Sample records for routine lumbar myelography

  1. The Value of Routine MR Myelography at MRI of the Lumbar Spine

    O' Connell, M. J.; Ryan, M.; Powell, T.; Eustace, S. [Cappagh National Orthopaedic Hospital and Mater Misericordiae Hospital, Dublin (Ireland). Dept. of Radiology


    Purpose: To determine whether a commercially available automated MR myelogram sequence improves the interpretation and diagnostic yield at MRI of the lumbar spine. Material and Methods: A total of 207 consecutive patients referred for MR examination of the lumbar spine for evaluation of low back pain or spinal radicular symptoms were included for study. All patients had initial imaging with sagittal T1-W and T2-W scans, followed by axial T2-W images. Subsequently an MR myelogram was acquired in each case in coronal, sagittal and oblique planes. MR myelogram images were evaluated initially and a diagnosis was established and recorded. Subsequently, a diagnosis was established by review of conventional images of the lumbar spine in sagittal and axial planes, in conjunction with the MR myelogram. The utility of the MR myelogram in establishing the diagnosis was graded on a 4-point scale, where grade 0 indicated that it contributed no additional information and grade 3 indicated that it was essential for diagnosis. Analysis of the additional value of myelography in patients with multilevel disease was made. Results: Primary diagnoses were disc herniation in 69 cases (33%), degenerative disc disease in 51 cases (26%), spinal stenosis in 19 cases (9%), isolated lateral recess stenosis in 5 cases (2%), or other diagnoses, including facet degeneration in 48 cases (23%). Scans were normal in 15 cases (7%). MR myelography was graded as grade 0 in 151 cases (73%), grade 1 in 44 cases (21%) and grade 2 in 12 cases (6%). In no case was MR myelography essential for diagnosis (grade 3). In patients with multilevel disease (n=27), in 17 cases MR myelography was graded as grade 1 (63%) and in 8 cases grade 2 (30%). Conclusion: MR myelography when employed in routine practice was of limited value, assisting in establishing a diagnosis in a minority of cases (6%). The technique was of limited additional value in patients with multilevel pathology and to a lesser extent in patients

  2. Comparison of MR myelography with conventional myelography lumbar disc diseases

    Jung, Kyung Jae; Youn, Eun Kyung; Kim, Jung Hyeon; Lee, Seung Hee; Lee, Young Uk; Kim, Dong Joo [Kangbuk Samsung Hospital, Samsung Medical Center, Seoul (Korea, Republic of)


    To compare MR myelography(MRM) using heavily T2 weighted fast spin echo(FSE) with conventional myelography in the evaluation of lumbar degenerative disc diseases. A total of 50 patients with lumbar degenerative disc diseases underwent both MRM and conventional myelography. A 1.5 T Sigma MR system was used. For MRM, heavily T2 weighted FSE pulse sequences were performed in sagittal, coronal and both oblique planes. The images of MRM and conventional myelography were analyzed retrospectively and compared, focusing on the pattern of compression of the cal sac and nerve roots. MRM yielded comparable images to conventional myelography in 68% (34/50). MRM was superior to conventional myelography in 11 cases (22%), and the opposite resulted in 5 cases(10%). MRM could visualize the spinal canal below the level of complete block in 6 patients, provided better contrast in the cases of dural ectasia in 3 cases and better delineation of individual nerve roots with source images in 1 case. Additional informations such as incidental retroperitoneal vascular malformation and extravasation of the CSF could be obtained by MRM in 1 case each. Disadvantages of MRM were poor contrast in the cases of multiple spinal stenosis, obscuration of the nerve roots by engorged paraspinal vessels, and occasional difficulty in defining the levels due to vanishment of the bony background image. MRM is a safe, noninvasive, nonionizing which in very effective in evaluating the lumbosacral disc disease. Use of FSE-MRM in addition to the routine MR imaging could be very helpful not only for better evaluation of nerve roots but also for the additional informations.

  3. Lumbar myelography with Omnipaque (iohexol)

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


    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.

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

    Kehler, M


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

  5. Isthmic lumbar spondylolisthesis with sciatica; MR imaging vs myelography

    Annertz, M.; Holtaas, S.; Cronqvist, S.; Joensson, B.; Stroemqvist, B. (Lund Univ. Hospital (Sweden). Dept. of Diagnostic Radiology Lund Univ. Hospital (Sweden). Dept. of Orthopedics)


    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.).

  6. Lumbar myelography using water-soluble contrast media. Lumbale Myelographie mit wasserloelichen Kontrastmitteln. Lehrbuch und Atlas

    Langlotz, M.


    With the new water-soluble contrast media developed in the last 10 years, lumbar myelography has become a simple and low-risk diagnostic method of great value which is hardly ever omitted before surgery is undertaken. The book attempts a synopsis of radiology and clinical examinations. In its first part, the pathological, clinical, and radiological aspects of diseases of the lumbosacral spinal duct are reviewed. The second part contains more than 300 myelographic pictures in original size. Each of the myelograms is supplemented by the case history of the patient (anamnesis, neurological examination, therapy and course). Interpretation is facilitated by drawings at the beginning of each chapter which show the major pathological and radiological changes.

  7. Excacerbation of systemic lupus erythematodes, aseptic meningitis and acute mental symptoms, following metrizamide lumbar myelography

    Gelmers, H.J.


    A clinical constellation of excacerbation of systemic lupus erythematodes (SLE), together with aseptic meningitis, and acutre mental symptoms occurred following lumbar myelography with metrizamide. Excacerbation of SLE has not been previously described following myelography with any contrast agent. Meningeal reactions and acute mental symptoms have been reported earlier, but this clinical constellation is new.

  8. Clinical significance of gas myelography and CT gas myelography of the thoracic spine and the lumbar spine

    Yoshinaga, Haruhiko (Tokyo Medical Coll. (Japan))


    Basic and clinical applications relating to air myelography of the cervical spine have already been studied and extensively been used as an adjuvant diagnostic method for diseases of the spine and the spinal cord. However, hardly any application and clinical evaluation have been made concerning gas myelography of the thoracic spine and the lumbar spine. The author examined X-ray findings of 183 cases with diseases of the thoracic spine and the lumbar spine, including contral cases. Gas X-ray photography included simple profile, forehead tomography, sagittal plane, and CT section. Morphological characteristics of normal X-ray pictures of the throacic spine and the lumbar spine were explained from 54 control cases, and all the diameters of the subarachnoidal space from the anterior to the posterior part were measured. X-ray findings were examined on pathological cases, namely 22 cases with diseases of the throacic spine and 107 cases with diseases of the lumbar spine, and as a result these were useful for pathological elucidation of spinal cord tumors, spinal carries, yellow ligament ossification, lumbar spinal canal stenosis, hernia of intervertebral disc, etc. Also, CT gas myelography was excellent in stereo observation of the spine and the spinal cord in spinal cord tumors, yellow ligament ossification, and spinal canal stenosis. On the other hand, it is not suitable for the diagnoses of intraspinal vascular abnormality, adhesive arachinitis, and running abnormality of the cauda equina nerve and radicle. Gas myelography of the thoracic spine and the lambar spine, is very useful in clinics when experienced techniques are used in photographic conditions, and diagnoses are made, well understanding the characteristics of gas pictures. Thus, its application has been opened to selection of an operative technique, determination of operative ranges, etc.

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

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


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

  10. Stress myelography. A new functional examination for diseases of the lumbar spinal canal

    Schumacher, M.


    To optimize functional diagnostics in lumbar syndromes a new myelographic technique was developed termed 'loading myelography'. During the procedure the patient stands with a 10 kg weight on his out-stretched arms. Based on the law of leverage the load exercised on the vertebral column is more than two and a half times of one-half of the body weight. The author tested the efficacy of the method in 119 patients suffering from disc prolapse, spinal canal stenosis, spondylolisthesis or arachnitis. The results of the conventional myelogram compared with myelography under load conditions demonstrate the value of the method: without load the diagnosis would have remained uncertain in 25% and in 18% load myelogram revealed a pathological finding although conventional myelography was normal. We consider as indications for load myelography: Discrepancy between clinical and conventional myelographic findings; clinically expected multisegmental lesions; spinal canal stenosis; and spondylolisthesis.

  11. Evaluation of the role of magnetic resonance myelography in lumbar spine imaging

    Thornton, M.J.; Lee, M.J.; Pender, S.; McGrath, F.P.; Brennan, R.P.; Varghese, J.C. [Department of Radiology, Beaumont Hospital, Dublin (Ireland)]|[Royal College of Surgeons in Ireland Medical School, Dublin (Ireland)


    The purpose of our study was to evaluate the accuracy of MR myelography in depicting disc herniation in the lumbar spine when compared with conventional MRI in patients presenting with clinical evidence of disc herniation. One hundred patients referred for conventional MR imaging of the lumbar spine also had coronal MR (TR 9000 ms, TE 272 ms eff, NEX 3, echo train length 32) myelography performed. Three experienced observers compared magnetic resonance myelography (MRM) with conventional lumbar spine MR using the following variables: visibility of thecal sac and nerve roots, and the presence, location and severity of disc herniation. Disc protrusions were seen at 110 disc space levels on conventional MR images as opposed to 93 on MRM. However, only 72 % of lesions seen on conventional MR were diagnosed by MRM. Similarly, only 63.8 % of nerve root compression abnormalities seen at conventional MR were visualized when compared with conventional MRM. The sensitivity, specificity and accuracy of MRM when compared with conventional MR was 72, 93 and 85 %, respectively. The MRM technique yields images that resemble conventional myelography and may be used to help confirm abnormalities seen on conventional MR in selected cases; however, the large number of false-positive and false-negative examinations indicates that caution should be used in interpreting MRM images. (orig.) With 5 figs., 1 tab., 25 refs.

  12. Myelography, CT and MRI in leukaemic infiltration of the lumbar theca

    Shen, W.C. (Dept. of Radiology, Taichung Veterans General Hospital (Taiwan, Province of China)); Lee, S.K. (Dept. of Radiology, Taichung Veterans General Hospital (Taiwan, Province of China)); Ho, Y.J. (Dept. of Radiology, Taichung Veterans General Hospital (Taiwan, Province of China)); Lee, K.R. (Inst. of Life Science, National TsingHua Univ. (Taiwan, Province of China))


    A 25-year-old woman with acute lymphoblastic leukaemia, while in remission, developed paraparesis, with faecal and urinary incontinence. CT demonstrated increased density of the lumbar theca and enlargement of the nerve roots. Myelography showed complete obstruction below the L3 level. MRI showed increased signal intensity in the lumbar sac on T1 weighting, and the cauda equina enhanced with gadolinium-DTPA. Lymphoblasts were seen in the lumbar spinal fluid. After chemoterhapy, these abnormalities resolved, as did the paraparesis and incontinence. (orig.)

  13. Functional and quantitative magnetic resonance myelography of symptomatic stenoses of the lumbar spine

    Eberhardt, Knut [District Hospital Castle of Werneck, MRI Center of Excellence, Werneck (Germany); Ganslandt, Oliver [University of Erlangen-Nuremberg, Department of Neurosurgery, Erlangen (Germany); Stadlbauer, Andreas [University of Erlangen-Nuremberg, Department of Neurosurgery, Erlangen (Germany); Medical University Vienna, Department of Radiology and Nuclear Medicine, Vienna (Austria)


    The objective of this study was to demonstrate that functional, quantitative magnetic resonance myelography (MRM) allows standardized diagnosis of symptomatic lumbar spinal stenoses which show at least equal detectability compared to functional myelography and postmyelographic CT (pmCT) based on intra- and postoperative findings. We investigated 43 volunteers and 47 patients with symptomatic lumbar spinal stenoses using MRM in normal position as well as in flexion and extension in a standard whole-body MR scanner. Twenty volunteers were additionally examined under axial loading. All patients were investigated by functional myelography and pmCT and 10 patients had a functional lumbar MRM postoperatively. Range of motion and cerebrospinal fluid (CSF) volumes in normal position, flexion, extension, and under axial loading (volunteers) were assessed for each segment. Detectability was determined by using intraoperative findings, and postoperative freedom of symptoms was correlated with CSF volume changes in MRM. The ranges of motion in a standard whole-body MR scanner provide adequate scope for investigations into function (flexion and extension) in both volunteers and patients. Axial loading was associated with a mechanism of extension, albeit to a far smaller extent. Detectability of lumbar stenoses was 100 % for MRM, 58 % for conventional myelography, and 68 % for pmCT. Postoperative changes in CSF volume of levels with stenoses in MRM strongly correlated with freedom of symptoms (R = 0.772). This MRM method allows for exact diagnosis and reproducible quantification of stenoses, motion-related changes, and spondylolistheses of the lumbar spine. It may be useful for early detection of alterations in order to avoid neuronal compression. (orig.)

  14. MR myelography of the lumbar spine with a PSIF sequence: First experiences. MR-Myelographie der Lendenwirbelsaeule mit einer PSIF-Sequenz: Erste Erfahrungen

    Schnarkowski, P.; Wallner, B.; Goldmann, A.; Friedrich, J.M. (Abt. fuer Roentgendiagnostik, Klinikum der Univ. Ulm (Germany))


    A rapid gradient-echo acquisition (PSIF) was used to delineate the lumber spine. Because this sequence is heavily T[sub 2] weighted the cerebrospinal fluid shows a bright signal, the myelon has a poor signal. 5 healthy voluteers and 5 patients with suspected lumbar disc herniation were examined by this technique. All MR myelograms were compared with spin-echo sequences (sagittal and transversal slices). All lumbar disc herniations which were recognized by MRI were also delineated by MR myelography. (orig.).

  15. Magnetic resonance imaging of lumbar spinal disorders; A comparison with myelography and discography

    Nojiri, Hajime (Nagoya City Univ. (Japan). Faculty of Medicine)


    To evaluate the stenotic condition of the lumbar spinal canal, MRI was compared with myelography and with discography in 102 patients, all of whom underwent surgical exploration. Various pathologic conditions were studied including 50 cases of herniated nucleus pulposus, 39 cases of lumbar canal stenosis (central, peripheral type or combined type), and 13 cases of spondylolisthesis (degenerative, spondylolytic, and dysplastic type). High correlation was detected between the T2 weighted mid-sagittal image of the thecal sac and the lateral view of a full-column myelogram, but subtle changes such as adhesive changes, or redundancy, or anomalous changes of the nerve roots were more clearly demonstrated on myelograms than on MRI. Actually some of these changes could not be detected on MRI. The degrees of disc degeneration were classified into five grades according to the signal intensity and the irregularity of the disc on the T2-weighted image. The MRI evaluation of disc degeneration in this series was similar to that of the discography. However, MRI could not replace discography for identifying the source of pain in symptomatic patients. Although MRI might be the imaging modality for diagnostic screening and for detecting stenotic conditions of the lumbar spinal canal, it will not be able to replace myelography and/or discography for determining indication for surgery and preferred surgical approach. (author).

  16. Using Magnetic Resonance Myelography to Improve Interobserver Agreement in the Evaluation of Lumbar Spinal Canal Stenosis and Root Compression.

    Al-Tameemi, Haider Najim; Al-Essawi, Sattar; Shukri, Mahmud; Naji, Farah Kasim


    Cross-sectional retrospective study designed to assess interobserver agreement. To investigate if interobserver agreement using magnetic resonance imaging (MRI) in the evaluation of lumbar spinal canal stenosis and root compression can be improved upon combination with magnetic resonance myelography (MRM). The interpretation of lumbar spinal MRI, which is the imaging modality of choice, often has a significant influence on the diagnosis and treatment of low back pain. However, using MRI alone, substantial interobserver variability has been reported in the evaluation of lumbar spinal canal stenosis and nerve root compression. Hardcopies of 30 lumbar spinal MRI (containing a total of 150 disk levels) as well as MRM films were separately reviewed by two radiologists and a neurosurgeon. At each intervertebral disk, the observers were asked to evaluate the thecal sac for the presence and degree of spinal stenoses (mild, moderate, or severe) and presence of root canal compression. Interobserver agreement was measured using weighted kappa statistics. Regarding lumbar spinal canal stenosis, interobserver agreement between the two radiologists was moderate (kappa, 0.4) for MRI and good (kappa, 0.6) for combination with MRM. However, the agreement between the radiologist and neurosurgeon remained fair for MRI alone or in combination with MRM (kappa, 0.38 and 033, respectively). In the evaluation of nerve root compression, interobserver agreement between the radiologists improved from moderate (kappa, 0.57) for MRI to good (kappa, 0.73) after combination with MRM; moderate agreement between the radiologist and neurosurgeon was noted for both MRI alone and after combination with MRM (kappa, 0.58 and 0.56, respectively). Interobserver agreement in the evaluation of lumbar spinal canal stenosis and root compression between the radiologists improved when MRM was combined with MRI, relative to MRI alone.

  17. Value of functional myelography with both lateral bending anterior-posterior views in lumbar radiculopathy

    Lee, Young Joon; Park, Jong Yeon; Kim, Kun Il; Sol, Chang Hyo; Kim, Byung Soo [Pusan National University College of Medicine, Pusan (Korea, Republic of)


    There are considerable discrepancies between clinical symptoms and imaging diagnosis in the localization of the responsible rediculopathy. The purpose of this study are to analyze the dynamic alteration of contrast filling of the spinal nerve sleeves during positional changes and determine how the abnormalities of nerve sleeves on lateral bending A-P views correlate with sciatica. The criteria indicating the root abnormality in functional myelography were (1) bad filling of ipsolateral root to sciatica and (2) good filling of contralateral root compared with those in neutral A-P view. Of total 77 patients, 67 had radiculopathy and 10 had no radiculopathy. In 23 (34.3%) of 67 patients with radiculopathy and 6 (60%) of 10 patients with no radiculopathy, their clinical symptoms well correlated with conventional myelographic findings. However, in 35 (52.2%) of 67 patients with radiculopathy and 6 (60%) of 10 patients with no radiculopathy, their symptoms well correlated with functional myelographic findings. This study suggest that the functional myelography using both lateral bending A-P views can be used as a complementary tool in the evaluation of the radiculopathy.

