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Sample records for lumbar facet joint

  1. Computed Tomography of the lumbar facet joints

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

    1989-08-15

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

  2. Computed Tomography of the lumbar facet joints

    International Nuclear Information System (INIS)

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

    1989-01-01

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

  3. Management of lumbar zygapophysial (facet) joint pain

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    Manchikanti, Laxmaiah; Hirsch, Joshua A; Falco, Frank JE; Boswell, Mark V

    2016-01-01

    AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain. METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including PubMed from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources including previous systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level I to level V

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

    International Nuclear Information System (INIS)

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

    2004-01-01

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

  5. Congenital absence of the lumbar facet joint associated with bilateral spondylolysis of the fifth lumbar vertebra.

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    Wang, Zhuo; Sakakibara, Toshihiko; Kasai, Yuichi

    2013-01-01

    A 14-year-old boy presented with a rare case of congenital absence of lumbar facet joint manifesting as low back pain. Physical examination showed no neurological or hematologic abnormalities. Radiography revealed absence of a facet joint on the right side of L4-5. Computed tomography and three-dimensional computed tomography revealed absence of the facet joint on the right side of L4-5 and spondylolysis on both sides of L5. Pain subsided after conservative treatment. This is an extremely rare case of congenital absence of lumbar facet joint associated with bilateral spondylolysis.

  6. [Feasibility and accuracy of ultrasound-guided methodology in the examination of lumbar spine facet joints].

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    Wen, Chuan-Bing; Li, Yong-Zhong; Tang, Qin-Qin; Sun, Lin; Xiao, Hong; Yang, Bang-Xiang; Song, Li; Liu, Hui

    2013-03-01

    To investigate the feasibility, accuracy of B ultrasound in the examination of joint space of lumbar spine facet joints compared with CT scan. Ten healthy adult volunteers were enrolled. The joint space of lumbar facet joints was measured by ultrasound. To identify the spinal levels, the posterior parasagittal sonograms were obtained at levels L1 to S1. The lumbar facet joints were delineated with the help of transverse sonograms at each level. Meanwhile, the lumbar facet joints were evaluated by spiral CT on the same plane, reformatted to 1-mm axial slices. A total of 88 lumbar facet joints from L1 to S1 were clearly visualized in the 10 volunteers. Both ultrasound and CT measurements showed the same average depth and lateral distance of lumbar facet joint space (P > 0.05). The lumbar facet joint space can be accurately demonstrated by ultrasound.

  7. In vivo facet joint loading of the canine lumbar spine.

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    Buttermann, G R; Schendel, M J; Kahmann, R D; Lewis, J L; Bradford, D S

    1992-01-01

    This study describes a technique to measure in vivo loads and the resultant load-contact locations in the facet joint of the canine lumbar spine. The technique is a modification of a previously described in vitro method that used calibrated surface strains of the lateral aspect of the right L3 cranial articular process. In the present study, strains were measured during various in vivo static and dynamic activities 3 days after strain gage implantation. The in vivo recording technique and its errors, which depend on the location of the applied facet loads, is described. The results of applying the technique to five dogs gave the following results. Relative resultant contact load locations on the facet tended to be in the central and caudal portion of the facet in extension activities, central and cranial in standing, and cranial and ventral in flexion or right-turning activities. Right-turning contact locations were ventral and cranial to left-turning locations. Resultant load locations at peak loading during walking were in the central region of the facet, whereas resultant load locations at minimum loading during walking were relatively craniad. This resultant load-contact location during a walk gait cycle typically migrated in an arc with a displacement of 4 mm from minimum to maximum loading. Static tests resulted in a range of facet loads of 0 N in flexion and lying to 185 N for two-legged standing erect, and stand resulted in facet loads of 26 +/- 15 N (mean +/- standard deviation [SD]). Dynamic tests resulted in peak facet loads ranging from 55 N while walking erect to 170 N for climbing up stairs. Maximum walk facet loads were 107 +/- 27 N. The technique is applicable to in vivo studies of a canine facet joint osteoarthritis model and may be useful for establishing an understanding of the biomechanics of low-back pain.

  8. Augmented Reality-Guided Lumbar Facet Joint Injections.

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    Agten, Christoph A; Dennler, Cyrill; Rosskopf, Andrea B; Jaberg, Laurenz; Pfirrmann, Christian W A; Farshad, Mazda

    2018-05-08

    The aim of this study was to assess feasibility and accuracy of augmented reality-guided lumbar facet joint injections. A spine phantom completely embedded in hardened opaque agar with 3 ring markers was built. A 3-dimensional model of the phantom was uploaded to an augmented reality headset (Microsoft HoloLens). Two radiologists independently performed 20 augmented reality-guided and 20 computed tomography (CT)-guided facet joint injections each: for each augmented reality-guided injection, the hologram was manually aligned with the phantom container using the ring markers. The radiologists targeted the virtual facet joint and tried to place the needle tip in the holographic joint space. Computed tomography was performed after each needle placement to document final needle tip position. Time needed from grabbing the needle to final needle placement was measured for each simulated injection. An independent radiologist rated images of all needle placements in a randomized order blinded to modality (augmented reality vs CT) and performer as perfect, acceptable, incorrect, or unsafe. Accuracy and time to place needles were compared between augmented reality-guided and CT-guided facet joint injections. In total, 39/40 (97.5%) of augmented reality-guided needle placements were either perfect or acceptable compared with 40/40 (100%) CT-guided needle placements (P = 0.5). One augmented reality-guided injection missed the facet joint space by 2 mm. No unsafe needle placements occurred. Time to final needle placement was substantially faster with augmented reality guidance (mean 14 ± 6 seconds vs 39 ± 15 seconds, P Augmented reality-guided facet joint injections are feasible and accurate without potentially harmful needle placement in an experimental setting.

  9. Intraarticular Pulsed Radiofrequency to Treat Refractory Lumbar Facet Joint Pain in Patients with Low Back Pain.

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    Chang, Min Cheol; Cho, Yun-Woo; Ahn, Da Hyun; Do, Kyung Hee

    2018-04-01

    Many treatment techniques have been used for refractory lumbar facet joint pain; however, their efficacy has been controversial. In this study, we investigated the clinical efficacy and safety of intra-articular pulsed radiofrequency for the treatment of refractory lumbar facet joint pain in patients with low back pain. Twenty patients with refractory lumbar facet joint pain were recruited, and each patient was treated via intra-articular pulsed radiofrequency. The treatment effects were measured with a numerical rating scale, and the technical accuracy of intra-articular pulsed radiofrequency treatment was evaluated independently by 2 radiologists. Any adverse events or complications also were checked. We performed intra-articular pulsed radiofrequency treatment at 48 levels of the lumbar facet joints in 20 patients (5 men and 15 women; mean age, 64.50 ± 10.65 years) with refractory lumbar facet joint pain. Pain scores were significantly reduced at 1 month, 3 months, and 6 months after treatment (P radiofrequency results in all 20 patients, without any serious adverse effects. Treatment using intra-articular pulsed radiofrequency is an alternative to other techniques in patients with refractory lumbar facet joint pain. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. Treatment of lumbar facet joint syndrome by CT-guided intraarticular infiltration of fact joints

    International Nuclear Information System (INIS)

    Schleifer, J.; Fenzl, G.; Wolf, A.; Diehl, K.

    1994-01-01

    In 62 patients with facet syndrome a total of 205 joints were infiltrated, CT monitoring being used in all cases. Each facet joint was infiltrated with 0.3 ml bupivacaine and 0.8 ml methylprednisolone. The patients were divided into three groups. Group 1 consisted of 24 persons who had undergone lumbar disc surgery, group 2 of 23 patients with spondylarthrosis of the facet joints, and group 3 of 15 patients who had undergone lumbar disc surgery but hat additional spondylarthrosis. Very good results were defined as pain relief for longer than 4 weeks, good results as pain relief for up to 4 weeks and poor results as brief pain relief or none at all. In 27 patients facet infiltration was performed for the purpose of diagnosis. Results were significantly in group 2 than in group 1. In group 3 results were better than in group 1, but worse than in group 2. These differences were not statistical by significant. Seven patients in the diagnostic group had no pain relief, and facet syndrome was excluded. (orig.) [de

  11. Lumbar Facet Joint Arthritis Is Associated with More Coronal Orientation of the Facet Joints at the Upper Lumbar Spine

    International Nuclear Information System (INIS)

    Jentzsch, Th.; Geiger, J.; Zimmermann, S.M.; Slankamenac, K.; Werner, C.M.L.; Nguyen-Kim, Th.D.L.

    2013-01-01

    We retrospectively analyzed CT scans of 620 individuals, who presented to our traumatology department between 2008 and 2010. Facet joint (FJ) arthritis was present in 308 (49.7%) individuals with a mean grade of 1. It was seen in 27% of individuals ≤40 years and in 75% of individuals ≥41 years ( Ρ <0.0001) as well as in 52% of females and 49% of males ( Ρ=0.61). Mean FJ orientation was 30.4° at L2/3, 38.7° at L3/4, 47° at L4/5, and 47.3° at L5/S1. FJ arthritis was significantly associated with more coronal (increased degree) FJ orientation at L2/3 (Ρ=0.03) with a cutoff point at ≥32°. FJs were more coronally oriented (48.8°) in individuals ≤40 years and more sagittally oriented (45.6°) in individuals ≥41 years at L5/S1 (Ρ=0.01). Mean FJ asymmetry was 4.89° at L2/3, 6.01° at L3/4, 6.67° at L4/5, and 7.27° at L5/S1, without a significant difference for FJ arthritis. FJ arthritis is common, increases with age, and affects both genders equally. More coronally oriented FJs (≥32°) in the upper lumbar spine may be an individual risk factor for development of FJ arthritis.

  12. Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique

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    Amoretti, Nicolas, E-mail: amorettinicolas@yahoo.fr; Gallo, Giacomo, E-mail: giacomo.gallo83@gmail.com; Bertrand, Anne-Sophie, E-mail: asbertrand3@hotmail.com [Centre Hospitalier Universitaire de Nice (France); Bard, Robert L., E-mail: rbard@cancerscan.com [New York Medical College (United States); Kelekis, Alexis, E-mail: akelekis@med.uoa.gr [University General Hospital “ATTIKON” (Greece)

    2016-01-15

    We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4–L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.

  13. Evaluation of the relationship between age, gender, and body mass index, and lumbar facet joint pain

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    Arman Taheri

    2016-01-01

    Full Text Available Introduction: Lumbar facet joint pain accounts for 5-15% of the cases of chronic, axial low back pain. Most commonly, facetogenic pain is the result of repetitive stress and/or cumulative low level trauma, leading to inflammation and stretching of the joint capsule. Patients and Methods: In this descriptive study 76 patients who were diagnosed, after a diagnostic block, as having lumbar facet joint pain were evaluated by their age, sex, and body mass index (BMI. Data were collected according to a checklist and entered to SPSS version 16. Results: The mean age of the participants was 48.53 years; the participants included 44 women and 32 men. Lumbar facet joint pain was more frequent in the age range of 40-55 years. With respect to BMI, lumbar facet joint pain was most frequently seen in patients with BMI of 24.5-29.5 kg/m 2 (40.8%. Conclusion: Based on our findings, the chances of developing lumbar facet joint pain is more in women who are between 40 years and 55 years of age and whose BMI is 24.5-29.5 kg/m 2 .

  14. Evaluation of Facet Joint Arthrosis in Stenotic and Normal Lumbar Spines with MRI

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    Ebru Ozan

    2013-10-01

    Full Text Available Aim: To reveal the prevalence of lumbar facet joint arthrosis in normal and stenotic lumbar spines with magnetic resonance imaging. Material and Method: Study group consisted of 30 patients with complaints and findings of lower back pain, neurologic claudicatio and lumbar spinal stenosis detected at L3-4, L4-5 and/or L5-S1 with magnetic resonance imaging (cross section area of the dural sac

  15. Correlation of the Features of the Lumbar Multifidus Muscle With Facet Joint Osteoarthritis.

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    Yu, Bo; Jiang, Kaibiao; Li, Xinfeng; Zhang, Jidong; Liu, Zude

    2017-09-01

    Facet joint osteoarthritis is considered a consequence of the aging process; however, there is evidence that it may be associated with degenerative changes of other structures. The goal of this study was to investigate the correlation between lumbar multifidus muscle features and facet joint osteoarthritis. This retrospective study included 160 patients who had acute or chronic low back pain and were diagnosed with facet joint osteoarthritis on computed tomography scan. Morphometric parameters, including cross-sectional area, muscle-fat index, and percentage of bilateral multifidus asymmetry at L3-L4, L4-L5, and L5-S1, were evaluated with T2-weighted magnetic resonance imaging. Patients with facet joint osteoarthritis had a smaller cross-sectional area and a higher muscle-fat index than those without facet joint osteoarthritis (Posteoarthritis at all 3 spinal levels (Posteoarthritis only at L4-L5 (P=.005). Asymmetry of the bilateral multifidus cross-sectional area was independently associated with facet joint osteoarthritis at L5-S1 (P=.009), but did not seem to be responsible for asymmetric degeneration of the bilateral facet joints. A higher multifidus muscle-fat index was independently associated with facet joint osteoarthritis, and bilateral multifidus size asymmetry was associated with the development of facet joint osteoarthritis at L5-S1. It seems more accurate to consider facet joint osteoarthritis a failure of the whole joint structure, including the paraspinal musculature, rather than simply a failure of the facet joint cartilage. [Orthopedics. 2017; 40(5):e793-e800.]. Copyright 2017, SLACK Incorporated.

  16. Facet joint orientation and tropism in lumbar degenerative disc disease and spondylolisthesis.

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    Pichaisak, Witchate; Chotiyarnwong, Chayaporn; Chotiyarnwong, Pojchong

    2015-04-01

    Although degenerative disc disease (DDD) and degenerative spondylolisthesis (DS) are two common causes of back pain in elderly, the association between the lumbarfacet joint angle and tropism in these conditions are still unclear. To evaluate the difference in facet joint angles between normal population and lumbar degenerative disc disease and spondylolisthesis patient. The angle of lumbar facet joints were retrospectively measured with magnetic resonance imaging (MRI) to determine whether there was a difference between degenerative diseases. MRI of patients with DDD, DS, and control group at facet joint between L3-4, L4-5 and L5-S1 level were measured in axial view (60 subjects in each group). There was no difference infacetjoint angle in DDD (44.1 ± 11.9) and control (45.6 ± 8.9), but differed in DS (40.1 ± 10. 7) and control group (p = 0.010) at L4-5 level. Facet tropism showed difference between degenerative groups and control group at L4-5 level. DS group showed difference in facet joints angle and tropism when compared with control population, while DDD showed difference only in facet tropism. In addition, longitudinal studies are needed to understand the clinical significant between facet joint angle and tropism in spinal degenerative diseases.

  17. Image-guided lumbar facet joint infiltration in nonradicular low back pain

    International Nuclear Information System (INIS)

    Chaturvedi, Arti; Chaturvedi, Sunil; Sivasankar, Rajiv

    2009-01-01

    To assess the efficacy of facet joint infiltrations for pain relief in 44 selected patients with chronic nonradicular low back pain (LBP). Forty-four patients with chronic LBP of more than 3 months' duration were selected for facet joint infiltration. The majority (n = 24) had facetal pain with no evidence of significant facetal arthropathy on imaging. Fifteen patients had radiological evidence of facetal arthropathy, one had a facet joint synovial cyst, three were post–lumbar surgery patients, and two patients had spondylolysis. Facet joint injections were carried out under fluoroscopic guidance in 39 patients and under CT guidance in 5 cases. Pain relief was assessed using the visual analog scale at 1 h post-procedure and, thereafter, at 1, 4, 12, and 24 weeks. A total of 141 facet joints were infiltrated in 44 patients over a 2-year period. There was significant pain relief in 81.8% patients 1 h after the procedure, in 86.3% after 1 week, in 93.3% after 4 weeks, in 85.7% after 12 weeks, and in 62.5% after 24 weeks. No major complications were encountered. Facet nerve block was found to be a simple, minimally invasive, and safe procedure. With meticulous patient selection, we achieved long-term success rates of over 60%. We conclude that this method represents an important alternative treatment for nonradicular back pain

  18. Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease

    International Nuclear Information System (INIS)

    Morrison, J.L.; Kaplan, P.A.; Dussault, R.G.; Anderson, M.W.

    2000-01-01

    Objective. Signal intensity changes in lumbar pedicles, similar to those described in vertebral body endplates adjacent to degenerated discs, have been described as an ancillary sign of spondylolysis on MRI. The purpose of this study was to determine whether pedicle marrow signal intensity changes also occur in association with facet degenerative joint disease.Design. Eighty-nine lumbar spine MRI examinations without spondylolysis were reviewed for marrow signal intensity changes in pedicles and vertebral bodies as well as for facet degenerative joint disease.Results. Five percent (46/890) of lumbar pedicles in 23 patients had marrow signal intensity changes. Ninety-one percent (42/46) of the abnormal pedicles had adjacent degenerative joint disease of the facets, while only 21% (189/890) of normal pedicles had adjacent facet degenerative joint disease (p<0.001). Eighty-nine percent (41/46) of the pedicles with marrow signal intensity changes had adjacent degenerative disc disease.Conclusions. Pedicle marrow signal intensity changes are not a specific sign of spondylolysis; they are commonly seen with adjacent facet degenerative joint disease in the absence of spondylolysis. Pedicle marrow signal intensity changes are probably a response to abnormal stresses related to abnormal motion or loading caused by the degenerative changes in the spinal segment. (orig.)

  19. Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease

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    Morrison, J.L.; Kaplan, P.A.; Dussault, R.G.; Anderson, M.W. [Dept. of Radiology, Univ. of Virginia Health System, Charlottesville, VA (United States)

    2000-12-01

    Objective. Signal intensity changes in lumbar pedicles, similar to those described in vertebral body endplates adjacent to degenerated discs, have been described as an ancillary sign of spondylolysis on MRI. The purpose of this study was to determine whether pedicle marrow signal intensity changes also occur in association with facet degenerative joint disease.Design. Eighty-nine lumbar spine MRI examinations without spondylolysis were reviewed for marrow signal intensity changes in pedicles and vertebral bodies as well as for facet degenerative joint disease.Results. Five percent (46/890) of lumbar pedicles in 23 patients had marrow signal intensity changes. Ninety-one percent (42/46) of the abnormal pedicles had adjacent degenerative joint disease of the facets, while only 21% (189/890) of normal pedicles had adjacent facet degenerative joint disease (p<0.001). Eighty-nine percent (41/46) of the pedicles with marrow signal intensity changes had adjacent degenerative disc disease.Conclusions. Pedicle marrow signal intensity changes are not a specific sign of spondylolysis; they are commonly seen with adjacent facet degenerative joint disease in the absence of spondylolysis. Pedicle marrow signal intensity changes are probably a response to abnormal stresses related to abnormal motion or loading caused by the degenerative changes in the spinal segment. (orig.)

  20. Septic arthritis of a lumbar facet joint: Detection with bone SPECT imaging

    International Nuclear Information System (INIS)

    Swayne, L.C.; Dorsky, S.; Caruana, V.; Kaplan, I.L.

    1989-01-01

    We present a rare case of septic arthritis of a lumbar facet joint with an associated epidural abscess resulting from Staphylococcus aureus. The infection was initially detected with planar bone scintigraphy and precisely localized with single photon emission computed tomography bone scintigraphy, despite an initially negative radiologic evaluation that included radiographs of the lumbar spine, lumbar myelography, and a postmyelography x-ray computed tomography scan. In the appropriate clinical setting, a bone scan demonstrating unilateral increased activity within the spine should raise the suspicion of inflammatory involvement of the posterior elements

  1. MR imaging and CT in osteoarthritis of the lumbar facet joints

    International Nuclear Information System (INIS)

    Weishaupt, D.; Zanetti, M.; Hodler, J.; Boos, N.

    1999-01-01

    Objective. To test the agreement between MR imaging and CT in the assessment of osteoarthritis of the lumbar facet joints, and thus to provide data about the need for an additional CT scan in the presence of an MR examination. Design and patients. Using a four-point scale, two musculoskeletal radiologists independently graded the severity of osteoarthritis of 308 lumbar facet joints on axial T2-weighted and on sagittal T1- and T2-weighted turbo-spin-echo images and separately on the corresponding axial CT scans. Kappa statistics and percentage agreement were calculated. Results. The weighted kappa coefficients for MR imaging versus CT were 0.61 and 0.49 for readers 1 and 2, respectively. The weighted kappa coefficients for interobserver agreement were 0.41 for MR imaging and 0.60 for CT, respectively. There was agreement within one grade between MR and CT images in 95% of cases for reader 1, and in 97% of cases for reader 2. Conclusion. With regard to osteoarthritis of the lumbar facet joints there is moderate to good agreement between MR imaging and CT. When differences of one grade are disregarded agreement is even excellent. Therefore, in the presence of an MR examination CT is not required for the assessment of facet joint degeneration. (orig.)

  2. The prevalence of lumbar facet joint edema in patients with low back pain

    International Nuclear Information System (INIS)

    Friedrich, Klaus M.; Pinker, Katja; Trattnig, Siegfried; Nemec, Stefan; Peloschek, Philipp; Weber, Michael

    2007-01-01

    The objective was to assess the prevalence of lumbar facet joint edema in patients with low back pain. Lumbar spine MR examinations (1.5 T) of 145 consecutive patients (87 women, 58 men; mean age 52.8, range 17-94 years) were retrospectively evaluated with regard to the presence of facet joint edema. The MR protocol included sagittal short-tau inversion recovery (STIR), T1- and T2-weighted as well as transverse T2-weighted images. In 9 patients follow-up MR examinations were performed and results were compared with pain. The agreement between the change in intensity of facet joint edema and the change in intensity of pain was assessed using kappa statistics and Kendall's tau coefficient. In 21 of the 145 patients (14%) edema was found at the facet joints: in 52.4% at L4/5, in 19.0% at L5/S1, in 14.3% at L4/5 and L5/S1, in 9.5% at L3/4 and L4/5, and in 4.8% at L3/4. The agreement between the change in pain score and intensity of edema within the follow-up group was ''almost perfect'' (kappa = 0.81). Kendall's tau coefficient was 0.91, indicating high agreement. Sagittal STIR images detect facet joint edema in 14% of patients with low back pain. This fact may be useful for planning treatment including facet joint injections. (orig.)

  3. Thermocoagulation of lumbar facet joints: Experience in 252 patients

    OpenAIRE

    Martínez-Suárez, J. E.; Camblor, L.; Salva, S.; Jongh, W. A. de

    2005-01-01

    Se presentan 252 pacientes con el diagnóstico de dolor lumbar facetario a los que se le realizó la técnica quirúrgica de termocoagulación percutánea de la faceta articular. Nuestro propósito principal fue aliviar el dolor en estos pacientes, evaluamos la eficacia de la técnica con un 74,7% de resultados quirúrgicos satisfactorios, así como la descripción de diferentes aspectos como: edad, sexo, causas y la topografía segmentaria del dolor. Two hundred fifty two patients with diagnosis of l...

  4. Degenerative Changes of the Facet Joints in Adults With Lumbar Spondylolysis.

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    Goda, Yuichiro; Sakai, Toshinori; Harada, Taihei; Takao, Shoichiro; Takata, Yoichiro; Higashino, Kosaku; Harada, Masafumi; Sairyo, Koichi

    2017-07-01

    Radiologic analysis using computed tomography. To analyze the degenerative changes of the facet joints in patients with spondylolysis in comparison with control subjects. Defects of the pars interarticularis are thought to result in a reduction of biomechanical stress on adjacent facet joints. Therefore, degenerative changes of the facet joints in patients with spondylolysis are expected to be less than those in patients without spondylolysis. Abdominal and pelvic multidetector computed tomography scans of 2000 subjects, performed for conditions unrelated to low back pain, were reviewed. A total of 107 patients (37 women and 70 men) with L5 spondylolysis were identified [spondylolysis (+) group]. Sex-matched and age-matched controls without spondylolysis were chosen randomly [spondylolysis (-) group]. Subjects in the spondylolysis group were subdivided into either bilateral spondylolysis or unilateral spondylolysis groups for comparison with the control group. Four radiologic findings (narrowing, sclerosis, osteophyte, and bone cyst) indicative of degenerative change of the facet joints adjacent to the L5 pars defects were evaluated and the degree of degenerative change was graded by summing the number of degenerative changes (score range, 0-4). The χ test and Mann-Whitney U test were used for statistical analysis. Significantly more degenerative changes in both L4/L5 and L5/S facet joints were found in the spondylolysis (+) group than in the spondylolysis (-) group (χ test, P spondylolysis (+) group than in the spondylolysis (-) group. Degenerative changes of the facet joints at both L4/L5 and L5/S were more severe in the unilateral spondylolysis (+) group than in the spondylolysis (-) group. Degenerative changes of the facet joints in patients with lumbar spondylolysis were more severe than those without spondylolysis.

  5. Lumbar facet joint fat pads: Their normal anatomy and their appearance when enlarged

    International Nuclear Information System (INIS)

    Taylor, J.R.; McCormick, C.C.

    1991-01-01

    The polar recesses, superior and inferior to lumbar facet joints, are filled by fat pads from which fat-filled synovial folds project between the articular surfaces for a distance of two to four millimetres. The intracapsular superior recess lies between the ligamentum flavum and the lamina above. The extracapsular inferior recess lies on the back of the lamina below and communicates with the joint through a hole in the inferior capsule. The intracapsular folds move freely in and out of the joint during movements. These features are demonstrated in anatomic studies using transverse sections and radiologic studies using computed tomography. In about 4% of lumbar spines examined, the intraarticular fat pads are enlarged and extend from the joint recess(es) into the middle third of one or more facet joints. The fat pads can be identified in CT scans by their radiolucency and distinguished from vacuum phenomenon by measuring their attenuation values. The cause of the intra-articular enlargement of the fat pads is unknown, but it is suggested that their extension into the middle third of the joint may be secondary to degenerative change in the motion segment with capsular laxity in the affected joint. (orig.)

  6. Contribution of facet joints, axial compression, and composition to human lumbar disc torsion mechanics.

    Science.gov (United States)

    Bezci, Semih E; Eleswarapu, Ananth; Klineberg, Eric O; O'Connell, Grace D

    2018-02-12

    Stresses applied to the spinal column are distributed between the intervertebral disc and facet joints. Structural and compositional changes alter stress distributions within the disc and between the disc and facet joints. These changes influence the mechanical properties of the disc joint, including its stiffness, range of motion, and energy absorption under quasi-static and dynamic loads. There have been few studies evaluating the role of facet joints in torsion. Furthermore, the relationship between biochemical composition and torsion mechanics is not well understood. Therefore, the first objective of this study was to investigate the role of facet joints in torsion mechanics of healthy and degenerated human lumbar discs under a wide range of compressive preloads. To achieve this, each disc was tested under four different compressive preloads (300-1200 N) with and without facet joints. The second objective was to develop a quantitative structure-function relationship between tissue composition and torsion mechanics. Facet joints have a significant contribution to disc torsional stiffness (∼60%) and viscoelasticity, regardless of the magnitude of axial compression. The findings from this study demonstrate that annulus fibrosus GAG content plays an important role in disc torsion mechanics. A decrease in GAG content with degeneration reduced torsion mechanics by more than an order of magnitude, while collagen content did not significantly influence disc torsion mechanics. The biochemical-mechanical and compression-torsion relationships reported in this study allow for better comparison between studies that use discs of varying levels of degeneration or testing protocols and provide important design criteria for biological repair strategies. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  7. Quantitative in vivo MRI evaluation of lumbar facet joints and intervertebral discs using axial T2 mapping.

    Science.gov (United States)

    Stelzeneder, David; Messner, Alina; Vlychou, Marianna; Welsch, Goetz H; Scheurecker, Georg; Goed, Sabine; Pieber, Karin; Pflueger, Verena; Friedrich, Klaus M; Trattnig, Siegfried

    2011-11-01

    To assess the feasibility of T2 mapping of lumbar facet joints and intervertebral discs in a single imaging slab and to compare the findings with morphological grading. Sixty lumbar spine segments from 10 low back pain patients and 5 healthy volunteers were examined by axial T2 mapping and morphological MRI at 3.0 Tesla. Regions of interest were drawn on a single slice for the facet joints and the intervertebral discs (nucleus pulposus, anterior and posterior annulus fibrosus). The Weishaupt grading was used for facet joints and the Pfirrmann score was used for morphological disc grading ("normal" vs. "abnormal" discs). The inter-rater agreement was excellent for the facet joint T2 evaluation (r = 0.85), but poor for the morphological Weishaupt grading (kappa = 0.15). The preliminary results show similar facet joint T2 values in segments with normal and abnormal Pfirrmann scores. There was no difference in mean T2 values between facet joints in different Weishaupt grading groups. Facet joint T2 values showed a weak correlation with T2 values of the posterior annulus (r = 0.32) This study demonstrates the feasibility of a combined T2 mapping approach for the facet joints and intervertebral discs using a single axial slab.

  8. Quantitative in vivo MRI evaluation of lumbar facet joints and intervertebral discs using axial T2 mapping

    International Nuclear Information System (INIS)

    Stelzeneder, David; Messner, Alina; Scheurecker, Georg; Goed, Sabine; Friedrich, Klaus M.; Trattnig, Siegfried; Vlychou, Marianna; Welsch, Goetz H.; Pieber, Karin; Pflueger, Verena

    2011-01-01

    To assess the feasibility of T2 mapping of lumbar facet joints and intervertebral discs in a single imaging slab and to compare the findings with morphological grading. Sixty lumbar spine segments from 10 low back pain patients and 5 healthy volunteers were examined by axial T2 mapping and morphological MRI at 3.0 Tesla. Regions of interest were drawn on a single slice for the facet joints and the intervertebral discs (nucleus pulposus, anterior and posterior annulus fibrosus). The Weishaupt grading was used for facet joints and the Pfirrmann score was used for morphological disc grading (''normal'' vs. ''abnormal'' discs). The inter-rater agreement was excellent for the facet joint T2 evaluation (r = 0.85), but poor for the morphological Weishaupt grading (kappa = 0.15). The preliminary results show similar facet joint T2 values in segments with normal and abnormal Pfirrmann scores. There was no difference in mean T2 values between facet joints in different Weishaupt grading groups. Facet joint T2 values showed a weak correlation with T2 values of the posterior annulus (r = 0.32) This study demonstrates the feasibility of a combined T2 mapping approach for the facet joints and intervertebral discs using a single axial slab. (orig.)

  9. Significance of interfacet distance, facet joint orientation, and lumbar lordosis in spondylolysis.

    Science.gov (United States)

    Chung, Sang-Bong; Lee, Sungjoon; Kim, Hoon; Lee, Sun-Ho; Kim, Eun Sang; Eoh, Whan

    2012-04-01

    The aim of this study is to reveal the association between lumbar spondylolysis and several radiologic parameters, which had been suggested to be significant. The authors examine interfacet distance (IFD), facet joint orientation (FJO), and lumbar segmental lordosis (LSL) all together on the basis of lumbar computed tomography (CT) scan of 35 patients with L5 spondylolysis and 36 unaffected control groups. Thirty-five Korean military recruits, aged 19-23 (mean 20.9 years), were diagnosed as L5 spondylolysis by lumber CT scans. As a control group, 36 male Korean military recruits, aged 18-25 (mean 21.3 years), were reconfirmed as not affected by lumbar spondylolysis by CT scan when they visited our hospital complaining of back pain. This study compares IFD, FJO, and LSL for each lumbar segment between the spondylolytic and unaffected groups. We also propose the use of normal mean data of IFD, FJO, and LSL of lumbar vertebrae from 36 Korean young military recruits because each measurement has power as an absolute value, like data from an osteologic collection in other studies. Comparison of IFD between spondylolytic and unaffected individuals reveals significant differences at the L3, L4, and L5 level (P = 0.0384, P = 0.0219, and P spondylolysis, the increase of IFD from L4 to S1 was less pronounced (P spondylolysis and individuals without pars defect on L5. In the spondylolysis group, and the increase of IFD from L4 to S1 was less pronounced and the LSL at L5-S1 was more lordotic. Copyright © 2011 Wiley Periodicals, Inc.

  10. Diagnostic value of lumbar facet joint injection: a prospective triple cross-over study.

    Directory of Open Access Journals (Sweden)

    Uwe Schütz

    Full Text Available The diagnosis "lumbar facet syndrome" is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilateral FJ blocks using local anesthetics. A prospective single blinded triple cross-over study was performed. 60 patients (31 f, 29 m, mean age 53.2 yrs (22-73 with chronic low back pain (mean pain persistance 31 months, 6 months of conservative treatment without success admitted to a local orthopaedic department for surgical or conservative therapy of chronic LBP, were included in the study. Effect on pain reduction (10 point rating scale was measured. The 60 subjects were divided into six groups with three defined sequences of fluoroscopically guided bilateral monosegmental lumbar FJ test injections in "oblique needle" technique: verum-(local anaesthetic-, placebo-(sodium chloride- and sham-injection. Carry-over and periodic effects were evaluated and a descriptive and statistical analysis regarding the effectiveness, difference and equality of the FJ injections and the different responses was performed. The results show a high rate of non-response, which documents the lack of reliable and valid predictors for a positive response towards FJ blocks. There was a high rate of placebo reactions noted, including subjects who previously or later reacted positively to verum injections. Equivalence was shown among verum vs. placebo and partly vs. sham also. With regard to test validity criteria, a single intraarticular FJ block with local anesthetics is not useful to detect the pain-responsible FJ and therefore is no valid and reliable diagostic tool to specify indication of lumbar spine surgery. Comparative FJ blocks with local anesthetics and placebo-controls have to be interpretated carefully also, because they solely give no proper diagnosis on FJ being main pain

  11. Subdural empyema following lumbar facet joint injection: An exceeding rare complication.

    Science.gov (United States)

    Fayeye, Oluwafikayo; Silva, Adikarige Haritha Dulanka; Chavda, Swarupsinh; Furtado, Navin Raoul

    2016-01-01

    Chronic low back pain is extremely common with a life time prevalence estimated at greater than 70%. Facet joint arthrosis is thought to be the causative aetiological substrate in approximately 25% of chronic low back pain cases. Facet joint injection is a routine intervention in the armamentarium for both the diagnostic and therapeutic management of chronic low back pain. In fact, a study by Carrino et al. reported in excess of 94,000 facet joint injection procedures were carried out in the US in 1999. Although generally considered safe, the procedure is not entirely without risk. Complications including bleeding, infection, exacerbation of pain, dural puncture headache, and pneumothorax have been described. We report a rare case of a 47-year-old female patient who developed a left L4/5 facet septic arthrosis with an associated subdural empyema and meningitis following facet joint injection. This case is unique, as to the best of our knowledge no other case of subdural empyema following facet joint injection has been reported in the literature. Furthermore this case serves to highlight the potential serious adverse sequelae of a routine and apparently innocuous intervention. The need for medical practitioners to be alert to and respond rapidly to the infective complications of facet joint injection cannot be understated. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  12. Desmoid type fibromatosis in the facet joint of lumbar spine: Case report and review of literature

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    Kim, So Jung; Ha, Doo Hoe; Lee, Sang Min; Kang, Hae Youn [CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of)

    2013-10-15

    Desmoid type fibromatosis is a benign fibroblastic tumor arising from the fascia or musculoaponeurosis. It may occur in various locations, but most commonly in the shoulder girdle and neck; to our knowledge, there has been no reported case originating from a facet joint of the spine. We report CT and MR imaging findings of a desmoid type fibromatosis, involving the facet joint of the L3-4 spine with bone involvement.

  13. Biomechanical analysis of press-extension technique on degenerative lumbar with disc herniation and staggered facet joint

    Directory of Open Access Journals (Sweden)

    Hong-gen Du

    2016-05-01

    Full Text Available This study investigates the effect of a new Chinese massage technique named “press-extension” on degenerative lumbar with disc herniation and facet joint dislocation, and provides a biomechanical explanation of this massage technique. Self-developed biomechanical software was used to establish a normal L1–S1 lumbar 3D FE model, which integrated the spine CT and MRI data-based anatomical structure. Then graphic technique is utilized to build a degenerative lumbar FE model with disc herniation and facet joint dislocation. According to the actual press-extension experiments, mechanic parameters are collected to set boundary condition for FE analysis. The result demonstrated that press-extension techniques bring the annuli fibrosi obvious induction effect, making the central nucleus pulposus forward close, increasing the pressure in front part. Study concludes that finite element modelling for lumbar spine is suitable for the analysis of press-extension technique impact on lumbar intervertebral disc biomechanics, to provide the basis for the disease mechanism of intervertebral disc herniation using press-extension technique.

  14. Evaluation of Water Content in Lumbar Intervertebral Discs and Facet Joints Before and After Physiological Loading Using T2 Mapping MRI.

    Science.gov (United States)

    Yamabe, Daisuke; Murakami, Hideki; Chokan, Kou; Endo, Hirooki; Oikawa, Ryosuke; Sawamura, Shoitsu; Doita, Minoru

    2017-12-15

    T2 mapping was used to quantify the water content of lumbar spine intervertebral discs (IVDs) and facet joints before and after physiological loading. The aim of this study was to clarify the interaction between lumbar spine IVD and facet joints as load-bearing structures by measuring the water content of their matrix after physiological loading using T2 mapping magnetic resonance imaging (MRI). To date, few reports have functionally evaluated lumbar spine IVD and facet joints, and their interaction in vivo. T2 mapping may help detect changes in the water content of IVD and articular cartilage of facet joints before and after physiological loading, thereby enabling the evaluation of changes in interacted water retention between IVD and facet joints. Twenty asymptomatic volunteers (10 female and 10 male volunteers; mean age, 19.3 years; age range, 19-20 years) underwent MRI before and after physiological loading such as lumbar flexion, extension, and rotation. Each IVD from L1/2 to L5/S1 was sliced at center of the disc space, and the T2 value was measured at the nucleus pulposus (NP), anterior annulus fibrosus (AF), posterior AF, and bilateral facet joints. In the NP, T2 values significantly decreased after exercise at every lumbar spinal level. In the anterior AF, there were no significant differences in T2 values at any level. In the posterior AF, T2 values significantly increased only at L4/5. In the bilateral facet joints, T2 values significantly decreased after exercise at every level. There was a significant decrease in the water content of facet joints and the NP at every lumbar spinal level after dynamic loading by physical lumbar exercise. These changes appear to play an important and interactional role in the maintenance of the interstitial matrix in the IVD NP and cartilage in the facet joint. 3.

  15. The possibility of the radiological and ultrasonographic examination of the facet joints of the equine thoracic and lumbar spine

    International Nuclear Information System (INIS)

    Reisinger, R.

    2003-03-01

    The facet joints of the equine thoracic and lumbar spine were examined by radiology and ultrasonography in 31 and 20 standing horses, respectively. The employed methods were evaluated. The left and right joints of 15/31 standing horses were comparatively x-rayed with both 20 o ventral oblique and 30 o dorsal oblique techniques. The independent evaluation of the ensuing films by four experienced veterinary surgeons yielded a significantly better assessment of the tested parameters in the 20 o ventral oblique technique. It was possible to depict the facet joints of the right and left sides between the caudal margin of the scapula and the diaphragm with the pulmonary field as background rich in contrast. In 20 horses, the facet joints were examined from Th10 to L6 in longitudinal and sagittal planes. A linear-array ultrasound probe with a frequency of 7,5 MHz and a convex ultrasound probe with a frequency of 3,5 MHz were used. Depending on the nutritional state, the soft tissue structures could be evaluated. The evaluation of the facet joints themselves was very limited. (author)

  16. Facet joint syndrome

    International Nuclear Information System (INIS)

    Zigrai, M.; Zakovic, J.; Brezinova, M.; Pavlovicova, M.

    2002-01-01

    It is the purpose of the study to demonstrate the clinical relevance of degenerative changes in the facet joint of patients with low back pain irradiating to the lower extremities, and discuss some problems relating to diagnosis and different diagnosis. 119 patients presenting the listed bellow syndromes are covered by the study: scoliosis, polytopic pain vertebral syndrome, paresis and history of trauma. all patients undergo comprehensive neurological examination with special attention focused on the spine: CT and plain x-rays are taken of the lumbosacral segment to assess the condition of the facet joints. The neurological examination demonstrates in all cases pain syndrome in the lumbar spine referred to one or both lower extremities. In 56% it is a matter of persisting pain, and in 44% - recurrent. More than half of the patients complain of sacroiliac (SI) dislocation and palpatory pain. Unilateral or bilateral degenerative changes are documented by imaging studies in all patients, including: subchondral thickening, osteopathy narrowing the lateral or central part of the spinal canal with ensuing nerve root compression. The lumbosacral zygoapophyseal joints are source of pseudoradicular pain. A correlation between clinical picture and GT changes is noted in all patients with facet joint syndrome. CT is an indispensable method in diagnosing facet joint syndrome. (authors)

  17. Lumbar disc degeneration was not related to spine and hip bone mineral densities in Chinese: facet joint osteoarthritis may confound the association.

    Science.gov (United States)

    Pan, Jianjiang; Lu, Xuan; Yang, Ge; Han, Yongmei; Tong, Xiang; Wang, Yue

    2017-12-01

    A sample of 512 Chinese was studied and we observed that greater disc degeneration on MRI was associated with greater spine DXA BMD. Yet, this association may be confounded by facet joint osteoarthritis. BMD may not be a risk factor for lumbar disc degeneration in Chinese. Evidence suggested that lumbar vertebral bone and intervertebral disc interact with each other in multiple ways. The current paper aims to determine the association between bone mineral density (BMD) and lumbar disc degeneration using a sample of Chinese. We studied 165 patients with back disorders and 347 general subjects from China. All subjects had lumbar spine magnetic resonance (MR) imaging and dual- energy X-ray absorptiometry (DXA) spine BMD studies, and a subset of general subjects had additional hip BMD measurements. On T2-weighted MR images, Pfirrmann score was used to evaluate the degree of lumbar disc degeneration and facet joint osteoarthritis was assessed as none, slight-moderate, and severe. Regression analyses were used to examine the associations between lumbar and hip BMD and disc degeneration, adjusting for age, gender, body mass index (BMI), lumbar region, and facet joint osteoarthritis. Greater facet joint osteoarthritis was associated with greater spine BMD (P osteoarthritis entered the regression model, however, greater spine BMD was associated with greater facet joint osteoarthritis (P  0.05). No statistical association was observed between spine BMD and lumbar disc degeneration in patients with back disorders (P > 0.05), and between hip BMD and disc degeneration in general subjects (P > 0.05). BMD may not be a risk factor for lumbar disc degeneration in Chinese. Facet joint osteoarthritis inflates DXA spine BMD measurements and therefore, may confound the association between spine BMD and disc degeneration.

  18. A New Technique for the Treatment of Lumbar Facet Joint Syndrome Using Intra-articular Injection with Autologous Platelet Rich Plasma.

    Science.gov (United States)

    Wu, Jiuping; Du, Zhenwu; Lv, Yang; Zhang, Jun; Xiong, Wei; Wang, Ruiqiang; Liu, Rui; Zhang, Guizhen; Liu, Qinyi

    2016-01-01

    Lumbar facet joint syndrome is currently suggested to be a main source of axial low back pain, and a large portion of axial low back pain is caused by disorders in lumbar facet joints. Intra-articular injection is one of the most common treatment methods in the early clinical application. Therefore, we attempt to seek a new injectable material, autologous platelet rich plasma (PRP), to treat lumbar facet syndrome, as well as to assess its therapeutic effectiveness and safety. A prospective clinic evaluation. The outpatient clinic of a single academic medical center. Total 19 patients with lumbar facet joint syndrome (8 men, 11 women; mean ages: 52.53 ± 6.79 years, range: 38 - 62 years) were enrolled to receive lumbar facet joint injection with autologous PRP under x-ray fluoroscopic control. Patients were followed up immediately, at one week, one month, 2 months, and 3 months following treatment, and the elements of this analysis included low back pain visual analogue scale (VAS) at rest and during flexion, Roland-Morris Disability Questionnaire (RMQ), Oswestry Disability Index (ODI), and modified MacNab criteria for the pain relief. All the 19 patients completed the intra-articular injections with autologous PRP successfully. At one week after treatment, low back pain reduced significantly compared with prior to treatment both at rest and during flexion. The outcomes were assessed as "good" or "excellent" for 9 patients (47.37%) immediately after treatment, 14 patients (73.68%) at one week, 15 patients (78.95%) at one month, 15 patients (78.95%) at 2 months, and 15 patients (78.95%) at 3 months. Statistically significant differences were observed based on RMQ and a more than 10% improvement in lumbar functional capacity was observed based on ODI between pre-treatment and post-treatment. In addition, there were no severe relevant complications during the whole process of injection and follow-up period. A control group and the curative effect observations with

  19. Unusual case of paediatric septic arthritis of the lumbar facet joints due to Kingella kingae.

    Science.gov (United States)

    Le Hanneur, M; Vidal, C; Mallet, C; Mazda, K; Ilharreborde, B

    2016-11-01

    A 32-month-old boy presented with febrile limping that had developed over 6days, associated with right lumbosacral inflammatory swelling. Magnetic resonance imaging (MRI) showed joint effusion of the right L5-S1 zygapophyseal joint, complicated by destructive osteomyelitis of the L5 articular process and paraspinal abscess. Surgery was decided to evacuate the fluid accumulation and rule out differential diagnoses. The diagnosis of septic arthritis of the facet joint was confirmed intraoperatively; real-time quantitative PCR analysis identified Kingella kingae. This is the first substantiated paediatric case of zygapophyseal joint septic arthritis due to K. kingae. K. kingae is the most common pathogen responsible for invasive osteoarticular infection in children under 4years of age. Since empiric antibiotics are effective in early stages, physicians should consider the possibility of spinal infections due to K. kingae when a limping child under 4years of age presents with a fever. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. CT-guided intradiscal ozone injection combined with intervertebral facet joint steroid injection for lumbar disk herniation accompanied with intervertebral arthritis

    International Nuclear Information System (INIS)

    Zhang Li; Chen Zhaohui; Sun Xijun; Liu Jianping; Li Jiakai

    2009-01-01

    Objective: To compare the clinical effectiveness of ozone (O 3 ) nucleus pulposus ablation only with that of O 3 nucleus pulposus ablation combined with intervertebral facet joint injection of compound Betamethasome in treating lumbar disk herniation accompanied with intervertebral facet arthritis. Methods: Eighty patients with lumbar disk herniation and intervertebral facet arthritis were equally and randomly divided into two groups. Under CT guidance, O 3 nucleus pulposus ablation was performed in patients of group A(n=40), while O 3 nucleus pulposus ablation combined with intervertebral facet joint injection of compound Betamethasome (0.5-1 ml) was carried out in patients of group B(n=40). Using double blind method the therapeutic effectiveness was evaluated before and 1 week,3,6-months after the procedure by an Oswestry Low Back Pain Disability Questionnaire. Results: One week after the procedure the effective rate of group A and group B was 65% and 82.5% respectively. Three and six months after the treatment, the effective rate was 75% and 70% respectively for group A, while it was 90% and 92.5% respectively for group B. The difference between two groups was significant (P 3 combined with intervertebral facet joint injection of compound Betamethasome is an effective and safe treatment for lumbar disk herniation accompanied with intervertebral facet arthritis.It is worth popularizing this technique in clinical practice. (authors)

  1. Treatment of lumbar facet joint syndrome by CT-guided intraarticular infiltration of fact joints; Behandlung des lumbalen Facettensyndroms durch CT-gesteuerte Infiltration der Zwischenwirbelgelenke

    Energy Technology Data Exchange (ETDEWEB)

    Schleifer, J. [Knappschaftsklinik Puettlingen/Saar (Germany). Orthopaedische Abteilung; Fenzl, G. [Knappschaftsklinik Puettlingen/Saar (Germany). Orthopaedische Abteilung; Wolf, A. [Knappschaftsklinik Puettlingen/Saar (Germany). Radiologische Abteilung; Diehl, K. [Knappschaftsklinik Puettlingen/Saar (Germany). Radiologische Abteilung

    1994-11-01

    In 62 patients with facet syndrome a total of 205 joints were infiltrated, CT monitoring being used in all cases. Each facet joint was infiltrated with 0.3 ml bupivacaine and 0.8 ml methylprednisolone. The patients were divided into three groups. Group 1 consisted of 24 persons who had undergone lumbar disc surgery, group 2 of 23 patients with spondylarthrosis of the facet joints, and group 3 of 15 patients who had undergone lumbar disc surgery but hat additional spondylarthrosis. Very good results were defined as pain relief for longer than 4 weeks, good results as pain relief for up to 4 weeks and poor results as brief pain relief or none at all. In 27 patients facet infiltration was performed for the purpose of diagnosis. Results were significantly in group 2 than in group 1. In group 3 results were better than in group 1, but worse than in group 2. These differences were not statistical by significant. Seven patients in the diagnostic group had no pain relief, and facet syndrome was excluded. (orig.) [Deutsch] Bei 62 Patienten mit lumbalem Facettensyndrom wurden insgesamt 205 Zwischenwirbelgelenke (Facettengelenke) perkutan CT-gesteuert infiltriert. Je Gelenk wurden 0,3 ml Bupivacain und 0,8 ml Methylprednisolon intraartikulaer infiziert. Die Patienten wurden in 3 Gruppen unterteilt. Die 1. Gruppe umfasste 24 Patienten mit Postnukleotomiesyndrom, die 2. Gruppe 23 Patienten mit spondylarthrotischen Veraenderungen, die 3. Gruppe 15 bandscheibenoperierte Patienten mit zusaetzlicher Spondylarthrose. In Gruppe 2 fanden sich signifikant bessere Ergebnisse als in Gruppe 1. Gute Resultate ergab auch die dritte Gruppe, sie waren jedoch nicht signifikant besser als die der Gruppe 1. Die sorgfaeltige Auswahl der Patienten ist fuer den Erfolg der Behandlung entscheidend. Die Infiltrationsbehandlung der Zwischenwirbelgelenke hat nahezu keine Nebenwirkungen. Ausser zur Therapie wird das Verfahren diagnostisch zum Ausschluss eines Facettensyndromes im Rahmen der Abklaerung

  2. Lumbar Facet Joint Compressive Injury Induces Lasting Changes in Local Structure, Nociceptive Scores, and Inflammatory Mediators in a Novel Rat Model

    Directory of Open Access Journals (Sweden)

    James L. Henry

    2012-01-01

    Full Text Available Objective. To develop a novel animal model of persisting lumbar facet joint pain. Methods. Sprague Dawley rats were anaesthetized and the right lumbar (L5/L6 facet joint was exposed and compressed to ~1 mm with modified clamps applied for three minutes; sham-operated and naïve animals were used as control groups. After five days, animals were tested for hind-paw sensitivity using von Frey filaments and axial deep tissue sensitivity by algometer on assigned days up to 28 days. Animals were sacrificed at selected times for histological and biochemical analysis. Results. Histological sections revealed site-specific loss of cartilage in model animals only. Tactile hypersensitivity was observed for the ipsi- and contralateral paws lasting 28 days. The threshold at which deep tissue pressure just elicited vocalization was obtained at three lumbar levels; sensitivity at L1>L3/4>L6. Biochemical analyses revealed increases in proinflammatory cytokines, especially TNF-α, IL-1α, and IL-1β. Conclusions. These data suggest that compression of a facet joint induces a novel model of local cartilage loss accompanied by increased sensitivity to mechanical stimuli and by increases in inflammatory mediators. This new model may be useful for studies on mechanisms and treatment of lumbar facet joint pain and osteoarthritis.

  3. Indian Hedgehog signaling pathway members are associated with magnetic resonance imaging manifestations and pathological scores in lumbar facet joint osteoarthritis

    Science.gov (United States)

    Shuang, Feng; Zhou, Ying; Hou, Shu-Xun; Zhu, Jia-Liang; Liu, Yan; Zhang, Chun-Li; Tang, Jia-Guang

    2015-05-01

    Indian Hedgehog (HH) has been shown to be involved in osteoarthritis (OA) in articular joints, where there is evidence that Indian HH blockade could ameliorate OA. It seems to play a prominent role in development of the intervertebral disc (IVD) and in postnatal maintenance. There is little work on IHH in the IVD. Hence the aim of the current study was to investigate the role of Indian Hedgehog in the pathology of facet joint (FJ) OA. 24 patients diagnosed with lumbar intervertebral disk herniation or degenerative spinal stenosis were included. Preoperative magnetic resonance imaging (MRI) and Osteoarthritis Research Society International (OARSI) histopathology grading system was correlated to the mRNA levels of GLI1, PTCH1, and HHIP in the FJs. The Weishaupt grading and OARSI scores showed high positive correlation (r = 0.894) (P < 0.01). MRI Weishaupt grades showed positive correlation with GLI1 (r = 0.491), PTCH1 (r = 0.444), and HHIP (r = 0.654) mRNA levels (P < 0.05 in each case). OARSI scores were also positively correlated with GLI1 (r = 0. 646), PTCH1 (r = 0. 518), and HHIP (r = 0.762) mRNA levels (P < 0.01 in each case). Cumulatively our findings indicate that Indian HH signaling is increased in OA and is perhaps a key component in OA pathogenesis and progression.

  4. Lumbar facet joint septic arthritis presenting atypically as acute abdomen – A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Aysha Rajeev

    2016-01-01

    Conclusion: The atypical presentation of facet joint septic arthritis is one of the reasons why early diagnosis is elusive. Definitive diagnoses with MRI and bacterial culture as well as prolonged antibiotic therapy are recommended in this condition.

  5. Termocoagulación facetaria lumbar: Experiencia en 252 pacientes Thermocoagulation of lumbar facet joints: Experience in 252 patients

    OpenAIRE

    J. E. Martínez-Suárez; L. Camblor; S. Salva; W. A. de Jongh

    2005-01-01

    Se presentan 252 pacientes con el diagnóstico de dolor lumbar facetario a los que se le realizó la técnica quirúrgica de termocoagulación percutánea de la faceta articular. Nuestro propósito principal fue aliviar el dolor en estos pacientes, evaluamos la eficacia de la técnica con un 74,7% de resultados quirúrgicos satisfactorios, así como la descripción de diferentes aspectos como: edad, sexo, causas y la topografía segmentaria del dolor.Two hundred fifty two patients with diagnosis of lumba...

  6. Assessment of trunk muscle density using CT and its association with degenerative disc and facet joint disease of the lumbar spine.

    Science.gov (United States)

    Sebro, Ronnie; O'Brien, Liam; Torriani, Martin; Bredella, Miriam A

    2016-09-01

    The purpose of this study was (1) to evaluate the association of trunk muscle density assessed by computed tomography (CT) with age, gender, and BMI and (2) to evaluate the association between trunk muscle CT density and degenerative disc and facet joint disease of the lumbar spine. The study was IRB approved and HIPAA compliant. The study group comprised 100 subjects (mean age 44.4 ± 22.2 years, 51 % male) who underwent CT of the abdomen and pelvis without intravenous contrast. Exclusion criteria included prior abdominal or spine surgery, active malignancy and scoliosis. CTs were reviewed and the attenuation of the rectus abdominis, transverse abdominis, internal and external obliques, psoas, multifidus, longissimus and gluteus maximus were measured bilaterally at consistent levels. Degenerative disc and bilateral facet joint disease were scored using established methods. Univariate analyses were performed using linear regression. Multivariate linear regression was performed to adjust for age, gender and BMI. CT density of each trunk muscle correlated inversely with age (p degenerative disc and facet joint disease in the univariate analyses (p degenerative disc and facet joint disease respectively in the multivariate analysis. Fatty infiltration of trunk musculature increases with age and BMI. Fatty infiltration of the gluteus maximus and transverse abdominis are associated with degenerative disc and facet joint disease, independent of age, gender and BMI.

