were enrolled. Standing x-rays taken in neutral, maximal flexion, and maximal extension were obtained. Following prone positioning on a hinged operative table, x-rays in neutral, maximal flexion, and maximal extension were taken. Total lumbar lordosis was calculated for all 6 images by two physicians. Disc degeneration was graded using Pfirrmann grades. Lumbar lordosis on the operative table was 56.5 ± 2.1, 43.6 ± 2.2, 63.2 ± 2.0 compared to 46.9 ± 3.1, 33.2 ± 2.8, 52.3 ± 3.3 on the standing films in neutral, flexion, and extension respectively. Average flexion (12.9 ± 1.1) and extension (6.7 ± 1.2) were significantly different from neutral on the table (p < .001). Lumbar lordosis was significantly higher on the operative table (p < .001). Total range of motion was 19.6 ± 1.9 on the table and 19.1 ± 2.0 with standing (p = 0.42). Average Pfirrmann disc grade was 2.77 ± 0.10 which did not correlate with range of motion (p = 0.40). In this cohort, the hinged operative table allowed for a physiologic arc of motion of nearly 20 from flexion to extension. A considerable amount of lumbar sagittal motion can be obtained on hinged operative tables without decreasing overall lumbar lordosis below physiologic levels. 3.

  9. Plasticity of autonomic nerves: differential effects of long-term guanethidine sympathectomy on the sensory innervation of the rat uterus during maturation.

    Science.gov (United States)

    Brauer, M M; Lincoln, J; Milner, P; Sarner, S; Blundell, D; Passaro, M; Corbacho, A; Burnstock, G

    1994-10-01

    The sensory nerves, containing substance P and calcitonin gene-related peptide, and noradrenaline-containing sympathetic nerves of the rat uterus were analyzed following long-term sympathectomy with guanethidine in prepubertal (four weeks), young adult (eight weeks) and fully adult animals (18 weeks). Immunohistochemical and histochemical methods were used in association with nerve density measurements and biochemical assays. The main findings were as follows: (1) long-term guanethidine treatment completely abolished the noradrenergic innervation of the uterine horn and parametrial tissue and markedly reduced the tissue levels of noradrenaline in both regions at the three ages analysed; (2) in the uterine horn guanethidine treatment had no effect on the tissue levels of either calcitonin gene-related peptide or substance P or on the density of calcitonin gene-related peptide-containing nerves, at any of the three ages studied; (3) in the parametrial tissue increased levels of calcitonin gene-related peptide were observed at 8 and 18 weeks of age, together with a significant increase in the density of calcitonin gene-related peptide-containing nerves. Substance P levels showed a transient increase in this tissue at eight weeks. In conclusion, long-term sympathectomy with guanethidine resulted in an increase in calcitonin gene-related peptide and substance P in sensory nerves in the parametrial tissue, but not in the uterine horn. The changes in the parametrial tissue only occurred after puberty. It is suggested that sensory nerves in the uterine horn may be less responsive to sympathetic denervation since loss of sympathetic nerves occurs as part of a normal physiological process during pregnancy in this region.

  10. Effects of lumbar stabilization exercise on functional disability and lumbar lordosis angle in patients with chronic low back pain.

    Science.gov (United States)

    Cho, Igsoo; Jeon, Chunbae; Lee, Sangyong; Lee, Daehee; Hwangbo, Gak

    2015-06-01

    [Purpose] This study examined the effects of lumbar stabilization exercises on the functional disability and lumbar lordosis angles in patients with chronic low back pain. [Subjects] The subjects were 30 patients with chronic low back pain divided into a lumbar stabilization exercise group (n = 15) and a conservative treatment group (n = 15). [Methods] The lumbar stabilization exercise and conservative treatment groups performed an exercise program and conservative physical treatment, respectively. Both programs were performed 3 times a week for 6 weeks. The degree of functional disability was assessed by the Oswestry disability index, and lumbar lordosis angles were measured by plain radiography. [Results] The Oswestry disability index decreased significantly in the both groups; however, it was significantly lower in the lumbar stabilization exercise group. The lumbar lordosis angle increased significantly in the lumbar stabilization exercise group after treatment and was also significantly greater than that in the conservative treatment group. [Conclusion] Lumbar stabilization exercise is more effective than conservative treatment for improving functional disability and lumbar lordosis angles.

  11. Changes in bending stiffness and lumbar spine range of movement following lumbar mobilization and manipulation.

    Science.gov (United States)

    Stamos-Papastamos, Nikolaos; Petty, Nicola J; Williams, Jonathan M

    2011-01-01

    The purpose of this study was to investigate the effects of lumbar rotational manipulation and lumbar central posteroanterior mobilization on lumbar bending stiffness and flexion and extension range of motion (ROM). A same-subject, repeated-measures, crossover design was used using 32 asymptomatic subjects (16 female and 16 male; mean [SD] age, 25.5 [4.5] years; weight, 65.7 [11.8] kg; and height, 1.70 [0.08] m). Each subject received mobilization or manipulation on 2 different occasions. Bending stiffness was calculated using a 3-point bending model using an electromagnetic tracking device and a force platform; lumbar flexion and extension ROM was measured using an electromagnetic tracking device. All variables were measured pre- and postintervention. Their effect was compared using paired t tests. Manipulation and mobilization did not significantly alter either bending stiffness or lumbar flexion and extension ROM (mobilization: P = .175, P = .613, and P = .535; manipulation: P = .973, P = .323, and P = .439). Bending stiffness changes were not correlated to changes in ROM (Pearson r for stiffness-flexion = -0.102, P = .586; Pearson r for stiffness-extension = 0.014, P = .941). Manipulation and mobilization had no significant effect on bending stiffness or flexion and extension ROM for this group of subjects. Some individual variations in effect were observed. Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-12-01

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

  13. Oriental Medical Treatment of Lumbar Spinal Stenosis

    Directory of Open Access Journals (Sweden)

    Hae-Yeon Lee

    2003-12-01

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

  14. Hemophilic pseudotumor of the first lumbar vertebra

    Directory of Open Access Journals (Sweden)

    Gurusamy Nachimuthu

    2014-01-01

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

  15. [Idiopathic Lumbar Hernia: A Case Report].

    Science.gov (United States)

    Tsujino, Takuya; Inamoto, Teruo; Matsunaga, Tomohisa; Uchimoto, Taizo; Saito, Kenkichi; Takai, Tomoaki; Minami, Koichiro; Takahara, Kiyoshi; Nomi, Hayahito; Azuma, Haruhito

    2015-11-01

    A 68-year-old woman, complained of an indolent lump about 60 × 70 mm in size in the left lower back. We conducted a computed tomography scan, which exhibited a hernia of Gerota'sfascia-commonly called superior lumbar hernia. In the right lateral position, the hernia contents were observed to attenuate, hence only closure of the hernial orifice was conducted by using Kugel patch, without removal of the hernia sack. Six months after the surgery, she has had no relapse of the hernia. Superior lumbar hernia, which occurs in an anatomically brittle region in the lower back, is a rare and potentially serious disease. The urologic surgeon should bear in mind this rarely seen entity.

  16. Laparoscopic transabdominal extraperitoneal repair of lumbar hernia

    Directory of Open Access Journals (Sweden)

    Sharma A

    2005-01-01

    Full Text Available Lumbar hernias need to be repaired due to the risk of incarceration and strangulation. A laparoscopic intraperitoneal approach in the modified flank position causes the intraperitoneal viscera to be displaced medially away from the hernia. The creation of a wide peritoneal flap around the hernial defect helps in mobilization of the colon, increased length of margin is available for coverage of mesh and more importantly for secure fixation of the mesh under vision to the underlying fascia. Laparoscopic lumbar hernia repair by this technique is a tensionless repair that diffuses total intra-abdominal pressure on each square inch of implanted mesh. The technique follows current principles of hernia repair and appears to confer all benefits of a minimal access approach.

  17. Single incision endoscopic surgery for lumbar hernia.

    Science.gov (United States)

    Kawaguchi, Masahiko; Ishikawa, Norihiko; Shimizu, Satsuki; Shin, Hisato; Matsunoki, Aika; Watanabe, Go

    2011-01-01

    Single Incision Endoscopic Surgery (SIES) has emerged as a less invasive surgery among laparoscopic surgeries, and this approach for incisional hernia was reported recently. This is the first report of SIES for an incisional lumbar hernia. A 66-year-old Japanese woman was referred to our institution because of a left flank hernia that developed after left iliac crest bone harvesting. A 20-mm incision was created on the left side of the umbilicus and all three trocars (12, 5, and 5 mm) were inserted into the incision. The hernial defect was 14 × 9 cm and was repaired with intraperitoneal onlay mesh and a prosthetic graft. The postoperative course was uneventful. SIES for lumbar hernia offers a safe and effective outcome equivalent compared to laparoscopic surgery. In addition, SIES is less invasive and has a cosmetic benefit.

  18. Costs and effects in lumbar spinal fusion

    DEFF Research Database (Denmark)

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

    2007-01-01

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

  19. Pedicular stress fracture in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Chong, V.F.H.; Htoo, M.M. [Singapore General Hospital, Singapore, (Singapore). Department of Diagnostic Radiology

    1997-08-01

    Spondylolisthesis with or without spondylolysis is common in the lumbar spine. Associated fracture in the pedicle (`pediculolysis`) is unusual. The margins of pedicular stress fractures, like spondylolysis, usually appear sclerotic. A patient with a pedicular stress fracture with minimal marginal sclerosis suggesting an injury of recent onset is presented here. There was associated bilateral spondylolysis. The findings in this patient suggest that established pediculolysis probably represents a stress fracture that has failed to heal. (authors). 10 refs., 2 figs.

  20. Synovial chondromatosis in a lumbar apophyseal joint

    Energy Technology Data Exchange (ETDEWEB)

    Burrafato, V.; Campanacci, D.A.; Capanna, R. [Department of Orthopedic Oncology, Centro Traumatologico Ortopedico, Florence (Italy); Franchi, A. [Institute of Pathology, University of Florence, Florence (Italy)

    1998-07-01

    A 31-year-old woman presented with painful swelling in the right paravertebral region that had been present for 2 years. Radiography and CT revealed an area of increased density due to multiple calcifications localized at the fourth lumbar vertebra. Histological examination revealed that the lesion consisted of nodules of hyaline cartilage, with focal areas of calcification, growing within synovial tissue. (orig.) With 5 figs., 11 refs.

  1. Lumbar discal cyst in an elite athlete.

    Science.gov (United States)

    Singleton, Alex; Agarwal, Vikas; Casagranda, Bethany; Hughes, Marion A; Rothfus, William E

    2013-01-01

    Our patient, a 22-year-old starting wide receiver for an NCAA Division I football team, presented with low back pain and sciatica. A lumbar-spine MRI without contrast demonstrated findings suspicious for discal cyst. The patient was referred for surgery, and the lesion was resected. The rarity of discal cyst makes it difficult to diagnose because most radiologists are not aware of the entity. An organized approach to diagnosis can facilitate appropriate management.

  2. Subarachnoid hemorrhage due to retained lumbar drain.

    Science.gov (United States)

    Guppy, Kern H; Silverthorn, James W; Akins, Paul T

    2011-12-01

    Intrathecal spinal catheters (lumbar drains) are indicated for several medical and surgical conditions. In neurosurgical procedures, they are used to reduce intracranial and intrathecal pressures by diverting CSF. They have also been placed for therapeutic access to administer drugs, and more recently, vascular surgeons have used them to improve spinal cord perfusion during the treatment of thoracic aortic aneurysms. Insertion of these lumbar drains is not without attendant complications. One complication is the shearing of the distal end of the catheter with a resultant retained fragment. The authors report the case of a 65-year-old man who presented with a subarachnoid hemorrhage due to the migration of a retained lumbar drain that sheared off during its removal. To the best of the authors' knowledge, this is the first case of rostral migration of a retained intrathecal catheter causing subarachnoid hemorrhage. The authors review the literature on retained intrathecal spinal catheters, and their findings support either early removal of easily accessible catheters or close monitoring with serial imaging.

  3. X-Ray parameters of lumbar spine

    Directory of Open Access Journals (Sweden)

    Otabek Ablyazov

    2012-05-01

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

  4. 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.

  5. The Neandertal vertebral column 2: The lumbar spine.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2014-05-01

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

  7. Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report.

    Science.gov (United States)

    Tamaki, Yasuaki; Sakai, Toshinori; Miyagi, Ryo; Nakagawa, Takefumi; Shimakawa, Tateaki; Sairyo, Koichi; Chikawa, Takashi

    2015-09-01

    A 64-year-old man was referred to the authors with low-back pain (LBP) and right leg pain with a history of previously diagnosed lumbar disc herniation (LDH) at L4-5. He had undergone 2 percutaneous endoscopic lumbar discectomies (PELDs) for the herniation at another institution, and according to the surgical record of the second surgery, a dural tear occurred intraoperatively but was not repaired. Postoperative conservative treatments such as an epidural block and blood patch had not relieved his persistent LBP or right leg pain. Upon referral to the authors, MRI and myelography revealed an intradural LDH. The herniated mass was removed by durotomy, and posterior lumbar interbody fusion was performed. His symptoms were partially improved after surgery. Primary suture is technically difficult when a dural tear occurs during PELD. Therefore, close attention should be paid to avoiding such tears, and surgeons should increase their awareness of intradural LDH as a possible postoperative complication of PELD.

  8. Lumbar hernia: surgical anatomy, embryology, and technique of repair.

    Science.gov (United States)

    Stamatiou, Dimitrios; Skandalakis, John E; Skandalakis, Lee J; Mirilas, Petros

    2009-03-01

    Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the posterolateral abdominal wall. Barbette was the first, in 1672, to suggest the existence of lumbar hernias. The first case was reported by Garangeot in 1731. Petit and Grynfeltt delineated the boundaries of the inferior and superior lumbar triangles in 1783 and 1866, respectively. These two anatomical sites account for about 95 per cent of lumbar hernias. Approximately 20 per cent of lumbar hernias are congenital. The rest are either primarily or secondarily acquired. The most common cause of primarily acquired lumbar hernias is increased intra-abdominal pressure. Secondarily acquired lumbar hernias are associated with prior surgical incisions, trauma, and abscess formation. During embryologic development, weakening of the area of the aponeuroses of the layered abdominal muscles that derive from somitic mesoderm, which invades the somatopleure, may potentially lead to lumbar hernias. Repair of lumbar hernias should be performed as early as possible to avoid incarceration and strangulation. The classic repair technique uses the open approach, where closure of the defect is performed either directly or using prosthetic mesh. The laparoscopic approach, either transabdominal or extraperitoneal, is an alternative.

  9. 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.

  10. Lumbar disk herniation surgery: outcome and predictors.

    Science.gov (United States)

    Sedighi, Mahsa; Haghnegahdar, Ali

    2014-12-01

    Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated

  11. Characterization of lumbar spinous process morphology: a cadaveric study of 2,955 human lumbar vertebrae.

    Science.gov (United States)

    Shaw, Jeremy D; Shaw, Daniel L; Cooperman, Daniel R; Eubanks, Jason D; Li, Ling; Kim, David H

    2015-07-01

    Despite the interest in lumbar spinous process (SP)-based surgical innovation, there are no large published studies that have characterized the morphometry of lumbar SPs. To provide accurate level-specific morphometric data with respect to human lumbar SPs using a human cadaveric lumbar spine model and to describe the morphometric variation of lumbar SPs with respect to gender, race, and age. An anatomic observational study. This study used 2,955 cadaveric lumbar vertebrae from 591 adult spines at the Hamann-Todd Human Osteological Collection. Specimens were aged 20 to 79 years. Each vertebra was photographed in standardized positions and measured using ImageJ software. Direct measurements were made for the SP length, width, height, slope, and caudal morphology. Gender, race, and age were recorded and analyzed. Spinous process length was 24.8±4.6 mm (L5) to 33.9±3.9 mm (L3). Effective length varied from 19.5±2.6 mm (L1) to 24.6±3.3 mm (L4). Height was shortest at L5 (18.2±2.7 mm). Caudal width was greater than the cranial width. Slope, caudal morphology, and radius measures showed large interspecimen variation. Slope at L5 was steeper than other levels (23.7°±10.5°, p<.0001). Most specimens demonstrated convex caudal morphology. L4 had the highest proportion of convexity (80.7%). L1 was the only level with predominantly concave morphology. Measurements for female SPs were smaller, but the slope was steeper. Anatomic and effective SP lengths were longer for specimens from white individuals. Specimens from black individuals had larger width and height, as well as steeper slope. Black specimens had more convex morphology at L4 and L5. With increasing age, the SP length, effective length, and width increased. Height increased with age only at L4 and L5. Slope and caudal radius of curvature decreased with age, and increasingly convex morphology was noted at most levels. This large cadaveric study provides level-specific morphometric data regarding the osseous

  12. Stabilization of lumbar-pelvic region in the syndrome of inespecific lumbar pain

    OpenAIRE

    Kock Schulz, Alejandro; Morales Osorio, Marco Antonio; Mejia Mejia, Johana Milena

    2013-01-01

    Objective. To learn about the various tissues which may contribute to stabilization of lumbar-pelvic region and integrate them to treatment of non-specific lumbar pain syndrome. Methodology. An electronic sear was carried out at PEDro, Cochrane, MEDLINE, CINAHL, EMBASE y  ScienceDirect data bases, of articles published between January 01, 1990, through December 31, 201. 105 potentially eligible articles were identified, selected in function of the title, and summary; 20 primary documents of w...

  13. Intrapleural analgesia after endoscopic thoracic sympathectomy Analgesia intrapleural após simpatectomia videotoracoscópica

    Directory of Open Access Journals (Sweden)

    Patrícia Gomes da Silva

    2011-12-01

    Full Text Available PURPOSE: To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS: Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS: In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION: Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.OBJETIVO: Comparar a analgesia tradicionalmente utilizada para simpatectomia videotoracoscópica à injeção intrapleural de ropivacaína em duas doses diferentes. MÉTODOS: Vinte e quatro pacientes foram distribuídos em três grupos semelhantes, e todos eles receberam dipirona endovenosa. O grupo A recebeu tramadol endovenoso e injeção intrapleural de solução salina. O grupo B recebeu injeção intrapleural de ropivacaína a 0,33%, e Grupo C ropivacaína a 0,5%. Os aspectos analisados foram: capacidade inspiratória, freqüência respiratória e dor. A dor foi avaliada no período pós-operatório por meio da escala visual analógica e durante o período de uma semana. RESULTADOS

  14. Combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis: indication and surgical outcomes

    OpenAIRE

    Hsieh, Ming-Kai; Chen, Lih-Huei; Niu, Chi-Chien; Fu, Tsai-Sheng; Lai, Po-Liang; Chen, Wen-Jer

    2015-01-01

    Background Traditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and posterior-only approaches. Most patients are treated with posterior-only approaches because the high complication rate of anterior approach. Our purpose is to compare and assess outcomes of combined anterior lumbar interbody fusion and instrumented posterolateral fusion with posterior alone approach for degenerative lumbar scoliosis with spinal stenosis. Methods...

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

    Science.gov (United States)

    Yang, Hae-Sun; Yoo, Won-Gyu

    2014-07-01

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

  16. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar surgery for adjacent segment degeneration and recurrent disc herniation.

    Science.gov (United States)

    Chen, Huan-Chieh; Lee, Chih-Hsun; Wei, Li; Lui, Tai-Ngar; Lin, Tien-Jen

    2015-01-01

    Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar surgery for patients with adjacent segment degeneration (ASD) and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients) or repeated open lumbar surgery (25 patients), due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and -0.56 in the open lumbar surgery group (P < 0.0001). Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort.

  17. Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Surgery for Adjacent Segment Degeneration and Recurrent Disc Herniation

    Directory of Open Access Journals (Sweden)

    Huan-Chieh Chen

    2015-01-01

    Full Text Available Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD and open lumbar surgery for patients with adjacent segment degeneration (ASD and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients or repeated open lumbar surgery (25 patients, due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery group P<0.0001. Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery group P<0.0001. Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and −0.56 in the open lumbar surgery group P<0.0001. Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort.

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

    OpenAIRE

    Yang, Hae-sun; Yoo, Won-gyu

    2014-01-01

    [Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4–5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4–5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4–5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale scores for stretchin...

  19. Functional aspects of strepsirrhine lumbar vertebral bodies and spinous processes.

    Science.gov (United States)

    Shapiro, Liza J; Simons, Cornelia V M

    2002-06-01

    The relationship between form and function in the lumbar vertebral column has been well documented among platyrrhines and especially catarrhines, while functional studies of postcranial morphology among strepsirrhines have concentrated predominantly on the limbs. This morphometric study investigates biomechanically relevant attributes of the lumbar vertebral morphology of 20 species of extant strepsirrhines. With this extensive sample, our goal is to address the influence of positional behavior on lumbar vertebral form while also assessing the effects of body size and phylogenetic history. The results reveal distinctions in lumbar vertebral morphology among strepsirrhines in functional association with their habitual postures and primary locomotor behaviors. In general, strepsirrhines that emphasize pronograde posture and quadrupedal locomotion combined with leaping (from a pronograde position) have the relatively longest lumbar regions and lumbar vertebral bodies, features promoting sagittal spinal flexibility. Indrids and galagonids that rely primarily on vertical clinging and leaping with orthograde posture share a relatively short (i.e., stable and resistant to bending) lumbar region, although the length of individual lumbar vertebral bodies varies phylogenetically and possibly allometrically. The other two vertical clingers and leapers, Hapalemur and Lepilemur, more closely resemble the pronograde, quadrupedal taxa. The specialized, suspensory lorids have relatively short lumbar regions as well, but the lengths of their lumbar regions are influenced by body size, and Arctocebus has dramatically longer vertebral bodies than do the other lorids. Lumbar morphology among galagonids appears to reflect a strong phylogenetic signal superimposed on a functional one. In general, relative length of the spinous processes follows a positively allometric trend, although lorids (especially the larger-bodied forms) have relatively short spinous processes for their body size

  20. 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

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

    Science.gov (United States)

    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.