  18. MR-myelography in patients with spinal canal stenosis; MR-Myelographie bei Spinalkanalstenosen

    Freund, M.; Hutzelmann, A.; Steffens, J.C.; Heller, M. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet zu Kiel (Germany); Buhl, R. [Klinik fuer Neurochirurgie, Christian-Albrechts-Universitaet zu Kiel (Germany)


    Purpose: The purpose of this prospective study was to evaluate the clinical value of 3D-MR-myelography (3D-MRM) in comparison to myelography and intra-operative findings. Material and Methods: 25 patients with suspected lumbar spinal canal stenosis were studied via myelography and 3D-MRM (volume-data set, 3D-FISP sequenz, T{sub R} 73 ms, T{sub E} 21 ms, flipangle 7 , sagittal slices) besides the routinely acquired sagittal and axial T{sub 1}- and T{sub 2}-weighted images. Diagnoses were made by two radiologists and one neurosurgeon without knowing the clinical history and symptoms, in two separate sessions. Results were compared to intraoperative findings. Results: 3D-MRM has the same diagnostic sensitivity (25/25=100%) as conventional X-ray myelography (25/25=100%) compared to intraoperative findings, but is not invasive and shows more diagnostic details than myelography. Especially in cases of high-grade spinal canal stenosis there is often a lack of intrathecal contrast medium distally of the stenosis. (orig./AJ) [Deutsch] Ziel: Bewertung der 3D-MR-Myelographie (3D-MRM) in der Diagnostik lumbaler Spinalkanalstenosen im Vergleich zu Myelographie und Korrelation mit intraoperativem Befund. Material und Methode: In einer fortlaufenden, prospektiven Studie wurden 25 Patienten mit den Symptomen einer lumbalen Spinalkanalstenose kernspintomographisch untersucht. Neben den ueblichen sagittalen und axialen T{sub 1}- und T{sub 2}-gewichteten Aufnahmen wurde ein Volumendatensatz mit einer 3D-FISP Sequenz (T{sub R} 73 ms, T{sub E} 21 ms, Flipwinkel 7 ) akquisiert. Die Nachverarbeitung erfolgte mittels Maximum Intensitaets-Projektion (MIP): 18 Projektionen von 0 -180 . Die 3D-MRM wurde der Myelographie gegenuebergestellt, beide Untersuchungen wurden getrennt von drei Untersuchern blind ausgewertet. Ergebnisse: Sowohl die 3D-MRM als auch die der Myelographie zeigten bei Patienten mit lumbaler Spinalkanalstenose in Korrelation zum intraoperativen Befund eine Uebereinstimmung

  19. Clinical potential and limitation of MRI for degenerative lumbar spinal diseases. Comparison of MRI, myelography, CT and selective nerve root infiltration

    Seki, Michihiro; Kikuchi, Shinichi [Fukushima Medical Coll. (Japan)


    To assess the clinical potential and limitations of magnetic resonance imaging (MRI) in degenerative lumbar spinal diseases, the findings of MR imaging were compared with those of myelography and CT. The subjects were 80 patients with intervertebral disc herniation (46), spondylosis (28), degenerative spondylolisthesis (5), and spondylolysis (one). There was a good correlation between sagittal MRI (T1-weighted images) and myelography in measuring the anteroposterior diameter and the compression rate of the injured dural canal in all disease categories. However, MRI was inferior, irrespective of sagittal and coronal images, to myelography in detecting blocking of the dural canal and intradural findings such as redundant nerve roots. MRI was inferior to selective nerve root infiltration in visualizing the compression of the nerve root, irrespective of diseases; however, there was no difference in abnormal findings of the running of nerve root between the two modalities. Transverse MRI was superior to CT in visualizing the nerve root. Thus, MRI alone is insufficient for the diagnosis of degenerative lumbar spinal diseases, and the other modalities should be supplementary for pathophysiological understanding of these diseases. (N.K.).

  20. Diagnostic imaging of the lumbar disc herniation for radiculopathy by 3D-MRI (MR-myelography)

    Taira, Gaku; Imakiire, Atsuhiro; Endo, Kenji [Tokyo Medical Coll. (Japan); Ichimaru, Katuji


    We have developed a new method of three-dimensional MRI (3D-MRI) which enables a stereoscopic view of the spinal cord and both sides of spinal nerve roots in one image. Anatomical study for normal subjects, the S1 angulations and length were significantly smaller than those of others. The S1 DRG was oval and was the largest. In a pathological study the use of 3D-MRI defects the signal changes following damage to the spinal nerve roots or ganglion in lumbar disc herniation. With regard to signal changes in damaged root ganglion, a good correlation between root compression and root inflammation was detected by experiments. We are currently examining the relationship between the damaged root ganglion, pain sensory disturbance. This study showed that the dorsal root ganglion plays an important role in sensory control of radiculopathy on 3D-MRI. (author)

  1. Dual energy CT myelography after lumba osteosynthesis

    Grams, A.E.; Gizewski, E.R. [Medical Univ. Innsbruck (Austria). Dept. of Neuroradiology; Sender, J.; Obert, M. [Univ. Hospital Giessen (Germany). Dept. of Neuroradiology; Mortiz, R.; Krombach, G.A. [Univ. Hospital Giessen (Germany). Dept. of Radiology; Stein, M. [Univ. Hospital Giessen (Germany). Dept. of Neurosurgery; Oertel, M. [Vogtland-Klinikum Plauen (Germany). Dept. of Neurosurgery; Schmidt, T. [Klinikum Wuppertal (Germany). Dept. of Neuroradiology


    The purpose of this study was to evaluate the benefits of CT myelography in the DE technique in patients with lumbar osteosynthesis. In 30 patients a DE-CT scan of the spine with tube voltages of 80 kV and 140 kV was performed and a virtual monochromatic series of 120 kV was generated after intrathecal contrast injection. The impact of metal artifacts on the spinal canal and the spinal foramina was evaluated. The visualization of nerve roots was compared between a VRT series of the dural sac and conventional myelography. With tube voltages of 140 kV, the artifacts were least pronounced. As no overlay disturbance was present, VRT visualization of the nerve roots was more reliable than conventional myelography. In patients after osteosynthesis, CT in the DE technique provides minimal artifact disturbance using a tube voltage of 140 kV. ''Virtual myelography'' seems to be superior to conventional myelography for the evaluation of nerve roots. This could reduce additional conventional radiography, may shorten the entire examination and radiation time and diminish unnecessary painful movements for the patient.

  2. Computer assisted myelography

    Tamakawa, Y.; Miyauchi, T.; Ogawa, T.; Saito, Y. (Akita Univ. (Japan))


    Spinal computed tomography was carried out after intrathecal introduction of metrizamide. This technique can clearly visualize the spinal subarachnoid space and structures contained in this space, and is an accurate and satisfactory modality for detecting spinal cord and various spinal lesions. In the cases with syringomyelia, the reflux of metrizamide into the syrinx was most marked several hours following intrathecal introduction of metrizamide. Computer assisted myelography with metrizamide is essential in the diagnosis of communicating sylingomyelia. It will demonstrate intraspinal extention and the total geography of the spinal cord tumor. Authors present their technique and results with representative cases of various spinal lesions.

  3. Lumbar-sacral dysplasias

    Schumacher, M.; Thron, A.


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

  4. Extraspinal incidental findings on routine MRI of lumbar spine: Prevalence and reporting Rates in 1278 patients

    Tuncel, Sedat Alpaslan; Cagli, Bekir; Tekatas, Aslan; Kirici, Yadigar Mehmet; Unlu, Ercument; Genchellac, Haken [Trakya University Faculty of Medicine, Balkan Campus, Edirne (Turkmenistan)


    The aim of the present study was to determine the prevalence and reporting rate of incidental findings (IF) in adult outpatients undergoing lumbar magnetic resonance imaging (MRI). Re-evaluation of a total of 1278 lumbar MRI images (collected from patients with a mean age of 50.5 years, range 16-91 years) captured between August 2010-August 2011 was done by a neuroradiologist and a musculoskeletal radiologist. IFs were classified according to organ or system (liver, gallbladder, kidney, bladder, uterus, ovary, lymph node, intestine and aorta). The rate of reporting of a range of IF was examined. The outcome of each patient's treatment was evaluated based on review of hospital records and by telephone interviews. A total of 253 IFs were found in 241 patients (18.8% of 1278). Among these, clinically significant IFs (n = 34) included: 2 renal masses (0.15%), 2 aortic aneurysms (0.15%), 2 cases of hydronephrosis (0.15%), 11 adrenal masses (0.86%), 7 lymphadenopathies (0.55%), 6 cases of endometrial or cervical thickening (0.47%), 1 liver hemangioma (0.08%), 1 pelvic fluid (0.08%) and 2 ovarian dermoid cysts (0.15%). Overall, 28% (71/253) of IFs were included in the clinical reports, while clinically significant findings were reported in 41% (14/34) of cases. Extraspinal IFs are commonly detected during a routine lumbar MRI, and many of these findings are not clinically significant. However, IFs including clinically important findings are occasionally omitted from formal radiological reports.

  5. Relationship among the myelography, MRI and EMG in young patients with low back pain or radiating pain

    Jang, Ji Youn [Soonchunhyang University Hospital, Seoul (Korea, Republic of); Kim, Dong Hun [Chosun University Hospital, Gwangju (Korea, Republic of); Park, Young Jae [Gwang-Ju City Geriatiric Hospital, Gwangju (Korea, Republic of)


    We wanted to evaluate the relationship among the myelography, magnetic resonance imaging (MRI), and electromyography (EMG) findings in young patients with low back pain, and we wanted to assess the significance of the spinal geometric measurements as well as type of disc herniation seen on MRI. Forty-four young men with lower back pain were included, and they were all clinically suspected of suffering with lumbar disc herniation. All of them underwent myelography, MRI and EMG. We measured spinal geometry including the anteroposterior diameters of the central canal and thecal sac, the interlaminar distance, the width of the lateral recess and the thickness of the ligamentum flavum, and we evaluated for root deviation as well as disc herniation on the MRIs. We compared the types of disc herniation on MRI with the myelography and EMG findings. Also, we investigated the correlation of the spinal geometric measurements on MRI with the EMG and myelography findings. The types of disc herniation on MRI were not significantly related to the myelography ({rho} = 0.298) and EMG findings ({rho} = 0.372). The EMG findings were not related to either the myelography findings ({rho} = 0.435) or the spinal geometric measurements ({rho} > 0.05) on MRI. Nerve root compression that was noted on myelography was related to the thecal sac AP diameter ({rho} = 0.016) and the width of the lateral recess ({rho} = 0.011). There were no correlations between myelography and the findings of root deviation on MRI ({rho} = 0.052). MRI can play an excellent diagnostic role for young patients with radiculopathy or lower back pain. It could increase the diagnostic accuracy if it is used in conjunction with myelography and EMG. The narrowing of thecal sac AP diameter and the width of lateral recess rather than the type of disc herniation on MRI were well correlated with the myelography and EMG findings.

  6. Computed tomography as the primary radiological examination of lumbar spine

    Ilkko, E.; Laehde, S.


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

  7. Computed tomographic metrizamide myelography in spinal disease

    Isu, T.; Ito, T.; Iwasaki, Y.; Tsuru, M. (Hokkaido Univ., Sapporo (Japan). School of Medicine); Kitaoka, K.


    Methods: Either EMT Head Scanner, CT 1010 (slice thickness 10 mm) or EMI Body Scanner, CT 5005 (slice thickness 13 mm) was used. The concentration of metrizamide was 170 - 250 mgI/ml and the amount was 7 - 10 ml. Either lumbar puncture or lateral C sub(1 - 2) puncture was made. Materials: 26 cases were included in this study. 1) disc disease: 11 cases, 2) spinal cord tumor: 6 cases, 3) Arnold-Chiari malformation: 3 cases, 4) atlantoaxial dislocation: 3 cases, 5) ossification of the posterior longitudinal ligament (associated with ossification of the ligamentum flavum): 2 cases (1 case), 6) spinal foreign body (acupuncture needle): 1 case. Results: 1) CT metrizamide myelography visualizes the subarachnoid space and makes it possible to know the lesion in the spinal canal in relation to the spinal cord in transverse plane. 2) It is difficult to determine the exact level of the lesion in axial plane. 3) The present technique does not allow to visualize the root sleeves. 4) It is difficult to delineate a compression of the subarachnoid space by small localized lesions (esp., disc diseases) due to overlapping the patent adjacent subarachnoid space within a slice 10 mm to 13 mm thick.

  8. Functional cervical myelography with iohexol

    Nakstad, P.; Aaserud, O.; Nyberg-Hansen, R.; Ganes, T.


    Thirty patients underwent functional cervical myelography, i.e. radiographs in the lateral view were obtained in extension as well as in flexion of the neck. Sagittal tomography was performed in both positions. Narrowing of the subarachnoid space and increased sagittal diameter of the spinal cord due to shortening were demonstrated in the lateral view in extension. In flexion a widening of the subarachnoid space was seen in almost all. In some cases with advanced narrowing or spinal block in extension, such widening in flexion resulted in better diagnostic images by providing passage of the contrast medium caudally. Although iohexol (Omnipaque, Nyegaard and Co., Oslo) was regularly forced into the posterior cranial fossa by the movements, the frequency of side effects was approximately the same as in our former trials with iohexol in conventional cervical myelography. EEG changes occurred in two patients (7%). A sitting position for 3-4 min after the examination followed by an elevated head end of the bed was probably important for preventing side effects from the contrast medium. Specific questioning revealed twice as many subjective side effects as reported after general questions alone.

  9. Fat-Suppressed T2 Sequences for Routine 3.0-Tesla Lumbar Spine Magnetic Resonance Imaging: A Preliminary Report

    McKinney, A. M.; Gadani, S.; Palmer, C. S.; Vidarsson, L. (Dept. of Radiology, Hennepin County and Univ. of Minnesota Medical Centers, Minneapolis, MN (United States))


    Background: Clear depiction of the ligamentum flavum on routine lumbar magnetic resonance imaging (MRI) is essential in accurately describing the extent of degenerative disease. In routine, noncontrast evaluations, focal fatty deposition or hemangiomas can be difficult to distinguish from malignant foci on fast spin-echo (FSE) T2-weighted images. Purpose: To describe the use of T2 fast field echo (T2FFE) in combination with spectral presaturation inversion recovery (SPIR) fat suppression for noncontrast, routine lumbar spine outpatient MR imaging at 3.0 Tesla (3T). Material and Methods: An axial gradient echo (GE) T2FFE sequence was combined with SPIR fat suppression (T2FFE-SPIR), via a 3T Philips Intera (Philips Medical Systems, Best, The Netherlands) scanner, and added to the routine, noncontrast lumbar MRI examinations, which included sagittal FSE T1-weighted (T1WI), T2-weighted (T2WI), short-tau inversion recovery (STIR), and axial FSE T2WI. The sequence was performed in over 500 patients over a 1-year period, without intravenous contrast, and with slice thickness and planes of section identical to the axial FSE T1WI and T2WI images. The sequence typically lasted about 4.5-6 min. Results: The use of T2FFE-SPIR enabled visualization of the ligamentum flavum in degenerative disease, and the exclusion of focal fatty lesions on FSE T2WI. Other benefits included: the identification of malignant foci, the uncommon detection of hemorrhage, and the elimination of spurious flow voids. Several brief examples are provided to demonstrate the utility of this technique. Conclusion: The addition of T2FFE-SPIR to routine, noncontrast protocols in outpatients could provide further confidence in the visualization of the ligamentum flavum in degenerative disease, and can exclude malignancy in T2-bright areas of focal fatty marrow. Larger studies would be helpful to evaluate the accuracy of this technique versus FSE techniques in depicting degenerative, malignant, or inflammatory

  10. SCTM对腰椎管狭窄症的影像病理学研究%The Image Pathologic Studies of Narrowing of Lumbar Vertebrae with SCTM (Spiral Computer Tomogram Myelography

    唐志伟; 陈双; 陈德基; 陈洁兰; 李树欣


    Objective To evaluate the imaging technology and clinical application of spiral CTM.Methods 42 patients were examined with SCTM. The images were analyzed and reconstructed by computer software. Results Among 42 cases, there were 27 of lumbar disc diseases, 2 of congenital bony narrowing of vertebral canal, 2 of hyperosteogeny at rear edge of vertebra, 5 of vertebral dislocation, 3 of pachynsis of yellow ligaments. All the patients received operative treatments. The SCTM made 100% positive diagnosis. Computer reconstruction software can provide the multi-plane and multi-angle images, illustrating the vertebral canal and subarachnoid cavity, the appearance, structure and connectivity of spinal nerves.Conclusions SCTM-MPR can clearly illustrate the anatomy of vertebral canal and its contents, the pathologic changes, making a precise localization of the focus. It's believed that SCTM can be very valuable in clinical application of narrowing of vertebral canal.%目的探讨螺旋CT椎管造影(SCTM)成像技术及临床应用价值.方法对42例腰椎管狭窄症患者进行T椎管造影检查,图像经计算机多平面重建软件处理.结果在42例患者中,椎间盘病变27例,先天性骨性椎管狭窄2例,椎体后缘增生骨刺2例,椎体滑脱5例,黄韧带肥厚3例,椎间盘突出术后及疤痕增生3例.全部病例均行手术治疗并证实.后处理多平面重建图像能提供不同平面、多角度、多方位的任意轴面(直面、曲面)影像,突出显示椎管内蛛网膜下腔及脊神经根的形态、结构、位置及其连续性改变.结论 SCTM-MPR能全面地清晰显示受检段脊柱及椎管内各解剖层次及其病理改变,提高病变定位及定性的准确性,对腰椎管狭窄症的诊断具有较高的临床实用价值.