  7. Arthrography of the lumber facet joint and facet block

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    Cho, Hee Kyung; Chung, Tae Sub; Kim, Young Soo; Park, Hyung Chun; Moon, Jae Ho; Suh, Jung Ho; Kim, Dong Ik [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1988-12-15

    In spite of numerous clinical and patho-anatomical studied made in the past, there are still different opinions concerning the mechanism of low back pain. We have focused attention on the posterior structures as an alternative source of low back pain with sciatica. So we have studied and analyzed the finding of arthrography of facet joint and effect of the injection of methyprednisolone acetate suspension (Depomedrol) 20mg into the each facet joint. Our results are as follows: 1. Abnormal findings of facet joint arthrogram were degenerative osteoarthritis of facet joint (70.5%), synovial cyst (11.8%), accessory bone (11.8%), and spondylolysis (5.9%). 2. The mean facet angulations of patients of facet syndrome were abnormal on lower lumbar facet joint in 9 of 13 cases (69.2%). 3. On initial assessment, 11 of 17 cases (64.7%) showed complete relief and one month later, 6 of 11 cases (35.3%) showed continuous relief, after steroid injection.

  8. Arthrography of the lumber facet joint and facet block

    International Nuclear Information System (INIS)

    Cho, Hee Kyung; Chung, Tae Sub; Kim, Young Soo; Park, Hyung Chun; Moon, Jae Ho; Suh, Jung Ho; Kim, Dong Ik

    1988-01-01

    In spite of numerous clinical and patho-anatomical studied made in the past, there are still different opinions concerning the mechanism of low back pain. We have focused attention on the posterior structures as an alternative source of low back pain with sciatica. So we have studied and analyzed the finding of arthrography of facet joint and effect of the injection of methyprednisolone acetate suspension (Depomedrol) 20mg into the each facet joint. Our results are as follows: 1. Abnormal findings of facet joint arthrogram were degenerative osteoarthritis of facet joint (70.5%), synovial cyst (11.8%), accessory bone (11.8%), and spondylolysis (5.9%). 2. The mean facet angulations of patients of facet syndrome were abnormal on lower lumbar facet joint in 9 of 13 cases (69.2%). 3. On initial assessment, 11 of 17 cases (64.7%) showed complete relief and one month later, 6 of 11 cases (35.3%) showed continuous relief, after steroid injection.

  9. Assessment of trunk muscle density using CT and its association with degenerative disc and facet joint disease of the lumbar spine

    International Nuclear Information System (INIS)

    Sebro, Ronnie; O'Brien, Liam; Torriani, Martin; Bredella, Miriam A.

    2016-01-01

    The purpose of this study was (1) to evaluate the association of trunk muscle density assessed by computed tomography (CT) with age, gender, and BMI and (2) to evaluate the association between trunk muscle CT density and degenerative disc and facet joint disease of the lumbar spine. The study was IRB approved and HIPAA compliant. The study group comprised 100 subjects (mean age 44.4 ± 22.2 years, 51 % male) who underwent CT of the abdomen and pelvis without intravenous contrast. Exclusion criteria included prior abdominal or spine surgery, active malignancy and scoliosis. CTs were reviewed and the attenuation of the rectus abdominis, transverse abdominis, internal and external obliques, psoas, multifidus, longissimus and gluteus maximus were measured bilaterally at consistent levels. Degenerative disc and bilateral facet joint disease were scored using established methods. Univariate analyses were performed using linear regression. Multivariate linear regression was performed to adjust for age, gender and BMI. CT density of each trunk muscle correlated inversely with age (p < 0.001) and BMI (p < 0.001). CT density of each trunk muscle correlated inversely with degenerative disc and facet joint disease in the univariate analyses (p < 0.001); however, only the gluteus maximus and the transverse abdominis remained significant predictors of degenerative disc and facet joint disease respectively in the multivariate analysis. Fatty infiltration of trunk musculature increases with age and BMI. Fatty infiltration of the gluteus maximus and transverse abdominis are associated with degenerative disc and facet joint disease, independent of age, gender and BMI. (orig.)

  10. Bipolar Radiofrequency Facet Ablation of the Lumbar Facet Capsule: An Adjunct to Conventional Radiofrequency Ablation for Pain Management.

    Science.gov (United States)

    Jacobson, Robert E; Palea, Ovidiu; Granville, Michelle

    2017-09-01

    Radiofrequency facet ablation (RFA) has been performed using the same technique for over 50 years. Except for variations in electrode size, tip shape, and change in radiofrequency (RF) stimulation parameters, using standard, pulsed, and cooled RF wavelengths, the target points have remained absolutely unchanged from the original work describing RFA for lumbar pain control. Degenerative changes in the facet joint and capsule are the primary location for the majority of lumbar segmental pathology and pain. Multiple studies show that the degenerated facet joint is richly innervated as a result of the inflammatory overgrowth of the synovium. The primary provocative clinical test to justify an RFA is to perform an injection with local anesthetic into the facet joint and the posterior capsule and confirm pain relief. However, after a positive response, the radiofrequency lesion is made not to the facet joint but to the more proximal fine nerve branches that innervate the joint. The accepted target points for the recurrent sensory branch ignore the characteristic rich innervation of the pathologic lumbar facet capsule and assume that lesioning of these recurrent branches is sufficient to denervate the painful pathologic facet joint. This report describes the additional targets and technical steps for further coagulation points along the posterior capsule of the lumbar facet joint and the physiologic studies of the advantage of the bipolar radiofrequency current in this location. Bipolar RF to the facet capsule is a simple, extra step that easily creates a large thermo-coagulated lesion in this capsule region of the pathologic facet joint. Early studies demonstrate bipolar RF to the facet capsule can provide long-term pain relief when used alone for specific localized facet joint pain, to coagulate lumbar facet cysts to prevent recurrence, and to get more extensive pain control by combining it with traditional lumbar RFA, especially when RFA is repeated.

  11. Relationship between facet tropism and facet joint degeneration in the sub-axial cervical spine

    Directory of Open Access Journals (Sweden)

    Xin Rong

    2017-02-01

    Full Text Available Abstract Background Facet tropism is the angular asymmetry between the left and right facet joint orientation. Although debatable, facet tropism was suggested to be associated with disc degeneration, facet degeneration and degenerative spondylolisthesis in the lumbar spine. The purpose of this study was to explore the relationship between facet tropism and facet degeneration in the sub-axial cervical spine. Methods A total of 200 patients with cervical spondylosis were retrospectively analyzed. Facet degeneration was categorized into 4 grade: grade I, normal; grade II, degenerative changes including joint space narrowing, cyst formation, small osteophytes (3 mm without fusion of the joint; grade IV, bony fusion of the facet joints. Facet orientations and facet tropisms with respect to the transverse, sagittal and coronal plane were calculated from the reconstructed cervical spine, which was based on the axial CT scan images. The paired facet joints were then categorized into three types: symmetric, moderated tropism and severe tropism. Univariate and multivariate analysis were performed to evaluate the relationship between any demographic and anatomical factor and facet degeneration. Results The mean age of enrolled patients was 46.23 years old (ranging from 30 to 64 years old. There were 114 males and 86 females. The degrees of facet degeneration varied according to cervical levels and ages. Degenerated facet joints were most common at C2-C3 level and more common in patients above 50 years old. The facet orientations were also different from level to level. By univariate analysis, genders, ages, cervical levels, facet orientations and facet tropisms were all significantly different between the normal facets and degenerated facets. However, results from multivariate logistic regression suggested only age and facet tropism with respect to the sagittal plane were related to facet degeneration. Conclusion Facet degeneration were more common at

  12. Lumbar Facet Tropism: A Comprehensive Review.

    Science.gov (United States)

    Alonso, Fernando; Kirkpatrick, Christina M; Jeong, William; Fisahn, Christian; Usman, Sameera; Rustagi, Tarush; Loukas, Marios; Chapman, Jens R; Oskouian, Rod J; Tubbs, R Shane

    2017-06-01

    Scattered reports exist in the medical literature regarding facet tropism. However, this finding has had mixed conclusions regarding its origin and impact on the normal spine. We performed a literature review of the anatomy, embryology, biomechanics, and pathology related to lumbar facet tropism. Facet tropism is most commonly found at L4-L5 vertebral segments and there is some evidence that this condition may lead to facet degenerative spondylolisthesis, intervertebral disc disease, and other degenerative conditions. Long-term analyses of patients are necessary to elucidate relationships between associated findings and facet tropism. In addition, a universally agreed definition that is more precise should be developed for future investigative studies. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Randomised sham-controlled double-blind multicentre clinical trial to ascertain the effect of percutaneous radiofrequency treatment for lumbar facet joint pain.

    Science.gov (United States)

    van Tilburg, C W J; Stronks, D L; Groeneweg, J G; Huygen, F J P M

    2016-11-01

    The aim of this study was to compare the effect of a percutaneous radiofrequency heat lesion at the medial branch of the primary dorsal ramus with a sham procedure, for the treatment of lumbar facet joint pain. A randomised sham-controlled double blind multicentre trial was carried out at the multidisciplinary pain centres of two hospitals. A total of 60 patients aged > 18 years with a history and physical examination suggestive of facet joint pain and a decrease of ≥ 2 on a numerical rating scale (NRS 0 to 10) after a diagnostic facet joint test block were included. In the treatment group, a percutaneous radiofrequency heat lesion (80 o C during 60 seconds per level) was applied to the medial branch of the primary dorsal ramus. In the sham group, the same procedure was undertaken without for the radiofrequency lesion. Both groups also received a graded activity physiotherapy programme. The primary outcome measure was decrease in pain. A secondary outcome measure was the Global Perceived Effect scale (GPE). There was a statistically significant effect on the level of pain in the factor Period (T0-T1). However, there was no statistically significant difference with the passage of time between the groups (Group × Period) or in the factor Group. In the crossover group, 11 of 19 patients had a decrease in NRS of ≥ 2 at one month crossover (p = 0.65). There was no statistically significant difference in satisfaction with the passage of time between the groups (Group × Period). The independent factors Group and Period also showed no statistically significant difference. There was no statistically significant Group × Period effect for recovery, neither an effect of Group or of Period. The null hypothesis of no difference in the decrease in pain and in GPE between the treatment and sham groups cannot be rejected. Post hoc analysis revealed that the age of the patients and the severity of the initial pain significantly predicted a positive outcome. Cite this article

  14. Up-regulation of p55 TNF alpha-receptor in dorsal root ganglia neurons following lumbar facet joint injury in rats.

    Science.gov (United States)

    Sakuma, Yoshihiro; Ohtori, Seiji; Miyagi, Masayuki; Ishikawa, Tetsu; Inoue, Gen; Doya, Hideo; Koshi, Takana; Ito, Toshinori; Yamashita, Masaomi; Yamauchi, Kazuyo; Suzuki, Munetaka; Moriya, Hideshige; Takahashi, Kazuhisa

    2007-08-01

    The rat L5/6 facet joint is multisegmentally innervated from the L1 to L6 dorsal root ganglia (DRG). Tumor necrosis factor (TNF) is a known mediator of inflammation. It has been reported that satellite cells are activated, produce TNF and surround DRG neurons innervating L5/6 facet joints after facet injury. In the current study, changes in TNF receptor (p55) expression in DRG neurons innervating the L5/6 facet joint following facet joint injury were investigated in rats using a retrograde neurotransport method followed by immunohistochemistry. Twenty rats were used for this study. Two crystals of Fluorogold (FG; neurotracer) were applied into the L5/6 facet joint. Seven days after surgery, the dorsal portion of the capsule was cut in the injured group (injured group n = 10). No injury was performed in the non-injured group (n = 10). Fourteen days after the first application of FG, bilateral DRGs from T13 to L6 levels were resected and sectioned. They were subsequently processed for p55 immunohistochemistry. The number of FG labeled neurons and number of FG labeled p55-immunoreactive (IR) neurons were counted. FG labeled DRG neurons innervating the L5/6 facet joint were distributed from ipsilateral L1 to L6 levels. Of FG labeled neurons, the ratio of DRG neurons immunoreactive for p55 in the injured group (50%) was significantly higher than that in the non-injured group (13%). The ratio of p55-IR neurons of FG labeled DRG neurons was significantly higher in total L1 and L2 DRGs than that in total L3, 4, 5 and 6 DRGs in the injured group (L1 and 2 DRG, 67%; L3, 4, 5 and 6 DRG, 37%, percentages of the total number of p55-IR neurons at L1 and L2 level or L3-6 level/the total number of FG-labeled neurons at L1 and L2 level or L3-6 level). These data suggest that up-regulation of p55 in DRG neurons may be involved in the sensory transmission from facet joint injury. Regulation of p55 in DRG neurons innervating the facet joint was different between upper DRG innervated

  15. Lumbar facet anatomy changes in spondylolysis: a comparative skeletal study

    Science.gov (United States)

    Dar, Gali; Peleg, Smadar; Steinberg, Nili; Alperovitch-Najenson, Dvora; Salame, Khalil; Hershkovitz, Israel

    2007-01-01

    Opinions differ as to the exact mechanism responsible for spondylolysis (SP) and whether individuals with specific morphological characteristics of the lumbar vertebral neural arch are predisposed to SP. The aim of our study was to reveal the association between SP and the architecture of lumbar articular facets and the inter-facet region. Methods: Using a Microscribe three-dimensional apparatus (Immersion Co., San Jose, CA, USA), length, width and depth of all articular facets and all inter-facet distances in the lumbar spine (L1–L5) were measured. From the Hamann-Todd Human Osteological Collection (Cleveland Museum of Natural History, OH, USA) 120 normal male skeletons with lumbar spines in the control group and 115 with bilateral SP at L5 were selected. Analysis of variance was employed to examine the differences between spondylolytic and normal spines. Results: Three profound differences between SP and the norm appeared: (1) in individuals with SP, the size and shape of L4’s neural arch had significantly greater inter-facet widths, significantly shorter inter-facet heights and significantly shorter and narrower articular facets; (2) only in the L4 vertebra in individuals with SP was the inferior inter-facet width greater in size than the superior inter-facet width of the vertebra below (L5) (38.7 mm versus 40 mm); (3) in all lumbar vertebrae, the right inferior articular facets in individuals with SP were flatter compared to the control group. Conclusions: Individuals with L4 “SP” characteristics are at a greater risk of developing fatigue fractures in the form of spondylolysis at L5. PMID:17440753

  16. An observational feasibility study to assess the safety and effectiveness of intranasal fentanyl for radiofrequency ablations of the lumbar facet joints

    Directory of Open Access Journals (Sweden)

    Bartoszek MW

    2017-02-01

    Full Text Available Michael W Bartoszek,1 Amy McCoart,2 Kyung-soo Jason Hong,3 Chelsey Haley,2 Krista Beth Highland,4 Anthony R Plunkett1 1Department of Anesthesiology, Womack Army Medical Center, Fort Bragg, NC, 2Clinical Investigations, Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, Womack Army Medical Center, Fort Bragg, NC, 3Research Department, The Center for Clinical Research, Sceptor Pain Foundation, Winston Salem, NC, 4Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, Uniformed Services University, Bethesda, MD, USA Purpose: The purpose of the present observational, feasibility study is to assess the preliminary safety and effectiveness of intranasal fentanyl for lumbar facet radiofrequency ablation procedures.Patients and methods: This cohort observational study included 23 adult patients. Systolic and diastolic blood pressures, heart rate, oxygen saturation percent, Pasero Opioid-Induced Sedation Scale score, and the Defense and Veterans Pain Rating Scale pain score were assessed prior to the procedure and intranasal fentanyl (100 μg administration and every 15 minutes after administration, up to 60 minutes post administration. Follow-up of patient satisfaction with pain control and treatment was assessed 24 hours after discharge. The primary outcome was safety as evidenced by adverse events. Secondary outcomes included the above-mentioned vital signs and pain ratings.Results: No adverse events occurred in the present study and all participants maintained an acceptable level of awareness throughout the assessment period. One-way repeated measures analyses of covariance tests with Bonferroni-adjusted means indicated that oxygen saturation, blood pressure, and heart rate changed from baseline, whereas pain scores were lower at post-administration levels compared with baseline. Finally, the majority of participants reported being satisfied with pain control and treatment

  17. Correlation between facet tropism and lumbar degenerative disease: a retrospective analysis.

    Science.gov (United States)

    Gao, Tian; Lai, Qi; Zhou, Song; Liu, Xuqiang; Liu, Yuan; Zhan, Ping; Yu, Xiaolong; Xiao, Jun; Dai, Min; Zhang, Bin

    2017-11-22

    The aim of this study was to investigate the correlation between facet tropism and spinal degenerative diseases, such as degenerative lumbar spondylolisthesis, degenerative lumbar scoliosis, and lumbar disc herniation. This study retrospectively analysed clinical data from the Department of Orthopaedics at The First Affiliated Hospital of Nanchang University. Ninety-two patients were diagnosed with lumbar spondylolisthesis, 64 patients with degenerative scoliosis, and 86 patients with lumbar disc herniation between 1 October 2014 and 1 October 2016. All patients were diagnosed using 3.0 T magnetic resonance imaging and underwent conservative or operative treatment. Facet tropism was defined as greater than a ten degree between the facet joint angles on both sides. For L3-L4 degenerative lumbar spondylolisthesis, one out of six cases had tropism compared to seven out of the 86 controls (p = 0.474). At the L4-L5 level, 17/50 cases had tropism compared to 4/42 cases in the control group (p = 0.013). At the L5-S1 level, 18/36 cases had tropism compared to 7/56 controls (p = 0.000). For degenerative lumbar scoliosis at the L1-L5 level, 83/256 cases had tropism as compared to 36/256 controls (p = 0.000). For L3-L4 lumbar disc herniation two out of eight cases had tropism compared to 14/78 controls (p = 0.625). At the L4-L5 level, 19/44 cases had tropism compared to four out of 42 controls (p = 0.001). At the L5-S1 level, 24/34 cases had tropism compared to 10/52 controls (p = 0.000). At the L4-5 and L5-S1 levels, facet tropism is associated with degenerative spondylolisthesis. In the degenerative lumbar scoliosis group, the number of case with facet tropism was significantly higher than that of the control group. Facet tropism was associated with lumbar disc herniation at the L4-5 and L5-S1 levels. Overall, in these three lumbar degenerative diseases, facet tropism is a common phenomenon.

  18. Association between facet joint osteoarthritis and the Oswestry Disability Index.

    Science.gov (United States)

    Maataoui, Adel; Vogl, Thomas J; Middendorp, Marcus; Kafchitsas, Konstantinos; Khan, M Fawad

    2014-11-28

    To investigate the correlation of facet joint osteoarthritis (FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index (ODI). The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years. The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner (Magnetom(®) Avanto, Siemens AG, Erlangen, Germany) using a dedicated receive only spine coil. After initial blinding, each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging. In total 2364 facet joints were graded. Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI. The index is scored from 0 to 100 and interpreted as follows: 0%-20%, minimal disability; 20%-40%, moderate disability; 40%-60%, severe disability; 60%-80%, crippled; 80%-100%, patients are bedbound. Spearman's coefficient of rank correlation was used for statistical analysis, with significance set at P disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%. The majority of patients (48.39%) had moderate functional disability (21%-40%). There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1. A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1. The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain. Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.

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

    OpenAIRE

    Grasso, Giovanni; Landi, Alessandro

    2017-01-01

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

  20. The lumbar facet arthrosis syndrome. Clinical presentation and articular surface changes.

    Science.gov (United States)

    Eisenstein, S M; Parry, C R

    1987-01-01

    We describe a lumbar facet syndrome in which disabling symptoms are associated with normal or near-normal plain radiographs. Local spinal fusion relieved symptoms in 12 patients; the excised facet joint surfaces showed some of the histological changes seen in chondromalacia patellae and in osteoarthritis of other large joints. The most frequent change was focal full-thickness cartilage necrosis or loss of cartilage with exposure of subchondral bone, but osteophyte formation was remarkably absent in all specimens. We suggest that there are both clinical and histological similarities between the facet arthrosis syndrome and chondromalacia patellae. Facet arthrosis may be a relatively important cause of intractable back pain in young and middle-aged adults.

  1. Lumbar radiculopathy due to unilateral facet hypertrophy following lumbar disc hernia operation: a case report.

    Science.gov (United States)

    Kökeş, Fatih; Günaydin, Ahmet; Aciduman, Ahmet; Kalan, Mehmet; Koçak, Halit

    2007-10-01

    To present a radiculopathy case due to unilateral facet hypertrophy developing three years after a lumbar disc hernia operation. A fifty two-year-old female patient, who had been operated on for a left L5-S1 herniated lumbar disc three years ago, was hospitalized and re-operated with a diagnosis of unilateral facet hypertrophy. She had complaints of left leg pain and walking restrictions for the last six months. Left Straight Leg Raising test was positive at 40 degrees , left ankle dorsiflexion muscle strength was 4/5, left Extensor Hallucis Longus muscle strength was 3/5, and left Achilles reflex was hypoactive. Lumbar spinal Magnetic Resonance Imaging revealed left L5-S1 facet hypertrophy. Lumbar radiculopathy due to lumbar facet hypertrophy is a well-known neurological condition. Radicular pain develops during the late postoperative period following lumbar disc hernia operations that are often related to recurrent disc herniation or to formation of post-operative scar tissue. In addition, it can be speculated that unilateral facet hypertrophy, which may develop after a disc hernia operation, might also be one of the causes of radiculopathy.

  2. Diagnostic accuracy of low-dose versus ultra-low-dose CT for lumbar disc disease and facet joint osteoarthritis in patients with low back pain with MRI correlation

    International Nuclear Information System (INIS)

    Lee, Sun Hwa; Yun, Seong Jong; Jo, Hyeon Hwan; Kim, Dong Hyeon; Song, Jae Gwang; Park, Yong Sung

    2018-01-01

    To compare the image quality, radiation dose, and diagnostic performance between low-dose (LD) and ultra-low-dose (ULD) lumbar-spine (L-spine) CT with iterative reconstruction (IR) for patients with chronic low back pain (LBP). In total, 260 patients with chronic LBP who underwent L-spine CT between November 2015 and September 2016 were prospectively enrolled. Of these, 143 underwent LD-CT with IR and 117 underwent ULD-CT with IR. The patients were divided according to their body mass index (BMI) into BMI1 (<22.9 kg/m 2 ), BMI2 (23.0-24.9 kg/m 2 ), and BMI3 (≥25 kg/m 2 ) groups. Two blinded radiologists independently evaluated the signal-to-noise ratio (SNR), qualitative image quality, and final diagnoses (lumbar disc disease and facet joint osteoarthritis). L-spine MRIs interpreted by consensus were used as the reference standard. All data were statistically analyzed. ULD protocol showed significantly lower SNR for all patients (p < 0.001) except the vertebral bodies and lower qualitative image quality for BMI3 patients (p ≤ 0.033). There was no statistically significant difference between ULD (sensitivity, 95.1-98.1%; specificity, 92.5-98.7%; accuracy, 94.6-98.0%) and LD protocols (sensitivity, 95.6-100%; specificity, 95.5-98.9%; accuracy, 97.4-98.1%), (all p≥0.1) in the BMI1 and BMI2; while dose was 60-68% lower with the ULD protocol. Interobserver agreements were excellent or good with regard to image quality and final diagnoses. For the BM1 and BMI2 groups, ULD-CT provided an acceptable image quality and exhibited a diagnostic accuracy similar to that of LD-CT. These findings suggest that it is a useful diagnostic tool for patients with chronic LBP who exhibit a BMI of <25 kg/m 2 . (orig.)

  3. Cervical facet joint dysfunction: a review.

    Science.gov (United States)

    Kirpalani, Dhiruj; Mitra, Raj

    2008-04-01

    To review the relevant literature on cervical facet joint dysfunction and determine findings regarding its anatomy, etiology, prevalence, clinical features, diagnosis, and treatment. A computer-aided search of several databases was performed, including Medline (1966 to present), Ovid (1966 to present), and the Cochrane database (1993 to present). Selected articles had the following criteria: (1) all articles analyzed cervical facet joint pain-anatomy, prevalence, etiology, diagnosis, treatment; (2) only full, published articles were studied, not abstracts; and (3) all articles were published in English. All articles were critically evaluated and included the following categories: randomized controlled trials, meta-analyses, uncontrolled clinical trials, uncontrolled comparison studies, nonquantitative systematic reviews, and literature-based reviews. We examined 45 references that consisted of 44 journal articles and relevant sections from 1 textbook. Cervical facet joints have been well established in the literature as a common nociceptive pain generator, with an estimated prevalence that ranges from 25% to 66% of chronic axial neck pain. No studies have reported clinical examination findings that are diagnostic for cervical facet mediated pain. Overall the literature provides very limited information regarding the treatment of this condition, with only radiofrequency neurotomy showing evidence of effectively reducing pain from cervical facet joint dysfunction.

  4. Facet orientation and tropism: Associations with asymmetric lumbar paraspinal and psoas muscle parameters in patients with chronic low back pain.

    Science.gov (United States)

    Xu, W B; Chen, S; Fan, S W; Zhao, F D; Yu, X J; Hu, Z J

    2016-08-10

    Many studies have explored the relationship between facet tropism and facet joint osteoarthritis, disc degeneration and degenerative spondylolisthesis. However, the associations between facet orientation and tropism, and paraspinal muscles have not been studied. To analyze the associations between facet orientation and tropism, and parameters of paraspinal muscles in patients with chronic low back pain. Ninety-five patients with chronic low back pain were consecutively enrolled. Their facet joint angles were measured on computed tomography (CT) while gross cross-sectional area (GCSA), functional cross-sectional area (FCSA) and T2 signal intensity of lumbar paraspinal and psoas muscle were evaluated on magnetic resonance imaging (MRI). The GCSA and FCSA were significantly smaller for multifidus muscle (Plow back pain. Longitudinal studies are needed to understand the causal relationship between facet orientation and tropism and muscular asymmetry in future.

  5. Lumbar facet septic arthritis. Report of two cases

    Directory of Open Access Journals (Sweden)

    Juan Manuel Velasco

    2017-02-01

    Full Text Available We report two cases with isolated septic arthritis of a lumbar facet after a non articular infection, and sepsis. Being a rarity, it is a condition that goes frequently unnoticed, unless taken into account directly. If it is not treated on time, it can leave serious sequelae. The treatment may vary, according to the time of diagnosis. It might have a good response to antibiotic therapy alone, or it may be necessary to associate surgical drainage.

  6. Diagnostic accuracy of low-dose versus ultra-low-dose CT for lumbar disc disease and facet joint osteoarthritis in patients with low back pain with MRI correlation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Hwa [Inje University College of Medicine, Department of Emergency Medicine, Sanggye Paik Hospital, Nowon-gu (Korea, Republic of); Yun, Seong Jong; Jo, Hyeon Hwan; Kim, Dong Hyeon [Republic of Korea Air Force, Department of Radiology, Aerospace Medical Center, Cheongwon-gun, Chungcheongbuk-do (Korea, Republic of); Song, Jae Gwang [Republic of Korea Air Force, Department of Orthopedic Surgery, Aerospace Medical Center, Cheongwon-gun, Chungcheongbuk-do (Korea, Republic of); Park, Yong Sung [Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Department of Radiology, Seoul (Korea, Republic of)

    2018-04-15

    To compare the image quality, radiation dose, and diagnostic performance between low-dose (LD) and ultra-low-dose (ULD) lumbar-spine (L-spine) CT with iterative reconstruction (IR) for patients with chronic low back pain (LBP). In total, 260 patients with chronic LBP who underwent L-spine CT between November 2015 and September 2016 were prospectively enrolled. Of these, 143 underwent LD-CT with IR and 117 underwent ULD-CT with IR. The patients were divided according to their body mass index (BMI) into BMI1 (<22.9 kg/m{sup 2}), BMI2 (23.0-24.9 kg/m{sup 2}), and BMI3 (≥25 kg/m{sup 2}) groups. Two blinded radiologists independently evaluated the signal-to-noise ratio (SNR), qualitative image quality, and final diagnoses (lumbar disc disease and facet joint osteoarthritis). L-spine MRIs interpreted by consensus were used as the reference standard. All data were statistically analyzed. ULD protocol showed significantly lower SNR for all patients (p < 0.001) except the vertebral bodies and lower qualitative image quality for BMI3 patients (p ≤ 0.033). There was no statistically significant difference between ULD (sensitivity, 95.1-98.1%; specificity, 92.5-98.7%; accuracy, 94.6-98.0%) and LD protocols (sensitivity, 95.6-100%; specificity, 95.5-98.9%; accuracy, 97.4-98.1%), (all p≥0.1) in the BMI1 and BMI2; while dose was 60-68% lower with the ULD protocol. Interobserver agreements were excellent or good with regard to image quality and final diagnoses. For the BM1 and BMI2 groups, ULD-CT provided an acceptable image quality and exhibited a diagnostic accuracy similar to that of LD-CT. These findings suggest that it is a useful diagnostic tool for patients with chronic LBP who exhibit a BMI of <25 kg/m{sup 2}. (orig.)

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

    Science.gov (United States)

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

    2013-12-01

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

  8. Delayed onset of a spinal epidural hematoma after facet joint injection

    Directory of Open Access Journals (Sweden)

    Mirko Velickovic

    2016-10-01

    Full Text Available The treatment of chronic back pain is a challenging problem. Facet joint infiltration is an established treatment for chronic low back pain caused by arthrosis of the lumbar facet joints. Due to the increasing number of patients with chronic low back pain, this therapy has become more frequent. We treated a 51-year-old male patient, who developed an epidural hematoma 2 months after infiltration therapy. Our case shows that even a delayed onset of spinal epidural hematoma is possible and should be kept in mind as a possible cause of acute myelopathy after spinal intervention.

  9. Isolation and Characterization of Human Mesenchymal Stem Cells From Facet Joints and Interspinous Ligaments.

    Science.gov (United States)

    Kristjánsson, Baldur; Limthongkul, Worawat; Yingsakmongkol, Wicharn; Thantiworasit, Pattarawat; Jirathanathornnukul, Napaphat; Honsawek, Sittisak

    2016-01-01

    A descriptive in vitro study on isolation and differentiation of human mesenchymal stem cells (MSCs) derived from the facet joints and interspinous ligaments. To isolate cells from the facet joints and interspinous ligaments and investigate their surface marker profile and differentiation potentials. Lumbar spinal canal stenosis and ossification of the posterior longitudinal ligament are progressive conditions characterized by the hypertrophy and ossification of ligaments and joints within the spinal canal. MSCs are believed to play a role in the advancement of these diseases and the existence of MSCs has been demonstrated within the ligamentum flavum and posterior longitudinal ligament. The aim of this study was to investigate whether these cells could also be found within facet joints and interspinous ligaments. Samples were harvested from 10 patients undergoing spinal surgery. The MSCs from facet joints and interspinous ligaments were isolated using direct tissue explant technique. Cell surface antigen profilings were performed via flow cytometry. Their lineage differentiation potentials were analyzed. The facet joints and interspinous ligaments-derived MSCs have the tri-lineage potential to be differentiated into osteogenic, adipogenic, and chondrogenic cells under appropriate inductions. Flow cytometry analysis revealed both cell lines expressed MSCs markers. Both facet joints and interspinous ligaments-derived MSCs expressed marker genes for osteoblasts, adipocytes, and chondrocytes. The facet joints and interspinous ligaments may provide alternative sources of MSCs for tissue engineering applications. The facet joints and interspinous ligaments-derived MSCs are part of the microenvironment of the human ligaments of the spinal column and might play a crucial role in the development and progression of degenerative spine conditions.

  10. Biochemical and biomechanical characterisation of equine cervical facet joint cartilage.

    Science.gov (United States)

    O'Leary, S A; White, J L; Hu, J C; Athanasiou, K A

    2018-04-15

    The equine cervical facet joint is a site of significant pathology. Located bilaterally on the dorsal spine, these diarthrodial joints work in conjunction with the intervertebral disc to facilitate appropriate spinal motion. Despite the high prevalence of pathology in this joint, the facet joint is understudied and thus lacking in viable treatment options. The goal of this study was to characterise equine facet joint cartilage and provide a comprehensive database describing the morphological, histological, biochemical and biomechanical properties of this tissue. Descriptive cadaver studies. A total of 132 facet joint surfaces were harvested from the cervical spines of six skeletally mature horses (11 surfaces per animal) for compiling biomechanical and biochemical properties of hyaline cartilage of the equine cervical facet joints. Gross morphometric measurements and histological staining were performed on facet joint cartilage. Creep indentation and uniaxial strain-to-failure testing were used to determine the biomechanical compressive and tensile properties. Biochemical assays included quantification of total collagen, sulfated glycosaminoglycan and DNA content. The facet joint surfaces were ovoid in shape with a flat articular surface. Histological analyses highlighted structures akin to articular cartilage of other synovial joints. In general, biomechanical and biochemical properties did not differ significantly between the inferior and superior joint surfaces as well as among spinal levels. Interestingly, compressive and tensile properties of cervical facet articular cartilage were lower than those of articular cartilage from other previously characterised equine joints. Removal of the superficial zone reduced the tissue's tensile strength, suggesting that this zone is important for the tensile integrity of the tissue. Facet surfaces were sampled at a single, central location and do not capture the potential topographic variation in cartilage properties. This

  11. Comparison of facet joint activity on 99mTc-MDP SPECT/CT with facet joint signal change on MRI with fat suppression.

    Science.gov (United States)

    Lehman, Vance T; Murphy, Robert C; Schenck, Louis A; Carter, Rickey E; Johnson, Geoffrey B; Kotsenas, Amy L; Morris, Jonathan M; Nathan, Mark A; Wald, John T; Maus, Timothy P

    2016-01-01

    We compared signal change on magnetic resonance imaging (MRI) with fat suppression and bone scan activity of lumbar facet joints to determine if these two imaging findings are correlated. We retrospectively identified all patients who underwent imaging of the lumbar spine for pain evaluation using both technetium-99m methylene disphosphonate single-photon emission computed tomography/computed tomography (99mTc-MDP SPECT/CT) and MRI with at least one fat-suppressed T2- or T1-weighted sequence with gadolinium enhancement within a 180-day interval, at our institution between 1 January 2008 and 19 February 2013. Facet joint activity on 99mTc-MDP SPECT/CT and peri-facet signal change on MRI were rated as normal or increased. Agreement between the two examination types were determined with the κ and prevalence-adjusted bias-adjusted κ (PABAK) statistics. This study included 60 patients (28 male, 47%), with a mean age of 49±19.7 years (range, 12-93 years). The κ value indicated no agreement between 99mTc-MDP SPECT/CT and MRI (κ=-0.026; 95% confidence interval: -0.051, 0.000). The PABAK values were fair to high at each spinal level, which suggests that relatively low disease prevalence lowered the κ values. Together, the κ and PABAK values indicate that there is some degree of intermodality agreement, but that it is not consistent. Overall, facet joint signal change on fat-suppressed MRI did not always correlate with increased 99mTc-MDP SPECT/CT activity. MRI and 99mTc-MDP SPECT/CT for facet joint evaluation should not be considered interchangeable examinations in clinical practice or research.

  12. Segmental translation after lumbar total disc replacement using Prodisc-L®: associated factors and relation to facet arthrosis.

    Science.gov (United States)

    Shin, Myung H; Ryu, Kyeong S; Rathi, Nitesh K; Park, Chun K

    2017-02-01

    Segmental translation after lumbar total disc replacement (TDR) with ProDisc-L® prosthesis frequently observed radiographic findings during follow-up period. However its precise pathomechanism and relation with facet arthrosis have not been investigated yet. This study was performed to evaluate possible factors that affect postoperative segmental translation and to identify its relation with facet joint degeneration after lumbar TDR using ProDisc-L® prosthesis. Thirty-five consecutive patients, who underwent lumbar TDR using ProDisc-L®, completed minimum 24 months follow-up. Segmental translation was assessed postoperatively at 1 month and at least at 24 months by using dynamic plain radiograph. Segmental translation was assessed in relation to patient age, sex, change of functional spinal unit (FSU) height, segmental range of motion (ROM), global lumbar ROM, implanted level, relative prosthesis size and prosthesis position. The comparison of segmental translation between progressive facet arthrosis (PFA) group and non-PFA group was also made. The mean segmental translation was 0.49±0.49 mm at 1 month after surgery and showed significant increase to 0.83±0.78 mm at last follow-up (P=0.014). Change of FSU height, segmental ROM, global lumbar ROM, implanted level and relative size of prosthesis were the significant factors among the variables related to segmental translation that authors assessed (P=0.032, P=0.000, P=0.001, P=0.046 and P=0.042, respectively). There was no significant intergroup difference of mean segmental translation between PFA group and non-PFA group (P=0.586). This study demonstrates that segmental translation after TDR using ProDisc-L® has significant relations with change of FSU height, segmental ROM, global lumbar ROM, implanted level and relative size of prosthesis. With the intergroup comparison, PFA group did not show significant higher segmental translation than non-PFA group.

  13. Association of facet tropism and progressive facet arthrosis after lumbar total disc replacement using ProDisc-L.

    Science.gov (United States)

    Shin, Myung-Hoon; Ryu, Kyeong-Sik; Hur, Jung-Woo; Kim, Jin-Sung; Park, Chun-Kun

    2013-08-01

    The purpose of this retrospective study was to examine the association of facet tropism and progressive facet arthrosis (PFA) after lumbar total disc replacement (TDR) surgery using ProDisc-L. A total of 51 segments of 42 patients who had undergone lumbar TDR using ProDisc-L between October 2003 and July 2007 and completed minimum 36-month follow-up period were retrospectively reviewed. The changes of facet arthrosis were categorized as non-PFA and PFA group. Comparison between non-PFA and PFA group was made according to age, sex, mean follow-up duration, grade of preoperative facet arthrosis, coronal and sagittal prosthetic position and degree of facet tropism. Multiple logistic regression analysis was also performed to analyze the effect of facet tropism on the progression of facet arthrosis. The mean age at the surgery was 44.43 ± 11.09 years and there were 16 males and 26 females. The mean follow-up period was 53.18 ± 15.79 months. Non-PFA group was composed of 19 levels and PFA group was composed of 32 levels. Age at surgery, sex proportion, mean follow-up period, level of implant, grade of preoperative facet arthrosis and coronal and sagittal prosthetic position were not significantly different between two groups (p = 0.264, 0.433, 0.527, 0.232, 0.926, 0.849 and 0.369, respectively). However, PFA group showed significantly higher degree of facet tropism (7.37 ± 6.46°) than that of non-PFA group (3.51 ± 3.53°) and p value was 0.008. After adjustment for age, sex and coronal and sagittal prosthetic position, multiple logistic regression analysis revealed that facet tropism of more than 5° was the only significant independent predictor of progression of facet arthrosis (odds ratio 5.39, 95 % confidence interval 1.251-19.343, p = 0.023). The data demonstrate that significant higher degree of facet tropism was seen in PFA group compared with non-PFA group and facet tropism of more than 5° had a significant association with PFA after TDR using ProDisc-L.

  14. Inter-rater reliability of diagnostic criteria for sacroiliac joint-, disc- and facet joint pain.

    Science.gov (United States)

    van Tilburg, Cornelis W J; Groeneweg, Johannes G; Stronks, Dirk L; Huygen, Frank J P M

    2017-01-01

    Several diagnostic criteria sets are described in the literature to identify low back pain subtypes, but very little is known about the inter-rater reliability of these criteria. We conducted a study to determine the reliability of diagnostic tests that point towards SI joint-, disc- or facet joint pain. Inter-rater reliability study alongside three randomized clinical trials. Multidisciplinary pain center of general hospital. Patients aged 18 or more with medical history and physical examination suggestive of sacroiliac joint-, disc- and facet joint pain on lumbar level. Making use of nowadays most common used diagnostic criteria, a physical examination is taken independently by three physicians (two pain physicians and one orthopedic surgeon). Inter-rater reliability (Kappa (κ) measure of agreement) and significance (p) between raters are presented. Strengths of agreement, indicated with κ values above 0,20, are presented in order of agreement. One hundred patients were included. None of the parameters from the physical investigation had κ values of more than 0.21 (fair) in all pairs of raters. Between two raters (C and D), there was an almost perfect agreement on three parameters, more specifically ``Abnormal sensory and motor examination, hyperactive or diminished reflexes'', ``Sitting exam shows no reflex, motor or sensory signs in the legs'' and ``Straight leg raising (Laségue) negative between 30 and 70 degrees of flexion''. The ``Drop test positive'' parameters had moderate strength of agreement between raters A and D and fair strength between raters A and B. The ``Digital interspinous pressure test positive'' had moderate strength of agreement between raters C and D and fair strength of agreement between raters A and B as well as raters B and C. Three other parameters had a fair strength of agreement between two raters, all other parameters had a slight or poor strength of agreement. Inter-rater reliability, confidence intervals and significance of

  15. Hypertrophic Synovitis of the Facet Joint Causing Root Pain

    Directory of Open Access Journals (Sweden)

    Koichi Iwatsuki M.D.

    2008-01-01

    Full Text Available Osteoarthritic changes in the facet joints are common in the presence of degenerative disc disease. Changes in the joint capsule accompany changes in the articular surfaces. Intraspinal synovial cysts that cause radicular pain, cauda equina syndrome, and myelopathy have been reported; however, there have been few reports in orthopedic or neurosurgical literature regarding hypertrophic synovitis of the facet joint presenting as an incidental para-articular mass. Here, we report a case of hypertrophic synovitis causing root pain. We describe the case of a 65-year-old man suffering from right sciatica and right leg pain in the L5 nerve-root dermatome for 1 year; magnetic resonance imaging (MRI revealed an enhanced mass around the L4–5 facet joint. We investigated this mass pathologically. After right medial facetectomy, the symptoms resolved. Pathological investigation revealed this mass was hypertrophic synovitis. Hypertrophic synovitis of the facet joint might cause root pain.

  16. Unilateral spondylolysis and the presence of facet joint tropism.

    Science.gov (United States)

    Rankine, James J; Dickson, Robert A

    2010-10-01

    Retrospective review of the CT scans performed in a group of patients examined for a possible spondylolysis. To investigate whether there is an association between unilateral spondylolysis and facet joint tropism. Spondylolysis is a fatigue fracture of the pars interarticularis of great importance in sports injury. The demonstration of a unilateral spondylolysis is important because there is a potential for full healing if the athletic activity is modified, whereas bilateral spondylolysis frequently leads to established nonunion. Coronally orientated facet joints are known to predispose to spondylolysis by increasing the point loading of the pars interarticularis. The importance of this finding has not been investigated in unilateral spondylolysis. A review of patients with low back pain and a possible diagnosis of spondylolysis who were investigated with multislice CT was performed. The coronal orientation of the facet joints at L4/5 and L5/S1 was measured and comparison was done between those with and without a spondylolysis. The coronal angle of 140 facet joints in 35 patients was recorded. Of 35 patients, 23 had a spondylolysis which was unilateral in 12 patients. The facet joint angle was significantly more coronally orientated in the presence of a spondylolysis when compared with an intact pars (means, 53° and 43°, respectively; P spondylolysis, the facet joint was significantly more coronally orientated on the side of the spondylolysis (means, 52° and 45°, respectively; P spondylolysis. Asymmetric facet joints do increase the force through one side of the spine, with a unilateral spondylolysis occurring on the side of the more coronally orientated facet joint.

  17. A new technique to treat facet joint pain with pulsed radiofrequency.

    Science.gov (United States)

    Schianchi, Pietro Martino

    2015-02-01

    Facet joint pain affects 5% to 15% of the population with low back pain and the prevalence increases with age due to progression of arthritis. While conservative treatments are often unsuccessful, the scientific evidence on minimally invasive therapies such as intra-articular steroid infiltration and continuous and pulsed radiofrequency (PRF) of the medial branches is contradictory. Since PRF has recently been reported to successfully treat joint pain, a new application of this method is proposed for facetogenic lumbar pain via an intra-articular subcapsular approach. Here we reported two cases with successful treatment. A 71-year-old patient presented because of persisting pain in the left gluteal region radiating to the lateral thigh and calf when standing. Anti-inflammatory drugs produced only short-lasting insufficient relief. A 52-year-old employee was admitted in June 2012 because of axial lower lumbar pain with intermittent diffuse radiation to the right lower extremity that worsened during walking and lying down despite receiving analgesics and physiotherapy. A new approach to treat lumbar facet joint pain with PRF is simple to perform and without serious complications. In view of the good long-lasting results obtained with the two reported cases, randomized control trials are necessary to validate this new approach.

  18. Uncovertebral joint injury in cervical facet dislocation: the headphones sign

    Energy Technology Data Exchange (ETDEWEB)

    Palmieri, Francesco; Cassar-Pullicino, Victor N.; Dell' Atti, Claudia; Lalam, Radhesh K.; Tins, Bernhard J.; Tyrrell, Prudencia N.M.; McCall, Iain W. [Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Department of Radiology, Oswestry, England (United Kingdom)

    2006-06-15

    The purpose of our study is to demonstrate the uncovertebral mal-alignment as a reliable indirect sign of cervical facet joint dislocation. We examined the uncovertebral axial plane alignment of 12 patients with unilateral and bilateral cervical facet joint dislocation (UCFJD and BCFJD, respectively), comparing its frequency to the reverse hamburger bun sign on CT and MR axial images. Of the seven cases with BCFJD, five clearly demonstrated the diagnostic reverse facet joint hamburger bun sign on CT and MR images, but in two cases this sign was not detectable. In the five cases with UCFJD, four demonstrated the reverse hamburger bun sign on both CT and MRI. In one case the reverse hamburger bun sign was not seen adequately with either image modality, but the facet dislocation was identified on sagittal imaging. The uncovertebral mal-alignment was detected in all 12 cases. Normally, the two components of the uncovertebral joint enjoy a concentric relationship that in the axial plane is reminiscent of the relationship of headphones with the wearer's head. We name this appearance the 'headphones' sign. Radiologists should be aware of the headphones sign as a reliable indicator of facet joint dislocation on axial imaging used in the assessment of cervical spine injuries. (orig.)

  19. Pseudomeningocele in communication with the facet joint: demonstration by computerized tomography-arthrography

    International Nuclear Information System (INIS)

    Ganiyusufoglu, Kursat; Ozturk, Cagatay; Sirvanci, Mustafa; Aksu, Neslihan; Hamzaoglu, Azmi

    2008-01-01

    Pseudomeningocele is an uncommon but well-known complication of lumbar spine operations. Although it is mostly asymptomatic and managed conservatively in most cases, it is claimed as a causative factor of failed back surgery syndrome and requires surgery in some cases. Usually, its diagnosis is confidently done with imaging modalities such as magnetic resonance imaging, computed tomography and myelography. In this report, we describe a case of pseudomeningocele that communicated with a facet joint. The diagnostic approach for this unusual lesion and its probable causes are discussed. (orig.)

  20. Pseudomeningocele in communication with the facet joint: demonstration by computerized tomography-arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Ganiyusufoglu, Kursat; Ozturk, Cagatay; Sirvanci, Mustafa; Aksu, Neslihan; Hamzaoglu, Azmi [Florence Nightingale Hospital, Istanbul Bilim University, Istanbul Spine Center, Istanbul (Turkey)

    2008-08-15

    Pseudomeningocele is an uncommon but well-known complication of lumbar spine operations. Although it is mostly asymptomatic and managed conservatively in most cases, it is claimed as a causative factor of failed back surgery syndrome and requires surgery in some cases. Usually, its diagnosis is confidently done with imaging modalities such as magnetic resonance imaging, computed tomography and myelography. In this report, we describe a case of pseudomeningocele that communicated with a facet joint. The diagnostic approach for this unusual lesion and its probable causes are discussed. (orig.)

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

    International Nuclear Information System (INIS)

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

    2015-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-05-15

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

  3. Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases.

    Science.gov (United States)

    Liu, Fubing; Jiang, Chun; Cao, Yuanwu; Jiang, Xiaoxing; Feng, Zhenzhou

    2014-07-01

    Transforaminal lumbar interbody fusion (TLIF) has been used in lumbar degenerative diseases. Some researchers have applied unilateral fixation in TLIF to reduce operational trauma without compromising the clinical outcome, but it is always suspected biomechanically unstable. The supplementary contralateral translaminar facet screw (cTLFS) seemed to be able to overcome the inherent drawbacks of unilateral pedicle screw (uPS) fixation theoretically. This study evaluates the safety, feasibility and efficacy of TLIF using uPS with cTLFS fixation in the treatment of lumbar degenerative diseases (LDD). 50 patients (29 male) underwent the aforementioned surgical technique for their LDD between December 2009 and April 2012. The results were evaluated based on visual analogue scale (VAS) of the leg and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were recorded. The radiographic examinations in form of X-ray, computed tomography (CT) or magnetic resonance imaging was done preoperatively and 1 week, 3 months, 6 months, 12 months and 24 months postoperatively. The student t-test was used for comparison between the preoperative values and postoperative counterparts. P degenerative diseases short termly.

  4. Image-based multiscale mechanical modeling shows the importance of structural heterogeneity in the human lumbar facet capsular ligament.

    Science.gov (United States)

    Zarei, Vahhab; Liu, Chao J; Claeson, Amy A; Akkin, Taner; Barocas, Victor H

    2017-08-01

    The lumbar facet capsular ligament (FCL) primarily consists of aligned type I collagen fibers that are mainly oriented across the joint. The aim of this study was to characterize and incorporate in-plane local fiber structure into a multiscale finite element model to predict the mechanical response of the FCL during in vitro mechanical tests, accounting for the heterogeneity in different scales. Characterization was accomplished by using entire-domain polarization-sensitive optical coherence tomography to measure the fiber structure of cadaveric lumbar FCLs ([Formula: see text]). Our imaging results showed that fibers in the lumbar FCL have a highly heterogeneous distribution and are neither isotropic nor completely aligned. The averaged fiber orientation was [Formula: see text] ([Formula: see text] in the inferior region and [Formula: see text] in the middle and superior regions), with respect to lateral-medial direction (superior-medial to inferior-lateral). These imaging data were used to construct heterogeneous structural models, which were then used to predict experimental gross force-strain behavior and the strain distribution during equibiaxial and strip biaxial tests. For equibiaxial loading, the structural model fit the experimental data well but underestimated the lateral-medial forces by [Formula: see text]16% on average. We also observed pronounced heterogeneity in the strain field, with stretch ratios for different elements along the lateral-medial axis of sample typically ranging from about 0.95 to 1.25 during a 12% strip biaxial stretch in the lateral-medial direction. This work highlights the multiscale structural and mechanical heterogeneity of the lumbar FCL, which is significant both in terms of injury prediction and microstructural constituents' (e.g., neurons) behavior.

  5. Isolated Facet Joint Fracture as a Cause of Chronic Low Back Pain and Sciatica

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    1996-01-01

    Full Text Available A case of facet joint fracture following a rear-end motor vehicle accident who presented with chronic low back pain and sciatica is outlined. Diagnosis was made with 99Tc nuclear bone scan and was confirmed on computed tomographic scan after diagnosis with regular radiographs had failed. Facetectomy relieved pain but led to symptoms related to asymmetric load on the opposite facet joint. Symptoms were substantially relieved with a facet joint deinnervation procedure. Facet joint fracture was felt to occur as a consequence of compression forces on the facet joint at the time of impact.

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

    Science.gov (United States)

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

    2016-10-01

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

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

    Science.gov (United States)

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

    2015-03-01

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

  8. Does sensory stimulation threshold affect lumbar facet radiofrequency denervation outcomes? A prospective clinical correlational study.

    Science.gov (United States)

    Cohen, Steven P; Strassels, Scott A; Kurihara, Connie; Lesnick, Ivan K; Hanling, Steven R; Griffith, Scott R; Buckenmaier, Chester C; Nguyen, Conner

    2011-11-01

    Radiofrequency facet denervation is one of the most frequently performed procedures for chronic low back pain. Although sensory stimulation is generally used as a surrogate measure to denote sufficient proximity of the electrode to the nerve, no study has examined whether stimulation threshold influences outcome. We prospectively recorded data in 61 consecutive patients undergoing lumbar facet radiofrequency denervation who experienced significant pain relief after medial branch blocks. For each nerve lesioned, multiple attempts were made to maximize sensory stimulation threshold (SST). Mean SST was calculated on the basis of the lowest stimulation perceived at 0.1-V increments for each medial branch. A positive outcome was defined as a ≥50% reduction in back pain coupled with a positive satisfaction score lasting ≥3 months. The relationship between mean SST and denervation outcomes was evaluated via a receiver's operating characteristic (ROC) curve, and stratifying outcomes on the basis of various cutoff values. No correlation was noted between mean SST and pain relief at rest (Pearson's r=-0.01, 95% confidence interval [CI]: -0.24 to 0.23, P=0.97), with activity (r=-0.17, 95% CI: -0.40 to 0.07, P=0.20), or a successful outcome. No optimal SST could be identified. There is no significant relationship between mean SST during lumbar facet radiofrequency denervation and treatment outcome, which may be due to differences in general sensory perception. Because stimulation threshold was optimized for each patient, these data cannot be interpreted to suggest that sensory testing should not be performed, or that high sensory stimulation thresholds obtained on the first attempt should be deemed acceptable.

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

    Science.gov (United States)

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

    2013-03-01

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

  10. Imaging findings predicting the outcome of cervical facet joint blocks

    International Nuclear Information System (INIS)

    Hechelhammer, Lukas; Pfirrmann, Christian W.A.; Zanetti, Marco; Hodler, Juerg; Schmid, Marius R.; Boos, Norbert

    2007-01-01

    To determine which cross-sectional imaging findings predict the short-term outcome of cervical facet joint blocks (FJB) and to evaluate the effect of combined intra-/periarticular versus periarticular injection on pain. Fifty facet joints in 37 patients were included in the study. Single, unilateral FJBs in 24 patients, and bilateral single level FJBs in 13 patients were performed, respectively. In all patients, pain relief was assessed using a visual analogue scale. All computed tomography (CT) examinations were blindly reviewed by two radiologists. Osteoarthritis was rated using the Kellgren classification. The presence of combined intra-/periarticular vs. sole periarticular injection of contrast was evaluated. Kellgren Grades 0 (n=23), 1 (n=5), 2 (n=3), 3 (n=9), and 4 (n=10) were found. Mean pain relief after injection was 35% (range: 0-100%). 40% of all injections were combined intra-/periarticular. There was neither a statistically significant difference between pain relief and combined intra-/periarticular versus sole periarticular injection (p=0.64) nor the grade of osteoarthritis (p=0.49). Pain relief after cervical FJBs does not correlate with morphologic alterations seen on CT. Periarticular FJBs are not less successful than combined intra-/periarticular FJBs. (orig.)