  2. Endoscopic thoracic sympathectomy

    Science.gov (United States)

    ... much heavier than normal. This condition is called hyperhidrosis . Usually the surgery is used to treat sweating ... PA: Elsevier Saunders; 2011:chap 91. Langtry JAA. Hyperhidrosis. In: Lebwohl MG, Heymann WR, Berth-Jones J, ...

  3. [Cortical venous thrombosis after a diagnostic lumbar puncture].

    Science.gov (United States)

    Pfeilschifter, W; Neumann-Haefelin, T; Hattingen, E; Singer, O C

    2009-10-01

    We present the case of a 49-year-old female patient who underwent a lumbar puncture in the context of an extended diagnostic work-up after a transient ischemic attack. A few days later the patient who suffered from severe post-lumbar puncture headache, developed a lobar hemorrhage due to a cortical venous thrombosis requiring decompression surgery.

  4. Classification of the lumbar disc degeneration using MRI

    Energy Technology Data Exchange (ETDEWEB)

    Yoshida, Hirotoshi; Shinomiya, Kenichi; Okamoto, Akihiko; Muto, Naoko; Furuya, Kotaro (Tokyo Medical and Dental Univ. (Japan). School of Medicine)

    1992-11-01

    Magnetic resonance (MR) imaging has been performed in consecutive 114 patients with a chief complaint of lumbar pain. A retrospective review of MR images of a total of 570 lumbar vertebrae from these patients were done to examine lumbar disc degeneration. According to the MR intensity of nucleus pulposus on T2-wighted sagittal images, lumbar disc degeneration was graded on a scale of 0-4: 0=uniform hyperintensity; 1=slight hypointensity; 2=centrally band-like hypointensity with marginal hyperintensity; 3=irregular hypointensity in both the central and marginal sites; 4=uniform hypointensity. Lumbar disc degeneration was observed in 76%; and it was rapidly increased in frequency in the 30 or older age groups. Of 570 vertebrae, 51 (8.9%) had narrowing of intervertebral cavity. For these vertebrae, a mean score of lumbar disc degeneration was 3.1. Lumbar disc herniation was seen in 93 vertebrae, with a mean score of lumbar disc degeneration being 3.07. Changes in vertebral body marrow were seen in 14 vertebrae (2.5%), in which a mean score of intervertebral disc degeneration was 3.71. (N.K.).

  5. Radiographic Results of Minimally Invasive (MIS) Lumbar Interbody Fusion (LIF) Compared with Conventional Lumbar Interbody Fusion.

    Science.gov (United States)

    Lim, Jae Kwan; Kim, Sung Min

    2013-06-01

    To evaluate the radiographic results of minimally invasive (MIS) anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF). Twelve and nineteen patients who underwent MIS-ALIF, MIS-TLIF, respectively, from 2006 to 2008 were analyzed with a minimum 24-months' follow-up. Additionally, 18 patients treated with single level open TLIF surgery in 2007 were evaluated as a comparative group. X-rays and CT images were evaluated preoperatively, postoperatively, and at the final follow-up. Fusion and subsidence rates were determined, and radiographic parameters, including lumbar lordosis angle (LLA), fused segment angle (FSA), sacral slope angle (SSA), disc height (DH), and foraminal height (FH), were analyzed. These parameters were also compared between the open and MIS-TLIF groups. In the MIS interbody fusion group, statistically significant increases were observed in LLA, FSA, and DH and FH between preoperative and final values. The changes in LLA, FSA, and DH were significantly increased in the MIS-ALIF group compared with the MIS-TLIF group, but SSA and FH were not significantly different. No significant differences were seen between open and MIS-TLIF except for DH. The interbody subsidence and fusion rates of the MIS groups were 12.0±4% and 96%, respectively. Radiographic results of MIS interbody fusion surgery are as favorable as those with conventional surgery regarding fusion, restoration of disc height, foraminal height, and lumbar lordosis. MIS-ALIF is more effective than MIS-TLIF for intervertebral disc height restoration and lumbar lordosis.

  6. Correlation between severity of lumbar spinal stenosis and lumbar epidural steroid injection.

    Science.gov (United States)

    Park, Chan-Hong; Lee, Sang-Ho

    2014-04-01

    Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal that causes mechanical compression of the spinal nerve roots. The compression of these nerve roots can cause leg pain, as well as neurogenic claudication. Lumbar epidural steroid injections have commonly been used in patients with LSS. The aim of our study was to determine the relationship between the severity of LSS using a grading system (grade 1 = mild stenosis with separation of all cauda equina; grade 2 = moderate stenosis with some cauda equina aggregated; grade 3 = severe stenosis with none of the cauda equina separated) and the subject's response to computed tomography-guided lumbar epidural steroid injection (CTG-LESI) and to evaluate the short-term effectiveness. Forty-seven consecutive patients with degenerative LSS were enrolled in this prospective study. All subjects underwent lumbar spine magnetic resonance imaging. Two radiologists independently graded lumbar central canal stenosis based on T2-weighted axial images. All CTG-LESI were performed in the procedure room. Outcome measures were obtained using the 5-point patient's satisfaction scale at 2 and 8 weeks post-treatment. To evaluate the outcome, we divided the patients into two groups according to their response to the treatment. Improvement (including reports of slightly improved, much improved, and no pain) was observed in 37 patients (78.7%) at 2 weeks and 36 patients (77.6%) at 8 weeks after the procedure. There was no statistically significant correlation between pain relief and age. The grade of LSS appears to have no effect on the degree of pain relief associated with CTG-LESI. However, CTG-LESI seems to provide effective short-term pain relief due to LSS. Wiley Periodicals, Inc.

  7. Limbus lumbar and sacral vertebral fractures.

    Science.gov (United States)

    Mendez, Jorge S; Huete, Isidro L; Tagle, Patricio M

    2002-03-01

    We evaluated the fractures of the lumbar and sacral vertebral limbus by disc impingement at the peripheral ring apophysis in 23 adults associated with trauma in 16 of them. Lumbalgia, radicular pain and narrow canal symptoms are the presenting forms of this underdiagnosed pathology. CT is the best method of examination, while plain roentgenograms and MR are usually negative. Accurate diagnosis and surgical technique with larger exposure are needed to resect the fractured fragments and protruded disc material for decompressing the roots and the dural sac. Our results were very good on the majority of cases.

  8. Percutaneous treatment of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-12-31

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

  9. Sensitivity of lumbar spine loading to anatomical parameters

    DEFF Research Database (Denmark)

    Putzer, Michael; Ehrlich, Ingo; Rasmussen, John

    2016-01-01

    models for four different postures. The in uence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine were studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force......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...... were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most in uential. The results indicated that measuring these parameters from X-rays would be most important to morph an existing musculoskeletal...

  10. Chemoembolization for Hepatocellular Carcinoma Supplied by a Lumbar Artery

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Han Myun, E-mail: seoul49@naver.com [Hallym University College of Medicine, Department of Radiology, Kangnam Sacred Heart Hospital (Korea, Republic of); Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Woo, Sungmin, E-mail: j-crew7@hotmail.com [Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Department of Radiology (Korea, Republic of); Son, Kyu Ri, E-mail: kyurad@gmail.com [Korea University College of Medicine, Department of Radiology, Korea University Medical Center (Korea, Republic of); Cho, Seong Whi, E-mail: chosw@kangwon.ac.kr [Kangwon National University College of Medicine, Department of Radiology, Kangwon National University Hospital (Korea, Republic of); Chung, Jin Wook, E-mail: chungjw@snu.ac.kr [Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Department of Radiology (Korea, Republic of)

    2015-02-15

    PurposeTo describe the radiologic findings and imaging response of hepatocellular carcinoma (HCC) supplied by the lumbar artery.MethodsBetween April 2004 and December 2012, we encountered HCC supplied by a lumbar artery in 21 patients. Two investigators retrospectively reviewed clinical and radiological findings of HCC supplied by the lumbar artery using computed tomography (CT) scans and digital subtraction angiograms.ResultsPatients had received 1–27 sessions of previous chemoembolization procedures (mean 7.7 sessions, median 4 sessions). Mean tumor size was 5.3 cm. The locations of HCC supplied by lumbar artery were the bare area (n = 14, 67 %) and segment VI (n = 7, 33 %). Tumor-feeding arteries arose from the main lumbar artery (n = 7), proximal anterior division (n = 4), and distal anterior division (n = 14). In 20 patients, selective chemoembolization through the tumor-feeding arteries of the lumbar artery was achieved. In 1 patient, nonselective embolization at the main lumbar artery was performed. There was no complication such as skin necrosis or paralysis. On the first follow-up enhanced CT scan, target tumors fed by the lumbar artery showed complete response (n = 6), partial response (n = 4), stable disease (n = 3), and progressive disease (n = 8), but overall tumor response was partial response (n = 1) and progressive disease (n = 20).ConclusionWhen HCC is located in the inferior tip or bare area of the liver, a lumbar artery may supply the tumor. Although selective chemoembolization via the tumor-feeding vessel of the lumbar artery can be achieved in most cases, overall tumor response is commonly unfavorable.

  11. Computed Tomography of the lumbar facet joints

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-08-15

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

  12. The reasons for delay lumbar puncture

    Directory of Open Access Journals (Sweden)

    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.

  13. [Mechanical studies of lumbar interbody fusion implants].

    Science.gov (United States)

    Bader, R J; Steinhauser, E; Rechl, H; Mittelmeier, W; Bertagnoli, R; Gradinger, R

    2002-05-01

    In addition to autogenous or allogeneic bone grafts, fusion cages composed of metal or plastic are being used increasingly as spacers for interbody fusion of spinal segments. The goal of this study was the mechanical testing of carbon fiber reinforced plastic (CFRP) fusion cages used for anterior lumbar interbody fusion. With a special testing device according to American Society for Testing and Materials (ASTM) standards, the mechanical properties of the implants were determined under four different loading conditions. The implants (UNION cages, Medtronic Sofamor Danek) provide sufficient axial compression, shear, and torsional strength of the implant body. Ultimate axial compression load of the fins is less than the physiological compression loads at the lumbar spine. Therefore by means of an appropriate surgical technique parallel grooves have to be reamed into the endplates of the vertebral bodies according to the fin geometry. Thereby axial compression forces affect the implants body and the fins are protected from damaging loading. Using a supplementary anterior or posterior instrumentation, in vivo failure of the fins as a result of physiological shear and torsional spinal loads is unlikely. Due to specific complications related to autogenous or allogeneic bone grafts, fusion cages made of metal or carbon fiber reinforced plastic are an important alternative implant in interbody fusion.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-04-01

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

  15. 49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine, abdomen, and pelvis assembly and...) 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...

  16. Preliminary evaluation of posterior dynamic lumbar stabilization in lumbar degenerative disease in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    JIA Yu-hua; SUN Peng-fei

    2012-01-01

    Background There has been some controversy related to the use of the Wallis system,rather than disc fusion in the treatment of patients with degenerative spine disease.Furthermore,there are no reports concerning the application of this dynamic stabilization system in Chinese patients,who have a slightly different lifestyle with Western patients.The aim of this study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases in Chinese patients.Methods The clinical outcomes of 20 patients with lumbar degenerative disease treated by posterior decompression with the Wallis posterior dynamic lumbar stabilization implant were studied.All of the patients completed the visual analogue scale and the Chinese version of the Oswestry Disability Index.The following radiologic parameters were measured in all patients:global lordotic angles and segmental lordotic angles (stabilized segments,above and below adjacent segments).The range of motion was then calculated.Results Nineteen patients (95%) were available for follow-up.The mean follow-up period was (27.25±5.16) months (range 16-35 months).The visual analogue scale decreased from 8.55±1.21 to 2.20±1.70 (P <0.001),and the mean score on the Chinese version of the Oswestry Disability Index was improved from 79.58%±15.93% to 22.17%±17.24% (P <0.001).No significant changes were seen in the range of motion at the stabilized segments (P=0.502) and adjacent segments (above,P=0.453; below,P=0.062).The good to excellent result was 94.4% at the latest follow-up.No complications related to the use of the Wallis posterior dynamic lumbar stabilization occurred.Conclusions It was found to be both easy and safe to use the Wallis posterior dynamic lumbar stabilization implant in the treatment of degenerative lumbar disease,and the early therapeutic effectiveness is good.The Wallis system provides an alternative method for the treatment of lumbar degenerative

  17. Imaging Characterization Lumbar Disk Hernia in Operated patients.

    Directory of Open Access Journals (Sweden)

    Enrique Hernández Padrón

    2009-07-01

    Full Text Available Background: The details of lumbar disk hernia are specifically described in imaging studies, which leads to very specific diagnosis contributing to its appropriate treatment. Objective: To characterize through imaging studies the lumbar disk hernia in operated patients. Methods: Descriptive observational, correlational, retrospective study of a series of cases, carried out in the University Hospital “Dr. Gustavo Aldereguía Lima” of Cienfuegos, from 2000 to 2005, including all the patients who required imaging studies for a suspect of lumbar disk hernia, who received surgical treatment in that institution. The available imaging means were used: spine simple radiography in lumbar area, myelography and computerized axial tomography. Results: Males were more affected by lumbar disk hernia. The most common sings observed through spine simple radiography in lumbar area were: decrease of the intervertebral space and arthrosic changes in the vertebral bodies. Myelography was performed in six patients and three of them were positive. The most common kind of hernia according with their localization was the lateral, and according with the amount of herniated material, the protruded hernia. The most affected spaces were: L5- S1 and L4-L5. The patients of the third and fourth decade of life were the most affected, with a prevalence of the protruded hernia in the L5-S1 y L4 -L5 spaces. Conclusions: The imaging studies contributed to a correct characterization of lumbar disk hernia.

  18. FUNCTIONAL DISABILITY, SAGITTAL ALIGNMENT AND PELVIC BALANCE IN LUMBAR SPONDYLOLISTHESIS

    Directory of Open Access Journals (Sweden)

    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.

  19. [Enlargement in managment of lumbar spinal stenosis].

    Science.gov (United States)

    Steib, J P; Averous, C; Brinckert, D; Lang, G

    1996-05-01

    Lumbar stenosis has been well discussed recently, especially at the 64th French Orthopaedic Society (SOFCOT: July 1989). The results of different surgical treatments were considered as good, but the indications for surgical treatment were not clear cut. Laminectomy is not the only treatment of spinal stenosis. Laminectomy is an approach with its own rate of complications (dural tear, fibrosis, instability... ).Eight years ago, J. Sénégas described what he called the "recalibrage" (enlargement). His feeling was that, in the spinal canal, we can find two different AP diameters. The first one is a fixed constitutional AP diameter (FCAPD) at the cephalic part of the lamina. The second one is a mobile constitutional AP diameter (MCAPD) marked by the disc and the ligamentum flavum. This diameter is maximal in flexion, minimal in extension. The nerve root proceeds through the lateral part of the canal: first above, between the disc and the superior articular process, then below, in the lateral recess bordered by the pedicle, the vertebral body and the posterior articulation. With the degenerative change the disc space becomes shorter, the superior articular process is worn out with osteophytes. These degenerative events are complicated by inter vertebral instability increasing the stenosis. The idea of the "recalibrage" is to remove only the upper part of the lamina with the ligamentum flavum and to cut the hypertrophied anterior part of the articular process from inside. If needed the disc and other osteophytes are removed. The surgery is finished with a ligamentoplasty reducing the flexion and preventing the extension by a posterior wedge.Our experience in spine surgery especially in scoliosis surgery, showed us that it was possible to cure a radicular compression without opening the canal. The compression is then lifted by the 3D reduction and restoration of an anatomy as normal as possible. Lumbar stenosis is the consequence of a degenerative process. Indeed, hip

  20. Outcome of Percutaneous Lumbar Synovial Cyst Rupture in Patients with Lumbar Radiculopathy.

    Science.gov (United States)

    Eshraghi, Yashar; Desai, Vimal; Cajigal Cajigal, Calvin; Tabbaa, Kutaiba

    2016-01-01

    Lumbar synovial cysts can result from spondylosis of facet joints. These cysts can encroach on adjacent nerve roots, causing symptoms of radiculopathy. Currently the only definitive treatment for these symptoms is surgery, which may involve laminectomy or laminotomy, with or without spinal fusion. Surgery has been reported to successfully relieve radicular pain in 83.5% of patients by Zhenbo et al. Little information is available concerning the efficacy and outcome of percutaneous fluoroscopic synovial cyst rupture for treatment of facet joint synovial cysts. The goal of this investigation was to assess the efficacy of fluoroscopically guided lumbar synovial cyst rupture, in particular for its relief of radicular symptoms and its potential to reduce the need for surgical intervention. Retrospective evaluation of a case series. University hospital and urban public health care system. With approval from the Institutional Review Board of Case Western Reserve University/ MetroHealth Medical Center, we reviewed the medical charts of patients with lumbar radiculopathy who underwent percutaneous lumbar synovial cyst rupture. The 30 patients in the cohort were treated by one pain specialist between 2006 and 2013. These patients were diagnosed with moderate to severe lower back pain, radiculopathy, and ranged in age from 42 to 80 years. Patients were followed up for a minimum of 6 months and up to 24 months. Pre- and post-procedure pain assessments were reviewed by clinical chart review. In addition post-procedure pain assessments and duration of pain relief were obtained with telephone interviews. Pain had been reported by the patients using a numeric rating scale of 0 - 10 (0 = no pain; 10 = worst possible pain). Charts were reviewed to determine if surgery was eventually performed to correct radicular symptoms. More than 6 months of pain relief was achieved in 14/30 patients (46%) and between one and 6 months of pain relief was achieved in 7/30 patients (23.3%). Nine

  1. Direction of the formation of anterior lumbar vertebral osteophytes

    Directory of Open Access Journals (Sweden)

    Akeda Koji

    2009-01-01

    Full Text Available Abstract Background X-ray images of lumbar degenerative diseases often show not only claw osteophytes, but also pairs of osteophytes that form in a direction away from the adjacent disc. We have investigated the direction of the formation of anterior lumbar vertebral osteophytes across the lumbar vertebrae using a sufficient number of lumbar radiographs, because osteophytes images can provide essential information that will contribute to the understanding of the pathology and progress of lumbar spine degeneration. Methods The direction of the formation of 14,250 pairs of anterior lumbar vertebral osteophytes across the adjacent intervertebral discs in 2,850 patients who were all over 60 years old was investigated. Anterior lumbar vertebral osteophytes were distributed into six groups based on the direction of extension of each pair of osteophytes across the intervertebral disc space. Results In L1–L2 and L2–L3, the number of patients classified into groups B (the pair of osteophytes extended in the direction of the adjacent disc and C (almost complete bone bridge formation by a pair of osteophytes across the intervertebral disc space was larger than that classified into group D (the pair of osteophytes extended in a direction away from the adjacent disc. In L3–L4, L4–L5 and L5-S1, the number of patients in group D was greater than that of patients belonging to groups B and C. Conclusion Our study showed that pairs of osteophytes frequently formed in the direction of the adjacent disc in the upper lumbar vertebrae (L1–L2 and L2–L3 and in the direction away from the adjacent disc in middle or lower lumbar vertebrae (L3–L4, L4–L5, and L5-S1.

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

    Science.gov (United States)

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

    2014-01-01

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

  3. 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.

  4. Comparison of the Dynesys Dynamic Stabilization System and Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease.

    Directory of Open Access Journals (Sweden)

    Yang Zhang

    Full Text Available There have been few studies comparing the clinical and radiographic outcomes between the Dynesys dynamic stabilization system and posterior lumbar interbody fusion (PLIF. The objective of this study is to compare the clinical and radiographic outcomes of Dynesys and PLIF for lumbar degenerative disease.Of 96 patients with lumbar degenerative disease included in this retrospectively analysis, 46 were treated with the Dynesys system and 50 underwent PLIF from July 2008 to March 2011. Clinical and radiographic outcomes were evaluated. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD.The mean follow-up time in the Dynesys group was 53.6 ± 5.3 months, while that in the PLIF group was 55.2 ± 6.8 months. At the final follow-up, the Oswestry disability index and visual analogue scale score were significantly improved in both groups. The range of motion (ROM of stabilized segments in Dynesys group decreased from 7.1 ± 2.2° to 4.9 ± 2.2° (P < 0.05, while that of in PLIF group decreased from 7.3 ± 2.3° to 0° (P < 0.05. The ROM of the upper segments increased significantly in both groups at the final follow-up, the ROM was higher in the PLIF group. There were significantly more radiographic ASDs in the PLIF group than in the Dynesys group. The incidence of complications was comparable between groups.Both Dynesys and PLIF can improve the clinical outcomes for lumbar degenerative disease. Compared to PLIF, Dynesys stabilization partially preserves the ROM of the stabilized segments, limits hypermobility in the upper adjacent segment, and may prevent the occurrence of ASD.