  11. MR myelography of sacral meningeal cysts

    Tsuchiya, K.; Katase, S.; Hachiya, J. [Kyorin Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology


    Purpose: To describe the findings of sacral meningeal cysts (SMCs) on MR myelography and assess its value for the diagnosis of SMCs. Material and Methods: We evaluated the MR images and MR myelograms obtained from 10 patients with SMC. MR myelograms were obtained using a 2D or 3D single-shot fast spin-echo sequence. In 5 patients, X-ray myelograms and postmyelographic CT images were compared with the MR myelograms. Results: A total of 33 SMCs were diagnosed within the spinal canal and/or sacral foramen. MR myelograms clearly revealed each cyst as a well-defined mass showing hyperintensity (10 cysts) or isointensity (23 cysts) compared to cerebrospinal fluid. MR myelograms demonstrated SMCs better than X-ray myelograms and postmyelographic CT images in 3 of the 5 patients. Conclusion: MR myelography can be an adjunct to conventional imaging techniques when surgical treatment is indicated, because it can precisely delineate the extent of SMCs. (orig.)

  12. Comparing the cost of spinal MR with conventional myelography and radiculography.

    du Boulay, G H; Hawkes, S; Lee, C C; Teather, B A; Teather, D


    All spinal magnetic resonance imaging examinations carried out during a three month period were analysed retrospectively in order to determine the clinical reasons for the scan requests. Technical details of the examinations they received and the clinical profiles formed a data set which revealed 10 separate "Clinical groups" for management purposes. Hardware, salary and expendables were costed as though the imaging unit had been sited within a National Health Service radiology department. A spread sheet was designed capable of calculating costs per patient for a variety of types of working week and of different staffing structures, sensitive to the mixture of clinical groups referred for examination. The spreadsheet also accomodated straight line depreciation for hardware value and interest rates for borrowed capital. A second, prospectively observed, sample of spinal MR examinations was used to improve the accuracy of the timing of the length of patient examinations. Costs were compared with those for patients submitted for myelography and radiculography at the adjacent hospital during the same period. The comparison indicated that spinal MR was less costly than myelography and radiculography. The most important element of the extra cost of myelography related to the need to admit patients to hospital for at least one night for this examination because of the likelihood of headache and other common (though usually minor) complications following lumbar puncture and/or the injection of contrast medium. From the limited information that it was possible to obtain in the period of follow up, it appeared that MR had either been superior or equivalent to myelography or radiculography in all the clinical groups of patients where both could be tested. There were a number of groups in which no myelograms had been requested, presumably because clinical suspicions had pointed toward conditions like tumours, developmental abnormalities and demyelinating diseases in which

  13. Intraoperative Three-Dimensional Imaging in Selective Decompression for Lumbar Spinal Stenosis: A Useful Tool in Theory but Also in Everyday Practice?

    Uwe Max Mauer


    Full Text Available Background. We conducted a pilot study to investigate the value of an Iso-C3D imaging system in determining the extent of decompression of lumbar spinal stenosis during surgery. We now address the question whether this imaging has become a routine tool. Material and Methods. Ten patients who underwent unilateral decompression for lumbar spinal stenosis were intraoperatively examined using the Iso-C3D imaging system. Four years after this study, we investigated whether this intraoperative imaging modality is still being used. Results. Evaluable images were intraoperatively obtained for all patients. In two cases, the surgical procedure was changed on the basis of the images. Myelography did not provide any additional information. In the four years following the study, this intraoperative imaging technique has not been used again. Conclusion. Intraoperative imaging using the Iso-C3D system provides additional safety. It, however, has not become established as a routine procedure.

  14. Superior facet syndrome. Findings on metrizamide CT myelography

    Kubo, Yoshichika; Igarashi, Seishi; Koyama, Tsunemaro


    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.

  15. CT myelography in the diagnosis of spinal diseases

    Kunishio, Katsuzo; Yamamoto, Yoshihiro; Sunami, Norio; Yamamoto, Yuji; Asari, Shoji


    CT myelography of the spinal column was carried out in 37 patients. There were 13 patients with disk lesions, 10 with narrow spinal canals, 2 each with ossifications of the posterior longitudinal ligament and metastatic spinal tumors, and one each with ossification of yellow ligament, atlanto-axial dislocation, syringomyelia, and spinal cord multiple sclerosis. CT myelography was of diagnostic value for various spinal problems.

  16. Influence of certain factors on the manifestations of the adverse effects of metrizamide myelography

    Yu, Y.L.; Du Boulay, G.H.; Paul, E.


    Although metrizamide is now being superseded by other contrast media, the mechanisms of its side effects may be of fundamental importance. One hundered and four consecutive patients with suspected cervical cord or root lesion were studied prospectively for factors which might influence the side effects of metrizamide myelography. Elderly patients were more prone to develop mental confusion. An earlier onset of dizziness and/or vertigo was associated with the lumbar route of intrathecal injection. Perhaps surprisingly, phenobarbitone prophylaxis shortened the duration of confusion and delayed the onset of headaches. Other factors, viz. sex, excess intracranial flow of metrizamide and myelographic blockage were not shown to have a signifiant influence on the adverse reactions.

  17. Functional myelographic differentiation of lumbar bulging annulus

    Park, Choong Ki; Kim, Hong Kil; Park, Sang Gyu; Lee, Young Jung; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of)


    Herniated disk and bulging annulus are the major causes of lower back pain. It is necessary to differentiate bulging annulus from herniated disk because of their different methods of treatment. Myelography is one of the useful diagnostic methods for disk diseases even though advanced diagnostic modalities such as CT and MRI are more accurate. Functional myelography is not a new technology expect for two additional views, flexion and extension, are obtained with conventional myelography. Differentiation between bulging annulus and herniated disk by conventional myelography is based on the extent and multiplicity of extradural deformity of the contrast filled dural sac and neural sleeve as well as the changes of nerve root. There is no previous report about differential points between bulging annulus and herniated disk according to functional myelography. It is the purpose of this study to find any additional differential points on functional myelography between bulging annulus and herniated disk over convectional myelography. Authors analysed functional myelographic findings of 152 cases from July 1986 to July 1987. Among them, 22 cases who had been suffered from cervical abnormality or vague lower back pain were diagnosed as normal by myelography, and 30 cases of L4-5 herniated disk and 21 cases of L4-5 bulging annulus which had been finally diagnosed by operation were studied. The results were as follows. 1. In normal group, anterior epidural space was gradually widened from the upper lumbar vertebra downward. And anterior epidural space was more sidened at the disk level in extension view than in flexion except for L5-S1 lever. 2. In bulging annulus group, the shape of anterior epidural space in flexion state was as similar as normal. Anoterior epidural space in extension state was more sidened at the buldging annulus than normal, but lesser than herniated disk. 3. In herniated disk group, widening of anterior epidural space at the herniated disk level was

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

    Nakagawa, Hiroshi (Aichi Medical Univ., Aichi (Japan))


    Plain CT described fairly accurately the anatomy and lesions of the lumbar and sacral spines on their transverse sections. Since hernia of the intervertebral disc could be directly diagnosed by CT, indications of myelography could be restricted. Spinal-canal stenosis of the lumbar spine occurs because of various factors, and CT not only demonstrated the accurate size and morphology of bony canals, but also elucidated thickening of the joints and yellow ligament. CT was also useful for the diagnosis of tumors in the lumbar and sacral spines, visualizing the images of bone changes and soft tissues on the trasverse sections. But the diagnosis of intradural tumors required myelography and metrizamide CT. CT has become important for the diagnosis of spinal and spinal-cord diseases and for selection of the route of surgical arrival.

  19. Chemical meningitis in metrizamide myelography. A report of seven cases

    Sand, T.; Hesselberg, J.P.; Anda, S.; Dale, L.; Hellum, K.


    Seven patients with acute chemcial meningitis after metrizamide myelography are described. Five of the cases occurred within a time span of two months. Clinical and cerebrospinal fluid findings in the acute stage of the illness were similar to findings in acute bacterial meningitis. Possible causes of this complication are discussed. (orig.).

  20. Spinal dermoid cyst. Characteristic CT findings after metrizamide myelography

    Miyamoto, Yoshihisa; Makita, Yasumasa; Nabeshima, Sachio; Tei, Taikyoku; Keyaki, Atsushi; Takahashi, Jun; Kawamura, Junichiro


    A 25-year-old male complained of intermittent, sharp pains about the left eye and in the left side of the chest. Neurological examination revealed paresthesia and impaired perception of touch and pin-pricks in the dermatomes of Th8 and Th9 on the left side. In all four extremities, the muscle stretch reflexes were equal and slightly hyperactive, without weakness or sensory deficits. Metrizamide myelography showed defective filling at the level between the upper 8th and 9th thoracic vertebrae. The lesion was also demonstrated by computed tomography (CT) scan performed 1 hour later, appearing as an oval, radiolucent mass in the left dorsal spinal canal, which compressed the spinal cord forward and toward the right. Serial sections of the spinal canal revealed the lesion to be partly filled with contrast medium. Repeat CT scan 24 hours after metrizamide myelography showed more contrast medium in the periphery of the lesion, giving it a doughnut-shaped appearance. At surgery a smooth-surfaced cyst containing sebum and white hair was totally removed from the intradural extramedullary space. The histological diagnosis was dermoid cyst. There have been a few reported cases of intracranial epidermoid cyst in which filling of the cyst was suggested on metrizamide CT myelography. These findings may complicate the differential diagnosis of arachnoid cyst and dermoid or epidermoid cyst when only CT is used.

  1. Imaging Characterization Lumbar Disk Hernia in Operated patients.

    Enrique Hernández Padrón


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

  2. Aphasia and right hemiplegia after cervical myelography with metrizamide

    Angiari, P.; Merli, G.A.; Crisi, G.


    We report a case of aphasia and right hemiplegia, developing after myelography with metrizamide and lasting for an unusually long time. The neurological disorders, manifested 1 h after the examination was completed, were due to accidental passage of contrast medium into the basal cisterns. In the light of analogous case reports in the literature, as well as experimental data concerning the biochemical activity of metrizamide, possible aetiopathogenetic mechanisms responsible for such disturbances are indicated. The authors underline the lack of effective therapeutic measures after the onset of the disorders, and thus the importance of preventing such complications that behave functionally as true ictuses although with no anatomic substratum.

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

    Inaoka, Masahiro; Tada, Koichi; Yonenobu, Kazuo


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

  4. Iopamidol vs Metrizamide: a double blind study for cervical myelography

    Drayer, P.; Warner, M.A.; Allen, S.; Bates, M.; Sudilovsky, A.; Luther, J.; Wilkins, R.


    A double-blind study was performed on 20 patients comparing the safety and efficacy of Iopamidol and Metrizamide in cervical myelography. The radiographic qualities of the Iopamidol and Metrizamide examinations were equivalent when using the same volume (12 to 13 ml), concentration (200 mg I/ml) and a C1-2 route of administration. The performance of a CT scan on selected patients in specified areas of interest provided additional diagnostic information in some patients (e.g. syringomyelia, degenerative spondylosis). The adverse reactions were mild in the Iopamidol group with 4 of the 10 patients experiencing no adverse reactions. The more severe reactions, including disorientation, agitation, dysarthria, asterixis, hyperreflexia and EEG abnormalities were limited to the Metrizamide group with one or more occurring in 2 of the 10 patients studies. Only one Metrizamide patient experienced no adverse reactions. In this study containing a limited number of patients, Iopamidol was shown to be a diagnostically effective and safer contrast medium for performing cervical myelography.

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

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


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

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

    Swayne, L.C.; Dorsky, S.; Caruana, V.; Kaplan, I.L. (Morristown Memorial Hospital, NJ (USA))


    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.

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

    Koyanagi, Izumi; Isu, Toyohiko; Iwasaki, Yoshinobu; Akino, Minoru; Abe, Hiroshi; Tashiro, Kunio; Miyasaka, Kazuo; Abe, Satoru; Kaneda, Kiyoshi


    Radiological findings in five cases with chronic spinal cord compressive lesion at thoraco-lumbar junction were reported. Three cases had spondylosis and two cases had ossification of yellow ligament (OYL). The levels of the lesions were T12/L1 in three cases and T11/12 in two cases. Two out of three spondylotic patients had also OYL at the same level. The five cases consisted of three men and two women. The ages ranged from 42 to 60 years old with a mean age of 53 years old. Neurologically, every patient showed flaccid paresis and sensory disturbance of the legs. Two cases had sensory disturbance of stocking type. The intervals from the onset of the symptoms to the final diagnosis were 6 months, 7 years, 8 years, 11 years and 12 years. Myelography showed anterior spinal cord compression by bony spur in spondylotic patients, and posterior compression by OYL in other cases. Myelography in flexion posture disclosed the cord compression by bony spur more clearly in two out of three spondylotic patients. Delayed CT-myelography showed intramedullary filling of contrast material in two cases, which indicated degenerative change or microcavitation due to long term compression of the spinal cord. MRI was taken in three spondylotic patients and could directly show compression of the spinal cord. Difficulty in detecting abnormality at thoraco-lumbar junction on plain roentgenogram, and similarity of the symptoms to peripheral nerve disease often lead to a delay in diagnosis. The significance of dynamic myelography and delayed CT-myelography when dealing with such a lesion was discussed here. MRI is also a useful method for diagnosing a compressive lesion at the thoraco-lumbar junction.

  8. CT myelography characteristics of spinal dysraphism in a young mixed breed dog Características de mielografía con TC de una disrafia espinal en un perro mestizo joven

    Gómez, M.; M Mieres; JC Gutiérrez; JC Jones


    Spinal dysraphism is a congenital defect of the vertebral column and spinal cord secondary to imperfect closure of the caudal neuropore of the developing neural tube. This report describes computed tomographic myelography (Myelo-CT) characteristics of spina bifida occulta, spinal cord aplasia/hypoplasia and split cord malformation type II (diplomyelia) in the caudal lumbar area of a 2 month old mixed breed dog.La disrafia espinal es un defecto congénito de la columna vertebral y la médula esp...

  9. Spine imaging after lumbar disc replacement: pitfalls and current recommendations

    Sandén Bengt


    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.

  10. Measurement of normal cervical spinal cord in metrizamide CT myelography

    Suzuki, Fumio; Koyama, Tsunemaro; Aii, Heihachirou


    The shape of the spinal cord is the most important factor in diagnosis of spinal disorders by metrizamide CT myelography (met. CT). Even in cases where the spinal cord looks normal in shape its size might be abnormal, for example in cases with spinal cord atrophy, syringomyelia, intramedullary tumor and several other conditions. In detecting the slightest abnormality in such cases, it is absolutely necessary to have in hand the knowledge of the nomal size of the spinal cord at each level. We measured, therefore, the sagittal and transverse diameters of the cervical spinal cord in 55 patients with no known lesions on met. CT. Comparing our results with those by others, we found some differences as to the size of the spinal cord. We assume that these differences are due to the differences in resolution of the CT scanners used. The size of the spinal cord tends to measure larger with a CT scanner with high resolution than with others. Previous authors reported that the size of the spinal cord would vary by window center settings. Our experimental results indicate, however, that window center settings do not significantly affect the measurements. It is concluded that the normal values of the spinal cord dimensions at each level somewhat differ by CT equipments used. One should have normal values with one's own equipment in hand in order to take full advantage of this sophisticated diagnostic technique. (author).

  11. Feasibility and potential value of flat-panel detector-based computed tomography in myelography after spinal surgery.

    Kau, Thomas; Rabitsch, Egon; Celedin, Stefan; Jeschofnig, Barbara; Illiasch, Herbert; Eicher, Wolfgang; Uhl, Eberhard; Honl, Matthias; Hausegger, Klaus Armin


    The purpose of this study was to assess the value of myelography using flat-panel detector-based computed tomography (fpCT) in 5 patients in whom the image quality of multislice CT (MSCT) or MR imaging was limited by metal artifacts. The application of fpCT to myelographic imaging of the lumbar spine and cervicothoracic junction after surgery was feasible. Multiplanar, preferably sagittal, and 3D reconstructions adequately depicted disc space implants and provided high resolution images of osseous structures. The images obtained with fpCT allowed evaluation of anatomical details such as single nerve roots and proved especially valuable in a patient with impaired MR imaging results caused by metal artifacts from an intraoperative abrasion. In a case of recurrent disc herniation, imaging results of myelographic fpCT and MSCT scanning were in good agreement. The novel imaging technique the authors describe yielded adequate results in patients with a history of spinal surgery, may be superior to MSCT scanning in depicting osseous structures and metallic implants, and has the potential to provide multilevel spinal images. Myelographic fpCT scanning may be the preferred modality in patients with expected or known metal artifacts on myelographic MSCT scans and/or MR images.

  12. Routine cranial computed tomography before lumbar puncture in HIV-positive adults presenting with seizures at Mitchells Plain Hospital, Cape Town

    Salma Moolla


    Full Text Available Background: Current international guidelines recommend that a cranial computed tomography (CT be performed on all HIV-positive patients presenting with new onset seizures, before a lumbar puncture (LP is performed. In the South African setting, however,this delay could be life threatening. The present study sought to measure the number of cranial CTs that contraindicate an LP and to predict which clinical signs and symptoms are likely to pose an increased risk from LP.Methods: The study was performed at a district level hospital in Western Cape Province. Data were collected retrospectively from October 2013 to October 2014. Associations between categorical variables were analysed using Pearson’s chi-squared test. Generalised linear regression was used to estimate prevalence ratios.Results: One hundred out of 132 patients were studied. Brain shift contraindicated an LP in 5% of patients. Patients with brain shift presented with decreased level of consciousness, focal signs, headache and neck stiffness. Twenty-five per cent of patients had a space-occupying lesion (SOL (defined as a discrete lesion that has a measurable volume or cerebral oedema. Multivariate analysis showed a CD4 count <50 (p = 0.033 to be a statistically significant predictor of patients with SOL and cerebral oedema. Univariate analysis showed focal signs (p = 0.0001, neck stiffness (p = 0.05, vomiting (p = 0.018 and a Glascow Coma Scale (GCS < 15 (p = 0.002 to be predictors of SOL and cerebral oedema.Conclusion: HIV-positive patients with seizures have a high prevalence of SOL and cerebral oedema but the majority of them are safe for LP. Doctors can use clinical parameters to determine which patients can undergo immediate LP.