  11. Factors affecting results of fluoroscopy-guided facet joint injection: Probable differences in the outcome of treatment between pure facet joint hypertrophy and concomitant diseases

    Directory of Open Access Journals (Sweden)

    Akif Albayrak

    2016-01-01

    Full Text Available Study Design: Retrospective cohort study. Purpose: Facet joints are considered a common source of chronic low-back pain. To determine whether pathogens related to the facet joint arthritis have any effect on treatment failure. Materials and Methods: Facet joint injection was applied to 94 patients treated at our hospital between 2011 and 2012 (mean age 59.5 years; 80 women and 14 men. For the purpose of analysis, the patients were divided into two groups. Patients who only had facet hypertrophy were placed in group A (47 patients, 41 women and 6 men, mean age 55.3 years and patients who had any additional major pathology to facet hypertrophy were placed in group B (47 patients, 39 women and 8 men, mean age 58.9 years. Injections were applied around the facet joint under surgical conditions utilizing fluoroscopy device guidance. A mixture of methylprednisolone and lidocaine was used as the injection ingredient. Results: In terms of Oswestry Disability Index (ODI and visual analog scale (VAS scores, no significant difference was found between preinjection and immediate postinjection values in both groups, and the scores of group A patients were significantly lower (P < 0.005 compared with that of group B patients at the end of the third, sixth, and twelfth month. Conclusion: For low-back pain caused by facet hypertrophy, steroid injection around the facet joint is an effective treatment, but if there is an existing major pathology, it is not as effective.

  12. Audit of conservative management of chronic low back pain in a secondary care setting--part I: facet joint and sacroiliac joint interventions.

    Science.gov (United States)

    Chakraverty, Robin; Dias, Richard

    2004-12-01

    The work of a chronic back pain service in secondary care in the West Midlands is reported. The service offers acupuncture, spinal injection procedures, osteopathy and a range of other interventions for patients whose back pain has not responded to conservative management. This section of the report focuses on injection procedures for lumbar facet joint and sacroiliac joint pain, which have been shown to be the cause of chronic low back pain in 16-40% and 13-19% of patients respectively. Diagnosis relies on the use of intra-articular or sensory nerve block injections with local anaesthetic. Possible treatments following diagnosis include intra-articular corticosteroid, radiofrequency denervation (for facet joint pain) or ligament prolotherapy injections (for sacroiliac joint pain). The results of several hospital audits are reported. At six month follow up, 50% of 38 patients undergoing radiofrequency denervation following diagnostic blocks for facet joint pain had improved by more than 50%, compared to 29% of 34 patients treated with intra-articular corticosteroid injection. Sixty three per cent of 19 patients undergoing prolotherapy following diagnostic block injection for sacroiliac joint pain had improved at six months, compared to 33% of 33 who had intra-articular corticosteroid. Both radiofrequency denervation and sacroiliac prolotherapy showed good long-term outcomes at one year.

  13. A Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain.

    Science.gov (United States)

    Boswell, Mark V; Manchikanti, Laxmaiah; Kaye, Alan D; Bakshi, Sanjay; Gharibo, Christopher G; Gupta, Sanjeeva; Jha, Sachin Sunny; Nampiaparampil, Devi E; Simopoulos, Thomas T; Hirsch, Joshua A

    2015-01-01

    Spinal zygapophysial, or facet, joints are a source of axial spinal pain and referred pain in the extremities. Conventional clinical features and other noninvasive diagnostic modalities are unreliable in diagnosing zygapophysial joint pain. A systematic review of the diagnostic accuracy of spinal facet joint nerve blocks. To determine the diagnostic accuracy of spinal facet joint nerve blocks in chronic spinal pain. A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. The level of evidence was classified as Level I to V based on the grading of evidence utilizing best evidence synthesis. Data sources included relevant literature identified through searches of PubMed and other electronic searches published from 1966 through March 2015, Cochrane reviews, and manual searches of the bibliographies of known primary and review articles. Studies must have been performed utilizing controlled local anesthetic blocks. The criterion standard must have been at least 50% pain relief from baseline scores and the ability to perform previously painful movements. The available evidence is Level I for lumbar facet joint nerve blocks with the inclusion of a total of 17 studies with dual diagnostic blocks, with at least 75% pain relief with an average prevalence of 16% to 41% and false-positive rates of 25% to 44%. The evidence for diagnosis of cervical facet joint pain with cervical facet joint nerve blocks is Level II based on a total of 11 controlled diagnostic accuracy studies, with significant variability among the prevalence in a heterogenous population with internal inconsistency. The prevalence rates ranged from 36% to 67% with at least 80% pain relief as the criterion standard and a false-positive rate of 27% to 63%. The level of evidence for the diagnostic accuracy of thoracic facet

  14. Facet joint injuries in acute cervical spine trauma : evaluation with CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Jeon Ju; Kim, Dong Hyun; Lee, Jeong Hwa; Lee, Keon; Kwon, Hyeok Po; Kwon, Jung Hyeok; Yun, Seong Mun [Dongkang General Hospital, Seoul (Korea, Republic of)

    1999-05-01

    To evaluate injury patterns of facet joints and associated soft tissue injuries in patients with acute traumatic cervical facet joint injuries. From among patients with cervical spine trauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzed with regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, and other associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury, intervertebral disc herniation, and spinal cord injury. The most common location of facet joint injury was C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) had bilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fracture of inferior facet was more frequent than superior. Patterns of fracture were vertical, transverse, or comminuted, but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facet fractures. Fractures other than facet included pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13), and spinous process(n=3). On MR images, anterior longitudinal ligament injury was found in 8 patients(30%), posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelve patients(44%) had spinal cord injuries including edema(n=8) and hemorrhage(n=4). Among patients with disc abnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine. Traumatic cervical facet joint injuries were manifested as various patterns and frequently associated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patterns helped formulate a therapeutic plan and determine of prognosis.

  15. Avaliação clínica da infiltração facetaria no tratamento da dor lombar crônica por síndrome facetaria: estudo prospectivo Evaluación clínica de la infiltración de las facetas en el tratamiento del dolor crónico de espalda baja por el síndrome de faceta síndrome: estudio prospectivo Clinical evaluation of the lumbar facet joint blocks in treatment of chronic low back pain: a prospective study

    Directory of Open Access Journals (Sweden)

    Thiago Miller Santana Silva

    2011-01-01

    Full Text Available OBJETIVO: Avaliar os resultados do bloqueio facetário lombar com anestésico local e corticóide em pacientes com lombalgia crônica por síndrome facetária. MÉTODOS: Realizou-se um estudo prospectivo em 30 pacientes com lombalgia crônica por síndrome facetária, os quais foram submetidos à infiltração facetária com bupivacaína a 0,25% e acetato de metilpredinisolona sob controle radioscópico, e foram seguidos e avaliados seguindo as escalas Visual Analógica da Dor, Oswestry Disability Index e os Critérios de MacNab nos quais 17 foram do sexo feminino e 13 do sexo masculino. RESULTADOS: Foi observada diminuição significativa (pOBJETIVO: Evaluar los resultados del bloqueo facetario lumbar, con anestésico local y corticoide, en pacientes con dorsalgia crónica por síndrome facetario. MÉTODOS: Se realizó un estudio prospectivo en 30 pacientes, 17 del sexo femenino y 13 del sexo masculino, con dorsalgia crónica por síndrome facetario, quienes fueron sometidos a la infiltración facetaria con bupivacaína a 0,25% y acetato de metilpredinisolona bajo control radioscópico, y fueron acompañados y evaluados siguiendo las escalas Visual Analógica del Dolor, Oswestry Disability Index y los Criterios de MacNab. RESULTADOS: Se observó una disminución significativa (pOBJECTIVE: To evaluate the lumbar facet block with local anesthetics and corticosteroids in patients with chronic low back pain of facet joint origin. METHODS: We conducted a prospective study on 30 patients with chronic low back pain in facet syndrome who underwent facet infiltration with bupivacaine 0.25% and methylprednisolone acetate under radioscopic control; the subjects were followed and evaluated following the Visual Analogue Scale of Pain , Oswestry Disability Index and MacNab criteria; 17 of them were female and 13 male. RESULTS: Reduction of pain was found by Visual Analogue Scale significant (p <0.05. We obtained 73.3% of satisfactory results in the first

  16. 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.

  17. Ageing and Incidence of Osteoarthritis of the Knee Joint, Lumbar ...

    African Journals Online (AJOL)

    There was a significant difference in the distribution of osteoarthritis between gender and within the age groups (P=0.000). Osteoarthritis of the lumbar spine was the highest in males within the age groups of 61-65, followed by 45- 50, 56 - 60, and 51 - 55; whereas in the females, osteoarthritis of the knee joint was the ...

  18. FACET

    International Nuclear Information System (INIS)

    Cole, C.W.; Banszky, I.J.

    1989-01-01

    The merits of using commercially available software packages versus in-house software and databases are frequently assessed by cost engineers in consulting, contracting and operating companies alike. There is no consensus on which approach is better as each company has individual requirements that are better provided for by one or the other alternative. This paper describes Mobil Oil Canada's FACET (Facilities Cost Estimating Techniques) programs and provides a framework for building any successful in-house PC-based cost estimating and control system. The FACET series of programs enables detailed cost estimates to be quickly developed from relatively conceptual cost data and allows project cost estimates to be compared with actual costs as the project proceeds

  19. Detailed examination of the lower cervical spine facet joints in a road traffic crash fatality - a case study

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Nielsen, Edith; Vesterby, Annie

    2005-01-01

    The lower cervical spine facet joints of a road traffic crash fatality were examined using diagnostic imaging and histological techniques. No injuries to the cervical spine facet joints could be identified with diagnostic imaging including conventional radiology, CT and MRI. Examination of stained...... histological sections visualised the morphology and integrity of the facet joints in detail. Occult injuries to and in close proximity of the cervical spine facet joints were identified only on histological examination....

  20. [Lumbar spondylosis].

    Science.gov (United States)

    Seichi, Atsushi

    2014-10-01

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

  1. Gradient-echo imaging of intervertebral disk degeneration and facet joint disease

    International Nuclear Information System (INIS)

    Berns, D.H.; Kormos, D.; Modic, M.T.; Carter, J.; Masaryk, T.J.; Ross, J.S.

    1988-01-01

    The purpose of this study was to evaluate the accuracy of gradient-echo, partial-flip angle images in the evaluation of components of degenerative spine disease. First, cadaveric spines were studied with plain radiographs, high-resolution CT, T1-weighted spin-echo (SE) MR images (repetition time msec/echo time msec=500/17). T2-weighted SE images (2,000/30-90), and fast low-angle shot (FLASH) images (200/10.50 0 ) before and after intradiskal injection of air (0.1-1cc). Second, lumbar spine MR images were retrospectively evaluated to compare gradient-echo and SE sequences. Results indicate that the signal intensity changes of the intervertebral disk related to degeneration were best appreciated on T2-weighted SE studies in both groups. Vacuum phenomenon and calcification were most accurately assessed with FLASH imaging (based on susceptibility changes) and CT images. SE images appeared more sensitive to adjacent marrow change. In the facet joints, CT was more accurate for changes in the subarticular bone, but FLASH images were more sensitive to change in the articular cartilage

  2. Isolated septic facet joint arthritis as a rare cause of acute and chronic low back pain – a case report and literature review

    International Nuclear Information System (INIS)

    Klekot, Dominika; Zimny, Anna; Czapiga, Bogdan; Sąsiadek, Marek

    2012-01-01

    The most common cause of low back pain is degenerative disease of the intervertebral disc and other structures of the lumbar spine. However, in some cases other less frequent causes of such pain can be seen, for example septic facet joint arthritis. Until now, only 40 cases of such inflammatory changes within the spine have been reported in the literature. The disease is probably underestimated due to improper diagnostic pathway. The authors describe a case of a 53-year-old woman who was repeatedly hospitalized during a five-month period because of an acute, severe low back pain, with sphincter dysfunction, partially resembling sciatic symptoms. Physical examinations revealed also focal tenderness in the area of the lumbar spine. Inflammatory markers (ESR – erythrocyte sedimentation rate, CRP – C-reactive protein) were elevated. Conservative analgetic treatment brought only partial and temporary relief of the pain and symptoms. The final accurate diagnosis of isolated septic facet joint arthritis at the level of L5/S1 was established after several months from the onset of the first symptoms, after performing various imaging examinations, including bone scintigraphy as well as CT and MRI of the lumbosacral spine. The patient fully recovered after antibiotic therapy and surgery, which was proven in several follow-up examinations showing no relevant pathology of the lumbar spine. The authors broadly describe the etiology and clinical symptoms of the septic facet joint arthritis as well as the significant role of imaging methods, especially MRI, in diagnostic process. The authors also discuss currently available treatment options, both conservative and surgical. The diagnostic procedure of septic facet joint arthritis requires several steps to be taken. Establishing a correct diagnosis may be difficult, that is why it is important to remember about rare causes of low back pain and to perform detailed physical examination, laboratory tests and choose appropriate

  3. Long-term outcomes of percutaneous lumbar facet synovial cyst rupture

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Ambrose J.; Bos, Stijn A.; Torriani, Martin; Simeone, F.J.; Chang, Connie Y.; Pomerantz, Stuart R.; Bredella, Miriam A. [Massachusetts General Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2017-01-15

    To evaluate the therapeutic value, safety, and long-term clinical outcomes of percutaneous lumbar facet synovial cyst (LFSC) rupture. Our study was institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant. The study group comprised 71 patients (44 women, mean age: 65 ± 17 years) who underwent CT- or fluoroscopy-guided percutaneous LFSC rupture. The technical success of LFSC rupture, the long-term clinical outcome, including repeat procedures or surgery, and imaging findings on MRI and CT were recorded. Seventy-nine LFSC ruptures were performed in 71 patients. CT guidance was used in 57 cases and fluoroscopy guidance in 22 cases. LFSC rupture was technically successful in 58 out of 79 cases (73 %). Mean injection volume for cyst rupture was 3.6 ± 2.2 mL and a combination of steroid and anesthetic was injected in all cases. Over a mean follow-up time of 44 months, 12 % of patients underwent repeat cyst rupture, and 46 % eventually underwent surgery, whereas the majority of patients (55 %) experienced symptomatic relief and did not undergo surgery. There was no significant association between a successful outcome and age, sex, level, or size of LFSC (p > 0.1). LFSCs with T2 hypointensity were more likely to require surgery (p = 0.02). There was one complication, a bacterial skin infection that completely resolved following antibiotic therapy. Percutaneous LFSC rupture is an effective and safe nonsurgical treatment option for LFSC. More than half of treated patients were able to avoid subsequent surgery. Therefore, percutaneous LFSC rupture should be considered before surgical intervention. (orig.)

  4. Comparative Analysis of Bone Structural Parameters Reveals Subchondral Cortical Plate Resorption and Increased Trabecular Bone Remodeling in Human Facet Joint Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Cordula Netzer

    2018-03-01

    Full Text Available Facet joint osteoarthritis is a prominent feature of degenerative spine disorders, highly prevalent in ageing populations, and considered a major cause for chronic lower back pain. Since there is no targeted pharmacological therapy, clinical management of disease includes analgesic or surgical treatment. The specific cellular, molecular, and structural changes underpinning facet joint osteoarthritis remain largely elusive. The aim of this study was to determine osteoarthritis-related structural alterations in cortical and trabecular subchondral bone compartments. To this end, we conducted comparative micro computed tomography analysis in healthy (n = 15 and osteoarthritic (n = 22 lumbar facet joints. In osteoarthritic joints, subchondral cortical plate thickness and porosity were significantly reduced. The trabecular compartment displayed a 42 percent increase in bone volume fraction due to an increase in trabecular number, but not trabecular thickness. Bone structural alterations were associated with radiological osteoarthritis severity, mildly age-dependent but not gender-dependent. There was a lack of association between structural parameters of cortical and trabecular compartments in healthy and osteoarthritic specimens. The specific structural alterations suggest elevated subchondral bone resorption and turnover as a potential treatment target in facet joint osteoarthritis.

  5. Histological Osteoarthritic Changes in the Human Cervical Spine Facet Joints Related to Age and Gender

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Charles, Annie Vesterby; Gregersen, Markil

    2018-01-01

    STUDY DESIGN: Cross-sectional autopsy study. OBJECTIVE: Quantify histological changes in the lower cervical spine facet joints with regard to age and gender using systematic random sampling of entire joints. SUMMARY OF BACKGROUND DATA: Neck pain is a common debilitating musculoskeletal condition...... and one of the highest ranked causes of years lived with disability. The cause of neck pain is multifactorial and osteoarthritis is one potential cause. The cervical spine facet joints have been implicated in the aetiology of chronic neck pain. Hence, a detailed description of their anatomy and age......- and gender related changes is needed. METHODS: The lower four cervical spine segments (C4-C7 included) were obtained from 72 subjects during autopsy; 29 females (median age 53 years [22-77]) and 43 males (median age 38 years [20-78]). A total of 1132 articular facets were embedded in toto in hard plastic...

  6. Characterisation of the correlation between standing lordosis and degenerative joint disease in the lower lumbar spine in women and men: a radiographic study.

    Science.gov (United States)

    Murray, Kelvin J; Le Grande, Michael R; Ortega de Mues, Arantxa; Azari, Michael F

    2017-08-01

    Degenerative joint disease (DJD) in the lumbar spine is a common condition that is associated with chronic low back pain. Excessive loading of lumbar joints is a risk factor for DJD. Changes in lumbar lordosis significantly redistribute the forces of weight-bearing on the facet joints and the intervertebral discs. However, the relationship between lumbar lordosis and DJD has not been characterized in men and women. We characterised the correlation between standing lumbar lordosis and DJD in standing radiographic images from 301 adult female and male chiropractic patients. DJD was rated using the Kellgren-Lawrence scale, and lordosis was measured using the Cobb angle. Linear and curvilinear correlations were investigated while controlling for age and sex. We found a highly significant curvilinear correlation between lordosis and DJD of the lower lumbar spine in both sexes, but especially in women, irrespective of the effects of age. We found the effect size of lordosis on lower lumbar DJD to be between 17.4 and 18.1% in women and 12.9% in older men. In addition, lordosis of 65 (95% CI 55.3-77.7) and 68 (98% CI 58.7-73.3) degrees were associated with minimal DJD in the lower lumbar spine of women and men respectively, and were therefore considered 'optimal'. This optimal lordotic angle was 73 (95% CI 58.8-87.2) degrees in older men. Both hypo- and hyper-lordosis correlate with DJD in the lumbar spine, particularly in women and in older men. These findings may well be of relevance to spinal pain management and spinal rehabilitation.

  7. Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints.

    Science.gov (United States)

    Walraevens, Joris; Liu, Baoge; Meersschaert, Joke; Demaerel, Philippe; Delye, Hans; Depreitere, Bart; Vander Sloten, Jos; Goffin, Jan

    2009-03-01

    Degeneration of intervertebral discs and facet joints is one of the most frequently encountered spinal disorders. In order to describe and quantify degeneration and evaluate a possible relationship between degeneration and biomechanical parameters, e.g., the intervertebral range of motion and intradiscal pressure, a scoring system for degeneration is mandatory. However, few scoring systems for the assessment of degeneration of the cervical spine exist. Therefore, two separate objective scoring systems to qualitatively and quantitatively assess the degree of cervical intervertebral disc and facet joint degeneration were developed and validated. The scoring system for cervical disc degeneration consists of three variables which are individually scored on neutral lateral radiographs: "height loss" (0-4 points), "anterior osteophytes" (0-3 points) and "endplate sclerosis" (0-2 points). The scoring system for facet joint degeneration consists of four variables which are individually scored on neutral computed tomography scans: "hypertrophy" (0-2 points), "osteophytes" (0-1 point), "irregularity" on the articular surface (0-1 point) and "joint space narrowing" (0-1 point). Each variable contributes with varying importance to the overall degeneration score (max 9 points for the scoring system of cervical disc degeneration and max 5 points for facet joint degeneration). Degeneration of 20 discs and facet joints of 20 patients was blindly assessed by four raters: two neurosurgeons (one senior and one junior) and two radiologists (one senior and one junior), firstly based on first subjective impression and secondly using the scoring systems. Measurement errors and inter- and intra-rater agreement were determined. The measurement error of the scoring system for cervical disc degeneration was 11.1 versus 17.9% of the subjective impression results. This scoring system showed excellent intra-rater agreement (ICC = 0.86, 0.75-0.93) and excellent inter-rater agreement (ICC = 0

  8. Talocalcaneal Joint Middle Facet Coalition Resection With Interposition of a Juvenile Hyaline Cartilage Graft.

    Science.gov (United States)

    Tower, Dyane E; Wood, Ryan W; Vaardahl, Michael D

    2015-01-01

    Talocalcaneal joint middle facet coalition is the most common tarsal coalition, occurring in ≤2% of the population. Fewer than 50% of involved feet obtain lasting relief of symptoms after nonoperative treatment, and surgical intervention is commonly used to relieve symptoms, increase the range of motion, improve function, reconstruct concomitant pes planovalgus, and prevent future arthrosis from occurring at the surrounding joints. Several approaches to surgical intervention are available for patients with middle facet coalitions, ranging from resection to hindfoot arthrodesis. We present a series of 4 cases, in 3 adolescent patients, of talocalcaneal joint middle facet coalition resection with interposition of a particulate juvenile hyaline cartilaginous allograft (DeNovo(®) NT Natural Tissue Graft, Zimmer, Inc., Warsaw, IN). With a mean follow-up period of 42.8 ± 2.9 (range 41 to 47) months, the 3 adolescent patients in the present series were doing well with improved subtalar joint motion and decreased pain, and 1 foot showed no bony regrowth on a follow-up computed tomography scan. The use of a particulate juvenile hyaline cartilaginous allograft as interposition material after talocalcaneal middle facet coalition resection combined with adjunct procedures to address concomitant pes planovalgus resulted in good short-term outcomes in 4 feet in 3 adolescent patients. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-06-15

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

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

    International Nuclear Information System (INIS)

    Masala, Salvatore; Tarantino, Umberto; Nano, Giovanni; Iundusi, Riccardo; Fiori, Roberto; Da Ros, Valerio; Simonetti, Giovanni

    2013-01-01

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

  11. Short-term outcome of fluoroscopic-guided steroid injection therapy of lumber facet cyst-induced radicular pain

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Mi Ri; Kwon, Jong Won; Lee, Jong Seo; Kim, Eu Sang [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2015-04-15

    To determine the short-term effect of fluoroscopic-guided steroid injection therapy of lumbar facet cyst-induced radicular pain. Seventeen patients with radiculopathy due to lumbar synovial cysts, who were treated with fluoroscopically guided injection, were retrospectively evaluated. All plain radiographic images and MR images before the therapy were reviewed. Five patients underwent only the facet joint injection, whereas twelve patients underwent the facet joint injection with perineural injection therapy. The clinical course of pain was evaluated on the first follow-up after therapy. Effective pain relief was achieved in 11 (64.7%) of the 17 patients. Among 12 patients who underwent facet joint injection with perineural injection, 9 patients (75%) had an effective pain relief. Of 5 patients, 2 (40%) patients only took the facet joint injection and had an effective pain relief. Fluoroscopic-guided steroid injection therapy shows a good short-term effect in patients with symptomatic lumbar facet joint synovial cysts.

  12. Optimized cervical spine bone SPET for detection of facet joint injury after whiplash injury

    Energy Technology Data Exchange (ETDEWEB)

    Cardaci, G T; Bower, G D; Taylor, J [Perth and Perth Pain Management, South Perth, WA (Australia). Mount Medical Centre, Isotope Imaging

    1999-04-01

    Full text: The most frequent origin for chronic cervical pain in patients with a remote history of whiplash injury is the cervical facet joints. Exact localization of facet joint injury is difficult and currently advocated methods include multiple invasive diagnostic injections. Optimization of {sup 99}Tc{sup m}-HDP cervical SPET (CSPET) to accurately localize facet joint pathology was attempted and the results correlated with clinical localization relying on focal joint tenderness and passive movement methods. Imaging was performed on a dual-headed gamma camera system using an elliptical orbit over 360 deg. The patient's neck was flexed to eliminate the cervical lordosis. Reconstructed CSPET images were reorientated into the long axis of the vertebral bodies. CSPET studies were independently scored by two observers blinded to the clinical and other imaging information and correlated with clinical localization and response to radiofrequency ablation. 54 patients have been studied using this technique in a prospective study. Early patient follow-up data will be presented. CSPET was felt to be clinically useful by pain therapists in targeting treatment.

  13. Optimized cervical spine bone SPET for detection of facet joint injury after whiplash injury

    International Nuclear Information System (INIS)

    Cardaci, G.T.; Bower, G.D.; Taylor, J.

    1999-01-01

    Full text: The most frequent origin for chronic cervical pain in patients with a remote history of whiplash injury is the cervical facet joints. Exact localization of facet joint injury is difficult and currently advocated methods include multiple invasive diagnostic injections. Optimization of 99 Tc m -HDP cervical SPET (CSPET) to accurately localize facet joint pathology was attempted and the results correlated with clinical localization relying on focal joint tenderness and passive movement methods. Imaging was performed on a dual-headed gamma camera system using an elliptical orbit over 360 deg. The patient's neck was flexed to eliminate the cervical lordosis. Reconstructed CSPET images were reorientated into the long axis of the vertebral bodies. CSPET studies were independently scored by two observers blinded to the clinical and other imaging information and correlated with clinical localization and response to radiofrequency ablation. 54 patients have been studied using this technique in a prospective study. Early patient follow-up data will be presented. CSPET was felt to be clinically useful by pain therapists in targeting treatment

  14. Work intensity in sacroiliac joint fusion and lumbar microdiscectomy

    Science.gov (United States)

    Frank, Clay; Kondrashov, Dimitriy; Meyer, S Craig; Dix, Gary; Lorio, Morgan; Kovalsky, Don; Cher, Daniel

    2016-01-01

    Background The evidence base supporting minimally invasive sacroiliac (SI) joint fusion (SIJF) surgery is increasing. The work relative value units (RVUs) associated with minimally invasive SIJF are seemingly low. To date, only one published study describes the relative work intensity associated with minimally invasive SIJF. No study has compared work intensity vs other commonly performed spine surgery procedures. Methods Charts of 192 patients at five sites who underwent either minimally invasive SIJF (American Medical Association [AMA] CPT® code 27279) or lumbar microdiscectomy (AMA CPT® code 63030) were reviewed. Abstracted were preoperative times associated with diagnosis and patient care, intraoperative parameters including operating room (OR) in/out times and procedure start/stop times, and postoperative care requirements. Additionally, using a visual analog scale, surgeons estimated the intensity of intraoperative care, including mental, temporal, and physical demands and effort and frustration. Work was defined as operative time multiplied by task intensity. Results Patients who underwent minimally invasive SIJF were more likely female. Mean procedure times were lower in SIJF by about 27.8 minutes (P<0.0001) and mean total OR times were lower by 27.9 minutes (P<0.0001), but there was substantial overlap across procedures. Mean preservice and post-service total labor times were longer in minimally invasive SIJF (preservice times longer by 63.5 minutes [P<0.0001] and post-service labor times longer by 20.2 minutes [P<0.0001]). The number of postoperative visits was higher in minimally invasive SIJF. Mean total service time (preoperative + OR time + postoperative) was higher in the minimally invasive SIJF group (261.5 vs 211.9 minutes, P<0.0001). Intraoperative intensity levels were higher for mental, physical, effort, and frustration domains (P<0.0001 each). After taking into account intensity, intraoperative workloads showed substantial overlap. Conclusion

  15. Groin pain associated with sacroiliac joint dysfunction and lumbar disorders.

    Science.gov (United States)

    Kurosawa, Daisuke; Murakami, Eiichi; Aizawa, Toshimi

    2017-10-01

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

  16. 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.

  17. Osseous associated cervical spondylomyelopathy at the C2-C3 articular facet joint in 11 dogs.

    Science.gov (United States)

    Cooper, C; Gutierrez-Quintana, R; Penderis, J; Gonçalves, R

    2015-11-21

    In dogs, vertebral canal stenosis at C2-C3 due to articular facet joint degeneration is only sporadically identified. The authors' aims were to review the clinical presentation, MRI characteristics, treatment and outcome of dogs presenting with this condition. Eleven cases were eligible for inclusion. Neurological examination revealed tetraparesis and proprioceptive ataxia in all 4 limbs in 3/11, proprioceptive tetra-ataxia only in 4/11, pelvic limb proprioceptive ataxia in 2/11 and no gait abnormalities in 2/11 dogs. Cervical hyperaesthesia was present in 7/11 dogs. MRI revealed bilateral articular facet joint degeneration in 10/11 cases and unilateral degeneration in one. Surgery was performed in six cases and medical management elected in five. Long-term follow-up information was available for 11 animals. Four of the surgical cases are alive and have no neurological deficits, one was euthanased for an unrelated condition and one lost to follow-up. Of the cases managed medically, three are alive showing no neurological deficits, one is alive still displaying neurological deficits and one euthanased for an unrelated condition whilst still ataxic. This study shows that both medical and surgical management can result in good outcomes in dogs with vertebral canal stenosis resulting from articular facet joint degeneration at the level of C2-C3. British Veterinary Association.

  18. Sacroiliac Joint Fusion Minimally Affects Adjacent Lumbar Segment Motion: A Finite Element Study.

    Science.gov (United States)

    Lindsey, Derek P; Kiapour, Ali; Yerby, Scott A; Goel, Vijay K

    2015-01-01

    Adjacent segment disease is a recognized consequence of fusion in the spinal column. Fusion of the sacroiliac joint is an effective method of pain reduction. Although effective, the consequences of sacroiliac joint fusion and the potential for adjacent segment disease for the adjacent lumbar spinal levels is unknown. The objective of this study was to quantify the change in range of motion of the sacroiliac joint and the adjacent lumbar spinal motion segments due to sacroiliac joint fusion and compare these changes to previous literature to assess the potential for adjacent segment disease in the lumbar spine. An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the sacroiliac joint using three laterally placed triangular implants (iFuse Implant System, SI-BONE, Inc., San Jose, CA). The range of motion of the sacroiliac joint and the adjacent lumbar spinal motion segments were calculated using a hybrid loading protocol and compared with the intact range of motion in flexion, extension, lateral bending, and axial rotation. The range of motions of the treated sacroiliac joints were reduced in flexion, extension, lateral bending, and axial rotation, by 56.6%, 59.5%, 27.8%, and 53.3%, respectively when compared with the intact condition. The stiffening of the sacroiliac joint resulted in increases at the adjacent lumbar motion segment (L5-S1) for flexion, extension, lateral bending, and axial rotation, of 3.0%, 3.7%, 1.1%, and 4.6%, respectively. Fusion of the sacroiliac joint resulted in substantial (> 50%) reductions in flexion, extension, and axial rotation of the sacroiliac joint with minimal (sacroiliac joint fusion, the long-term clinical results remain to be investigated.

  19. Kinematic relationship between rotation of lumbar spine and hip joints during golf swing in professional golfers.

    Science.gov (United States)

    Mun, Frederick; Suh, Seung Woo; Park, Hyun-Joon; Choi, Ahnryul

    2015-05-14

    Understanding the kinematics of the lumbar spine and hip joints during a golf swing is a basic step for identifying swing-specific factors associated with low back pain. The objective of this study was to examine the kinematic relationship between rotational movement of the lumbar spine and hip joints during a golf swing. Fifteen professional golfers participated in this study with employment of six infrared cameras to record their golf swings. Anatomical reference system of the upper torso, pelvis and thigh segments, and the location of each hip and knee joint were defined by the protocols of the kinematic model of previous studies. Lumbar spine and hip joint rotational angle was calculated utilizing the Euler angle method. Cross-correlation and angle-angle plot was used to examine the degree of kinematic relationship between joints. A fairly strong coupling relationship was shown between the lumbar spine and hip rotational movements with an average correlation of 0.81. Leading hip contribution to overall rotation was markedly high in the early stage of the downswing, while the lumbar spine contributed greater towards the end of the downswing; however, the relative contributions of the trailing hip and lumbar spine were nearly equal during the entire downswing. Most of the professional golfers participated in this study used a similar coordination strategy when moving their hips and lumbar spine during golf swings. The rotation of hips was observed to be more efficient in producing the overall rotation during the downswing when compared to the backswing. These results provide quantitative information to better understand the lumbar spine and hip joint kinematic characteristics of professional golfers. This study will have great potential to be used as a normal control data for the comparison with kinematic information among golfers with low back pain and for further investigation of golf swing-specific factors associated with injury.

  20. Lumbar facet and interfacet shape variation during growth in children from the general population: a three-year follow-up MRI study

    DEFF Research Database (Denmark)

    Masharawi, Youssef M; Kjaer, Per; Bendix, Tom

    2009-01-01

    and orientation is seen in children independent of gender both at t0 and t1. Lumbar facets have widened significantly only in boys from t0 to t1 (up to 30.8%). Girls at t1 manifest greater superior interfacet width relatively to the superior vertebral body width than boys at L2-L4. No significant difference......: The growth of the lumbar facet and interfacet area in children from the general population has rarely been discussed in the literature. This is an important caveat considering the important role these structures play in the development of spinal anomalies. MATERIALS AND METHODS: All lumbar (L1-S1) facet...... and interfacet widths and transverse orientations were measured twice by the same investigator (Y.M.) from T2-weighted MRIs of 100 healthy children (51 boys and 49 girls) from the general population at the mean age of 12 to 13 years (t0) and after 3 years at the mean age of 15 to 16 years (t1) using the i...

  1. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Lee, Chang-Hyun; Chung, Chun Kee; Kim, Chi Heon

    2017-11-01

    Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial. We aimed to elucidate the precise effects of radiofrequency denervation in patients with low back pain originating from the facet joints relative to those obtained using control treatments, with particular attention to consistency in the denervation protocol. A meta-analysis of randomized controlled trials was carried out. Adult patients undergoing radiofrequency denervation or control treatments (sham or epidural block) for facet joint disease of the lumbar spine comprised the patient sample. Visual analog scale (VAS) pain scores were measured and stratified by response of diagnostic block procedures. We searched PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trials regarding radiofrequency denervation and control treatments for back pain. Changes in VAS pain scores of the radiofrequency group were compared with those of the control group as well as the minimal clinically important difference (MCID) for back pain VAS. Meta-regression model was developed to evaluate the effect of radiofrequency treatment according to responses of diagnostic block while controlling for other variables. We then calculated mean differences and 95% confidence intervals (CIs) using random-effects models. We included data from seven trials involving 454 patients who had undergone radiofrequency denervation (231 patients) and control treatments such as sham or epidural block procedures (223 patients). The radiofrequency group exhibited significantly greater improvements in back pain score when compared with the control group for 1-year follow-up. Although the average improvement in VAS scores exceeded the MCID, the lower limit of the 95% CI encompassed the MCID. A subgroup of patients who responded very well to diagnostic block

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

    Science.gov (United States)

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

    2017-01-01

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

  3. A musculoskeletal lumbar and thoracic model for calculation of joint kinetics in the spine

    International Nuclear Information System (INIS)

    Kim, Yong Cheol; Ta, Duc manh; Koo, Seung Bum; Jung Moon Ki

    2016-01-01

    The objective of this study was to develop a musculoskeletal spine model that allows relative movements in the thoracic spine for calculation of intra-discal forces in the lumbar and thoracic spine. The thoracic part of the spine model was composed of vertebrae and ribs connected with mechanical joints similar to anatomical joints. Three different muscle groups around the thoracic spine were inserted, along with eight muscle groups around the lumbar spine in the original model from AnyBody. The model was tested using joint kinematics data obtained from two normal subjects during spine flexion and extension, axial rotation and lateral bending motions beginning from a standing posture. Intra-discal forces between spine segments were calculated in a musculoskeletal simulation. The force at the L4-L5 joint was chosen to validate the model's prediction against the lumbar model in the original AnyBody model, which was previously validated against clinical data.

  4. A musculoskeletal lumbar and thoracic model for calculation of joint kinetics in the spine

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Cheol; Ta, Duc manh; Koo, Seung Bum [Chung-Ang University, Seoul (Korea, Republic of); Jung Moon Ki [AnyBody Technology A/S, Aalborg (Denmark)

    2016-06-15

    The objective of this study was to develop a musculoskeletal spine model that allows relative movements in the thoracic spine for calculation of intra-discal forces in the lumbar and thoracic spine. The thoracic part of the spine model was composed of vertebrae and ribs connected with mechanical joints similar to anatomical joints. Three different muscle groups around the thoracic spine were inserted, along with eight muscle groups around the lumbar spine in the original model from AnyBody. The model was tested using joint kinematics data obtained from two normal subjects during spine flexion and extension, axial rotation and lateral bending motions beginning from a standing posture. Intra-discal forces between spine segments were calculated in a musculoskeletal simulation. The force at the L4-L5 joint was chosen to validate the model's prediction against the lumbar model in the original AnyBody model, which was previously validated against clinical data.

  5. A report of 3 soldiers returned to full duty after lumbar radiofrequency facet denervation in a theater of war.

    Science.gov (United States)

    Dragovich, Anthony; Trainer, Robert J

    2011-04-01

    To provide the advanced interventional procedure of zygapophysial joint neurotomy to soldiers meeting the diagnostic criteria in a combat environment and thus reduce medical evacuations of soldiers from a theater of war. Retrospective chart review was performed on three consecutive soldiers who received neuroablation of the lumbar ZP joint. Patients received single MBB with 1 cc of 1% lidocaine at the b/l L3-L5 levels considered diagnostic if >50% analgesia was achieved concordant with duration of anesthetic.   All procedures were co-performed by the two authors at the Ibn Sina hospital in Baghdad, Iraq over a 3-month period. Three consecutive patients with >50% pain relief from diagnostic medial branch blocks were treated with radiofrequency ablation of the bilateral L3-L4 medial branch nerves and L5 posterior primary ramus. Sensory test stimulation at 50 Hz and motor stimulation at 2 Hz were performed at each level. The nerves were then lesioned at 80° Centigrade for 90 seconds after injection of lidocaine and methylprednisolone. Procedure was considered successful if patients were able to wear body armour without significant discomfort (at least 1 hour/day). Medical evacuation from Iraq was prevented and all soldiers returned to rigorous combat duties including the wearing of body armour daily. We believe to be the first to report on the use of RF nerve ablation in a war time setting and with this functional outcome. Wiley Periodicals, Inc.

  6. Hip and pelvis diseases on lumbar AP radiographs including both hip joints

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Hyun Soo; Juhng, Seon Kwan; Kim, Eun A; Kim, Jeong Ho; Song, Ha Heon; Shim, Dae Moo [Wonkwang University School of Medicine, Iksan (Korea, Republic of)

    2002-12-01

    To determine the frequency of disease, and to evaluate the methods used for lumbar spine radiography in Korea. Sixty university and training hospitals were randomly selected and asked to describe the projections, film size and radiographic techniques employed for routine radiography in patients with suspected disease of the lumbar spine. Plain radiographs of 1215 patients, taken using 14x17 inch film and depicting both hip joints and the lumbar region, were analysed between March 1999 and February 2000. In 15 patients (1.2%), the radiographs revealed hip or pelvic lesion, confirmed as follows: avascular necrosis of the femoral head (n=11, with bilateral lesion in four cases); sustained ankylosing spondylitis (n=2); acetabular dysplasia (n=1); and insufficiency fracture of the pubic rami secondary to osteoporosis (n=1). In 11 or the 20 hospitals which responded, 14{sup x}17{sup f}ilm was being used for lumbar radiography, while in the other nine, film size was smaller. Plain radiography of the lumbar spine including both hip joints, may be a useful way to simultaneously evaluate lesions not only of the lumbar spine but also of the hip and/or pelvis.

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

    Science.gov (United States)

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

    2010-11-01

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

  8. Sacroiliac joint dysfunction in patients with herniated lumbar disc: a cross-sectional study.

    Science.gov (United States)

    Madani, Seyed Pezhman; Dadian, Mohammad; Firouznia, Keykavous; Alalawi, Salah

    2013-01-01

    To determine the relative frequency of sacroiliac joint dysfunction in a sample of patients with image proven lumbar disc herniation. A single group cross-sectional study was conducted in a three year period from 2007 in an outpatient clinic at a university hospital. Overall, 202 patients aged more than or equal to 18 years with image proven herniated lumbar disc and with physical findings suggestive of lumbosacral root irritation were included. Overall, 146 (72.3%) participants had sacroiliac joint dysfunction. The dysfunction was significantly more prevalent in females (pSacroiliac joint dysfunction is a significant pathogenic factor with high possibility of occurrence in low back pain. Thus, regardless of intervertebral disc pathology, sacroiliac joint dysfunction must be considered in clinical decision making.

  9. Lumbar spine joint synovial cysts of intraspinal development. CT scan imaging

    Energy Technology Data Exchange (ETDEWEB)

    Vallee, C.; Chevrot, A.; Benhamouda, M. and others

    CT scan imaging findings are described in 22 patients with lumbar spine joint synovial cysts, of intraspinal development, provoking sciatica or lumbosciatica from nerve compression in spinal canal. Diagnosis was suggested by a mass at the posterior joint level, of variable density, sometimes with peripheral calcification, presenting a vacuum appearance on occasions, and with enhanced image with contrast. Differential diagnosis is from excluded hernia and postoperative fibrosis. Posterior intra-articular arthrography can confirm diagnosis and allow treatment with prolonged action corticoid infiltrations.

  10. Prevalence of Concomitant Sacroiliac joint Dysfunction in Patients With Image Proven Herniated Lumbar Discs

    OpenAIRE

    Salah Alalawi; Ali akbar Jafarian; Seyed Pezhman Madani; Mohammad Dadian; Keykavous Firouznia

    2009-01-01

    Background:Sacroiliac joint (SIJ) dysfunction is a widely known but poorly defined cause of low back pain. To our knowledge, few published studies have been conducted to evaluate systematically the prevalence and significance of concomitant sacroiliac joint dysfunction in patients with herniated lumbar discs. As concomitant SIJ dysfunction in low back pain patients is likely to respond to particular noninvasive interventions such as manipulation,improved understanding of the relationship bet...

  11. Facet orientation and tropism: associations with spondylolysis.

    Science.gov (United States)

    Kalichman, Leonid; Guermazi, Ali; Li, Ling; Hunter, David J; Suri, Pradeep

    2010-04-01

    Cross-sectional study. To evaluate the association between lumbar spine facet joint orientation, facet joint tropism, and spondylolysis identified by multidetector computed tomography (CT) in the community-based Framingham Heart Study. The association between lumbar spondylolysis and facet orientation and tropism remains unclear. This study was an ancillary project to the Framingham Heart Study. Three thousand five hundred twenty-nine participants of the Framingham Heart Study aged 40 to 80 years underwent multidetector CT imaging to assess aortic calcification. One hundred ninety-one subjects were included in this ancillary study. Facet joint features and spondylolysis were evaluated on CT scans. The final analyzed sample included 104 men with mean age 51.90+/-11.25 years and 84 women with mean age 53.61+/-10.20 years. The association between spondylolysis and facet orientation and tropism was examined using univariate and multivariate analyses. Spondylolysis was prevalent in 11.5% of the total population. chi2 test demonstrated a significant sex difference in prevalence of spondylolysis (P=0.0154), with almost 3 times higher prevalence among men. There was no statistically significant difference in facet orientation and continuous facet tropism between individuals with and without spondylolysis at the L5 level (P=0.49 to 0.91). After adjustment for age, sex, and body mass index, no significant association between the occurrence of spondylolysis and facet orientation and tropism was found. In the studied sample the prevalence of facet joint osteoarthritis was significantly higher in individuals with spondylolysis than in those without spondylolysis at both sides of L4-L5 spinal level (P=0.044 at the right side and P=0.003 at the left side) and at left side of L5-S1 level (P=0.038). We did not find an association between facet orientation, facet tropism, and spondylolysis. One of the possible explanations for this is that the high prevalence of facet joint

  12. Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. A prospective study

    International Nuclear Information System (INIS)

    Fotiadou, Anastasia; Wojcik, Andrew; Shaju, Antony

    2012-01-01

    The aim of this work was to assess the performance of facet joint and nerve root infiltrations under computed tomography guidance for the management of low back pain and to investigate the complications and patient tolerance. The study was board-certified and informed consent was obtained from all patients. In 1 year, 86 consecutive patients (47 male, 39 female, age range 47-87 years, mean age 63) with low back pain for more than 2 years were included. All patients were clinically examined and had cross-sectional imaging performed before the procedure. Fifty-five facet joint infiltrations and 31 nerve blocks were performed under computed tomography guidance. All patients completed two valid pain questionnaires before and 3 months after the procedures. At the same time, they were clinically examined by the referring Orthopaedic Surgeon. The pain response was assessed by comparing the scores of the questionnaires. The improvement in clinical examination findings was assessed as well. In patients who underwent facet joint infiltrations, long-term pain improvement was achieved in 79% and in those with nerve blocks in 85%. Immediate pain relief was demonstrated in 83% of patients with nerve infiltrations. No complications were observed. All procedures were very well tolerated by patients. Facet joint and nerve infiltrations under computed tomography guidance constitute an accurate and safe method that could be used to relieve low back pain and minimize the risk of disability. (orig.)

  13. Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints.

    Science.gov (United States)

    Maas, E T; Juch, J N S; Ostelo, R W J G; Groeneweg, J G; Kallewaard, J W; Koes, B W; Verhagen, A P; Huygen, F J P M; van Tulder, M W

    2017-03-01

    Patient history and physical examination are frequently used procedures to diagnose chronic low back pain (CLBP) originating from the facet joints, although the diagnostic accuracy is controversial. The aim of this systematic review is to determine the diagnostic accuracy of patient history and/or physical examination to identify CLBP originating from the facet joints using diagnostic blocks as reference standard. We searched MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Collaboration database from inception until June 2016. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias. We calculated sensitivity and specificity values, with 95% confidence intervals (95% CI). Twelve studies were included, in which 129 combinations of index tests and reference standards were presented. Most of these index tests have only been evaluated in single studies with a high risk of bias. Four studies evaluated the diagnostic accuracy of the Revel's criteria combination. Because of the clinical heterogeneity, results were not pooled. The published sensitivities ranged from 0.11 (95% CI 0.02-0.29) to 1.00 (95% CI 0.75-1.00), and the specificities ranged from 0.66 (95% CI 0.46-0.82) to 0.91 (95% CI 0.83-0.96). Due to clinical heterogeneity, the evidence for the diagnostic accuracy of patient history and/or physical examination to identify facet joint pain is inconclusive. Patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be studied, and high quality studies are required to confirm the results of single studies. Patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be studied, and high quality studies are required to confirm the results of single studies. © 2016 European Pain Federation - EFIC®.

  14. MR-guided facet joint injection therapy using an open 1.0-T MRI system: an outcome study

    International Nuclear Information System (INIS)

    Freyhardt, Patrick; Bucourt, Maximilian de; Maurer, Martin; Renz, Diane; Gebauer, Bernhard; Hamm, Bernd; Streitparth, Florian; Hartwig, Tony; Teichgraeber, Ulf K.M.

    2013-01-01

    To evaluate the accuracy, safety and efficacy of magnetic resonance imaging (MRI)-guided facet joint injection therapy using a 1.0-T open MRI. One hundred and sixty-six facet joint blocks in 45 patients with lower back pain were performed under MR fluoroscopic guidance using a proton-density-weighted turbo-spin-echo sequence. An in-room monitor, wireless MR-mouse for operator-controlled multiplanar navigation, a flexible surface coil and MR-compatible 20-G needle were used. Clinical outcome was evaluated by questionnaire before intervention and after 1 week, 3, 6 and 12 months using a numerical visual analogue scale (VAS). All facet joint blocks were considered technically successful with distribution of the injectant within and/or around the targeted facet joint. No major complications occurred. The final outcome analysis included 38 patients. An immediate effect was reported by 63 % of the patients. A positive mid-/long-term effect was seen in 13 patients (34 %) after 6 months and in 9 patients (24 %) after 12 months. Mean VAS was reduced from 7.1 ± 1.7 (baseline) to 3.5 ± 2.2, 4.1 ± 3.0, 3.8 ± 2.9 and 4.6 ± 2.9 at 1 week, 3, 6 and 12 months (P < 0.01). MR-guided facet joint injection therapy of the lumbosacral spine is accurate, safe and efficient in the symptomatic treatment of lower back pain. (orig.)

  15. Intra-articular nerve growth factor regulates development, but not maintenance, of injury-induced facet joint pain & spinal neuronal hypersensitivity.

    Science.gov (United States)

    Kras, J V; Kartha, S; Winkelstein, B A

    2015-11-01

    The objective of the current study is to define whether intra-articular nerve growth factor (NGF), an inflammatory mediator that contributes to osteoarthritic pain, is necessary and sufficient for the development or maintenance of injury-induced facet joint pain and its concomitant spinal neuronal hyperexcitability. Male Holtzman rats underwent painful cervical facet joint distraction (FJD) or sham procedures. Mechanical hyperalgesia was assessed in the forepaws, and NGF expression was quantified in the C6/C7 facet joint. An anti-NGF antibody was administered intra-articularly in additional rats immediately or 1 day following facet distraction or sham procedures to block intra-articular NGF and test its contribution to initiation and/or maintenance of facet joint pain and spinal neuronal hyperexcitability. NGF was injected into the bilateral C6/C7 facet joints in separate rats to determine if NGF alone is sufficient to induce these behavioral and neuronal responses. NGF expression increases in the cervical facet joint in association with behavioral sensitivity after that joint's mechanical injury. Intra-articular application of anti-NGF immediately after a joint distraction prevents the development of both injury-induced pain and hyperexcitability of spinal neurons. Yet, intra-articular anti-NGF applied after pain has developed does not attenuate either behavioral or neuronal hyperexcitability. Intra-articular NGF administered to the facet in naïve rats also induces behavioral hypersensitivity and spinal neuronal hyperexcitability. Findings demonstrate that NGF in the facet joint contributes to the development of injury-induced joint pain. Localized blocking of NGF signaling in the joint may provide potential treatment for joint pain. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  16. Prevalence of Concomitant Sacroiliac joint Dysfunction in Patients With Image Proven Herniated Lumbar Discs

    Directory of Open Access Journals (Sweden)

    Salah Alalawi

    2009-05-01

    Full Text Available Background:Sacroiliac joint (SIJ dysfunction is a widely known but poorly defined cause of low back pain. To our knowledge, few published studies have been conducted to evaluate systematically the prevalence and significance of concomitant sacroiliac joint dysfunction in patients with herniated lumbar discs. As concomitant SIJ dysfunction in low back pain patients is likely to respond to particular noninvasive interventions such as manipulation,improved understanding of the relationship between these two diagnoses would improve clinical decision making and research.Methods:This study was designated to estimate the prevalence of concomitant sacroiliac joint dysfunction in sub acute low back pain patients with image proven discopathy and evaluate the theory that sacroiliac joint dysfunction can be a source of pain and functional disability in discopathy. A total of 202 patients with sub acute radicular back pain and MRI proven herniated lumbar discs underwent standardized   physiatrist history and physical examination, specified for detection of concomitant sacroiliac joint dysfunction.Results: Sacroiliac joint dysfunction is a concomitant finding in 72.3% of evaluated patients.There was significantly higher SIJ dysfunction prevalence in female patients (p <0.0001. Conclusion: SIJ dysfunction is a significant pathogenic factor with high possibility of occurrence in low back pain. Thus, in the presence of radicular and sacroiliac joint symptoms, SIJ dysfunction, regardless of intervertebral disc pathology, must be considered in clinical decisiomaking.

  17. Effect of Posterior Iliosacral Joint Manipulation on Subjects With Hyperlordosis of Lumbar Spine

    International Nuclear Information System (INIS)

    Mahmoud, Y.M.; Kattabel, O.M.A.; Amin, D.I.

    2016-01-01

    Back ground: Lumbar spine hyperlordosis combined with excessive anterior pelvic tilting is considered as a wide spread postural disorder related to abnormalities in musculoskeletal balance. Although there were a lot of studies reporting that anterior pelvic tilting is correlated to sacroiliac joint, hip dysfunction and knee pain, fewer studies had related showed its effect on low back pain. The purpose: this study was conducted to investigate the effect of posterior iliosacral joint manipulation on subjects with hyperlordosis of lumbar spine. Subject and methods: Thirty subject of both gender with age ranged from 20 to 40 years , body mass index (BMI) ranging between 18.5-24.9 and assigned in one group, hyperlordosis of lumbar spine was measured by photographic analysis (surgimap software), while anterior pelvic tilting was measured by inclinometer and pain intensity was measured by numerical rating scale and posterior iliosacral joint manipulation (Chicago manipulation) was the treatment procedure Results: there was significant difference in the mean values of anterior pelvic tilting in the pre and immediate post treatment tests, 8.86±0.77 degrees and 4.86±0.68 degrees respectively with F=535.385,and p < 0.0001) Also there was a significant difference in the mean values of pain level in the pre and immediate post treatment tests, 5.8±1.44 degrees and 5.03±1.32 degrees respectively with F=29.445 and P < 0.0001). Conclusion: posterior iliosacral joint manipulation has a value effect in increasing the sacroiliac joint range of motion and decreasing sacroiliac pain and low back pain in subjects with hyperlordosis of lumbar spine.

  18. Effects of Facet Joint Injection Reducing the Need for Percutaneous Vertebroplasty in Vertebral Compression Fractures

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    Im, Tae Seong; Lee, Joon Woo; Lee, Eugene; Kang, Yusuhn; Ahn, Joong Mo, E-mail: joongmoahn@gmail.com; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology (Korea, Republic of)

    2016-05-15

    ObjectiveTo evaluate the effects of facet joint injection (FJI) reducing the need for percutaneous vertebroplasty (PVP) in cases of vertebral compression fracture (VCF).Materials and MethodsA total of 169 patients who were referred to the radiology department of our institution for PVP between January 2011 and December 2014 were retrospectively evaluated. The effectiveness of FJI was evaluated by the proportion of patients who cancelled PVP and who experienced reduced pain. In addition, by means of medical chart and MRI review, those clinical factors (age, sex, history of trauma, amount of injected steroids and interval days elapsed between VCF and FJI) and MR image factors (kyphosis angle, height loss, single or multiple level of VCF, burst fracture, central canal compromise, posterior element injury) that were believed to be significant for the effectiveness of FJI were statistically analysed.ResultsIn the 26 patients with FJI prior to PVP, six (23 %) patients cancelled PVP with considerable improvement in reported pain. In the 20 patients with PVP after FJI, improvement in pain after FJI was reported by six patients, resulting in a total of 12 patients (46 %) who experienced reduced pain after FJI. Clinical factors and MR image factors did not show any statistically significant difference between those groups, divided by PVP cancellation and by improvement of pain.ConclusionAfter FJI prior to PVP, about one quarter of patients cancelled PVP due to reduced pain and overall about half of the patients experienced reduced pain.

  19. Biomechanical evaluation of the impact of various facet joint lesions on the primary stability of anterior plate fixation in cervical dislocation injuries: a cadaver study: Laboratory investigation.