  5. Long-term comparison of video-assisted thoracic sympathectomy and clinical observation for the treatment of palmar hyperhidrosis in children younger than 14.

    Science.gov (United States)

    Neves, Samantha; Uchoa, Patricia C; Wolosker, Nelson; Munia, Marco A; Kauffman, Paulo; de Campos, Jose Ribas M; Puech-Leão, Pedro

    2012-01-01

    The results of video-assisted thoracic sympathectomy (VATS)in children are unknown. To investigate the improvement in quality of life (QOL) of a group of 45 children who did and did not undergo VATS for the treatment of palmar hyperhidrosis (PH) 4 years after the initial evaluation. Forty-five children with PH were initially evaluated. Children were divided into two groups: 30 in the VATS group and 15 in the control group. We studied the evolution of PH, negative effect of hyperhidrosis on the QOL before the treatment, and improvement in QOL after treatment. Twenty-five patients (83.4%) in the VATS group experienced great improvement in PH, and five (16.6%) experienced partial improvement; 12 (80.0%) children from the control group had some type of improvement, and three (20.0%) had partial improvement. Two (13.3%) children in the control group and 23 (76.7%) in the VATS group had great improvement in QOL. For children with PH and poor QOL, VATS is better than no treatment. It produces better results with regard to sweating and greater improvement in QOL. © 2012 Wiley Periodicals, Inc.

  6. Factors affecting long-term satisfaction after thoracic sympathectomy for palmar and plantar hyperhidrosis. Is the sudomotor reflex the only villain?

    Science.gov (United States)

    de Lima, Alexandre Garcia; Das-Neves-Pereira, João-Carlos; de Campos, José Ribas Milanez; Jatene, Fabio Biscegli

    2011-04-01

    The main objective of this study was to determine if there are variations in the level of improvement of the palmar and plantar hyperhidrotic symptoms, as well as the incidence and intensity of the sudomotor reflex, throughout the seasons of the year, after thoracic sympathectomy for hyperhidrosis. The study also looks for the real impact of these variables in the long-term satisfaction. A cohort of 75 patients was followed through distinct seasons. A multivariate analysis was performed to identify possible variables responsible for dissatisfaction. Both the palmar (P=0.002) and plantar (P<0.001) symptoms and the presence and the intensity of the sudomotor reflex varies significantly throughout the seasons of the year. The sudomotor reflex was the main factor associated with low satisfaction in our patients in the summer (P=0.025) and winter (P<0.001) but in spring the lack of improvement in the hyperhidrosis in the foot was the unique factor related to dissatisfaction (P<0.001). The sudomotor reflex is the main negative factor in the summer and in the winter, independent of its intensity. However, at least in spring, the lack of removal of the plantar symptoms had a negative impact on satisfaction.

  7. MEDICINAL INJECTION FOR TREATMENT OF 54 CASES OF LUMBAR STRAIN

    Institute of Scientific and Technical Information of China (English)

    WANG Zhan-hui

    2006-01-01

    @@ Lumbar strain refers to the long-term accumulated mild injuries due to improper posture and overload in soft tissues, such as in lumbar sacral muscle, ligament and fascia. It happens generally at young age, is the common disorder in clinic and leads to quite inconvenience and pain in the life of patient. The author adopted medicinal injection with procaine and Vit. B1 on Tingyaoxue (挺腰穴) to treat 54 cases of lumbar strain and has achieved the remarkable effects. The report is presented as follows.

  8. 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

  9. A global CT to US registration of the lumbar spine

    Science.gov (United States)

    Nagpal, Simrin; Hacihaliloglu, Ilker; Ungi, Tamas; Rasoulian, Abtin; Osborn, Jill; Lessoway, Victoria A.; Rohling, Robert N.; Borschneck, Daniel P.; Abolmaesumi, Purang; Mousavi, Parvin

    2014-03-01

    During percutaneous lumbar spine needle interventions, alignment of the preoperative computed tomography (CT) with intraoperative ultrasound (US) can augment anatomical visualization for the clinician. We propose an approach to rigidly align CT and US data of the lumbar spine. The approach involves an intensity-based volume registration step, followed by a surface segmentation and a point-based registration of the entire lumbar spine volume. A clinical feasibility study resulted in mean registration error of approximately 3 mm between CT and US data.

  10. Microendoscopic discectomy for treatment of lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    ARJUN Sinkemani; WU Xiao-tao

    2015-01-01

    A lumbar microendoscopic discectomy ( MED ) is a minimally invasive surgical technique performed through a tubular device which is designed for the pain relieve caused by herniated discs pressing the nerve roots . In 1997, a new minimally invasive surgical approach for the management of symptomatic lumbar disc herniation , MED was introduced .This technique uses a tubular retractor system and a microendoscope for visualization rather than the operating microscope .However , recent literature suggests that MED is an effective microendoscopic system which has a fine long-term outcome in treating lumbar disc herniation .This article describes the operative tech-niques and outcomes reported in the literature for MED .

  11. [Clinical manifestation and surgical treatment of superior lumbar disc herniation].

    Science.gov (United States)

    Klishin, D N; Dreval', O N; Gorozhanin, A V

    2011-01-01

    On the basis of analysis of presentation and surgical treatment of 103 patients with lumbar disc herniation the authors performed comparative assessment of symptoms and therapeutic techniques in patients with higher and lower lumbar disc disease. Short-term and long-term results were evaluated using visual analogue scale and Oswestry disability index (ODI). Statistically significant differences in dynamics of pain and ODI were not present. In spite of differences in clinical presentation, the results of surgical treatment in both groups were similar. They depended on severity of preoperative neurological deficit regardless of level of lesion. Specific features of surgical procedure in superior lumbar disk herniation are described.

  12. Grynfelt lumbar hernias. Presentation of a congenital case.

    Directory of Open Access Journals (Sweden)

    Cleopatra Cabrera Cuellar

    2006-04-01

    Full Text Available Lumbar hernias are uncommon and are reported rarely, they are informed only few more than 300 in literature and of them only 10 cases are congenital. The hernias that are produced through the superior lumbar space or Grynfelt-Lesshalf´s hernia, are due to the fact that they are more constant and larger they are usually more frequent than the Petit triangle. We are reporting a Newborn infant with the diagnosis of bilateral lumbar hernias and malformation of the vertebral column.

  13. Traumatic lumbar hernia: can't afford to miss.

    Science.gov (United States)

    Saboo, Sachin S; Khurana, Bharti; Desai, Naman; Juan, Yu-Hsiang; Landman, Wendy; Sodickson, Aaron; Gates, Jonathan

    2014-06-01

    We describe the radiological and surgical correlation of an uncommon case of a traumatic lumbar hernia in a 22-year-old man presenting to the emergency department following a motor vehicle accident. Computed tomography (CT) of the abdomen revealed a right-sided traumatic inferior lumbar hernia containing a small amount of fat through the posterior lateral internal oblique muscle with hematoma in the subcutaneous fat and adjacent abdominal wall musculature, which was repaired surgically via primary closure on emergent basis. The purpose of this article is to emphasize the importance of diagnosing traumatic lumbar hernia on CT and need for urgent repair to avoid potential complications of bowel incarceration and strangulation.

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

    Science.gov (United States)

    Eun, Jong-Pil; Oh, Young-Min

    2015-01-01

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

  15. Manejo del síndrome doloroso lumbar Management of lumbar syndrome

    Directory of Open Access Journals (Sweden)

    Rafael Rivas Hernández

    2010-03-01

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

  16. Lumbar extension exercises in conjunction with mechanical traction for the management of a patient with a lumbar herniated disc.

    Science.gov (United States)

    Gagne, Allison R; Hasson, Scott M

    2010-05-01

    Low back pain resulting from lumbar disc herniation is a common reason for referral for physical therapy. There is no evidence to support the management of lumbar disc herniation and derangement using mechanical traction combined with lumbar extension exercises. Therefore, the purpose of this case report was to describe and discuss the use of mechanical traction in conjunction with lumbar extension exercises for a patient with a lumbar herniated disc. The patient was a 49-year-old male referred to physical therapy with a medical diagnosis of a lumbar herniated disc at L5-S1 with compression of the L5 nerve root confirmed by MRI. The patient's chief complaint was pain over the left lumbosacral and central lumbar region with radiating pain into the left buttock accompanied by numbness and tingling in the left lower leg and foot. The patient was seen for a total of 14 visits. The first 5 days (2 weeks) of therapy consisted of lumbar extension exercises. For the following nine visits (over a 3-week period), mechanical traction was added as an adjunct to the extension exercises. Outcome measures included the Oswestry Disability Questionnaire, Back Pain Function Scale (BPFS), and the Numeric Pain Rating Scale (NPRS). Results from initial evaluation to discharge (Oswestry: 36% to 0%; BPFS: 33/60 to 57/60; NPRS: 7/10 to 0/10) demonstrated that the patient no longer experienced low back pain and improved in terms of functional status and pain-related disability. The patient no longer complained of numbness and tingling in the left lower extremity and the goals for the patient had been attained. The data from this case report suggests lumbar extension exercises in conjunction with mechanical traction facilitated the patient's improvement in pain and return to prior level of function.

  17. Lumbar disc cyst with contralateral radiculopathy

    Directory of Open Access Journals (Sweden)

    Kishore Tourani

    2012-08-01

    Full Text Available Disc cysts are uncommon intraspinal cystic lesions located in the ventrolateral epidural space. They communicate with the nucleus pulposus of the intervertebral disc and cause symptoms by radicular compression. We report a unique case of lumbar disc cyst that was associated with disc herniation and contralateral radiculopathy. A 22 year old male presented with one month history of back-ache radiating to the left leg. Magnetic Resonance Imaging (MRI showed L3-L4 disc herniation with annular tear and cystic lesion in the extradural space anterior to the thecal sac on right side, which increased in size over a period of 3 weeks. L3 laminectomy and bilateral discectomy and cyst excision was done with partial improvement of patients symptoms.

  18. [Lumbar myelography with metrizamid (author's transl)].

    Science.gov (United States)

    Kehler, M

    1977-03-01

    A series of lumbar myelographies -- 105 in 98 patients - was carried out with water-soluble Metrizamid (Amipaque R) in a concentration of 170 mg I/ml and showed side-effects in 32% and a quality of contrast similar to that of other water-soluble contrast media used before. The side effects were mild, of short duration and needed no treatment. There were no epileptic fits, tonic or clonic carried out 1 - 12 months later showed no signs of arachnoiditis. Dangers of more serious complications appeared to increase, the higher the level of injection into the spinal canal. A short survey of contrast media used in myelography and earlier experience of experimental or clinical side effects caused by Medtrizamid in myelography follows.

  19. 胸腔镜下单孔胸交感神经链切断术治疗原发性手汗症%Thoracoscopic sympathectomy with one operative incision for palmar hyperhidrosis

    Institute of Scientific and Technical Information of China (English)

    徐世斌; 马冬春; 徐美清; 魏大中; 梅新宇; 李田; 柳常青

    2012-01-01

    Objective To discuss the therapeutic efficacy and safety of thoracoscopic sympathectomy from one operative incision in treatment of patients with palmar hyperhidrosis. Methods From April 2009 to December 2011, 80 patients with palmar hyperhidrosis underwent bilateral thoracoscopic sympathectomy with one operative incision at different segments of T2-T5. Palmar temperature was measured to observe the curative effects of sympathectomy during the operation. The following information were obtained during follow up; symptoms associated or re-currenced with hyperhidrosis and compensatory sweating(CS). Results The operation was completed successfully in 80 patients. The mean operation time was (49. 8±4. 2)minutes. Symptoms of hyperhidrosis disappeared and the palmar temperature of both hands increased significantly (P <0. 05) in all patients without serious complications after operations. 77 patients were followed up for 1-32 months (mean 16. 8 months) and one hand of a patient had recurrence. It had been treated successfully with the second operation, 38 of 80 patients (47. 5%) had CS , 2 had moderate CS and 36 had minor CS. The CS rate of undergoing T3, T4 or T3 -4 sympathectomy was 42. 6%(29/68) and that of undergoing other segments sympathectomy was 75. 0% (9/12). Conclusion Thoracoscopic sympathectomy with one operative incision for palmar hyperhidrosis is simply,safe effective , minimally invasive and worthy of clinical promoted applicatioa%目的 探讨电视胸腔镜下单孔胸交感神经链切断术治疗原发性手汗症的疗效和安全性.方法 2009年4月至2011年12月,80例原发性手汗症患者在胸腔镜下单孔操作,分别行T2~T5不同节段交感神经链切断术,术中持续监测双手掌温以判断手术疗效,随访症状缓解情况、有无复发以及代偿性出汗情况.结果 全组病例手术均获成功,平均手术时间为(49.8±4.2)min,术后患者手掌多汗症状消失,双手转为干燥温暖状,双手掌皮肤温

  20. The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients.

    Science.gov (United States)

    Jeong, Ui-Cheol; Sim, Jae-Heon; Kim, Cheol-Yong; Hwang-Bo, Gak; Nam, Chan-Woo

    2015-12-01

    [Purpose] The aim of this study was to examine the effects of exercise to strengthen the muscles of the hip together with lumbar segmental stabilization exercise on the lumbar disability index, lumbar muscle strength, and balance. [Subjects and Methods] This study randomly and equally assigned 40 participants who provided written consent to participate in this study to a lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus group (SMG + LES group) and a lumbar segmental stabilization exercise group. [Results] Each evaluation item showed a statistically significant effect. [Conclusion] Clinical application of exercise in this study showed that lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus resulted in a greater decrease in low back pain disability index and increase in lumbar muscle strength and balance ability than lumbar segmental stabilization exercise in chronic low back pain patients receiving the exercise treatments during the same period.

  1. 胸腔镜交感神经切断术治疗手汗症的临床研究%Evaluation of endoscopic thoracic sympathectomy for palmar hyperhidrosis

    Institute of Scientific and Technical Information of China (English)

    云峰; 张水军; 余艳华; 赵红军; 蔡灵乐

    2012-01-01

    [Objective] To summarize the experience on 106 cases endoscopic thoracic sympathectomy for ten years. [Methods] Clinical materials of T2-T4 sympathectomy under thoracoscope for treating palmar hyperhidrosis from March 2000 to March 2010 were analyzed. [Results] All the 106 cases were successfully operated on. Follow up observations in 102 cases for 6 to 36 months showed one recurrence (1%), quite a seasoning in one patient's hands (1%). Compensatory hyperhidrosis was found in 23 cases (22.5%). [Conclusion] Endoscopic thoracic sympathectomy is a micro-invasive, safe and effective treatment for palmar hyperhidrosis.%目的 总结胸腔镜交感神经切断术10年106例治疗手汗症的临床经验.方法 分析2000年3月~2010年3月胸腔镜交感神经T2~T4切断术的临床资料,按拟定的标准进行疗效判定.结果 106例手术均获成功.102例术后6~36个月随访,1例复发,但手多汗较术前为轻(1%);1例手掌过于干燥(1%);23例出现代偿性多汗(22.5%),无其他手术并发症.结论 胸腔镜交感神经切断术是治疗手汗症微创、安全和有效的方法.

  2. 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

  3. Intermittent priapism as a clinical feature of lumbar spinal stenosis

    National Research Council Canada - National Science Library

    Rojas, J I; Zurrú-Ganen, M C; Romano, M; Patrucco, L; Cristiano, E

    2007-01-01

    .... Patients with lumbar spinal stenosis may present a variety of signs and symptoms. One such syndrome is neurogenic intermittent claudication, characterized by radicular symptoms exacerbated by walking or standing and relieved by rest...

  4. Endoscopic anatomy and features of lumbar discectomy by Destandau technique

    Directory of Open Access Journals (Sweden)

    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.

  5. Assessment of Residents Readiness to Perform Lumbar Puncture

    DEFF Research Database (Denmark)

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

    2017-01-01

    BACKGROUND: Lumbar puncture is a common procedure in many specialties. The procedure serves to diagnose life-threatening conditions, often requiring rapid performance. However, junior doctors possess uncertainties regarding performing the procedure and frequently perform below expectations. Hence...

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

    Directory of Open Access Journals (Sweden)

    Rajendra Nath

    2012-01-01

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

  7. Lumbar puncture in patients using anticoagulants and antiplatelet agents.

    Science.gov (United States)

    Domingues, Renan; Bruniera, Gustavo; Brunale, Fernando; Mangueira, Cristóvão; Senne, Carlos

    2016-08-01

    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.

  8. Lumbar puncture in patients using anticoagulants and antiplatelet agents

    Directory of Open Access Journals (Sweden)

    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.

  9. Laparoscopic tension-free hernioplasty for lumbar hernia.

    Science.gov (United States)

    Maeda, K; Kanehira, E; Shinno, H; Yamamura, K

    2003-09-01

    Lumbar hernia, a defect of the posterior abdominal wall, is a very rare condition. The repair of a posterior abdominal wall hernia by simply closing the hernia port with sutures may not be adequate, especially when the herniation is due to a weakness in the abdominal wall. Recently, a simple, logical method of tension-free repair has become a popular means for the treatment of various abdominal wall hernias. Previous studies have advocated the use of tension-free repair for lumbar hernia; the technique uses a mesh replacement and requires an extensive incision. Herein we present a case of superior lumbar hernia. Our technique consisted of a laparoscopic tension-free hernioplasty with the application of a Prolene mesh. This technique, which provides an excellent operative view, is safe, feasible, and minimally invasive. We conclude that laparoscopic tension-free repair should be the preferred option for the treatment of lumbar hernia.

  10. Lumbar hernia misdiagnosed as a subcutaneous lipoma: a case report

    Directory of Open Access Journals (Sweden)

    Amelio Gianfranco

    2009-12-01

    Full Text Available Abstract Introduction Lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. Case presentation We report the case of a 40-year-old Caucasian woman with a superior lumbar hernia (Grynfeltt hernia initially misdiagnosed as a recurrent lipoma. The correct diagnosis was made intra-operatively and the hernia was repaired using synthetic mesh. The patient was free of recurrence at 4 months after the operation. Conclusion A lumbar or flank mass should always raise suspicion of a lumbar hernia. Ultrasound and computed tomography may confirm the diagnosis. Adequate surgical treatment should be planned on the basis of etiology and hernia size. Both open and laparoscopic techniques can be used with good results.

  11. Therapeutic efficacy of hydro-kinesiotherapy Programs in lumbar spondylosis

    Directory of Open Access Journals (Sweden)

    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

  12. Acute cauda equina syndrome secondary to a lumbar synovial cyst.

    Science.gov (United States)

    Muir, Jeffery J; Pingree, Matthew J; Moeschler, Susan M

    2012-01-01

    Cauda equina syndrome is a well described state of neurologic compromise due to lumbosacral root compression. In most cases, it is due to a herniated disc, tumor, infection, or hematoma. We report a case of rapid lumbar synovial cyst expansion leading to acute cauda equina syndrome and compare it to similar cases in the literature. The patient is a 49-year-old woman with a history of chronic low back pain who developed cauda equina syndrome. Serial lumbar magnetic resonance imaging studies demonstrated a significant increase in the size of a lumbar synovial cyst over a 2 week interval. After an unsuccessful attempt to relieve her acute symptoms with computed tomography-guided cyst aspiration, an L4-5 posterior spinal decompression with excision of the synovial cyst was performed. Postoperatively the patient's perineal numbness, bladder incontinence, and associated pain complaints resolved. The only residual symptom at one month follow-up was continued numbness in the right lower limb in an L5 distribution. This report adds to 6 other well described similar cases found in the literature by illustrating several important points. First, a lumbar synovial cyst is a rare but possible cause of acute cauda equina syndrome. Second, magnetic resonance imaging is the test of choice to diagnose and characterize lumbar synovial cysts; serial imaging can detect fluctuations in cyst size. Third, percutaneous treatment of lumbar synovial cysts is variable in efficacy and proved to be unsuccessful in our patient. Finally, surgical management has shown high success rates for symptomatic cysts. Specifically, in the setting of acute cauda equina syndrome secondary to a lumbar synovial cyst, urgent surgical decompression has led to resolution of neurologic symptoms in most reported cases. A lumbar synovial cyst is an uncommon cause of acute cauda equina syndrome. Prompt diagnosis and treatment may lead to reduced morbidity associated with this condition.

  13. The effect of breast shielding during lumbar spine radiography:

    OpenAIRE

    Žontar, Dejan; Škrk, Damijan; Mekiš, Nejc

    2013-01-01

    Background The aim of the study was to determine the influence of lead shielding on the dose to female breasts in conventional x-ray lumbar spine imaging. The correlation between the body mass index and the dose received by the breast was also investigated. Materials and methods Breast surface dose was measured by thermoluminescent dosimeters (TLD). In the first phase measurements of breast dose with and without shielding from lumbar spine imaging in two projections were conducted on an anthr...

  14. Contraindications to lumbar puncture as defined by computed cranial tomography.

    OpenAIRE

    Gower, D. J.; Baker, A. L.; Bell, W O; Ball, M R

    1987-01-01

    Papilloedema is not always an adequate predictor of potential complications from lumbar puncture, and many clinicians are using computed tomography (CT) before lumbar puncture in an effort to identify more accurately the "at risk" patient. This paper identifies the following anatomical criteria defined by CT scanning that correlate with unequal pressures between intracranial compartments and predispose a patient to herniation following decompression of the spinal compartment: lateral shift of...