  13. MR and CT image fusion of the cervical spine: a noninvasive alternative to CT-myelography

    Hu, Yangqiu; Mirza, Sohail K.; Jarvik, Jeffrey G.; Heagerty, Patrick J.; Haynor, David R.


    CT-Myelography (CTM) is routinely used for planning surgery for degenerative disease of the spine, but its invasive nature, significant potential morbidity, and high costs make a noninvasive substitute desirable. We report our work on evaluating CT and MR image fusion as an alternative to CTM. Because the spine is only piecewise rigid, a multi-rigid approach to the registration of spinal CT and MR images was developed (SPIE 2004), in which the spine on CT images is first segmented into separate vertebrae, each of which is then rigidly registered with the corresponding vertebra on MR images. The results are then blended to obtain fusion images. Since they contain information from both modalities, we hypothesized that fusion images would be equivalent to CTM. To test this we selected 34 patients who had undergone MRI and CTM for degenerative disease of the cervical spine, and used the multi-rigid approach to produce fused images. A clinical vignette for each patient was created and presented along with either CT/MR fusion images or CTM images. A group of spine surgeons are asked to formulate detailed surgical plans based on each set of images, and the surgical plans are compared. A similar study assessing diagnostic agreement is being performed with neuroradiologists, who also assess the accuracy of registration. Our work to date has demonstrated the feasibility of segmentation and multi-rigid fusion in clinical cases and the acceptability of the questionnaire to physicians. Preliminary analysis of one surgeon's and one neuroradiologist"s evaluation has been performed.

  14. Comparative study of myelography with postmyelographic CT in cervical spondylosis and herniated disk

    Jung, Kyoon Soon; Park, Yong Tae; Choi, Woo Suk; Lee, Sun Wha; Lim, Jae Hoon [Kyung Hee University College of Medicine, Seoul (Korea, Republic of)


    Eight patients, who had symptoms and signs of cervical spondylosis and/or disk were studied with myelography (using Omnipaque) followed by postmyelographic computed tomography to evaluate the relative efficacy of these two methods in the determination of cervical herniation and spondylosis. Thirty nine levels in 26 patients were confirmed by surgery. Of these, 20 levels proved to have operative evidence of herniated disk. Postmyelographic CT adds useful information to the myelographic findings. Cord and root compression are better evaluated and osteopathy can be differentiated from disk herniation. In osteopathy, myelography was as diagnostic as postmyelographic CT. But, disk herniation was identified in 70% (14/20 levels) with postmyelographic CT and only in 15% (3/20 levels) with myelography.

  15. Magnetic resonance tomography of the spine and spinal cord compared with CT and myelography

    Fenzl, G.; Heywang, S.H.; Vogl, T.; Obermueller, J.; Einhaeupl, K.; Clados, D.; Steinhoff, H.


    In cases of syringomyelia MR is superior to CT and myelography in visualisation and delineation of the extent of the process. In diagnosing spinal tumours MR is a more sensitive method than CT and myelography. MR provides additional information on sagittal and frontal planes regarding the extent of the tumour. In diagnosis of disc prolapse MR seems to be as accurate as CT or myelography. We obtained additional information in diagnosis of degenerated disc tissue. Spinal stenosis is easily recognisable. CT was superior in differentiation of bony and disc protrusion. The results show that MR has opened up new possibilities in the diagnosis of spinal diseases and will result in a reorientation of the diagnostic approach.

  16. Comparison of magnetic resonance imaging and conventional neuroradiographies in lumbar herniated nucleus pulposus

    Nishijima, Yuichiro; Taniguchi, Mitsukazu; Michishita, Masamitsu; Ohta, Yoshiaki; Kondo, Takeshi; Tonami, Hisao; Yamazaki, Yasuro; Higashida, Norihiko; Yamamoto, Tatsu (Kanazawa Medical Univ., Ishikawa (Japan))


    To determine whether magnetic resonance imaging (MRI) would replace conventional neuroradiographies in lumbar herniated nucleus pulposus, preoperative MRI findings were compared with surgery-confirmed pathophysiology of 63 intervertebral disks in 58 patients. Conventional neuroradiographies consisted of myelography, CT myelography, discography, and CT discography. Pathophysiology of 63 herniated disks fall into normal (n=7), bulging (n=9), protrusion (n=14), extrusion (n=17), and free migrated (n=16). Diagnostic accuracy of MRI was evaluated in terms of the presence or absence of herniation, height, location, and morphology of herniated disk. In diagnosing herniation, MRI had a sensitivity of 96%, a specificity of 25%, and an accuracy of 78%. In determining the height of herniated disk, the diagnostic rate of MRI was 77%, being lower than both CT myelography (94%) and CT discography (89%). MRI had a concordance rate of 55% for bilateral location in transaxial view, compared with 76% for CT myelography and 74% for CT discography. MRI failed to differentiate extrusion from protrusion. In conclusion, MRI was the most suitable for screening the presence or absence of herniation; however, it was inferior to other neuroradiographies in the diagnosis of morphology of herniated disk, as well as the determination of height and surgical intervention site of herniated disk. (N.K.).

  17. Computer-assisted myelography (CAM) in the diagnosis of cervical disk disease. Correlation with surgical findings

    Kotwica, Z.; Kasprzak, P. (Medical Univ. of Lodz, Dept. of Neurosurgery (Poland)); Chmielowski, M. (Medical Univ. of Lodz, School of Medicine, Dept. of Medical Imaging (Poland))

    A comparison was made between results obtained from preoperative computer-assisted myelography (CAM), on the one hand, and surgical findings, on the other, for 45 patients with suspicion of cervical disk disease. Full and correct diagnosis, subsequently confirmed by surgery, was enabled by CAM in 98% of all cases. Only one case was left in which preoperative diagnosis had been extraspinal tumour, while surgery revealed prolapse of the nucleus pulposus, the latter lying exposed on the anterior wall of the dural sac. The authors feel CAM to be sufficient for planning of surgical treatment for cervical disk desease, with other neuroradiological investigations, myelography or magnetic resonance tomography usually not being necessary. (orig.).

  18. Comparative aspects of occult intrasacral meningocele with conventional X-ray, myelography and CT

    Grivegnee, A.; Delince, P.; Ectors, P.


    A case of occult intrasacral meningocele is reported and the diagnostic reliability of conventional roentgenography, myelography and CT for the management of this rare lesions are evaluated. Probably, CT with the use of an intrathecal contrast agent could yield the most complete information about the precise nature of this cystic congenital dysraphism.

  19. 3D-MR myelography (3D-MRM) for the diagnosis of lumbal nerve root compression syndrome. A comparison with conventional myelography. 3D-MR Myelographie (3D-MRM) zur Diagnose von lumbalen Nervenwurzelkompressionssyndromen. Vergleichsstudie zu konventioneller Myelographie

    Eberhardt, K.E.W. (Neuroradiologische Abt., Neurochirurgische Klinik, Nuernberg-Erlangen Univ., Erlangen (Germany)); Hollenbach, H.P.; Huk, W.J.


    65 patients with nerve root compression syndrome were examined using a new type of MR-technique, which is comparable to the conventional X-ray myelography. The results of the prospective case study were compared with previous clinical experiences (1). For the examinations a 1.0 T whole body MR-system (Siemens Magnetom Impact) was used. A strong T[sub 2]*-weighted 3D-FISP sequence (TR=73 ms, TE=21 ms, [alpha]=7 ) was applied in sagittal orientation using a circularly polarized oval spine coil. To obtain fat suppression a frequency selective 1-3-3-1 prepulse was applied prior to the imaging sequence. The acquired 3D-data set was evaluated using a Maximum Intensity Projection (MIP) program. Our results confirmed earlier experiences which showed that the diagnostic sensitivity of 3D-MR myelography (3D-MRM) is comparable to that of conventional X-ray myelography. In cases of severe spinal canal stenosis and spondylolisthesis, and in cases of postoperative scar tissue with nerve root compressions, the sensitivity of the 3D-MRM is higher as compared to that of conventional X-ray myelography. (orig.)

  20. Myelography CPT Coding Updates: Effects of 4 New Codes and Unintended Consequences.

    Chokshi, F H; Tu, R K; Nicola, G N; Hirsch, J A


    The Current Procedural Terminology of the American Medical Association has recently introduced coding changes for myelography with the introduction of new bundled codes. The aim of this review was to help neuroradiologists understand these code changes and their unintended consequences and to discuss various scenarios in which permutations of various codes could occur in clinical practice.


    Sangeeta Wazir


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

  2. [Lumbar hernia].

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


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

  3. Difficulty of diagnosing the origin of lower leg pain in patients with both lumbar spinal stenosis and hip joint osteoarthritis.

    Saito, Junya; Ohtori, Seiji; Kishida, Shunji; Nakamura, Junichi; Takeshita, Munenori; Shigemura, Tomonori; Takazawa, Makoto; Eguchi, Yawara; Inoue, Gen; Orita, Sumihisa; Takaso, Masashi; Ochiai, Nobuyasu; Kuniyoshi, Kazuki; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Arai, Gen; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Yamauchi, Kazuyo; Toyone, Tomoaki; Takahashi, Kazuhisa


    Case series. To present the difficulty of diagnosing the origin of lower leg pain in patients with lumbar spinal stenosis and hip joint arthritis. Pain arising from a degenerated hip joint is sometimes localized to the lower leg. Patients with lumbar spinal disease may also show radicular pain corresponding to the lower leg area. If patients present with both conditions and only pain at the lower leg, it is difficult to determine the origin of the pain. We reviewed 420 patients who had leg pain with lumbar spinal stenosis diagnosed by myelography, computed tomography after myelography, or magnetic resonance imaging. Pain only at the ipsilateral lateral aspect of the lower leg but slight low back pain or pain around the hip joint was shown in 4 patients who had lumbar spinal stenosis and hip osteoarthritis. The symptoms resolved after L5 spinal nerve block, but remained after lidocaine infiltration into the hip joint. We performed decompression and posterolateral fusion surgery for these 4 patients. Leg pain did not resolve after lumbar surgery in all patients. Conservative treatment was not effective from 6 to 12 months, so ultimately we performed ipsilateral total hip replacement for all patients and they became symptom-free. It is difficult to determine the origin of lower leg pain by spinal nerve block and hip joint block in patients with lumbar spinal stenosis and hip osteoarthritis. We take this into consideration before surgery.

  4. Oedema in the Lumbar Subcutaneous Fat, on Routine Magnetic Resonance Imaging, of Patients with No History of Cardiac, Renal or Hepatic Disease, Is Significantly Associated with Obesity and Age

    WM West


    Full Text Available Objectives: To investigate the association between oedema in the subcutaneous fat of the lumbar region during routine magnetic resonance imaging (MRI and patients’ age, gender and body mass index (BMI. Methods: One hundred and forty-nine consecutive examinations of 95 females and 54 males, 18 years and older, scanned at 1.5T between October 1, 2010, and December 31, 2010, were reviewed. Presence and extent of oedema were determined. Oedema was sized on the anatomical segments. Data were analysed using tests for means, odd’s ratio (OR, Chi-squared test, McNemar’s test, linear and backward stepwise multiple regression and analysis of variance (ANOVA. Results: Patients with oedema had significantly higher BMI (30.3 kg/m2 vs 24.9 kg/m2, p < 0.001, and were older (49.9 years vs 43.9 years, p = 0.01 than those without oedema. The OR for oedema in obese vs non-obese patients was 8.6. The Chi-squared and McNemar tests were significant, p = 0 and p < 0.001, respectively. Body mass index and age predicted oedema on backward stepwise regression and, on ANOVA, at 23.6% and 4.7%, respectively. Males were marginally less likely to have oedema (p = 0.056 and had marginally less oedema (p = 0.056 than females. Conclusion: Body mass index and age, but not gender, predict oedema. Body mass index predicts oedema five times as much as age.

  5. Application of 3D-myelo-CT for lumbar disease

    Taira, Gaku; Endo, Kenji; Karasawa, Haruhiro; Urawa, Yasuhito; Ito, Koichi; Ichimaru, Katsuji [Tokyo Medical Coll., Ami, Ibaraki (Japan). Kasumigaura Hospital; Miura, Yukio


    Helical CTs for lumbar disk hernia (LDH) and for lumbar canal stenosis (LCS) were compared with ordinary imaging diagnosis. Subjects were 10 cases of LDH and of LCS, who were 24-71 (mean 58.7) years old. The apparatus was Siemens Somatom Plus 4 and its 3D-program soft was used for reconstruction. The ordinary myelography was performed with a non-ionic contrasting medium and 60 min later, helical CT was carried out with conditions of 140 kV, 204 mA, slice thickness 3 mm, bed speed 3 mm/sec and reconstruction 1.5 mm. MRI was done on sagittal, axial and coronary sections and 3D-MRI was reconstructed from the coronary ones with the maximum intensity projection procedure. The 3D-myelo-CT images were compared with those by myelography, 2D-MRI and 3D-MRI in diagnostic rate of impaired nerve root, anatomical relationships between dura tube and bony factors and imaging rate of redundant nerve root. Exclusions of dura tube and of nerve root were found observable in 3D-myelo-CT, which was useful for surgery simulation and for explaining to patients. (K.H.)

  6. Epidemiological aspects of myelography in dogs: 61 cases (2003–2012

    Marina Rodacki


    Full Text Available Myelography is a radiological contrast examination technique frequently used in the diagnosis of vertebral spine and spinal cord disorders. The procedure involves inserting a needle with subsequent injection of contrast medium, which delimits the spinal cord. The main indication is suspected spinal injuries not visualized on plain radiographs. Myelography is effective in the identification of the location of the lesion but is contraindicated in patients with infectious diseases or who have recently experienced trauma. Advantages of myelography are cost effectiveness in both the examination procedure and maintenance of equipment, and delivery of quality images, compared with other imaging methods in dogs. Disadvantages include a relatively long examination procedure, the need for general anesthesia, and the risk of seizures or death. The aim of this study was to characterize a population of dogs undergoing myelography according to the following factors: severity of injury, breed, age, sex, reproductive status, diet, weight, previous illnesses, vertebral region evaluated, lesion location in spinal cord or meninges, cause of radiographic signs, and possible complications. The database was created from information in medical records, and included 61 dogs with suspected disorders of the vertebral spine, spinal cord, and/or meninges that underwent myelography at the Unidade Hospitalar para Animais de Companhia of Pontifícia Universidade Católica do Paraná from January 2003 through December 2012. The results indicate that the most common degree of injury severity was Grade 2 (39.34% of the patients. The most prevalent breeds were mixed breed dogs (22.58% and the dachshund (18.03%. Ages with higher frequency were 6 and 10 years (average, 7.6 years. According to sex and reproductive status, intact male (42.62% and female (36.06% dogs were most affected. The commercial (50.82% and mixed (44.26% diets were the most common diets. The body weight between


    戴力扬; 徐印坎


    ObjectS. To investigate the biomechanical aspects of etiology, pathology, clinical manifestation, diagnosis and surgical treatment of the lumbar spinal stenosis. Methods. A series of biomechanical methods, such as three-dimensional finite element models, threedimensional kinematic measurement, cadeveric evaluation, and imaging assessment was applied to correlate lumbar biomechanics and lumber spinal stenosls. Surgery of lumber spinal stenosis has been improved. Results.The stresses significantly concentrate on the posterolateral part of the annulus fibrcsms of disc, the posterior surface of vertebral body, the pedlcle, the interarticularis and the beet joints. This trend is intensified by disc degeneration and lumber backward extension. Posterior elcxnent resection has a definite effect upon the biomechanical behavior of lumbar vertebrae. The improved operations proved satisfactory. Conclusion. Stress concentration in the lumber vertebrae is of importance to the etiology of degenerative lumbar spinal stenosls, and disc degeneratkm is the initial key of this process. Than these will be aggravatnd by backward extension. Functloval radiography and myelography are of assistance to the diagnosis of the lumhar spinal stenosls. For the surgcal treatment of the lumber spinal stenosis, destruction of the posterior element should be avoid as far as possible based upon the thorough decmnpression. Maintaining the lumbar spine in flexion by fusion after decorapression has been proved a useftd method. When developmental spinal stenoals is combined with disc herniation, discectoray through laminotomy is recommend for decompression.

  8. Cardiovascular and respiratory alterations in dogs during cervical myelography using ioversol

    S.R.A. Melo e Silva


    Full Text Available Subarachnoid infusion of most contrast mediums and the steps involved in performing a cervical myelography have adverse affects that can discourage its use in the radiographic diagnosis of spinal cord diseases. Thus, the cardiovascular and respiratory alterations associated with neck flexion, subarachnoid puncture, and cerebrospinal fluid drainage during subarachnoid infusion of ioversol (320mgI/mL in dogs under general anesthesia using isoflurane were evaluated. The dogs received subarachnoid infusion of autologous cerebrospinal fluid kept at 38°C - control group (GC; ioversol 0.3mL/kg at 25°C (GI25 and ioversol 0.3mL/kg heated to 38°C (GI38. Each dog had its heart rate (HR, systolic arterial pressure (SAP, diastolic arterial pressure (DAP, respiratory rate (RR, oxyhemoglobin saturation (SaO2 and electrocardiography readings (PR and QT intervals recorded. Group comparisons showed no statistical difference regarding neck positioning, subarachnoid puncture, and subarachnoid infusion of contrast medium on HR, RR and SaO2, cardiac rhythm or conduction. However, isoflurane significantly increased PR and QT intervals. Based on these findings, it is concluded that the steps involved in cervical myelography and the use of ioversol 320mgI/mL at 0.3mL/kg (25ºC and 38ºC during cervical myelography did not result in relevant cardiovascular and respiratory alterations, except for an elevation in arterial pressure after injection of ioversol.