    Science.gov (United States)

    Oberkircher, Ludwig; Born, Sebastian; Struewer, Johannes; Bliemel, Christopher; Buecking, Benjamin; Wack, Christina; Bergmann, Martin; Ruchholtz, Steffen; Krüger, Antonio

    2014-10-01

    Injuries of the subaxial cervical spine including facet joints and posterior ligaments are common. Potential surgical treatments consist of anterior, posterior, or anterior-posterior fixation. Because each approach has its advantages and disadvantages, the best treatment is debated. This biomechanical cadaver study compared the effect of different facet joint injuries on primary stability following anterior plate fixation. Fractures and plate fixation were performed on 15 fresh-frozen intact cervical spines (C3-T1). To simulate a translation-rotation injury in all groups, complete ligament rupture and facet dislocation were simulated by dissecting the entire posterior and anterior ligament complex between C-4 and C-5. In the first group, the facet joints were left intact. In the second group, one facet joint between C-4 and C-5 was removed and the other side was left intact. In the third group, both facet joints between C-4 and C-5 were removed. The authors next performed single-level anterior discectomy and interbody grafting using bone material from the respective thoracic vertebral bodies. An anterior cervical locking plate was used for fixation. Continuous loading was performed using a servohydraulic test bench at 2 N/sec. The mean load failure was measured when the implant failed. In the group in which both facet joints were intact, the mean load failure was 174.6 ± 46.93 N. The mean load failure in the second group where only one facet joint was removed was 127.8 ± 22.83 N. In the group in which both facet joints were removed, the mean load failure was 73.42 ± 32.51 N. There was a significant difference between the first group (both facet joints intact) and the third group (both facet joints removed) (p cadaver study, primary stability of anterior plate fixation for dislocation injuries of the subaxial cervical spine was dependent on the presence of the facet joints. If the bone in one or both facet joints is damaged in the clinical setting, anterior plate

  20. Superior facet syndrome

    International Nuclear Information System (INIS)

    Kubo, Yoshichika; Igarashi, Seishi; Koyama, Tsunemaro

    1985-01-01

    Sciatica caused by root entrapment in the lateral recess was named superior facet syndrome by Epstein in 1972. Few reports on this subject based on large numbers of cases have been documented to date. Of the patients with sciatica, 32 patients were diagnosed to have root entrapment at the lateral recess L 5 or/and S 1 lumbar spine. Out of 32 patients, 20 patients were operated on and the lateral entrapment was recognized in all of surgical cases. Neuroradiological findings, especially of metrizamide CT (met. CT), were documented in detail. Thirty two patients were classified in three types according to radiological findings. They were congenital or developmental, degenerative, and combined type, respectively, Fourteen cases belonged to the congenital type, 13 to the degenerative and 5 to the combined type. Each group had the mean ages of 23.4, 53.8, and 36.8 years old, respectively. Of 32 cases the entrapment occured in 47 L 5 roots and 11 S 1 roots. There was no remarkable laterality. In operation the unroofing of the lateral recess were done and the sciatica subsided postoperatively in all of surgical cases. Met. CT revealed extreme medial protrusion of the superior articular joint in 18 of 24 cases(75%) and none filling of the root in the lateral recess in 21 of 24 cases (87.5%). In the degenerative type, met. CT showed some degenerative changes that were hypertrophy or deformity of the articular joints and spur formation of the vertebral body. In contrast to met. CT, metrizamide myelography revealed only slight changes, which were poor filling of the root before it turned out the pedicle of lateral compression of the root. In plain films or lumbar spine articular joints at Lsub(4/5) were formed in coronal plane in 69% of cases of the L 5 root entrapment. Met. CT using ReView technique was of great diagnostic value in superior facet syndrome. (author)

  1. Radicular compression syndrome in the lumbar region resulting from synovial cyst of the small zygapophysical joints. A case report; Lumbales Wurzelkompressionssyndrom bei Synovialzyste des kleinen Wirbelgelenkes

    Energy Technology Data Exchange (ETDEWEB)

    Stimmer, H. [Inst. fuer Roentgendiagnostik, Klinikum rechts der Isar, Technische Univ. Muenchen (Germany); Allgayer, B. [Inst. fuer Roentgendiagnostik, Klinikum rechts der Isar, Technische Univ. Muenchen (Germany)

    1994-12-01

    The formation of a synovial cyst in the small zygapophysial joints is a possibility to be considered in all patients presenting with vague lumbar pains or radicular syndrome, particularly in individuals of advanced age with a prolonged history of disorders classifiable with the so-called ``facet syndrome`` or degenerative changes to the vertebral column. Both computerized tomography and nmr imaging permit a reliable diagnostic differentiation on the basis of the criteria defined above. (orig./MG) [Deutsch] Die Synovialzyste des kleinen Wirbelgelenkes ist als Differentialdiagnose sowohl unspezifischer lumbaler Beschwerden als auch radikulaerer Syndrome zu beruecksichtigen, dies insbesondere bei aelteren Patienten mit laenger bestehenden Beschwerden im Sinne eines sogen. Facettensyndromes und degenerativen Wirbelsaeulenveraenderungen. Computertomographie und Kernspintomographie erlauben unter Beruecksichtigung der beschriebenen Kriterien eine sichere diagnostische Zuordnung. (orig./MG)

  2. Fluoroscopy-guided intrA-articular facet joint steroid injection for the management of low back pain: Therapeutic effectiveness and arthrographic pattern

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Jin; Lee, Jun Woo; Lee, Guen Young; You, Ja Yeon; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Chai, Jae Won [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); Ahn, Joong Mo [Dept. of Radiology, University of Pittsburgh Medical Center, Pittsburgh (United States)

    2015-09-15

    To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases.

  3. Fluoroscopy-guided intrA-articular facet joint steroid injection for the management of low back pain: Therapeutic effectiveness and arthrographic pattern

    International Nuclear Information System (INIS)

    Kim, Su Jin; Lee, Jun Woo; Lee, Guen Young; You, Ja Yeon; Kang, Heung Sik; Chai, Jae Won; Ahn, Joong Mo

    2015-01-01

    To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases

  4. Osteoporosis of lumbar spine, hip joints and calcaneous: a clinical-radiological study

    International Nuclear Information System (INIS)

    Knoplich, J.; Braun, W.; Roque, J.A.O.; Strapetti, F.; Iachida, O.; Staub, H.

    1987-01-01

    In order to accurately ascertain the presence of osteoporosis, the AA examined 92 women over 65 by means of radiographies of lumbar spine, hip joints and calcaneus. They concluded that even with examinations by four investigators the certainty ratio is 29.8% of the X-ray examinations reviewed, which is still very low. The ratio psoas-3rd lumbar vertebra width is an indicator which is difficult to apply in women over 65 owing to the prevalence of lumbar scoliosis in this age group. Pain is a complaint commonly found in this age group. 82 patients (89.2%) complained of some kind of pain (abdominal, articular bones and spine) but the complaint of pain in general was more frequent in the osteoporotic group. The women in the osteoporotic group were leaner than non-osteoporotic ones, as measured by the ratio height (which may be shortened) to weight (p < 0.05), and also older (p < 0.05) patients. The gamma globulin was elevated in 55.5% of the patients in this sample and the relative tests aided in detecting three cases of more serious pathologies. (author)

  5. Single photon emission computed tomography in lumbar degenerative spondylolisthesis

    International Nuclear Information System (INIS)

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

    1998-01-01

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

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

    Science.gov (United States)

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

    2014-07-01

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

  7. Rotatory Subluxation and Facet Deformity in the Atlanto-occipital Joint in Patients with Chronic Atlantoaxial Rotatory Fixation: Two Case Reports.

    Science.gov (United States)

    Kashii, Masafumi; Masuhara, Kenta; Kaito, Takashi; Iwasaki, Motoki

    2017-01-01

    The relationship between the morphometry of atlantoaxial joint and chronic atlantoaxial rotatory fixation (AARF) is well known, but disorders in the atlanto-occipital joint in chronic AARF are not fully elucidated. The authors report two rare cases of secondary deformities in the atlanto-occipital joint in chronic AARF. Two patients with chronic AARF were treated with closed manipulation, skull traction and halo-vest immobilization. Clinical outcomes and radiographs were reviewed retrospectively, focusing on pathological changes in the atlanto-occipital joint using multiplanar reconstruction computed tomography and three-dimensional computed tomography images. Case 1 (12-year-old girl) had rotatory subluxation with a superior facet deformity of the atlas in the atlanto-occipital joint before the initiation of treatment. After a series of conservative treatments, both atlantoaxial and atlanto-occipital rotatory fixation could not be reduced, and both the superior facet deformity of the atlas and osteoarthritic changes in the atlanto-occipital developed. She was monitored without surgery because the disorder progressed to the spontaneous fusion of the occipital bone to the axis. Case 2 (13-year-old boy) had rotatory subluxation without facet deformity of the atlas in the atlanto-occipital joint before the initiation of treatment. However, both the superior facet deformity of the atlas and osteoarthritic changes in the atlanto-occipital developed over time, and both atlantoaxial and atlanto-occipital rotatory fixation could not be reduced after a series of conservative treatments. He still had severe neck pain and severely restricted neck mobility and underwent spinal fusion. Atlanto-occipital rotatory subluxation and facet deformity in the atlanto-occipital joint may occur after prolonged AARF. It is necessary to pay attention to pathological changes not only in the atlantoaxial joint but also in the atlanto-occipital joint, when orthopedic surgeons treat patients

  8. The immediate effect of lumbar spine patterns of neuromuscular joint facilitation in young amateur baseball players.

    Science.gov (United States)

    Huo, Ming; Maruyama, Hitoshi; Kaneko, Takasumi; Naito, Daiki; Koiso, Yuta

    2013-12-01

    [Purpose] The aim of the study was to investigate the changes in baseball pitching velocity, the functional reach test (FR) and the simple reaction times (SRT) in young amateur baseball players after lumbar spine patterns of neuromuscular joint facilitation (NJF) treatment. [Subjects] The subjects were 11 young amateur baseball players. An NJF intervention and a proprioceptive neuromuscular facilitation (PNF) intervention were performed. The interventions were performed one after the other with one week between them. The order of the interventions was completely randomized. [Methods] The baseball pitching velocity, the FR and the SRT were evaluated before and after treatment. [Results] In the NJF group, there were significant differences in baseball pitching velocity, FR and SRT after treatment. In the PNF group, there was a significant difference in SRT after treatment. [Conclusion] NJF intervention shortens the SRT, increases the baseball pitching velocity and FR, and may be recommended to improve performance in baseball players.

  9. The impact of office chair features on lumbar lordosis, intervertebral joint and sacral tilt angles: a radiographic assessment.

    Science.gov (United States)

    De Carvalho, Diana; Grondin, Diane; Callaghan, Jack

    2017-10-01

    The purpose of this study was to determine which office chair feature is better at improving spine posture in sitting. Participants (n = 28) were radiographed in standing, maximum flexion and seated in four chair conditions: control, lumbar support, seat pan tilt and backrest with scapular relief. Measures of lumbar lordosis, intervertebral joint angles and sacral tilt were compared between conditions and sex. Sitting consisted of approximately 70% of maximum range of spine flexion. No differences in lumbar flexion were found between the chair features or control. Significantly more anterior pelvic rotation was found with the lumbar support (p = 0.0028) and seat pan tilt (p < 0.0001). Males had significantly more anterior pelvic rotation and extended intervertebral joint angles through L1-L3 in all conditions (p < 0.0001). No one feature was statistically superior with respect to minimising spine flexion, however, seat pan tilt resulted in significantly improved pelvic posture. Practitioner Summary: Seat pan tilt, and to some extent lumbar supports, appear to improve seated postures. However, sitting, regardless of chair features used, still involves near end range flexion of the spine. This will increase stresses to the spine and could be a potential injury generator during prolonged seated exposures.

  10. A critical evaluation of subtalar joint arthrosis associated with middle facet talocalcaneal coalition in 21 surgically managed patients: a retrospective computed tomography review. Investigations involving middle facet coalitions-part III.

    Science.gov (United States)

    Kernbach, Klaus J; Barkan, Howard; Blitz, Neal M

    2010-01-01

    Symptomatic middle facet talocalcaneal coalition is frequently associated with rearfoot arthrosis that is often managed surgically with rearfoot fusion. However, no objective method for classifying the extent of subtalar joint arthrosis exists. No study has clearly identified the extent of posterior facet arthrosis present in a large cohort treated surgically for talocalcaneal coalition through preoperative computerized axial tomography. The authors conducted a retrospective review of 21 patients (35 feet) with coalition who were surgically treated over a 12-year period for coalition on at least 1 foot. Using a predefined original staging system, the extent of the arthrosis was categorized into normal or mild (Stage I), moderate (Stage II), and severe (Stage III) arthrosis. The association of stage and age is statistically significant. All of the feet with Stage III arthrosis had fibrous coalitions. No foot with osseous coalition had Stage III arthrosis. The distribution of arthrosis staging differs between fibrous and osseous coalitions. Only fibrous coalitions had the most advanced arthrosis (Stage III), whereas osseous coalitions did not. This suggests that osseous coalitions may have a protective effect in the prevention of severe degeneration of the subtalar joint. Concomitant subtalar joint arthrosis severity progresses with age; surgeons may want to consider earlier surgical intervention to prevent arthrosis progression in patients with symptomatic middle facet talocalcaneal coalition.

  11. 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

  12. Synovial cysts of the lumbar spine; diagnosed with magnetic resonance

    International Nuclear Information System (INIS)

    Bermudez Munoz, Sonia; Charry Lopez, Marco Luciano

    1998-01-01

    A series of nine cases of synovial cysts of the lumbar spine, diagnosed with magnetic resonance is presented. The cysts were found in patients aged 24 to 73 yrs, most of which had symptoms related with this finding. Some were seen as incidental findings or unrelated to symptoms. The most typical characteristic of these lesions is that of a rounded, ovoid or bilobed image, with close anatomical relation with the facet joints or the ligamentum flavum, that presented with facet joint arthrosis and degenerative spondylolisthesis was significant and useful for diagnosis

  13. Cervical Facet Joint Infection and Associated Epidural Abscess with Streptococcus intermedius from a Dental Infection Origin A Case Report and Review.

    Science.gov (United States)

    Kaye, Ian David; Protopsaltis, Themistocles S

    2016-09-01

    Pyogenic cervical facet joint infections are rare and such infections from a dental origin are even less common. Of these few cases, none have described infection with Streptococcus intermedius as the pathogen. A 65-year-old orthopaedic surgeon complained of fevers, right-sided radiating neck pain, stiffness, swelling, erythema, and right upper extremity weakness one month after he had broken a crown over his right mandibular premolar, a continued source of pain. Imaging of the cervical spine showed a right C4-C5 facet inflammatory arthropathy and a small epidural abscess that was cultured and initially treated with intravenous antibiotics. The oral maxillofacial surgery team performed an extraction of the infected, symptomatic tooth. For continued right upper extremity weakness, the patient underwent C4-C5 laminoforaminotomy and irrigation and debridement of the right C4-C5 facet joint. After 6 weeks of intravenous antibiotics, the patient's infectious and inflammatory markers had normalized. By 4 months, he had regained full strength at his upper extremity and a painless and full range of motion of his cervical spine.Pyogenic cervical facet joint infection is very rare and potentially dangerous. A high clinical suspicion and appropriate imaging, including magnetic resonance imaging, are important for correct diagnosis. Prompt medical and surgical treatment may avert complications, and although the patient presented made a complete recovery, patients may be left with neurological compromise.

  14. Radiofrequency neurotomy of the medial branch for the management of lumbar zygapophysial joint pain

    International Nuclear Information System (INIS)

    Lee, Sang Hoon; Kim, Hyoung Ihl; Han, Young Min

    2006-01-01

    We wanted to investigate the efficacy of percutaneous radiofrequency (RF) neurotomy of the medial branch for the management of chronic low back pain due to lumbar zygapophysial joint dysfunction. Thirteen patients who had unremitting chronic low back pain for more than 6 months and whose VAS scores were over 7 were selected on the basis of double comparative nerve blocks. The patients consist of three males and 10 females, and their nean age was 67 years. Sensory stimulation was performed to detect the 'pathologic branches' that were responsible for pain generation. RF neurotomy was performed using a lesion generator at 80 C for 90 seconds. The postoperative outcome was classified, depending on the degree of pain reduction, as excellent (≥ 75%), good (50-75%), and poor (<50%). Follow-up evaluation was performed at 6 weeks, 3 months and 6 months after surgery. The mean number of medial branches was 6.2. Eleven patients had bilateral disease and two had unilateral disease. Sensory stimulation was positive in all patients with a mean amplitude of 4.5V (range: 0.15-6 V). The L5 dorsal ramus was the most frequently involved segment, and this was followed by L4, L3 and L2. The number of lesionings for each medial branch was 3.7. The surgical outcome was graded as excellent (53%), good (23%), and poor (24%) after 6 months of follow-up. Transient backaches were noticed in two patients; however, complications were not observed. Recurrences were not demonstrated during the follow-up period. We conclude that RF neurotomy of the medial branches is an efficient method to substantially alleviate the chronic low back pain caused by zygapophysial joint dysfunction

  15. Radiofrequency neurotomy of the medial branch for the management of lumbar zygapophysial joint pain

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hoon [Bong-Sang Clinic, Seoul (Korea, Republic of); Kim, Hyoung Ihl [Presbyterian Medical Center, Seoul (Korea, Republic of); Han, Young Min [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2006-08-15

    We wanted to investigate the efficacy of percutaneous radiofrequency (RF) neurotomy of the medial branch for the management of chronic low back pain due to lumbar zygapophysial joint dysfunction. Thirteen patients who had unremitting chronic low back pain for more than 6 months and whose VAS scores were over 7 were selected on the basis of double comparative nerve blocks. The patients consist of three males and 10 females, and their nean age was 67 years. Sensory stimulation was performed to detect the 'pathologic branches' that were responsible for pain generation. RF neurotomy was performed using a lesion generator at 80 C for 90 seconds. The postoperative outcome was classified, depending on the degree of pain reduction, as excellent ({>=} 75%), good (50-75%), and poor (<50%). Follow-up evaluation was performed at 6 weeks, 3 months and 6 months after surgery. The mean number of medial branches was 6.2. Eleven patients had bilateral disease and two had unilateral disease. Sensory stimulation was positive in all patients with a mean amplitude of 4.5V (range: 0.15-6 V). The L5 dorsal ramus was the most frequently involved segment, and this was followed by L4, L3 and L2. The number of lesionings for each medial branch was 3.7. The surgical outcome was graded as excellent (53%), good (23%), and poor (24%) after 6 months of follow-up. Transient backaches were noticed in two patients; however, complications were not observed. Recurrences were not demonstrated during the follow-up period. We conclude that RF neurotomy of the medial branches is an efficient method to substantially alleviate the chronic low back pain caused by zygapophysial joint dysfunction.

  16. Differences Regarding Branded HA in Italy, Part 2: Data from Clinical Studies on Knee, Hip, Shoulder, Ankle, Temporomandibular Joint, Vertebral Facets, and Carpometacarpal Joint

    Science.gov (United States)

    Migliore, A.; Bizzi, E.; De Lucia, O.; Delle Sedie, A.; Tropea, S.; Bentivegna, M.; Mahmoud, A.; Foti, C.

    2016-01-01

    OBJECTIVES The aim of the current study is to collect scientific data on all branded hyaluronic acid (HA) products in Italy that are in use for intra-articular (IA) injection in osteoarthritis (OA) compared with that reported in the leaflet. METHODS An extensive literature research was performed for all articles reporting data on the IA use of HA in OA. Selected studies were taken into consideration only if they are related to products based on HAs that are currently marketed in Italy with the specific joint indication for IA use in patients affected by OA. RESULTS Sixty-two HA products are marketed in Italy: 30 products are indicated for the knee but only 8 were proved with some efficacy; 9 products were effective for the hip but only 6 had hip indication; 7 products proved to be effective for the shoulder but only 3 had the indication; 5 products proved effective for the ankle but only one had the indication; 6 products were effective for the temporomandibular joint but only 2 had the indication; only 2 proved effective for vertebral facet joints but only 1 had the indication; and 5 products proved effective for the carpometacarpal joint but only 2 had the indication. CONCLUSIONS There are only a few products with some evidences, while the majority of products remain without proof. Clinicians and regulators should request postmarketing studies from pharmaceuticals to corroborate with that reported in the leaflet and to gather more data, allowing the clinicians to choose the adequate product for the patient. PMID:27279754

  17. [The third lumbar transverse process syndrome treated with acupuncture at zygapophyseal joint and transverse process:a randomized controlled trial].

    Science.gov (United States)

    Li, Fangling; Bi, Dingyan

    2017-08-12

    To explore the effects differences for the third lumbar transverse process syndrome between acupuncture mainly at zygapophyseal joint and transverse process and conventional acupuncture. Eighty cases were randomly assigned into an observation group and a control group, 40 cases in each one. In the observation group, patients were treated with acupuncture at zygapophyseal joint, transverse process, the superior gluteus nerve into the hip point and Weizhong (BL 40), and those in the control group were treated with acupuncture at Qihaishu (BL 24), Jiaji (EX-B 2) of L 2 -L 4 , the superior gluteus nerve into the hip point and Weizhong (BL 40). The treatment was given 6 times a week for 2 weeks, once a day. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) low back pain score and simplified Chinese Oswestry disability index (SC-ODI) were observed before and after treatment as well as 6 months after treatment, and the clinical effects were evaluated. The total effective rate in the observation group was 95.0% (38/40), which was significantly higher than 82.5% (33/40) in the control group ( P process for the third lumbar transverse process syndrome achieves good effect, which is better than that of conventional acupuncture on relieving pain, improving lumbar function and life quality.

  18. Lumbar Radiofrequency Rhizotomy in Patients with Chronic Low Back Pain Increases the Diagnosis of Sacroiliac Joint Dysfunction in Subsequent Follow-Up Visits

    Science.gov (United States)

    2017-01-01

    Chronic back pain is often a result of coexisting pathologies; secondary causes of pain can become more apparent sources of pain once the primary pathology has been addressed. The objective of our study was to determine if there is an increase in diagnosis of Sacroiliac joint pain following a Lumbar Rhizotomy. A list of patients who underwent Lumbar Radiofrequency during a 6-month period in our clinic was generated. Records from subsequent clinic visits were reviewed to determine if a new diagnosis of SI joint pathology was made. In patients who underwent a recent Lumbar Rhizotomy procedure to treat facetogenic pain, the prevalence of Sacroiliac joint pain increased to 70%. We infer that there is a significant increase in the diagnosis of Sacroiliac joint syndrome following a Lumbar Rhizotomy, potentially due to unmasking of a preexisting condition. In patients presenting with persistent back pain after Lumbar Rhizotomy, the clinician must have a high degree of suspicion for latent Sacroiliac joint pain prior to attributing the pain to block failure. It would be prudent to use >80% relief of pain after a diagnostic medial branch block as a diagnostic criterion for facetogenic pain rather than the currently accepted >50% in order to minimize unmasking of preexisting subclinical pain from the SI joint. PMID:28255260

  19. Lumbar Radiofrequency Rhizotomy in Patients with Chronic Low Back Pain Increases the Diagnosis of Sacroiliac Joint Dysfunction in Subsequent Follow-Up Visits

    Directory of Open Access Journals (Sweden)

    Varun Kumar Rimmalapudi

    2017-01-01

    Full Text Available Chronic back pain is often a result of coexisting pathologies; secondary causes of pain can become more apparent sources of pain once the primary pathology has been addressed. The objective of our study was to determine if there is an increase in diagnosis of Sacroiliac joint pain following a Lumbar Rhizotomy. A list of patients who underwent Lumbar Radiofrequency during a 6-month period in our clinic was generated. Records from subsequent clinic visits were reviewed to determine if a new diagnosis of SI joint pathology was made. In patients who underwent a recent Lumbar Rhizotomy procedure to treat facetogenic pain, the prevalence of Sacroiliac joint pain increased to 70%. We infer that there is a significant increase in the diagnosis of Sacroiliac joint syndrome following a Lumbar Rhizotomy, potentially due to unmasking of a preexisting condition. In patients presenting with persistent back pain after Lumbar Rhizotomy, the clinician must have a high degree of suspicion for latent Sacroiliac joint pain prior to attributing the pain to block failure. It would be prudent to use >80% relief of pain after a diagnostic medial branch block as a diagnostic criterion for facetogenic pain rather than the currently accepted >50% in order to minimize unmasking of preexisting subclinical pain from the SI joint.

  20. Lumbar Radiofrequency Rhizotomy in Patients with Chronic Low Back Pain Increases the Diagnosis of Sacroiliac Joint Dysfunction in Subsequent Follow-Up Visits.

    Science.gov (United States)

    Rimmalapudi, Varun Kumar; Kumar, Sanjeev

    2017-01-01

    Chronic back pain is often a result of coexisting pathologies; secondary causes of pain can become more apparent sources of pain once the primary pathology has been addressed. The objective of our study was to determine if there is an increase in diagnosis of Sacroiliac joint pain following a Lumbar Rhizotomy. A list of patients who underwent Lumbar Radiofrequency during a 6-month period in our clinic was generated. Records from subsequent clinic visits were reviewed to determine if a new diagnosis of SI joint pathology was made. In patients who underwent a recent Lumbar Rhizotomy procedure to treat facetogenic pain, the prevalence of Sacroiliac joint pain increased to 70%. We infer that there is a significant increase in the diagnosis of Sacroiliac joint syndrome following a Lumbar Rhizotomy, potentially due to unmasking of a preexisting condition. In patients presenting with persistent back pain after Lumbar Rhizotomy, the clinician must have a high degree of suspicion for latent Sacroiliac joint pain prior to attributing the pain to block failure. It would be prudent to use >80% relief of pain after a diagnostic medial branch block as a diagnostic criterion for facetogenic pain rather than the currently accepted >50% in order to minimize unmasking of preexisting subclinical pain from the SI joint.

  1. MRI-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis low back pain - case series of an innovative new technique

    Energy Technology Data Exchange (ETDEWEB)

    Weeks, Evan M.; Platt, Michael W. [St Mary' s Hospital, Imperial College Healthcare NHS Trust, Department of Anaesthesia and Pain Medicine, London (United Kingdom); Gedroyc, Wladyslaw [St Mary' s Hospital, Imperial College Healthcare NHS Trust, Department of Radiology, London (United Kingdom)

    2012-12-15

    To evaluate the safety and efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis pain. Patients with a positive response to facet joint interventions were recruited from Pain and Spinal Clinics. Treatments were performed at the levels of pain according to symptomatology, previous invasive treatment and MRI grading of facet joint osteoarthritis. Both safety and efficacy data were collected. Pain palliation was evaluated using a validated pain numerical rating scale (NRS), Oswestry disability questionnaire (ODQ), Brief Pain Inventory (BPI) and the EuroQol (EQ-5D) health state score Eighteen patients were treated. There were no major adverse events. At 6/12 we found a reduction in both the NRS (average/worst) pain scores (60.2 %/51.2 %). This was associated with 45.9 % improvement in the ODQ score and 61.9 % reduction in the BPI interference score. We observed an improvement in the EuroQol (EQ-5D) health state score based on UK coefficients of +0.379 (0.317 to 0.696). Our phase I observational pilot study has evaluated an innovative new technique that is both non-invasive and radiation free. It is the first description of this procedure in the literature. In all patients the technique was safe, free of complications, effective and well tolerated. (orig.)

  2. MRI-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis low back pain - case series of an innovative new technique

    International Nuclear Information System (INIS)

    Weeks, Evan M.; Platt, Michael W.; Gedroyc, Wladyslaw

    2012-01-01

    To evaluate the safety and efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis pain. Patients with a positive response to facet joint interventions were recruited from Pain and Spinal Clinics. Treatments were performed at the levels of pain according to symptomatology, previous invasive treatment and MRI grading of facet joint osteoarthritis. Both safety and efficacy data were collected. Pain palliation was evaluated using a validated pain numerical rating scale (NRS), Oswestry disability questionnaire (ODQ), Brief Pain Inventory (BPI) and the EuroQol (EQ-5D) health state score Eighteen patients were treated. There were no major adverse events. At 6/12 we found a reduction in both the NRS (average/worst) pain scores (60.2 %/51.2 %). This was associated with 45.9 % improvement in the ODQ score and 61.9 % reduction in the BPI interference score. We observed an improvement in the EuroQol (EQ-5D) health state score based on UK coefficients of +0.379 (0.317 to 0.696). Our phase I observational pilot study has evaluated an innovative new technique that is both non-invasive and radiation free. It is the first description of this procedure in the literature. In all patients the technique was safe, free of complications, effective and well tolerated. (orig.)

  3. Synovial chondromatosis of the lumbar spine with compressive myelopathy: a case report with review of the literature

    International Nuclear Information System (INIS)

    Abdelwahab, Ibrahim Fikry; Contractor, Daniel; Bianchi, Stefano; Hermann, George; Hoch, Benjamin

    2008-01-01

    Synovial chondromatosis has been rarely reported to occur in the spine with only one case found in the lumbar spine. We describe another case of synovial chondromatosis in the lumbar spine in a 41-year-old man who presented with compressive myelopathy. The tumor was located in the left ventrolateral corner of the epidural space just below the L 4 -L 5 intervertebral space. Besides being extremely rare, our case was unusual in that the juxtaposed facet joint was radiologically normal. (orig.)

  4. Sacroiliac joint dysfunction.

    Science.gov (United States)

    Ilaslan, Hakan; Arslan, Ahmet; Koç, Omer Nadir; Dalkiliç, Turker; Naderi, Sait

    2010-07-01

    Sacroiliac joint dysfunction is a disorder presenting with low back and groin pain. It should be taken into consideration during the preoperative differential diagnosis of lumbar disc herniation, lumbar spinal stenosis and facet syndrome. Four cases with sacroiliac dysfunction are presented. The clinical and radiological signs supported the evidence of sacroiliac dysfunction, and exact diagnosis was made after positive response to sacroiliac joint block. A percutaneous sacroiliac fixation provided pain relief in all cases. The mean VAS scores reduced from 8.2 to 2.2. It is concluded that sacroiliac joint dysfunction diagnosis requires a careful physical examination of the sacroiliac joints in all cases with low back and groin pain. The diagnosis is made based on positive response to the sacroiliac block. Sacroiliac fixation was found to be effective in carefully selected cases.

  5. Synovial cysts of the lumbar spine

    International Nuclear Information System (INIS)

    Rosa, Ana Claudia Ferreira; Machado, Marcio Martins; Figueiredo, Marco Antonio Junqueira; Cerri, Giovanni Guido

    2002-01-01

    Intraspinal synovial cysts of the lumbar spine are rare and commonly associated with osteoarthritis of the facet joints, particularly at level L4-L5. Symptoms are uncommon and may include low-back pain or sciatica. These cysts are accurately diagnosed by using computed tomography and magnetic resonance imaging. Diagnosis is essential for the correct management of the cysts. Several treatment options are available including rest and immobilization, computed tomography guided corticosteroid injection, and surgery in patients that are nonresponsive to other treatment methods. (author)

  6. Reprodutibilidade intra e interobservadores da classificação de hipersinal facetário lombar e correlação com a degeneração discal para ressonância magnética Reproducibilidad intra e inter observadores de la clasificación de hiperseñal facetaria lumbar y correlación con la degeneración discal para resonancia magnética Intraobserver and interobserver reproducibility of lumbar facet hypersignal rating and correlation with disc degeneration by magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    André Evaristo Marcondes César

    2011-01-01

    Full Text Available OBJETIVO: Avaliar a reprodutibilidade intra e interobservadores da "classificação de hipersinal facetário lombar" e avaliar a correlação com a degeneração discal. MÉTODOS: Estudo retrospectivo de imagens de ressonância magnética obtidas de 41 (N=41 pacientes (18 homens e 23 mulheres, com idade variando de 26 a 84 anos, com média de 48 anos e três meses. As imagens foram revisadas por três ortopedistas especialistas em cirurgia de coluna e um radiologista, para avaliar e quantificar a presença do hipersinal facetário lombar. Posteriormente, foi verificada a relação entre a artrose facetária e degeneração discal. RESULTADOS: Foram avaliados e classificados 205 discos lombares e suas facetas articulares pelos quatro examinadores, com os dados analisados pelo Teste de Cronbach e da Análise de Correlação de Spearman com resultados estatisticamente elevados, confirmando boa relação intra e interobservadores para a "classificação de hipersinal facetário". Não foi observada relação estatisticamente significante entre artrose facetária e degeneração discal. CONCLUSÃO: Foram obtidos resultados suficientes para afirmar que existe boa relação intra e interobservadores para a "classificação de hipersinal facetário lombar". Não se verificou relação estatisticamente significante entre artrose facetária e degeneração discal.OBJETIVO: Evaluar la reproducibilidad inter e intra observadores de la "Clasificación de hiperseñal facetaria lumbar" y evaluar la correlación con la degeneración discal. Métodos: Estudio retrospectivo de imágenes de resonancia magnética obtenidas de 41 (N=41 pacientes (18 hombres y 23 mujeres, con la edad de 26 años hasta 84 años y, con promedio de 48 años y 3 meses. Las imágenes fueran revisadas por tres cirujanos ortopedistas especialistas en cirugía de columna vertebral y un radiólogo para evaluar y cuantificar la presencia de hiperseñal facetario lumbar. Después fue verificada

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

    International Nuclear Information System (INIS)

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

    2007-01-01

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

  8. Faceted Search

    CERN Document Server

    Tunkelang, Daniel

    2009-01-01

    We live in an information age that requires us, more than ever, to represent, access, and use information. Over the last several decades, we have developed a modern science and technology for information retrieval, relentlessly pursuing the vision of a "memex" that Vannevar Bush proposed in his seminal article, "As We May Think." Faceted search plays a key role in this program. Faceted search addresses weaknesses of conventional search approaches and has emerged as a foundation for interactive information retrieval. User studies demonstrate that faceted search provides more

  9. [Assessing the treatment for sacroiliac joint dysfunction, piriformis syndrome and tarsal tunnel syndrome associated with lumbar degenerative disease].

    Science.gov (United States)

    Morimoto, Daijiro; Isu, Toyohiko; Shimoda, Yuusuke; Hamauchi, Shuuji; Sasamori, Tooru; Sugawara, Atsushi; Kim, Kyongsong; Matsumoto, Ryouji; Isobe, Masanori

    2009-09-01

    Sacroiliac joint (SIJ) dysfunction, piriformis syndrome (PFS) and tarsal tunnel syndrome (TTS) produce symptoms similar to lumbar degenerative disease (LDD). Patients who have these diseases plus LDD sometimes experience residual symptoms after surgery for LDD. We therefore assessed the results of treatment of SIJ dysfunction, PFS and TTS associated with LDD. We assessed 25 patients who underwent surgery for LDD and were affected with SIJ dysfunction (12 patients), PFS (7 patients) or TTS (6 patients). SIJ dysfunction was treated with rest, drugs, pelvic band and sacroiliac joint block. PFS was treated with rest, drugs, physical exercise, injection of local anesthetic into the piriformis muscle, and surgical resection of the piriformis muscle. TTS was treated with drugs and tarsal tunnel opening. We analyzed the improvement score and recovery rate (JOA score) for both LDD surgery and the treatment of SIJ dysfunction, PFS and TTS. Symptom improvement was observed in all patients with SIJ dysfunction and PFS and in 4 patients with TTS. The improvement score and recovery rate of treatments for SIJ dysfunction, PFS and TTS were lower than those of surgery for LDD. The improvement score and recovery rate of treatment for SIJ dysfunction, PFS and TTS were not as high as those for LDD. To enhance patient satisfaction, it is important to consider these complicating diseases when designing treatments for LDD.

  10. Chronic whiplash-associated disorder and traumatic cerebrospinal fluid leak. Analysis of cases with radioisotope cisternography, epidural blood patch, and cervical facet joint blocks

    International Nuclear Information System (INIS)

    Ishikawa, Shinichi; Kobayashi, Hiroyuki; Takahara, Hiroshi; Kojo, Shigeru; Hashimoto, Hidenori; Moriyama, Eiji; Nishida, Ayumi

    2008-01-01

    This paper describes RI cisternographic (RIC) examinations of whiplash-associated disorder (WAD) and results of their treatment with nerve block and epidural blood patch (EBP) conducted in authors' facilities. Subjects were 40 chronic (av. symptomatic period of 3.1 y) WAD patients (av. age 34 y) with traffic (28 cases), sports (7) and falling (5) causes with complication of suspicious cerebrospinal fluid (CSF) leak. RIC was done 2.5-24 hr after injection of 37 MBq of 111 In-diethylenetriamine pentaacetic acid (DTPA) in the medullary space through epidural puncturing needle. Positive finding of clear leak or early accumulation of RI in the bladder was seen in 21 cases and negative, in 19. Positive patients had significantly higher rates of headache, abnormal vision and fatigue than negative ones. EBP was conducted through X-ray to all positive patients and to negative ones with strongly suspicious leak complication (7 cases), which resulted in improvement of symptoms like headache and vision in the former, but no improvement in the latter cases. Repeated RIC of the patients with poor improvement in the former was suggested effective for judgment of repetition of EBP treatment. Cervical facet joint blocks were found effective in cases with posterior cervical pain. Symptoms in WAD accompanying headache should be differentially diagnosed whether it is derived from posttraumatic CSF leak or from pain due to cervical facet arthritis. (R.T.)

  11. Effect of hamstring flexibility on hip and lumbar spine joint excursions during forward-reaching tasks in participants with and without low back pain.

    Science.gov (United States)

    Johnson, Erica N; Thomas, James S

    2010-07-01

    To examine the correlation between hamstring flexibility and hip and lumbar spine joint excursions during standardized reaching and forward-bending tasks. Retrospective analysis of data obtained during 2 previous prospective studies that examined kinematics and kinetics during forward-reaching tasks in participants with and without low back pain (LBP). The 2 previous studies were conducted in the Motor Control Lab at Ohio University and the Orthopaedic Ergonomics Laboratory at The Ohio State University. Data from a total of 122 subjects from 2 previous studies: study 1: 86 subjects recovered from an episode of acute LBP (recovered) and study 2 (A.I. McCallum, unpublished data): 18 chronic LBP subjects and 18 healthy-matched controls (healthy). Not applicable. Correlation values between hamstring flexibility as measured by straight leg raise (SLR) and amount of hip and lumbar spine joint excursions used during standardized reaching and forward-bending tasks. No significant correlation was found between hamstring flexibility and hip and lumbar joint excursions during forward-bending tasks in the LBP or recovered groups. The SLR had a significant negative correlation with lumbar spine excursions during reaching tasks to a low target in the healthy group (right SLR: P=.011, left SLR: P=.004). Hamstring flexibility is not strongly related to the amount of lumbar flexion used to perform forward-reaching tasks in participants who have chronic LBP or who have recovered from LBP. More research needs to be conducted to examine the influence of hamstring flexibility on observed movement patterns to further evaluate the efficacy of flexibility training in the rehabilitation of patients with LBP. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. A narrative review of evidence-based recommendations for the physical examination of the lumbar spine, sacroiliac and hip joint complex.

    Science.gov (United States)

    Wong, C K; Johnson, E K

    2012-09-01

    Non-specific low back pain is a frequent complaint in primary care, but the differential diagnosis for low back pain can be complex. Despite advances in diagnostic imaging, a specific pathoanatomical source of low back pain can remain elusive in up to 85% of individuals. Best practice guidelines recommend that clinicians conduct a focused physical examination to help to identify patients with non-specific low back pain and an evidence-based course of clinical management. The use of sensitive and specific clinical methods to assess the lumbar spine, sacroiliac and hip joints is critical for effective physical examination. Psychosocial factors also play an important role in the evaluation of individuals with low back pain, but are not included in this narrative review of physical examination methods. Physical examination of the lumbar spine, sacroiliac and hip joints is presented, organized around patient position for efficient and effective clinical assessment. Copyright © 2012 John Wiley & Sons, Ltd.

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

    Directory of Open Access Journals (Sweden)

    Cher DJ

    2015-09-01

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

  14. Factors associated with lumbar disc hernia recurrence after microdiscectomy.

    Science.gov (United States)

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

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

  15. Lumbar CT findings of patients with low back pain

    International Nuclear Information System (INIS)

    Lee, Yong Chul; Kim, Yang Soo; Kim, Kyun Sang

    1986-01-01

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  16. Lumbar CT findings of patients with low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yong Chul; Kim, Yang Soo; Kim, Kyun Sang [Chung-Ang University, Seoul (Korea, Republic of)

    1986-04-15

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  17. A radiological study on the degenerative joint disease of the lumbar spine in Korean adult men below the age of forty

    International Nuclear Information System (INIS)

    Lee, Sook Hi; Lee, Sang Seun

    1979-01-01

    It is generally believed that this disease is a degenerative process, a part of the general phenomena, hastened by excessive functional demand and a decreasing efficiency of blood supply. Though degenerative joint disease is the commonest of all ailments, its manifestations do not appear as a rule until the fourth or fifth decade, and it is not always easy to diagnose because we know less about it than about many less common types. Little information is available on its frequency in person below the age of forty. The present study was designed to obtain more precise information about development of this disease in person below the age of forty. After a detailed clinical examination, x-ray findings of a total of 566 men with low back pain checked at the Department of Radiology, National Public Hospital from Jan. 1976 to Dec. 1978 were received. The following result were obtained: 1. 111 (19.6%) of the 566 men had radiologic evidence of degenerative disease in lumbar spine. The degenerative joint disease first appeared on the age of 26. The degenerative joint disease was found in 16 (14.9%) of the 107 men between 25 and 29 years old, 14 (16.3%) of the 86 men between 35 and 39 years old, 31 (27.4%) of the 113 men between 35 and 39 years old, and 50 (50%) of the 100 between 40 and 44 years old. 2.The 4th lumbar spine was most commonly involved, being in 82.0% of the cases, and less frequent sites were the 5th lumbar spine (67.6%), the 3rd lumbar spine (51.3%), the 2nd lumbar spine (18.9%) and the 1st lumbar spine (3.6%). 38 (28.8%) of the 111 cases revealed single level involvement, but 79 (71.2%) cases showed multiple level involvement with the highest incidence at 14 and 15. 3. 111 cases of the 566 revealed marginal spurring. Bridging was noted in 8 cases, space narrowing 8 cases, and eburnation 7 caes.

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

    Science.gov (United States)

    Cher, Daniel Joseph; Reckling, W Carlton

    2015-01-01

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

  19. Synovial cysts of the lumbar spine; Cistos sinoviais lombares

    Energy Technology Data Exchange (ETDEWEB)

    Rosa, Ana Claudia Ferreira; Machado, Marcio Martins [Goias Univ., Goiania, GO (Brazil). Faculdade de Medicina. Hospital das Clinicas]. E-mail: anaclaudiaferreira@ig.com.br; Figueiredo, Marco Antonio Junqueira [Hospital Sirio-Libanes, Sao Paulo, SP (Brazil). Servico de Tomografia Computadorizada; Cerri, Giovanni Guido [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina. Dept. de Radiologia

    2002-10-01

    Intraspinal synovial cysts of the lumbar spine are rare and commonly associated with osteoarthritis of the facet joints, particularly at level L4-L5. Symptoms are uncommon and may include low-back pain or sciatica. These cysts are accurately diagnosed by using computed tomography and magnetic resonance imaging. Diagnosis is essential for the correct management of the cysts. Several treatment options are available including rest and immobilization, computed tomography guided corticosteroid injection, and surgery in patients that are nonresponsive to other treatment methods. (author)

  20. Superior facet syndrome. Findings on metrizamide CT myelography

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Yoshichika; Igarashi, Seishi; Koyama, Tsunemaro

    1985-02-01

    Sciatica caused by root entrapment in the lateral recess was named superior facet syndrome by Epstein in 1972. Few reports on this subject based on large numbers of cases have been documented to date. Of the patients with sciatica, 32 patients were diagnosed to have root entrapment at the lateral recess L5 or/and S1 lumbar spine. Out of 32 patients, 20 patients were operated on and the lateral entrapment was recognized in all of surgical cases. Neuroradiological findings, especially of metrizamide CT (met. CT), were documented in detail. Thirty two patients were classified in three types according to radiological findings. They were congenital or developmental, degenerative, and combined type, respectively. Fourteen cases belonged to the congenital type, 13 to the degenerative and 5 to the combined type. Each group had the mean ages of 23.4, 53.8, and 36.8 years old, respectively. Of 32 cases the entrapment occured in 47 L5 roots and 11 S1 roots. There was no remarkable laterality. In operation the unroofing of the lateral recess were done and the sciatica subsided postoperatively in all of surgical cases. Met. CT revealed extreme medial protrusion of the superior articular joint in 18 of 24 cases(75%) and none filling of the root in the lateral recess in 21 of 24 cases (87.5%). In the degenerative type, met. CT showed some degenerative changes that were hypertrophy or deformity of the articular joints and spur formation of the vertebral body. In contrast to met. CT, metrizamide myelography revealed only slight changes, which were poor filling of the root before it turned out the pedicle of lateral compression of the root. In plain films or lumbar spine articular joints at Lsub(4/5) were formed in coronal plane in 69% of cases of the L5 root entrapment. Met. CT using ReView technique was of great diagnostic value in superior facet syndrome.

  1. Bending stresses in Facetted Glass Shells

    DEFF Research Database (Denmark)

    Bagger, Anne; Jönsson, Jeppe; Almegaard, Henrik

    2008-01-01

    A shell structure of glass combines a highly effective structural principle with a material of optimal permeability to light. A facetted shell structure has a piecewise plane geometry, and together the facets form an approximation to a curved surface. A distributed load on a plane-based facetted...... structure will locally cause bending moments in the loaded facets. The bending stresses are dependent on the stiffness of the joints. Approximate solutions are developed to estimate the magnitude of the bending stresses. A FE-model of a facetted glass shell structure is used to validate the expressions...

  2. THERAPEUTIC EFFECTIVENESS OF THORACIC FACET JOINT INTERVENTIONS IN CHRONIC THORACIC PAIN%X光引导胸椎小关节注射治疗胸背痛的疗效观察

    Institute of Scientific and Technical Information of China (English)

    李晓宏; 李世杰; 黄翔; 富沛勇; 杨承祥

    2013-01-01

    目的:评价小关节注射治疗胸背部疼痛的临床疗效及安全性.方法:60例经保守治疗无效的慢性胸背痛患者,随机分为超激光治疗组(S组,n=30)和介入治疗组(Ⅰ组,n=30).S组患者取俯卧位,超激光照射病变关节部位,每天1次,每次15 rain,共14次;Ⅰ组患者取俯卧位,在X光引导下确定病变小关节平面,穿刺针经皮正确无误到达胸椎后关节突关节间隙,到位后注射消炎镇痛液.对治疗后第1周、2周、1个月、3个月的VAS进行评分、生活质量改善情况及安全性进行评估.结果:与S组比较,Ⅰ组治疗患者术后3个月的VAS评分较治疗前有显著性降低(P<0.05),且未发现有严重并发症.结论:小关节注射治疗胸背痛是一项操作简便、安全,疗效确切、可靠的微创介入治疗方法.%Objective:To determine the clinical effectiveness of zygapophysial joint injections with fluoroscopy in managing chronic mid back or upper back pain of facet joint origin.Methods:A total of 60 patients were randomized divided into two groups,with 30 patients in each of the super laser and facet joint interventions groups.All of the patients met the diagnostic criteria of thoracic facet joint pain by means of the inclusion criteria.Group S patients received thoracic facet joint with super laser,whereas Group Ⅰ patients received thoracic facet joint intervention with bupivacaine and non-particulate betamethasone.The clinical efficacy were assessed by patients with visual analogue scale(VAS).All outcomes were assessed at baseline,1 week,2 weeks,1 month,and 3 months after treatment.Results:In Group S,compared with baseline,patients showed significant pain relief and functional improvement at 1 week (P < 0.05) But there were no significant pain relief after 2 weeks.In Group Ⅰ,patients showed significant pain relief and functional improvement after facet joint injection,a significant change 3 months after treatment from baseline (P < 0

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

    Directory of Open Access Journals (Sweden)

    Feng-Chun Kao

    2014-04-01

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

  4. 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

  5. The clinical aspects of the acute facet syndrome

    DEFF Research Database (Denmark)

    Hestbaek, Lise; Kongsted, Alice; Jensen, Tue Secher

    2009-01-01

    ABSTRACT: BACKGROUND: The term 'acute facet syndrome' is widely used and accepted amongst chiropractors, but poorly described in the literature, as most of the present literature relates to chronic facet joint pain. Therefore, research into the degree of consensus on the subject amongst a large g...... from the facet joints has been described in the literature. Furthermore, the acute, uncomplicated facet syndrome was considered to have an uncomplicated clinical course, responding quickly to spinal manipulative therapy....

  6. Musculoskeletal simulations to investigate the influence of vertebral geometrical parameters on lumbar spine loading

    DEFF Research Database (Denmark)

    Putzer, Michael; Rasmussen, John; Penzkofer, Rainer

    Body Modeling System and a parameterized musculoskeletal lumbar spine model for four different postures: upright standing, flexion (50°), torsion (10°) and lateral bending (15°). The linear dimensions of the vertebral body, the posterior parts of the vertebrae as well as the disc height, the orientation...... of the facet joints and the curvature of the lumbar spine have been varied. Figure 1 depicts the used musculoskeletal model in the flexed posture and a lumbar vertebra labeled with all relevant linear dimensions except the disc height. Additionally, all combinations of the three parameters vertebral body...... are consistent with the corresponding results of Han et al. (2012) and Niemeyer et al. (2012). As mentioned above, the vertebral body depth showed a recognizable effect for the flexed and lateral bended postures, too. These characteristics can be justified with increasing moments due to the changed offset...

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

    International Nuclear Information System (INIS)

    Ihara, Koichiro

    1989-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-12-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-12-01

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

  10. Facet Effusion without Radiographic Instability Has No Effect on the Outcome of Minimally Invasive Decompression Surgery.

    Science.gov (United States)

    Tamai, Koji; Kato, Minori; Konishi, Sadahiko; Matsumura, Akira; Hayashi, Kazunori; Nakamura, Hiroaki

    2017-02-01

    Retrospective cohort study. Lumbar segmental instability is a key factor determining whether decompression alone or decompression and fusion surgery is required to treat lumbar spinal stenosis (LSS). Some recent reports have suggested that facet joint effusion is correlated with spinal segmental instability. The aim of this study is to report the effect of facet effusion without radiographic segmental instability on the outcome of less-invasive decompression surgery for LSS. Seventy-nine patients with LSS (32 women, mean age: 69.1 ± 9.1 years) who had no segmental instability on dynamic radiographs before undergoing L4-L5 microsurgical decompression and who were followed for at least 2 years postoperatively were analyzed. They were divided into three groups on the basis of the existence and size of L4-L5 facet effusion using preoperative magnetic resonance imaging: grade 0 had no effusion ( n  = 31), grade 1 had measurable effusion ( n  = 35), and grade 2 had large effusion ( n  = 13). Japanese Orthopedics Association (JOA) score, visual analog scale (VAS), and the Short-Form (SF)-36 scores were recorded preoperatively and 12 and 24 months postoperatively. JOA score; VAS of low back pain, leg pain, and numbness; and SF-36 (physical component summary and mental component summary) scores did not differ significantly between the three groups in every terms ( p  = 0.921, 0.996, 0.950, 0.693, 0.374, 0.304, and 0.624, respectively, at final follow-up). In the absence of radiographic instability, facet joint effusion has no effect on the outcome of less-invasive decompression surgery.

  11. Painful lumbar spondylolysis among pediatric sports players: a pilot MRI study.

    Science.gov (United States)

    Sairyo, Koichi; Sakai, Toshinori; Mase, Yasuyoshi; Kon, Tamiyo; Shibuya, Isao; Kanamori, Yasuo; Kosugi, Tatsuo; Dezawa, Akira

    2011-11-01

    For children and adolescents who are very active athletes, fresh lumbar spondylolysis is the main pathologic cause of lower back pain (LBP). However, regarding the terminal-stage spondylolysis (pars defect), there have been few studies to clarify the pathomechanism of LBP. The purpose of this study is to clarify the cause of LBP associated with pars defects in athletes. This is the first report showing a possible pathomechanism of LBP in active athletes with painful pars defect. Six pediatric athletes (5 boys and 1 girl) below 18 years old with painful bilateral lumbar spondylolysis were evaluated. In all cases, spondylolysis was identified as terminal stage (pseudoarthrosis) on CT scan. To evaluate the inflammation around the pars defects, short time inversion recovery (STIR) MRI was performed along with the sagittal section. Fluid collection, which is an indicator of inflammatory events, was evaluated in 12 pars defects as well as in 12 cranial and caudal adjoining facet joints. Inflammation (i.e., fluid collection) was observed in all 12 pars defects in six subjects at the pseudoarthrotic pars defects. In terms of facet joints, 7 of 12 (58%) pars defects showed fluid collection at the cranial and/or caudal adjoining joints on STIR MRI. The present study showed that inflammation was always present at the pars defects and in some cases at the adjoining facet joints. Thus, it is not difficult to understand how, during sports activity, inflammation may first occur at the pseudoarthrotic site and then spread to the adjoining facet joints. This mechanism could cause LBP associated with terminal-stage (pseudoarthrotics) spondylolysis in athletes.

  12. Tophaceous gout causing lumbar stenosis: A case report.

    Science.gov (United States)

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

    2017-08-01

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

  13. 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.

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

    Science.gov (United States)

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

    2015-01-01

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

  15. FacetGist: Collective Extraction of Document Facets in Large Technical Corpora.

    Science.gov (United States)

    Siddiqui, Tarique; Ren, Xiang; Parameswaran, Aditya; Han, Jiawei

    2016-10-01

    Given the large volume of technical documents available, it is crucial to automatically organize and categorize these documents to be able to understand and extract value from them. Towards this end, we introduce a new research problem called Facet Extraction. Given a collection of technical documents, the goal of Facet Extraction is to automatically label each document with a set of concepts for the key facets ( e.g. , application, technique, evaluation metrics, and dataset) that people may be interested in. Facet Extraction has numerous applications, including document summarization, literature search, patent search and business intelligence. The major challenge in performing Facet Extraction arises from multiple sources: concept extraction, concept to facet matching, and facet disambiguation. To tackle these challenges, we develop FacetGist, a framework for facet extraction. Facet Extraction involves constructing a graph-based heterogeneous network to capture information available across multiple local sentence-level features, as well as global context features. We then formulate a joint optimization problem, and propose an efficient algorithm for graph-based label propagation to estimate the facet of each concept mention. Experimental results on technical corpora from two domains demonstrate that Facet Extraction can lead to an improvement of over 25% in both precision and recall over competing schemes.