  15. Cerebellar Herniation after Lumbar Puncture in Galactosemic Newborn

    Directory of Open Access Journals (Sweden)

    Salih Kalay

    2011-09-01

    Full Text Available Cerebral edema resulting in elevated intracranial pressure is a well-known complication of galactosemia. Lumbar puncture was performed for the diagnosis of clinically suspected bacterial meningitis. Herniation of cerebral tissue through the foramen magnum is not a common problem in neonatal intensive care units because of the open fontanelle in infants. We present the case of a 3-week-old infant with galactosemia who presented with signs of cerebellar herniation after lumbar puncture.

  16. Iliac artery pseudoaneurysm after lumbar disc hernia operation

    Directory of Open Access Journals (Sweden)

    Mehmet Atay

    2016-03-01

    Full Text Available Lumbar disc herniation surgery is usually performed through a posterior approach. Vascular injuries can be counted among the complications. 39 years old male patient had lower extremity pain which has started after lumbar disc herniation surgery and continued for a month. Iliac arterial pseudoaneurysm has been detected in computerized tomography. It was successfully treated with vascular surgery [Cukurova Med J 2016; 41(0.100: 5-7

  17. Effect of Load Carriage on Lumbar Spine Kinematics

    Science.gov (United States)

    2013-01-01

    LCS) confi gurations. 7 In gen- eral, the LCS backpack confi guration is preferred among the military because of the proximity of the load to the...population has been associated with lower back pain. 10 – 12 The kinematic behavior of the lumbar spine while carrying load using a backpack confi...posterior load over the base of support. Key words: low back pain , backpack , military , load carriage , MRI , upright MRI , lumbar spine

  18. Minimal Invasive Percutaneous Fixation of Thoracic and Lumbar Spine Fractures

    Directory of Open Access Journals (Sweden)

    Federico De Iure

    2012-01-01

    Full Text Available We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months, and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.

  19. Lumbar puncture in patients using anticoagulants and antiplatelet agents

    OpenAIRE

    Renan Domingues; Gustavo Bruniera; Fernando Brunale; Cristóvão Mangueira; Carlos Senne

    2016-01-01

    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 pharmaco...

  20. Reproducibility of tomographic evaluation of posterolateral lumbar arthrodesis consolidation

    OpenAIRE

    Marcelo Italo Risso Neto; Guilherme Rebechi Zuiani; Roberto Rossanez; Sylvio Mistro Neto; Augusto Celso Scarparo Amato Filho; Paulo Tadeu Maia Cavali; Ivan Guidolin Veiga; Wagner Pasqualini; Marcos Antônio Tebet; Elcio Landim

    2015-01-01

    OBJECTIVE: To evaluate interobserver agreement of Glassman classification for posterolateral lumbar spine arthrodesis.METHODS: One hundred and thirty-four CT scans from patients who underwent posterolateral arthrodesis of the lumbar and lumbosacral spine were evaluated by four observers, namely two orthopedic surgeons experienced in spine surgery and two in training in this area. Using the reconstructed tomographic images at oblique coronal plane, 299 operated levels were systematically analy...

  1. Kidney herniation through lumbar triangle following open pyeloplasty

    Directory of Open Access Journals (Sweden)

    Qais Al Hooti

    2014-01-01

    Full Text Available Kidney herniation through the lumbar triangle is an uncommon type of hernia which is classically managed surgically. Contrast enhanced computerised tomography revealed lower pole of the right kidney herniating through the lumbar triangle in a 60-year-old woman, 10 years after an open right pyeloplasty. Surgical intervention was advised, however, patient opted for non-surgical management. Patient was successfully treated conservatively in clinic requiring regular analgesics for relief of mild pain.

  2. Laparoscopic repair of left lumbar hernia after laparoscopic left nephrectomy.

    Science.gov (United States)

    Gagner, Michel; Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair.

  3. Lumbar Spine Musculoskeletal Physiology and Biomechanics During Simulated Military Operations

    Science.gov (United States)

    2016-06-01

    Significant decreases in lumbar lordosis were found through all levels except L1-L2 when sitting. When prone on elbows, the only increase in lumbar lordosis...was found at L5-S1. A caudal increase in fat fraction of the multifidus was observed, with no significant increase in the erector spine. No...proportional to Pfirrmann grade. No significant differences were found between volume, fat fraction, T2, or DTI in any of the muscles in subjects with disc

  4. Neutral lumbar spine sitting posture in pain-free subjects

    OpenAIRE

    O'Sullivan, Kieran; O'Dea, Patrick; Dankaerts, Wim; O'Sullivan, Peter; Clifford, Amanda; O'Sullivan, Leonard

    2010-01-01

    Sitting is a common aggravating factor in low back pain (LBP), and re-education of sitting posture is a common aspect of LBP management. However, there is debate regarding what is an optimal sitting posture. This pilot study had 2 aims; to investigate whether pain-free subjects can be reliably positioned in a neutral sitting posture (slight lumbar lordosis and relaxed thorax); and to compare perceptions of neutral sitting posture to habitual sitting posture (HSP). The lower lumbar spine HSP o...

  5. Possibilities of balneotherapy in treatment of subjective symptoms of chronic low back pain (lumbar syndrome

    Directory of Open Access Journals (Sweden)

    Batsialou Ioanna

    2002-01-01

    Full Text Available Introduction Chronic low back pain is a degenerative rheumatic disease and is characterized by various symptoms and clinical signs. Balneotherapy Balneotherapy represents a therapy by various hot or warm baths in natural mineral waters of specific physical and chemical characteristics. When used externally, they have mechanical, chemical and thermic effects. Balneotherapy of lumbar syndrome includes: individual baths, swimming in the pool, hydrokinesitherapy, underwater massage, underwater extension, mud therapy, mud baths. The therapy should be closely monitored for optimal efficacy and it is necessary to examine: functional status of the lumbosacral region, general functional status (level of activity, lower extremities, pain measurement, use of non-steroid anti-rheumatic and analgesic agents. In order to follow-up the effects of therapy and establish the prognosis it is important to perform: detailed anamnesis, anthropometrics measurements, socio-epidemiological research, clinical examinations. Conclusion Lumbar syndrome is usually caused by a degenerative disease of the spinal column. More than 25% of people under 45 years of age are unable to work due to chronic low back pain. That is why preventive measures, prompt diagnosis and adequate therapy are of utmost importance.

  6. Sensitivity of lumbar spine loading to anatomical parameters.

    Science.gov (United States)

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

    2016-04-11

    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 influence of defined geometrical parameters on lumbar spine loading utilising five parametrised musculoskeletal lumbar spine models for four different postures. The influence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine was studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most influential. These parameters can be easily acquired from X-rays and should be used to morph a musculoskeletal lumbar spine model for subject-specific approaches with respect to bone geometry. Furthermore, the model was very sensitive to uncommon configurations and therefore, it is advised that stiffness properties of discs and ligaments should be individualised.

  7. [Lumbar herniated disks treated with a dynamic interspacer].

    Science.gov (United States)

    Cueva-del Castillo Mendoza, J F; Franco-López, E A; Hinojosa-Sandoval, F; de León-Martínez, U A; Cueva-del Castillo Mendoza, F J

    2013-01-01

    Lumbar herniated disks result in lumbar pain with neurologic involvement. Medical treatment and rehabilitation provide improvement for this type of lumbar pain at the early stages. When conservative treatment fails, the surgical option offers the possibility of improving patients' health status. Moojen considers that the application of interspinous spacers provides good results. The purpose of this research is to assess the clinical and imaging results in patients with contained lumbar herniated disk treated with the DYNAMIC INTERSPACER interspinous spacer, a Mexican product. The efficacy of the interspinous device was assessed by means of a near-investigational and longitudinal study conducted at "General Ignacio Zaragoza" ISSSTE Regional Hospital in patients with a diagnosis of lumbar pain. The mean age of the sample is 46.1 years, with an age range of 26-55 years. The treated levels were 6 L5-S1 and 5 L4-L5; two levels were treated in two patients. The mean preoperative VAS score was 8.1. The mean VAS score at postoperative year three was 1.6. Multiple types and brands of foreign interspinous devices are applied in Mexico which results in patients' clinical improvement. We proved that the use of the Mexican interspinous device can clinically improve patients with lumbar pain due to herniated disk. A decrease in the compression of the sac or the nerve roots by the hernia was observed in the comparative preoperative and postoperative MRI images.

  8. 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.

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

    Science.gov (United States)

    Guo, Shuguang; Sun, Junying; Tang, Genlin

    2013-03-01

    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 spinal stability. Attention was given to ensure the correct pre-operative fenestration, complete decompression and the prevention of adhesions. After an average follow-up of 26.4 months, the one year post-operative X-ray radiographs suggested that the successful fusion rate was 88.1%, and this was 100% in the two-year post-operative radiographs. Moreover, the functional recovery rate was 97.9%. Bilateral vertebral lamina fenestration for lumbar interbody fusion is an ideal surgical method for the treatment of lower lumbar instability. The surgical method retains the spinal posterior column and middle column and results in full decompression and reliable fusion by a limited yet effective surgical approach.

  10. Intervertebral disc degeneration and bone density in degenerative lumbar scoliosis: a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosis

    Institute of Scientific and Technical Information of China (English)

    DING Wen-yuan; YANG Da-long; CAO Lai-zhen; SUN Ya-peng; ZHANG Wei; XU Jia-xin; ZHANG Ying-ze; SHEN Yong

    2011-01-01

    Background Degenerative lumbar scoliosis is common in older patients.Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis.A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed.The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.Methods From January 2001 to August 2010,96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls.Cobb angle,height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides,the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group.The height of L2/L3,L3/L4,L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group.The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups.The bone density of lumbar vertebrae was measured with dual-energy X-ray.Results In scoliosis group,the intervertebral disc height on the convex side was greater than the height on the concave side (P <0.001 ).The vertebral body height on the convex side was greater than the height on the concave side (P=0.016).There was a significant difference between the scoliosis group and the control group (P=0.003),and between T-value and the rate of osteoporosis between the two groups (both P <0.001).Results were verified using multiple linear regression analysis.Conclusions Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces.There is a positive correlation between the angle of scoliosis and

  11. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems.

    Directory of Open Access Journals (Sweden)

    Li-Peng Yu

    Full Text Available BACKGROUND: To evaluate by MRI intervertebral disc degeneration in patients with lumbar degenerative disease using the Pfirrmann grading system and to determine whether Modic changes correlated with the Pfirrmann grades and modified Pfirrmann grades of disc degeneration. METHODS: The clinical data of 108 surgical patients with lumbar degenerative disease were reviewed and their preoperative MR images were analyzed. Disc degeneration was evaluated using the Pfirrmann grading system. Patients were followed up and low back pain was evaluated using the visual analog scale (VAS and the effect of back pain on the daily quality of life was assessed using Oswestry disability index (ODI. RESULTS: Forty-four cases had normal anatomical appearance (Modic type 0 and their Pfirrmann grades were 3.77±0.480 and their modified Pfirrmann grades were of 5.81±1.006. Twenty-seven cases had Modic type I changes and their Pfirrmann grades were 4.79±0.557 and their modified Pfirrmann grades were 7.00±0.832. Thirty-six cases exhibited Modic type II changes and their Pfirrmann grades and modified Pfirrmann grades were 4.11±0.398 and 6.64±0.867, respectively. One case had Modic type III changes. Kruskal-Wallis test revealed significant difference in modified Pfirrmann grade among Modic type 0, I and II changes (P0.05. Binary regression analysis showed that Modic changes correlated most strongly with disc degeneration. Follow up studies indicated that the VAS and ODI scores were markedly improved postoperatively. However, no difference was noted in VAS and ODI scores among patients with different Modic types. CONCLUSION: Modic changes correlate with the Pfirrmann and modified Pfirrmann grades of disc degeneration in lumbar degenerative disease. There is no significant correlation between Modic types and surgical outcomes.

  12. Minimally invasive percutaneous posterior lumbar interbody fusion.

    Science.gov (United States)

    Khoo, Larry T; Palmer, Sylvain; Laich, Daniel T; Fessler, Richard G

    2002-11-01

    The wide exposure required for a standard posterior lumbar interbody fusion (PLIF) can cause unnecessary trauma to the lumbar musculoligamentous complex. By combining existing microendoscopic, percutaneous instrumentation and interbody technologies, a novel, minimally invasive, percutaneous PLIF technique was developed to minimize such iatrogenic tissue injury (MIP-PLIF). The MIP-PLIF technique was validated in three cadaveric torsos with six motion segments decompressed and fused. Preoperative variables measured from imaging included interpedicular distance, pedicular height and width, interspinous distance, lordosis, intervertebral height, Cobb angle, and foraminal height and volume. Using the METRx and MD spinal access systems (Medtronic Sofamor Danek, Memphis, TN), bilateral laminotomies were performed using a hybrid of microsurgical and microendoscopic techniques. The intervertebral disc spaces were then distracted and prepared with the Tangent (Medtronic Sofamor Danek) interbody instruments. Either a 10 or 12 by 22 mm interbody graft was then placed. Using the Sextant (Medtronic Sofamor Danek) system, percutaneous pedicle screw-rod fixation of the motion segment was completed. We then applied MIP-PLIF in three patients. For segments with preoperative intervertebral/foraminal height loss, MIP-PLIF was effective in restoring both heights in all cases. The amount of improvement (9.7 to 38% disc height increase; 7.7 to 29.9% foraminal height increase) varied directly with the size of the graft used and the original degree of disc and foraminal height loss. Segmental lordosis improved by 29% on average. Graft and screw placement was accurate in the cadavers, except for a single Grade 1 screw violation of one pedicle. The average operative time was 3.5 hours per level. In our three clinical cases, the MIP-PLIF procedure required a mean of 5.4 hours, estimated blood loss was 185 ml, and inpatient stay was 2.8 days, with no intravenous narcotic use after 2 days in

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

    Directory of Open Access Journals (Sweden)

    Manchikanti L

    2012-08-01

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

  14. 经脐内镜下胸交感神经节切除术%The investigation of endoscopic transumbilical thoracic sympathectomy in experimental models

    Institute of Scientific and Technical Information of China (English)

    杨胜生; 朱立桓; 陈炜生; 李达周; 张志坚; 王雯

    2013-01-01

    目的 探讨经脐内镜下胸交感神经切除术的安全性和可行性.方法 4只家猪常规麻醉下经脐放入特制超长腹腔镜戳卡(trocar),建立气腹.胃镜沿戳卡进入腹腔后使用针状刀分别在左右膈肌穹顶做一切口,将胃镜送入胸腔.单肺通气下使用热活检钳行左右T3交感神经节切除术,膈肌切口自然旷置.手术完成后将其处死解剖.结果 4例手术均成功完成,手术平均(81.7 ±15.4) min,术中无明显出血及周围脏器损伤.术后无气胸发生.解剖证实所有猪的左右T3交感神经节均被切除.结论 经脐内镜下胸部交感神经节切除术安全、可行,美容效果好.%Objective To evaluate the safety and feasibility of endoscopic transumbilical thoracic sympathectomy.Methods The technique was performed in 4 swine models.Under general anesthesia,a newly developed long abdominal trocar (60 cm in lengths) was placed through the umbilicus,which was also used to establish pneumoperitoneum.After insertion of gastroscope through this trocar,two small incisions of diagrams were created by needle-knife,through which the gastroscope was sent into the thoracic cavity to ablate the T3 ganglia by Hot biopsy forceps under One-lung ventilation.The animals were killed at the completion of the procedure.Results This procedure was completed in four pigs.The sympathetic chain was successfully ablated in all swine,as confirmed by gross surgical pathology and histology,the mean operative time was (81.7 ±15.4) minutes.There was no major bleeding.All bilateral T3 sympathetic chains were successfully ablated in the 4 swines as confirmed by gross surgical pathology and histology.There was no severe bleeding and damage to peripheral organs during the operation in any of the cases,and no prominent pneumothorax was revealed by postoperative chest X-ray radiography.Conclusion Endoscopic transumbilical thoracic sympathectomy is safe,feasible and effective with good cosmetic result.

  15. Experience with botulinum toxin therapy for axillary hyperhidrosis and comparison to modelled data for endoscopic thoracic sympathectomy - A quality of life and cost effectiveness analysis.

    Science.gov (United States)

    Gibbons, John P; Nugent, Emmeline; O'Donohoe, Nollaig; Maher, Barry; Egan, Bridget; Feeley, Martin; Tierney, Sean

    2016-10-01

    To estimate cost-effectiveness of botulinum toxin therapy for axillary hyperhidrosis compared to the standard surgical intervention of endoscopic thoracic sympathectomy (ETS). The validated dermatology life quality index questionnaire was given to patients attending for treatment over a 4 month period, to assess their quality of life (QoL) over the preceding week (n = 44). Follow-up was performed 4-6 weeks later by telephone using the same questionnaire to validate the effectiveness of the treatment. The duration of effect of the botulinum toxin treatment was also recorded and this data was used as the basis for cost effectiveness analysis. Using HIPE data, the baseline cost for single intervention using botulinum toxin and ETS was retrieved. Using figures provided by HIPE and expert opinion of the costs of complications, a stochastic model for 10,000 patients was used to evaluate the total costs for ETS including the complications. The results from the QoL analysis show that botulinum toxin therapy is a successful therapy for improvement of symptoms. It was revealed that the mean interval before recurrence of original symptoms after botulinum toxin therapy was 5.6 months. The baseline cost for both treatments are €389 for botulinum toxin and €9389 for uncomplicated ETS. The stochastic model yields a mean cost of €11,390 for ETS including complications. Treatments reached cost equivalence after 13.3 years. However, given the efficacy of the botulinum toxin therapy and the low risk we propose that botulinum toxin therapy for hyperhidrosis should be considered the gold standard. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  16. REHABILITATION OF LUMBAR HYPERLORDOSIS THROUGH SWIMMING-SPECIFIC EXERCISES

    Directory of Open Access Journals (Sweden)

    Petrea Renato-Gabriel

    2014-12-01

    Full Text Available The purpose of this paper is to show the importance and utility of swimming within rehabilitation and therapeutic programs for posture deficiencies, in our context for the rehabilitation of lumbar hyperlordosis. We consider that, by using exercises specific to swimming and means specific to acquiring swimming procedures, we will reduce the range of lumbar hyperlordosis. More precisely, we believe that, through exercises specific to swimming, we will reduce the range of lumbar hyperlordosis by at least 15 mm. Our study comprise three subjects (young girls, who suffer from lumbar hyperlordosis. For establishing the diagnostic, the following examinations and tests took place: anamnesis; somatoscopy; somatometry; muscular testing; specific tests (Schõber, “finger-floor”. The therapeutic program applied included the following: exercises for learning and consolidating the swimming procedures of crawl, backstroke, breaststroke and butterfly. The rehabilitation program lasted five months and a half; we had two sessions per week, each session of 35-40 minutes; water temperature ranged between 29 and 31 degrees Celsius. Initial testing showed that the lordosis amplitude was 70 mm for subject A.B., 60 mm for subject R.A. and 55 mm for subject S.A. At the end of research the results of the lordosis amplitude were 52 mm for subject A.B., 45 mm for subject R.A. and 40 mm for subject S.A. The conclusion of this study underlines that the early and correct intervention through individualized rehabilitation programs for lumbar hyperlordosis leads to a decrease in the lumbar curvature, down to physiological values. In addition, the means used for acquiring and consolidating swimming procedures can constitute important means in the rehabilitation process for lumbar hyperlordosis.

  17. Lubrication regimes in lumbar total disc arthroplasty.

    Science.gov (United States)

    Shaheen, A; Shepherd, D E T

    2007-08-01

    A number of total disc arthroplasty devices have been developed. Some concern has been expressed that wear may be a potential failure mode for these devices, as has been seen with hip arthroplasty. The aim of this paper was to investigate the lubrication regimes that occur in lumbar total disc arthroplasty devices. The disc arthroplasty was modelled as a ball-and-socket joint. Elastohydrodynamic lubrication theory was used to calculate the minimum film thickness of the fluid between the bearing surfaces. The lubrication regime was then determined for different material combinations, size of implant, and trunk velocity. Disc arthroplasties with a metal-polymer or metal-metal material combination operate with a boundary lubrication regime. A ceramic-ceramic material combination has the potential to operate with fluid-film lubrication. Disc arthroplasties with a metal-polymer or metal-metal material combination are likely to generate wear debris. In future, it is worth considering a ceramic-ceramic material combination as this is likely to reduce wear.