  9. 3-D MRI/CT fusion imaging of the lumbar spine

    Yamanaka, Yuki; Kamogawa, Junji; Misaki, Hiroshi; Kamada, Kazuo; Okuda, Shunsuke; Morino, Tadao; Ogata, Tadanori; Yamamoto, Haruyasu [Ehime University, Department of Bone and Joint Surgery, Toon-shi, Ehime (Japan); Katagi, Ryosuke; Kodama, Kazuaki [Katagi Neurological Surgery, Imabari-shi, Ehime (Japan)


    The objective was to demonstrate the feasibility of MRI/CT fusion in demonstrating lumbar nerve root compromise. We combined 3-dimensional (3-D) computed tomography (CT) imaging of bone with 3-D magnetic resonance imaging (MRI) of neural architecture (cauda equina and nerve roots) for two patients using VirtualPlace software. Although the pathological condition of nerve roots could not be assessed using MRI, myelography or CT myelography, 3-D MRI/CT fusion imaging enabled unambiguous, 3-D confirmation of the pathological state and courses of nerve roots, both inside and outside the foraminal arch, as well as thickening of the ligamentum flavum and the locations, forms and numbers of dorsal root ganglia. Positional relationships between intervertebral discs or bony spurs and nerve roots could also be depicted. Use of 3-D MRI/CT fusion imaging for the lumbar vertebral region successfully revealed the relationship between bone construction (bones, intervertebral joints, and intervertebral disks) and neural architecture (cauda equina and nerve roots) on a single film, three-dimensionally and in color. Such images may be useful in elucidating complex neurological conditions such as degenerative lumbar scoliosis(DLS), as well as in diagnosis and the planning of minimally invasive surgery. (orig.)

  10. The value of MRI and CT in the pre-operative diagnosis of lumbar disc herniation

    Hirabayashi, Shigeru; Kumano, Kiyoshi; Takahashi, Soichiro; Ishii, Jun (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan))


    A prospective analysis of computed tomography (CT) and magnetic resonance imaging (MRI) scans in 51 patients with lumbar disc herniation was made to determine the height of hernia for operation and, if impossible, the indications of myelography. Among the 51 patients, 40 (78%) received surgery based on these imaging modalities (Group A); and the remaining 11 (22%) underwent myelography for the confirmation of the height of hernia or detailed examination (Group B). Satisfactory or excellent surgical outcome was achieved in 95% in Group A and in 91% in Group B. Twenty seven patients had multiple disc herniation on CT and MRI; in 17 patients surgery was performed for one disc hernia that was radiologically found to compress the spinal nerve root; and in the other 10 hernia-related disc was not determined by either radiological or neurological manifestations. Satisfactory or excellent surgical outcome could, however, be achieved in 26 patients (96%). Myelography should be indicated when there is no neurological radicular sign in the lower extremities, and when there is no radiological evidence of the compressed spinal nerve root in spite of the presence of multiple disc herniation. The height of hernia may be determined when compression of the spinal nerve root is visualized on CT or MRI. (N.K.).

  11. CT five years after myelographic diagnosis of lumbar disk herniation

    Hurme, M.; Katevuo, K.; Nykvist, F.; Aalto, T.; Alaranta, H.; Einola, S. (Turku Univ. Central Hospital (Finland). Dept. of Surgery Turku Univ. Central Hospital (Finland). Dept. of Diagnostic Radiology Social Insurance Inst., Turku (Finland). Rehabilitation Research Centre)


    Fifty-seven patients were examined with CT 5 years after primary myelography for disabling sciatica and suspected herniated lumbar disk. Forty were in an operated group, 22 with good and 18 with poor results evaluated by occupational handicap (21) 5 years after surgery. Seventeen patients had myelography indicating disk herniation, but were treated conservatively, 9 with good and 8 with poor result. Various spinal dimensions measured at CT did not correlate with outcome. Operated patients had narrower canals than others, and male canals were broader than those in females. Increased amount of scar tissue at L4 level correlated with poor result (p=0.008). Operated patients with poor result had more advanced lateral stenosis than those treated conservatively (p<0.001). Patients with good result after operation had more degeneration observed on CT of erector spinae muscle than those treated conservatively with good outcome. Only 9% of operated patients did not have muscle degeneration. A tendency for more frequent recurrent disk herniations could be ssen for conservatively treated patients. The narrowing of the spinal canal 5 years after operation did not correlate with the 5-year outcome. (orig.).

  12. Hernia of intervertebral disk in the lumbar vertebral column

    Beyer, H.K.; Uhlenbrock, D.; Steiner, G.


    Degenerations of the spinal disc especially in the lumbar region are the most frequent degenerative diseases in orthopedics. As diagnostic proceedings to discover disc herniation myelography and computerized tomography have been proven to be very useful. Each of those methods show a high sensitivity and accuracy. Computerized tomography seems to be the first procedure because of the lac of any risk. Myelography has been reserved for the second approach, if there is any doubt in diagnosis. This paper will especially discuss advantages and disadvantages of MRI-tomography for the diagnosis of disc herniation. In MRI-tomography we have no radiation, there is no risk for the patient and we have the possibility of slices in different orientations with the sagittal orientation having priority in diagnosis of disc herniation. A more pronounced contrast in MRI relatively to the computerized tomography with nearly the same spatial resolution is an other important fact in favour for MRI. The value of MRI diagnosis of the spine depends however mainly on the use of special surface coils and on the use of high magnetic fields which provides a good signal to noise relation and which would permit us to use a thin-slice technique. The main disadvantage by now are the relative high costs.

  13. Lumbar lordosis.

    Been, Ella; Kalichman, Leonid


    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. Lumbar spine CT scan

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

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

    Emch, Todd M. [Cleveland Clinic, Division of Neuroradiology, Imaging Institute, Neuroradiology L-10, Cleveland, OH (United States); Modic, Michael T. [Cleveland Clinic, Division of Neuroradiology, Imaging Institute, Neurological Institute T-13, Cleveland, OH (United States)


    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.)

  16. Axial loaded MRI of the lumbar spine

    Saifuddin, A. E-mail:; Blease, S.; MacSweeney, E


    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.

  17. Follow-up CT myelography of severe cervical spinal cord injury

    Okada, Keiichi; Onoda, Kimio; Kawashima, Yasuhiro; Muto, Atsushi; Kobayashi, Yoichi


    There are many reports describing gross anatomical and microscopical findings of severely injured cervical cords in autopsy of the acute and chronic state, but no morphological findings of a severe cervical spinal cord injury in a chronic state by follow-up CT myelography have been found in the literature so far. The sagittal and transverse diameters of the cervical spinal cord and subarachnoid space of 9 out of 14 severe cervical spinal cord injury patients were measured with CT myelography within 7.5 years after the tranuma and their size compared with a control group which was made up of 29 patients with slight radiculopathy due to cervical spondylosis and whiplash injuries. Injured cord levels were C4 4 cases, C5 4 cases and C6 1 case. Remarkable spinal cord atrophy was recogniged in the sagittal diameter from C1 to C7 and in the transverse diameter below C4 and narrowing of the cervical subarachnoid space in the sagittal diameter from C2 to C5. The significance level was set at 1 - 5 %. From these fingings, we have concluded that atrophy appeared not only in the injured segment but also the whole cervical cord after the trauma. There was less cord atrophy in a good functional prognosis than in a poor prognosis.

  18. CT myelography characteristics of spinal dysraphism in a young mixed breed dog Características de mielografía con TC de una disrafia espinal en un perro mestizo joven

    M Gómez


    Full Text Available Spinal dysraphism is a congenital defect of the vertebral column and spinal cord secondary to imperfect closure of the caudal neuropore of the developing neural tube. This report describes computed tomographic myelography (Myelo-CT characteristics of spina bifida occulta, spinal cord aplasia/hypoplasia and split cord malformation type II (diplomyelia in the caudal lumbar area of a 2 month old mixed breed dog.La disrafia espinal es un defecto congénito de la columna vertebral y la médula espinal secundaria a un cierre imperfecto del neuroporo caudal del tubo neural en desarrollo. Este reporte describe las características observadas en una mielografía por tomografía computarizada (mielo-TC de una espina bífida oculta, aplasia/hipoplasia segmentaria de médula espinal y duplicación de médula espinal tipo II (diplomielia en el segmento lumbar caudal de un perro mestizo de dos meses de edad.

  19. A Symptomatic Spinal Extradural Arachnoid Cyst with Lumbar Disc Herniation

    Yoshinori Kadono


    Full Text Available Spinal epidural arachnoid cyst (EAC is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression.

  20. Breaking Routines

    Kesting, Peter; Jørgensen, Frances


    On some level, innovation begins when the current way of doing things is questioned and alternatives are sought. In cognitive terms, this can be conceptualized as the point at which an agent breaks with existing routine and returns to planning and decision-making. Thus far, however, very little...

  1. Dynamics of the spinal cord: An analysis of functional myelography by CT scan

    Ishida, Y.; Suzuki, K.; Ohmori, K.


    The antero-posterior movement of the spinal cord with flexion and extension of the neck was analyzed in order to clarify the mechanism of spinal cord compression in cases with postoperative spinal deformity, and to contribute to the improvement of the surgical methods of conventional laminectomy. The control subjects were 47 cases without cervico-thoracic neurological symptoms, who underwent CT myelography in flexion and extension of the neck; the cervical spinal cord was examined in 27 of these cases and the thoracic cord in the other 20. CT myelography was also carried out in 16 patients with cervical myelopathy and in 5 patients after posterior decompression surgery (suspension laminotomy). CT sections in flexion and extension of the neck were analyzed for (1) change of configuration of the dura mater and the spinal cord, and (2) antero-posterior shift of the spinal cord in the subarachnoid space. In the control subjects, the configuration of the dura mater was slightly flattened at C5/6, C6 and C6/7 in extension of the neck. The cervical spinal cord shifted anteriorly in flexion and posteriorly in extension of the neck, and was flattened at the midcervical level in flexion in the control subjects. There was a statistically significant correlation between the location of the spinal cord and the adjacent intervertebral angles at the levels of C4, C5 and C6. These results were compared with the results from the 16 patients with cervical myelopathy and 5 patients after suspension laminotomy. The thoracic spinal cord shifted anteriorly in neck flexion and posteriorly in extension, especially at upper thoracic level. In order to avoid spinal cord compression due to anterior shift of the spinal cord caused by postoperative kyphosis, it is necessary to employ the surgical method which can prevent postoperative kyphotic deformity.

  2. Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography.

    Schultz, Randall; Steven, Andrew; Wessell, Aaron; Fischbein, Nancy; Sansur, Charles A; Gandhi, Dheeraj; Ibrahimi, David; Raghavan, Prashant


    OBJECTIVE Dorsal arachnoid webs (DAWs) and spinal cord herniation (SCH) are uncommon abnormalities affecting the thoracic spinal cord that can result in syringomyelia and significant neurological morbidity if left untreated. Differentiating these 2 entities on the basis of clinical presentation and radiological findings remains challenging but is of vital importance in planning a surgical approach. The authors examined the differences between DAWs and idiopathic SCH on MRI and CT myelography to improve diagnostic confidence prior to surgery. METHODS Review of the picture archiving and communication system (PACS) database between 2005 and 2015 identified 6 patients with DAW and 5 with SCH. Clinical data including demographic information, presenting symptoms and neurological signs, and surgical reports were collected from the electronic medical records. Ten of the 11 patients underwent MRI. CT myelography was performed in 3 patients with DAW and in 1 patient with SCH. Imaging studies were analyzed by 2 board-certified neuroradiologists for the following features: 1) location of the deformity; 2) presence or absence of cord signal abnormality or syringomyelia; 3) visible arachnoid web; 4) presence of a dural defect; 5) nature of dorsal cord indentation (abrupt "scalpel sign" vs "C"-shaped); 6) focal ventral cord kink; 7) presence of the nuclear trail sign (endplate irregularity, sclerosis, and/or disc-space calcification that could suggest a migratory path of a herniated disc); and 8) visualization of a complete plane of CSF ventral to the deformity. RESULTS The scalpel sign was positive in all patients with DAW. The dorsal indentation was C-shaped in 5 of 6 patients with SCH. The ventral subarachnoid space was preserved in all patients with DAW and interrupted in cases of SCH. In no patient was a web or a dural defect identified. CONCLUSIONS DAW and SCH can be reliably distinguished on imaging by scrutinizing the nature of the dorsal indentation and the integrity of

  3. A radiological study on lumbar disc herniation in Korean

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


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

  4. Acquired lumbar spinal stenosis.

    Deasy, JoAnn


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

  5. Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury

    Medina, L.S. [Miami Children' s Hospital, Division of Neuroradiology, Department of Radiology, Brain Institute, Health Outcomes, Policy, and Economics (HOPE) Center, Miami, FL (United States); Miami Children' s Hospital, Department of Radiology, Miami, FL (United States); Yaylali, Ilker [Miami Children' s Hospital, Brachial Plexus and Peripheral Nerve Surgery Program, Miami, FL (United States); Zurakowski, David [Harvard Medical School, Boston Children' s Hospital, Boston, MA (United States); Ruiz, Jennifer; Altman, Nolan R. [Miami Children' s Hospital, Division of Neuroradiology, Department of Radiology, Brain Institute, Health Outcomes, Policy, and Economics (HOPE) Center, Miami, FL (United States); Grossman, John A.I. [Miami Children' s Hospital, Brachial Plexus and Peripheral Nerve Surgery Program, Miami, FL (United States); New York University, Hospital for Joint Disease, New York, NY (United States)


    Detailed evaluation of a brachial plexus birth injury is important for treatment planning. To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined. From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8-12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion. In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine

  6. Congenital Lumbar Hernia

    Sanjay Sharma


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

  7. Intelligent Routines

    Anastassiou, George A

    “Intelligent Routines II: Solving Linear Algebra and Differential Geometry with Sage” contains numerous of examples and problems as well as many unsolved problems. This book extensively applies the successful software Sage, which can be found free online Sage is a recent and popular software for mathematical computation, available freely and simple to use. This book is useful to all applied scientists in mathematics, statistics and engineering, as well for late undergraduate and graduate students of above subjects. It is the first such book in solving symbolically with Sage problems in Linear Algebra and Differential Geometry. Plenty of SAGE applications are given at each step of the exposition.

  8. Two cases of cervical disc disease with intramedullary pathological changes, which are responsible for their neurological syndromes, on delayed CT myelography

    Isu, Toyohiko; Iwasaki, Yoshinobu; Abe, Hiroshi; Tashiro, Kunio; Murai, Hiroshi; Miyasaka, Kazuo


    We report two cases of cervical disc disease with myelopathy classified as of motor system syndrome type showing small contrast accumulation within the spinal cord on delayed CT myelography. In our two cases, high density spots on delayed CT myelography were bilaterally localized within the spinal cord, and believed represent pathological changes of the spinal cord, such as collection of microcavities or cystic necrosis. In case 1, the high density areas seemed to be localized in the anterior horn and corticospinal tract, and in case 2, they seemed to be localized in the corticospinal tract. The patient in case 1 produced signs and symptoms resembling motor neurone disease and lesion could not be differentiated from the latter. Delayed CT myelography showed that the cause of the upper limb amyotrophy was attributed to an anterior horn disorder and that of pyramidal tract sign to a corticospinal tract disorder. Therefore, we could differentiate the lesion from motor neurone disease on delayed CT myelography in case 1. In conclusion, we emphasize that delayed CT myelography can demonstrate the intramedullary pathological changes in the cervical disc disease and is useful in distinguishing between cervical disc disease simulating motor neurone disease and the latter.

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

    M.W. Berfelo


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

  10. Metrizamide lumbar epidurography with Seldinger technique through the sacral notch and selective nerve root injection

    Hatten, H.P. Jr.


    Lumbar epidurography serves as an important radiographic procedure in the evaluation of patients with equivocal myelography and confusing or non-diagnostic physical findings. It is particularly valuable in patients with a wide ventral epidural space secondary to previous surgery, arachnoiditis or on a congenital basis. Several techniques and various contrast agents have been employed for the procedure. A pure Seldinger technique with a caudal approach through the sacral hiatus and injection of metrizamide gives excellent visualization of the epidural space and nerve root sleeves. The proper concentration of metrizamide is crucial for optimal results. Lateral, AP, and AP oblique radiographs, occasionally combined with lateral, complex motion tomography, clearly demonstrate the root sleeves and ventral epidural space. CT scanning, with present technology, does not provide the necessary detail for evaluating the epidural space.

  11. Comparative study of non-ionic contrast agents Optiray 350 and Ultravist 370 in myelography in dogs

    Radu Lăcătuș


    Full Text Available Introduction: An essential quality of non-ionic contrast agents is that of containing in their chemical composition, elements with high atomic weight, which determine an increasing absorption of the X-ray beam and this will cause intense radiopacity. The possibilities for radiological exploration with non-ionic contrast agents are very wide. Currently the radiological examination with contrast agent no longer constitutes a risky step in medical diagnosis. Aims: To highlight the importance of using the non-ionic contrast agents Optiray 350 and Ultravist 370 in dog’s myelography and to compare the changes induced in cerebrospinal fluid and blood biochemical constituents by the administration of those non-ionic contrast substances. Materials and Methods: To determine the influence of non-ionic preparations Optiray 350 and Ultravist 370 on cerebrospinal fluid and on some haematological parameters were included in the study a total of 10 dogs. Results: Myelographies with Optiray 350 and Ultravist 370 in dogs with severe spinal condition negatively influence biochemical and haematological blood status, being necessary to take preventive measures. Optiray 350 and Ultravist 370 administration cause a slight sensitization of liver with blood biochemical parameters return to normal within 24-48 hours. Conclusion: Non-ionic contrast agents Optiray 350 and Ultravist 370 offer a very good opacification of the subarachnoidian space, but because it causes liver sensitization, we recommend using them with caution and only after a prior check of liver function.