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

    Science.gov (United States)

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

    2006-01-01

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

  17. Lower thoracic degenerative spondylithesis with concomitant lumbar spondylosis.

    Science.gov (United States)

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

    2014-03-01

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

  18. A novel minimally invasive percutaneous facet augmentation device for the treatment of lumbar radiculopathy and axial back pain: technical description, surgical technique and case presentations Un nuevo dispositivo percutáneo mínimamente invasivo de aumento facetáreo para el tratamiento de radiculopatía lumbar y dolor axial lumbar: descripción técnica, técnica quirúrgica y presentación de casos Um novo dispositivo percutâneo minimamente invasivo de aumento facetário para o tratamento da radiculopatia lombar e dor axial lombar: descrição técnica, técnica cirúrgica e apresentação de casos

    Directory of Open Access Journals (Sweden)

    Larry T. Khoo

    2009-03-01

    Full Text Available OBJECTIVE: to describe a new posterior minimally invasive method of facet stabilization for treatment of the degenerating lumbar motion segment. The biomechanics of this Percudyn (Interventional Spine; Irvine, CA system are distinct from that of other interspinous dynamic stabilization systems as it acts bilaterally directly within the middle column of the spine. Based on biomechanical evalution, the paired prosthesis supports, cushions, and reinforces the facet complexes by limiting both extension and lateral bending thereby maintaining central and foraminal volumes. METHODS: the Percudyn device consists of a pedicle anchor upon which sits a cushioning polycarbonate-urethane stabilizer that serves as a mechanically reinforcing stop between the inferior and superior articular facets. A 1.5 cm skin incision is made bilaterally over the lower pedicle of the treated segment through which a Jamshidi needle is percutaneously targeted under biplanar fluoroscopic guidance into the caudal aspect of the superior articular process directly underneath the lip of the inferior facet from the level above. Progressive onestep tubular dilation is then performed to secure a small disposable working portal. Through this access, the Percudyn stabilizers are then placed over the wire and anchored bilaterally into the inferior pedicles of the degenerated motion segment. RESULTS: three patients (ages 26-41, male with significant low back pain as well as radiculopathy with lateral recess stenosis from a large disc herniation/ ligamentum and facet hypertrophy (L4-5 and/or L5-S1 underwent a minimally invasive decompression/ discectomy and bilateral Percudyn placement at each disease level. Each patient had significant relief of both his radiculopathy and axial back pain post-operatively and was discharged home within 18 hours without sequelae. CONCLUSION: this novel technique of percutaneous posterior facet augmentation allows for safe placement of bilateral middle

  19. Validation of lumbar spine loading from a musculoskeletal model including the lower limbs and lumbar spine.

    Science.gov (United States)

    Actis, Jason A; Honegger, Jasmin D; Gates, Deanna H; Petrella, Anthony J; Nolasco, Luis A; Silverman, Anne K

    2018-02-08

    Low back mechanics are important to quantify to study injury, pain and disability. As in vivo forces are difficult to measure directly, modeling approaches are commonly used to estimate these forces. Validation of model estimates is critical to gain confidence in modeling results across populations of interest, such as people with lower-limb amputation. Motion capture, ground reaction force and electromyographic data were collected from ten participants without an amputation (five male/five female) and five participants with a unilateral transtibial amputation (four male/one female) during trunk-pelvis range of motion trials in flexion/extension, lateral bending and axial rotation. A musculoskeletal model with a detailed lumbar spine and the legs including 294 muscles was used to predict L4-L5 loading and muscle activations using static optimization. Model estimates of L4-L5 intervertebral joint loading were compared to measured intradiscal pressures from the literature and muscle activations were compared to electromyographic signals. Model loading estimates were only significantly different from experimental measurements during trunk extension for males without an amputation and for people with an amputation, which may suggest a greater portion of L4-L5 axial load transfer through the facet joints, as facet loads are not captured by intradiscal pressure transducers. Pressure estimates between the model and previous work were not significantly different for flexion, lateral bending or axial rotation. Timing of model-estimated muscle activations compared well with electromyographic activity of the lumbar paraspinals and upper erector spinae. Validated estimates of low back loading can increase the applicability of musculoskeletal models to clinical diagnosis and treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Ozone therapy for t he complex prolapse of lumbar intervertebral disc: a clinical observation

    International Nuclear Information System (INIS)

    Peng Yong; Wei Mengqi; Wu Juan; Zhou Jianshou; Yang Yong; Zhao Hongliang; Shi Mingguo

    2010-01-01

    Objective: To evaluate the therapeutic outcome of ozone injection therapy for the treatment of complex prolapse of lumbar intervertebral disc, which is accompanied with spinal stenosis due to hypertrophy of ligamentum flavum, degeneration of intervertebral facet joints, intervertebral hyperosteogeny and degeneration, lumbar muscle strain and negative pressure in intervertebral discs. Methods: Seventy patients with simple intervertebral disc prolapse (simple group) and 70 patients with complex intervertebral disc prolapse (complex group) were selected for the study. The complex intervertebral disc prolapse included negative pressure in intervertebral disc (n=11), recurrence after resection of nucleus polposus of intervertebral disc (n=5), spinal stenosis (n=10), degeneration of intervertebral facet joints and interver-tebral hyperosteogeny (n=30), stenosis of lateral recess (n=4) and lumbar muscle strain (n=10). All patients were treated with ozone injection under the CT guidance. A total of 2-3 ml ozone with the concentration of 40-50 μg / ml was injected into the intervertebral disk and a total of 5-8 ml ozone with the concentration of 30-40 μg / ml was injected into the paraspinal space. Infiltration injection into the pain spots with 20 ml ozone was carried out in patients with lumbar muscle strain. Results: A comparison of the therapeutic outcomes between simple group and complex group was made. Immediate relief from clinical symptoms was obtained in 80% of all treated patients. The effective rate one week after the procedure was 95%, which became 96% at 3-6 months after the treatment. Conclusion: Correct clinical diagnosis, skilled and accurate manipulation during the surgery and reasonable use of ozone injection in the treatment of soft tissue injury, etc. can markedly improve the therapeutic effect for complex lumbar intervertebral disc prolase. (authors)

  1. [Epidemiology of bone and joint disease - the present and future - . Epidemiology of lumbar spondylosis in Japan : the ROAD study].

    Science.gov (United States)

    Yoshimura, Noriko

    2014-05-01

    To clarify the prevalence and estimate the number of people with osteoarthritis, and osteoporosis in Japan, we established a large-scale population-based cohort study entitled Research on Osteoarthritis/osteoporosis Against Disability (ROAD). The prevalence of lumbar spondylosis (LS) in men and women was 80.6% and 61.5%, respectively with utilizing the ROAD baseline data. The cumulative incidence of LS in men and women was 15.2%/y and 10.4%/y, respectively with using the follow-up data. The estimated number of prevalent cases and incident cases/y of LS in Japan was approximately 38 million and 9 million, respectively. Older age, male-sex, and greater BMI were associated with the occurrence of LS.

  2. Postoperative Clinical Outcome and Risk Factors for Poor Outcome of Foraminal and Extraforaminal Lumbar Disc Herniation.

    Science.gov (United States)

    Bae, Jung Sik; Kang, Kyung Hee; Park, Jeong Hyun; Lim, Jae Hyeon; Jang, Il Tae

    2016-03-01

    We evaluated postoperative outcomes in patients who have lumbar foraminal or extraforaminal disc herniation (FELDH) and suggested the risk factors for poor outcomes. A total of 234 patients were selected for this study. Pre- and post-operative Visual Analogue Scale (VAS) and Korean version Oswestry Disability Index (KODI) were evaluated and the changes of both score were calculated. Outcome was defined as excellent, good, fair, and poor based on Mcnab classification. The percentage of superior facetectomy was calculated by using the Maro-view 5.4 Picture Archiving Communication System (PACS). Paramedian lumbar discectomy was performed in 180 patients and combined lumbar discectomy was performed in 54 patients. Paramedian lumbar discectomy group showed better outcome compared with combined discectomy group. p value of VAS change was 0.009 and KODI was 0.013. The average percentage of superior facetectomy was 33% (range, 0-79%) and it showed negative correlation with VAS and KODI changes (Pearson coefficient : -0.446 and -0.498, respectively). Excellent or good outcome cases (Group I) were 136 (58.1%) and fair or poor outcome cases (Group II) were 98 (41.9%). The percentage of superior facetectomy was 26.5% at Group I and 42.5% at Group II. There was significant difference in superior facetectomy percentage between Group I and II (p=0.000). This study demonstrated that paramedian lumbar discectomy with preservation of facet joints is an effective and good procedure for FELDH. At least 60% of facet should be preserved for excellent or good outcomes.

  3. Modified fenestration with restorative spinoplasty for lumbar spinal stenosis.

    Science.gov (United States)

    Matsudaira, Ko; Yamazaki, Takashi; Seichi, Atsushi; Hoshi, Kazuto; Hara, Nobuhiro; Ogiwara, Satoshi; Terayama, Sei; Chikuda, Hirotaka; Takeshita, Katsushi; Nakamura, Kozo

    2009-06-01

    The authors developed an original procedure, modified fenestration with restorative spinoplasty (MFRS) for the treatment of lumbar spinal stenosis. The first step is to cut the spinous process in an L-shape, which is caudally reflected. This procedure allows easy access to the spinal canal, including lateral recesses, and makes it easy to perform a trumpet-style decompression of the nerve roots without violating the facet joints. After the decompression of neural tissues, the spinous process is anatomically restored (spinoplasty). The clinical outcomes at 2 years were evaluated using the Japanese Orthopaedic Association (JOA) scale and patients' satisfaction. Radiological follow-up included radiographs and CT. Between January 2000 and December 2002, 109 patients with neurogenic intermittent claudication with or without mild spondylolisthesis underwent MFRS. Of these, 101 were followed up for at least 2 years (follow-up rate 93%). The average score on the self-administered JOA scale in 89 patients without comorbidity causing gait disturbance improved from 13.3 preoperatively to 22.9 at 2 years' follow-up. Neurogenic intermittent claudication disappeared in all cases. The patients' assessment of treatment satisfaction was "satisfied" in 74 cases, "slightly satisfied" in 12, "slightly dissatisfied" in 2, and "dissatisfied" in 1 case. In 16 cases (18%), a minimum progression of slippage occurred, but no symptomatic instability or recurrent stenosis was observed. Computed tomography showed that the lateral part of the facet joints was well preserved, and the mean residual ratio was 80%. The MFRS technique produces an adequate and safe decompression of the spinal canal, even in patients with narrow and steep facet joints in whom conventional fenestration is technically demanding.

  4. Outcomes of extended transforaminal lumbar interbody fusion for lumbar spondylosis.

    Science.gov (United States)

    Talia, Adrian J; Wong, Michael L; Lau, Hui C; Kaye, Andrew H

    2015-11-01

    This study aims to assess the results of extended transforaminal lumbar interbody fusion (TLIF) for a two surgeon, single institution series. In total, extended TLIF with bilateral decompression was performed in 57 patients. Pain, American Spinal Injury Association scores, patient demographics, body mass index (BMI), perioperative indices and radiographic measurements were recorded and analysed. The surgeries were performed between February 2011 and January 2014 on 38 women and 19 men. The mean patient age was 62.86 years, and the mean BMI was 30.31 kg/m(2). In 49 patients, spondylolisthesis was the primary indication. The mean intraoperative time was 284.65 min, and this decreased as the series progressed. The median length of stay was 5 days (range: 2-9). The surgical complication rate was 19.3%. Two patients died from cardiopulmonary complications. Single level TLIF was performed in 78.9% of the cohort, with L4/5 the most commonly fused level. Significant pain reduction was achieved from a mean (± standard deviation) preoperative visual analogue scale (VAS) of 8.28 ± 1.39 to 1.50 ± 1.05 at 12 months postoperatively. No patients deteriorated neurologically. Spondylolisthesis was significantly corrected from a preoperative mean of 6.82 mm to 2.80 mm postoperatively. Although there is a learning curve associated with the procedure, extended TLIF with bilateral facet joint removal and decompression appeared to be a safe and effective alternative to other fusion techniques, and our results were comparable to other published case series. The stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Pulsed Dose Radiofrequency Before Ablation of Medial Branch of the Lumbar Dorsal Ramus for Zygapophyseal Joint Pain Reduces Post-procedural Pain.

    Science.gov (United States)

    Arsanious, David; Gage, Emmanuel; Koning, Jonathon; Sarhan, Mazin; Chaiban, Gassan; Almualim, Mohammed; Atallah, Joseph

    2016-01-01

    center. The procedures were exclusively performed using one model of radiofrequency generator, at one setting for the PDRF and RFA. The difference in the number of levels of ablation was not considered in the analysis of the results. Treating patients with pulsed dose radiofrequency prior to continuous thermal radiofrequency ablation can provide patients with less post-procedural pain during the first 24 hours and also reduce analgesic requirements. Furthermore, the addition of PDRF to standard thermal RFA did not prolong the time of standard thermal radiofrequency ablation procedures, as it was performed during the typically allotted time for local anesthetic action. Low back pain, facet joint disease, medial branch block, Radiofrequency ablation, thermal radiofrequency, pulsed dose radiofrequency, PDRF, zygapophyseal joint.

  6. An Unexplored Facet of International Business in Greece: Foreign and Diaspora Shareholders in Joint Stock Company Start-Ups, 1833-1920

    Directory of Open Access Journals (Sweden)

    Ioanna Sapfo Pepelasis

    2016-07-01

    Full Text Available This paper focuses on an unexplored aspect of the history of international business in Greece, the presence of international shareholders in Greek Joint stock company start-ups. Our main findings are that these investors participated in numerous such firms usually as minority shareholders in capital and or knowledge intensive firms. Rarely did they opt for the exclusive international ownership of a joint stock company in Greece and the dividing line  between foreign direct investment and foreign portfolio investment was not always clear. It is also the case that international capital inflow into the nascent corporate sector involved a mosaic of collaborating actors including not only the foreign but also the diasporic.

  7. Finite element simulation and clinical follow-up of lumbar spine biomechanics with dynamic fixations.

    Directory of Open Access Journals (Sweden)

    Yolanda Más

    Full Text Available Arthrodesis is a recommended treatment in advanced stages of degenerative disc disease. Despite dynamic fixations were designed to prevent abnormal motions with better physiological load transmission, improving lumbar pain and reducing stress on adjacent segments, contradictory results have been obtained. This study was designed to compare differences in the biomechanical behaviour between the healthy lumbar spine and the spine with DYNESYS and DIAM fixation, respectively, at L4-L5 level. Behaviour under flexion, extension, lateral bending and axial rotation are compared using healthy lumbar spine as reference. Three 3D finite element models of lumbar spine (healthy, DYNESYS and DIAM implemented, respectively were developed, together a clinical follow-up of 58 patients operated on for degenerative disc disease. DYNESYS produced higher variations of motion with a maximum value for lateral bending, decreasing intradiscal pressure and facet joint forces at instrumented level, whereas screw insertion zones concentrated stress. DIAM increased movement during flexion, decreased it in another three movements, and produced stress concentration at the apophyses at instrumented level. Dynamic systems, used as single systems without vertebral fusion, could be a good alternative to degenerative disc disease for grade II and grade III of Pfirrmann.

  8. Central and foraminal stenosis of the lumbar spine

    International Nuclear Information System (INIS)

    Major, N.M.; Helms, C.A.

    1995-01-01

    The discussion include clinical presentation, anatomy, imaging techniques, central canal stenosis, iatrogenic stenosis, post-traumatic stenosis, neural foraminal stenosis, facet joint disease, lateral recess disease (15 refs.)

  9. Central and foraminal stenosis of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Major, N M; Helms, C A [California Univ., San Francisco, CA (United States). Dept. of Radiology

    1996-12-31

    The discussion include clinical presentation, anatomy, imaging techniques, central canal stenosis, iatrogenic stenosis, post-traumatic stenosis, neural foraminal stenosis, facet joint disease, lateral recess disease (15 refs.).

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

    Science.gov (United States)

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

    2018-04-03

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

  11. Bertolotti's syndrome revisited. Transitional vertebrae of the lumbar spine.

    Science.gov (United States)

    Elster, A D

    1989-12-01

    Bertolotti's syndrome refers to the association of back pain with lumbosacral transitional vertebrae. Such vertebrae were observed in 140 of 2,000 adults with back pain over a 4-year period of study. Each patient had radiographic evaluation of the lumbar spine by plain films as well as a sectional imaging modality (magnetic resonance [MR] or computed tomography [CT]). The overall incidence of structural pathology (eg, spinal stenosis and disc protrusion) detected by CT or MR was not apparently higher in patients with transitional vertebrae, but the distribution of these lesions was significantly different. Disc bulge or herniation, when it occurred, was nearly nine times more common at the interspace immediately above the transitional vertebra than at any other level. Spinal stenosis and nerve root canal stenosis were more common at or near the interspace above the transitional vertebra than at any other level. Degenerative change at the articulation between the transverse process of the transitional vertebra and the pelvis was an uncommon occurrence; when seen there was no significant correlation with the reported side of pain. It is postulated that hypermobility and altered stresses become concentrated in the spine at the level immediately above a lumbar transitional vertebra. Accelerated disc and facet joint degeneration at this level may then result.

  12. MRI findings in the lumbar spines of asymptomatic elite junior tennis players

    International Nuclear Information System (INIS)

    Rajeswaran, G.; Healy, J.C.; Turner, M.; Gissane, C.

    2014-01-01

    To evaluate the MRI findings in the lumbar spines of asymptomatic elite junior tennis players. The lumbar spine MRI studies of 98 asymptomatic junior elite tennis players (51 male, 47 female) with a mean age of 18 years (age range 11.2-26.3 years; standard deviation 3.1) was reviewed by two consultant musculoskeletal radiologists using consensus opinion. Images were assessed using accepted classification systems. Four players (4 %) had no abnormality. Facet joint arthropathy occurred in 89.7 % of the players, being mild in 84.5 % of cases. There were 41 synovial cysts in 22.4 % of the cohort all occurring in the presence of facet arthropathy. Disc degeneration was noted in 62.2 % of players, being mild in 76.2 % of those affected. Disc herniation was noted in 30.6 % of players, with 86.1 % of these being broad based and 13.9 % being focal. There was nerve root compression in 2 %. There were 41 pars interarticularis abnormalities in 29.6 % of patients, 63.4 % of these being grades 1-3. There was grade 1 spondylolisthesis in 5.1 % of players. The prevalence of facet joint arthropathy, disc degeneration, disc herniation and pars interarticularis fracture was lower in female players than in male and lower in the under 16-year-olds compared with the over 20-year-olds. There is a significant amount of underlying pathology that would normally go undetected in this group of asymptomatic elite athletes. Whilst these findings cannot be detected clinically, their relevance is in facilitating appropriate prehabilitation to prevent loss of playing time and potentially career-ending injuries. (orig.)

  13. 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.

  14. Cistos sinoviais lombares Synovial cysts of the lumbar spine

    Directory of Open Access Journals (Sweden)

    Ana Cláudia Ferreira Rosa

    2002-10-01

    Full Text Available Os cistos sinoviais localizados na coluna lombar são raros, em geral associados a alterações degenerativas das articulações facetárias, mais freqüentemente vistos na transição L4-L5. Raramente causam sintomas, que, quando ocorrem, são sobretudo lombociatalgia. O diagnóstico é feito de maneira satisfatória pela tomografia computadorizada e pela ressonância magnética e é importante para que se institua o correto tratamento dos cistos. Existem diversas formas de tratamento, desde repouso e imobilização até a injeção de corticóide no cisto sinovial guiada por tomografia computadorizada, e mesmo cirurgia nos casos refratários aos outros tipos de tratamento.Intraspinal synovial cysts of the lumbar spine are rare and commonly associated with osteoarthritis of the facet joints, particularly at level L4-L5. Symptoms are uncommon and may include low-back pain or sciatica. These cysts are accurately diagnosed by using computed tomography and magnetic resonance imaging. Diagnosis is essential for the correct management of the cysts. Several treatment options are available including rest and immobilization, computed tomography guided corticosteroids injection, and surgery in patients that are nonresponsive to other treatment methods.

  15. Structure-Specific Movement Patterns in Patients With Chronic Low Back Dysfunction Using Lumbar Combined Movement Examination.

    Science.gov (United States)

    Monie, Aubrey P; Price, Roger I; Lind, Christopher R P; Singer, Kevin P

    2017-06-01

    A test-retest cohort study was conducted to assess the use of a novel computer-aided, combined movement examination (CME) to measure change in low back movement after pain management intervention in 17 cases of lumbar spondylosis. Additionally we desired to use a CME normal reference range (NRR) to compare and contrast movement patterns identified from 3 specific structural pathologic conditions: intervertebral disc, facet joint, and nerve root compression. Computer-aided CME was used before and after intervention, in a cohort study design, to record lumbar range of movement along with pain, disability, and health self-report questionnaires in 17 participants who received image-guided facet, epidural, and/or rhizotomy intervention. In the majority of cases, CME was reassessed after injection together with 2 serial self-reports after an average of 2 and 14 weeks. A minimal clinically important difference of 30% was used to interpret meaningful change in self-reports. A CME NRR (n = 159) was used for comparison with the 17 cases. Post hoc observation included subgrouping cases into 3 discrete pathologic conditions, intervertebral disc, facet dysfunction, and nerve root compression, in order to report intergroup differences in CME movement. Seven of the 17 participants stated that a "combined" movement was their most painful CME direction. Self-report outcome data indicated that 4 participants experienced significant improvement in health survey, 5 improved by ≥30% on low back function, and 8 reported that low back pain was more bothersome than stiffness, 6 of whom achieved the minimal clinically important difference for self-reported pain. Subgrouping of cases into structure-specific groups provided insight to different CME movement patterns. The use of CME assists in identifying atypical lumbar movement relative to an age and sex NRR. Data from this study, exemplified by representative case studies, provide preliminary evidence for distinct intervertebral disc

  16. MRI of degenerative lumbar spine disease: comparison of non-accelerated and parallel imaging

    International Nuclear Information System (INIS)

    Noelte, Ingo; Gerigk, Lars; Brockmann, Marc A.; Kemmling, Andre; Groden, Christoph

    2008-01-01

    Parallel imaging techniques such as GRAPPA have been introduced to optimize image quality and acquisition time. For spinal imaging in a clinical setting no data exist on the equivalency of conventional and parallel imaging techniques. The purpose of this study was to determine whether T1- and T2-weighted GRAPPA sequences are equivalent to conventional sequences for the evaluation of degenerative lumbar spine disease in terms of image quality and artefacts. In patients with clinically suspected degenerative lumbar spine disease two neuroradiologists independently compared sagittal GRAPPA (acceleration factor 2, time reduction approximately 50%) and non-GRAPPA images (25 patients) and transverse GRAPPA (acceleration factor 2, time reduction approximately 50%) and non-GRAPPA images (23 lumbar segments in six patients). Comparative analyses included the minimal diameter of the spinal canal, disc abnormalities, foraminal stenosis, facet joint degeneration, lateral recess, nerve root compression and osteochondrotic vertebral and endplate changes. Image inhomogeneity was evaluated by comparing the nonuniformity in the two techniques. Image quality was assessed by grading the delineation of pathoanatomical structures. Motion and aliasing artefacts were classified from grade 1 (severe) to grade 5 (absent). There was no significant difference between GRAPPA and non-accelerated MRI in the evaluation of degenerative lumbar spine disease (P > 0.05), and there was no difference in the delineation of pathoanatomical structures. For inhomogeneity there was a trend in favour of the conventional sequences. No significant artefacts were observed with either technique. The GRAPPA technique can be used effectively to reduce scanning time in patients with degenerative lumbar spine disease while preserving image quality. (orig.)

  17. Influence of BMI, gender, and sports on pain decrease and medication usage after facet-medial branch neurotomy or SI joint lateral branch cooled RF-neurotomy in case of low back pain: original research in the Austrian population.

    Science.gov (United States)

    Stelzer, Wolfgang; Stelzer, Valentin; Stelzer, Dominik; Braune, Monika; Duller, Christine

    2017-01-01

    This retrospective original research was designed to illustrate the general outcome after radiofrequency (RF) neurotomy of lumbar medial branch (MB) and posterior ramus of the sacroiliac joint of 160 patients with chronic low back pain (LBP) 1, 6, and 12 months after treatment. Visual Analog Scale (VAS) 0-10 pain scores, quality of life, body mass index (BMI), medication usage, and frequency of physical exercise/sports participation (none, 1-3×/week, more) were collected before the procedure, at 1 month post procedure (n=160), and again at 6 (n=73) and 12 months (n=89) post procedure. A VAS decrease of 4 points on a 10-point scale (from 8 to 4) in the overall group was seen after 6 months and of 4.5 after 12 months. Lower medication usage was reported, with opioids decreased by 40% and nonsteroidal anti-inflammatory drugs (NSAIDs) by 60%. Decreased pain lasted for 12 months. Significantly better outcomes were reported by patients with BMIs gender-specific differences occurred in the reported decrease in VAS. Analysis of the "no-sports" group versus the more active (1-3 times weekly sports) group showed a better pain decrease after 1 year in the active group. The data suggest RF treatment for chronic LBP that can lead to long-term improvement. Patients with a BMI >30 are less likely to report decreased pain. The better long-term pain relief in the sports participating group is a motivation for the authors to keep the patients in motion.

  18. Effects of ground and joint reaction force exercise on lumbar spine and femoral neck bone mineral density in postmenopausal women: a meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Kelley George A

    2012-09-01

    Full Text Available Abstract Background Low bone mineral density (BMD and subsequent fractures are a major public health problem in postmenopausal women. The purpose of this study was to use the aggregate data meta-analytic approach to examine the effects of ground (for example, walking and/or joint reaction (for example, strength training exercise on femoral neck (FN and lumbar spine (LS BMD in postmenopausal women. Methods The a priori inclusion criteria were: (1 randomized controlled trials, (2 exercise intervention ≥ 24 weeks, (3 comparative control group, (4 postmenopausal women, (5 participants not regularly active, i.e., less than 150 minutes of moderate intensity (3.0 to 5.9 metabolic equivalents weight bearing endurance activity per week, less than 75 minutes of vigorous intensity (> 6.0 metabolic equivalents weight bearing endurance activity per week, resistance training g was calculated for each FN and LS BMD result and pooled using random-effects models. Z-score alpha values, 95%confidence intervals (CI and number-needed-to-treat (NNT were calculated for pooled results. Heterogeneity was examined using Q and I2. Mixed-effects ANOVA and simple meta-regression were used to examine changes in FN and LS BMD according to selected categorical and continuous variables. Statistical significance was set at an alpha value ≤0.05 and a trend at >0.05 to ≤ 0.10. Results Small, statistically significant exercise minus control group improvements were found for both FN (28 g’s, 1632 participants, g = 0.288, 95% CI = 0.102, 0.474, p = 0.002, Q = 90.5, p I2 = 70.1%, NNT = 6 and LS (28 g’s, 1504 participants, g = 0.179, 95% CI = −0.003, 0.361, p = 0.05, Q = 77.7, p I2 = 65.3%, NNT = 6 BMD. Clinically, it was estimated that the overall changes in FN and LS would reduce the 20-year relative risk of osteoporotic fracture at any site by approximately 11% and 10%, respectively. None of the mixed

  19. Effect of aging and lumbar spondylosis on lumbar lordosis

    Directory of Open Access Journals (Sweden)

    Francis Osita Okpala

    2018-01-01

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

  20. Value of 18F-FDG PET/MRI for the outcome of CT-guided facet block therapy in cervical facet syndrome: initial results

    International Nuclear Information System (INIS)

    Sawixki, Lino M.; Schaarscjmidt, Benedikt M.; Heusch, Philipp; Buchbender, Christian; Antoch, Gerald; Rosenbaum-Krumme, Sandra; Bockisch, Andreas; Umutlu, Lale; Eicker, Sven O.; Floeth, Frank W.

    2017-01-01

    The aim of this study was to evaluate the ability of 18 F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ( 18 F-FDG PET/MRI) to detect PET-positive cervical facet arthropathy and identify patients who benefit from facet block therapy. Ten patients with cervical facet syndrome (mean age: 65 ± 12 years) underwent 18 F-FDG PET/MRI of the neck. Focal 18 F-FDG uptake in PET-positive facet joints served as target for computed tomography (CT)-guided facet blocks. In PET-negative patients, the target joint for facet block therapy was selected by current clinical standards considering the level of maximum facet arthrosis and pain. Neck pain was measured on visual analogue scale (VAS) before and after therapy. Bone marrow signal intensity (SI) ratio on turbo inversion recovery magnitude (TIRM) images and maximum standard uptake values (SUVmax) was calculated for each facet joint. Pearson's correlation coefficient (r) was calculated between bone marrow SI ratios on TIRM and SUVmax. 18 F-FDG PET/MRI detected PET-positive facet arthropathy in six patients. Patients with PET-positive facet arthropathy had significantly less pain compared with the pretreatment pain 3 h (P = 0.002), 4 weeks (P = 0.002) and 3 months (P = 0.026) after facet block therapy. Pain did not change significantly in patients with PET-negative facet arthropathy. TIRM SI ratio was higher in PET-positive facet arthropathy than in PET-negative facet arthropathy (P < 0.001). Correlation was strong between bone marrow SI ratio on TIRM images and SUVmax (r = 0.7; P < 0.001).

  1. FACET Emittance Growth

    Energy Technology Data Exchange (ETDEWEB)

    Frederico, J; Hogan, M.J.; Nosochkov, Y.; Litos, M.D.; Raubenheimer, T.; /SLAC

    2011-04-05

    FACET, the Facility for Advanced Accelerator and Experimental Tests, is a new facility being constructed in sector 20 of the SLAC linac primarily to study beam driven plasma wakefield acceleration. The FACET beamline consists of a chicane and final focus system to compress the 23 GeV, 3.2 nC electron bunches to {approx}20 {micro}m long and {approx}10 {micro}m wide. Simulations of the FACET beamline indicate the short-duration and large, 1.5% rms energy spread beams may suffer a factor of four emittance growth from a combination of chromaticity, incoherent synchrotron radiation (ISR), and coherent synchrotron radiation (CSR). Emittance growth is directly correlated to head erosion in plasma wakefield acceleration and is a limiting factor in single stage performance. Studies of the geometric, CSR, and ISR components are presented. Numerical calculation of the rms emittance can be overwhelmed by long tails in the simulated phase space distributions; more useful definitions of emittance are given. A complete simulation of the beamline is presented as well, which agrees with design specifications.

  2. FACET Emittance Growth

    International Nuclear Information System (INIS)

    Frederico, Joel

    2011-01-01

    FACET, the Facility for Advanced Accelerator and Experimental Tests, is a new facility being constructed in sector 20 of the SLAC linac primarily to study beam driven plasma wakefield acceleration. The FACET beamline consists of a chicane and final focus system to compress the 23 GeV, 3.2 nC electron bunches to ∼20 (micro)m long and ∼10 (micro)m wide. Simulations of the FACET beamline indicate the short-duration and large, 1.5% rms energy spread beams may suffer a factor of four emittance growth from a combination of chromaticity, incoherent synchrotron radiation (ISR), and coherent synchrotron radiation (CSR). Emittance growth is directly correlated to head erosion in plasma wakefield acceleration and is a limiting factor in single stage performance. Studies of the geometric, CSR, and ISR components are presented. Numerical calculation of the rms emittance can be overwhelmed by long tails in the simulated phase space distributions; more useful definitions of emittance are given. A complete simulation of the beamline is presented as well, which agrees with design specifications.

  3. Investigation of stresses in facetted glass shell structures

    DEFF Research Database (Denmark)

    Bagger, Anne; Jönsson, Jeppe; Wester, Ture

    2007-01-01

    by in-plane forces in the facets and the transfer of distributed in-plane forces across the joints. It is described how these facets work structurally, specifically how bending moments develop and cause possible stress concentrations in the corners, which are subjected to uplift. Apart from local...... bending moments from distributed load, other types of bending moments are likely to occur, especially if the shell has areas of low stiffness, for example along a free edge. A facetted shell structure has been modelled in a finite element program, and the resulting stresses are presented and discussed....

  4. Return to Work After Lumbar Microdiscectomy - Personalizing Approach Through Predictive Modeling.

    Science.gov (United States)

    Papić, Monika; Brdar, Sanja; Papić, Vladimir; Lončar-Turukalo, Tatjana

    2016-01-01

    Lumbar disc herniation (LDH) is the most common disease among working population requiring surgical intervention. This study aims to predict the return to work after operative treatment of LDH based on the observational study including 153 patients. The classification problem was approached using decision trees (DT), support vector machines (SVM) and multilayer perception (MLP) combined with RELIEF algorithm for feature selection. MLP provided best recall of 0.86 for the class of patients not returning to work, which combined with the selected features enables early identification and personalized targeted interventions towards subjects at risk of prolonged disability. The predictive modeling indicated at the most decisive risk factors in prolongation of work absence: psychosocial factors, mobility of the spine and structural changes of facet joints and professional factors including standing, sitting and microclimate.

  5. Magnetic Resonance Imaging in degenerative disease of the lumbar spine: Fat Saturation technique and contrast medium.

    Science.gov (United States)

    D'Aprile, Paola; Nasuto, Michelangelo; Tarantino, Alfredo; Cornacchia, Samantha; Guglielmi, Giuseppe; Jinkins, J Randy

    2018-01-19

    To examine both anterior and posterior elements of the lumbar spine in patients with low back pain using MRI T2-weighted sequences with Fat Saturation (FS) and contrast enhanced T1-weighted sequences with FS. Two thousand eight hundred and twenty (2820) patients (1628 male, 1192 female, mean age 54) presenting low back pain underwent MRI standard examination (Sagittal T1w TSE and T2w TSE, axial T1 SE) with the addition of sagittal and axial T2w Fat Sat (FS) sequences. Among all the patients, 987 (35%) have been studied adding Contrast Enhanced (CE) T1w FS sequences after administration of contrast medium. Among 987 patients studied with contrast medium, we found: active-inflammatory intervertebral osteochondrosis in 646 (65%) patients; degenerative-inflammatory changes in facet joints (facet joint effusion, synovitis, synovial cysts) in 462 (47%); spondylolysis in 69 (7%); degenerative-inflammatory changes of the flava, interspinous and supraspinous ligaments in 245 (25%); inflammatory changes of posterior perispinal muscles in 84 (8%) patients. In patients with suspected no-disc-related low back pain, the implementation of T2w FS and CE T1w FS sequences to the standard MR protocol could allow a better identification of degenerative-inflammatory changes more likely associated to the pain.

  6. 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.

  7. The diagnostic contribution of the frontal lumbar spine radiograph in community referred low back pain - A prospective study of 1030 patients

    Energy Technology Data Exchange (ETDEWEB)

    Khoo, L.A.L. E-mail: lisanne.khoo@stgeorges.nhs.uk; Heron, C.; Patel, U.; Given-Wilson, R.; Grundy, A.; Khaw, K.T.; Dundas, D

    2003-08-01

    AIM: The diagnostic contribution of the anteroposterior (AP) view was studied to assess whether this view could be omitted safely, thus reducing the radiation burden received by patients undergoing lumbar spine radiography. MATERIALS AND METHODS: Prospective analysis of 1030 consecutive referrals for lumbar spine radiography from general practice. RESULTS: In the majority of cases (90.5%) the AP view was non-contributory. In 4.2% the diagnosis was strengthened and it was altered in 4.6%. However, in the latter group only 1.3% of the total were considered significant alterations. These were cases of possible, but not definite, pars defects and sacroiliitis. Specific important conditions such as infection, malignancy and benign tumours were not missed on the lateral view alone, in our study population. The radiation burden is reduced by 75% by omitting the AP view. CONCLUSION: A single lateral view is an adequate examination, with the proviso that sacroiliac joint disease is not assessed on this view and some pars defects and facet joint degenerative changes may be overlooked. The radiation protection gains are considerable. A single lateral lumbar view is now our routine practice unless sacroiliitis is a specific clinical concern.

  8. Direct Posterior Bipolar Cervical Facet Radiofrequency Rhizotomy: A Simpler and Safer Approach to Denervate the Facet Capsule.

    Science.gov (United States)

    Palea, Ovidiu; Andar, Haroon M; Lugo, Ramon; Granville, Michelle; Jacobson, Robert E

    2018-03-14

    Radiofrequency cervical rhizotomy has been shown to be effective for the relief of chronic neck pain, whether it be due to soft tissue injury, cervical spondylosis, or post-cervical spine surgery. The target and technique have traditionally been taught using an oblique approach to the anterior lateral capsule of the cervical facet joint. The goal is to position the electrode at the proximal location of the recurrent branch after it leaves the exiting nerve root and loops back to the cervical facet joint. The standard oblique approach to the recurrent nerve requires the testing of both motor and sensory components to verify the correct position and ensure safety so as to not damage the slightly more anterior nerve root. Bilateral lesions require the repositioning of the patient's neck. Poorly positioned electrodes can also pass anteriorly and contact the nerve root or vertebral artery. The direct posterior approach presented allows electrode positioning over a broader expanse of the facet joint without risk to the nerve root or vertebral artery. Over a four-year period, direct posterior radiofrequency ablation was performed under fluoroscopic guidance at multiple levels without neuro-stimulation testing with zero procedural neurologic events even as high as the C2 spinal segment. The direct posterior approach allows either unipolar or bipolar lesioning at multiple levels. Making a radiofrequency lesion along the larger posterior area of the facet capsule is as effective as the traditional target point closer to the nerve root but technically easier, allowing bilateral access and safety. The article will review the anatomy and innervation of the cervical facet joint and capsule, showing the diffuse nerve supply extending into the capsule of the facet joint that is more extensive than the recurrent medial sensory branches that have been the focus of radiofrequency lesioning.

  9. The value of SPECT bone scans in diagnosis of patients with zygapophseal joint pain

    International Nuclear Information System (INIS)

    Hu Jiajia; Liang Yu; Li Biao; Zhu Chengmo; Chen Gang; Wang Chao; Tian Weijia; Qu Liumin

    2008-01-01

    Objective: Bone scintigraphy with SPECT of the lumbar spine allows identification of lesions not seen with planar imaging, in patients with chronic low back pain. The aim of this study was to investigate the value of SPECT bone scans in diagnosis of patients with zygapophyseal joint pain. Methods: Thirty-five consecutive patients in Ruijin hospital from July 2006 to March 2007 with low back pain were en- rolled. All patients underwent bone scintigraphy with SPECT. According to the results of SPECT, patients with isotope-uptake joints received injections at the levels where abnormalities were identified on the scan. Patients with negative scans received other treatment (conservative treatment or surgery) but not facet joint injection. Clinical records were collected at 1-, 3-, and 6-month in SPECT-positive group after their initial treatment. And the SPECT-negative group were followed up at 6-month after therapy. Statistical analysis was performed with SPSS 10.0. Patients with SPECT-positive and -negative results were performed with the grouped t-test. Visual analog scales (VAS) were with the paired t-test used in patients with positive scans at before and after treatment. Results: Fifteen cases had facetal uptake of isotope on SPECT bone scans. After facet joint injection, 85.7% patients (12/14, 1 patient was excluded for operation) had improvement in pain score at 1-month, 78.6% (11/14) at 3-month, and 50.0% (7/14) at 6-month. Of 20 negative cases, 3 were treated by surgery and 17 by conservative treatment. All 20 cases were followed up for 6 months and 70.0% (14/20) had long time pain relief. Conclusion: SPECT bone scans are helpful to identify patients with low back pain who would benefit from facet joint injections. (authors)

  10. The role of PET/CT in evaluation of Facet and Disc abnormalities in patients with low back pain using 18Fluorine

    International Nuclear Information System (INIS)

    Gamie, S.; El-Maghraby, T.

    2008-01-01

    Bone scintigraphy including Single Photon Emission Computed Tomography (SPECT) is known for its role in the diagnosis of low back pain disorders. Positron Emission Tomography (PET) with 18 Fluoride) as a tracer can be used to carry out bone scans with improved image quality. With the addition of CT, simultaneous PET/CT fused images provide more accurate anatomical details. The objectives of this work are E VCT 64-Slice combined scanner. Imaging started 45-60 minutes after administration of 12-15 mCi (444-55 MBq) of 18 F-Fluoride. The PET scan was acquired from the skull base through the inguinal region in 3D mode at 2 minutes/bed. A low resolution, non-contrast CT scan was also acquired for anatomic localization and attenuation correction. The 18 F-PET/CT showed abnormal uptake in the spine in 56 patients, with an overall detection ability of 84%. Facet joints as a cause of back pain was much more frequent (25 with abnormal scans). One-third (36%) of the patients showed multiple positive uptake in both facet joints and disc areas (20/56). The patients were further divided into two groups. Group A consisted of 42 patients (63%) with back pain and no previous operative procedures, and the 18 F-PET/CT showed a high sensitivity (88%) in identifying the source of pain in 37/42 patients. Group B included 25 patients (37%) with prior lumbar fusion or laminectomy, in which the PET/CT showed positive uptake in 76% (19/25 patients). 18 F-PET/CT showed positive uptake in all patients (100%) with a history of pain after lumbar fusion, while in the laminectomy subgroup only 11 cases (65%) showed positive focal uptake. 18 FPET-CT has potential use in evaluating adult patients with back pain. It has a promising role in identifying causes of persistent back pain following vertebral surgical interventions. (authors)

  11. Segmental lumbar spine instability at flexion-extension radiography can be predicted by conventional radiography

    Energy Technology Data Exchange (ETDEWEB)

    Pitkaenen, M.T.; Manninen, H.I.; Lindgren, K.-A.J.; Sihvonen, T.A.; Airaksinen, O.; Soimakallio, S

    2002-07-01

    AIM: To identify plain radiographic findings that predict segmental lumbar spine instability as shown by functional flexion-extension radiography. MATERIALS AND METHODS: Plain radiographs and flexion-extension radiographs of 215 patients with clinically suspected lumbar spine instability were analysed. Instability was classified into anterior or posterior sliding instability. The registered plain radiographic findings were traction spur, spondylarthrosis, arthrosis of facet joints, disc degeneration, retrolisthesis, degenerative spondylolisthesis, spondylolytic spondylolisthesis and vacuum phenomena. Factors reaching statistical significance in univariate analyses (P < 0.05) were included in stepwise multiple logistic regression analysis. RESULTS: Degenerative spondylolisthesis (P = 0.004 at L3-4 level and P = 0.017 at L4-5 level in univariate analysis and odds ratio 16.92 at L4-5 level in multiple logistic regression analyses) and spondylolytic spondylolisthesis (P = 0.003 at L5-S1 level in univariate analyses) were the strongest independent determinants of anterior sliding instability. Retrolisthesis (odds ratio 10.97), traction spur (odds ratio 4.45) and spondylarthrosis (odds ratio 3.20) at L3-4 level were statistically significant determinants of posterior sliding instability in multivariate analysis. CONCLUSION: Sliding instability is strongly associated with various plain radiographic findings. In mechanical back pain, functional flexion-extension radiographs should be limited to situations when symptoms are not explained by findings of plain radiographs and/or when they are likely to alter therapy. Pitkaenen, M.T. et al. (2002)

  12. Segmental lumbar spine instability at flexion-extension radiography can be predicted by conventional radiography

    International Nuclear Information System (INIS)

    Pitkaenen, M.T.; Manninen, H.I.; Lindgren, K.-A.J.; Sihvonen, T.A.; Airaksinen, O.; Soimakallio, S.

    2002-01-01

    AIM: To identify plain radiographic findings that predict segmental lumbar spine instability as shown by functional flexion-extension radiography. MATERIALS AND METHODS: Plain radiographs and flexion-extension radiographs of 215 patients with clinically suspected lumbar spine instability were analysed. Instability was classified into anterior or posterior sliding instability. The registered plain radiographic findings were traction spur, spondylarthrosis, arthrosis of facet joints, disc degeneration, retrolisthesis, degenerative spondylolisthesis, spondylolytic spondylolisthesis and vacuum phenomena. Factors reaching statistical significance in univariate analyses (P < 0.05) were included in stepwise multiple logistic regression analysis. RESULTS: Degenerative spondylolisthesis (P = 0.004 at L3-4 level and P = 0.017 at L4-5 level in univariate analysis and odds ratio 16.92 at L4-5 level in multiple logistic regression analyses) and spondylolytic spondylolisthesis (P = 0.003 at L5-S1 level in univariate analyses) were the strongest independent determinants of anterior sliding instability. Retrolisthesis (odds ratio 10.97), traction spur (odds ratio 4.45) and spondylarthrosis (odds ratio 3.20) at L3-4 level were statistically significant determinants of posterior sliding instability in multivariate analysis. CONCLUSION: Sliding instability is strongly associated with various plain radiographic findings. In mechanical back pain, functional flexion-extension radiographs should be limited to situations when symptoms are not explained by findings of plain radiographs and/or when they are likely to alter therapy. Pitkaenen, M.T. et al. (2002)

  13. Magnetic resonance imaging of the lumbar spine with axial loading: A review of 120 cases

    International Nuclear Information System (INIS)

    Kinder, Andre; Palma Filho, Fernando; Ribeiro, Elisio; Domingues, Romeu C.; Domingues, Roberto C.; Marchiori, Edson; Gasparetto, Emerson

    2012-01-01

    Purpose: To evaluate the imaging findings of patients with clinical symptoms of lower back pain who underwent magnetic resonance imaging (MRI) of the lumbar spine with axial loading. Materials and methods: We examined 120 patients by MRI, before and after axial loading, using a compression device that applied 50% of their body weight for a load time of 5 min. The dural sac cross area (DSCA) was examined by two experienced radiologists before and after axial load, and their findings were compared. Degenerative abnormalities within and adjacent to the spinal canal were also analyzed. Results: A reduction in DSCA greater than 15 mm 2 after axial load was defined as significant, and was found in 81 patients (67.5%) and 138 disc spaces (38.3%). Reduction was most frequent at L4-L5 (n = 55). For other disorders, a 9% increase in cases of bulging disc was seen during axial loading, and seven disc spaces showed protrusion/extrusion only after load. Facet joint synovial cysts, foraminal stenosis, and hypertrophy of the flavum ligaments showed almost no differences, pre- and post-load. Conclusion: For adequate evaluation of lumbar symptoms, examination should be performed with axial loading, especially in cases of suspected spinal stenosis.

  14. Facets of a life

    International Nuclear Information System (INIS)

    Sakharov, A.

    1991-01-01

    This book is physicist's tribute to Andrei Dmitrievich Sakharov. This out-standing person - a talented physicist and citizen of the world - has played an extremely important role in the deep-going changes occurring in our country. His name belongs to history. Accounts of people who met him and are capable of assessing his scientific work and public activism are just beginning to pour in. In our view, this collection of reminiscences is only a small but essential, contribution to the restoration of A.D. Sakharov's image. Most of the authors, physicists, mathematicians and computer scientists from many countries, knew him as a colleague. To a varying extent, they were a part of his difficult life. This is what this collection is about. Both professional and humanistic facets of his life are described. The book begins with the texts published when he ran for a post of a people's deputy of the USSR and the biographical note printed in the Uspekhi Fizicheskikh Nauk journal after his death. They are mutually complementary for the former contains a short description of his biography and human rights activism, and the latter emphasizes Sakharov's scientific work. The authors' index contains basic data about them. The Annexes contain some previously unpublished Sakharov's documents. Among them there is 'The Letter to Soviet Scientists' with an appeal which, unfortunately, did not get the support it deserved

  15. Partial Facetectomy for Lumbar Foraminal Stenosis

    Directory of Open Access Journals (Sweden)

    Kevin Kang

    2014-01-01

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

  16. Spinal decompensation in degenerative lumbar scoliosis

    NARCIS (Netherlands)

    de Vries, A.A.; Mullender, M.G.; Pluymakers, W.J.; Castelein, R.M.; van Royen, B.J.

    2010-01-01

    Due to the aging population, degenerative scoliosis is a growing clinical problem. It is associated with back pain and radicular symptoms. The pathogenesis of degenerative scoliosis lies in degenerative changes of the spinal structures, such as the intervertebral disc, the facet joints and the

  17. SLAC Linac Preparations for FACET

    International Nuclear Information System (INIS)

    Erickson, Roger

    2011-01-01

    The SLAC 3km linear electron accelerator has been cut at the two-thirds point to provide beams to two independent programs. The last third provides the electron beam for the Linac Coherent Light Source (LCLS), leaving the first two-thirds available for FACET, the new experimental facility for accelerator science and test beams. In this paper, we describe this separation and projects to prepare the linac for the FACET experimental program.

  18. Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review

    Energy Technology Data Exchange (ETDEWEB)

    Bonaldi, G., E-mail: bbonaldi@yahoo.com [Neuroradiology Department, Ospedale Papa Giovanni XXIII, Bergamo (Italy); Brembilla, C. [Department of neurosurgery, Ospedale Papa Giovanni XXIII, Bergamo (Italy); Cianfoni, A. [Neuroradiology of Neurocenter of Italian Switzerland, Lugano, CH (Switzerland)

    2015-05-15

    The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered “standard of care”, are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists’ interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications.

  19. Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review

    International Nuclear Information System (INIS)

    Bonaldi, G.; Brembilla, C.; Cianfoni, A.

    2015-01-01

    The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered “standard of care”, are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists’ interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications

  20. The Effect of Core Stabilization Exercise on the Kinematics and Joint Coordination of the Lumbar Spine and Hip During Sit-to-Stand and Stand-to-Sit in Patients With Chronic Nonspecific Low Back Pain (COSCIOUS): Study Protocol for a Randomized Double-Blind Controlled Trial.

    Science.gov (United States)

    Pourahmadi, Mohammad Reza; Ebrahimi Takamjani, Ismail; Jaberzadeh, Shapour; Sarrafzadeh, Javad; Sanjari, Mohammad Ali; Mohsenifar, Holakoo; Bagheri, Rasool; Taghipour, Morteza

    2017-06-01

    Chronic nonspecific low back pain (CNLBP) is among the most prevalent health problems. Lumbar spine and hips kinematics and coordination can be affected in CNLBP. The effects of exercises on the kinematics and coordination of lumbar spine and hips during sit-to-stand (STS) and its reverse have not been evaluated. The aim of this study is to investigate the effect of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during STS and its reverse in CNLBP patients. COSCIOUS is a parallel randomized double-blind controlled trial. A total of 30 CNLBP patients and 15 asymptomatic participants will be included. The kinematics and joint coordination of the lumbar spine and hips will be evaluated during STS and its reverse using a motion capture system. The participants will be asked to sit in their usual posture on a stool. Reflective markers will be placed over the T12, S2, anterior and posterior superior iliac spines, greater trochanters, and lateral femoral epicondyles of both legs. The participants will be instructed to stand up at natural speed, remain in the erect posture for 3 seconds, and then sit down. Kinematic variables of the lumbar spine and hip will be computed. Afterward, the CNLBP participants will be allocated at random to receive one of 2 interventions: core stabilization or general exercise. Treatment sessions will be held 3 times per week for 16 sessions. After intervention, CNLBP participants will be assessed again. Funding for the study was provided in 2016 by Iran University of Medical Sciences. The study is expected to last approximately 12 months, depending on recruitment. Findings on the study's primary outcomes are expected to be finalized by December 2017. The results of the study will be published in a peer-reviewed journal. This investigation will evaluate the effects of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during STS and its reverse in

  1. 13. Sacroiliac joint pain

    NARCIS (Netherlands)

    Vanelderen, P.; Szadek, K.M.; Cohen, S.P.; Witte, J.; Lataster, A.; Patijn, J.; Mekhail, N.; van Kleef, M.; van Zundert, J.

    2010-01-01

    The sacroiliac joint accounts for approximately 16% to 30% of cases of chronic mechanical low back pain. Pain originating in the sacroiliac joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumbar region, groin, abdomen, and/ or lower

  2. 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.

  3. The reproducibility of quantitative measurements in lumbar magnetic resonance imaging of children from the general population

    DEFF Research Database (Denmark)

    Masharawi, Y; Kjær, Per; Bendix, T

    2008-01-01

    --zygoappophyseal tranverse superior facet angles, sagittal VB, and disc wedging, lumbar lordosis, and sacral inclination. Statistical analysis included the concordance correlation coefficient (CCC), and Bland and Altman's limits of agreement (LOA). RESULTS: A total of 6160 measurements were analyzed. Good to excellent...... intratester reproducibility (0.75 lordosis, and sacral inclination (LOA: 11.22 degrees ; 12.34 degrees). VB and disc...

  4. Preamble to marine microbiology: Facets and opportunities

    Digital Repository Service at National Institute of Oceanography (India)

    Ramaiah, N.

    The book titled 'Marine Microbiology: Facets & Opportunities' is an attempt to bring together some facets of marine microbiology as have been made out by many contemporaries in particular from the tropical marine regions. There are 18 contributed...

  5. Development and Validation of the Faceted Inventory of the Five-Factor Model (FI-FFM).

    Science.gov (United States)

    Watson, David; Nus, Ericka; Wu, Kevin D

    2017-06-01

    The Faceted Inventory of the Five-Factor Model (FI-FFM) is a comprehensive hierarchical measure of personality. The FI-FFM was created across five phases of scale development. It includes five facets apiece for neuroticism, extraversion, and conscientiousness; four facets within agreeableness; and three facets for openness. We present reliability and validity data obtained from three samples. The FI-FFM scales are internally consistent and highly stable over 2 weeks (retest rs ranged from .64 to .82, median r = .77). They show strong convergent and discriminant validity vis-à-vis the NEO, the Big Five Inventory, and the Personality Inventory for DSM-5. Moreover, self-ratings on the scales show moderate to strong agreement with corresponding ratings made by informants ( rs ranged from .26 to .66, median r = .42). Finally, in joint analyses with the NEO Personality Inventory-3, the FI-FFM neuroticism facet scales display significant incremental validity in predicting indicators of internalizing psychopathology.

  6. Bilateral locked facets in the thoracic spine

    NARCIS (Netherlands)

    M.H.A. Willems; Braakman, R. (Reinder); B. van Linge (Bert)

    1984-01-01

    textabstractTwo cases of traumatic bilateral locked facets in the thoracic spine are reported. Both patients had only minor neurological signs. They both made a full neurological recovery after surgical reduction of the locked facets. Bilateral locked facets are very uncommon in the thoracic spine.

  7. Computed tomography in lumbar canal stenosis

    International Nuclear Information System (INIS)

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

    1984-01-01

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

  8. Facets of Facebook: Use and Users

    OpenAIRE

    2016-01-01

    The debate on Facebook raises questions about the use and users of this information service. This collected volume gathers a broad spectrum of social science and information science articles about Facebook.Facebook has many facets, and we just look forward above all to the use and users. The facet of users has sub-facets, such as different age, sex, and culture. The facet of use consists of sub-facets of privacy behavior after the Snowden affair, dealing with friends, unfriending and becoming...

  9. Quantum mechanical facets of chemical bonds

    International Nuclear Information System (INIS)

    Daudel, R.

    1976-01-01

    To define the concept of bond is both a central problem of quantum chemistry and a difficult one. The concept of bond appeared little by little in the mind of chemists from empirical observations. From the wave-mechanical viewpoint it is not an observable. Therefore there is no precise operator associated with that concept. As a consequence there is not a unique approach to the idea of chemical bond. This is why it is preferred to present various quantum mechanical facets, e.g. the energetic facet, the density facet, the partitioning facet and the functional facet, of that important concept. (Auth.)

  10. The cervical facet capsule and its role in whiplash injury: a biomechanical investigation.

    Science.gov (United States)

    Winkelstein, B A; Nightingale, R W; Richardson, W J; Myers, B S

    2000-05-15

    Cervical facet capsular strains were determined during bending and at failure in the human cadaver. To determine the effect of an axial pretorque on facet capsular strains and estimate the risk for subcatastrophic capsular injury during normal bending motions. Epidemiologic and clinical studies have identified the facet capsule as a potential site of injury and prerotation as a risk factor for whiplash injury. Unfortunately, biomechanical data on the cervical facet capsule and its role in whiplash injury are not available. Cervical spine motion segments were tested in a pure-moment test frame and the full-field strains determined throughout the facet capsule. Motion segments were tested with and without a pretorque in pure bending. The isolated facet was then elongated to failure. Maximum principal strains during bending were compared with failure strains, by paired t test. Statistically significant increases in principal capsular strains during flexion-extension loading were observed when a pretorque was applied. All measured strains during bending were significantly less than strains at catastrophic joint failure. The same was true for subcatastrophic ligament failure strains, except in the presence of a pretorque. Pretorque of the head and neck increases facet capsular strains, supporting its role in the whiplash mechanism. Although the facet capsule does not appear to be at risk for gross injury during normal bending motions, a small portion of the population may be at risk for subcatastrophic injury.