  18. Computed tomography in lumbar degenerative disease

    Energy Technology Data Exchange (ETDEWEB)

    Isu, Toyohiko; Miyasaka, Kazuo; Abe, Satoru; Takei, Hidetoshi; Kaneda, Kiyoshi (Hokkaido Univ., Sapporo (Japan). School of Medicine)

    1984-02-01

    We reported the 18 patients which underwent surgical exploration and reviewed these CT findings. Method All CT scans were obtained on Somatom II, high resolution CT scanner, with the patient in the supine position. A lateral localizer image (Topogram) was used to select the appropriate intervertebral disk space. The slice thickness was 4 mm. Results 1) CT findings in lumbar degenerative diseases include bony canal stenosis (central canal stenosis, narrowed lateral recess), soft tissue abnormalities (herniated nucleus pulposus, bulging annulus, hypertrophy and/or ossification of ligamentum flavum, no delineation of nerve root in lateral recess), and spinal instability (spondylolisthesis, vacuum phenomenon). 2) The above three factors contribute to narrowing of spinal canal. 3) No delineation of nerve root or soft tissue replacement of epidural fat in lateral recess suggests that the nerve root may be compressed by some factors. 4) Herniated nucleus pulposus may cause nerve root compression with or without canal stenosis. Conclusion This study revealed that the CT findings correlated closely with the surgical findings and the site of nerve root compression could be determined.

  19. Clinical clerkship course for medical students on lumbar puncture using simulators.

    Science.gov (United States)

    Adachi, Koji; Yoshimura, Akinobu; Aso, Ryoko; Miyashita, Tsuguhiro; Yoshida, Daizo; Teramoto, Akira; Shimura, Toshiro

    2012-01-01

    Lumbar puncture is a medical technique that physicians must learn and is, therefore, considered a basic medical procedure. The lumbar puncture simulators Lumbar-Kun (Lumbar Puncture Simulator) and Lumbar-Kun II (Lumbar Puncture Simulator II) (Kyoto Kagaku, Kyoto, Japan) are teaching aids designed for practicing spinal insertions. We describe and results of a lumbar puncture clerkship course, provided to 5th-year medical students during clinical clerkship activity. The aim of this study was to evaluate the effectiveness of the lumbar puncture clerkship course in the medical education program. Comprehension, technical achievement, and satisfaction were scored by students and instructors using a 6-point Likert scale. Scores for both comprehension and technical achievement were high, but technical achievement scores tended to be higher than comprehension scores. In addition, the scores students gave themselves were higher than the scores they were given by instructors. Student satisfaction was high. The lumbar puncture simulators, Lumbar-Kun and Lumbar-Kun II, achieved excellent overall impressions and represent useful tools for training in lumbar puncture procedures. In addition to the simulators, an appropriate preparatory text and a short lecture before training seemed to increase the educational effect of this lumbar puncture clerkship course for medical students.

  20. Point of Technique

    African Journals Online (AJOL)

    .

    (1,2, 3,4 5,6) Department of Cardiovascular Surgery GATA Haydarpasa Training Hospital,, İstanbul, Turkey. Request for rprints ... newer and much more unknown. Open lumbar sympathectomy for certain .... extraperitoneal laparoscopic lumbar.

  1. 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.)

  2. Congenital lumbar hernia associated to lumbar costovertebral syndrome. A case report. Hernia lumbar congénita asociada a síndrome lumbocostovertebral. Reporte de un caso.

    Directory of Open Access Journals (Sweden)

    Yusimy Izaguirre Martínez

    2005-12-01

    Full Text Available Reported the case of a born patient of color of white skin, 6 years old, of pregnancy and normal childbirth that it was valued in the Service of Surgery of the Pediatric Hospital ¨Paquito González Cueto¨ because it presented increase of volume in both lumbar regions, without another associate sintomatology. Congenital bilateral lumbar hernia associated to syndrome lumbocostovertebral, strange affection in the pediatric age.

    Se reporta el caso de una paciente de color de piel blanca, de 6 años de edad, nacida de embarazo y parto normal que fue valorada en el Servicio de Cirugía del Hospital Pediátrico ¨Paquito González Cueto¨ debido a que presentaba aumento de volumen en ambas regiones lumbares, sin otra sintomatología asociada. Se diagnostica hernia lumbar bilateral congénita asociada a síndrome lumbocostovertebral, afección rara en la edad pediátrica.

  3. Is lumbar facet fusion biomechanically equivalent to lumbar posterolateral onlay fusion?

    Science.gov (United States)

    Toth, Jeffrey M; Foley, Kevin T; Wang, Mei; Seim, Howard B; Simon Turner, A

    2017-02-03

    OBJECTIVE This study was designed with the following research objectives: 1) to determine the efficacy of facet fusion with recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS) in an ovine lumbar facet fusion model; 2) to radiographically and histologically compare the efficacy of lumbar facet fusion with rhBMP-2/ACS to facet fusion with an iliac crest bone graft (ICBG); and 3) to biomechanically compare lumbar facet fusion with rhBMP-2/ACS to lumbar posterolateral fusion (PLF) with ICBG. METHODS The efficacies of the 3 treatments to induce fusion were evaluated in an instrumented ovine lumbar fusion model. Eight sheep had 10 cm(3)/side ICBG placed as an onlay graft for PLF at L2-3. At the adjacent L3-4 level, 0.5 cm(3)/side ICBG was placed for facet fusion. Finally, 0.5 cm(3)/side rhBMP-2/ACS (0.43 mg/ml) was placed for facet fusion at L4-5. CT scans were obtained at 2, 4, and 6 months postoperatively with 2 reviewers conducting an evaluation of the 6-month results for all treated spinal levels. All 8 sheep were killed at 6 months, and all posterolateral instrumentation was removed at this time. The spines were then sectioned through L3-4 to allow for nondestructive unconstrained biomechanical testing of the L2-3 and L4-5 segments. All treated spinal levels were analyzed using undecalcified histology with corresponding microradiography. Statistical comparisons were made between the treatment groups. RESULTS The PLF with ICBG (ICBG PLF group) and the rhBMP-2 facet fusion (rhBMP-2 Facet group) treatment groups demonstrated similar levels of stiffness, with the rhBMP-2 Facet group having on average slightly higher stiffness in all 6 loading directions. All 8 levels in the autograft facet fusion treatment group demonstrated CT radiographic and histological fusion. All 8 levels in the rhBMP-2 Facet group showed bilateral CT radiographic and histological fusion. Six of 16 rhBMP-2/ACS-treated facet defects demonstrated small

  4. OUTCOME OF POSTEROLATERAL FUSION VERSUS CIRCUMFERENTIAL FUSION WITH CAGE FOR LUMBAR STENOSIS AND LOW DEGREE LUMBAR SPONDYLOLISTHESIS

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis. Methods From April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups. Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion. The two groups were compared for clinical and radiological outcomes. Results All patients were followed up for 12 to 72 months. In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24). Two cases suffered from residual symptoms. Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%. No infection or neurological complication occurred in this group. In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90. 5% ( 19/21 ). One case suffered from residual symptoms. Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%. Four cases of infection or neurological complication occurred in this group. Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during followup. But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.Conclusions The first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion. Only when patients suffer from severe preoperative disc

  5. Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain.

    Science.gov (United States)

    Hildebrandt, Markus; Fankhauser, Gabriela; Meichtry, André; Luomajoki, Hannu

    2017-01-10

    Lumbar multifidus muscles (LMM) are important for spinal motion and stability. Low back pain (LBP) is often associated with fat infiltration in LMM. An increasing fat infiltration of LMM may lead to lumbar dysfunction. The purpose of this study was to investigate whether there is a correlation between the severity of lumbar dysfunction and the severity of fat infiltration of LMM. In a cross-sectional study, 42 patients with acute or chronic LBP were recruited. Their MRI findings were visually rated and graded using three criteria for fat accumulation in LMM: Grade 0 (0-10%), Grade 1 (10-50%) and Grade 2 (>50%). Lumbar sagittal range of motion, dynamic upright and seated posture control, sagittal movement control, body awareness and self-assessed functional disability were measured to determine the patients' low back dysfunction. The main result of this study was that increased severity of fat infiltration in the lumbar multifidus muscles correlated significantly with decreased range of motion of lumbar flexion (p = 0.032). No significant correlation was found between the severity of fat infiltration in LMM and impaired movement control, posture control, body awareness or self-assessed functional disability. This is the first study investigating the relationship between the severity of fat infiltration in LMM and the severity of lumbar dysfunction. The results of this study will contribute to the understanding of the mechanisms leading to fat infiltration of LMM and its relation to spinal function. Further studies should investigate whether specific treatment strategies are effective in reducing or preventing fat infiltration of LMM.

  6. Jogging gait kinetics following fatiguing lumbar paraspinal exercise.

    Science.gov (United States)

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

    2009-12-01

    A relationship exists between lumbar paraspinal muscle fatigue and quadriceps muscle activation. The objective of this study was to determine whether hip and knee joint moments during jogging changed following paraspinal fatiguing exercise. Fifty total subjects (25 with self-reported history of low back pain) performed fatiguing, isometric lumbar extension exercise until a shift in EMG median frequency corresponding to a mild level of muscle fatigue was observed. We compared 3-dimensional external joint moments of the hip and knee during jogging before and after lumbar paraspinal fatigue using a 10-camera motion analysis system. Reduced external knee flexion, knee adduction, knee internal rotation and hip external rotation moments and increased external knee extension moments resulted from repetitive lumbar paraspinal fatiguing exercise. Persons with a self-reported history of LBP had larger knee flexion moments than controls during jogging. Neuromuscular changes in the lower extremity occur while resisting knee and hip joint moments following isolated lumbar paraspinal exercise. Persons with a history of LBP seem to rely more heavily on quadriceps activity while jogging.

  7. Importance of greenstick lamina fractures in low lumbar burst fractures

    Science.gov (United States)

    Ersozlu, S.; Aydinli, U.

    2006-01-01

    Lumbar burst fractures (L3–L5) represent a small percentage of all spinal fractures. The treatment of fractures involving the lumbar spine has been controversial. Lamina fractures may be complete or of the greenstick type. Dural tears and nerve root entrapment may accompany these lamina fractures. The aim of this retrospective study was to determine the incidence of dural tear in patients who had lumbar burst fractures with greenstick lamina fractures and the importance of these lamina fractures when choosing the optimum treatment. Twenty-six patients with 28 lumbar burst fractures were treated from 1995 through 2002. The average follow-up was 60 months (range 32–110 months). The male to female ratio was 21:5 and the mean age was 37 years (17–64). Dural tear was detected in seven (25%) out of 28 burst fractures. The functional outcome of the entire study group was assessed using the Smiley-Webster Scale. Good to excellent results were obtained in 24 (92%) of 26 patients. Lumbar burst fractures with greenstick lamina fractures occur mostly in the L2–L4 area. In the surgical treatment, any reduction manoeuvre will close the fracture and crush the entrapped neural elements. Therefore, it may be better to explore the greenstick lamina fracture whether there is any neural entrapment or not, before any reduction manoeuvre is attempted. PMID:16501977

  8. Rapid prototyping drill guide template for lumbar pedicle screw placement

    Institute of Scientific and Technical Information of China (English)

    LU Sheng; XU Yong-qing; ZHANG Yuan-zhi; LI Yan-bing; SHI Ji-hong; CHEN Guo-ping; CHEN Yu-bing

    2009-01-01

    To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods: A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engi-neering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its correspond-ing vertebra were manufactured using the rapid prototyping technique. Results: The accuracy of the drill template was con-firmed by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to cus-tomize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill tem-plate fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the per-sonalized template. During surgery, no additional computer assistance was needed.Conclusions: The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.

  9. Effects of interspinous spacers on lumbar degenerative disease.

    Science.gov (United States)

    Zhou, Dong; Nong, Lu-Ming; DU, Rui; Gao, Gong-Ming; Jiang, Yu-Qing; Xu, Nan-Wei

    2013-03-01

    The present study aimed to evaluate the early effects of interspinous spacers on lumbar degenerative disease. The clinical outcomes of 23 patients with lumbar degenerative disease, treated using interspinous spacer implantation alone or combined with posterior lumbar fusion, were retrospectively studied and assessed with a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Pre-operative and post-operative interspinous distance, disc space height, foraminal width and height and segmental lordosis were determined. The early effects and complications associated with the interspinous spacers were recorded. The surgical procedures performed with the in-space treatment were easy and minimally invasive. The VAS scores and ODI were improved post-operatively compared with pre-operatively. Significant changes in the interspinous distance, disc space height, foraminal width and height and segmental lordosis were noted. In-space treatment for degenerative lumbar disease is easy and safe, with good early effects. The in-space system provides an alternative treatment for lumbar degenerative disease.

  10. Characterization of radiographic features of consecutive lumbar spondylolisthesis

    Science.gov (United States)

    Sun, Yapeng; Wang, Hui; Yang, Dalong; Zhang, Nan; Yang, Sidong; Zhang, Wei; Ding, Wenyuan

    2016-01-01

    Abstract Radiographic features of consecutive lumbar spondylolisthesis were retrospectively analyzed in a total of 17 patients treated for this condition at the Third Hospital of Hebei Medical University from June 2005 to March 2012. To investigate the radiographic features, pelvic compensatory mechanisms, and possible underlying etiologies of consecutive lumbar spondylolisthesis. To the best of our knowledge, there is no previous report concerning the characteristics of consecutive lumbar spondylolisthesis. The Taillard index and the lumbar lordosis (LL), pelvic incidence (PI), sacrum slope (SS), and pelvic tilt (PT) were determined on lateral X-ray images, and the angular displacement was analyzed on flexion–extension X-ray images. Correlation between LL and various pelvic parameters and correlation between Taillard index and angular displacement were assessed by Pearson correlation analysis. A total of 20 cases of isthmic spondylolisthesis and 14 of degenerative spondylolisthesis were retrospectively studied in 17 patients. The Taillard index and the angular displacement in the lower vertebrae were both larger than those in the upper vertebrae. Statistical analysis revealed that LL was correlated with PI and PT, whereas PI was correlated with PT and SS. However, no correlation was identified between Taillard index and angular displacement. In consecutive lumbar spondylolisthesis, the degree of vertebral slip and the angular displacement of the lower vertebrae were both greater than those of the upper vertebrae, indicating that the compensatory mechanism of the pelvis plays an important role in maintaining sagittal balance. PMID:27861359

  11. Complex multilevel lumbar spine fractures with transverse sacral fracture

    Directory of Open Access Journals (Sweden)

    Kshitij Chaudhary

    2011-01-01

    Full Text Available We report an unusual and complex case of spinal trauma in a 17-year-old boy who presented with a transverse sacral fracture associated with multiple-level lumbar fractures, paraparesis, and bladder involvement. A two-stage surgery was performed. The lumbar spine fractures were treated with posterior instrumented correction of displacements, followed by anterior instrumentation and fusion. The sacral fracture was left untreated. At 5-year followup, the patient had complete neurological recovery except for the right L5 root function. The long-segment lumbar fusion and the untreated displaced sacral fracture contributed to spinal imbalance, due to which the patient is now able to stand only in a crouched posture. Determining the optimal treatment for the case is presented due to the relative rarity of transverse sacral fracture and paucity of evidence-based treatment approaches. In patients with associated lumbar spine fractures that require extension of instrumentation to the upper lumbar spine, it is critical to restore sacropelvic alignment to achieve spinal balance. Adequate reduction of sacropelvic anatomy can be achieved with iliac screw fixation.

  12. LUMBAR SPINAL STENOSIS. A REVIEW OF BIOMECHANICAL STUDIES

    Institute of Scientific and Technical Information of China (English)

    戴力扬; 徐印坎

    1998-01-01

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

  13. Posterior lumbar interbody fusion via a unilateral approach.

    Science.gov (United States)

    Shin, Hyun Chul; Yi, Seong; Kim, Keung Nyun; Kim, Sang Hyun; Yoon, Do Heum

    2006-06-30

    This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain.

  14. [Isokinetic and functional lumbar evaluation in workers pensioned with disability].

    Science.gov (United States)

    Navarro-Trujillo, Luz Rocío; Mireles-Pérez, Ana Bárbara Isabel; Castañeda-Borrayo, Yaocihuatl; Plascencia-García, José Luis

    2013-01-01

    Introducción: en 2008 se formularon 13 371 dictámenes de invalidez en Jalisco, gran parte de ellos motivados por lesiones de la columna lumbar. La mayoría es de naturaleza definitiva y requiere evaluaciones completas de las capacidades lumbares. El objetivo de esta investigación fue evaluar la funcionalidad de la columna lumbar con el cuestionario de Oswestry y con el estudio isocinético en pensionados por lesiones lumbares. Métodos: estudio comparativo de 20 trabajadores con dictamen de invalidez por lesiones lumbares, a quienes se les solicitó realizar ejercicios isocinéticos y contestar el cuestionario de Oswestry. Resultados: con el cuestionario de Oswestry se determinó una discapacidad de 60 %. En cuanto a la evaluación isocinética, en la extensión se obtuvo un torque máximo de 44 Nw. En el trabajo fatiga se encontraron una media y una moda de cero. En la flexión, el torque máximo fue de -75.5 Nw. En la potencia, la moda fue de 40 V. En el trabajo-fatiga, la media y la moda fueron de cero. Conclusiones: la evaluación isocinética no fue normal en ninguno de los trabajadores, con lo que se corroboró la invalidez.

  15. Modified lumbar artery perforator flaps for gluteal pressure sore reconstruction.

    Science.gov (United States)

    Yoon, Chi Sun; Yim, Ji Hong; Kim, Min Ho; Ha, Won; Kim, Kyu Nam

    2016-03-21

    Gluteal perforator flaps (GPFs) are the most useful for gluteal region pressure sore reconstruction. However, application is difficult if the surrounding area has scar tissue from previous operations or trauma, especially with recurrent sores. We describe the use of modified lumbar artery perforator flaps when GPFs cannot be used. Between May 2009 and April 2014, 51 patients underwent gluteal pressure sore reconstructions with gluteal (n = 39) or modified lumbar artery (n = 12) perforator flaps. Patients in the modified lumbar artery perforator group had scar tissue from trauma or previous surgery. In this retrospective review, we analyzed patient age and sex, defect size and location, operative time, follow-up duration, immediate postoperative issues, flap necrosis, dehiscence, re-operation, donor-site morbidity and recurrence. Complications and clinical outcomes were compared between groups. We found no significant differences in patient demographics, surgical complications or clinical outcomes. There were eight cases of temporary congestion (20.51%) and four of partial flap necrosis (10.25%) in the gluteal perforator group. In the modified lumbar artery perforator group, there were three cases of temporary congestion (25%) and one of partial flap necrosis (8.33%). No pressure sores recurred during follow-up in either group. GPFs are the gold standards for gluteal pressure sores, but modified lumbar artery perforator flaps are relatively easy and useful when GPFs cannot be used due to scar tissue. © 2016 Royal Australasian College of Surgeons.

  16. CHANGES IN RADIOGRAPHIC PARAMETERS AFTER MINIMALLY INVASIVE LUMBAR INTERBODY FUSION

    Directory of Open Access Journals (Sweden)

    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.

  17. Functional kyphosis and lumbar kyphosis in adolescent paddlers

    Directory of Open Access Journals (Sweden)

    Pedro Ángel López-Miñarro

    2010-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    examined patients' subsequent rehabilitation. Group-based rehabilitation is both efficient and cost-effective in rehabilitation of lumbar spinal fusion patients.Methods: Patients with degenerative disc diseases undergoing instrumented lumbar spinal fusion were randomly assigned to initiate...

  19. An audit of consent practices and perceptions of lumbar puncture, Botswana inpatient setting experience

    Directory of Open Access Journals (Sweden)

    M.B. King

    2015-06-01

    Conclusion: Contrasting responses between doctors and patients indicates a need for standard consenting practices among doctors. Also, patients’ attitudes and receptiveness to lumbar punctures can be improved through education on lumbar puncture indications, benefits, and risks.