  12. Intradural lumbar disc herniations: the role of MRI in preoperative diagnosis and review of the literature.

    D'Andrea, Giancarlo; Trillò, Giuseppe; Roperto, Raffaelino; Celli, Paolo; Orlando, Epimenio Ramundo; Ferrante, Luigi


    The goal of this article is to report our experience on intradural lumbar disc herniation, consider the causes of this pathology, and analyze it from clinical, diagnostic, and therapeutic perspectives with a particular emphasis on the role of MRI in preoperative diagnosis. We analyzed nine patients treated surgically for intradural lumbar disc hernia. All of them underwent surgery, and hemilaminectomy was performed. In six cases, the diagnosis of intradural herniation was definitive and, in the three remaining, it was confirmed at surgery. In five cases, CT (with no contrast medium) of the lumbar area revealed disc herniation, but none could it confirm its intradural location. Myelography was performed in two cases but also could not prove intradural extrusion. Magnetic resonance imaging study was used in four cases. In five, the postoperative outcome has been excellent. Patients 6 and 9 recovered anal function postoperatively; patient 6 suffered from occasional and mild micturition urgency. The three patients previously operated (1, 2, 7) showed good outcome. Presently, we believe that radiologic diagnosis of intradural herniation is possible in carefully selected patients, thanks to MRI with gadolinium.

  13. Laparoscopic lumbar hernia repair.

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


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

  14. Aracnoidite constritiva causada por pantopaque resultando em siringomielia e paraparesia: relato de caso Thoracic constrictive arachnoiditis after pantopaque myelography causing syringomyelia and paraparesis: case report

    José Alberto Gonçalves da Silva


    Full Text Available Relatamos caso de aracnoidite constritiva torácica, verificada 10 anos após o uso de pantopaque, que foi utilizado em mielografia no diagnóstico de cisto aracnóideo.We present an unusual case of thoracic constrictive arachnoiditis after pantopaque myelography, used 10 years before in the diagnosis of intradural arachnoid cyst.

  15. Transabdominal sonography of lumbar intervertebral discs and intraspinal structures

    Toelly, E.


    This paper reports a prospective study on 64 patients in whom sonography was used to diagnose pathological changes in lumbar discs and intraspinal space occupying lesions; the results were compared with myelography and computer assisted tomography (CAT). The sonography device used was a mechanical sector scanner with a medium focused transducer with a frequency of 3.5 MHz. The normal and pathological anatomy as shown by ultrasound was correlated to the known anatomy of CAT-scanning; the nerve roots, the dural sac and the intervertebral disc were recognizable in sonography and in CAT. The extent of an intraspinal lesion beyond the upper and lower limiting planes of the intervertebral discs were not demonstrable by ultrasound. The sonographic study was at least partially successful in 55 of 64 patients (86%). It failed in 14% (9 cases) because of obesity or because of diminution of the intervertebral space. The study revealed a specifity and sensitivity of transabdominal spinal sonography of 0.86 respectively 0.84.

  16. Lumbar stenosis: clinical case

    Pedro Sá


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

  17. MR imaging compared with CT, angiography, and myelography supplemented with CT in the diagnosis of spinal tumors

    Hasuo, Kanehiro; Uchino, Akira; Matsumoto, Shunichi; Fujii, Kiyotaka; Fukui, Masashi; Masuda, Kouji (Kyushu Univ., Fukuoka (Japan). Faculty of Medicine)

    To clarify the significance of MR imaging and the present status of CT, angiography, and myelography supplemented by CT (M-CTM), the radiological findings of 50 spinal tumors were reviewed and analyzed. MR imaging was most effective for visualizing morphological features such as the margins and/or inner structures of the tumors. CT was also effective for imaging 'dumbbell' neurinomas and extradural tumors. Angiography was necessary in one hemangioblastoma and in cervical extradural tumors. M-CTM visualized the morphology of intradural extramedullary tumors and extradural tumors, but provided no new information in most of these cases. It was concluded that when using MR the indications for CT, angiography, and M-CTM are limited and that CT or angiography should be performed only in selected cases. M-CTM appeared to be unnecessary. (author).

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

    Truumees, Eeric


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

  19. Lumbar corsets can decrease lumbar motion in golf swing

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


    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...

  20. Clinical efficacy of three different minimally invasive procedures for far lateral lumbar disc herniation

    LIU Tao; ZHOU Yue; WANG Jian; CHU Tong-wei; LI Chang-qing; ZHANG Zheng-feng; ZHANG Chad; ZHENG Wen-jie


    Background Far lateral lumbar disc hemiation (FLLDH) accounts for 2.6% to 11.7% of all lumbar herniated discs.Numerous surgical approaches have been described for treating this condition.The purpose of this study was to evaluate minimally invasive surgical techniques for the treatment of FLLDH.Methoda From June 2000 to March 2006,52 patients with FLLDH were treated with minimally invasive procedures.All patients were assessed by anteroposterior and lateral roentgenography and computed tomography (CT).Some patients underwent myelography,discography,and magnetic resonance imaging.Procedures performed included Yeung Endoscopy Spine System (YESS) (n=25),METRx MicroDiscectomy System (n=13),and X-tube (n=14).Patients were followed up for a mean of 13.5 months.Clinical outcomes were assessed using a visual analog scale (VAS) and Nakai criteria.Results All 3 procedures significantly improved radiating leg symptoms (P <0.005).After surgery,84.0%,84.6%,and 92.8% of patients in the YESS,METRx,and X-tube groups had excellent or good outcomes.There were no statistically significant differences of VAS scores between the groups.The YESS procedure was associated with the shortest operation time,simplest anesthesia,and least trauma compared with the other 2 procedures,especially for type Ⅰherniations.The METRx procedure was the most suitable for type Ⅱ herniations and posterior endoscopic facetectomy.Posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was the most suitable for herniations combined with degenerative lumbar instability (type Ⅲ).Conclusion Minimally invasive strategies and options should be determined with reference to the type of FLLDH.

  1. Lateral Lumbar Interbody Fusion

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


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

  2. Thoracic Meningioma In Combination With Severe Lumbar Spinal Stenosis Presenting With Atypical Neurological Deficit.

    Kehayov, Ivo I; Raykov, Stephan D; Hubavenska, Iveta N; Davarski, Atanas N; Kitova, Tanya T; Zhelyazkov, Christo B; Kitov, Borislav D


    We report on a case of a 47-year-old female patient with a long history of low back pain irradiating bilaterally to the legs. Twenty days before admission to our clinic, she had developed progressive weakness in the legs, more pronounced on the left side. The initial neurological examination revealed signs of damage to both the cauda equina and the spinal cord. The neuroimaging studies (computed tomography, myelography and magnetic-resonance tomography) found spinal stenosis most severe at L4-L5 level, and right lateral thoracic intradural-extramedullary tumor at T9-T10 level. The patient underwent two neurosurgical procedures. The first stage included microsurgical resection of the thoracic lesion and the second stage aimed at decompressing the lumbar spinal stenosis. To avoid missing a diagnosis of thoracic lesions, it is necessary to perform a thorough neurological examination of the spinal cord motor and sensory functions. In addition, further MRI examination of upper spinal segment is needed if the neuroimaging studies of the lumbar spine fail to provide reasonable explanation for the existing neurological symptoms.

  3. Trauma related changes in cervical spine and spinal cord in myelography and MRI; Zmiany pourazowe kregoslupa i rdzenia w odcinku szyjnym, w mielografii i w obrazie NMR

    Wozniak, E.; Bronarski, J.; Kiwerski, J.; Krasuski, M. [Akademia Medyczna, Warsaw (Poland)]|[Stoleczny Zespol Rehabilitacji, Konstancin (Poland)


    Myelographic and MRI results in 14 patients treated in 1992 because of cervical spine injury with neurological complications have been presented. Myelography proves to be useful in posttraumatic spine diagnostics but in some cases does not render sufficient information, especially if the trauma superimposes previously existing pathological changes. MRI is exceptionally valuable diagnostic modality in cervical spine injuries offering an advantage of both early and late evaluation of the post-traumatic spinal cord changes. (author). 12 refs, 6 figs, 2 tabs.

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

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


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

  5. Consuming technologies - developing routines

    Gram-Hanssen, Kirsten


    Routines in daily life are crucial for consumption by households of energy and water and therefore knowledge of how routines develop and change is extremely relevant from a sustainable consumption perspective. Routines emerge, develop and change in close relation with different kinds of everyday ...

  6. Revisiting Routine Questions

    Hughes, Rebecca; Monaghan, John; Shingadia, Eisha; Vaughan, Stephen


    What is a routine question? The focus of this paper is routine questions and time (in years) since a hitherto routine question was last attempted by the solver. The data comes from undergraduate students' work on solving two calculus questions. The data was selected for reporting purposes because it is well documented and because it threw up…

  7. Lumbar spinal stenosis CAD from clinical MRM and MRI based on inter- and intra-context features with a two-level classifier

    Koh, Jaehan; Alomari, Raja S.; Chaudhary, Vipin; Dhillon, Gurmeet


    An imaging test has an important role in the diagnosis of lumbar abnormalities since it allows to examine the internal structure of soft tissues and bony elements without the need of an unnecessary surgery and recovery time. For the past decade, among various imaging modalities, magnetic resonance imaging (MRI) has taken the significant part of the clinical evaluation of the lumbar spine. This is mainly due to technological advancements that lead to the improvement of imaging devices in spatial resolution, contrast resolution, and multi-planar capabilities. In addition, noninvasive nature of MRI makes it easy to diagnose many common causes of low back pain such as disc herniation, spinal stenosis, and degenerative disc diseases. In this paper, we propose a method to diagnose lumbar spinal stenosis (LSS), a narrowing of the spinal canal, from magnetic resonance myelography (MRM) images. Our method segments the thecal sac in the preprocessing stage, generates the features based on inter- and intra-context information, and diagnoses lumbar disc stenosis. Experiments with 55 subjects show that our method achieves 91.3% diagnostic accuracy. In the future, we plan to test our method on more subjects.

  8. Routines and Organizational Change

    Yi, Sangyoon; Becker, Markus; Knudsen, Thorbjørn


    Routines have been perceived as a source of inertia in the process of organizational change. In this study, we suggest an overlooked, but prevalent, mechanism by which the inertial nature of routines helps, rather than hinders, organizational adaptation. Routine-level inertia plays a hidden role...... of generating and retaining useful variations in the process of organization-level adaptation. We demonstrate this mechanism by using a simple theoretical model which formalizes an organization as a configuration of inertial, interdependent routines, and the managerial process by which this configuration adapts...... by discussing how this advanced understanding of the role of routines helps elaborate the theory of economic evolution....

  9. Lumbar hernia: a diagnostic dilemma.

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


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

  10. Epidurography in lumbar spondylolisthesis

    Johansen, J.G.; Hauge, O.


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

  11. Variant lumbar pedicle

    Whelan, M.A.; Feldman, F.


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

  12. The cervical cord in amyotrophic lateral sclerosis. A comparison of the CT-myelography with pathological observation

    Sugamiya, Hitoshi; Tokumaru, Yukio; Arai, Kimihito; Hirayama, Keizo [Chiba Univ. (Japan). School of Medicine


    The spinal cord with amyotrophic lateral sclerosis was macroscopically examined in five patients using CT-myelography (CTM) and autopsied specimens. The autopsied ages were from 48 to 75 years old (average: 64), and their clinical follow-up periods were from 0.8 to 4.0 years (average: 1.9). Muscular atrophy developed from an upper limb in three patients, whereas from a lower limb in one case and from bulbar muscles in another case. Cervical CTM was performed at C3 to C7 cervical vertebrae less than one year (four cases) and 1.9 years (one case) prior to autopsy. The macroscopical examination of the CTM and autopsied specimens showed the following characteristics: Two patients, whose clinical courses were less than one year from the onset, showed no abnormalities. Three patients, whose clinical courses were more than one year from the onset, showed a marked cervical flattening and concave of the posterolateral fissure, especially at the lower cervical level. It was supposed that this lower cervical abnormalities caused pronounced amyotrophy in the upper limbs and pyramidal tract sign of the lower limbs. Although muscular atrophy was asymmetric in one case, the spinal cord was symmetric in macroscopic appearance in both CTM and autopsied specimens. It was concluded that marked flattening and concave at the posterolateral fissure of the lower cervical spinal cord were revealed by CTM in patients whose clinical courses of amyotrophic lateral sclerosis were more than one year from the onset. (author).

  13. Lumbar facet syndromes.

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


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

  14. Electrodiagnosis of lumbar radiculopathy.

    Barr, Karen


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

  15. Haemostasis and safety measures before lumbar puncture in the haematology ward

    Møller, Anders; Bjerrum, Ole Weis; Afshari, Arash


    BACKGROUND/AIMS: Thrombocytopenia and the increasing use and variety of antithrombotic drugs is a challenge prior to lumbar puncture. This study examined the Danish haematology practice regarding drug pausation, assessment of haemostasis and whether fundoscopy is a routine safety measure. METHODS...... national guidelines are warranted and there is a need for studies to establish an evidence-based approach for the management of patients at risk of bleeding when lumbar puncture or another invasive procedure is indicated....

  16. Management of Cerebellar Tonsillar Herniation following Lumbar Puncture in Idiopathic Intracranial Hypertension

    Kenneth R. Hoffman


    Full Text Available Lumbar puncture is performed routinely for diagnostic and therapeutic purposes in idiopathic intracranial hypertension, despite lumbar puncture being classically contraindicated in the setting of raised intracranial pressure. We report the case of a 30-year-old female with known idiopathic intracranial hypertension who had cerebellar tonsillar herniation following therapeutic lumbar puncture. Management followed guidelines regarding treatment of traumatic intracranial hypertension, including rescue decompressive craniectomy. We hypothesize that the changes in brain compliance that are thought to occur in the setting of idiopathic intracranial hypertension are protective against further neuronal injury due to axonal stretch following decompressive craniectomy.

  17. Routines and Organizational Change

    Yi, Sangyoon; Becker, Markus; Knudsen, Thorbjørn


    Routines have been perceived as a source of inertia in the process of organizational change. In this study, we suggest an overlooked, but prevalent, mechanism by which the inertial nature of routines helps, rather than hinders, organizational adaptation. Routine-level inertia plays a hidden role...... to cope with its task environment. In our nuanced perspective, inertia is not only a consequence of adaptation but also a source of adaptation. This logic is helpful to understand why reliable but apparently inertial organizations keep surviving and often exhibit outstanding performance. We conclude...

  18. Importance of Family Routines

    ... Structure Your Child's Nighttime Routine . Weekends: Weekends are good times for family togetherness. You might go grocery shopping as a family, visit museums and zoos, do chores​ that everyone participates in, go on ...

  19. Routine sputum culture

    Sputum culture ... There, it is placed in a special dish (culture). It is then watched to see if bacteria ... Chernecky CC, Berger BJ. Culture, routine. In: Chernecky CC, Berger BJ, ... . 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:409- ...

  20. Pulmonary edema following lumbar puncture

    Gupta D


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

  1. 后路脊椎镜治疗腰椎间盘突出症与术后早期功能锻炼的相关性%Correlation of early functional exercises after the operation with vertebrascope in route of retreat to treat lumbar disc protrusion

    吕原; 姚建祥; 张宁; 张庆彬; 赵立新; 朱卉敏; 于振声


    Objective To observe therapeutic effect in the near future of the operation of vertebrascope in route of retreat to treat lumbar disc protrusion and complications.Method According to symptoms,signs,myelography and CTM results to determine protrusion interspace and side type,applied the operation of vertebrascope in route of retreat to treat lumbar disc protrusion and perform functional exercises.Results 86 patients were followed up,and within these patients,58 appeared excellent (67% ),25 appeared good (29% ), 2 appeared not bad (2% ),and 1 appeared bad(1% ).Conclusion The technology has many advantages, such as little wound, little hemorrhage, little pain and fast restoration,which provide advantageous conditions for early functional exercises after operation.

  2. An unexpected lumbar lesion

    Laura Beard


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

  3. Magnetic resonance imaging of lumbar disc herniation with special reference to the myelographic and anatomical correlation

    Iwamura, Yuichi; Imamura, Kiyohiko; Uematsu, Hirokazu; Sakai, Naotaka; Yamashita, Hajime; Takemura, Kenji (Yokosuka Kyosai Hospital, Kanagawa (Japan))


    T1-weighted magnetic resonance (MR) images of 49 lumbar vertebrae from 44 patients were restrospectively reviewed, focusing on herniated material, low signal intensity zone and extradural fatty tissue in the posterior edge of intervertebral disc. Morphological MR appearance was correlated with myelograms and surgical findings to determine which morphology can be detected by MR imaging alone. The MR features of the posterior edge of intervertebral disc were morphologically divided into three main types: (I) massive, swollen herniation and clear low signal intensity zone, but little or no disruption of the extradual fatty tissue; (II) posterior protrusion of the segmental herniation, partial unclearness or lack of low signal intensity zone, and disrupted extradual fatty tissue; and (III) massive herniation, lack of low signal intensity zone, and widespread disruption of the extradual fatty tissue. Types I, II and, III were seen in 18, 19, and 12 vertebrae, respectively. Herniation was clearly visualized on T1-weighted images in 73% for Type II and 83% for Type III, compared to 28% for Type I. Herniated material was seen as isointensity in 18 vertebrae in Type II and as hyperintensity in 7 vertebrae in Type III. Fifteen vertebrae (79%) in Type II and 9 vertebrae (75%) in Type III were diagnosed by MR imaging alone, which is contrast with Type I in which 11 vertebrae required myelography for diagnosis. In evaluable 25 vertebrae, common surgical findings were bulging in Type I, prolaps in Type II, and extrusion or sequestration in Type III. (N.K.).