  11. The potential impact of various diagnostic strategies in cases of chronic pain syndromes associated with lumbar spine degeneration

    Directory of Open Access Journals (Sweden)

    Bokov A

    2013-04-01

    Full Text Available Andrey Bokov, Olga Perlmutter, Alexander Aleynik, Marina Rasteryaeva, Sergey Mlyavykh Scientific Research Institute of Traumatology and Orthopedics, Nizhniy Novgorod, Russian Federation Purpose: To study the possible effects of various diagnostic strategies and the relative contribution of various structures in order to determine the optimal diagnostic strategy in treating patients with noncompressive pain syndromes. Study design: Prospective, nonrandomized cohort study of 83 consecutive patients with noncompressive pain syndromes resistant to repeated courses of conservative treatment. The follow-up period was 18 months. Results: Nucleoplasty was effective in cases of discogenic pain; the consequences related to false positive results of the discography were significant. The most specific criterion was 80% pain relief after facet joint blocks, whereas 50% pain relief and any subjective pain relief were not associated with a significant increase in the success rate. A considerable rate of false negative results was associated with 80% pain relief, whereas 50% pain relief after facet joint blocks showed the optimal ratio of sensitivity and specificity. Facet joint pain was detected in 50.6% of cases (95% confidence interval 44.1%–66.3%, discogenic pain in 16.9% cases (95% confidence interval 9.5%–26.7%, and sacroiliac joint pain in 7.2% cases (95% confidence interval 2.7%–15%. It was impossible to differentiate the main source of pain in 25.3% of cases. Conclusion: It is rational to adjust the diagnostic algorithm to the probability of detecting a particular pain source and, in doing so, reduce the number of invasive diagnostic measures to evaluate a pain source. False positive results of diagnostic measures can negatively affect the overall efficacy of a particular technology; therefore, all reasons for the failure should be studied in order to reach an unbiased conclusion. In choosing diagnostic criteria, not only should the success rate

  12. Prevalence and Characteristics of Discogenic Pain in Tertiary Practice: 223 Consecutive Cases Utilizing Lumbar Discography.

    Science.gov (United States)

    Verrills, Paul; Nowesenitz, Gillian; Barnard, Adele

    2015-08-01

    Between 26% and 42% of chronic low back pain is attributed to internal disc disruption of lumbar intervertebral discs. These prevalence estimates and data characterizing discogenic pain originate largely from research at elite practices, conducted 20 years ago. With few studies since, their concordance with rates in community practice has rarely been addressed. To assess the prevalence and key features of discogenic pain within community-based tertiary practice, and to evaluate the accuracy and clinical utility of discography. This prospective, three-year study of 223 consecutive cases of chronic low back pain used image-guided lumbar discography to identify symptomatic and flanking asymptomatic discs. A subset of patients (n = 195) had previously undergone posterior column blocks to investigate spinal facet and/or sacroiliac joints as contributing pain sources. A total of 644 discs were tested without infection or complication. Positive discograms were recorded in 74% of patients, with 22.9% negative and 3.1% assessed as indeterminate. Among patients receiving both discography and diagnostic blocks, 63% had proven discogenic pain, 18% had pain of mixed etiology and 14% remained undiagnosed. Taking into account all low back pain cases during this study (n = 756), discogenic pain prevalence was 21.8% (95% CI: 17-26%). The prevalence of discogenic pain in this community practice is below the range, but within confidence intervals, previously reported. Prevalence is considerably elevated, however, among well-selected patients and discography enabled a firm diagnosis in most such cases. These findings are broadly in keeping with those reached in key publications and support the clinical utility of discography. Wiley Periodicals, Inc.

  13. Lumbar dorsal ramus syndrome.

    Science.gov (United States)

    Bogduk, N

    1980-11-15

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

  14. Evidence-based radiology (part 1): Is there sufficient research to support the use of therapeutic injections for the spine and sacroiliac joints?

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Cynthia; Hodler, Juerg [Orthopaedic University Hospital of Balgrist, Radiology, Zuerich (Switzerland)

    2010-01-15

    This review article addresses the best evidence currently available for therapeutic injection therapy for conditions targeting the spine and sacroiliac joints. The article is presented by spinal region. Controversies and areas of interest for further studies are identified. There is conclusive evidence supporting the effectiveness of the caudal approach for the administration of epidural steroid injections for patients with low back pain from a variety of causes. In general, there is moderate-to-strong evidence supporting the use of transforaminal therapeutic epidural injections for lumbar nerve-root compression and facet injections for joint pain arising from these joints in the cervical, thoracic and lumbar spine, but further subgroup analysis is needed to help predict which specific patients may receive the most benefit from these procedures. No randomized controlled trials, meta-analyses or systematic reviews addressing the effectiveness of therapeutic sacroiliac joint injections have been found. For some injections, corticosteroids may not provide better outcomes compared to local anesthetic injections alone. (orig.)

  15. 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

  16. Lumbar spinal stenosis

    DEFF Research Database (Denmark)

    Lønne, Greger; Fritzell, Peter; Hägg, Olle

    2018-01-01

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

  17. MANAGEMENT OF LUMBAR SPINAL CANAL STENOSIS

    Directory of Open Access Journals (Sweden)

    Mukhergee G. S

    2016-06-01

    degenerative. This process is most commonly localised to the facet joints and ligamentum flavum, with the resultant arthritic changes in the joints visible on radiographic studies. Frequently, these abnormalities are symmetrical and bilateral. The L4-L5 level is the most commonly involved, followed by L5-S1 and L3-L4 disc herniation and spondylolisthesis may exacerbate the narrowing further. 1. METHODS This study was taken up to evaluate the management of lumbar spinal canal stenosis cases. The study was conducted from May 2012 to October 2014: A total of 86 patients of 55-70 age groups with degenerative LCS were followed prospectively from May 2012 to October 2014. All the treatment methods were explained to patients and treatment method was determined by patient’s choice. The sample is divided into two groups 42 surgical and 44 conservative based on patient’s preference. MEASUREMENT OF OUTCOME Outcomes were measures of bodily pain and physical function on the medical outcomes study 36-item short-Form General Health Study (SF-36 22-25 and on the modified Oswestry Disability Index 26 measured at 6 weeks, 3 months, 6 months, and 1 year and 18 months. SF-36 scores range from 0 to 100 with higher scores indicating less severe symptoms. The Oswestry Disability Index ranges from 0 to 100, with lower scores indicating less severe symptoms. STUDY INTERVENTION The protocol surgery was standard posterior decompressive laminectomy operated by three surgeons. The type of nonsurgical care included physical therapy (68% of patients, epidural injections (56%, the use of anti-inflammatory drugs (55% and use of opioid analgesics (27%. Informed consent was taken from every patient after explaining the particulars of study interventions. In this study, 82% patients (n=70 were in age group 50-59 years with an average age of 50.2 years with a total sample size of 86 patients followed by 60-69 years age group. Both the surgical and conservative groups had similar sex distribution. Initially

  18. Different facets of market orientation

    DEFF Research Database (Denmark)

    Ormrod, Robert P.; Henneberg, Stephan C.

    2009-01-01

    the UK parties generally exhibited similar levels of market orientation on each of the relevant construct dimensions, the German parties had more distinct profiles; thus the applied dimensions of political market orientation show discriminatory power within and across electoral systems. In the UK......In this study we employ the concept of political market orientation to better understand how the main political parties in the UK and Germany relate to other stakeholders in the political sphere through an exploratory content analysis of their core election offering, the manifesto. This study has...... two aims: firstly, we will discuss the different facets of the market orientation of the main UK and German parties in their respective 2005 General Elections through an exploratory content analysis, and secondly, we will compare characteristics of market orientation between the two countries. Whilst...

  19. Overload pain but root differentiation discomfort in the lumbar spine

    Directory of Open Access Journals (Sweden)

    Joanna Siminska

    2017-06-01

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

  20. Assessment of the suitability of biodegradable rods for use in posterior lumbar fusion: An in-vitro biomechanical evaluation and finite element analysis.

    Directory of Open Access Journals (Sweden)

    Fon-Yih Tsuang

    Full Text Available Interbody fusion with posterior instrumentation is a common method for treating lumbar degenerative disc diseases. However, the high rigidity of the fusion construct may produce abnormal stresses at the adjacent segment and lead to adjacent segment degeneration (ASD. As such, biodegradable implants are becoming more popular for use in orthopaedic surgery. These implants offer sufficient stability for fusion but at a reduced stiffness. Tailored to degrade over a specific timeframe, biodegradable implants could potentially mitigate the drawbacks of conventional stiff constructs and reduce the loading on adjacent segments. Six finite element models were developed in this study to simulate a spine with and without fixators. The spinal fixators used both titanium rods and biodegradable rods. The models were subjected to axial loading and pure moments. The range of motion (ROM, disc stresses, and contact forces of facet joints at adjacent segments were recorded. A 3-point bending test was performed on the biodegradable rods and a dynamic bending test was performed on the spinal fixators according to ASTM F1717-11a. The finite element simulation showed that lumbar spinal fusion using biodegradable implants had a similar ROM at the fusion level as at adjacent levels. As the rods degraded over time, this produced a decrease in the contact force at adjacent facet joints, less stress in the adjacent disc and greater loading on the anterior bone graft region. The mechanical tests showed the initial average fatigue strength of the biodegradable rods was 145 N, but this decreased to 115N and 55N after 6 months and 12 months of soaking in solution. Also, both the spinal fixator with biodegradable rods and with titanium rods was strong enough to withstand 5,000,000 dynamic compression cycles under a 145 N axial load. The results of this study demonstrated that biodegradable rods may present more favourable clinical outcomes for lumbar fusion. These polymer rods

  1. Coupled motions in human and porcine thoracic and lumbar spines

    NARCIS (Netherlands)

    Kingma, Idsart; Busscher, Iris; van der Veen, Albert J.; Verkerke, Gijsbertus J.; Veldhuizen, Albert G.; Homminga, Jasper; van Dieën, Jaap H.

    2018-01-01

    Coupled motions, i.e., motions along axes other than the loaded axis, have been reported to occur in the human spine, and are likely to be influenced by inclined local axes due to the sagittal plane spine curvature. Furthermore, the role of facet joints in such motions is as yet unclear. Therefore,

  2. Coupled motions in human and porcine thoracic and lumbar spines

    NARCIS (Netherlands)

    Kingma, Idsart; Busscher, Iris; van der Veen, Albert J.; Verkerke, Gijsbertus J.; Veldhuizen, Albert G.; Homminga, Jasper; van Dieën, Jaap H.

    2017-01-01

    Coupled motions, i.e., motions along axes other than the loaded axis, have been reported to occur in the human spine, and are likely to be influenced by inclined local axes due to the sagittal plane spine curvature. Furthermore, the role of facet joints in such motions is as yet unclear. Therefore,

  3. Association between CT-evaluated lumbar lordosis and features of spinal degeneration, evaluated in supine position

    Science.gov (United States)

    Kalichman, Leonid; Li, Ling; Hunter, David; Been, Ella

    2013-01-01

    Background Context Few studies have directly evaluated the association of lumbar lordosis and segmental wedging of the vertebral bodies and intervertebral disks with prevalence of spinal degenerative features. Purpose To evaluate the association of CT-evaluated lumbar lordosis, segmental wedging of the vertebral bodies and that of the intervertebral disks with various spinal degeneration features. Study design This cross-sectional study was a nested project to the Framingham Heart Study. Sample A random consecutive subset of 191 participants chosen from the 3590 participants enrolled in the Framingham Heart Study who underwent multi-detector CT to assess aortic calcification. Outcome Measures Physiologic Measures Dichotomous variables indicating the presence of intervertebral disc narrowing, facet joint osteoarthritis, spondylolysis, spondylolisthesis and spinal stenosis and density (in Hounsfield units) of multifidus and erector spinae muscles were evaluated on supine CT, as well as the lordosis angle (LA) and the wedging of the vertebral bodies and intervertebral disks. Sum of vertebral bodies wedging (ΣB) and sum of intervertebral discs wedging (ΣD) were used in analyses. Methods Mean values (±SD) of LA, ΣB and ΣD were calculated in males and females and compared using the t-test. Mean values (±SD) of LA, ΣB and ΣD in 4 age groups: 0.05) with increasing age. LA showed statistically significant association with presence of spondylolysis (OR(95%CI): 1.08(1.02–1.14)) and with density of multifidus (1.06 (1.01–1.11). as well as a marginally significant association with isthmic spondylolisthesis (1.07(1.00–1.14). ΣB showed a positive association with degenerative spondylolisthesis and disc narrowing ((1.14(1.06–1.23) and 1.04 (1.00–1.08), correspondingly), whereas ΣD showed negative one (0.93(0.87–0.98) and (0.93(0.89–0.97), correspondingly). Conclusions Significant associations were found between lumbar lordosis evaluated in supine position

  4. Eight Key Facets of Small Business Management.

    Science.gov (United States)

    Scott, James Calvert

    1980-01-01

    Identifies eight key facets of small business management and suggests activities that may be used to assist in their development. The key facets are (1) product or service, (2) competition, (3) marketing strategies, (4) personnel needs, (5) equipment and facility needs, (6) finances, (7) planning, and (8) entrepreneurship. (JOW)

  5. Intradiscal and intra-articular facet infiltrations with plasma rich in growth factors reduce pain in patients with chronic low back pain

    Science.gov (United States)

    Kirchner, Fernando; Anitua, Eduardo

    2016-01-01

    Context: Low back pain (LBP) is a complex and disabling condition, and its treatment becomes a challenge. Aims: The aim of our study was to assess the clinical outcome of plasma rich in growth factors (PRGF-Endoret) infiltrations (one intradiscal, one intra-articular facet, and one transforaminal epidural injection) under fluoroscopic guidance-control in patients with chronic LBP. PRGF-Endoret which has been shown to be an efficient treatment to reduce joint pain. Settings and Design: The study was designed as an observational retrospective pilot study. Eighty-six patients with a history of chronic LBP and degenerative disease of the lumbar spine who met inclusion and exclusion criteria were recruited between December 2010 and January 2012. Subjects and Methods: One intradiscal, one intra-articular facet, and one transforaminal epidural injection of PRGF-Endoret under fluoroscopic guidance-control were carried out in 86 patients with chronic LBP in the operating theater setting. Statistical Analysis Used: Descriptive statistics were performed using absolute and relative frequency distributions for qualitative variables and mean values and standard deviations for quantitative variables. The nonparametric Friedman statistical test was used to determine the possible differences between baseline and different follow-up time points on pain reduction after treatment. Results: Pain assessment was determined using a visual analog scale (VAS) at the first visit before (baseline) and after the procedure at 1, 3, and 6 months. The pain reduction after the PRGF-Endoret injections showed a statistically significant drop from 8.4 ± 1.1 before the treatment to 4 ± 2.6, 1.7 ± 2.3, and 0.8 ± 1.7 at 1, 3, and 6 months after the treatment, respectively, with respect to all the time evaluations (P PRGF in patients with chronic LBP resulted in significant pain reduction assessed by VAS. PMID:27891035

  6. Lumbar spine chordoma

    Directory of Open Access Journals (Sweden)

    M.A. Hatem, M.B.Ch.B, MRes, LMCC

    2014-01-01

    Full Text Available Chordoma is a rare tumor arising from notochord remnants in the spine. It is slow-growing, which makes it difficult to diagnose and difficult to follow up after treatment. Typically, it occurs in the base of the skull and sacrococcygeal spine; it rarely occurs in other parts of the spine. CT-guided biopsy of a suspicious mass enabled diagnosis of lumbar spine chordoma.

  7. Osteocondroma lumbar sintomático

    OpenAIRE

    González Darder, José M.; Barcia, Juan Antonio; Vera Roman, J. Mª; Vargas, S.

    1993-01-01

    Se presenta un caso de osteocondroma solitario espinal localizado en la zona para-articular de la lámina izquierda de L4 y que producía una lumbociática secundaria a la estenosis del receso lateral. El osteocondroma espinal sintomático es una lesión neoplásica benigna poco frecuente y cuyo tratamiento de elección es la extirpación quirúrgica. A case of solitary spinal osteochondroma growing from the left L4 lamina, close to the facet joint, is presented. The tumor produced a st...

  8. Spontaneous resolution of symptoms associated with a facet synovial cyst in an adult female – a case report

    Science.gov (United States)

    Ngo, Trung; Decina, Philip; Hsu, William

    2013-01-01

    Background: Facet cysts are implicated in neural compression in the lumbar spine. Surgery is the definitive treatment for symptomatic facet cysts since the failure rate for conservative treatment is quite high; however, the role of physical/manual medicine practitioners in the management of symptomatic facet cysts has not been well explored. This case report will add to the body of evidence of spontaneous resolution of symptoms associated with facet cysts in the chiropractic literature. Case: A 58 year old female presented with acute low back and right leg pain which she attributed to a series of exercise classes that involved frequent foot stomping. Physical examination did not elicit any objective evidence of radiculopathy but MRI and CT scans revealed a facet cyst impinging on the right L5 nerve root. Injections and surgery were recommended; however, the patient’s radicular symptoms completely resolved after three months without surgical intervention. Summary: There is currently a paucity of data in the literature regarding the chiropractor’s role in the management of symptomatic facet cysts. The case presented here has added to this literature and possible areas for future research have been explored. PMID:23483069

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

  10. Unilateral lumbar spondylolysis on radiography and MRI: emphasis on morphologic differences according to involved segment.

    Science.gov (United States)

    Park, Ji Seon; Moon, Sung Kyoung; Jin, Wook; Ryu, Kyung Nam

    2010-01-01

    The objective of our study was to retrospectively compare the radiography and MRI findings of unilateral spondylolysis in the upper lumbar segment and in the lower lumbar segment and to consider how these radiologic findings can be applied in the diagnosis of unilateral spondylolysis. Thirty patients with unilateral lumbar spondylolysis were categorized into one of two groups according to the lumbar levels involved with pars interarticularis defects: group A (L1, L2, and L3) or group B (L4 and L5). On radiographs, we evaluated contour bulging of the affected pars interarticularis, reactive sclerosis in the contralateral pedicle, anterolisthesis of the involved vertebra, and deviation of the spinous process. On MRI, we assessed pseudoarticulation of the pars interarticularis defect, uneven distribution of posterior epidural fat, the interspinous distance between adjacent segments, facet and disk degeneration in adjacent segments, and other anomalous changes. Among the 63 patients with unilateral spondylolysis, the upper lumbar segment was involved in 29 and the lower lumbar segment, in 34. Group A often displayed contour bulging of the affected pars interarticularis, reactive sclerosis of the contralateral pedicle, and contralateral deviation of the spinous process, all of which were easily detectable on radiography. Group B frequently showed anterolisthesis, pseudoarticulation of the pars interarticularis defect, adjacent facet-disk degeneration, and other anomalous changes that were well observed on MRI. Unilateral lumbar spondylolysis displayed radiologic differences in morphology of the isthmic defect itself and in ancillary findings of the adjacent structures based on the segment involved. Recognition of different ancillary features of unilateral spondylolysis with the use of a feasible diagnostic tool can be helpful for the diagnosis of cases in which a direct sign of isthmic defect is equivocal.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    1996-05-01

    flexion, obesity or quite simply overuse, involve an increase in the lumbar lordosis. The posterior articulations are worn out and the disc gets damaged by shear forces. The disc space becomes shorter with a bulging disc, and the inferior articular process of the superior vertebra goes down. This is responsible of a loss of lordosis. For restoring the sagittal balance the patient needs more extension of the spine. Above and below the considered level the degenerative disease carries on extending to the whole spine. At the level considered, because of local extension, the inferior facet moves forward, the disc bulges, the ligamentum flavum is shortened and the stenosis is increased. This situation is improved by local kyphosis: the inferior facet moves backward, the disc and the ligamentum flavum are stretched with a quite normal posterior disc height and most often there is no more stenosis. Myelograms show this very well with a quite normal appearance lying, clear compression standing, worse in extension and improved, indeed disappeared in flexion. CT scan and MRI don't show that because they are done lying. The expression of the clinical situation is the same, mute lying and maximum standing with restriction of walking. For us lumbar stenosis is operated with lumbar reconstruction without opening the canal. The patient is in moderate kyphosis on the operating table. Pedicle screws rotated to match a bent rod allow reduction of the spine. The posterior disc height is respected and not distracted, and the anterior part of the disc is stretched in lordosis. The inferior facet is cut for the arthrodesis and no longer compresses the dura. The canal is well enlarged and the lumbar segment in lordosis is the best protection of the adjacent levels at follow-up. This behaviour responds to the same analysis as the ≪recalibrage≫ (enlargement). The mobile segment is damaged by the degenerative disease, the stenosis is a consequence of this damage. It's logical to treat the

  13. 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.

  14. Sideflexion induced lumbar spine conjunct rotation and its influencing factors.

    Science.gov (United States)

    Vicenzino, G; Twomey, L

    1993-01-01

    Twenty motion segments from four male post mortem subjects with a mean age of 29 years were moved into the lumbar spine test positions of extension/left sideflexion, extension/right sideflexion, flexion/left sideflexion and flexion/right sideflexion Jheconjunct rotation (CR) that occurred was measured from a photographic record. The results indicated that the direction of the CR of the whole lumbar spine (ie between L1 and S1) was significantly different between the flexed and extended lumbar spine position. The direction of the CR was also significantly different between the different intervertebral motion segment levels. There was no relationship between CR and zygapophyseal joint geometry or intervertebral disc degeneration. Copyright © 1993 Australian Physiotherapy Association. Published by . All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-01-01

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

  16. The use of CT scanning for the study of posterior lumbar intervertebral articulations

    International Nuclear Information System (INIS)

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

    1983-01-01

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

  17. Characteristic MRI and MR Myelography Findings for the Facet Cyst Hematoma at T12-L1 Spine: A Case Report

    International Nuclear Information System (INIS)

    Chung, Seung Eun; Lee, Sang Ho; Kim, Tae Hong; Choi, Gun; Paeng, Sung Suk

    2011-01-01

    A facet cyst is a very rare condition in the thoracolumbar spine and more so, hemorrhage into a cyst is extremely rare. We present a case of a facet cyst hematoma in the T12-L1 spine. A 69-year-old woman complained of chronic back pain with right lower extremity pain, and weakness for 3 years. MRI and MR myelography showed an extradural mass at the T12-L1 level with heterogeneous signal intensity on both T1-and T2-weighted images, which was continuous to the right T12-L1 facet joint. The neighboring facet joint showed severe degeneration on the CT scan. The mass a was simple hematoma covered with a thin fibrous membrane and connected with facet joint macroscopically and microscopically. The pathogenesis of the facet cyst hematoma is not clear but it can compress nerve roots or dura mater and cause radiculopathy or cauda equina syndrome. Surgical removal should be recommended for symptomatic relief.

  18. Characteristic MRI and MR Myelography Findings for the Facet Cyst Hematoma at T12-L1 Spine: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Seung Eun [Dept of Diagnostic Radiology, Wooridul Spine Hospital, Seoul (Korea, Republic of); Lee, Sang Ho [Dept. of Neurosurgery, Wooridul Spine Hospital, Seoul (Korea, Republic of); Kim, Tae Hong [Dept. of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Choi, Gun [Dept. of Neurosurgery, Seoul Wooridul Hospital, Seoul (Korea, Republic of); Paeng, Sung Suk [Dept of Radiology, Wooridul Spine Hospital, Seoul (Korea, Republic of)

    2011-05-15

    A facet cyst is a very rare condition in the thoracolumbar spine and more so, hemorrhage into a cyst is extremely rare. We present a case of a facet cyst hematoma in the T12-L1 spine. A 69-year-old woman complained of chronic back pain with right lower extremity pain, and weakness for 3 years. MRI and MR myelography showed an extradural mass at the T12-L1 level with heterogeneous signal intensity on both T1-and T2-weighted images, which was continuous to the right T12-L1 facet joint. The neighboring facet joint showed severe degeneration on the CT scan. The mass a was simple hematoma covered with a thin fibrous membrane and connected with facet joint macroscopically and microscopically. The pathogenesis of the facet cyst hematoma is not clear but it can compress nerve roots or dura mater and cause radiculopathy or cauda equina syndrome. Surgical removal should be recommended for symptomatic relief.

  19. Scalable Faceted Ranking in Tagging Systems

    Science.gov (United States)

    Orlicki, José I.; Alvarez-Hamelin, J. Ignacio; Fierens, Pablo I.

    Nowadays, web collaborative tagging systems which allow users to upload, comment on and recommend contents, are growing. Such systems can be represented as graphs where nodes correspond to users and tagged-links to recommendations. In this paper we analyze the problem of computing a ranking of users with respect to a facet described as a set of tags. A straightforward solution is to compute a PageRank-like algorithm on a facet-related graph, but it is not feasible for online computation. We propose an alternative: (i) a ranking for each tag is computed offline on the basis of tag-related subgraphs; (ii) a faceted order is generated online by merging rankings corresponding to all the tags in the facet. Based on the graph analysis of YouTube and Flickr, we show that step (i) is scalable. We also present efficient algorithms for step (ii), which are evaluated by comparing their results with two gold standards.

  20. The growth of faceted/nonfaceted eutectics

    International Nuclear Information System (INIS)

    Suchtelen, J. van

    1976-01-01

    This paper is concerned with the unidirectional solidification of eutectic melts in which one of the phases has a faceted, the other a nonfaceted solid-liquid interface. The occurrence of complex microstructures in such eutectics is explained as a growth phenomenon. The essential condition for the occurrence of such structures is a non-isothermal solid-liquid interface, developing into a faceted-cellular structure. The faceted shape of the cells is imposed by the faceted component of the eutectic. Breakdown to such a cellular structure occurs not only in constitutional-supercooling conditions, but under any circumstances, the cellular period being a function of growth velocity, temperature gradient etc. The two-phase morphology of the eutectic structure is discussed in terms of the relative magnitude of the periods of the cellular and of the eutectic structure. (orig.) [de

  1. FACET CLASSIFICATIONS OF E-LEARNING TOOLS

    Directory of Open Access Journals (Sweden)

    Olena Yu. Balalaieva

    2013-12-01

    Full Text Available The article deals with the classification of e-learning tools based on the facet method, which suggests the separation of the parallel set of objects into independent classification groups; at the same time it is not assumed rigid classification structure and pre-built finite groups classification groups are formed by a combination of values taken from the relevant facets. An attempt to systematize the existing classification of e-learning tools from the standpoint of classification theory is made for the first time. Modern Ukrainian and foreign facet classifications of e-learning tools are described; their positive and negative features compared to classifications based on a hierarchical method are analyzed. The original author's facet classification of e-learning tools is proposed.

  2. PARAMETRIC MODEL OF LUMBAR VERTEBRA

    Directory of Open Access Journals (Sweden)

    CAPPETTI Nicola

    2010-11-01

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

  3. 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 <50% improvement in ODI and VAS or any additional surgery at index or adjacent spine motion segment. Three ADRs were evaluated: 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.

  4. Migration mechanisms of a faceted grain boundary

    Science.gov (United States)

    Hadian, R.; Grabowski, B.; Finnis, M. W.; Neugebauer, J.

    2018-04-01

    We report molecular dynamics simulations and their analysis for a mixed tilt and twist grain boundary vicinal to the Σ 7 symmetric tilt boundary of the type {1 2 3 } in aluminum. When minimized in energy at 0 K , a grain boundary of this type exhibits nanofacets that contain kinks. We observe that at higher temperatures of migration simulations, given extended annealing times, it is energetically favorable for these nanofacets to coalesce into a large terrace-facet structure. Therefore, we initiate the simulations from such a structure and study as a function of applied driving force and temperature how the boundary migrates. We find the migration of a faceted boundary can be described in terms of the flow of steps. The migration is dominated at lower driving force by the collective motion of the steps incorporated in the facet, and at higher driving forces by the step detachment from the terrace-facet junction and propagation of steps across the terraces. The velocity of steps on terraces is faster than their velocity when incorporated in the facet, and very much faster than the velocity of the facet profile itself, which is almost stationary. A simple kinetic Monte Carlo model matches the broad kinematic features revealed by the molecular dynamics. Since the mechanisms seem likely to be very general on kinked grain-boundary planes, the step-flow description is a promising approach to more quantitative modeling of general grain boundaries.

  5. [Lumbar spinal angiolipoma].

    Science.gov (United States)

    Isla, Alberto; Ortega Martinez, Rodrigo; Pérez López, Carlos; Gómez de la Riva, Alvaro; Mansilla, Beatriz

    2016-01-01

    Spinal angiolipomas are fairly infrequent benign tumours that are usually located in the epidural space of the thoracic column and represent 0.14% to 1.3% of all spinal tumours. Lumbar angiolipomas are extremely rare, representing only 9.6% of all spinal extradural angiolipomas. We report the case of a woman who complained of a lumbar pain of several months duration with no neurological focality and that had intensified in the last three days without her having had any injury or made a physical effort. The MR revealed an extradural mass L1-L2, on the posterior face of the medulla, decreasing the anteroposterior diameter of the canal. The patient symptoms improved after surgery. Total extirpation of the lesion is possible in most cases, and the prognosis is excellent even if the lesion is infiltrative. For this reason, excessively aggressive surgery is not necessary to obtain complete resection. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Reliability of MRI findings in candidates for lumbar disc prosthesis

    International Nuclear Information System (INIS)

    Berg, Linda; Espeland, Ansgar; Neckelmann, Gesche; Gjertsen, Oeivind; Hellum, Christian; Johnsen, Lars G.; Eide, Geir E.

    2012-01-01

    Limited reliability data exist for localised magnetic resonance imaging (MRI) findings relevant to planning of treatment with lumbar disc prosthesis and later outcomes. We assessed the reliability of such findings in chronic low back pain patients who were accepted candidates for disc prosthesis. On pretreatment MRI of 170 patients (mean age 41 years; 88 women), three experienced radiologists independently rated Modic changes, disc findings and facet arthropathy at L3/L4, L4/L5 and L5/S1. Two radiologists rerated 126 examinations. For each MRI finding at each disc level, agreement was analysed using the kappa statistic and differences in prevalence across observers using a fixed effects model. All findings at L3/L4 and facet arthropathy at L5/S1 had a mean prevalence <10% across observers and were not further analysed, ensuring interpretable kappa values. Overall interobserver agreement was generally moderate or good (kappa 0.40-0.77) at L4-S1 for Modic changes, nucleus pulposus signal, disc height (subjective and measured), posterior high-intensity zone (HIZ) and disc contour, and fair (kappa 0.24) at L4/L5 for facet arthropathy. Posterior HIZ at L5/S1 and severely reduced subjective disc height at L4/L5 differed up to threefold in prevalence between observers (p < 0.0001). Intraobserver agreement was mostly good or very good (kappa 0.60-1.00). In candidates for disc prosthesis, mostly moderate interobserver agreement is expected for localised MRI findings. (orig.)

  7. Reliability of MRI findings in candidates for lumbar disc prosthesis

    Energy Technology Data Exchange (ETDEWEB)

    Berg, Linda; Espeland, Ansgar [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Section for Radiology, Department of Surgical Sciences, Bergen (Norway); Neckelmann, Gesche [Haukeland University Hospital, Department of Radiology, Bergen (Norway); Gjertsen, Oeivind [Oslo University Hospital, Department of Neuroradiology, Oslo (Norway); Hellum, Christian [Oslo University Hospital, Department of Orthopaedics, Oslo (Norway); University of Oslo, Department of Orthopaedics, Oslo (Norway); Johnsen, Lars G. [University Hospital of Trondheim, National Centre for Diseases of the Spine, Trondheim (Norway); University Hospital of Trondheim, Orthopaedic Department, Trondheim (Norway); Eide, Geir E. [Haukeland University Hospital, Centre for Clinical Research, Bergen (Norway); University of Bergen, Department of Public Health and Primary Health Care, Bergen (Norway)

    2012-07-15

    Limited reliability data exist for localised magnetic resonance imaging (MRI) findings relevant to planning of treatment with lumbar disc prosthesis and later outcomes. We assessed the reliability of such findings in chronic low back pain patients who were accepted candidates for disc prosthesis. On pretreatment MRI of 170 patients (mean age 41 years; 88 women), three experienced radiologists independently rated Modic changes, disc findings and facet arthropathy at L3/L4, L4/L5 and L5/S1. Two radiologists rerated 126 examinations. For each MRI finding at each disc level, agreement was analysed using the kappa statistic and differences in prevalence across observers using a fixed effects model. All findings at L3/L4 and facet arthropathy at L5/S1 had a mean prevalence <10% across observers and were not further analysed, ensuring interpretable kappa values. Overall interobserver agreement was generally moderate or good (kappa 0.40-0.77) at L4-S1 for Modic changes, nucleus pulposus signal, disc height (subjective and measured), posterior high-intensity zone (HIZ) and disc contour, and fair (kappa 0.24) at L4/L5 for facet arthropathy. Posterior HIZ at L5/S1 and severely reduced subjective disc height at L4/L5 differed up to threefold in prevalence between observers (p < 0.0001). Intraobserver agreement was mostly good or very good (kappa 0.60-1.00). In candidates for disc prosthesis, mostly moderate interobserver agreement is expected for localised MRI findings. (orig.)

  8. Side effects after diagnostic lumbar puncture and lumbar iohexol myelography

    International Nuclear Information System (INIS)

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

    1987-01-01

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

  9. Mindfulness facets and Big Five personality facets in persons with recurrent depression in remission

    NARCIS (Netherlands)

    Spinhoven, Philip; Huijbers, Marloes J.; Zheng, Yixia; Ormel, Johan; Speckens, Anne E. M.

    2017-01-01

    Studies examining mindfulness in relation to personality traits have been mainly conducted in non-clinical samples and resulted in mixed findings. The present cross-sectional study examined which mindfulness facets are most strongly associated with Big Five personality domains and facets implicated

  10. Herniated lumbar intervertebral disk

    International Nuclear Information System (INIS)

    Hochhauser, L.; Cacayorin, E.D.; Karcnik, T.J.; McGowan, D.P.; Clark, K.G.; Storrs, D.; Kieffer, S.A.

    1988-01-01

    From a series of 25 patients with low-back pain and sciatica who subsequently underwent surgical exploration, 24 lumbar herniated disks and one asymmetrically bulging disk were correctly diagnosed with use of a 0.5-T MR imaging unit. The radiologic findings on saggital images included a polypoid protrusion beyond the posterior margin of the vertebral bodies more clearly displayed with T1-weighted than with T-2 weighted sequences and a focal extension into the extradural space on axial views. In most, the signal intensity of HNP was isointense to the disk of origin. The study suggests that MR imaging is currently capable of accurately predicting an HNP. The diagnosis is based primarily on morphologic characteristics rather than signal intensity alterations

  11. Percutaneous lumbar discectomy

    International Nuclear Information System (INIS)

    Xiao Chengjiang; Su Huanbin; Xu Sui; He Xiaofeng; Li Yanhao

    2004-01-01

    Objective: To probe the therapeutic effects, indications and safety of the percutaneous lumbar discectomy (PLDP). Methods: To ameliorate percutaneous punctured route based on classic PLD and modified jaw structure of pulpiform nacleus forceps, with statistic analysis of the therapeutic results of 352 cases of patient undergone PLDP and follow up ranging from 6 to 38 months retrospectively. Results: The effective ratios were excellent in 45.5%, good for 45.4% and bad in 9.1%. 44 of 352 cases with pulps prolapse were cured. No intervertebral inflammation and paradisc hematoma took place. One case complicated with cauda equina injury and 4 cases with appliances broken inside the disc. Conclusions: PLDP is effective and safe, not only adaptive to the contained disc herniation, but also for noncontained herniation. (authors)

  12. Ameliorative percutaneous lumbar discectomy

    International Nuclear Information System (INIS)

    Xiao Chengjiang; Su Huanbin; He Xiaofeng; Li Yanhao

    2005-01-01

    Objective: To ameliorate the percutaneous lumbar discectomy (APLD) for improving the effectiveness and amplifying the indicative range of PLD. Methods: To ameliorate percutaneous punctured route based on classic PLD and discectomy of extracting pulp out of the herniated disc with special pulpforceps. The statistical analysis of the therapeutic results on 750 disc protrusions of 655 cases undergone APLD following up from 6 to 54 months retrospectively. Results: The effective ratios were excellent in 40.2%, good for 46.6% and bad of 13.3%. No occurrance of intervertebral inflammation and paradiscal hematoma, there were only 1 case complicated with injuried cauda equina, and 4 cases with broken appliance within disc. Conclusions: APLD is effective and safe, not only indicative for inclusion disc herniation, but also for noninclusion herniation. (authors)

  13. Lumbar myelography with iohexol

    International Nuclear Information System (INIS)

    Nestvold, K.; Sortland, O.

    1988-01-01

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

  14. [Lumbar stabilization exercises].

    Science.gov (United States)

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

    2014-01-01

    Exercise is the intervention with the highest level of evidence on efficacy for treatment of chronic low back pain, with a higher benefit in terms of pain and function compared to any other intervention. A wide variety of exercises programs have been designed; however, "lumbar stabilization exercises" have become increasingly popular among clinicians who are in contact with spine diseases. However, there is controversy regarding the adequate prescription and there are multiple protocols. The aim of this literature review is to analyze the information about these exercises to promote better decision-making among clinicians and design the best program for each patient. We found the program an essential tool in the treatment of low back pain in both therapeutic and preventive phases.

  15. Lumbar spondylolysis: a review.

    Science.gov (United States)

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

    2011-06-01

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

  16. Lumbar spondylolysis: a review

    International Nuclear Information System (INIS)

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

    2011-01-01

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

  17. 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

  18. Facet development for a faceted stretched-membrane dish by Solar Kinetics, Inc

    Energy Technology Data Exchange (ETDEWEB)

    Schertz, P.T.; Brown, D.C.; Konnerth, A. III (Solar Kinetics, Inc., Dallas, TX (United States))

    1991-07-01

    A 3.6-meter diameter stretched-membrane optical facet for a parabolic dish has been successfully designed and demonstrated under contract with Sandia National Laboratories. Twelve facets identical to them will be used to make the lightweight reflector of the dish. The project goal of 2.5-mrad surface accuracy was met with each of the two full-sized prototypes, and accuracies of as low as 1.1 mrad were achieved. The facet weight is 11.7 kg/m{sup 2} (2.4lbs/ft{sup 2}). The facet is similar in construction to the successful stretched-membrane heliostat; it has two thin metal membranes attached to a ring. However, the front membrane for this facet is plastically formed at the factor in order to achieve a shorter facet f/D (approximately 3.0). A passive tether restrains the from membrane when not in operation, that is, when the stabilizing vacuum is off. The optical surface is achieved with a silvered-acrylic film laminated to the metal membrane. The facet is expected to cost $55.40/m{sup 2} at a production rate of 10,000 facets per year and $115, 000/m{sup 2}-at a production rate of 500 facets a year. Several key issues have been resolved. Stress concentrations due to seams in the reflective laminate did not cause membrane rupture during forming as they have for dishes with lower focal length-to-diameter ratios. The laminate survived the forming process and simulated operation without deterioration. The optical effect of the tether on the membrane was tested and found to be very small. Most important, highly accurate shapes were obtained using a simple forming procedure. Additional tests are needed to demonstrate process repeatablility and facet performance in typical operating conditions. 18 refs., 36 figs., 11 tabs.

  19. The association of spinal osteoarthritis with lumbar lordosis

    Science.gov (United States)

    2010-01-01

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

  20. Reproduction of the lumbar lordosis

    DEFF Research Database (Denmark)

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

    2007-01-01

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

  1. Stabilization of the sacroiliac joint.

    Science.gov (United States)

    Shaffrey, Christopher I; Smith, Justin S

    2013-07-01

    Lower back pain and pain involving the area of the posterior iliac spine are extremely common. Degeneration of the sacroiliac joint (SIJ) is one potential cause for lower back pain and pain radiating into the groin or buttocks. Degenerative changes to the lumbar spine and sacroiliac joints are common. A recent study evaluating SIJ abnormalities in a primary low back pain population demonstrated 31.7% of patients demonstrated SI joint abnormalities. (4) As is the case for the evaluation and management of isolated lower back pain, the evaluation, management, and role for surgical intervention in SIJ pain is very controversial. Many patients have degenerative changes of the disc, facet joints, and SIJs. A recent systematic review performed to determine the diagnostic accuracy of tests available to clinicians to identify the disc, facet joint, or SIJ as the source of low back pain concluded that tests do exist that change the probability of the disc or SIJ (but not the facet joint) as the source of low back pain. (3) It was also concluded that the usefulness of these tests in clinical practice, particularly for guiding treatment selection, remains unclear. (3) Although there is general agreement that SIJ pathological changes are a potential cause of pain, there is far less agreement about the optimal management of these conditions. A variety of conditions can cause SIJ dysfunction including degenerative and inflammatory arthritis, trauma, prior lumbosacral fusion, hip arthritis, limb length inequality, infections, and neoplasia. (8) There is increasing evidence that image intensifier-guided single periarticular injection can correctly localize pain to the SIJ but the optimal management strategy remains controversial. Recent publications have compared surgical versus injection treatments and fusion versus denervation procedures. (1 , 8) A systematic review found improvement regardless of the treatment, with most studies reporting over 40% improvement in pain as measured

  2. Biomechanical study of percutaneous lumbar diskectomy

    International Nuclear Information System (INIS)

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

    2003-01-01

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

  3. Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches?

    Directory of Open Access Journals (Sweden)

    Catarina C. Lins

    Full Text Available ABSTRACT Surgical treatment is well accepted for patients with traumatic cervical facet joint dislocations (CFD, but there is uncertainty over which approach is better: anterior, posterior or combined. We performed a systematic literature review to evaluate the indications for anterior and posterior approaches in the management of CFD. Anterior approaches can restore cervical lordosis, and cause less postoperative pain and less wound problems. Posterior approaches are useful for direct reduction of locked facet joints and provide stronger fixation from a biomechanical point of view. Combined approaches can be used in more complex cases. Although both anterior and posterior approaches can be used interchangeably, there are some patients who may benefit from one of them over the other, as discussed in this review. Surgeons who treat cervical spine trauma should be able to perform both procedures as well as combined approaches to adequately manage CFD and improve patients’ final outcomes.

  4. Intraarticular Facet Injections for Low Back Pain: Design Considerations, Consensus Methodology to Develop the Protocol for a Randomized Controlled Trial.

    Science.gov (United States)

    Mars, Tom; Ellard, David R; Antrobus, James H L; Cairns, Melinda; Underwood, Martin; Haywood, Kirstie; Keohane, Susie; Sandhu, Harbinder; Griffiths, Frances

    2015-01-01

    Since the publication of guidelines by the UK National Institute for Health and Care Excellence (NICE) and the American Pain Society guidelines for low back pain in 2009 there have been deep divisions in the pain treatment community about the use of therapeutic intraarticular facet joint injections. While evidence for the effectiveness or not of intraarticular facet joint injections remains sparse, uncertainty will remain. The Warwick feasibility study, along with a concurrent study with a different design led by another group, aims to provide a stable platform from which the effectiveness and cost effectiveness of intraarticular facet joint injections added to normal care could be evaluated in randomized controlled trials (RCTs). To reach consensus on key design considerations for the Warwick facet feasibility study from which the study protocol and working manuals will be developed. A consensus conference involving expert professionals and lay members. Preliminary work identified 5 key design considerations for deliberation at our consensus conference. Three concerned patient assessment and treatment: diagnosis of possible facet joint pain, interaarticular facet joint injection technique, and best usual care. Two concerned trial analysis: a priori sub-groups and minimally important difference and are reported elsewhere. We did systematic evidence reviews of the design considerations and summarized the evidence. Our design questions and evidence summaries were distributed to all delegates. This formed the basis for discussions on the day. Clinical experts in all aspects of facet joint injection from across the UK along with lay people were invited via relevant organizations. Nominal group technique was used in 15 facilitated initial small group discussions. Further discussion and ranking was undertaken in plenary. All small group and plenary results were recorded and checked and verified post conference. Where necessary participants were contacted via email to

  5. Polygons and Faceted Polyhedra and Nanoporous Networks.

    Science.gov (United States)

    Lu, Jianjiang; Mondal, Arunendu; Moulton, Brian; Zaworotko, Michael J

    2001-06-01

    Small rhombihexahedra and small cubicuboctahedra, namely faceted polyhedra, form the basis of two novel low-density framework solids that are afforded by the self-assembly of molecular squares only or molecular squares and triangles, respectively. © 2001 WILEY-VCH Verlag GmbH, Weinheim, Fed. Rep. of Germany.

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

    Science.gov (United States)

    Goel, Atul; Shah, Abhidha

    2011-06-01

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

  7. Lumbar spinal stenosis

    International Nuclear Information System (INIS)

    Anon.

    1985-01-01

    Spinal stenosis, which has attracted increasing attention in recent years, represents an important group of clinical and radiologic entities. Recognition and ultimate surgical management of the many abnormalities found in this group require precise preoperative delineation of the morbid anatomy. Conventional axial tomography provided the first accurate picture of the sagittal dimension, but it was limited by poor contrast resolution. Computerized tomography and ultrasound have finally provided the means for accurate measurement of midsagittal diameter and surface area. It is now possible to provide a preoperative assessment of bony and soft-tissue canal compression and to guide surgical decompression by objective anatomic measurements. True spinal stenosis of the lumbar vertebral canal is a form of compression produced by the walls of the vertebral canal. It involves the whole of the vertebral canal by exerting compression at two of its opposite surfaces. There are two types of stenosis: (1) transport stenosis, wherein the clinical manifestations are due to impeded flow of fluid, which is dependent on the available cross-sectional area of the canal surface of the stenotic structure, and (2) compressive stenosis, which includes abnormal compression of opposing surfaces only. According to these definitions, indentation on the spinal canal by disc protrusion or localized tumor is not considered true spinal stenoses. In this chapter the authors discuss only those conditions that produce true canal stenosis

  8. RELIABILITY AND VALIDITY OF SUBJECTIVE ASSESSMENT OF LUMBAR LORDOSIS IN CONVENTIONAL RADIOGRAPHY.

    Science.gov (United States)

    Ruhinda, E; Byanyima, R K; Mugerwa, H

    2014-10-01

    Reliability and validity studies of different lumbar curvature analysis and measurement techniques have been documented however there is limited literature on the reliability and validity of subjective visual analysis. Radiological assessment of lumbar lordotic curve aids in early diagnosis of conditions even before neurologic changes set in. To ascertain the level of reliability and validity of subjective assessment of lumbar lordosis in conventional radiography. A blinded, repeated-measures diagnostic test was carried out on lumbar spine x-ray radiographs. Radiology Department at Joint Clinical Research Centre (JCRC), Mengo-Kampala-Uganda. Seventy (70) lateral lumbar x-ray films were used for this study and were obtained from the archive of JCRC radiology department at Butikiro house, Mengo-Kampala. Poor observer agreement, both inter- and intra-observer, with kappa values of 0.16 was found. Inter-observer agreement was poorer than intra-observer agreement. Kappa values significantly rose when the lumbar lordosis was clustered into four categories without grading each abnormality. The results confirm that subjective assessment of lumbar lordosis has low reliability and validity. Film quality has limited influence on the observer reliability. This study further shows that fewer scale categories of lordosis abnormalities produce better observer reliability.

  9. Studies on the pathogenesis of degenerative lumbar canal stenosis by computed tomography, 2. Investigation about measurements of the lumbar canal

    Energy Technology Data Exchange (ETDEWEB)

    Kido, Kenji

    1987-07-01

    To evaluate the significance of measurement parameters for the lumbar canal (LC), a retrospective analysis was made of computed tomography (CT) scans in a total of 129 patients, including 20 with degenerative lumbar canal stenosis (DLCS), 65 with degenerative spondylosis, 21 with disc hernia, and 23 with lumbar pain. The shape of the transverse LC was not reflected by the anteroposterior and transverse diameters of LC, but was somewhat reflected by the transverse area of LC. The transverse area of dural sac (DS) was considered important in determining the degree of stenosis. Regarding the transverse area, the DS correlated more strongly with the LC with soft-tissue windows than that with bone windows. The angle of intervertebral joint was likely to be related to the pathophysiology of the LC. In particular, sagittal tendency was seen at the levels of L3-4 and L4-5 in the DLCS group. There was correlation between the angle of intervertebral joint and the transverse areas of both soft-tissue LC and DS at the levels of L4-5. A multivariate analysis suggested the possibility that the significance of measurement parameters might vary depending on the vertebral level for the lower lumbar spine. The following criteria for indicating DLCS were obtained: 1) a transverse area of less than or equal to 100 mm/sup 2/ for DS or less than or equal to 118 mm/sup 2/ for soft-tissue LC at the levels of L3-4; 2) a transverse area of less than or equal to 90 mm/sup 2/ for DS and an angle of less than or equal to 90 deg for the intervertebral joint at the levels of L4-5; and 3) lateral recess of less than or equal to 3 mm in anteroposterior diameter at the levels of L5-S1. (Namekawa, K.).

  10. The hamatolunate facet: characterization and association with cartilage lesions - magnetic resonance arthrography and anatomic correlation in cadaveric wrists

    Energy Technology Data Exchange (ETDEWEB)

    Pfirrmann, C.W.A. [Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161 (United States); Orthopedic University Hospital Balgrist, Department of Radiology, Forchstrasse 340, 8008 Zurich (Switzerland); Theumann, N.H.; Chung, C.B.; Trudell, D.J.; Resnick, D. [Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161 (United States)

    2002-08-01

    The objective of this study was to characterize the appearance of the hamatolunate facet using high-resolution magnetic resonance (MR) arthrography in cadavers and to correlate the presence of this anatomic variant with the presence of osteoarthritis in the wrist. High-resolution MR images of 22 cadaveric wrist specimens were obtained after tri-compartmental arthrography. Two readers in consensus analyzed the MR images and recoded the presence or absence of a hamatolunate facet. Geometric characteristics and cartilage and ligament integrity were analyzed. A third reader, who was blinded to the purpose of the study, recorded cartilage lesions of all the bones of the proximal and distal carpal rows. A hamatolunate facet was present in 11 of 22 wrists (50%). The mean coronal size of the lunate facet at the lunate (type II lunate) was 4.5 mm (range, 2-6 mm). The highest frequencies of cartilage lesions were seen in the scapho-trapezio-trapezoid joint (45.5%) and at the proximal pole of the hamate (54.4% and 40.9% for consensus reading/blinded reading, respectively). In cases with a hamatolunate facet, the frequency of cartilage lesions in the proximal pole of the hamate was 81.8% and 63.6% versus 27.3% and 18.2% without such a facet (chi-squared, P=0.01/P=0.03). No correlation of the presence of a hamatolunate facet with interosseous ligament tears or lesions of the triangular fibrocartilage was seen. In conclusion, the hamatolunate facet is a very common anatomic variant. The presence of a hamatolunate facet is associated with cartilage damage in the proximal pole of the hamate. (orig.)

  11. Pain from intra-articular NGF or joint injury in the rat requires contributions from peptidergic joint afferents.

    Science.gov (United States)

    Kras, Jeffrey V; Weisshaar, Christine L; Pall, Parul S; Winkelstein, Beth A

    2015-09-14

    Non-physiological stretch of the cervical facet joint's capsular ligament induces persistent behavioral hypersensitivity and spinal neuronal hyperexcitability via an intra-articular NGF-dependent mechanism. Although that ligament is innervated by nociceptors, it is unknown if a subpopulation is exclusively responsible for the behavioral and spinal neuronal responses to intra-articular NGF and/or facet joint injury. This study ablated joint afferents using the neurotoxin saporin targeted to neurons involved in either peptidergic ([Sar(9),Met (O2)(11)]-substance P-saporin (SSP-Sap)) or non-peptidergic (isolectin B4-saporin (IB4-Sap)) signaling to investigate the contributions of those neuronal populations to facet-mediated pain. SSP-Sap, but not IB4-Sap, injected into the bilateral C6/C7 facet joints 14 days prior to an intra- articular NGF injection prevents NGF-induced mechanical and thermal hypersensitivity in the forepaws. Similarly, only SSP- Sap prevents the increase in mechanical forepaw stimulation- induced firing of spinal neurons after intra-articular NGF. In addition, intra-articular SSP-Sap prevents both behavioral hypersensitivity and upregulation of NGF in the dorsal root ganglion after a facet joint distraction that normally induces pain. These findings collectively suggest that disruption of peptidergic signaling within the joint may be a potential treatment for facet pain, as well as other painful joint conditions associated with elevated NGF, such as osteoarthritis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. 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

  13. New insights on equid locomotor evolution from the lumbar region of fossil horses.

    Science.gov (United States)

    Jones, Katrina Elizabeth

    2016-04-27

    The specialization of equid limbs for cursoriality is a classic case of adaptive evolution, but the role of the axial skeleton in this famous transition is not well understood. Extant horses are extremely fast and efficient runners, which use a stiff-backed gallop with reduced bending of the lumbar region relative to other mammals. This study tests the hypothesis that stiff-backed running in horses evolved in response to evolutionary increases in body size by examining lumbar joint shape from a broad sample of fossil equids in a phylogenetic context. Lumbar joint shape scaling suggests that stability of the lumbar region does correlate with size through equid evolution. However, scaling effects were dampened in the posterior lumbar region, near the sacrum, which suggests strong selection for sagittal mobility in association with locomotor-respiratory coupling near the lumbosacral joint. I hypothesize that small-bodied fossil horses may have used a speed-dependent running gait, switching between stiff-backed and flex-backed galloping as speed increased. © 2016 The Author(s).

  14. Imaging of lumbar degenerative disk disease: history and current state

    International Nuclear Information System (INIS)

    Emch, Todd M.; Modic, Michael T.

    2011-01-01

    One of the most common indications for performing magnetic resonance (MR) imaging of the lumbar spine is the symptom complex thought to originate as a result of degenerative disk disease. MR imaging, which has emerged as perhaps the modality of choice for imaging degenerative disk disease, can readily demonstrate disk pathology, degenerative endplate changes, facet and ligamentous hypertrophic changes, and the sequelae of instability. Its role in terms of predicting natural history of low back pain, identifying causality, or offering prognostic information is unclear. As available modalities for imaging the spine have progressed from radiography, myelography, and computed tomography to MR imaging, there have also been advances in spine surgery for degenerative disk disease. These advances are described in a temporal context for historical purposes with a focus on MR imaging's history and current state. (orig.)