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

    Institute of Scientific and Technical Information of China (English)

    张力; 洪珏

    2009-01-01

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

  1. MANAGEMENT OF LUMBAR SPINAL CANAL STENOSIS

    Directory of Open Access Journals (Sweden)

    Mukhergee G. S

    2016-06-01

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

  2. Analysis of the efficacy of video-assisted thoracoscopic sympathectomy and the differences of compensatory hyperhidrosis after sympathec-tomy in the treatment of palmar hyperhidrosis by different operative methods and/or exscinding positions%不同节段胸交感神经干切断术治疗手汗症疗效及术后代偿性多汗的比较(附1040例报告)

    Institute of Scientific and Technical Information of China (English)

    王海涛; 严志焜; 许林海; 朱理; 戴备军

    2014-01-01

    目的:比较胸腔镜下不同节段胸交感神经干切断术治疗手汗症的疗效和术后代偿性多汗的差异。方法本院自1995年7月至2011年12月,收治的原发性手汗症患者共1040例。依据切断胸交感神经节段的不同分为两组比较分析。A组(不保留T2神经节段)503例, B组(保留T2神经节段)537例。对上述两组病例进行随访观察,评定与比较两组之间的疗效以及代偿性多汗的发生情况。结果1040例患者随访到834例,随访率80.2%。到访两组手术成功率均为100%,术中、术后无严重并发症发生,术后12个月内两组代偿性多汗总体发生率37.8%(315/834)。两组代偿性多汗和重度代偿性多汗发生率的差异均有统计学意义(P<0.01或<0.05)。结论与经典的A组(不保留T2神经节段)胸交感神经干切断术相比,B组(保留T2神经节段)T3或T4胸交感神经干+旁路切断术式疗效确切,且能明显减少代偿性多汗的发生率,是一种较为合理的术式。%Objective To analyze the efficacy of video-assisted thoracoscopic sympathectomy and the differences of compensatory hyper-hidrosis after sympathectomy in the treatment of palmar hyperhidrosis by different operative methods. Methods 1040 patients with palmar hyper-hidrosis being undergone video-assisted thoracoscopic bilateral sympathectomy were retrospectively studied during the period of July 1995 and De-cember 2011. The patients were divided into two groups for Group A (T2 not remained)and Group B (T2 remained) by different operative methods. Results All the cases were successfully performed for video assisted thoracoscopic bilateral sympathectomy without severe morbidity and mortality. 834 cases were followed up from 1040 patients. The incidence of compensatory hyperhidrosis of two groups were 37.8%(315/834).There were signifi-cant differences for compensatory hyperhidrosis and serious compensatory hyperhidrosis between

  3. Comparison of bilateral T3 sympathectomy versus right T3 combined with left T4 sympa-thectomy in treatment of primary palmar hyperhidrosis%左 T4右 T3与双侧 T3交感神经链切断术治疗手汗症疗效比较

    Institute of Scientific and Technical Information of China (English)

    陈光春; 文毅; 廖小勇; 邱干; 郭伟华; 陈景松; 滕树炎; 陈洁; 吴维微

    2014-01-01

    Objective To evaluate the effect and side effect of right T 3 combined with left T 4 sympathectomy in the surgical management of primary palmar hyperhidrosis (PPH)through randomized controlled tria1.Methods From February 2012 to Apr 2014, 45 patients(19 males and 26 females)with PPH were enrolled in the study and randomly assigned into Group A (n=23) who recieved right T3 combined with left T4 sympathectomy and and Group B(n=22) who underwent bilateral T3 sympathectomy.The curative effects and side effects were compared between the tow groups .Results All procedures were carried out successfully without severe morbidity or mortality.After a mean follow-up period of 12.6 months,symptoms of PPH were improved in all patients .The left hands in Group A had more wet palms compared with the left hands in Group B (47.8%vs 9.1%,P0.05)and patients’ satisfaction (91.3%vs 95.5%,P>0.05)between Group A and B showed no statistically significant difference.Compensatory hyperhidrosis(CH) occurred in 66.7%of patients, and no patient was affected with severe CH .Moderate CH occurred in 3 cases and 9 cases respectively in groups A and B , and there was significant difference between the groups (13.0%vs 40.9%,P<0.05).Conclusions The procedure of right T3 combined with left T4 sympathectomy is an effective method which can improve quality of life and reduce compensatory hyperhidrosis .%目的:探讨左T4右T3交感神经链切断术治疗手汗症的可行性。方法2012-02至2014-04对45例手汗症行胸腔镜下胸交感神经链切断术,男19例,女26例,年龄15~42岁。患者自行选择哪种手术方式而随机进入两个组:A组为左T4右T3切断23例,B组为双侧T3链切断22例。结果所有手术均顺利完成,无严重并发症和围术期死亡病例。所有患者平均随访(12.6±9.5)个月。患者手掌多汗症状均改善。 A组9例(47.8%)的左侧手掌, A组2例(8.7%)和 B组2例(9.1%)的双侧手掌

  4. Why Lumbar Artificial Disk Replacements (LADRs) Fail.

    Science.gov (United States)

    Pettine, Kenneth; Ryu, Robert; Techy, Fernando

    2017-07-01

    A retrospective review of prospectively collected data. To determine why artificial disk replacements (ADRs) fail by examining results of 91 patients in FDA studies performed at a single investigational device exemption (IDE) site with minimum 2-year follow-up. Patients following lumbar ADR generally achieve their 24-month follow-up results at 3 months postoperatively. Every patient undergoing ADR at 1 IDE site by 2 surgeons was evaluated for clinical success. Failure was defined as Maverick, 25 patients; Charité, 31 patients; and Kineflex, 35 patients. All procedures were 1-level operations performed at L4-L5 or L5-S1. Demographics and inclusion/exclusion criteria were similar and will be discussed. Overall clinical failure occurred in 26% (24 of 91 patients) at 2-year follow-up. Clinical failure occurred in: 28% (Maverick) (7 of 25 patients), 39% (Charité) (12 of 31 patients), and 14% (Kineflex) (5 of 35 patients). Causes of failure included facet pathology, 50% of failure patients (12 of 24). Implant complications occurred in 5% of total patients and 21% of failure patients (5 of 24). Only 5 patients went from a success to failure after 3 months. Only 1 patient went from a failure to success after a facet rhizotomy 1 year after ADR. Seventy-four percent of patients after ADR met strict clinical success after 2-year follow-up. The clinical success versus failure rate did not change from their 3-month follow-up in 85 of the 91 patients (93%). Overall clinical success may be improved most by patient selection and implant type.

  5. Tuina Therapy for Prolapsed Lumbar Intervertebral Disc

    Institute of Scientific and Technical Information of China (English)

    ZHANG Bi-meng; WU Huan-gan; SHEN Jian; XIAO Yuan-chun

    2004-01-01

    Recurrent low back pain and reflex sciatica of lower limbs are the two leading symptoms of prolapsed lumbar intervertebral disc, which can be confirmed in the history, symptoms, signs and imaging examination such as CT scan and MRI. It should be differentiated from those conditions characterized by lumbago and/or possible sciatica. Tuina was performed mostly on the Bladder Meridian,Gallbladder Meridian and Governor Vessel, as well as their acupoints such as Jiaji (Ex-B 2) points,Shenshu (BL 23), Dachangshu (BL 25), Yaoyangguan (GV 3), Huantiao (GB 30), Weizhong (BL 40),Chengshan (BL 57), Yanglingquan (GB 34) and Ashi points. Thumb-massaging manipulation, rolling manipulation, pulling manipulation, pressing manipulation, kneading manipulation and grasping manipulation are often performed.%反复下腰痛和下肢反射性坐骨神经痛是腰椎间盘突出症的两大症状.根据病史、症状、体征以及影像学(包括CT、MRI等)结果,可以确诊.需与以腰痛为主要表现的疾病,以腰痛伴坐骨神经痛为主要表现的疾病和以坐骨神经痛为主要表现的疾病相鉴别.推拿保守治疗多以足太阳膀胱经、足少阳胆经及督脉为主,取相应的夹脊穴、肾俞、大肠俞、腰阳关、环跳、委中、承山、阳陵泉及阿是穴等以一指禅推法、滚法、扳法、按法、揉法和拿法等进行治疗.

  6. OPERATIVE TREATMENT FOR DEGENERATIVE LUMBAR SPINAL STENOSIS

    Directory of Open Access Journals (Sweden)

    Samo K. Fokter

    2002-11-01

    Full Text Available Background. Degenerative lumbar spinal stenosis (DLSS is a common cause of low back and leg pain in the elderly. Conservative treatment seldom results in sustained improvement.Methods. Fifty-six patients (33 women, 23 men older than 50 years (mean 67 years, range 51 to 82 years and with no prior low back surgery were treated from 1993 to 1999 for clinical and radiologic evidence of DLSS. The goal of this study was to describe the results of decompressive laminectomy with or without fusion in terms of reoperation, severity of back pain, leg pain and patient satisfaction. Answers to Swiss spinal stenosis questionnaires completed before surgery and one to five years afterwards were evaluated. Seven patients (12.5% with degenerative spondylolisthesis, scoliosis and/or more radical facetectomies received fusion.Results. Of the 56 patients in the original cohort, two were deceased and two had undergone reoperation by follow-up. Forty-eight patients answered questionnaires. Average duration of follow-up was 2.5 years. More than 70 percent of the respondents had no or only mild back or buttock pain at follow-up and more than 60 percent were able to walk more than 500 m. Added fusion reduced the incidence of low back pain and pain frequency, and increased walking distance (ANOVA.Conclusions. Eighty-one percent of patients were satisfied with the results of surgery and 87.5% would choose to have the operation again if they had the choice. Decompressive laminectomy for DLSS yields best results if instrumented fusion is included in the procedure.

  7. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Sonne-Holm, Stig; Rovsing, Hans;

    2007-01-01

    STUDY DESIGN: A cross-sectional epidemiological survey of 4151 participants of the Copenhagen Osteoarthritis Study. OBJECTIVE: To identify prevalences and individual risk factors for degenerative lumbar spondylolisthesis. SUMMARY OF BACKGROUND DATA: The Copenhagen Osteoarthritis Study has...... registered health parameters since 1976. In 1993, standardized, lateral radiographs of the lumbar spine were recorded. There were 1533 men and 2618 women. METHODS: Statistical correlations were made between degenerative spondylolisthesis, and physical, occupational, and general epidemiological data. RESULTS......: A total of 254 cases of lumbar slip were found (males 2.7%, females 8.4%). In females, no significant relationship between age at menopause or childbirths and the presence of degenerative spondylolisthesis were found. In women, relationships between body mass index (BMI) in 1976 and L4 olisthesis (P = 0...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-02-15

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

  9. Multiexpandable cage for minimally invasive posterior lumbar interbody fusion

    Science.gov (United States)

    Coe, Jeffrey D; Zucherman, James F; Kucharzyk, Donald W; Poelstra, Kornelis A; Miller, Larry E; Kunwar, Sandeep

    2016-01-01

    The increasing adoption of minimally invasive techniques for spine surgery in recent years has led to significant advancements in instrumentation for lumbar interbody fusion. Percutaneous pedicle screw fixation is now a mature technology, but the role of expandable cages is still evolving. The capability to deliver a multiexpandable interbody cage with a large footprint through a narrow surgical cannula represents a significant advancement in spinal surgery technology. The purpose of this report is to describe a multiexpandable lumbar interbody fusion cage, including implant characteristics, intended use, surgical technique, preclinical testing, and early clinical experience. Results to date suggest that the multiexpandable cage allows a less invasive approach to posterior/transforaminal lumbar interbody fusion surgery by minimizing iatrogenic risks associated with static or vertically expanding interbody prostheses while providing immediate vertebral height restoration, restoration of anatomic alignment, and excellent early-term clinical results. PMID:27729817

  10. Sex determination by discriminant function analysis of lumbar vertebrae.

    Science.gov (United States)

    Ostrofsky, Kelly R; Churchill, Steven E

    2015-01-01

    Sex determination is critical for developing the biological profile of unidentified skeletal remains. When more commonly used elements (os coxa, cranium) for sexing are not available, methods utilizing other skeletal elements are needed. This study aims to assess the degree of sexual dimorphism of the lumbar vertebrae and develop discriminant functions for sex determination from them, using a sample of South African blacks from the Raymond A. Dart Collection (47 males, 51 females). Eleven variables at each lumbar level were subjected to univariate and multivariate discriminant function analyses. Univariate equations produced classification rates ranging from 57.7% to 83.5%, with the highest accuracies associated with dimensions of the vertebral body. Multivariate stepwise analysis generated classification rates ranging from 75.9% to 88.7%. These results are comparable to other methods for sexing the skeleton and indicate that measures of the lumbar vertebrae can be used as an effective tool for sex determination.

  11. Conservative management of psoas haematoma following complex lumbar surgery

    Directory of Open Access Journals (Sweden)

    Sandesh Lakkol

    2014-01-01

    Full Text Available We report psoas hematoma communicating with extradural hematoma and compressing on lumbar nerve roots during the postoperative period in a patient who underwent L3/4 level dynamic stabilization and L4/5 and L5/S1 posterior lumbar interbody fusion. Persistent radicular symptoms occurring soon after posterior lumbar surgery are not an unknown entity. However, psoas hematoma communicating with the extradural hematoma and compressing on L4 and L5 nerve roots soon after surgery, leading to radicular symptoms has not been reported. In addition to the conservative approach in managing such cases, this case report also emphasizes the importance of clinical evaluation and utilization of necessary imaging techniques such as computed tomography (CT scan and magnetic resonance imaging (MRI scan to diagnose the cause of persistent severe radicular pain in the postoperative period.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1982-08-01

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

  13. Regional lumbar motion and patient-rated outcomes

    DEFF Research Database (Denmark)

    Mieritz, Rune M; Bronfort, Gert; Hartvigsen, Jan

    2014-01-01

    OBJECTIVE: The purpose of this study was to examine the relationship in change scores between regional lumbar motion and patient-rated pain of the previous week and back-related function in chronic low back pain patients enrolled in a randomized clinical trial and treated with either exercise...... therapy or spinal manipulation using 6 different motion parameters. METHODS: Regional lumbar motions were sampled using a 6 degrees of freedom instrumented spatial linkage system in 199 participants at baseline and 12-week follow-up. The regional lumbar motion data were analyzed as a total cohort as well...... as relative to subgroup stratifications; back pain only vs back and leg pain, and treatment modality. For identifying clinically meaningful improvements in the measurements of back pain and back-related function, we used a 30% threshold. RESULTS: The relationship between change scores in patient...

  14. 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.

  15. Decoupled pelvis adjustment to induce lumbar motion: A technique that controls low back load in sitting

    NARCIS (Netherlands)

    Geffen, van Paul; Reenalda, Jasper; Veltink, Peter H.; Koopman, Bart F.J.M.

    2010-01-01

    Static sitting in confined settings have been associated with low back pain in sedentary occupations such as office works and car driving. To prevent lumbar discomfort in prolonged static sitting, periodic motion of the lumbar spine is needed. Because the pelvis forms the basis for lumbar spine curv

  16. Transforaminal lumbar interbody fusion versus posterolateral fusion in degenerative lumbar spondylosis

    Science.gov (United States)

    Zhang, Bin-Fei; Ge, Chao-Yuan; Zheng, Bo-Long; Hao, Ding-Jun

    2016-01-01

    Abstract Objective: The aim of the study was to evaluate the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) versus posterolateral fusion (PLF) in degenerative lumbar spondylosis. Methods: A systematic literature review was performed to obtain randomized controlled trials (RCTs) and observational studies (OSs) of TLIF and PLF for degenerative lumbar spondylosis. Trials performed before November 2015 were retrieved from the Medline, EMBASE, Cochrane library, and Chinese databases. Data extraction and quality evaluation of the trials were performed independently by 2 investigators. A meta-analysis was performed using STATA version 12.0. Results: Two RCTs and 5 OSs of 630 patients were included. Of these subjects, 325 were in the TLIF and 305 were in the PLF group. Results showed that TLIF did not increase the fusion rate based on RCTs (relative risk [RR] = 1.06; 95% confidence interval [CI]: 0.95–1.18; P = 0.321), but increased it based on OSs (RR = 1.14; 95% CI: 1.07–1.23; P = 0.000) and overall (RR = 1.11; 95% CI: 1.05–1.18; P = 0.001) as compared with PLF. TLIF was able to improve the clinical outcomes based on 1 RCT (RR = 1.33; 95% CI: 1.11–1.59, P = 0.002) and overall (RR = 1.19; 95% CI: 1.07–1.33; P = 0.001), but not based on OSs (RR = 1.11; 95% CI: 0.97–1.27; P = 0.129) as compared with PLF. There were no differences between TLIF and PLF in terms of visual analogue scale, Oswestry Disability Index, reoperation, complications, duration of surgical procedure, blood loss, and hospitalization. Conclusions: In conclusion, evidence is not sufficient to support that TLIF provides higher fusion rate than PLF, and this poor evidence indicates that TLIF might improve only clinical outcomes. Higher quality, multicenter RCTs are needed to better define the role of TLIF and PLF. PMID:27749558

  17. Genetic association studies in lumbar disc degeneration: a systematic review.

    Directory of Open Access Journals (Sweden)

    Pasi J Eskola

    Full Text Available OBJECTIVE: Low back pain is associated with lumbar disc degeneration, which is mainly due to genetic predisposition. The objective of this study was to perform a systematic review to evaluate genetic association studies in lumbar disc degeneration as defined on magnetic resonance imaging (MRI in humans. METHODS: A systematic literature search was conducted in MEDLINE, MEDLINE In-Process, SCOPUS, ISI Web of Science, The Genetic Association Database and The Human Genome Epidemiology Network for information published between 1990-2011 addressing genes and lumbar disc degeneration. Two investigators independently identified studies to determine inclusion, after which they performed data extraction and analysis. The level of cumulative genetic association evidence was analyzed according to The HuGENet Working Group guidelines. RESULTS: Fifty-two studies were included for review. Forty-eight studies reported at least one positive association between a genetic marker and lumbar disc degeneration. The phenotype definition of lumbar disc degeneration was highly variable between the studies and replications were inconsistent. Most of the associations presented with a weak level of evidence. The level of evidence was moderate for ASPN (D-repeat, COL11A1 (rs1676486, GDF5 (rs143383, SKT (rs16924573, THBS2 (rs9406328 and MMP9 (rs17576. CONCLUSIONS: Based on this first extensive systematic review on the topic, the credibility of reported genetic associations is mostly weak. Clear definition of lumbar disc degeneration phenotypes and large population-based cohorts are needed. An international consortium is needed to standardize genetic association studies in relation to disc degeneration.

  18. 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.

  19. The association of spinal osteoarthritis with lumbar lordosis.

    Science.gov (United States)

    Papadakis, Michael; Papadokostakis, Georgios; Kampanis, Nikos; Sapkas, Georgios; Papadakis, Stamatios A; Katonis, Pavlos

    2010-01-02

    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. 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 S1 was also measured. 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 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.

  20. The association of spinal osteoarthritis with lumbar lordosis

    Directory of Open Access Journals (Sweden)

    Sapkas Georgios

    2010-01-01

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

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

    Science.gov (United States)

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

    2010-03-01

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

  2. Destructive discovertebral degenerative disease of the lumbar spine.

    Science.gov (United States)

    Charran, A K; Tony, G; Lalam, R; Tyrrell, P N M; Tins, B; Singh, J; Eisenstein, S M; Balain, B; Trivedi, J M; Cassar-Pullicino, V N

    2012-09-01

    The uncommon variant of degenerative hip joint disease, termed rapidly progressive osteoarthritis, and highlighted by severe joint space loss and osteochondral disintegration, is well established. We present a similar unusual subset in the lumbar spine termed destructive discovertebral degenerative disease (DDDD) with radiological features of vertebral malalignment, severe disc resorption, and "bone sand" formation secondary to vertebral fragmentation. Co-existing metabolic bone disease is likely to promote the development of DDDD of the lumbar spine, which presents with back pain and sciatica due to nerve root compression by the "bone sand" in the epidural space. MRI and CT play a complimentary role in making the diagnosis.

  3. Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

    Science.gov (United States)

    Lee, Su-Keon; 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 spondylolisthesis on lumbar lordosis after an intraoperative prone position. Methods Sixty-seven patients, who underwent spinal fusion at the Department of Orthopaedic Surgery of Gwangmyeong Sungae Hospital between May 2007 and February 2012, were included in this study. The study compared lumbar lordosis on preoperative upright, intraoperative prone and postoperative upright lateral X-rays between the simple stenosis (SS) group and spondylolisthesis group. The average age of patients was 67.86 years old. The average preoperative lordosis was 43.5° (± 14.9°), average intraoperative lordosis was 48.8° (± 13.2°), average postoperative lordosis was 46.5° (± 16.1°) and the average change on the frame was 5.3° (± 10.6°). Results Among all patients, 24 patients were diagnosed with simple spinal stenosis, 43 patients with spondylolisthesis (29 degenerative spondylolisthesis and 14 isthmic spondylolisthesis). Between the SS group and spondylolisthesis group, preoperative lordosis, intraoperative lordosis and postoperative lordosis were significantly larger in the spondylolisthesis group. The ratio of patients with increased lordosis on the OSI frame compared to preoperative lordosis was significantly higher in the spondylolisthesis group. The risk of increased lordosis on frame was significantly higher in the spondylolisthesis group (odds ratio, 3.325; 95% confidence interval, 1.101 to 10.039; p = 0.033). Conclusions Intraoperative lumbar lordosis on the OSI frame with a prone

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

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    Lucky Gupta

    2014-02-01

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

  5. Pelvic retroversion: a compensatory mechanism for lumbar stenosis.

    Science.gov (United States)

    Pourtaheri, Sina; Sharma, Akshay; Savage, Jason; Kalfas, Iain; Mroz, Thomas E; Benzel, Edward; Steinmetz, Michael P

    2017-08-01

    OBJECTIVE The flexed posture of the proximal (L1-3) or distal (L4-S1) lumbar spine increases the diameter of the spinal canal and neuroforamina and can relieve symptoms of neurogenic claudication. Distal lumbar flexion can result in pelvic retroversion; therefore, in cases of flexible sagittal imbalance, pelvic retroversion may be compensatory for lumbar stenosis and not solely compensatory for the sagittal imbalance as previously thought. The authors investigate underlying causes for pelvic retroversion in patients with flexible sagittal imbalance. METHODS One hundred thirty-eight patients with sagittal imbalance who underwent a total of 148 fusion procedures of the thoracolumbar spine were identified from a prospective clinical database. Radiographic parameters were obtained from images preoperatively, intraoperatively, and at 6-month and 2-year follow-up. A cohort of 24 patients with flexible sagittal imbalance was identified and individually matched with a control cohort of 23 patients with fixed deformities. Flexible deformities were defined as a 10° change in lumbar lordosis between weight-bearing and non-weight-bearing images. Pelvic retroversion was quantified as the ratio of pelvic tilt (PT) to pelvic incidence (PI). RESULTS The average difference between lumbar lordosis on supine MR images and standing radiographs was 15° in the flexible cohort. Sixty-eight percent of the patients in the flexible cohort were diagnosed preoperatively with lumbar stenosis compared with only 22% in the fixed sagittal imbalance cohort (p = 0.0032). There was no difference between the flexible and fixed cohorts with regard to C-2 sagittal vertical axis (SVA) (p = 0.95) or C-7 SVA (p = 0.43). When assessing for postural compensation by pelvic retroversion in the stenotic patients and nonstenotic patients, the PT/PI ratio was found to be significantly greater in the patients with stenosis (p = 0.019). CONCLUSIONS For flexible sagittal imbalance, preoperative attention should

  6. Diagnostic accuracy of magnetic resonance imaging of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Takashi; Nakamura, Takafumi; Kikuchi, Taro; Watanabe, Hiroyuki; Takagi, Katsumasa; Yoshizumi, Kazuhiro; Katahira, Kazuhiro [Kumamoto Univ. (Japan). School of Medicine

    2000-03-01

    We studied the accuracy of MRI in lumbar disc herniation, comparing the results with the operative findings in the assessment of the rupture of the posterior longitudinal ligament (PLL), and type of herniation. The MRI findings in 47 subjects who were operated on for lumbar disc herniation were retrospectively studied. The accuracy rate was 75.2% for the rupture of the PLL and 40.4% for the type of herniation respectively. It was hard to differentiate subligamentous extrusion from transligamentous extrusion on MRI. (author)

  7. Spontaneous ligamentum flavum hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Keynan, Ory; Ashkenazi, Ely; Floman, Yizhar [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Smorgick, Yossi [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Assaf Harofeh Medical Center, Department of Orthopedic Surgery, Zerifin (Israel); Schwartz, Allan J. [Hadassah University Hospital, Department of Radiology, Section of Neuroradiology, Jerusalem (Israel)

    2006-09-15

    Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome. (orig.)