  4. 3-D MRI for lumbar degenerative diseases; Visualization of nerve roots

    Aota, Yoichi; Kumano, Kiyoshi; Hirabayashi, Shigeru; Ogawa, Yu; Izumi, Yasujiro; Yoshikawa, Koki (Kanto Rosai Hospital, Kawasaki (Japan)); Yamazaki, Tatsuo


    Three-dimensional (3-D) magnetic resonance (MR) images obtained from 10 patients with lumbar degenerative diseases were retrospectively reviewed to determine how far 3-D MR imaging is capable of demonstrating nerve roots. In 8 of the 10 patients, the area up to the dorsal root ganglion was visualized on 3-D MR images. Thus, it is capable of detecting a wide area of nerve roots, thereby allowing the determination of running of nerve root, and size and location of dorsal root ganglion. In delineating the area from the dural canal to root cyst, 3-D MR imaging was equal to conventional myelography. The former was superior to the latter in detecting the positional relation between the degenerative intervertebral disc and the nerve root, and herniation-compressed root cyst. In 3 of 9 patients who presented with root symptoms, disturbed nerve roots were of high signal on 3-D MR images. This may suggest that it has the potential for selectively detecting root nerves associated with clinical manifestations. (N.K.).

  5. The imaging of lumbar spondylolisthesis

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


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

  6. Reproduction of the lumbar lordosis

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


    OBJECTIVE: This study investigates whether it is possible to reproduce the lumbar lordosis in the upright position during magnetic resonance imaging (MRI) by positioning the patient supine with straightened lower extremities and investigates intra- and interexaminer reliability of measurements...... supine with straightened lower extremities. These measurements were compared statistically. Intra- and interexaminer reliability was calculated applying the Bland and Altman method. RESULTS: The lumbar lordosis in the standing position was reproduced in the straightened supine position with a median......: The findings of this study show that lumbar lordosis in the upright position can be reproduced by positioning the patient supine with straightened lower extremities....


    Koji Hashimoto


    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

  8. Motivation through Routine Documentation

    Koth, Laurie J.


    This informed commentary article offers a simple, effective classroom management strategy in which the teacher uses routine documentation to motivate students both to perform academically and to behave in a manner consistent with established classroom rules and procedures. The pragmatic strategy is grounded in literature, free to implement,…

  9. Learning from Homeschooling Routines

    Thomas, Jesse


    This study provides a rare opportunity to look inside the homeschool and to observe the routines of homeschooling families from across the United States. With more than 1000 survey participants, and nine parents selected for interviews, the compiled data were analyzed through open coding techniques. Meaningful aspects that arose from the routines…

  10. Routine neonatal circumcision?

    Tran, P. T.; Giacomantonio, M.


    Routine neonatal circumcision is still a controversial procedure. This article attempts to clarify some of the advantages and disadvantages of neonatal circumcision. The increased rate of penile cancer among uncircumcised men appears to justify the procedure, but that alone is not sufficient justification. The final decision on neonatal circumcision should be made by parents with balanced counsel from attending physicians.

  11. Memory for Routines.

    Galambos, James A.; Rips, Lance J.


    Presents experiments which compare two theories of memory for routine events, one emphasizing temporal sequence of events, the other focusing on events' hierarchical structure or centrality. Findings suggest that sequence and centrality information may be computed as needed, rather than precompiled. (Author/BK)

  12. [Intradural lumbar disk hernia].

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


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

  13. Lumbar spondylolysis: a review

    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)


    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

  14. Lumbar peritoneal shunt

    Yadav Yad


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


    王黎; 赖新生


    "Lumbar three-point needling", meaning puncturing Shenshu (BL 23), Dachangshu (BL 25) and Ciliao(BL 32) at the same time, is a commonly used acupuncture method in the treatment of lumbocrural diseases. Points supplemented according to symptoms. Weizhong(BL 40) is supplemented for lumbar vertebra hypertrophy spondylitis; Weizhong (BL 40) and Kunlun(BL 60) supplemented for acute lumbar muscle sprain; Zhibian (BL 54), Huantiao (GB 30) and Ahshi points supplemented for nervi cluniam superior inflammation, and Sanyinjiao (SP 6) and Mingmen(GV 4) supplemented for impotence. Gauge-28 2 curt long needles are used. The needles are inserted perpendicularly into Shenshu(BL 23), Dachengshu(BL 25) and Ciliao(BL 32) to a depth of about 1.2 --- 1.5 cun. Other supplementary points are needled and stimulated with routine manipulations, generally the reducing method is used for excess syndrome, and the reinforcing method applied to deficiency syndrome. The author, on the basis of many years of clinical practice, considers that "lumbar three-point needling" is fairly effective in treating lumbosacral diseases.

  16. Routine CSF analysis in coccidioidomycosis is not required.

    George Thompson

    Full Text Available Although routinely done, there has been no evaluation of the utility of performing routine cerebrospinal fluid (CSF examination in patients with active coccidioidomycosis and high complement fixation (IgG antibody titers or other risk factors for disseminated infection. In our review 100% of patients diagnosed with coccidioidal meningitis had at least one sign or symptom consistent with infection of the central nervous system, headache was present in 100% of those with meningitis, while no patients without signs/symptoms of CNS infection were found to have coccidioidal meningitis, irrespective of antibody titers or other risk factors. Thus routine lumbar puncture may be unnecessary for patients with coccidioidomycosis who lack suggestive clinical symptoms.

  17. Utility of electrodiagnostic testing and computed tomography myelography in the preoperative evaluation of neonatal brachial plexus palsy.

    Vanderhave, Kelly L; Bovid, Karen; Alpert, Hilary; Chang, Kate Wan-Chu; Quint, Douglas J; Leonard, James A; Yang, Lynda J S


    The rate of neonatal brachial plexus palsy (NBPP) remains 0.4%-4% despite improvements in perinatal care. Among affected children, the extent of brachial plexus palsy differs greatly, as does the prognosis. Controversial elements in management include indications and timing of nerve repair as well as type of reconstruction in patients in whom function will ultimately not be recovered without surgical intervention. Differentiating preganglionic (avulsion) from postganglionic (rupture) lesions is critical because preganglionic lesions cannot spontaneously recover motor function. Distinguishing between these lesions at initial presentation based on clinical examination alone can be difficult in infants. The purpose of the present study was to determine the sensitivity of preoperative electrodiagnostic studies (EDSs) and CT myelography (CTM) in determining the presence of nerve root rupture and avulsions in infants with NBPP. After receiving institutional review board approval, the authors conducted a retrospective review of patients referred to the Neonatal Brachial Plexus Program between 2007 and 2010. Inclusion criteria included children who underwent brachial plexus exploration following preoperative EDSs and CTM. The CTM scans were interpreted by a staff neuroradiologist, EDSs were conducted by a single physiatrist, and intraoperative findings were recorded by the operating neurosurgeon. The findings from the preoperative EDSs and CTM were then compared with intraoperative findings. The sensitivities and 95% confidence intervals were determined to evaluate performance accuracy of each preoperative measure. Twenty-one patients (8 male amd 13 female) met inclusion criteria for this study. The sensitivity of EDSs and CTM for detecting a postganglionic rupture was 92.8% (CI 0.841-0.969) and 58.3% (CI 0.420-0.729), respectively. The sensitivity for EDSs and CTM for preganglionic nerve root avulsion was 27.8% (CI 0.125-0.509) and 72.2% (CI 0.491-0.875), respectively. In

  18. [Lateral lumbar disk hernia].

    Monod, A; Desmoineaux, P; Deburge, A


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

  19. [Lumbar stabilization exercises].

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


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

  20. CHR -- Character Handling Routines

    Charles, A. C.; Rees, P. C. T.; Chipperfield, A. J.; Jenness, T.

    This document describes the Character Handling Routine library, CHR, and its use. The CHR library augments the limited character handling facilities provided by the Fortran 77 standard. It offers a range of character handling facilities: from formatting Fortran data types into text strings and the reverse, to higher level functions such as wild card matching, string sorting, paragraph reformatting and justification. The library may be used simply for building text strings for interactive applications or as a basis for more complex text processing applications.


    Ville Leinonen


    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

  2. Preoperative education for lumbar surgery for radiculopathy

    Louw, A; Louw, Q; L. Crous


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

  3. Quantitative Data-driven Utilization of Hematologic Labs Following Lumbar Fusion.

    Yew, Andrew Y; Hoffman, Haydn; Li, Charles; McBride, Duncan Q; Holly, Langston T; Lu, Daniel C


    Retrospective case series. Large national inpatient databases estimate that approximately 200,000 lumbar fusions are performed annually in the United States alone. It is common for surgeons to routinely order postoperative hematologic studies to rule out postoperative anemia despite a paucity of data to support routine laboratory utilization. To describe quantitative criteria to guide postoperative utilization of hematologic laboratory assessments. A retrospective analysis of 490 consecutive lumbar fusion procedures performed at a single institution by 3 spine surgeons was performed. Inclusion criteria included instrumented and noninstrumented lumbar fusions performed for any etiology. Data were acquired on preoperative and postoperative hematocrit, platelets, and international normalized ratio as well as age, sex, number of levels undergoing operation, indication for surgery, and intraoperative blood loss. Multivariate logistic regression was performed to determine correlation to postoperative transfusion requirement. A total of 490 patients undergoing lumbar fusion were identified. Twenty-five patients (5.1%) required postoperative transfusion. No patients required readmission for anemia or transfusion. Multivariate logistic regression analysis demonstrated that reduced preoperative hematocrit and increased intraoperative blood loss were independent predictors of postoperative transfusion requirement. Intraoperative blood loss >1000 mL had an odds ratio of 8.9 (P=0.013), and preoperative hematocrit quantitative preoperative and intraoperative criteria to guide data-driven utilization of postoperative hematologic studies following lumbar fusion.

  4. Segmentalliverincarcerationthrougha recurrent incisional lumbar hernia

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


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

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

    Barrero Candau, R; Garrido Morales, M


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

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

    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)


    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. Lumbar discography: an update.

    Anderson, Mark W


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

  8. A lumbar disc surgery predictive score card.

    Finneson, B E


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

  9. Noncontiguous multifocal brucellar spondylitis involving the cervical, thoracic, and lumbar spine: A case report

    Rong Wang


    Full Text Available Brucellosis is a zoonosis infectious disease, brucellar spondylitis primarily infects the lumbar, the cervical is uncommon. Multiple-level involvement is extremely rare. This report describes a 46-year-old man with noncontiguous multifocal brucellar spondylitis involving the cervical, thoracic, and lumbar spine. Brucellar spondylitis is difficult to diagnose. Routine laboratory findings for the disease have little diagnostic value. Manifestations and radiological features are usually nonspecific. Radiological features of brucellar spondylitis are similar to tuberculous spondylitis and pyogenic spondylitis. MRI findings have diagnostic value. Suspicious patients with unexplained fever, musculoskeletal complaints at risk of infection should be considered.

  10. Chondroblastoma of the lumbar vertebra

    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)


    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.)

  11. Diagnosis of lumbar disc hernia with computed tomography

    Yoshizumi, Atsuro; Ohira, Nobuhiro; Ojima, Tadashi; Oshida, Midori; Horaguchi, Mitsuru (Tohoku Rosai Hospital, Sendai (Japan))


    Results of computed tomography performed on patients with clinically diagnosed hernia were compared with those of myelography and operative findings. This comparative study suggested that computed tomography is quite different from other methods and very useful in diagnosis of hernia. Some cases of hernia were shown, and the characteristics of CT were reviewed.

  12. Atlanto-axial approach for cervical myelography in a Thoroughbred horse with complete fusion of the atlanto-occipital bones.

    Aleman, Monica; Dimock, Abigail N; Wisner, Erik R; Prutton, Jamie W; Madigan, John E


    A 2-year-old Thoroughbred gelding with clinical signs localized to the first 6 spinal cord segments (C1 to C6) had complete fusion of the atlanto-occipital bones which precluded performing a routine myelogram. An ultrasound-assisted myelogram at the intervertebral space between the atlas and axis was successfully done and identified a marked extradural compressive myelopathy at the level of the atlas and axis, and axis and third cervical vertebrae.

  13. Surgical results in hidden lumbar spinal stenosis detected by axial loaded computed tomography and magnetic resonance imaging: an outcome study.

    Willén, Jan; Wessberg, Per J; Danielsson, Barbro


    An outcome study of patients with neurogenic claudication and/or sciatica with hidden stenosis, detected only by axial loading of the lumbar spine (ACE) but not at the traditional unloaded examination (psoas relaxed position) during computed tomography (CT) myelography or magnetic resonance imaging (MRI), followed up after surgery. To estimate the clinical effect of decompression with or without fusion in patients with hidden stenosis in the lumbar spine. A number of patients with neurogenic claudicatio with or without sciatica do not have corresponding imaging abnormalities. Axial loaded CT and MRI have disclosed hidden stenosis in certain cases. The surgical effect in patients with hidden stenosis has never been described. Axial loading of the lumbar spine during CT and MRI was performed in 250 patients with neurogenic claudication and sciatica. All fulfilled the inclusion criteria for ACE, i.e., suspected but not verified spinal stenosis in 1 to 3 levels. In 125 patients (50%), a significant narrowing of the spinal canal occurred. Out of these 125 patients, 101 had a clear stenosis besides the stenosis only detected at ACE. In 24 patients, a hidden stenosis was detected in 1 to 3 levels only at the ACE. These patients were observed for 1 to 6 years after decompression with or without fusion regarding subjective improvement of leg and back pains, walking capacity, satisfaction, and health related quality of life. At follow-up, 76% of the patients had leg pain less than 25/100 on a VAS scale and 62% had back pain less than 25/100. Ninety-six percent were improved or much improved regarding leg and back pains The ability to walk increased significantly after surgery. Walking capacity to more than 500 m increased from 4% to 87%. Twenty-two patients were subjectively satisfied with the surgical results. The ODI score, the SF-36 and the EQ-5D score corresponded well to the above mentioned improvements at follow-up. According to this study, the results of surgery in

  14. Coronal MR imaging of the normal 3rd, 4th, and 5th lumbar and 1st sacral nerve roots

    Hald, J.K.; Nakstad, P.H.; Hauglum, B.E. (National Hospital, Oslo (Norway). Dept. of Radiology)


    Seven healthy volunteers underwent coronal MR imaging at 1.5 tesla of the normal 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots. Coronal slices, 3-mm-thick with a 0.3-mm gap between the slices were obtained (TR/TE 600/22) through the lumbar spinal canal. All the nerve roots were visible on at least one image. One can routinely expect to demonstrate the 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots on T1-weighted, 3-mm-thick coronal MR scans. We found no correlation between the degree of lumbar lordosis and the lengths of the visible nerve roots. Five patients with one of the following spinal problems: anomaly, tumor, disk herniation, and failed back surgery syndrome were examined according to our protocol. In all these cases coronal MR imaging gave the correct diagnosis. (orig.).

  15. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

    Koshi Ninomiya


    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.




    Objective: To observe the therapeutic effect of acupuncture plus manual reposition for treatment of acute lumbar vertebral articular dyskinesia for choosing a better remedy. Methods: 66 cases of acute lumbar vertebral articular dyskinesia were randomly divided into acupuncture plus manual reposition group (treatment group, n= 33) and routine manual reposition group (control group, n = 33). Yaotong-point was punctured, when, the patient was asked to move his or her waist simultaneously. Results: After one session of treatment, of the two 33 cases in treatment and control groups, 28 (84.85%) and20 (60.61%) were cured, 4 (12.12%) and 9 (27.27%) were improved, and 1 (3.03%) and 4 (12.12%) failed in the treatment. The therapeutic effect of treatment group was significantly superior to that of control group ( P< 0.05). Conclusion: Acupuncture combined with manual reposition is apparently superior to simple routine manual reposition in relieving acute lumbar vertebral articular dyskinesia.

  17. Degenerative diseases of the cervical spine: comparison of a multiecho data image combination sequence with a magnetisation transfer saturation pulse and cervical myelography and CT

    Dorenbeck, U. [Department of Neuroradiology, University Hospital of the Saarland, 66421, Homburg (Germany); Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93042, Regensburg (Germany); Schreyer, A.G.; Held, P.; Feuerbach, S.; Seitz, J. [Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93042, Regensburg (Germany); Schlaier, J. [Department of Neurosurgery, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93042, Regensburg (Germany)


    Assessing degenerative disease in the cervical spine remains a challenge. There is much controversy about imaging the cervical spine using MRI. Our aim in this prospective study was to compare a T2*-weighted 2D spoiled gradient-echo multiecho sequence (MEDIC) with a magnetisation transfer saturation pulse with cervical myelography and postmyelographic CT. Using an assessment scale we looked at the vertebral bodies, intervertebral discs, neural foramina, anterior and posterior nerve roots, grey matter, ligamenta flava, oedema in the spinal cord and stenosis of the spinal canal. We also evaluated postmyelography CT and the MEDIC sequence for assessing narrowing of the neural foramina in a cadaver cervical spine. We examined 67 disc levels in 18 patients, showing 18 disc prolapses and 21 osteophytes narrowing the spinal canal or the neural foramina. All MRI studies showed these abnormalities findings equally well. Postmyelography CT was significantly better for showing the bony structures and the anterior and posterior nerve roots. The MEDIC sequence provided excellent demonstration of soft-tissue structures such as the intervertebral disc and ligamentum flavum. No statistical differences between the imaging modalities were found in the assessment of narrowing of the neural foramina or the extent of spinal stenosis. The cadaver measurements showed no overestimation of abnormalities using the MEDIC sequence. (orig.)