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

    OpenAIRE

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

    2017-01-01

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

  16. EFFECTIVENESS OF CHIROPRACTIC ADJUSTMENT IN LUMBAR PAIN IN CROSSFIT PRACTITIONERS

    Directory of Open Access Journals (Sweden)

    DESIREE MOEHLECKE

    Full Text Available ABSTRACT Objective: To evaluate the efficacy of acute chiropractic adjustment in individuals who practice CrossFit with regard to complaints of low back pain and the joint range of motion in this region. Methods: A randomized clinical trial comprised of CrossFit practitioners from a box in Novo Hamburgo-RS, of both sexes and aged 18 to 40 years who had low back pain at the time of the study. The following tools were used: Semi-structured Anamnesis Questionnaire, Visual Analog Scale, McGill Pain Questionnaire, and SF-36 Quality of Life Questionnaire. Individuals in the control group answered the questionnaires before and after CrossFit training. The chiropractic group performed the same procedure, plus pre-training chiropractic adjustment and joint range of motion (ROM before and after lumbar adjustment. Results: There was a significant increase in pain in the control group, and a significant decrease in pain in the chiropractic group, including one day after the chiropractic adjustment. In the chiropractic group, the joint ranges of motion had a significant increase in flexion and extension of the lumbar spine after chiropractic adjustment. Conclusion: The chiropractic group achieved a significant improvement in pain level and joint range of motion, suggesting that acute chiropractic adjustment was effective in reducing low back pain.

  17. Lumbar Spine Surgery in Patients with Parkinson Disease.

    Science.gov (United States)

    Schroeder, Joshua E; Hughes, Alexander; Sama, Andrew; Weinstein, Joseph; Kaplan, Leon; Cammisa, Frank P; Girardi, Federico P

    2015-10-21

    Parkinson disease is the second most common neurodegenerative condition. The literature on patients with Parkinson disease and spine surgery is limited, but increased complications have been reported. All patients with Parkinson disease undergoing lumbar spine surgery between 2002 and 2012 were identified. Patients' charts, radiographs, and outcome questionnaires were reviewed. Parkinson disease severity was assessed with use of the modified Hoehn and Yahr staging scale. Complications and subsequent surgeries were analyzed. Risk for reoperation was assessed. Ninety-six patients underwent lumbar spine surgery. The mean patient age was 63.0 years. The mean follow-up duration was 30.1 months. The Parkinson disease severity stage was Parkinson disease severity stage of ≥3 (p Parkinson disease is good, with improvement of spine-related pain. A larger prospective study is warranted. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

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

    International Nuclear Information System (INIS)

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

    2006-01-01

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

  19. Local facet approximation for image stitching

    Science.gov (United States)

    Li, Jing; Lai, Shiming; Liu, Yu; Wang, Zhengming; Zhang, Maojun

    2018-01-01

    Image stitching aims at eliminating multiview parallax and generating a seamless panorama given a set of input images. This paper proposes a local adaptive stitching method, which could achieve both accurate and robust image alignments across the whole panorama. A transformation estimation model is introduced by approximating the scene as a combination of neighboring facets. Then, the local adaptive stitching field is constructed using a series of linear systems of the facet parameters, which enables the parallax handling in three-dimensional space. We also provide a concise but effective global projectivity preserving technique that smoothly varies the transformations from local adaptive to global planar. The proposed model is capable of stitching both normal images and fisheye images. The efficiency of our method is quantitatively demonstrated in the comparative experiments on several challenging cases.

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

    African Journals Online (AJOL)

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

  1. Lumbar myelography with omnipaque (iohexol)

    International Nuclear Information System (INIS)

    Lilleaas, F.; Weber, H.

    1986-01-01

    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. (orig.)

  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. Collagen Organization in Facet Capsular Ligaments Varies With Spinal Region and With Ligament Deformation.

    Science.gov (United States)

    Ban, Ehsan; Zhang, Sijia; Zarei, Vahhab; Barocas, Victor H; Winkelstein, Beth A; Picu, Catalin R

    2017-07-01

    The spinal facet capsular ligament (FCL) is primarily comprised of heterogeneous arrangements of collagen fibers. This complex fibrous structure and its evolution under loading play a critical role in determining the mechanical behavior of the FCL. A lack of analytical tools to characterize the spatial anisotropy and heterogeneity of the FCL's microstructure has limited the current understanding of its structure-function relationships. Here, the collagen organization was characterized using spatial correlation analysis of the FCL's optically obtained fiber orientation field. FCLs from the cervical and lumbar spinal regions were characterized in terms of their structure, as was the reorganization of collagen in stretched cervical FCLs. Higher degrees of intra- and intersample heterogeneity were found in cervical FCLs than in lumbar specimens. In the cervical FCLs, heterogeneity was manifested in the form of curvy patterns formed by collections of collagen fibers or fiber bundles. Tensile stretch, a common injury mechanism for the cervical FCL, significantly increased the spatial correlation length in the stretch direction, indicating an elongation of the observed structural features. Finally, an affine estimation for the change of correlation length under loading was performed which gave predictions very similar to the actual values. These findings provide structural insights for multiscale mechanical analyses of the FCLs from various spinal regions and also suggest methods for quantitative characterization of complex tissue patterns.

  5. Rachipagus: A Report of Two Cases - Thoracic and Lumbar

    OpenAIRE

    Sanoussi, Samuila; Rachid, Sani; Sani, Chaibou Maman; Mahamane, Bawa; Addo, Guemou

    2010-01-01

    We present two cases of rachipagus in two male infants and review the literature on this anomaly. These infants were from consanguineous marriages and cases of twins were reported in their families. In the first case it was a limb attached to the lower lumbar region with a rudimentary posterior arch. At the junction there was a lipomeningocele. Anatomical dissection of the limb identified the bones of the lower limb. In the second case, the parasites were joints of the upper limb that were at...

  6. 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.

  7. Methodological problems of sacroiliac joint scintigraphy

    International Nuclear Information System (INIS)

    Schoerner, W.; Haubold, U.

    1981-01-01

    Bone scintigraphy of the sacroiliac joints and the lumbar spine was performed in 35 patients with ankylosing spondylitis and 30 control subjects. The scans were evaluated by qualitative and quantitative assessment. The sacroiliac/sacrum ratio (index ISG/sacrum), the sacroiliac/lumbar spine ratio (index ISG/LWS), and the left sacroiliac joint/right sacroiliac joint ratio (index li. ISG/re. ISG) were calculated. The visual interpretation of colour scans proved to be unreliable. The index ISG/sacrum was more sensitive than the index ISG/LWS. The index li. ISG/re. ISG was helpful as an additional criterion. When digital sacroiliac joint scintigraphy is well standardized it can be considered as a useful technique in early diagnosis of ankylosing spondylitis. (orig.) [de

  8. The Variations in Calcaneal Articular Facets In North Indian Population and its Clinical Implication

    Directory of Open Access Journals (Sweden)

    Seema

    2012-01-01

    Full Text Available Aims and Objectives- To know the most common type of calcanei in North Indian population and itsclinical importance. There are three articular facets on superior surface of calcaneus- anterior, middle andposterior. Three types of calcanei are noted according to number and arrangement of the articular facets-type A, B and C. Methodology - The present studywas done on 300 dry adult human calcanei of unknownsex taken from Department of Anatomy Sri Guru Ram Das Institute of Medical Sciences and ResearchVallah (Amritsar. Results- In our study Type B was found as the most common type. Type A is the nextmost common. Interpretation- The talocalcaneal joint is important in arthritis and coalition, flat foot, valgus deformity, congenital anomalies and intra articular fractures.

  9. Reliability of standing weight-bearing (0.25T) MR imaging findings and positional changes in the lumbar spine

    International Nuclear Information System (INIS)

    Hansen, Bjarke B.; Bliddal, Henning; Hansen, Philip; Christensen, Anders F.; Trampedach, Charlotte; Rasti, Zoreh; Boesen, Mikael

    2018-01-01

    To test the reliability and absolute agreement of common degenerative findings in standing positional magnetic resonance imaging (pMRI). Low back pain patients with and without sciatica were consecutively enrolled to undergo a supine and standing pMRI. Three readers independently evaluated the standing pMRI for herniation, spinal stenosis, spondylolisthesis, HIZ lesions and facet joint effusion. The evaluation included a semi-quantitative grading of spinal stenosis, foraminal stenosis and spinal nerve root compression. The standing pMRI images were evaluated with full access to supine MRI. In case lower grades or the degenerative findings were not present in the supine images, this was reported separately as position-dependent changes. A subsample of 20 pMRI examinations was reevaluated after two months. The reproducibility was assessed by inter- and intra-reader reliability (kappa statistic) and absolute agreement between readers. Fifty-six patients were included in this study. There was fair-to-substantial inter-reader reliability (κ 0.47 to 0.82) and high absolute agreement (72.3% to 99.1%) for the pMRI findings. The intra-reader assessment showed similar reliability and agreement (κ 0.36 to 0.85; absolute agreement: 62.5% to 98.8%). Positional changes between the supine and standing position showed a fair-to-moderate inter- and intra-reader reliability (κ 0.25 to 0.52; absolute agreement: 97.0% to 99.1). Evaluation of the lumbar spine for degenerative findings by standing pMRI has acceptable reproducibility; however, positional changes from the supine to the standing position as an independent outcome should be interpreted with caution because of lower reliability, which calls for further standardisation. (orig.)

  10. Analysis of radiological parameters associated with decreased fractional anisotropy values on diffusion tensor imaging in patients with lumbar spinal stenosis.

    Science.gov (United States)

    Wang, Xiandi; Wang, Hongli; Sun, Chi; Zhou, Shuyi; Meng, Tao; Lv, Feizhou; Ma, Xiaosheng; Xia, Xinlei; Jiang, Jianyuan

    2018-04-26

    Previous studies have indicated that decreased fractional anisotropy (FA) values on diffusion tensor imaging (DTI) are well correlated with the symptoms of nerve root compression. The aim of our study is to determine primary radiological parameters associated with decreased FA values in patients with lumbar spinal stenosis involving single L5 nerve root. Patients confirmed with single L5 nerve root compression by transforaminal nerve root blocks were included in this study. FA values of L5 nerve roots on both symptomatic and asymptomatic side were obtained. Conventional radiological parameters, such as disc height, degenerative scoliosis, dural sac cross-sectional area (DSCSA), foraminal height (FH), hypertrophic facet joint degeneration (HFJD), sagittal rotation (SR), sedimentation sign, sagittal translation and traction spur were measured. Correlation and regression analyses were performed between the radiological parameters and FA values of the symptomatic L5 nerve roots. A predictive regression equation was established. Twenty-one patients were included in this study. FA values were significantly lower at the symptomatic side comparing to the asymptomatic side (0.263 ± 0.069 vs. 0.334 ± 0.080, P = 0.038). DSCSA, FH, HFJD, and SR were significantly correlated with the decreased FA values, with r = 0.518, 0.443, 0.472 and - 0.910, respectively (P values, and the regression equation is FA = - 0.012 × SR + 0.002 × DSCSA. DSCSA and SR were primary contributors to decreased FA values in LSS patients involving single L5 nerve root, indicating that central canal decompression and segmental stability should be the first considerations in preoperative planning of these patients. These slides can be retrieved under Electronic Supplementary Material.

  11. Reliability of standing weight-bearing (0.25T) MR imaging findings and positional changes in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, Bjarke B.; Bliddal, Henning [Department of Reumatology, Copenhagen University Hospital, The Parker Institute, Koebenhavn Oe (Denmark); Hansen, Philip; Christensen, Anders F.; Trampedach, Charlotte; Rasti, Zoreh; Boesen, Mikael [Copenhagen University Hospital, Department of Radiology, Koebenhavn Oe (Denmark)

    2018-01-15

    To test the reliability and absolute agreement of common degenerative findings in standing positional magnetic resonance imaging (pMRI). Low back pain patients with and without sciatica were consecutively enrolled to undergo a supine and standing pMRI. Three readers independently evaluated the standing pMRI for herniation, spinal stenosis, spondylolisthesis, HIZ lesions and facet joint effusion. The evaluation included a semi-quantitative grading of spinal stenosis, foraminal stenosis and spinal nerve root compression. The standing pMRI images were evaluated with full access to supine MRI. In case lower grades or the degenerative findings were not present in the supine images, this was reported separately as position-dependent changes. A subsample of 20 pMRI examinations was reevaluated after two months. The reproducibility was assessed by inter- and intra-reader reliability (kappa statistic) and absolute agreement between readers. Fifty-six patients were included in this study. There was fair-to-substantial inter-reader reliability (κ 0.47 to 0.82) and high absolute agreement (72.3% to 99.1%) for the pMRI findings. The intra-reader assessment showed similar reliability and agreement (κ 0.36 to 0.85; absolute agreement: 62.5% to 98.8%). Positional changes between the supine and standing position showed a fair-to-moderate inter- and intra-reader reliability (κ 0.25 to 0.52; absolute agreement: 97.0% to 99.1). Evaluation of the lumbar spine for degenerative findings by standing pMRI has acceptable reproducibility; however, positional changes from the supine to the standing position as an independent outcome should be interpreted with caution because of lower reliability, which calls for further standardisation. (orig.)

  12. Reliability of standing weight-bearing (0.25T) MR imaging findings and positional changes in the lumbar spine.

    Science.gov (United States)

    Hansen, Bjarke B; Hansen, Philip; Christensen, Anders F; Trampedach, Charlotte; Rasti, Zoreh; Bliddal, Henning; Boesen, Mikael

    2018-01-01

    To test the reliability and absolute agreement of common degenerative findings in standing positional magnetic resonance imaging (pMRI). Low back pain patients with and without sciatica were consecutively enrolled to undergo a supine and standing pMRI. Three readers independently evaluated the standing pMRI for herniation, spinal stenosis, spondylolisthesis, HIZ lesions and facet joint effusion. The evaluation included a semi-quantitative grading of spinal stenosis, foraminal stenosis and spinal nerve root compression. The standing pMRI images were evaluated with full access to supine MRI. In case lower grades or the degenerative findings were not present in the supine images, this was reported separately as position-dependent changes. A subsample of 20 pMRI examinations was reevaluated after two months. The reproducibility was assessed by inter- and intra-reader reliability (kappa statistic) and absolute agreement between readers. Fifty-six patients were included in this study. There was fair-to-substantial inter-reader reliability (κ 0.47 to 0.82) and high absolute agreement (72.3% to 99.1%) for the pMRI findings. The intra-reader assessment showed similar reliability and agreement (κ 0.36 to 0.85; absolute agreement: 62.5% to 98.8%). Positional changes between the supine and standing position showed a fair-to-moderate inter- and intra-reader reliability (κ 0.25 to 0.52; absolute agreement: 97.0% to 99.1). Evaluation of the lumbar spine for degenerative findings by standing pMRI has acceptable reproducibility; however, positional changes from the supine to the standing position as an independent outcome should be interpreted with caution because of lower reliability, which calls for further standardisation.

  13. Prevention: Exercise

    Medline Plus

    Full Text Available ... Steroid Injections Lumbar Zygapophysical (Facet) Joint Injections PREVENTION Lifestyle Choices 10 Tips for a Healthy Back Smoking Weight Patient Safety Exercise Strengthening Strengthen ...

  14. FACET, Radiation View Factor with Shadowing

    International Nuclear Information System (INIS)

    Shapiro, A.B.

    1988-01-01

    1 - Description of program or function: FACET calculates the radiation geometric view factor (alternatively called shape factor, angle factor, or configuration factor) between surfaces for axisymmetric, two-dimensional planar and three-dimensional geometries with interposed third surface obstructions. FACET was developed to calculate view factors as input data to finite element heat transfer analysis codes. 2 - Method of solution: Three algorithms are incorporated to integrate the view factor equation for three dimensional geometries. The algorithm used for any two surfaces depends on their geometric relationship and whether third surface obstructions exist. The three algorithms are the area integration (AI) method, the line integration method (LI), and the Mitalas and Stephenson (MS) method. The LI method is used to calculate the view factor between two disjoint surfaces. If the two surfaces have an adjoint edge, the MS method is used. The AI method is used if there is self or third surface shadowing. In two-dimensional planar geometries, the view factor between two surfaces is calculated using Hottel's cross string method. For axisymmetric geometries in the absence of shadowing, the view factor between two surfaces is calculated by view factor algebra using the view factors between parallel coaxial discs. In the presence of self or third surface shadowing, the geometry is represented in three dimensions before calculating the view factors

  15. Morphometric analysis of the cervical facets and the feasibility, safety, and effectiveness of Goel inter-facet spacer distraction technique

    Directory of Open Access Journals (Sweden)

    Abhidha Shah

    2014-01-01

    Full Text Available Aim: Quantitative anatomy of the facets of the sub-axial cervical spine was performed. The purpose of the evaluation was to determine the feasibility of insertion of Goel inter-facetal articular spacers in the sub-axial cervical spine. Only few studies detailing the morphometry of the facets are available in the literature. Materials and Methods: Ten cervical vertebrae from C3 to C7 with a total of 20 facets were evaluated by the author. The anatomic parameters studied were the height, width, thickness, shape, orientation, and inclination of each of the superior and inferior facets. The alterations in a number of intervertebral segmental distances were measured before and after spacer insertion. The distance of the inferior facet from the foramen tranversarium, spinal canal, and neural foramina was measured to assess safety of spacer insertion with respect to the vertebral artery and neural structures. Results: The height, width and thickness of the superior facets from C3 to C7 ranged from 6 to 12 mm, 8 to 12 mm, and 2.5 to 6 mm, respectively. The inferior facets had an average height of 10.5 mm, average width of 11.2 mm and average thickness of 3.5 mm. The inclination of the superior facets with respect to the transverse plane ranged from 22° to 45° and that of the inferior facets ranged from 29° to 53°. The distance of the anterior margin of the inferior facet from the posterior border of the foramen transversium ranged from 5 to 7 mm. This distance was maximum at C3 level, then decreased at C4 and remained constant from C5 to C7. Conclusion: This anatomic evaluation aided in understanding the morphology of the cervical facets and the suitability of the cervical facetal articular cavity for insertion of spacers.

  16. Work functions and surface charges at metallic facet edges

    International Nuclear Information System (INIS)

    Fall, C.J.; Binggeli, N.; Baldereschi, A.

    2002-04-01

    The electronic charge densities and work functions at sharp metallic facet edges are determined from ab initio calculations, combined with macroscopic averaging techniques. In particular, we examine how two different work functions coexist at close range near edges between inequivalent facets. The surface ionic relaxation at facet edges is shown to influence appreciably the local electrostatic potential in the vacuum. Various edges between Al(100) and Al(111) facets are studied, as well as between Na(110) facets. We also develop a model of electronic surface dipoles, which accounts for the surface charge transfer between inequivalent facets, and which allows us to predict the influence of the shape and size of a macroscopic crystal on its work functions. (author)

  17. 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.

  18. A folk-psychological ranking of personality facets

    Directory of Open Access Journals (Sweden)

    Eka Roivainen

    2016-10-01

    Full Text Available Background Which personality facets should a general personality test measure? No consensus exists on the facet structure of personality, the nature of facets, or the correct method of identifying the most significant facets. However, it can be hypothesized (the lexical hypothesis that high frequency personality describing words more likely represent important personality facets and rarely used words refer to less significant aspects of personality. Participants and procedure A ranking of personality facets was performed by studying the frequency of the use of popular personality adjectives in causal clauses (because he is a kind person on the Internet and in books as attributes of the word person (kind person. Results In Study 1, the 40 most frequently used adjectives had a cumulative usage frequency equal to that of the rest of the 295 terms studied. When terms with a higher-ranking dictionary synonym or antonym were eliminated, 23 terms remained, which represent 23 different facets. In Study 2, clusters of synonymous terms were examined. Within the top 30 clusters, personality terms were used 855 times compared to 240 for the 70 lower-ranking clusters. Conclusions It is hypothesized that personality facets represented by the top-ranking terms and clusters of terms are important and impactful independent of their correlation with abstract underlying personality factors (five/six factor models. Compared to hierarchical personality models, lists of important facets probably better cover those aspects of personality that are situated between the five or six major domains.

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

    Science.gov (United States)

    Hu, Boyi; Ning, Xiaopeng

    2015-01-01

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

  20. 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.

  1. Fuerza lumbar en jugadores de hockey hierba

    OpenAIRE

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

    2007-01-01

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

  2. 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

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

    Science.gov (United States)

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

    2011-04-14

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

  4. Ultrasound-guided facet block to low back pain: a case report

    Directory of Open Access Journals (Sweden)

    Ana Ellen Q. Santiago

    2014-07-01

    Full Text Available BACKGROUND: Osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. CASE REPORT: Female patient, 88 years old, 1.68 m and 72 kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25 G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10 mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. CONCLUSIONS: The visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study.

  5. Diagnostics Challenges for FACET-II

    Energy Technology Data Exchange (ETDEWEB)

    Clarke, Christine

    2015-10-07

    FACET-II is a prospective user facility at SLAC National Accelerator Laboratory. The facility will focus on high-energy, high-brightness beams and their interaction with plasma and lasers. The accelerator is designed for high-energy-density electron beams with peak currents of approximately 50 kA (potentially 100 kA) that are focused down to below 10x10 micron transverse spot size at an energy of 10 GeV. Subsequent phases of the facility will provide positron beams above 10 kA peak current to the experiment station. Experiments will require well characterised beams; however, the high peak current of the electron beam can lead to material failure in wirescanners, optical transition radiation screens and other instruments critical for measurement or delivery. The radiation environment and space constraints also put additional pressure on diagnostic design.

  6. Is facet analysis based on rationalism?

    DEFF Research Database (Denmark)

    Hjørland, Birger

    2014-01-01

    In several writings I have claimed that the basis of knowledge organisation (KO) must be found in subject knowledge, and that researchers and practitioners in KO must achieve knowledge about the domains that they are organising. Domain knowledge is not neutral, but rather is based on competing...... epistemologies and worldviews, and the classifier is therefore participating in struggles related to worldviews. Different traditions, approaches and paradigms in knowledge organisation research (and practice) can best be understood as more or less associated with one of four epistemologies: empiricism......, rationalism, historicism/hermeneutics, or pragmatism/critical theory (of which only the last position fully acknowledges the non-neutrality of knowledge organisation). Ranganathan – and the whole facet-analytic school – has formerly been exemplified as a rather clear example of rationalism. Some have objected...

  7. FACET Tolerances for Static and Dynamic Misalignments

    Energy Technology Data Exchange (ETDEWEB)

    Federico, Joel

    2012-07-13

    The Facility for AdvancedAccelerator and Experimental Tests (FACET) at the SLAC National Accelerator Laboratory is designed to deliver a beam with a transverse spot size on the order of 10 {micro}m x 10 {micro}m in a new beamline constructed at the two kilometer point of the SLAC linac. Commissioning the beamline requires mitigating alignment errors and their effects, which can be significant and result in spot sizes orders of magnitude larger. Sextupole and quadrupole alignment errors in particular can introduce errors in focusing, steering, and dispersion which can result in spot size growth, beta mismatch, and waist movement. Alignment errors due to static misalignments, mechanical jitter, energy jitter, and other physical processes can be analyzed to determine the level of accuracy and precision that the beamline requires. It is important to recognize these effects and their tolerances in order to deliver a beam as designed.

  8. Weak layer fracture: facets and depth hoar

    Directory of Open Access Journals (Sweden)

    I. Reiweger

    2013-09-01

    Full Text Available Understanding failure initiation within weak snow layers is essential for modeling and predicting dry-snow slab avalanches. We therefore performed laboratory experiments with snow samples containing a weak layer consisting of either faceted crystals or depth hoar. During these experiments the samples were loaded with different loading rates and at various tilt angles until fracture. The strength of the samples decreased with increasing loading rate and increasing tilt angle. Additionally, we took pictures of the side of four samples with a high-speed video camera and calculated the displacement using a particle image velocimetry (PIV algorithm. The fracture process within the weak layer could thus be observed in detail. Catastrophic failure started due to a shear fracture just above the interface between the depth hoar layer and the underlying crust.

  9. Diagnostic value of saccoradiculography and of cat scan to detect stenosis of the lumbar canal

    International Nuclear Information System (INIS)

    Arrault, I.; Benoist, M.; Rocolle, J.; Busson, J.; Lassale, B.; Deburge, A.

    1987-01-01

    Radiculographic X-rays and CAT scans of 60 patients operated on for stenosis of the lumbar canal were analysed separately and retrospectively by rheumatologists, a radiologist and surgeons working jointly, without knowledge of findings revealed by surgery. Comparison of findings with a detailed surgical report reveals that in the case of central lumbar canal stenosis, CAT scan provides a higher degree of reliability (72%) in diagnosis than does radiculography (56%). With lateral stenosis of the lateral cleft, reliability of both tests is identical (62%). The diagnostic deficiencies of these two examinations are discussed as well as diagnostic criteria employed and possible avenues of research. Currently, in the case of stenosis of the lumbar canal, it is still necessary to perform both of these examinations in combination and to accept the fact that, in certain cases, only one of the two tests reveals the stenosis, to be able to attain a preoperative rate of correct diagnosis greater than 80% [fr

  10. Assessment of movement distribution in the lumbar spine using the instantaneous axis of rotation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ki Won [Trine University, Angola (Indonesia)

    2014-12-15

    The position of the torso and the magnitude of exertion are thought to influence the distribution pattern of intervertebral movements within the lumbar spine. Abnormal intervertebral movements have been correlated with the risk of spine injuries. Since the capability to measure movement distribution within the lumbar spine noninvasively is limited, a convenient method to diagnose joint motion function was proposed. The goal of this research was to test the efficacy of the instantaneous axis of rotation for assessment of the distribution of movement within the lumbar spine. The proposed method was evaluated in the bio mechanical model. The results showed that the location of instantaneous axis of rotation lowered with increased trunk exertion force, and slightly moved higher with increased trunk angle. Recognizing that abnormal location of the instantaneous axis of rotation correlated with spinal pain, these results suggest potential the location of the instantaneous axis of rotation relates to the risk of low back pain on distributed spinal kinematics.

  11. Facet-controlled synthesis and facet-dependent photocatalytic properties of SnO{sub 2} micropolyhedrons

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Gengxia [Key Laboratory of Modern Acoustics, MOE, Institute of Acoustics and Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructures, Nanjing University, Nanjing 210093 (China); Wu, Xinglong, E-mail: hkxlwu@nju.edu.cn [Key Laboratory of Modern Acoustics, MOE, Institute of Acoustics and Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructures, Nanjing University, Nanjing 210093 (China); Liu, Lizhe; Zhu, Xiaobin [Key Laboratory of Modern Acoustics, MOE, Institute of Acoustics and Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructures, Nanjing University, Nanjing 210093 (China); Zhu, Xiaoshu [Center for Analysis and Testing, Nanjing Normal University, Nanjing 210093 (China); Hao, Yanling [Key Laboratory of Modern Acoustics, MOE, Institute of Acoustics and Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructures, Nanjing University, Nanjing 210093 (China); Chu, Paul K. [Department of Physics and Materials Science, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong (China)

    2015-09-15

    Graphical abstract: - Highlights: • SnO{sub 2} micropolyhedrons with (1 0 1) and (1 0 0) facets at different ratios are fabricated. • The vapor–solid growth mechanism of micropolyhedrons is discussed. • SnO{sub 2} octahedrons with complete (1 0 1) facets show strong photocatalytic activity. • Enhanced photocatalytic activity stems from the facet-dependent surface states. - Abstract: The facet-dependent properties of SnO{sub 2} are of fundamental and practical importance. In this study, by adjusting the deposition temperature during chemical vapor deposition, octahedral SnO{sub 2} with the exposed (1 0 1) facet and two other kinds of SnO{sub 2} polyhedrons with (1 0 1) and (1 0 0) facets with different ratios are fabricated controllably based on the vapor–solid growth mechanism. A slight increase in the deposition temperature from 1030 to 1070 °C decreases the surface energy of the reduced (1 0 1) facet with Sn termination, leading to the formation of polyhedrons with different area ratios of (1 0 1) to (1 0 0) facets. By adopting the terephthalic acid fluorescent method, the SnO{sub 2} octahedrons are demonstrated to have the strongest photocatalytic activity due to the formation of surface states induced by 5s electrons of bivalent Sn on the (1 0 1) surface. The results reveal that the photocatalytic properties of SnO{sub 2} microcrystals can be enhanced by facet-controlled synthesis.

  12. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

    OpenAIRE

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

    2014-01-01

    A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to...

  13. Acromioclavicular joint separation

    Directory of Open Access Journals (Sweden)

    Devan Pandya, BS

    2018-04-01

    Full Text Available History of present illness: A 30-year-old male was brought in by ambulance to the emergency department as a trauma activation after a motorcycle accident. The patient was the helmeted rider of a motorcycle traveling at an unknown speed when he lost control and was thrown off his vehicle. He denied loss of consciousness, nausea, or vomiting. The patient’s vital signs were stable and his only complaint was pain around his left shoulder. On exam, the patient had a prominent left clavicle without skin compromise. He had adequate range of motion in the left shoulder with moderate pain, and his left upper extremity was neurovascularly intact. Significant findings: Plain films of the left shoulder showed elevation of the left clavicle above the acromion. There was an increase in the acromioclavicular (AC and coracoclavicular (CC distances (increased joint distances marked with red and blue arrows, respectively. A normal AC joint measures 1-3 mm whereas a normal CC distance measures 11-13 mm.1 The injury was classified as a Rockwood type III AC joint separation. Discussion: The AC joint is a synovial joint between an oval facet on the acromion and a similar facet on the distal end of the clavicle. Horizontal stability is provided by the AC joint while axial stability is provided by the CC joint.2,3 AC joint injuries account for about 9%-12% of shoulder girdle injuries, and the most common mechanism is direct trauma.4,5 Initial evaluation with imaging includes plain films with three views: the anterior-posterior (AP view with the shoulder in internal and external rotation as well as an axillary, or scapula-Y view (sensitivity 40%, specificity 90% for all films.6,7 AC joint injuries are classified by the Rockwood system.8 Type I involves a sprain or incomplete tear of the AC ligaments with an intact CC ligament. The AC joint appears normal on X-ray, but can become widened with stress, achieved by having the patient hold a 10-15 pound weight from each

  14. Improving personality facet scores with multidimensional computer adaptive testing

    DEFF Research Database (Denmark)

    Makransky, Guido; Mortensen, Erik Lykke; Glas, Cees A W

    2013-01-01

    personality tests contain many highly correlated facets. This article investigates the possibility of increasing the precision of the NEO PI-R facet scores by scoring items with multidimensional item response theory and by efficiently administering and scoring items with multidimensional computer adaptive...

  15. The Structure of Spatial Ability Items: A Faceted Analysis.

    Science.gov (United States)

    Guttman, Ruth; Shoham, Ilana

    1982-01-01

    Eight spatial tests assembled with a mapping sentence of four content facets (rule type, dimensionality, presence or absence of rotation, and test format) were administered to 800 individuals. Smallest Space Analysis of an intercorrelation matrix yielded three facets which formed distinct regions in a two-dimensional projection of a…

  16. 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...

  17. Remote cerebellar hemorrhage after lumbar spinal surgery

    International Nuclear Information System (INIS)

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

    2009-01-01

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

  18. [A woman with a postoperative lumbar swelling].

    Science.gov (United States)

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

    2013-01-01

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

  19. Concurrent, parallel, multiphysics coupling in the FACETS project

    Energy Technology Data Exchange (ETDEWEB)

    Cary, J R; Carlsson, J A; Hakim, A H; Kruger, S E; Miah, M; Pletzer, A; Shasharina, S [Tech-X Corporation, 5621 Arapahoe Avenue, Suite A, Boulder, CO 80303 (United States); Candy, J; Groebner, R J [General Atomics (United States); Cobb, J; Fahey, M R [Oak Ridge National Laboratory (United States); Cohen, R H; Epperly, T [Lawrence Livermore National Laboratory (United States); Estep, D J [Colorado State University (United States); Krasheninnikov, S [University of California at San Diego (United States); Malony, A D [ParaTools, Inc (United States); McCune, D C [Princeton Plasma Physics Laboratory (United States); McInnes, L; Balay, S [Argonne National Laboratory (United States); Pankin, A, E-mail: cary@txcorp.co [Lehigh University (United States)

    2009-07-01

    FACETS (Framework Application for Core-Edge Transport Simulations), is now in its third year. The FACETS team has developed a framework for concurrent coupling of parallel computational physics for use on Leadership Class Facilities (LCFs). In the course of the last year, FACETS has tackled many of the difficult problems of moving to parallel, integrated modeling by developing algorithms for coupled systems, extracting legacy applications as components, modifying them to run on LCFs, and improving the performance of all components. The development of FACETS abides by rigorous engineering standards, including cross platform build and test systems, with the latter covering regression, performance, and visualization. In addition, FACETS has demonstrated the ability to incorporate full turbulence computations for the highest fidelity transport computations. Early indications are that the framework, using such computations, scales to multiple tens of thousands of processors. These accomplishments were a result of an interdisciplinary collaboration among computational physics, computer scientists and applied mathematicians on the team.

  20. The Association of Flexibility, Balance, and Lumbar Strength with Balance Ability: Risk of Falls in Older Adults

    Directory of Open Access Journals (Sweden)

    Emilio J. Martínez-López Emilio

    2014-06-01

    Full Text Available The purpose of the present study was to determine the effects of a proprioceptive training program on older adults, as well as to analyze the association between flexibility, balance and lumbar strength (physical fitness test with balance ability and fall risk (functional balance tests. This study was a controlled, longitudinal trial with a 12-week follow-up period. Subjects from a population of older adults were allocated to the intervention group (n = 28 or to the usual care (control group (n = 26. Subjects performed proprioceptive training twice weekly (6 specific exercises with Swiss ball and BOSU. Each session included 50 minutes (10 minutes of warm-up with slow walk, 10 minutes of mobility and stretching exercises, 30 minutes of proprioceptive exercises. The outcome variables were physical fitness (lower-body flexibility, hip-joint mobility, dynamic balance, static balance, and lumbar strength and functional balance (Berg scale and Tinetti test. The experimental group obtained significantly higher values than the control group in lower-body flexibility, dynamic balance, and lumbar strength (p = 0.019, p < 0.001, and p = 0.034 respectively. Hip-joint mobility, dynamic balance, and lumbar strength were positively associated with balance ability (p < 0.001, p < 0.001, and p = 0.014, respectively and the prevention of falls (p = 0.001, p < 0.001, and p = 0.017 respectively. These findings suggest that a 12-week proprioception program intervention (twice a week significantly improves flexibility, balance, and lumbar strength in older adults. Hip-joint mobility, dynamic balance and lumbar strength are positively associated to balance ability and the risk of falls in older adults. This proprioceptive training does not show a significant improvement in hip-joint mobility or static balance.

  1. Cervical facet dislocation adjacent to the fused motion segment

    Directory of Open Access Journals (Sweden)

    Kunio Yokoyama

    2016-01-01

    Full Text Available This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B. Cervical computed tomography (CT indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D. In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation.

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

    Science.gov (United States)

    Chang, Han Soo

    2018-01-01

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

  3. Lumbar total disc replacement from an extreme lateral approach: clinical experience with a minimum of 2 years' follow-up.

    Science.gov (United States)

    Pimenta, Luiz; Oliveira, Leonardo; Schaffa, Thomas; Coutinho, Etevaldo; Marchi, Luis

    2011-01-01

    found to have hypertrophy of the quadriceps contralateral to the approach side at the 12-month visit, which was resolved by the 2-year visit. Four patients (11%) had postoperative facet joint pain, all in hybrid cases. All patients were 2 years or more postsurgery as of this writing, although 3 were lost to follow-up between the 1- and 2-year visits. In 2 cases (5.6%), removal of the TDR device and revision to fusion were required due to unresolved pain. At 2 years' follow-up, the average visual analog scale and Oswestry Disability Index scores had improved 69.6% and 61.4%, respectively, and ROM averaged 8.6°, well within physiological norms. long-term results of a laterally placed TDR device demonstrate maintenance of pain relief and functional improvement. The benefits of this technique-minimal morbidity, avoiding mobilization of the great vessels, preserving the ALL, biomechanically stable orientation, and broader revision options-suggest a promising new direction for TDR procedures.

  4. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Science.gov (United States)

    2010-10-01

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

  5. Anterior Hip Subluxation due to Lumbar Degenerative Kyphosis and Posterior Pelvic Tilt

    Directory of Open Access Journals (Sweden)

    Hiroyuki Tsuchie

    2014-01-01

    Full Text Available Nontraumatic anterior subluxation and dislocation of the hip joint are extremely rare. A 58-year-old woman presented to our outpatient clinic with left hip pain with a duration of 15 years. There was no history of trauma or other diseases. Her hip pain usually occurred only on walking and not at rest. Physical examinations demonstrated no tenderness in the hip joint. The range of motion of both hip joints was almost normal. Laxity of other joints was not observed. The bone mineral density of the lumbar spine and proximal femur confirmed a diagnosis of osteoporosis. A plain radiograph showed osteoarthritic changes of the hip joints, severe posterior pelvic tilt, and superior displacement of both femoral heads, especially in a standing position. Three-dimensional computed tomography (3DCT revealed anterior subluxation of both femoral heads. Seven years after the initial visit, both hip joints showed progression to severe osteoarthritis. Although the exact cause remains unclear, lumbar kyphosis, posterior pelvic tilt, and a decrease in acetabular coverage may have influenced the current case. We should be aware of these factors when we examine patients with hip osteoarthritis.

  6. Impact of Project Leadership Facets on Project Outcome

    Directory of Open Access Journals (Sweden)

    Arslan Ayub

    2015-08-01

    Full Text Available The study analyzes the role of project leadership facets on effective project outcome. Numerous such initiatives have already been taken on project outcome/performance in the context of apposite leadership styles or project management. However, the current study is unique in the milieu of project outcome that it introduces a new leadership approach, which throws light on the significance of variant leadership facets on project outcome. The study uses explanatory approach; primary data is collected from project management professionals working in different project organizations. The study uses structural equation model (SEM technique to test the hypothesis. The study found a positive relationship between project leadership facets and project outcome.

  7. 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.

  8. 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.

  9. ISASS Policy Statement – Lumbar Artificial Disc

    Science.gov (United States)

    Garcia, Rolando

    2015-01-01

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

  10. Gonadal dose reduction in lumbar spine radiography

    International Nuclear Information System (INIS)

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

    1983-01-01

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

  11. A Japanese Stretching Intervention Can Modify Lumbar Lordosis Curvature.

    Science.gov (United States)

    Kadono, Norio; Tsuchiya, Kazushi; Uematsu, Azusa; Kamoshita, Hiroshi; Kiryu, Kazunori; Hortobágyi, Tibor; Suzuki, Shuji

    2017-08-01

    Eighteen healthy male adults were assigned to either an intervention or control group. Isogai dynamic therapy (IDT) is one of Japanese stretching interventions and has been practiced for over 70 years. However, its scientific quantitative evidence remains unestablished. The objective of this study was to determine whether IDT could modify lumbar curvature in healthy young adults compared with stretching exercises used currently in clinical practice. None of previous studies have provided data that conventional stretching interventions could modify spinal curvatures. However, this study provides the first evidence that a specific form of a Japanese stretching intervention can acutely modify the spinal curvatures. We compared the effects of IDT, a Japanese stretching intervention (n=9 males), with a conventional stretching routine (n=9 males) used widely in clinics to modify pelvic tilt and lumbar lordosis (LL) angle. We measured thoracic kyphosis (TK) and LL angles 3 times during erect standing using the Spinal Mouse before and after each intervention. IDT consisted of: (1) hip joint correction, (2) pelvic tilt correction, (3) lumbar alignment correction, and (4) squat exercise stretch. The control group performed hamstring stretches while (1) standing and (2) sitting. IDT increased LL angle to 25.1 degrees (±5.9) from 21.2 degrees (±6.9) (P=0.047) without changing TK angle (pretest: 36.8 degrees [±6.9]; posttest: 36.1 degrees [±6.5]) (P=0.572). The control group showed no changes in TK (P=0.819) and LL angles (P=0.744). IDT can thus be effective for increasing LL angle, hence anterior pelvic tilt. Such modifications could ameliorate low back pain and improve mobility in old adults with an unfavorable pelvic position.

  12. [Meniscoids of the intervertebral joints].

    Science.gov (United States)

    Kos, J; Hert, J; Sevcík, P

    2002-01-01

    A large amount of material was used to study the distribution, location and shape of meniscoids in intervertebral joints of the human spine, from the atlanto-occipital joint to the sacrum, in order to find out how many of intervertebral joints had mobile meniscoids. These might be regarded as possible causes of spinal blockade or other vertebrogenous complaints. The materials provided by the Department of Anatomy and Department of Forensic Medicine at the Faculty of Medicine of Charles University in Pilznen included 20 cadaverous spines from humans aged 20 to 80 years. Access to each joint was provided by dissection of the articular capsule from the lower articular processes of the vertebra situated above. In the orthograde view, all meniscoids were described in terms of shape, size, consistence and location. Their structure was ascertained by histological examination of cross sections stained with haematoxylin and eosin. Meniscoids varying in shape and size were found in all of the intervertebral joints. They were classified by their histological structure as synovial, fat and fibrous meniscoids. The first category was observed frequently, the last only rarely. A total of 29 mobile meniscoids were recorded, most of them in the lumbar spine. Most of the meniscoids present in the cervical spine were of synovial and less frequently of fat types. Meniscoids found in the thoracic spine were poorly developed synovial ones and those present in the lumbar spine were of all types and were also largest in size. The most conspicuous meniscoids were seen in the spines that showed degenerative changes in intervertebral joints. Large fat pads were found in atlanto-occipital and atlanto-axial joints. Mobile meniscoids, most of them present in the lumbar spine (6.4% of all joints.), were connected with the capsule by a thin pedicle and it was possible to move them over a half of the articular surface. Some inter-individual changes were also found; in some spines, the most

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

    International Nuclear Information System (INIS)

    Mou Ling

    2009-01-01

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

  14. Facets of operational performance in an emergency room (ER)

    NARCIS (Netherlands)

    van der Vaart, Taco; Vastag, Gyula; Wijngaard, Jacob

    This paper, using detailed time measurements of patients complemented by interviews with hospital management and staff, examines three facets of an emergency room's (ER) operational performance: (1) effectiveness of the triage system in rationing patient treatment; (2) factors influencing ER's

  15. Clarifying associations between psychopathy facets and personality disorders among offenders

    NARCIS (Netherlands)

    Klipfel, Kristen M.; Garofalo, C.; Kosson, D.S.

    2017-01-01

    Purpose This study examined bivariate, unique, and multivariate associations between psychopathy facets and other Personality Disorders (PDs). Method 76 incarcerated males were assessed with clinical interviews measuring psychopathy and DSM-5 PDs. Canonical Correlation Analysis (CCA) was used to

  16. Giant, Completely Calcified Lumbar Juxtafacet Cyst: Report of an Unusual Case

    Science.gov (United States)

    Huang, Kevin T.; Owens, Timothy R.; Wang, Teresa S.; Moreno, Jessica R.; Bagley, Jacob H.; Bagley, Carlos A.

    2013-01-01

    Study Design Case report. Objective To report the case of one patient who developed a giant, completely calcified, juxtafacet cyst. Methods A 57-year-old woman presented with a 2-year history of progressively worsening lower back pain, left leg pain, weakness, and paresthesias. Imaging showed a giant, completely calcified mass arising from the left L5–S1 facet joint, with coexisting grade I L5 on S1 anterolisthesis. The patient was treated with laminectomy, excision of the mass, and L5–S1 fixation and fusion. Results The patient had an uncomplicated postoperative course and had complete resolution of her symptoms as of 1-year follow-up. Conclusions When presented with a solid-appearing, calcified mass arising from the facet joint, a completely calcified juxtafacet cyst should be considered as part of the differential diagnosis. PMID:25083359

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

    Science.gov (United States)

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

    2017-01-01

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

  18. Structural behavior of human lumbar intervertebral disc under direct shear.

    Science.gov (United States)

    Schmidt, Hendrik; Häussler, Kim; Wilke, Hans-Joachim; Wolfram, Uwe

    2015-03-18

    The intervertebral disc (IVD) is a complex, flexible joint between adjacent vertebral bodies that provides load transmission while permitting movements of the spinal column. Finite element models can be used to help clarify why and how IVDs fail or degenerate. To do so, it is of importance to validate those models against controllable experiments. Due to missing experimental data, shear properties are not used thus far in validating finite element models. This study aimed to investigate the structural shear properties of human lumbar IVDs in posteroanterior (PA) and laterolateral (LL) loading directions. Fourteen lumbar IVDs (median age: 49 years) underwent direct shear in PA and LL loading directions. A custom-build shear device was used in combination with a materials testing machine to load the specimens until failure. Shear stiffness, ultimate shear force and displacement, and work to failure were determined. Each specimen was tested until complete or partial disruption. Median stiffness in PA direction was 490 N/mm and in LL direction 568 N/mm. Median ultimate shear force in the PA direction was 2,877 N and in the LL direction 3,199 N. Work to failure was 12 Nm in the PA and 9 Nm in the LL direction. This study was an experiment to subject IVDs to direct shear. The results could help us to understand the structure and function of IVDs with regard to mechanical spinal stability, and they can be used to validate finite element models of the IVD.

  19. Framework Application for Core Edge Transport Simulation (FACETS)

    Energy Technology Data Exchange (ETDEWEB)

    Malony, Allen D; Shende, Sameer S; Huck, Kevin A; Mr. Alan Morris, and Mr. Wyatt Spear

    2012-03-14

    The goal of the FACETS project (Framework Application for Core-Edge Transport Simulations) was to provide a multiphysics, parallel framework application (FACETS) that will enable whole-device modeling for the U.S. fusion program, to provide the modeling infrastructure needed for ITER, the next step fusion confinement device. Through use of modern computational methods, including component technology and object oriented design, FACETS is able to switch from one model to another for a given aspect of the physics in a flexible manner. This enables use of simplified models for rapid turnaround or high-fidelity models that can take advantage of the largest supercomputer hardware. FACETS does so in a heterogeneous parallel context, where different parts of the application execute in parallel by utilizing task farming, domain decomposition, and/or pipelining as needed and applicable. ParaTools, Inc. was tasked with supporting the performance analysis and tuning of the FACETS components and framework in order to achieve the parallel scaling goals of the project. The TAU Performance System® was used for instrumentation, measurement, archiving, and profile / tracing analysis. ParaTools, Inc. also assisted in FACETS performance engineering efforts. Through the use of the TAU Performance System, ParaTools provided instrumentation, measurement, analysis and archival support for the FACETS project. Performance optimization of key components has yielded significant performance speedups. TAU was integrated into the FACETS build for both the full coupled application and the UEDGE component. The performance database provided archival storage of the performance regression testing data generated by the project, and helped to track improvements in the software development.

  20. Proposal plan of classification faceted for federal universities

    Directory of Open Access Journals (Sweden)

    Renata Santos Brandão

    2017-09-01

    Full Text Available This study aims to present a faceted classification plan for the archival management of documents in the federal universities of Brazil. For this, was done a literature review on the archival management in Brazil, the types of classification plans and the theory of the Ranganathan faceted classification, through searches in databases in the areas of Librarianship and Archivology. It was identified the classification plan used in the Federal Institutions of Higher Education to represent the functional facet and created the structural classification plan to represent the structural facet. The two classification plans were inserted into a digital repository management system to give rise to the faceted classification plan. The system used was Tainacan, free software wordpress-based used in digital document management. The developed faceted classification plan allows the user to choose and even combine the way to look for the information that guarantees agreater efficiency in the information retrieval.

  1. Knowledge-based iterative model reconstruction technique in computed tomography of lumbar spine lowers radiation dose and improves tissue differentiation for patients with lower back pain

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Cheng Hui [Department of Medical Imaging, Pojen General Hopsital, Taipei, Taiwan (China); School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Wu, Tung-Hsin [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (China); Lin, Chung-Jung, E-mail: bcjlin@me.com [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China); Chiou, Yi-You; Chen, Ying-Chou; Sheu, Ming-Huei; Guo, Wan-Yuo; Chiu, Chen Fen [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China)

    2016-10-15

    Highlights: • Knowledge-based IMR improves tissue differentiation in CT of L-spine better than hybrid IR (iDose{sup 4}). • Higher strength IMR improves image qualities of the IVD and IVF in spinal stenosis. • IMR provides diagnostic lower dose CT of L-spine. - Abstract: Purpose: To evaluate the image quality and diagnostic confidence of reduced-dose computed tomography (CT) of the lumbar spine (L-spine) reconstructed with knowledge-based iterative model reconstruction (IMR). Materials and methods: Prospectively, group A consisted of 55 patients imaged with standard acquisition reconstructed with filtered back-projection. Group B consisted of 58 patients imaged with half tube current, reconstructed with hybrid iterative reconstruction (iDose{sup 4}) in Group B1 and knowledge-based IMR in Group B2. Signal-to-noise ratio (SNR) of different regions, the contrast-to-noise ratio between the intervetebral disc (IVD) and dural sac (D-D CNR), and subjective image quality of different regions were compared. Higher strength IMR was also compared in spinal stenosis cases. Results: The SNR of the psoas muscle and D-D CNR were significantly higher in the IMR group. Except for the facet joint, subjective image quality of other regions including IVD, intervertebral foramen (IVF), dural sac, peridural fat, ligmentum flavum, and overall diagnostic acceptability were best for the IMR group. Diagnostic confidence of narrowing IVF and IVD was good (kappa = 0.58–0.85). Higher strength IMR delineated IVD better in spinal stenosis cases. Conclusion: Lower dose CT of L-spine reconstructed with IMR demonstrates better tissue differentiation than iDose{sup 4} and standard dose CT with FBP.

  2. Knowledge-based iterative model reconstruction technique in computed tomography of lumbar spine lowers radiation dose and improves tissue differentiation for patients with lower back pain

    International Nuclear Information System (INIS)

    Yang, Cheng Hui; Wu, Tung-Hsin; Lin, Chung-Jung; Chiou, Yi-You; Chen, Ying-Chou; Sheu, Ming-Huei; Guo, Wan-Yuo; Chiu, Chen Fen

    2016-01-01

    Highlights: • Knowledge-based IMR improves tissue differentiation in CT of L-spine better than hybrid IR (iDose 4 ). • Higher strength IMR improves image qualities of the IVD and IVF in spinal stenosis. • IMR provides diagnostic lower dose CT of L-spine. - Abstract: Purpose: To evaluate the image quality and diagnostic confidence of reduced-dose computed tomography (CT) of the lumbar spine (L-spine) reconstructed with knowledge-based iterative model reconstruction (IMR). Materials and methods: Prospectively, group A consisted of 55 patients imaged with standard acquisition reconstructed with filtered back-projection. Group B consisted of 58 patients imaged with half tube current, reconstructed with hybrid iterative reconstruction (iDose 4 ) in Group B1 and knowledge-based IMR in Group B2. Signal-to-noise ratio (SNR) of different regions, the contrast-to-noise ratio between the intervetebral disc (IVD) and dural sac (D-D CNR), and subjective image quality of different regions were compared. Higher strength IMR was also compared in spinal stenosis cases. Results: The SNR of the psoas muscle and D-D CNR were significantly higher in the IMR group. Except for the facet joint, subjective image quality of other regions including IVD, intervertebral foramen (IVF), dural sac, peridural fat, ligmentum flavum, and overall diagnostic acceptability were best for the IMR group. Diagnostic confidence of narrowing IVF and IVD was good (kappa = 0.58–0.85). Higher strength IMR delineated IVD better in spinal stenosis cases. Conclusion: Lower dose CT of L-spine reconstructed with IMR demonstrates better tissue differentiation than iDose 4 and standard dose CT with FBP.

  3. 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.

  4. A faceted eye on intellectual giftedness: Examining the personality of gifted students using FFM domains and facets

    Directory of Open Access Journals (Sweden)

    Altaras-Dimitrijević Ana

    2012-01-01

    Full Text Available The study examines the personality profile of gifted vs. average-ability students from the perspective of the FFM. The issue was approached by (1 reviewing the literature for well-established personality characteristics of the gifted, (2 establishing correspondences between these traits and FFM domains/facets, and (3 formulating a domain and a facet-level model which were hypothesized to discriminate significantly between gifted and nongifted students. The domain-level model consisted of Openness and Agreeableness. The facet-level model included 14 traits: Anxiety, Impulsiveness, Gregariousness, Assertiveness, Fantasy, Feelings, Aesthetics, Ideas, Compliance, Modesty, Tendermindedness, Order, Achievement, and Deliberation. The models were tested on three samples (N1=515 high-school students, 155 gifted; N2=132 psychology students, 28 gifted; N3=443 psychology students, 91 gifted. Results indicate that the domain-level model does not discriminate significantly between gifted and nongifted students in each sample, whereas the proposed 14-facet model yields a significant discrimination across all samples. The latter model may be further adjusted by removing facets which proved inconsistent or unsubstantial in distinguishing between the two groups. This yields a 7-facet discriminant function, which is also significant across samples, indicating that gifted students are consistently distinguished by a combination of high Ideas, Fantasy, Aesthetics, and Assertiveness, but low Gregariuosness, Modesty, and Tendermindeness. Educational implications and limitations are discussed. [Projekat Ministarstva nauke Republike Srbije, br. 179018

  5. Computed tomography in lumbar canal stenosis. Relationship between its findings and clinical symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Ohta, Shu; Baba, Itsushi; Ishida, Akihisa; Sumida, Tadayuki; Sasaki, Seishu (Hiroshima Shiritsu Asa Shimin Hospital (Japan))

    1984-09-01

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

  6. Studies on the pathogenesis of degenerative lumbar canal stenosis by computed tomography, 2

    International Nuclear Information System (INIS)

    Kido, Kenji

    1987-01-01

    To evaluate the significance of measurement parameters for the lumbar canal (LC), a retrospective analysis was made of computed tomography (CT) scans in a total of 129 patients, including 20 with degenerative lumbar canal stenosis (DLCS), 65 with degenerative spondylosis, 21 with disc hernia, and 23 with lumbar pain. The shape of the transverse LC was not reflected by the anteroposterior and transverse diameters of LC, but was somewhat reflected by the transverse area of LC. The transverse area of dural sac (DS) was considered important in determining the degree of stenosis. Regarding the transverse area, the DS correlated more strongly with the LC with soft-tissue windows than that with bone windows. The angle of intervertebral joint was likely to be related to the pathophysiology of the LC. In particular, sagittal tendency was seen at the levels of L3-4 and L4-5 in the DLCS group. There was correlation between the angle of intervertebral joint and the transverse areas of both soft-tissue LC and DS at the levels of L4-5. A multivariate analysis suggested the possibility that the significance of measurement parameters might vary depending on the vertebral level for the lower lumbar spine. The following criteria for indicating DLCS were obtained: 1) a transverse area of ≤ 100 mm 2 for DS or ≤ 118 mm 2 for soft-tissue LC at the levels of L3-4; 2) a transverse area of ≤ 90 mm 2 for DS and an angle of ≤ 90 deg for the intervertebral joint at the levels of L4-5; and 3) lateral recess of ≤ 3 mm in anteroposterior diameter at the levels of L5-S1. (Namekawa, K.)

  7. [Clinical effects of Dynesys system and transfacet decompression through Wiltse approach in the treatment of lumbar degenerative diseases].