  8. Laparoscopic management of inferior lumbar hernia (Petit triangle hernia).

    Science.gov (United States)

    Ipek, T; Eyuboglu, E; Aydingoz, O

    2005-05-01

    Lumbar hernias are rare defects in the posterolateral abdominal wall that may be congenital or acquired. We present a case of laparoscopic approach to repair an acquired inferior triangle (Petit) lumbar hernia in a woman by using polytetrafluoroethylene mesh. The size of the hernia was 8 x 10 cm. The length of her hospital stay was 2 days. The patient resumed normal activities in less than 2 weeks. The main advantage of this approach is excellent operative visualization, thus avoiding injury to structures near the hernia during repair. Patients benefit from a minimally invasive approach with less pain, shortened hospital course, less analgesic requirements, better cosmetic result, and minimal life-style interference.

  9. Incarcerated small bowel within a spontaneous lumbar hernia.

    Science.gov (United States)

    Teo, K A T; Burns, E; Garcea, G; Abela, J E; McKay, C J

    2010-10-01

    Lumbar hernias are rare, resulting from protrusion through the posterior abdominal wall that may be congenital, acquired or spontaneous. They very rarely present with acute bowel obstruction. We present a case of incarcerated small bowel within a spontaneous inferior (Petit's) lumbar hernia, treated by early open repair with mesh insertion. This case highlights the importance of thorough clinical examination and a high index of suspicion, even in the absence of previous surgery around the anatomical site of the suspected hernia, in order to effect an early repair before the onset of ischaemia in incarcerated contents.

  10. Lumbar Spine Musculoskeletal Physiology and Biomechanics During Simulated Military Operations

    Science.gov (United States)

    2015-06-01

    l ationship between 3D geometry of the lumbar spine, under different l oading conditions and positions , and the pathophysiol ogy of the...Marines were scanned in a high- resolut i on 3T MRI scanner to quantify musc l e qua lity and I VD degeneration . Lumbar l ordos i s s i gnificantl y...measured using a force mat in a structure with the dimensions of the MRI scanner . 7 Figure 2. Photographs of the load distribution system used for

  11. Lumbo-costo-vertebral syndrome with congenital lumbar hernia.

    Science.gov (United States)

    Gupta, Lucky; Mala, Tariq Ahmed; Gupta, Rahul; Malla, Shahid Amin

    2014-01-01

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

  12. Development of a fibre optic goniometer system to measure lumbar and hip movement to detect activities and their lumbar postures.

    Science.gov (United States)

    Bell, J A; Stigant, M

    2007-01-01

    If sitting postures influence the risk of developing low back pain then it is important that quantification of sedentary work activities and simultaneous measurement of lumbar postural characteristics takes place. The objective of this study was to develop a system for identifying activities and their associated lumbar postures using fibre optic goniometers (FOGs). Five student subjects wore two FOGs attached to the lumbar spine and hip for 8 min while being recorded using a video camera when sitting, standing and walking. Observer Software was used to code the video recording, enabling the sagittal movement characteristics of each FOG to be described for individual activities. Results indicated that each activity produced unique data, and could be independently identified from their motion profiles by three raters (k = 1). The data will be used to develop algorithms to automate the process of activity detection. This system has the potential to measure behaviour in non-clinical settings.

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

    Science.gov (United States)

    Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar; Benyamin, Ramsin

    2012-01-01

    Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures), the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or discogenic pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the pain source.

  14. Effect of steerable cage placement during minimally invasive transforaminal lumbar interbody fusion on lumbar lordosis.

    Science.gov (United States)

    Lindley, Timothy E; Viljoen, Stephanus V; Dahdaleh, Nader S

    2014-03-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is commonly used for the treatment of a variety of degenerative spine disorders. Recently, steerable interbody cages have been developed which potentially allow for greater restoration of lumbar lordosis. Here we describe a technique and radiographic results following minimally invasive placement of steerable cages through a bilateral approach. A retrospective review was conducted of the charts and radiographs of 15 consecutive patients who underwent 19 levels of bilateral MIS-TLIF with the placement of steerable cages. These were compared to 10 patients who underwent 16 levels of unilateral MIS-TLIF with the placement of bullet cages. The average age, body mass index, distribution of the levels operated and follow-up were similar in both groups. The average height of the steerable cage placed was 10.9 mm compared to 8.5mm for bullet cages. The preoperative focal Cobb's angle per level was similar between both groups with a mean of -5.3 degrees for the steerable cage group and -4.8 degrees for the bullet cage group. There was a significant improvement in postoperative Cobb's angle after placement of a steerable cage with a mean of -13.7 (p<0.01) and this persisted at the last follow-up with -13 degrees (p<0.01). There was no significant change in Cobb's angle after bullet cage placement with -5.7 degrees postoperatively and a return to the baseline preoperative Cobb's angle of -4.8 at the last follow-up. Steerable cage placement for MIS-TLIF improves focal lordosis compared to bullet cage placement.

  15. 胸腔镜下T3胸交感神经切断术治疗手汗症62例临床分析%Thoracoscopic T3 Sympathectomy for Palmar Hyperhidrosis: Analysis on 62 Cases

    Institute of Scientific and Technical Information of China (English)

    钟卫权; 吕坤; 廖金文; 廖承辉

    2012-01-01

    Objective To discuss and analyze our clinical experience on thoracoscopic T, sympathectomy for palmar hyperhidrosis. Methods From July 2008 to March 2011, we performed thoracoscopic T3 sympathectomy on totally 62 patients with palmar hyperhidrosis. With incisions made at the 5th intercostal space on the midaxillary line, and 3rd intercostal space on the anterior axillary line as observation and operation holes, respectively, we cut the thoracic sympathetic chain and communicating branches. Results The procedure was completed successfully on all the 62 patients. The mean operation time for bilateral procedure was 24. 3 minutes (19-36 minutes) , and mean hospital stay was 4. 5 days (3-6 days) . Nine patients developed postoperative pleural effusion but were all cured afterwards. Totally 56 patients received follow-up for 3-12 months with a mean of 7. 2 months, during which, 2 patients showed recurrent mild palmar hyperhidrosis and 3 patients had mild compensatory sweating. Conclusion Thoracoscopic T3 sympathectomy is an effective, minimally invasive and safe therapy for palmar hyperhidrosis with a low recurrence rate.%目的 探讨胸腔镜下T3胸交感神经切断术治疗手汗症的疗效. 方法 2008年7月~2011年3月对62例手汗症行胸腔镜下经操作孔电凝钩切断T3胸交感神经及可能存在的交通支. 结果 62例手术均获成功,手术时间(双侧)19~36 min,平均24.3 min.住院3~6d,平均4.5d.术后出现胸腔积液9例,4例行胸腔穿刺抽液,5例经保守治疗治愈.56例术后随访3~12个月,平均7.2月,2例复发轻度手汗,3例出现轻度代偿性出汗. 结论 胸腔镜下T3胸交感神经切断术治疗手汗症疗效确切,不易复发,术后代偿性多汗发生率低,安全性高.

  16. The clinical experience of T3-4 thoracic sympathectomy in the treatment of hyperhidrosis%T3~4交感神经链切断术治疗手汗症的临床经验

    Institute of Scientific and Technical Information of China (English)

    徐彪; 吴君旭; 周晓; 沙纪名; 赵旭东; 石开虎

    2014-01-01

    目的 总结胸腔镜下T3~4交感神经链切断术治疗原发性手汗症的临床经验.方法 回顾性分析胸腔镜下T3~4交感神经链切断术治疗80例原发性手汗症患者的临床资料.结果 80例患者手术均获成功,术后手掌多汗症状立即消失,手术时间(42.5±15.7) min,住院时间(3.9±0.6)d.无霍纳综合征及死亡病例.62例患者随访6~24个月,发生轻度代偿性多汗26例,均无复发.结论 胸腔镜下T3~4交感神经链切断术是治疗原发性手汗症的一种安全、有效的微创治疗方法.%Objective To summarize the clinical experience of T3-4 thoracic sympathectomy in the treatment of primary hyperhidrosis.Methods The clinical data of 80 patients with primary hyperhidrosis who underwent T3-4 thoracic sympathectomy were analyzed retrospectively.Results The operation was successfully performed on all patients.The symptom of palmar hyperhidrosis vanished in all patients,the operative time was (42.5 ± 15.7) min,the length of stay in hospital was (3.9 ± 0.6) d.No death and Horner syndrome occurred.All the patients were followed up for 6-24 months,compensatory hyperhidrosis was found in 26 patients,and no recurrence was found.Conclusion T3-4 thoracic sympathectomy is a safe and effective minimally invasive treatment for primary hyperhidrosis.

  17. Hallazgos degenerativos de columna lumbar en resonancia magnética de pacientes con dolor lumbar Edgar

    OpenAIRE

    González Rodríguez, Edgar Iván

    2013-01-01

    El resumen es una presentación abreviada y precisa (la NTC 1486 de 2008 recomienda Introducción: Entre los padecimientos que mayor impacto genera en la población económicamente activa en todo el mundo se encuentra el dolor lumbar bajo también conocido como lumbago, lumbalgia o lumbociatalgia. Metodología: Estudio descriptivo retrospectivo de pacientes adultos con dolor lumbar y hallazgos degenerativos en RM. Resultados: La edad promedio fue de 50.8 años. El 86% de los pacientes...

  18. Hallazgos degenerativos de columna lumbar en resonancia magnética de pacientes con dolor lumbar Edgar

    OpenAIRE

    González Rodríguez, Edgar Iván

    2013-01-01

    El resumen es una presentación abreviada y precisa (la NTC 1486 de 2008 recomienda Introducción: Entre los padecimientos que mayor impacto genera en la población económicamente activa en todo el mundo se encuentra el dolor lumbar bajo también conocido como lumbago, lumbalgia o lumbociatalgia. Metodología: Estudio descriptivo retrospectivo de pacientes adultos con dolor lumbar y hallazgos degenerativos en RM. Resultados: La edad promedio fue de 50.8 años. El 86% de los pacientes...

  19. Functional myelographic differentiation of lumbar bulging annulus

    Energy Technology Data Exchange (ETDEWEB)

    Park, Choong Ki; Kim, Hong Kil; Park, Sang Gyu; Lee, Young Jung; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of)

    1988-08-15

    Herniated disk and bulging annulus are the major causes of lower back pain. It is necessary to differentiate bulging annulus from herniated disk because of their different methods of treatment. Myelography is one of the useful diagnostic methods for disk diseases even though advanced diagnostic modalities such as CT and MRI are more accurate. Functional myelography is not a new technology expect for two additional views, flexion and extension, are obtained with conventional myelography. Differentiation between bulging annulus and herniated disk by conventional myelography is based on the extent and multiplicity of extradural deformity of the contrast filled dural sac and neural sleeve as well as the changes of nerve root. There is no previous report about differential points between bulging annulus and herniated disk according to functional myelography. It is the purpose of this study to find any additional differential points on functional myelography between bulging annulus and herniated disk over convectional myelography. Authors analysed functional myelographic findings of 152 cases from July 1986 to July 1987. Among them, 22 cases who had been suffered from cervical abnormality or vague lower back pain were diagnosed as normal by myelography, and 30 cases of L4-5 herniated disk and 21 cases of L4-5 bulging annulus which had been finally diagnosed by operation were studied. The results were as follows. 1. In normal group, anterior epidural space was gradually widened from the upper lumbar vertebra downward. And anterior epidural space was more sidened at the disk level in extension view than in flexion except for L5-S1 lever. 2. In bulging annulus group, the shape of anterior epidural space in flexion state was as similar as normal. Anoterior epidural space in extension state was more sidened at the buldging annulus than normal, but lesser than herniated disk. 3. In herniated disk group, widening of anterior epidural space at the herniated disk level was

  20. Warrior Injury Assessment Manikin (WIAMan) Lumbar Spine Model Validation: Development, Testing, and Analysis of Physical and Computational Models of the WIAMan Lumbar Spine Materials Demonstrator

    Science.gov (United States)

    2016-08-01

    6400 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) US Army Research Laboratory ATTN: RDRL-DPW...Anthropomorphic Test Device (ATD) Lumbar Spine Materials Demonstrator. A primary objective of this work was to generate experimental data for FEM validation...Lumbar Spine Materials Demonstrator 1 1.2.1 WIAMan ATD Lumbar Spine Assembly 1 1.2.2 Materials Consideration 2 1.2.3 Test Method 3 2. Preliminary

  1. 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.

  2. Decreasing the required lumbar extensor moment induces earlier onset of flexion relaxation.

    Science.gov (United States)

    Zwambag, Derek P; De Carvalho, Diana E; Brown, Stephen H M

    2016-10-01

    Flexion relaxation (FR) is characterized by the lumbar erector spinae (LES) becoming myoelectrically silent near full trunk flexion. This study was designed to: (1) determine if decreasing the lumbar moment during flexion would induce FR to occur earlier; (2) characterize thoracic and abdominal muscle activity during FR. Ten male participants performed four trunk flexion/extension movement conditions; lumbar moment was altered by attaching 0, 5, 10, or 15lb counterweights to the torso. Electromyography (EMG) was recorded from eight trunk muscles. Lumbar moment, lumbar flexion and trunk inclination angles were calculated at the critical point of LES inactivation (CPLES). Results demonstrated that counterweights decreased the lumbar moment and lumbar flexion angle at CPLES (pactive throughout flexion. Abdominal muscles activated at the same instant as CPLES, except in the 15lb condition where abdominal muscles activated before CPLES resulting in a period of increased co-contraction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Complex rehabilitation of the invalids with lumbar radiculopathies

    OpenAIRE

    2015-01-01

    In this article was researched clinical, instrumental and diagnostic criterion of definition of physical disability in the patients with lumbar radiculopathies, caused by osteochondrosis of the spine as well as were developed principles of medico-social and professional rehabilitation of this category of the patients and invalids.

  4. MRI of degenerative cysts of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-03-15

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

  5. Adjacent level disease following lumbar spine surgery: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Conclusions: The incidence of postoperative ASD (up to 30% is greater following either open or MIS instrumented lumbar fusions (e.g., TLIF/PLIF, while decompressions with noninstrumented fusions led to a much smaller 5.6% risk of ASD. Other findings included: MIS instrumented fusions contributed to higher perioperative complication rates, and dynamic stabilization did not protect against ASD.

  6. Ventricular Pneumocephalus with Meningitis after Lumbar Nerve Root Block

    Directory of Open Access Journals (Sweden)

    Shin Ahn

    2013-01-01

    Full Text Available Lumbar nerve root block is a common modality used in the management of radiculopathy. Its complications are rare and usually minor. Despite its low morbidity, significant acute events can occur. Pneumocephalus is an accumulation of air in the intracranial space. It indicates a violation of the dura or the presence of infection. The object of this report is to describe the case of a patient with intraventricular pneumocephalus and bacterial meningitis after lumbar nerve root block. A 70-year-old female was brought into emergency department with severe headache and vomiting which developed during her sleep. She had received lumbar nerve block for her radiculopathy one day before her presentation. Cranial computed tomography scan revealed a few hypodense lesions in her left lateral ventricle frontal horn and basal cistern indicating ventricular pneumocephalus. Five hours later, she developed sudden hearing loss. Cerebrospinal fluid analysis showed bacterial meningitis, and she was treated with high dose steroid and antibiotics. However, her impaired hearing as a sequela from meningitis was persistent, and she is still in follow-up. Intracranial complications of lumbar nerve root block including meningitis and pneumocephalus can occur and should be considered as high-risk conditions that require prompt intervention.

  7. Lumbar facet stress fracture in a ballet dancer.

    Science.gov (United States)

    Fehlandt, A F; Micheli, L J

    1993-12-01

    A frequent cause of back pain in athletes and dancers is stress injury to the posterior vertebral elements. Stress fractures affect the pars interarticularis and, rarely, other vertebral regions. The authors present their experience with the diagnosis and treatment of a fourth lumbar inferior articular facet stress fracture in a ballerina in this brief report and discuss the literature concerning posterior element stress fractures.

  8. COMPARATIVE RETROSPECTIVE STUDY ON ANAESTHESIA APPROACHES FOR LUMBAR SPINE SURGERY

    Directory of Open Access Journals (Sweden)

    Rangalakshmi S

    2016-07-01

    Full Text Available OBJECTIVE Lumbar spinal surgeries have been performed with either spinal or general anaesthesia. In this study, we aimed to evaluate the superiority of either spinal or general anaesthesia on lumbar spine surgery. METHODS After approval of institutional ethical committee, we retrospectively analysed 270 patients (ASA I and II undergoing surgery of lumbar spine from 2009 to 2015 by one surgeon. Of these 150 patients underwent general anaesthesia with controlled ventilation, 120 patients were offered spinal anaesthesia with conscious sedation. Patient records were reviewed to obtain demographic features, type of anaesthesia, baseline heart rate, mean arterial pressure, intraoperative maximum heart rate, mean arterial pressure, duration of surgery, amount of intravenous fluids, intraoperative blood loss, incidence of perioperative complications such as bleeding, nausea, vomiting, hypotension, bradycardia, and postoperative analgesic consumption. RESULTS Patient characteristics including baseline/intraoperative mean arterial pressure and heart rate values did not differ between groups. However, the spinal anaesthesia group experienced significantly shorter durations in the operating room and had a lower incidence of nausea, vomiting. Analgesic consumptions in general anaesthesia group was significantly higher than in spinal anaesthesia group. CONCLUSION The present study revealed that spinal anaesthesia is a safe and effective alternative to general anaesthesia for patients undergoing single level or two level lumbar laminectomy, discectomy, or even instrumentation below L2 level and has the advantage of decreased nausea, antiemetic, analgesic requirements, and fewer complications. It also ensures better postoperative recovery when compared to general anaesthesia

  9. Treatment of Acute Lumbar Sprain by Acupuncture plus Cupping

    Institute of Scientific and Technical Information of China (English)

    WANG Jun-ying; WANG Si-you

    2003-01-01

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

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

    OpenAIRE

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2017-02-12

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

  12. Ergonomic lumbar risk analysis of construction workers by NIOSH method

    Directory of Open Access Journals (Sweden)

    Cinara Caetano Pereira

    2015-09-01

    Full Text Available Work in construction has tasks directly connected with manual transport. One of the body segments suffering greater demand in works with these characteristics is the lumbar spine segment. The aim of this study was to analyze the level of risk of lumbar construction workers in the shipment of materials. The sample was composed of 74 construction workers. Were used as a research tool: the NIOSH method for lumbar risk verification expressed by weight limit recommended (WPR and the lifting Index (IL, Visual analogue scale (VAS for the evaluation of pain intensity, the e-1 Corlett.0 for the mapping of the pain and Borg to the subjective perception of the intensity of physical exertion. The present study identified the weight limit (WP of 8.707 for management activity of bags of cement for the load of 8.194 wheelbarrows used. These findings are 6 times under actual weights handled during the activities that revolve around 50 kg with the sacks and averaged 49.72 kg stands with mass. The dimensional settings found in the search are at high risk for ergonomic lumbar region, and measures of reconfiguration of workplaces and operation of auxiliary devices for lifting, transporting and unloading are fundamental, in addition to the need for reflection about the current logistical problems that induce producers to supply the cement sacks with 50 kg.

  13. A method for quantitative measurement of lumbar intervertebral disc structures

    DEFF Research Database (Denmark)

    Tunset, Andreas; Kjær, Per; Samir Chreiteh, Shadi

    2013-01-01

    There is a shortage of agreement studies relevant for measuring changes over time in lumbar intervertebral disc structures. The objectives of this study were: 1) to develop a method for measurement of intervertebral disc height, anterior and posterior disc material and dural sac diameter using MRI...

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

    Science.gov (United States)

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

    2013-07-01

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

  15. Residual complaints following lumbar disc surgery: prognostic indicators of outcome

    NARCIS (Netherlands)

    Ostelo, R.W.J.G.; Vlaeyen, J.W.S.; Brandt, van den P.A.; Vet, de H.C.W.

    2005-01-01

    Physical as well as psychological features might be important prognostic factors for residual complaints following lumbar disc surgery in primary care. No studies have yet investigated both factors simultaneously. The aim of this prospective cohort study was to identify indicators of the short and l

  16. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Sonne-Holm, Stig; Rovsing, Hans

    2007-01-01

    : A total of 254 cases of lumbar slip were found (males 2.7%, females 8.4%). In females, no significant relationship between age at menopause or childbirths and the presence of degenerative spondylolisthesis were found. In women, relationships between body mass index (BMI) in 1976 and L4 olisthesis (P = 0...

  17. [Traumatic lumbar hernia of the Petit's triangle. A clinical case].

    Science.gov (United States)

    Rosato, L; Paino, O; Ginardi, A

    1996-12-01

    Lumbar hernias are very rare and no more than 300 are reported in literature. They can be classified as congenital and acquired. The latter are in turn subdivided into primary and secondary. Secondary traumatic lumbar hernias account for 25% of all cases. The site of the formation of this hernia is mainly Grynfelt's triangle and, to a lesser extent, Petit's triangle. Traumatic lumbar hernia have very moderate symptoms and may be corrected surgically relatively easily, in particular with the use of Marlex nets. Recidivations can be easily identified owing to the lack of aponeurotic support structures in this anatomic site. Owing to their traumatic etiopathogenesis these hernias are of particular medicolegal importance for the purposes of indemnity. The case reported refers to a 46-years-old man involved in a road accident who sustained an injury caused by the explosion of hollow viscera in the abdomen and the subsequent onset of a hernia swelling through Petit's triangle in the right lumbar region. Owing to the width of the breach, plastic surgery was carried out using a Marlex graft. A large recidivation was observed around one year later.

  18. Spontaneous regression of lumbar herniated disc Case presentation

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2015-12-01

    Full Text Available Intervertebral disc herniation is a common disease that usually requires surgical intervention. However, in some cases, neurological symptoms may improve with conservative treatment. In this article, we present a case with spontaneous regression of extruded lumbar herniated disc correlated with clinical improvement and documented with follow up MRI studies.

  19. Surgical treatment in thoraco-lumbar region fractures.

    Directory of Open Access Journals (Sweden)

    Jorge Alberto Jerez Labrada

    2008-08-01

    Full Text Available Background: thoraco-lumbar fractures may affect people at any moment of their lives, especially at their most fruitful and useful stage. Its correct diagnosis and treatment may directly influence in the posterior evolution of the patients. Objectives: to evaluate the results of the surgical treatment in thoraco-lumbar region fractures. Methods: a descriptive retrospective correlational study of series cases which included 54 patients attended due to thoraco-lumbar region fractures in the University Hospital “Dr. Gustavo Aldereguía Lima” in Cienfuegos city, Cuba from January 1999 to June 2007. Age, sex, etiology of the fracture, type and level of the fractures, associated diseases, surgical techniques used for, pre and post operatory neurological damage, usage of metilprednisolone, complications and final results were the variables taken into consideration in this study. Results: most of the patients belonged to male sex under the age of 45. The totality of the cases had type IV fracture, and a great part of them had Denis type II fracture having surgical treatment. The causes of the lesions were traffic accidents, working accidents and height falls. The most useful surgical techniques were posterior decompression, instrumentation and fusion. Surgery improved the neurological damage in almost half of sick patients with this condition. Complications were minimum and rupture of the implant was predominant. Conclusion: surgical treatment in thoraco-lumbar region fractures had satisfactory results in our milieu.

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

    Science.gov (United States)

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

    1999-08-01

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

  1. Synovial cysts of the lumbar spine: a review.

    Science.gov (United States)

    Radatz, M; Jakubowski, J; Cooper, J; Powell, T

    1997-12-01

    Four cases of synovial cyst (ganglion) arising from the facet joints of the lumbar spine are reported. A typical presenting feature was exacerbation of pain on standing or walking, mimicking vascular claudication. MRI proved in all four cases to be the definitive investigation and surgery the treatment of choice, producing excellent results.

  2. Laparoscopic surgery for treatment of incisional lumbar hernia

    Directory of Open Access Journals (Sweden)

    M. Tobias-Machado

    2005-08-01

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

  3. [Major vascular complications following surgery for a herniated lumbar disk].

    Science.gov (United States)

    Abad, C; Martel, D; Feijóo, J J; Carreira, L

    1993-01-01

    Two cases of arterial injury of the iliac arteries during surgery of the lumbar disc are presented. Both patients were successfully operated, in the first case a primary repair was accomplished, the second patient was treated by means of an ileo-femoral bypass graft. A comment of the pathophysiology, diagnostic and surgical management of this unusual complication is presented.

  4. 49 CFR 572.43 - Lumbar spine and pelvis.

    Science.gov (United States)

    2010-10-01

    ... vertical plane which is tangent to the back of the dummy's buttocks. (3) Align the test probe so that at... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) ANTHROPOMORPHIC TEST DEVICES Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a fully assembled dummy...

  5. Lumbar bone mass predicts low back pain in males

    NARCIS (Netherlands)

    Hoozemans, M.J.M.; Koppes, L.L.J.; Twisk, J.W.R.; Dieën, J.H. van

    2012-01-01

    STUDY DESIGN.: Longitudinal study of lumbar bone mass as predictor of low back pain (LBP). OBJECTIVE.: To investigate whether low bone mineral content (BMC) and bone mineral density (BMD) values at the age of 36 years are associated with the prevalence of LBP at the age of 42 years among the study p

  6. Spontaneous regression of lumbar herniated disc Case presentation

    OpenAIRE

    Chiriac A.; Ion Giorgiana; Faiyad Z.; Poeata I.

    2015-01-01

    Intervertebral disc herniation is a common disease that usually requires surgical intervention. However, in some cases, neurological symptoms may improve with conservative treatment. In this article, we present a case with spontaneous regression of extruded lumbar herniated disc correlated with clinical improvement and documented with follow up MRI studies.

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

    Directory of Open Access Journals (Sweden)

    Sandén Bengt

    2009-07-01

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

  8. Lumbar spinal mobility changes among adults with advancing age

    Directory of Open Access Journals (Sweden)

    Ismaila Adamu Saidu

    2011-01-01

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

  9. Femoral Intertrochanteric Fracture With Spontaneous Lumbar Hernia: A Case Report

    Directory of Open Access Journals (Sweden)

    Luo

    2016-03-01

    Full Text Available Introduction The diagnosis of lumbar hernia can be easily missed, as it is a rare case to which most orthopedists are not exposed in their common clinical practice. Approximately 300 cases have been reported in the literature since it was first described by Barbette in 1672. Case Presentation A 76-year-old woman who had been diagnosed with a femoral intertrochanteric fracture was sent to our department. Physical examination revealed a smooth, soft, and movable mass, with no tenderness, palpable on her left flank, which had gradually increased during the last seven years and presented with a slight feeling of swelling. We initially misdiagnosed the case as a left lipoma combined with the femoral intertrochanteric fracture. However, after six hours, the patient presented with a sudden onset of nausea, vomiting, and abdominal distension. Afterward, computed tomography (CT examination confirmed that the mass was a spontaneous lumbar hernia. Conclusions A lumbar hernia may, on rare occasions, become incarcerated or strangulated, with the consequent complication of mechanical bowel obstruction. We suggest that a patient with a flank mass should always raise suspicions of a lumbar hernia.

  10. Femoral Intertrochanteric Fracture With Spontaneous Lumbar Hernia: A Case Report

    Science.gov (United States)

    Luo, Peng; HE, Xing-Wen; Chen, Qing-Yun; Hong, Hao; Yang, Lei

    2016-01-01

    Introduction The diagnosis of lumbar hernia can be easily missed, as it is a rare case to which most orthopedists are not exposed in their common clinical practice. Approximately 300 cases have been reported in the literature since it was first described by Barbette in 1672. Case Presentation A 76-year-old woman who had been diagnosed with a femoral intertrochanteric fracture was sent to our department. Physical examination revealed a smooth, soft, and movable mass, with no tenderness, palpable on her left flank, which had gradually increased during the last seven years and presented with a slight feeling of swelling. We initially misdiagnosed the case as a left lipoma combined with the femoral intertrochanteric fracture. However, after six hours, the patient presented with a sudden onset of nausea, vomiting, and abdominal distension. Afterward, computed tomography (CT) examination confirmed that the mass was a spontaneous lumbar hernia. Conclusions A lumbar hernia may, on rare occasions, become incarcerated or strangulated, with the consequent complication of mechanical bowel obstruction. We suggest that a patient with a flank mass should always raise suspicions of a lumbar hernia.

  11. Effectiveness of a mucolythic agent as a local adjuvant in revision lumbar spine surgery

    Science.gov (United States)

    Denaro, Vincenzo; Di Martino, Alberto; Costa, Vincenzo; Papalia, Rocco; Forriol, Francisco; Denaro, Luca

    2008-01-01

    Aim of this prospective randomized trial was to analyze the effectiveness of MESNA in chemical dissection of peridural fibrosis in patients who underwent revision lumbar spine surgery. Between January 2003 and October 2006, 30 patients who underwent revision lumbar spine surgery were enrolled in the study. Patients were randomly assigned to one of two groups: a study group (A) and a control group (B). Once peridural fibrosis was exposed, MESNA (Uromixetan MESNA, 50 mg/ml) was intraoperatively applied on the fibrous tissue (Group A) to ease tissue dissection and enter the canal. In patients of Group B, saline solution was used. Surgical time, preoperative and 1 week postoperative hemoglobin (Hb), length of hospitalization (days), and incidence of perioperative complications were evaluated. The blinded surgeon assigned the surgeries to one of four categories as none, minimal, moderate, and severe basing on intraoperative difficulty in dissecting the fibrous tissue and intraoperative bleeding. Statistical analysis used chi-square analysis to evaluate the difference in surgery difficulty and the incidence of intraoperative complications between the two groups. The analysis of surgical time and hemoglobin levels was performed using a one-sample Wilcoxon test and Mann–Whitney U test. Patients in whom MESNA was used intraoperatively (Group A) presented better intraoperative and perioperative parameters with respect to the control group. Average surgical time and decrease in Hb postoperatively were more in the saline group (B) respect to MESNA (A) (P = 0.004 and P = 0.001, respectively), while no difference in average hospital stay was reported between the two groups. Surgeon-blinded intraoperative report on surgical difficulty showed a significant difference between the two groups (P < 0.05). Postoperatively, no complications directly attributable to the use of MESNA were experienced. The incidence of dural tears and intraoperative bleeding from epidural veins

  12. Sagittal endplate morphology of the lower lumbar spine.

    Science.gov (United States)

    Lakshmanan, Palaniappan; Purushothaman, Balaji; Dvorak, Vlasta; Schratt, Walter; Thambiraj, Sathya; Boszczyk, Maximilian

    2012-05-01

    The sagittal profile of lumbar endplates is discrepant from current simplified disc replacement and fusion device design. Endplate concavity is symmetrical in the coronal plane but shows considerable variability in the sagittal plane, which may lead to implant-endplate mismatch. The aim of this investigation is to provide further analysis of the sagittal endplate morphology of the mid to lower lumbar spine study (L3–S1), thereby identifying the presence of common endplate shape patterns across these levels and providing morphological reference values complementing the findings of previous studies. Observational study. A total of 174 magnetic resonance imaging (MRI) scans of the adult lumbar spine from the digital archive of our centre, which met the inclusion criteria, were studied. Superior (SEP) and inferior (IEP) endplate shape was divided into flat (no concavity), oblong (homogeneous concavity) and ex-centric (inhomogeneous concavity). The concavity depth (ECD) and location of concavity apex (ECA) relative to endplate diameter of the vertebrae L3–S1 were determined. Flat endplates were only predominant at the sacrum SEP (84.5%). The L5 SEP was flat in 24.7% and all other endplates in less than 10%. The majority of endplates were concave with a clear trend of endplate shape becoming more ex-centric from L3 IEP (56.9% oblong vs. 37.4% ex-centric) to L5 IEP (4% oblong vs. 94.3% ex-centric). Ex-centric ECA were always found in the posterior half of the lumbar endplates. Both the oblong and ex-centric ECD was 2-3 mm on average with the IEP of a motion segment regularly possessing the greater depth. A sex- or age-related difference could not be found. The majority of lumbar endplates are concave, while the majority of sacral endplates are flat. An oblong and an ex-centric endplate shape can be distinguished, whereby the latter is more common at the lower lumbar levels. The apex of the concavity of ex-centric discs is located in the posterior half of the endplate

  13. Is age group a predictive factor for satisfaction among patients undergoing sympathectomy to treat hyperhidrosis? A idade é um fator preditivo de satisfação entre pacientes submetidos à simpatectomia para o tratamento da hiper-hidrose?

    Directory of Open Access Journals (Sweden)

    José Ribas Milanez de Campos

    2011-12-01

    Full Text Available OBJECTIVE: Video-assisted thoracic sympathectomy is currently the procedure of choice for the definitive treatment of primary hyperhidrosis, because it is an effective, safe, and minimally invasive method. In the search for better quality of life indexes, all researchers look for predictive factors indicating better surgical outcomes. Failure in the primary treatment, postoperative compensatory hyperhidrosis, body mass index over 25, level of resection of the sympathetic chain, and extent of resection are some of the factors that may negatively influence the results. The objective of this study was to compare, according to the age group, the quality of life after bilateral thoracic sympathectomy for treatment of primary hyperhidrosis in a cohort of 1,644 patients. METHODS: From February 2000 to October 2008, data were collected from 1,644 patients with palmar (71% or axillary (29% hyperhidrosis who underwent video-assisted thoracic sympathectomy. The patients were divided into three groups according to their ages. The first group consisted of patients up to 17 years-old, the second from 18 to 30 years-old, and the third of over 30 years-old. All patients had a body mass index of less than 25. RESULTS: In the evaluation 30 days after surgery, improvement of the quality of life in the three groups was observed. There was no significant difference between the age groups. In the present study, 91.9% of the patients presented compensatory hyperhidrosis, with no difference between the age groups. CONCLUSIONS: Patients with primary hyperhidrosis experience quality of life improvement after thoracic sympathectomy regardless of their age.OBJETIVO: A simpatectomia torácica por videotoracoscopia é atualmente o procedimento de escolha para o tratamento definitivo da hiper-hidrose palmar, pois é um método eficaz, seguro e minimamente invasivo. Na busca de melhores índices de qualidade de vida, os pesquisadores procuram por fatores preditivos de bom

  14. Epidural steroid injection for lumbar disc herniation in NFL athletes.

    Science.gov (United States)

    Krych, Aaron J; Richman, Daniel; Drakos, Mark; Weiss, Leigh; Barnes, Ronnie; Cammisa, Frank; Warren, Russell F

    2012-02-01

    To our knowledge, there is no published information on the efficacy of epidural steroid injections for the treatment of lumbar disc herniation in an athletic population. The purpose of this study was to evaluate the efficacy of epidural corticosteroid injection for treatment of lumbar disc herniation in a group of National Football League (NFL) players. We retrospectively reviewed the records of all NFL players who underwent an epidural steroid injection at our institution for incapacitating pain secondary to an acute lumbar disc herniation (confirmed on magnetic resonance imaging) from 2003 to 2010. Our primary outcome was success of the injection, defined as return to play. The secondary outcome of the study was to evaluate risk factors for failure of this treatment approach. Seventeen players had a total of 37 injections for 27 distinct lumbar disc herniation episodes from 2003 to 2010. The success rate of returning an athlete to play for a given episode of disc herniation was 89% (24 of 27 episodes) with an average loss of 2.8 practices (range = 0-12) and 0.6 games (range = 0-2) after the injection. Four players required a repeat injection for the same episode. Three of these four players ultimately failed conservative management and required surgical intervention. Risk factors for failing injection therapy included sequestration of the disc herniation on magnetic resonance imaging (P = 0.01) and weakness on physical examination (P = 0.002). There were no complications reported. In this highly selective group of professional athletes, our results suggest that epidural steroid injections are a safe and effective therapeutic option in the treatment of symptomatic lumbar disc herniation.

  15. The Lumbar Lordosis in Males and Females, Revisited.

    Directory of Open Access Journals (Sweden)

    Ori Hay

    Full Text Available Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females.Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height.Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined.Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis. The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing.

  16. The Lumbar Lordosis in Males and Females, Revisited.

    Science.gov (United States)

    Hay, Ori; Dar, Gali; Abbas, Janan; Stein, Dan; May, Hila; Masharawi, Youssef; Peled, Nathan; Hershkovitz, Israel

    2015-01-01

    Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females. Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height. Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined). Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis). The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing.

  17. Testing biomechanical models of human lumbar lordosis variability.

    Science.gov (United States)

    Castillo, Eric R; Hsu, Connie; Mair, Ross W; Lieberman, Daniel E

    2017-05-01

    Lumbar lordosis (LL) is a key adaptation for bipedalism, but factors underlying curvature variations remain unclear. This study tests three biomechanical models to explain LL variability. Thirty adults (15 male, 15 female) were scanned using magnetic resonance imaging (MRI), a standing posture analysis was conducted, and lumbar range of motion (ROM) was assessed. Three measures of LL were compared. The trunk's center of mass was estimated from external markers to calculate hip moments (Mhip ) and lumbar flexion moments. Cross-sectional areas of lumbar vertebral bodies and trunk muscles were measured from scans. Regression models tested associations between LL and the Mhip moment arm, a beam bending model, and an interaction between relative trunk strength (RTS) and ROM. Hip moments were not associated with LL. Beam bending was moderately predictive of standing but not supine LL (R(2)  = 0.25). Stronger backs and increased ROM were associated with greater LL, especially when standing (R(2)  = 0.65). The strength-flexibility model demonstrates the differential influence of RTS depending on ROM: individuals with high ROM exhibited the most LL variation with RTS, while those with low ROM showed reduced LL regardless of RTS. Hip moments appear constrained suggesting the possibility of selection, and the beam model explains some LL variability due to variations in trunk geometry. The strength-flexibility interaction best predicted LL, suggesting a tradeoff in which ROM limits the effects of back strength on LL. The strength-flexibility model may have clinical relevance for spinal alignment and pathology. This model may also suggest that straight-backed Neanderthals had reduced lumbar mobility. © 2017 Wiley Periodicals, Inc.

  18. 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 respons

  19. CLINICAL APPLICATION OF "LUMBAR THREE-POINT NEEDLING" IN TREATMENT OF LUMBAR AND BUTTOCK DISEASES

    Institute of Scientific and Technical Information of China (English)

    王黎; 赖新生

    2001-01-01

    "Lumbar three-point needling", meaning puncturing Shenshu (BL 23), Dachangshu (BL 25) and Ciliao(BL 32) at the same time, is a commonly used acupuncture method in the treatment of lumbocrural diseases. Points supplemented according to symptoms. Weizhong(BL 40) is supplemented for lumbar vertebra hypertrophy spondylitis; Weizhong (BL 40) and Kunlun(BL 60) supplemented for acute lumbar muscle sprain; Zhibian (BL 54), Huantiao (GB 30) and Ahshi points supplemented for nervi cluniam superior inflammation, and Sanyinjiao (SP 6) and Mingmen(GV 4) supplemented for impotence. Gauge-28 2 curt long needles are used. The needles are inserted perpendicularly into Shenshu(BL 23), Dachengshu(BL 25) and Ciliao(BL 32) to a depth of about 1.2 --- 1.5 cun. Other supplementary points are needled and stimulated with routine manipulations, generally the reducing method is used for excess syndrome, and the reinforcing method applied to deficiency syndrome. The author, on the basis of many years of clinical practice, considers that "lumbar three-point needling" is fairly effective in treating lumbosacral diseases.

  20. Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion

    Science.gov (United States)

    Kulkarni, Arvind G; Bohra, Hussain; Dhruv, Abhilash; Sarraf, Abhishek; Bassi, Anupreet; Patil, Vishwanath M

    2016-01-01

    Background: The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar interbody fusion (MI-TLIF) translate into superior, equal, or inferior outcomes as compared to open-transforaminal lumbar interbody fusion (O-TLIF). This is the first study from the Indian subcontinent prospectively comparing the outcomes of MI-TLIF and O-TLIF. Materials and Methods: All consecutive cases of open and MI-TLIF were prospectively followed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, radiation exposure, quantitative C-reactive protein (QCRP), and blood loss were compared between the two groups. The parameters were statistically analyzed (using IBM® SPSS® Statistics version 17). Results: 129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 patients were excluded on account of insufficient data and/or no followup. The mean followup was 36.5 months (range 18-54 months). The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days + 1.8, P blood loss (open 358.8 ml, MI 111.81 ml, P group. On an average, 57.77 fluoroscopic exposures were required in MI-TLIF which was significantly higher than in O-TLIF (8.2). There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups. The change in QCRP values preoperative and postoperative was significantly lower (P group than in O-TLIF group, indicating lesser tissue trauma. Conclusion: The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are