    Science.gov (United States)

    Shang, K; Chen, M J; Wang, D G

    2017-05-23

    Objective: To investigate the early clinical effects of Dynesys system and transfacet decompression by Wiltse approach in the treatment of lumbar degenerative diseases. Methods: From January 2010 to December 2013, 48 patients suffering from lumbar degenerative diseases were treated with Dynesys system in addition to transfacet decompression through Wiltse approach.There were 28 males and 20 females with age of (51.8±6.8). The preoperative diagnosis included lumbar spinal stenosis(10 cases); lumber intervertebral disc herniation (38 cases). There were 23 cases in L4/5, 16 cases in L5/S1 and 9 cases in both of L4/5 and L5/S1.Posterolateral fixation with Dynesys pedicle screw through Wiltse approach.Unilateral resection of the inferior articular facet of the superior vertebra and the superior articular facet of the inferior vertebra.Decompression of the vertebral canal until the never root was decompressed satisfactorily.In the end, Dynesys was performed according to normal procedure.VAS, ODI evaluating standards were applied to evaluate the therapeutic effect.The intervertebral space and ROM of the lumbar were observed by X ray. Results: All patients underwent surgery safely without severe complications occurred.The average following up time was 33.5 (24-60) months.Compared with preoperative parameters (7.7±1.3, 70.8±13.5), the scores of VAS and ODI decreased significantly after surgery (2.3±1.5, 23.6±12.2) and at the final follow-up (2.2±1.4, 20.0±9.8) ( P 0.05). X-ray scan showed neither instability or internal fixation loosen, breakage or distortion in follow-up. Conclusion: Dynesys system in addition to transfacet decompression through Wiltse approach is a therapy option for mild lumbar degenerative disease.This method can retention the structure of lumbar posterior complex and the activity of the fixed segment, reduce the risk of low back pain together with nerve root decompressed.The early clinical results are satisfactory.

  8. 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.

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

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

    Science.gov (United States)

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

    2012-07-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  12. 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.

  13. Isthmic lumbar spondylolisthesis with sciatica

    International Nuclear Information System (INIS)

    Annertz, M.; Holtaas, S.; Cronqvist, S.; Joensson, B.; Stroemqvist, B.; Lund Univ. Hospital

    1990-01-01

    Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: Normal nerve (n=8), II: Compressed nerve (n=16); III: Disappearance of fat, nerve not possible to identify (n=9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information. (orig.)

  14. 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.)

  15. MR-guided lumbar sympathicolysis

    International Nuclear Information System (INIS)

    Koenig, Claudius W.; Schott, Ulrich G.; Pereira, Philippe L.; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H.; Schneider, Wilke

    2002-01-01

    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.)

  16. Future ATM Concepts Evaluation Tool (FACET) Interface Control Document

    Science.gov (United States)

    Grabbe, Shon R.

    2017-01-01

    This Interface Control Document (ICD) documents the airspace adaptation and air traffic inputs of NASA's Future ATM Concepts and Evaluation Tool (FACET). Its intended audience is the project manager, project team, development team, and stakeholders interested in interfacing with the system. FACET equips Air Traffic Management (ATM) researchers and service providers with a way to explore, develop and evaluate advanced air transportation concepts before they are field-tested and eventually deployed. FACET is a flexible software tool that is capable of quickly generating and analyzing thousands of aircraft trajectories. It provides researchers with a simulation environment for preliminary testing of advanced ATM concepts. Using aircraft performance profiles, airspace models, weather data, and flight schedules, the tool models trajectories for the climb, cruise, and descent phases of flight for each type of aircraft. An advanced graphical interface displays traffic patterns in two and three dimensions, under various current and projected conditions for specific airspace regions or over the entire continental United States. The system is able to simulate a full day's dynamic national airspace system (NAS) operations, model system uncertainty, measure the impact of different decision-makers in the NAS, and provide analysis of the results in graphical form, including sector, airport, fix, and airway usage statistics. NASA researchers test and analyze the system-wide impact of new traffic flow management algorithms under anticipated air traffic growth projections on the nation's air traffic system. In addition to modeling the airspace system for NASA research, FACET has also successfully transitioned into a valuable tool for operational use. Federal Aviation Administration (FAA) traffic flow managers and commercial airline dispatchers have used FACET technology for real-time operations planning. FACET integrates live air traffic data from FAA radar systems and weather data

  17. Joint ventures

    DEFF Research Database (Denmark)

    Sørensen, Karsten Engsig

    Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret......Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret...

  18. Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports.

    Science.gov (United States)

    Ke, Xijian; Li, Ji; Liu, Yong; Wu, Xi; Mei, Wei

    2017-06-26

    Anesthesia management for patients with severe ankylosing spondylitis scheduled for total hip arthroplasty is challenging due to a potential difficult airway and difficult neuraxial block. We report 4 cases with ankylosing spondylitis successfully managed with a combination of lumbar plexus, sacral plexus and T12 paravertebral block. Four patients were scheduled for total hip arthroplasty. All of them were diagnosed as severe ankylosing spondylitis with rigidity and immobilization of cervical and lumbar spine and hip joints. A combination of T12 paravertebral block, lumbar plexus and sacral plexus block was successfully used for the surgery without any additional intravenous anesthetic or local anesthetics infiltration to the incision, and none of the patients complained of discomfort during the operations. The combination of T12 paravertebral block, lumbar plexus and sacral plexus block, which may block all nerves innervating the articular capsule, surrounding muscles and the skin involved in total hip arthroplasty, might be a promising alternative for total hip arthroplasty in ankylosing spondylitis.

  19. 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.

  20. Coracoclavicular joint

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Sang; Park, Chan Il; Ahn, Jae Doo; Lim, Chong Won [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1970-10-15

    The coracoclvicular joint, a rear abnormality which may be the cause of pain in the shoulder and limitation of motion of the shoulder joint, is discussed. A case of coracoclvicular joint with shoulder pain was observed in 65 yrs old Korean male.

  1. Rhetorical facets of imagination in contemporary poetry

    Directory of Open Access Journals (Sweden)

    Hassan Delbari

    2015-03-01

    Full Text Available Abstract The present article deals with the trend of literary imaginative descriptions in the purview of poetical imaginations which have been regarded greatly in the discourse of rhetoric’s. The different facets of imagination of these imageries are also introduced in this article. Throughout this study poetical demonstrations are dealt with on the basis of their indications, functions and profundity. Meanwhile overcoming superficial and intermediate layers of imagination towards inner and profound thoughts would represent the domination of the poets in depiction of imagery. For this purpose, an introduction of numerous imagery layers with their deep and superficial, positive and subsidiary nature is presented through some examples. The result suggests that the extent of imagery complexity among many poets has a direct relation to their subjectivity in such a way that different levels of imageries are internalized as a unique stylistic feature of any individual poet. He endeavors to ornament his poem through imagery devices. Yousefi says: “any poem in which there is not imagery cannot be regarded as a poem. “The attractiveness of such imagination and the success or failure of the poet in conveying this imagery is a matter of poet’s tendency in using imagery devices. Through this article the contemporary poems are analyzed from the view point of objectivity and subjectivity. Furthermore, the poems are studied on their functions. The analysis has been carried out from two perspectives idiosyncratic features of the poet and the characteristics of the era in which he has lived. The examples presented in this article are selected from among the poets with different linguistic backgrounds and unique ideologies. The reason behind this specific consideration is an indication of a generalizability rather than a representativeness of few poets with their idiosyncratic styles. Therefore, the results indicate the style characteristics

  2. Rhetorical facets of imagination in contemporary poetry

    Directory of Open Access Journals (Sweden)

    Hassan Delbari

    2015-04-01

    Full Text Available Abstract The present article deals with the trend of literary imaginative descriptions in the purview of poetical imaginations which have been regarded greatly in the discourse of rhetoric’s. The different facets of imagination of these imageries are also introduced in this article. Throughout this study poetical demonstrations are dealt with on the basis of their indications, functions and profundity. Meanwhile overcoming superficial and intermediate layers of imagination towards inner and profound thoughts would represent the domination of the poets in depiction of imagery. For this purpose, an introduction of numerous imagery layers with their deep and superficial, positive and subsidiary nature is presented through some examples. The result suggests that the extent of imagery complexity among many poets has a direct relation to their subjectivity in such a way that different levels of imageries are internalized as a unique stylistic feature of any individual poet. He endeavors to ornament his poem through imagery devices. Yousefi says: “any poem in which there is not imagery cannot be regarded as a poem. “The attractiveness of such imagination and the success or failure of the poet in conveying this imagery is a matter of poet’s tendency in using imagery devices. Through this article the contemporary poems are analyzed from the view point of objectivity and subjectivity. Furthermore, the poems are studied on their functions. The analysis has been carried out from two perspectives idiosyncratic features of the poet and the characteristics of the era in which he has lived. The examples presented in this article are selected from among the poets with different linguistic backgrounds and unique ideologies. The reason behind this specific consideration is an indication of a generalizability rather than a representativeness of few poets with their idiosyncratic styles. Therefore, the results indicate the style characteristics of poet

  3. 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.)

  4. Tractography of lumbar nerve roots: initial results

    International Nuclear Information System (INIS)

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

    2011-01-01

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

  5. Tests of beam-based alignement at FACET

    CERN Document Server

    Latina, A; Schulte, D; Adli, E

    2014-01-01

    The performance of future linear colliders will depend critically on beam-based alignment (BBA) and feedback systems, which will play a crucial role in guaranteeing the low emittance transport throughout such machines. BBA algorithms designed to improve the beam transmission in a linac by simultaneously optimising the trajectory and minimising the residual dispersion, have thoughtfully been studied in theory over the last years, and successfully verified experimentally. One such technique is called Dispersion-Free Steering (DFS). A careful study of the DFS performance at the SLAC test facility FACET lead us to design a beam-based technique specifically targeted to reduce the impact of transverse short-range wakefields, rather than of the dispersion, being the wakefields the limiting factor to the FACET performance. This technique is called Wakefield-Free Steering (WFS). The results of the first tests of WFS at FACET are presented in this paper.

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

    Science.gov (United States)

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

  7. Large conservation gains possible for global biodiversity facets

    Science.gov (United States)

    Pollock, Laura J.; Thuiller, Wilfried; Jetz, Walter

    2017-06-01

    Different facets of biodiversity other than species numbers are increasingly appreciated as critical for maintaining the function of ecosystems and their services to humans. While new international policy and assessment processes such as the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) recognize the importance of an increasingly global, quantitative and comprehensive approach to biodiversity protection, most insights are still focused on a single facet of biodiversity—species. Here we broaden the focus and provide an evaluation of how much of the world’s species, functional and phylogenetic diversity of birds and mammals is currently protected and the scope for improvement. We show that the large existing gaps in the coverage for each facet of diversity could be remedied by a slight expansion of protected areas: an additional 5% of the land has the potential to more than triple the protected range of species or phylogenetic or functional units. Further, the same areas are often priorities for multiple diversity facets and for both taxa. However, we find that the choice of conservation strategy has a fundamental effect on outcomes. It is more difficult (that is, requires more land) to maximize basic representation of the global biodiversity pool than to maximize local diversity. Overall, species and phylogenetic priorities are more similar to each other than they are to functional priorities, and priorities for the different bird biodiversity facets are more similar than those of mammals. Our work shows that large gains in biodiversity protection are possible, while also highlighting the need to explicitly link desired conservation objectives and biodiversity metrics. We provide a framework and quantitative tools to advance these goals for multi-faceted biodiversity conservation.

  8. Large conservation gains possible for global biodiversity facets.

    Science.gov (United States)

    Pollock, Laura J; Thuiller, Wilfried; Jetz, Walter

    2017-06-01

    Different facets of biodiversity other than species numbers are increasingly appreciated as critical for maintaining the function of ecosystems and their services to humans. While new international policy and assessment processes such as the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) recognize the importance of an increasingly global, quantitative and comprehensive approach to biodiversity protection, most insights are still focused on a single facet of biodiversity-species. Here we broaden the focus and provide an evaluation of how much of the world's species, functional and phylogenetic diversity of birds and mammals is currently protected and the scope for improvement. We show that the large existing gaps in the coverage for each facet of diversity could be remedied by a slight expansion of protected areas: an additional 5% of the land has the potential to more than triple the protected range of species or phylogenetic or functional units. Further, the same areas are often priorities for multiple diversity facets and for both taxa. However, we find that the choice of conservation strategy has a fundamental effect on outcomes. It is more difficult (that is, requires more land) to maximize basic representation of the global biodiversity pool than to maximize local diversity. Overall, species and phylogenetic priorities are more similar to each other than they are to functional priorities, and priorities for the different bird biodiversity facets are more similar than those of mammals. Our work shows that large gains in biodiversity protection are possible, while also highlighting the need to explicitly link desired conservation objectives and biodiversity metrics. We provide a framework and quantitative tools to advance these goals for multi-faceted biodiversity conservation.

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

    International Nuclear Information System (INIS)

    Kunishi, Yoshihiko

    2003-01-01

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

  10. Development of a clinically relevant impingement test method for a mobile bearing lumbar total disc replacement.

    Science.gov (United States)

    Siskey, Ryan; Peck, Jonathan; Mehta, Hitesh; Kosydar, Allison; Kurtz, Steven; Hill, Genevieve

    2016-09-01

    Total disc arthroplasty is an alternative therapy to spinal fusion for the treatment of neck or low back pain and is hypothesized to reduce the risk of disease progression to the adjacent spinal levels. Radiographic and retrieval analyses of various total disc replacements (TDRs) have shown evidence of impingement damage. Impingement of TDRs can occur when the device reaches the limits of its functional range of motion, causing contact between peripheral regions of the device. Impingement can be associated with increased wear and mechanical damage; however, impingement conditions are not simulated in current standardized mechanical bench test methods. This study explored the test conditions necessary to apply clinically relevant impingement loading to a lumbar TDR in vitro. An experimental protocol was developed and evaluated using in vivo retrievals for qualitative and quantitative validation. Retrieval analysis was conducted on a set of 11 size 3 retrieved Charité devices using American Society for Testing and Materials F561 as a guide. The impingement range of motion was determined using a combination of modeling and experiments, and was used as an input in vitro testing. A 1-million cycle in vitro test was then conducted, and the in vitro samples were characterized using methods similar to the retreived devices. All in vitro tested samples exhibited impingement regions and damage patterns consistent with retrieved devices. Consistent with the retrievals, the impingement damage on the rim was a combination of abrasive wear and plastic deformation. Micro computed tomography (microCT) was used to quantitatively assess rim damage due to impingement. Rim penetration was statistically lower in the retrievals when compared with both in vitro groups. Rim elongation was comparable among all groups. The simulated-facet group had statistically greater angular rim deformations than the retrieval group and the no-facet group. Results demonstrate that clinically relevant

  11. b-tree facets for the simple graph partitioning polytope

    DEFF Research Database (Denmark)

    Sørensen, Michael Malmros

    2004-01-01

    The simple graph partitioning problem is to partition an edge-weighted graph into mutually disjoint subgraphs, each consisting of no more than b nodes, such that the sum of the weights of all edges in the subgraphs is maximal. In this paper we introduce a large class of facet defining inequalities...... for the simple graph partitioning polytopes P_n(b), b >= 3, associated with the complete graph on n nodes. These inequalities are induced by a graph configuration which is built upon trees of cardinality b. We provide a closed-form theorem that states all necessary and sufficient conditions for the facet...... defining property of the inequalities. Udgivelsesdato: JUN...

  12. 2016 FACET-II Science Workshop Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    Hogan, Mark J., ed.

    2017-07-19

    The second in a series of FACET-II Science Workshops was held at SLAC National Accelerator Laboratory on October 17-19, 2016 [1]. The workshop drew thirty-five participants from eighteen different institutions including CERN, DESY, Ecole Polytechnique, FNAL, JAI, LBNL, LLNL, Radiabeam, Radiasoft, SLAC, Stony Brook, Strathclyde, Tech-X, Tsinghua, UC Boulder, UCLA and UT Austin. The 2015 workshop [2, 3] helped prioritize research directions for FACET-II. The 2016 workshop was focused on understanding what improvements are needed at the facility to support the next generation of experiments. All presentations are linked to the workshop website as a permanent record.

  13. Optical fiber end-facet polymer suspended-mirror devices

    Science.gov (United States)

    Yao, Mian; Wu, Jushuai; Zhang, A. Ping; Tam, Hwa-Yaw; Wai, P. K. A.

    2017-04-01

    This paper presents a novel optical fiber device based on a polymer suspended mirror on the end facet of an optical fiber. With an own-developed optical 3D micro-printing technology, SU-8 suspended-mirror devices (SMDs) were successfully fabricated on the top of a standard single-mode optical fiber. Optical reflection spectra of the fabricated SU- 8 SMDs were measured and compared with theoretical analysis. The proposed technology paves a way towards 3D microengineering of the small end-facet of optical fibers to develop novel fiber-optic sensors.

  14. Faceted MoS2 nanotubes and nanoflowers

    International Nuclear Information System (INIS)

    Deepak, Francis Leonard; Mayoral, Alvaro; Yacaman, Miguel Jose

    2009-01-01

    A simple synthesis of novel faceted MoS 2 nanotubes (NTs) and nanoflowers (NFs) starting from molybdenum oxide and thiourea as the sulphur source is reported. The MoS 2 nanotubes with the faceted morphology have not been observed before. Further the as-synthesized MoS 2 nanotubes have high internal surface area. The nanostructures have been characterized by a variety of electron microscopy techniques. It is expected that these MoS 2 nanostrutures will find important applications in energy storage, catalysis and field emission.

  15. The shape of the human lumbar vertebral canal

    OpenAIRE

    Zarzur,Edmundo

    1996-01-01

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

  16. Sensitivity of lumbar spine loading to anatomical parameters

    DEFF Research Database (Denmark)

    Putzer, Michael; Ehrlich, Ingo; Rasmussen, John

    2016-01-01

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

  17. Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

    OpenAIRE

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

    2016-01-01

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

  18. Structural models of faceted-faceted eutectic system vanillin-acenaphthene

    International Nuclear Information System (INIS)

    Sharma, B.L.

    2003-01-01

    Thermodynamic model for the eutectic system vanillin-acenaphthene has been developed by analysing the excess functions computed from its experimentally determined solidus-liquidus equilibrium data. Spontaneous nucleation model has been explored from the maximum limit of undercooling of the system and verified by the experimental evidences of dislocation mechanism governing the anisotropic velocity of crystallisation determined at different undercoolings. Viscosity measurements of eutectic and non-eutectic melts at different temperatures revealed the essence of peculiar structural changes and specific energy interactions in the eutectic melt in the temperature range near its melting temperature. The rheological activation energy, E vis for eutectic and non-eutectic melts is found to be a function of temperature. Crystalline faceted structure of the system has been furnished with morphological evidences obtained from microscopic studies at different growth rates, whereas whisker reinforced structural model has been accomplished with mechanical properties computed for both isotropic and anisotropic modes of growth. Of greater interest is the special reference of moderate anisotropic growth, since experimental confirmation was obtained for the theoretical shape of parabolic variation in the mechanical properties of eutectic composite material with growth velocity. Direct evidence of three- to four-fold increase in strength properties of the eutectic material at its moderate anisotropic growth velocity (3.11x10 -7 m 3 s -1 ) in comparison with its isotropic growth in an ice bath (∼273 K), confirms a complete composite microstructure with whiskers in equilibrium with the matrix, embedded parallel to the growth direction

  19. Congenital lumbar vertebrae agenesis in a lamb.

    Science.gov (United States)

    Farajli Abbasi, Mohammad; Shojaei, Bahador; Azari, Omid

    2017-01-01

    Congenital agenesis of lumbar vertebrae was diagnosed in a day-old female lamb based on radiology and clinical examinations. There was no neurological deficit in hindlimb and forelimb associated with standing disability. Radiography of the abdominal region revealed absence of lumbar vertebrae. Necropsy confirmed clinical and radiographic results. No other anomaly or agenesis was seen macroscopically in the abdominal and thoracic regions as well as vertebral column. Partial absence of vertebral column has been reported in human and different animal species, as an independent occurrence or associated with other organs anomalies. The latter has been designated as caudal regression syndrome. Vertebral agenesis may arise from irregularity in the differentiation of somites to the sclerotome or sclerotome to the vertebral primordium. Most of the previously reported cases of agenesis were related to the lumbosacral region, lonely or along with other visceral absences. This case was the first report of congenital agenesis of lumbar vertebrae in a lamb.

  20. Biomechanical implications of lumbar spinal ligament transection.

    Science.gov (United States)

    Von Forell, Gregory A; Bowden, Anton E

    2014-11-01

    Many lumbar spine surgeries either intentionally or inadvertently damage or transect spinal ligaments. The purpose of this work was to quantify the previously unknown biomechanical consequences of isolated spinal ligament transection on the remaining spinal ligaments (stress transfer), vertebrae (bone remodelling stimulus) and intervertebral discs (disc pressure) of the lumbar spine. A finite element model of the full lumbar spine was developed and validated against experimental data and tested in the primary modes of spinal motion in the intact condition. Once a ligament was removed, stress increased in the remaining spinal ligaments and changes occurred in vertebral strain energy, but disc pressure remained similar. All major biomechanical changes occurred at the same spinal level as the transected ligament, with minor changes at adjacent levels. This work demonstrates that iatrogenic damage to spinal ligaments disturbs the load sharing within the spinal ligament network and may induce significant clinically relevant changes in the spinal motion segment.

  1. Optimizing Residents' Performance of Lumbar Puncture

    DEFF Research Database (Denmark)

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

    2018-01-01

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

  2. Side effects after lumbar iohexol myelography

    International Nuclear Information System (INIS)

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

    1990-01-01

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

  3. Antero-medial approach to the wrist: anatomic basis and new application in cases of fracture of the lunate facet.

    Science.gov (United States)

    Uzel, A-P; Bulla, A; Laurent-Joye, M; Caix, P

    2011-08-01

    The Henry approach is the classical anterolateral surgical exposure of the volar aspect of the distal radius. This approach does not allow good access to the medial side of the volar distal radius (lunate facet) and the distal radio-ulnar joint, unless it is extended proximally, retracting the tendons and the median nerve medially, which can cause some trauma. The purpose of our study was to investigate the anatomic basis and to outline the advantages of the unusual anteromedial approach, reporting our experience in the treatment of 4 distal radius fractures, with a 90° or 180° twist of the lunate facet, and 10 wrist dissections on cadavers. The average follow-up was 68.8 months (range 18 to 115 months). In our series, this approach did not cause any nerve injuries or any sensory loss of the distal forearm and the palm. All the fractures of the lunate facet and of the radial styloid process healed. One patient with an ulnar styloid process fracture associated showed pseudarthrosis, but with no instability of the distal radio-ulnar joint or pain on the ulnar side. Using the criteria of Green and O'Brien, modified by Cooney, the results were: excellent in two cases, good in one case, and average in another. The evaluation of arthritis according to Knirk and Jupiter's classification showed grade 0 in three cases and grade 3 in one case with osteochondral sclerosis. We showed that the anteromedial approach is reliable and convenient in the case of fractures situated in the antero-medial portion of the radius, for the double objective of reducing the fracture under direct control and checking the congruence of the distal radio-ulnar joint.

  4. Simulation of the Lumbar Spine as a Multi-Module Paralel Manipulator

    Directory of Open Access Journals (Sweden)

    M. Ceccarelli

    2011-01-01

    Full Text Available In this paper a simulation of movements of lumbar spine is proposed by using a model with serially connected parallel manipulators. An analysis has been computed for the human spine structure and its movements, in order to simulate the motions and forces that actuate a spine specifically in the lumbar segment. A mechanical model has been designed with available identified parameters of human spine, by using characteristics of parallel manipulators and spring stiffness. This model is suitable to properly simulate the trunk behavior at macroscopic level but also the smooth behavior of intervertebral discs and actuating motions of muscles and tendons. Simulation results for spring actions and joints reaction forces can give an evaluation of the forces that intervertebral discs supports during motions of a real spine.

  5. Lumbar Vertebral Canal Diameters in Adult Ugandan Skeletons ...

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

  7. Imaging of the lumbar spine after diskectomy

    International Nuclear Information System (INIS)

    Laredo, J.D.; Wybier, M.

    1995-01-01

    The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy. (authors). 34 refs., 5 tabs

  8. Fine needle diagnosis in lumbar osteomyelitis

    International Nuclear Information System (INIS)

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

    1983-01-01

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

  9. Cervical endplate and facet arthrosis: an anatomic study of cadaveric specimens.

    Science.gov (United States)

    Master, Daniel L; Toy, Jason O; Eubanks, Jason D; Ahn, Nicholas U

    2012-10-01

    An anatomic, epidemiologic study of cervical endplate and facet arthrosis in cadaveric spines. To determine the prevalence of cervical endplate and facet arthrosis and the relationship between these 2 entities in a large population sample. Cervical endplate and facet arthrosis are common radiographic findings, which have both been linked to pain. However, the prevalence and relationship between cervical endplate and facet arthrosis has not been clearly defined. The cervical vertebrae from 234 cadaveric spines were examined by a single investigator for evidence of endplate and facet arthrosis. Arthrosis at each endplate and facet was graded on a continuum from 0 to IV. Race, age at death, and sex of each specimen were also recorded. Stepwise multiple linear regression was used to analyze any association between race, age, sex, endplate arthrosis, and facet arthrosis. Factors with P values arthrosis severity scores among patients within the same decades of life. Concurrent cervical endplate and facet arthrosis was present in 77% of the study population. Stepwise multiple linear regression revealed significant (Parthrosis and between age and facet arthrosis. Race and sex did not correlate with facet arthrosis. In addition, patients in age groups 30 to 39, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and 80 to 89 demonstrated more severe (Parthrosis in comparison with facet arthrosis. Concurrent cervical endplate and facet arthrosis is a common condition. Cervical endplate arthrosis and advancing age are associated with cervical facet arthrosis independent of race and sex. Cervical endplate arthrosis precedes facet arthrosis.

  10. 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...

  11. Alflutop efficacy in chronic vertebrogenous lumbar ischialgia. A double blind placebo controlled study

    Directory of Open Access Journals (Sweden)

    O S Levin

    2004-01-01

    Full Text Available Objective. To assess efficacy and safety of intramuscular (im and paravertebral (pv alflutop injections in pts with chronic vertebrogenous lumbar ischialgia. Material and methods. 83 pts with lumbar ischialgia syndrome (44 male, 39 female aged 31 to 56 years (mean 43,1 ±5,2 years were included. Disease duration varied from I to 7 years (mean 3,5± 1,9 years, duration of the present exacerbation - from 1 to 4 months (mean 2.4±0,8 months. Vertebroneurologic diagnosis was made according to H. Hall criteria. Pts were randomized into 4 groups. 32 pts of group Al received im, 23 pts of group A2 - pv alflutop injections. 14 pts of group Bl and 14 pts of group B2 received im and pv placebo injections respectively. Treatment results were scored by the doctor. Pts assessed spine pain changes on visual analog scale. Quantitative assessment of verbal syndrome was performed with Waddle scale. Results. Im alflutop injections provided good or fair effect in 61%, pv - in 69% of pts (significantly better than placebo. Effect was evident during the first 2 weeks of treatment and persisted for 3 months after its termination. The best results were achieved in pts with facet syndrome, the worst - in spinal stenosis. Drug tolerability was good in both modes of administration.

  12. Effect of Lumbar Stabilization Exercises Versus Kinesiotaping on Chronic Mechanical Low Back Pain

    International Nuclear Information System (INIS)

    Abdellatif, M.M.; Kamel, M.R.; Ahmed, H.H.; Diab, H.R.

    2016-01-01

    Background: Low back pain (LBP) is one of the most common musculoskeletal problems in modern society. Approximately two third of the adults are affected by mechanical low back pain. Lumbar stabilization exercise is a therapeutic technique that uses a progressive sequence of training in coordination, balance, endurance and strengthening. It helps increasing the range of joint motion and reducing associated pain. Kinesiotape is an adhesive tape which has approximately the same elasticity as skin. The flexibility of the tape will lift the skin to create space between the skin and the muscle, prompting improvement of blood circulation and lymphatic fluids drainage in the taped area, and this will decrease pain, increase Range Of Motion (ROM) and improve Activities of Daily Level (ADL). Purpose: This study was conducted to compare the effect of lumbar stabilization exercises and Kinesiotape in patients with Chronic Mechanical Low Back Pain. Design of the study: Thirty patients were divided randomly into two equal groups. Group A was received lumber stabilization exercises and Infrared Radiation and Group B was received kinesiotape and Infrared Radiation. Method: Visual Analogue Scale (VAS) was used to measure the pain intensity level and Dual Inclinometer was used to measure ROM of the lumbar spine. Results: There was a high significant decrease in pain level in both groups Group A (p < 0.0001) and Group B (p < 0.0001). There was a high significant improvement in Lumbar ROM in both groups A and B where Group A: Flexion (p < 0.0001), extension (p < 0.0001), lateral flexion (p < 0.0001) and rotation (p < 0.0001), Group B: Flexion (p < 0.0001), extension (p < 0.0001), later al flexion (p < 0.0001) and rotation (p < 0.0001). Conclusion: There was no significant difference between the Lumbar Stabilization Exercise and kinesiotaping for the patients with chronic mechanical low back pain in increasing lumbar ROM and pain relief after treatment and during the follow up after

  13. REHABILITATION THERAPY VERSUS DRUG THERAPY IN PATIENTS WITH LUMBAR DISC DEGENERATION

    Directory of Open Access Journals (Sweden)

    BROSCATEAN, Emanuela-Flavia

    2013-12-01

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

  14. A note on clique-web facets for multicut polytopes

    DEFF Research Database (Denmark)

    Sørensen, Michael Malmros

    2002-01-01

    In this note we provide a previously undiscovered necessary condition for the facet-defining property of clique-web inequalities for the multicut polytope. This condition imposes a minimum cardinality requirement on the node set of the clique, thus implying, in general, that clique-web inequaliti...

  15. Buckling behavior of origami unit cell facets under compressive loads

    Science.gov (United States)

    Kshad, Mohamed Ali Emhmed; Naguib, Hani E.

    2018-03-01

    Origami structures as cores for sandwich structures are designed to withstand the compressive loads and to dissipate compressive energy. The deformation of the origami panels and the unit cell facets are the primary factors behind the compressive energy dissipation in origami structures. During the loading stage, the origami structures deform through the folding and unfolding process of the unit cell facets, and also through the plastic deformation of the facets. This work presents a numerical study of the buckling behavior of different origami unit cell elements under compressive loading. The studied origami configurations were Miura and Ron-Resch-like origami structures. Finite element package was used to model the origami structures. The study investigated the buckling behavior of the unit cell facets of two types of origami structures Miura origami and Ron-Resch-Like origami structures. The simulation was conducted using ANSYS finite element software, in which the model of the unit cell represented by shell elements, and the eigenvalues buckling solver was used to predict the theoretical buckling of the unit cell elements.

  16. [Multi-facetted clinical presentation of thrombotic thrombocytopenic purpura

    DEFF Research Database (Denmark)

    Niemann, C.U.; Jurlander, J.; Daugaard, G.

    2009-01-01

    smears. Determination of the ADAMTS13-activity is now becoming available as a routine analysis. We present two cases that illustrate the multi-facetted clinical presentation under which TTP occurs. The importance of access to ADAMTS13 measurements is stressed Udgivelsesdato: 2009/1/26...

  17. Two-velocity elasticity theory and facet growth

    OpenAIRE

    Andreev, A. F.; Melnikovsky, L. A.

    2002-01-01

    We explain the linear growth of smooth solid helium facets by the presence of lattice point defects. To implement this task, the framework of very general two-velocity elasticity theory equations is developed. Boundary conditions for these equations for various surface types are derived. We also suggest additional experiments to justify the concept.

  18. The Cool and Belkin Faceted Classification of Information Interactions Revisited

    Science.gov (United States)

    Huvila, Isto

    2010-01-01

    Introduction: The complexity of human information activity is a challenge for both practice and research in information sciences and information management. Literature presents a wealth of approaches to analytically structure and make sense of human information activity including a faceted classification model of information interactions published…

  19. The usability issues of faceted navigation in digital libraries

    Directory of Open Access Journals (Sweden)

    Eliane Blumer

    2014-05-01

    For more than five years, the project ACCEPT, a subproject of a Swiss national project called e-lib.ch, analyzes the usability and usefulness of digital libraries, by using user oriented methods. Experience has shown that filters provided through faceted navigation are considered as positive and very useful by end users. Nevertheless, based on different test results, several returning mistakes have been detected and it turns out that there are some ‘unwritten standards’ concerning e.g. position, labelling or ranking which should be respected to fulfil the aim of a good usability which users do expect of such web services. In this poster we will first give an introduction to faceted navigation, actual design issues and their use in digital libraries and then present testing methods, which can be easily applied in a digital library context. Together with a list of best practices concerning faceted navigation drawn out of different test experiences, the paper should give the reader all important information to evaluate its current faceted navigation and see where improvements could be made.

  20. Hydrothermal synthesis of magnetite particles with uncommon crystal facets

    Directory of Open Access Journals (Sweden)

    Junki Sato

    2014-09-01

    Full Text Available Hydrothermal synthesis of Fe3O4 (magnetite particles was carried out using organic compounds as morphology control agents to obtain magnetite crystals with uncommon facets. It was established that the morphology of Fe3O4 crystals obtained by hydrothermal treatment of an aqueous solution containing Fe2+ and organic compounds depended on the organic compound used. The shape of the Fe3O4 particles obtained when no additives were used was quasi-octahedral. In contrast, the addition of picolinic acid, citric acid or pyridine resulted in the formation of polyhedral crystals, indicating the presence of not only {1 1 1}, {1 0 0} and {1 1 0} facets but also high-index facets including at least {3 1 1} and {3 3 1}. When citric acid was used as an additive, octahedral crystals with {1 1 1} facets also appeared, and their size decreased as the amount of citric acid was increased. Thus, control of Fe3O4 particle morphology was achieved by a simple hydrothermal treatment using additives.

  1. Personality Facets and RIASEC Interests: An Integrated Model

    Science.gov (United States)

    Armstrong, Patrick Ian; Anthoney, Sarah Fetter

    2009-01-01

    Research examining links between personality and interest have typically focused on links between measures of the five factor model and Holland's RIASEC types. However, the five factor model of personality can be divided in to a larger set of narrow domain personality scales measuring facets of the "big five" traits. Research in a number of fields…

  2. Posterior longitudinal ligament status in cervical spine bilateral facet dislocations

    International Nuclear Information System (INIS)

    Carrino, John A.; Manton, Geoffrey L.; Morrison, William B.; Flanders, Adam E.; Vaccaro, Alex R.; Schweitzer, Mark E.

    2006-01-01

    It is generally accepted that cervical spine bilateral facet dislocation results in complete disruption of the posterior longitudinal ligament. The goal of this study was to evaluate the integrity of numerous spine-stabilizing structures by MRI, and to determine if any associations between injury patterns exist with respect to the posterior longitudinal ligament status. Retrospective case series. A retrospective review was performed of 30 cervical spine injury subjects with bilateral facet dislocation. Assessment of 1.5T MRI images was carried out for: intervertebral disc disruption, facet fracture, and ligamentous disruption. Statistical analyses were performed to evaluate for associations between various injury patterns and posterior longitudinal ligament status. The frequency of MRI abnormalities was: anterior longitudinal ligament disruption (26.7%), disc herniation or disruption (90%), posterior longitudinal ligament disruption (40%), facet fracture (63.3%) and disruption of the posterior column ligament complex (97%). There were no significant associations between injury to the posterior longitudinal ligament and other structures. Compared to surgical reports, MRI was accurate for determining the status for 24 of 26 ligaments (three of three anterior longitudinal ligament, seven of nine posterior longitudinal ligament, and 14 of 14 posterior column ligament complex) but generated false negatives in two instances (in both MRI showed an intact posterior longitudinal ligament that was torn at surgery). (orig.)

  3. Beyond Conflict: Functional Facets of the Work-Family Interplay

    Science.gov (United States)

    Wiese, Bettina S.; Seiger, Christine P.; Schmid, Christian M.; Freund, Alexandra M.

    2010-01-01

    The present paper deals with three positive facets of the work-family interplay, i.e., transfer of competencies, transfer of positive mood, and cross-domain compensation. The latter refers to the experience that engagement in one domain helps dealing with failures in the other domain. In two correlational studies (N[subscript 1] = 107 working…

  4. Conceptualizing Educational Leadership: Does Exploring Macro-Level Facets Matters?

    Science.gov (United States)

    Sinha, Chetan

    2013-01-01

    The present review attempts to examine the present status of educational leadership highlighting the role of macro-level facets in Asian Pacific context. The conceptualization of educational leadership among researchers so far had been found to vary according to different contexts and situations. Theoretical perspectives associated with…

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

    Science.gov (United States)

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

    2017-07-01

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

  6. Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

    African Journals Online (AJOL)

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

  7. Benign fibrous histiocytoma of the lumbar vertebrae

    International Nuclear Information System (INIS)

    Demiralp, Bahtiyar; Oguz, Erbil; Sehirlioglu, Ali; Kose, Ozkan; Sanal, Tuba; Ozcan, Ayhan

    2009-01-01

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

  8. Postoperative braces for degenerative lumbar diseases

    NARCIS (Netherlands)

    Machado, Andre N.; Ayala, Ana Patricia; Rubinstein, Sidney M.; El Dib, Regina; Rodrigues, Luciano M.; Gotfryd, Alberto Ofenhejm; Tamaoki, Marcel Jun; Belloti, João Carlos

    2017-01-01

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective is to evaluate the effectiveness of orthosis following lumbar spinal surgery for people with degenerative disease on pain reduction and improvement of functional status. Secondary objectives

  9. FUNCTIONAL PATHOLOGY OF LUMBAR SPINAL STENOSIS

    NARCIS (Netherlands)

    PENNING, L

    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

  10. Multiple-level lumbar spondylolysis and spondylolisthesis.

    Science.gov (United States)

    Liu, Xinyu; Wang, Lianlei; Yuan, Suomao; Tian, Yonghao; Zheng, Yanping; Li, Jianmin

    2015-03-01

    Lumbar spondylolysis and isthmic spondylolisthesis occur most commonly at only one spinal level. The authors report on 13 cases of lumbar spondylolysis with spondylolisthesis at multiple levels. During July 2007-March 2012, multiple-level spondylolysis associated with spondylolisthesis was diagnosed in 13 patients (10 male, 3 female) at Qilu Hospital of Shandong University. The mean patient age was 43.5 ± 14.6 years. The duration of low-back pain was 11.7 ± 5.1 months. Spondylolysis occurred at L-2 in 2 patients, L-3 in 4 patients, L-4 in all patients, and L-5 in 5 patients. Spondylolysis occurred at 3 spinal levels in 3 patients and at 2 levels in 10 patients. All patients had spondylolisthesis at 1 or 2 levels. Japanese Orthopaedic Association and visual analog scale scores were used to evaluate preoperative and postoperative neurological function and low-back pain. All patients underwent pedicle screw fixation and interbody fusion or direct pars interarticularis repair. Both low-back pain scores improved significantly after surgery (p spondylolysis and spondylolisthesis occurred more often in men. Most multiplelevel lumbar spondylolysis occurred at 2 spinal levels and was associated with sports, trauma, or heavy labor. Multiplelevel lumbar spondylolysis occurred mostly at L3-5; associated spondylolisthesis usually occurred at L-4 and L-5, mostly at L-4. The treatment principle was the same as that for single-level spondylolisthesis.

  11. Changing the needle for lumbar punctures

    DEFF Research Database (Denmark)

    Engedal, Thorbjørn Søndergaard; Ording, H.; Vilholm, O. J.

    2015-01-01

    Objective: Post-dural puncture headache (PDPH) is a common complication of diagnostic lumbar punctures. Both a non-cutting needle design and the use of smaller size needles have been shown to greatly reduce the risk of PDPH. Nevertheless, larger cutting needles are still widely used. This study d...

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

    OpenAIRE

    Bogduk, N

    1980-01-01

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

  13. Facet blockade, peridural and periradicular pain therapy; Facettenblockade, peridurale und periradikulaere Schmerztherapie

    Energy Technology Data Exchange (ETDEWEB)

    Waggershauser, T.; Reiser, M. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet, Institut fuer klinische Radiologie, Muenchen (Germany); Schwarzkopf, S. [Klinikum der Ludwig-Maximilians-Universitaet, Institut fuer Gesundheits- und Rehabilitationswissenschaften, Muenchen (Germany)

    2006-06-15

    More than 80% of vertebrogenic lumbar pain is unspecific and can only be attributed to a specific anatomic structure with difficulty. The pain can emanate from the intervertebral discs, intervertebral and sacroiliac (SI) joints, musculature, and ligaments. In a maximum of 7% of cases, the pain is radicular (4% due to intervertebral discs and 3% caused by stenoses). In 7-15% of cases, the pain's origin is located in the region of the vertebral joints and in up to 15% in the region of the SI joint. Although the overwhelming majority of pain has no clear structural cause, infiltrations of medications and nerve blockades are frequently employed. The efficacy of these procedures has however not been verified in controlled studies with the exception of epidural injection of corticosteroids for radicular pain. Epidural and epiradicular application of corticosteroids appear to be effective for radicular pain, at least on a short-term basis, although controlled studies have yielded controversial results. The difficulty lies partly in the exact placement at the affected root for applying the medication. This is hardly possible with a caudal injection, while with a lumbar peridural injection and periradicular injections it is only possible under X-ray control or even better CT guidance. (orig.) [German] Mehr als 80% der vertebragenen lumbalen Schmerzen sind unspezifisch und koennen nur schwer einer bestimmten anatomischen Struktur zugeordnet werden. Die Schmerzen koennen von den Bandscheiben, den Zwischenwirbel- und Iliosakralgelenken, der Muskulatur und den Baendern ausgehen. In hoechstens 7% der Faelle sind die Schmerzen radikulaer (4% durch Bandscheiben, 3% durch Stenosen). In 7-15% der Faelle liegt die Schmerzursache im Bereich der Wirbelgelenke, in bis zu 15% im Bereich der Iliosakralgelenke (ISG). Obschon die ueberwaeltigende Mehrheit der Schmerzen keine eindeutige strukturelle Ursache hat, werden Infiltrationen von Medikamenten und Nervenblockaden haeufig

  14. [Discarthrosis with hyperalgic lumbar multileveled radicular syndrome].

    Science.gov (United States)

    Sardaru, D; Tiţu, Gabriela; Pendefunda, L

    2012-01-01

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

  15. Physiological pattern of lumbar disc height

    International Nuclear Information System (INIS)

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

    1997-01-01

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

  16. Return to Golf After Lumbar Fusion.

    Science.gov (United States)

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

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

  17. Case Report: A case report highlighting bilateral EDB wasting as a clinical marker for lumbar canal stenosis [version 1; referees: 2 approved, 1 approved with reservations

    Directory of Open Access Journals (Sweden)

    Bijoy Mohan Kumar

    2015-08-01

    Full Text Available Herein we discuss a case of a 55 year old male presenting with history suggestive of sciatica on the left leg. Straight leg raising (SLR test was positive at 45 degrees on the left side. His ankle reflex was absent and the power of extensor hallusus longus (EHL was 4/5 on the same side. MRI lumbosacral spine revealed left paramedian disc prolapsed on L4/L5 level with spinal canal diameter of 9mm.However since his bilateral extensor digitorm brevis (EDB were wasted, we suspected associated lumbar canal stenosis and thereby opted for laminectomy and discectomy in this case. Intraoperatively dural wasting, hypertrophied facets and narrow canal were confirmed. Laminectomy, medial facectectomy and discectomy were carried out. The patient recovered uneventfully with resolution of his sciatica-like pain. Bilateral EDB wasting thereby provides a clinical clue to the underlying lumbar canal stenosis and can help in making correct therapeutic decisions.

  18. Temporomandibular joint

    International Nuclear Information System (INIS)

    Westesson, P.L.; Hatala, M.; Tallents, R.H.; Katzberg, R.W.; Musgrave, M.; Levitt, S.

    1990-01-01

    This paper determines the frequency of MR signs of abnormal temporomandibular joints (TMJs) in asymptomatic volunteers. Forty-two volunteers with 84 clinically normal TMJs were imaged in the sagittal and coronal planes with surface coil MR imaging. Sagittal closed and open and coronal closed views were obtained bilaterally in all volunteers. The images were classified as normal (superior disk position) or abnormal (disk displacement of degenerative joint disease). Eighteen joints in 11 volunteers were abnormal; 12 had disk displacement with reduction and six had disk displacement without reduction, with associated degenerative joint disease in three of the six. Asymptomatic internal derangement and degenerative joint disease occur in about one-fourth of asymptomatic volunteers

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

    International Nuclear Information System (INIS)

    Wang Linyou; Li Yuan; Shao Yangtong

    2004-01-01

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

  20. Post-operative X-ray morphology: Joints

    International Nuclear Information System (INIS)

    Vogel, H.

    1987-01-01

    The description of X-ray findings after operations with the object of implanting protheses in joints makes up most of the contents of this book. The reconstruction of joints after trauma is only marginally dealt with. Among the various indications for implanting protheses, the replacement of joints destroyed by wear and trauma is the most important. Also considered were X-ray examinations after hallux-valgus operations and plastic surgery on hands and feet, as well as X-ray findings following operations on the lumbar part of the vertebral column (disc surgery). (orig./MG) [de

  1. Correlation between lumbar lordosis and the treatment of chronic low back pain with pulsed radiofrequency applied to the L2 dorsal root ganglion

    Directory of Open Access Journals (Sweden)

    Hsien-Ta Hsu

    2017-01-01

    Conclusion: PRF applied to the L2 DRG is an alternative procedure for treating patients with chronic low back pain, regardless of which type of LL the patients have. Chronic low back pain, including discogenic pain and facet joint pain, may be treated by PRF applied to the L2 DRG.

  2. Distribution and length of osteophytes in the lumbar vertebrae and risk of rupture of abdominal aortic aneurysms: a study of dry bones from Chiang Mai, Thailand.

    Science.gov (United States)

    Chanapa, Patcharin; Yoshiyuki, Tohno; Mahakkanukrauh, Pasuk

    2014-09-01

    Vertebral osteophytes are a characteristic feature of intervertebral disc degeneration. In the lumbar spinal region, the two major structures in close proximity anterior to the spine are the inferior vena cava and the abdominal aorta, both of which have been reported to be affected by osteophytes. The purpose of this study was to determine the distribution, classification and lengths of osteophytes in the lumbar vertebrae. One hundred and eighty lumbar columns of 90 males and 90 females from Chiang Mai, Thailand, in the age range 15 to 96 years (mean age, 63 years) were collected. The measuring length of osteophytes was assessed on vertebral body and articular facet. Statistical analysis was performed by descriptive analysis, chi-square and Pearson Correlation. Lumbar osteophytes were presented in 175 specimens (97.2%), 88 males and 87 females. The highest frequency was at L4, most were on the superior, inferior surface of body and articular facet (39.7%, 38.4%, and 22%), respectively. The greatest mean length was 3.47±2.21 mm at L5, and the longest length of anterior superior surface of body was 28.56 mm. The osteophyte length was significantly correlated directly with age (P<0.01), and males were significantly greater than females (P<0.05). The highest prevalence of osteophytes was on the anterior side of superior surface of body (30.4%), and the classification was traction. It can be proposed that the abdominal aorta could be damaged, especially a risk of rupture of abdominal aortic aneurysm.

  3. The diagnostic value of axially loaded magnetic resonance imaging in patients with degenerative disorders of lumbar spine

    International Nuclear Information System (INIS)

    Liu Qingyu; Chen Jianyu; Shen Jun; Zhang Xiaoya; Liang Biling

    2008-01-01

    Objective: To evaluate the diagnostic value of axially loaded MR imaging with supine position in patients with degenerative disorders of lumbar spine. Methods Thirty asymptomatic volunteers and 89 patients were examined in psoas-relaxed position (PRP) and axially compressed supine position (ACE) of the lumbar spine. Sixty-one patients with low back pain, 19 with sciatica and 9 with neurogenic claudication were included in the symptomatic study group. The disc levels from L3 to S1 were examined. Results: In 30 asymptomatic volunteers, a significant decrease in dural sac cross-sectional area (DSCA) was found at 14 disc levels (15.6%)in 10 individuals(33.3% ) during ACE ( >15 mm 2 ). In 89 patients, a significant decrease in DSCA was found at 55 disc levels (20.6%) in 38 patients (42.7%) during ACE ( >15 mm 2 ), and the mean decrease was 28 mm 2 . During ACE, 32 disc levels with an increasing severity of disc herniation were noted in 26 patients, 16 disc levels with neural foramen stenosis were found in 12 patients, 11 disc levels with ligamentum flavum thickening were observed in 10 patients, 3 cases facet dislocation and 3 cases lumbar spondylolisthesis were also seen. In 22 of the 89 patients (24.7%), additional valuable information (AVI) was found during ACE, including 7 patients (7/9) with neurogenic claudication, 8 patients (8/19)with sciatica, and 11.5% (7/61) of the patients with low back pain. Conclusion: As compared with conventional imaging methods, axially loaded imaging provides AVI, and more occult lesions can be found during ACE. ACE MRI is a valuable tool in diagnosing degenerative disorders of lumbar spine. (authors)

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

    Science.gov (United States)

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

    2017-12-01

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

  5. Job Stress, Employee Health, and Organizational Effectiveness: A Facet Analysis, Model, and Literature Review.

    Science.gov (United States)

    Beehr, Terry A.; Newman, John E.

    1978-01-01

    The empirical research on job stress and employee health is reviewed within the context of six facets (environmental, personal, process, human consequences, organizational consequences, and time) of a seven facet conceptualization of the job stress-employee health research domain. Models are proposed for tying the facets together. (Author/SJL)

  6. Dioptrics of the facet lenses in the dorsal rim area of the cricket Gryllus bimaculatus

    NARCIS (Netherlands)

    Ukhanov, KY; Leertouwer, HL; Gribakin, FG; Stavenga, DG

    1996-01-01

    1. The optics of the corneal facet lenses from the dorsal rim area (DRA) and from the dorso-lateral areas (DA) of the compound eye of the cricket Gryllus bimaculatus were studied. 2. The DRA of the cricket eye contains quite normally shaped facet lenses. The diameter of the facet lens in the DA is

  7. Influence of higher order modes on angled-facet amplifiers

    DEFF Research Database (Denmark)

    Wang, Z.; Mikkelsen, B.; Stubkjær, Kristian

    1991-01-01

    The influence of the first-order mode on the residual reflectivity of angled-facet amplifiers is analyzed. For a 7 degrees angled-facet ridge waveguide amplifier with a single-layer antireflective (AR) coating, a gain ripple lower than 1-dB at 25-dB gain can be obtained independent...... of the polarization, even in the presence of a first-order mode with a 15-dB gain. The tolerances for the thickness and refractive index of the AR coating are reduced by a factor of three compared to operation in the fundamental mode only. The influence of the higher order mode can virtually be suppressed...

  8. The Role of Surface Passivation in Controlling Ge Nanowire Faceting.

    Science.gov (United States)

    Gamalski, A D; Tersoff, J; Kodambaka, S; Zakharov, D N; Ross, F M; Stach, E A

    2015-12-09

    In situ transmission electron microscopy observations of nanowire morphologies indicate that during Au-catalyzed Ge nanowire growth, Ge facets can rapidly form along the nanowire sidewalls when the source gas (here, digermane) flux is decreased or the temperature is increased. This sidewall faceting is accompanied by continuous catalyst loss as Au diffuses from the droplet to the wire surface. We suggest that high digermane flux and low temperatures promote effective surface passivation of Ge nanowires with H or other digermane fragments inhibiting diffusion and attachment of Au and Ge on the sidewalls. These results illustrate the essential roles of the precursor gas and substrate temperature in maintaining nanowire sidewall passivation, necessary to ensure the growth of straight, untapered, ⟨111⟩-oriented nanowires.

  9. Using Facet Clusters to Map Learner Modes of Reasoning

    Science.gov (United States)

    Vokos, Stamatis; DeWater, L. S.; Seeley, L.; Kraus, P.

    2006-12-01

    The Department of Physics and the School of Education at Seattle Pacific University, together with FACET Innovations, LLC, are beginning the second year of a five-year NSF TPC project, Improving the Effectiveness of Teacher Diagnostic Skills and Tools. We are working in partnership with school districts in Washington State to use formative assessment as a means to helping teachers and precollege students deepen their understanding of foundational topics in physical science. We utilize a theoretical framework of knowledge-in-pieces to identify and categorize widespread productive and unproductive modes of reasoning in the topical areas of Properties of Matter, Heat and Temperature, and Physical and Chemical Changes. In this talk, we describe the development and iterative refinement of certain facet clusters of student ideas, as well as the usefulness and limitations of such a mapping scheme. * Supported in part by NSF grant #ESI-0455796, The Boeing Corporation, and the SPU Science Initiative.

  10. General practitioners' willingness to request plain lumbar spine radiographic examinations

    International Nuclear Information System (INIS)

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

    2001-01-01

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

  11. Additional merit of coronal STIR imaging for MR imaging of lumbar spine

    Directory of Open Access Journals (Sweden)

    Ranjana Gupta

    2015-01-01

    Full Text Available Introduction: Back pain is a common clinical problem and is the frequent complaint for referral of lumbar spine magnetic resonance imaging (MRI. Coronal short tau inversion recovery sequence (STIR can provide diagnostically significant information in small percentage of patients. Materials and Methods: MRI examinations of a total of 350 patients were retrospectively included in the study. MR sequences were evaluated in two settings. One radiologist evaluated sagittal and axial images only, while another radiologist evaluated all sequences, including coronal STIR sequence. After recording the diagnoses, we compared the MRI findings in two subsets of patients to evaluate additional merit of coronal STIR imaging. Results: With addition of coronal STIR imaging, significant findings were observed in 24 subjects (6.8%. Twenty-one of these subjects were considered to be normal on other sequences and in three subjects diagnosis was changed with the addition of coronal STIR. Additional diagnoses on STIR included sacroiliitis, sacroiliac joint degenerative disease, sacral stress/insufficiency fracture/Looser′s zones, muscular sprain and atypical appendicitis. Conclusion: Coronal STIR imaging can provide additional diagnoses in a small percentage of patients presenting for lumbar spine MRI for back pain. Therefore, it should be included in the routine protocol for MR imaging of lumbar spine.

  12. Wheelchair pushing and turning: lumbar spine and shoulder loads and recommended limits.

    Science.gov (United States)

    Weston, Eric B; Khan, Safdar N; Marras, William S

    2017-12-01

    The objective of this study was to determine how simulated manual wheelchair pushing influences biomechanical loading to the lumbar spine and shoulders. Sixty-two subjects performed simulated wheelchair pushing and turning in a laboratory. An electromyography-assisted biomechanical model was used to estimate spinal loads. Moments at the shoulder joint, external hand forces and net turning torque were also assessed. Multiple linear regression techniques were employed to develop biomechanically based wheelchair pushing guidelines relating resultant hand force or net torque to spinal load. Male subjects experienced significantly greater spinal loading (p pushing (p pushing and turning can pose biomechanical risk to the lumbar spine and shoulders. Psychophysically determined maximum acceptable push forces do not appear to be protective enough of this biomechanical risk. Practitioner Summary: This laboratory study investigated biomechanical risk to the low back and shoulders during simulated wheelchair pushing. Manual wheelchair pushing posed biomechanical risk to the lumbar spine (in compression and A/P shear) and to the shoulders. Biomechanically determined wheelchair pushing thresholds are presented and are more protective than the closest psychophysically determined equivalents.

  13. (100) faceted anion voids in electron irradiated fluorite

    International Nuclear Information System (INIS)

    Johnson, E.

    1979-01-01

    High fluence electron irradiation of fluorite crystals in the temperature range 150 to 320 K results in formation of a simple cubic anion void superlattice. Above 320 K the damage structure changes to