  18. Lumbar disc excision through fenestration

    Sangwan S


    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.

  19. Case report and review of lumbar hernia.

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


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

  20. Microfoundations of Routines and Capabilities

    Felin, Teppo; Foss, Nicolai Juul; Heimriks, Koen H.

    We discuss the microfoundations of routines and capabilities, including why a microfoundations view is needed and how it may inform work on organizational and competitive heterogeneity. Building on extant research, we identify three primary categories of micro-level components underlying routines...

  1. Evaluation of unconstrained optimization routines

    Nazareth, L.; Schlick, F.


    Different approaches to evaluating optimization routines are discussed, and a particular method which uses parameterized test problems is described. This approach is illustrated through a simple case study of three well-known unconstrained optimization routines applied to three parameterized test problems. The results are displayed as a set of graphs. 3 figures.

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

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


    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.

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

    Ding Zi-hai


    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

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

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


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

  5. Computed tomography before lumbar puncture in acute meningitis: a review of the risks and benefits.

    Archer, B D


    OBJECTIVE: To determine the indications, if any, for routine computed tomography (CT) of the brain before lumbar puncture in the management of acute meningitis. DATA SOURCES: Original research papers, reviews and editorials published in English from 1965 to 1991 were retrieved from MEDLINE. The bibliographies of these articles and of numerous standard texts were examined for pertinent references. A survey of local neurologists was conducted, and legal opinion was sought from the Canadian Medi...

  6. The institutionalization of a routine

    Nickelsen, Niels Christian


    The theoretical ambition in this paper is to contribute to institutionalism, and the literature on organizational routines, by allotting a precise role to the context and the material. Through a theoretical discussion of several perspectives on organizational routines, I argue that materiality-wh...... of production. I argue that the negotiation of these changes during test production is the fulcrum in the routinization of the production procedure. It is through these identity shifts that the valve is both reified, and rendered producible and applicable in the customer world....

  7. Remote cerebellar hemorrhage after lumbar spinal surgery

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


    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.

  8. Genetic association studies in lumbar disc degeneration

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


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

  9. Primary lumbar hernia: A rarely encountered hernia

    Sharada Sundaramurthy


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

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

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


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

  11. Hernia discal lumbar: Tratamiento conservador

    López-Sastre Núñez, Antonio; Candau Pérez, Ernesto


    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...

  12. Lumbar Epidural Varix Mimicking Disc Herniation.

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


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

  13. Magnetic resonance study of lumbar disks in female dancers.

    Capel, Antonio; Medina, Fernando Santonja; Medina, Daniel; Gómez, Sebastian


    Previous imaging studies have shown that degenerative disk disease is more common in the competitive female gymnast than in asymptomatic nonathletic people of the same age training to any degree. However, results of exposure-discordant monozygotic and classic twin studies suggest that physical loading specific to occupation and sport has a relatively minor role in disk degeneration, beyond that of upright postures and routine activities of daily living. Intensive, regular, and prolonged dancing causes strain on the lumbar spine and can trigger or accelerate the development of degenerative diskopathy. Cross-sectional study; Level of evidence, 3. Forty volunteer female dancers (20 ballet and 20 flamenco) aged between 18 and 31 years (mean = 24.2) underwent magnetic resonance imaging of the lumbar spine. They were compared against a control group of 20 women of the same age. A descriptive analysis was done, and the 2 groups were compared by contingency table analysis using the Pearson chi-square test complemented by an analysis of residuals. Results Nine of the 20 women (45%) in the control group had disk degeneration compared with 13 of the 40 (32.5%) women in the dancer group, with a chi-square of 0.897 (not significant). There were 12 degenerated disks of the 100 explored (12%) in the control group compared with 21 of the 200 explored (10.5%) in the dancer group (chi-square = 0.153; not significant). Dancing cannot be considered a risk factor for lumbar disk degeneration in women. The present study indicates that dancing has no negative effect on the development of degenerative diskopathy.

  14. Routines.


    Melser and Michie (1970), 135-151. Sacerdoti, Earl D, [1977], A structure for plans and behavior, Elsevier. * Sartre , Jean - Paul , [1976], Critique of...theorem proving to problem solving," Artificial Intelligence, 2 (3) 189-208. Fitts, Paul M and Michael I Posner, [1967], Human performance, Brooks/Cole...Laing, R D and A Esterson, [1964], Sanity, Madness, and the Family, Tavistock. Laird, John E, Paul Rosenbloom, and Allen Newell, [1984], Towards

  15. Lumbar pedicle cortical bone trajectory screw

    Song Tengfei; Wellington K Hsu; Ye Tianwen


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

  16. Multiple vascular anomalies involving testicular, suprarenal arteries and lumbar veins

    P Jyothsna


    Full Text Available Testicular arteries arise from the abdominal aorta and the inferior suprarenal artery from the renal artery. There are reports about variant origin and course of these arteries. Accessory testicular artery is also a common finding but its providing origin to inferior suprarenal artery is an important observation. During a routine dissection of abdomen of approximately 55-year-old male cadaver, unique vascular abnormality was observed. On the left side, a common arterial trunk originating from abdominal aorta immediately branched to give rise to superior testicular and inferior suprarenal arteries, the former after a short course hooked by the left suprarenal vein. In addition, the left suprarenal vein, second left lumbar vein, and left testicular vein joined to form a common trunk which drained into the left renal vein. A sound knowledge of vascular variations in relation to the kidney and suprarenal gland is important to surgeons dissecting the abdominal cavity.

  17. Lumbar interspinous bursitis in active polymyalgia rheumatica.

    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


    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.

  18. Lumbar hernia: a short historical survey.

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


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

  19. Minimal Invasive Decompression for Lumbar Spinal Stenosis

    Victor Popov


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

  20. Microfoundations of Routines and Capabilities

    Felin, Tippo; Foss, Nicolai Juul; Heimericks, Koen H.;


    This article introduces the Special Issue and discusses the microfoundations of routines and capabilities, including why a microfoundations view is needed and how it may inform work on organizational and competitive heterogeneity. Building on extant research, we identify three primary categories...

  1. Lumbar herniated disc: spontaneous regression

    Yüksel, Kasım Zafer


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



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

  3. Lumbar Epidural Varix Mimicking Perineural Cyst

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


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

  4. Posteroanterior versus anteroposterior lumbar spine radiology

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


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

  5. Fem Modelling of Lumbar Vertebra System

    Rimantas Kačianauskas


    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.

  6. Preoperative education for lumbar surgery for radiculopathy

    A. Louw


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

  7. Scoliosis secondary to lumbar osteoid osteoma

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


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

  8. Routine Design for Mechanical Engineering

    Brinkop, Axel; Laudwein, Norbert; Maasen, Rudiger


    COMIX (configuration of mixing machines) is a system that assists members of the EKATO Sales Department in designing a mixing machine that fulfills the requirements of a customer. It is used to help the engineer design the requested machine and prepare an offer that's to be submitted to the customer. comix integrates more traditional software techniques with explicit knowledge representation and constraint propagation. During the process of routine design, some design decisions have to be mad...

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

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


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

  10. Splenic rupture following routine colonoscopy.

    Rasul, Tabraze; Leung, Edmund; McArdle, Kirsten; Pathak, Rajiv; Dalmia, Sanjay


    Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent.

  11. The effects of stabilization exercise on pain, functional disability and muscle endurance in patients suspectedto lumbar segmental instability

    Y. Javadian


    Full Text Available AbstractIntroduction: Lumbar segmental instability is one of the subgroups of non specific chronic low back pain and it seems that 30-40% of patients with LBP suffer from lumbar segmental instability. Pain intensity, functional disability and reduced muscle endurance are common in such patients. The aim of this study was to evaluate the effects of stabilization exercise on pain, functional disability and muscle endurance in patients suspected to lumbar segmental instability Material & methods: Following ethical approval, a randomized clinical trial was carried out on 30 patients suspected to lumbar segmental instability ranging from 18-45 years old. They were randomly divided into two groups; the first group underwent routine exercise only while the second group performed routine exercise plus stabilization training for 8 weeks. Outcome measure included pain intensity, functional disability, and flexion and extension range of motion and flexor, extensor and side support muscle endurance which were evaluated before and after treatment. Data were analyzed using paired t test and independent t test.Results: Muscle endurance and flexion range of motion increased in both groups although the increase was higher in stabilization training group (p=0.00. Pain intensity and functional disability significantly decreased in both groups (p=0.00, but decreasing of pain intensity and functional disability were more in stabilization training group (p=0.00. Conclusion: Stabilization training is more effective than routine exercise in improvement of pain intensity, functional disability, muscle endurance and range of motion in patients suspected to lumbar segmental instability. J Mazand Univ Med Sci 2008; 18(65: 63-73 (Persian

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

    Surendra Mohan Tuli


    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.

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

    Manchikanti, Laxmaiah; Hirsch, Joshua A


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

  14. Correlation between Radiologic Sign of Lumbar Lordosis and Functional Status in Patients with Chronic Mechanical Low Back Pain

    Ashraf, Alireza; Farahangiz, Siamak; Pakniat Jahromi, Bita; Setayeshpour, Nazanin; Nasseri, Ali


    Study Design A cross-sectional study. Purpose To describe the correlation between lumbar lordosis angle and functional status of patients with chronic mechanical low back pain (CMLBP). Overview of Literature There are different and conflicting opinions regarding the relationship between the degree of lumbar lordosis and functional status of patients with low back pain. Nonetheless, the severity of lordosis is still one of the routine physical exams considered in rehabilitation clinics. Methods The degree of lumbar lordosis of 150 patients with CMLBP was measured by means of Cobb's method using sagittal standing spinal radiographs. Subjects with probable secondary causes of low back pain (trauma, congenital anomaly, spinal infection, rheumatologic problems and history of spinal surgery) were excluded. Besides recording demographic data, their score of functional disability was estimated using Oswestry Disability Questionnaire, one of the most useful and reliable questionnaires. Comparison between these data was made regarding different age and gender groups. Results In this study, 119 subjects were female and 31 male, with an age range of 19-85 years. The average degree of lumbar lordosis was 44.69±11.43 and that of Oswestry disability index (ODI) 30.52%. Although we found a significant direct relationship between age and degree of lumbar lordosis (Pearson's correlation coefficient, p=0.016, r=0.197), while insignificant correlation was seen between the degree of lumbar lordosis and ODI (p=0.129). Conclusions There was no significant correlation between the degree of lumbar lordosis and the score of functional disability with regards to different age groups and gender. PMID:25346808

  15. Topical analgesia treats pain and decreases propofol use during lumbar punctures in a randomized pediatric leukemia trial.

    Whitlow, Puja G; Saboda, Kathylynn; Roe, Denise J; Bazzell, Susan; Wilson, Cera


    Lumbar punctures are frequently performed in pediatric leukemia for central nervous system leukemic prophylaxis. The contribution of local anesthetic with deep sedation is unknown. The objective was to evaluate EMLA (eutectic mixture of local anesthetics) cream as a pain reliever in conjunction with propofol in the setting of routine lumbar punctures. We included patients with acute lymphoblastic leukemia aged 3-21 years requiring at least two routine lumbar punctures. Patients were randomly assigned to receive EMLA or placebo cream and the alternate treatment with the second procedure. Patients, personnel and outcome assessors were blinded to allocation. The primary outcome included three indirect measures of pain: total median propofol doses, patient movement and heart rate changes at the time of skin puncture in both treatment groups. Twenty-six patients were enrolled and 25 were analyzed. With EMLA cream, 4 mg/kg (median) of propofol was required (95% CI 3.5-4.4). With placebo, 4.9 mg/kg of propofol was needed (95% CI 4.3-5.6; P = 0.008). When EMLA cream was applied, 8% of patients moved, whereas 84% moved with placebo cream (P propofol is beneficial. Topical analgesics are at the discretion of the oncologist, allowing us to advocate for patients by providing safe and efficacious pain management for lumbar punctures. © 2014 Wiley Periodicals, Inc.

  16. A comparative roentgenographic analysis of the lumbar spine in male army recruits with and without lower back pain

    Steinberg, E.L. E-mail:; Luger, E.; Arbel, R.; Menachem, A.; Dekel, S


    AIM: To determine whether there is an association between lumbar spine radiographic findings and reported current and/or past lower back pain (LBP). MATERIALS AND METHODS: Four hundred and sixty-four age-matched (mean age 18 years{+-}2 months) consecutive male army recruits were examined. Half of them had a history of episodes of LBP. An orthopaedic evaluation (including radiographs of the lumbar spine) is part of the routine medical examination for all military recruits. Two senior orthopaedic surgeons and one radiologist who performed the morphological measurements assessed the radiographs. RESULTS: We found an increased frequency of right-sided scoliosis, lumbar lordosis, sacral lumbarization, wedge vertebra, bilateral spondylolysis of L5 and/or a sagittal diameter of less than 12 mm among the recruits with LBP. No such association was found with spina bifida, left-sided scoliosis, hemi-lumbarization, sacralization and hemi-sacralization, Schmorl's nodules or mild degenerative changes. CONCLUSION: Given that radiographic screening shows that LBP is more common in those with spinal deformity it may be a reasonable means of predicting which individuals are more likely to develop LBP.

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

    Tevfik Yilmaz


    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.

  18. Appropriateness of lumbar spine magnetic resonance imaging in Spain

    Kovacs, Francisco M. [Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); Research Department, Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); Arana, Estanislao, E-mail: [Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); Servicio de Radiología, Fundación Instituto Valenciano de Oncología, Valencia (Spain); Fundación Instituto de Investigación en Servicios de Salud, Valencia (Spain); Royuela, Ana [Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); CIBER Epidemiología y Salud Pública (CIBERESP) (Spain); Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRYCIS, Ctra. Colmenar Km. 9.1, 28034 Madrid (Spain); Cabrera, Alberto [Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); Hospital de Galdakao, Barrio Labeaga, 48960 Galdakao, Vizcaya (Spain); Casillas, Carlos [Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); Instituto de Traumatología Unión de Mutuas, Av. del Lledó, C/Juan de Herrera, 27 12004 Castellón (Spain); and others


    Objectives: To determine the minimum percentage of lumbar spine magnetic resonance imaging (LSMRI) which are inappropriately prescribed in routine practice. Methods: LSMRI performed prospectively on 602 patients in 12 Radiology Services across 6 regions in Spain, were classified as “appropriate”, “uncertain” or “inappropriate” based on the indication criteria established by the National Institute for Clinical Excellence, the American College of Physicians and Radiology, and current evidence-based clinical guidelines. Studies on patients reporting at least one “red flag” were classified as “appropriate”. A logistic regression model was developed to identify factors associated with a higher likelihood of inappropriate LSMRI, including gender, reporting of referred pain, health care setting (private/public), and specialty of prescribing physician. Before performing the LSMRI, the radiologists also assessed the appropriateness of the prescription. Results: Eighty-eight percent of LSMRI were appropriate, 1.3% uncertain and 10.6% inappropriate. The agreement of radiologists’ assessment with this classification was substantial (k = 0.62). The odds that LSMRI prescriptions were inappropriate were higher for patients without referred pain [OR (CI 95%): 13.75 (6.72; 28.16)], seen in private practice [2.25 (1.20; 4.22)], by orthopedic surgeons, neurosurgeons or primary care physicians [2.50 (1.15; 5.56)]. Conclusion: Efficiency of LSMRI could be improved in routine practice, without worsening clinical outcomes.

  19. MR-guided lumbar sympathicolysis

    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)


    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.)

  20. MRI after successful lumbar discectomy

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


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

  1. Lumbar lordosis in female collegiate dancers and gymnasts.

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


    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.

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

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


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

  3. Tractography of lumbar nerve roots: initial results

    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)


    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. Minimally invasive procedures on the lumbar spine

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


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

  5. A musculoskeletal model for the lumbar spine.

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


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

  6. Economic impact of minimally invasive lumbar surgery

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


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

  7. CT myelography in communicating syringomyelia

    Pamir, M.N.; Ozer, A.F.; Zirh, T.A. (Marmara University Faculty of Medicine, Istanbul (Turkey). Department of Neurosurgery); Gurmen, N.; Erzen, C. (Marmara University, Istanbul (Turkey). Department of Radiology)

    Although the etiology of syringomyelia is not clearly understood, many surgical methods have been proposed for its treatment. One widely used technique in cases of communicating syringomyelia is that of posterior fossa decompression and plugging of the obex (Gardner's Operation). In this paper 5 cases of syringomyelia are presented which were investigated using detailed myelo-computerized tomographic techniques, of which 2 appeared to be communicating syringomyelia and which were treated by posterior fossa decompression and obex plugging. The authors also discuss the place of computed tomography in the differential diagnosis of communicating syringomyelia. (author). 42 refs.; 3 figs.; 2 tabs.

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

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


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

  9. The lumbar lordosis below Harrington instrumentation for scoliosis.

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


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

  10. Evaluation and Treatment of Lumbar Facet Cysts.

    Boody, Barrett S; Savage, Jason W


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

  11. Traumatic lumbar hernia: report of a case.

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


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

  12. Lumbar hernia repaired using a new technique.

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


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

  13. 49 CFR 572.115 - Lumbar spine and pelvis.


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

  14. 49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.


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

  15. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.


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

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

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


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

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

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


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

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

    Mörl, Falk; Bradl, Ingo


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

  19. Use of autologous growth factors in lumbar spinal fusion.

    Lowery, G L; Kulkarni, S; Pennisi, A E


    The results of spinal fusion, especially posteriorly above the lumbosacral junction, have been mixed. Autologous growth factor concentrate (AGF) prepared by ultraconcentration of platelets contains multiple growth factors having a chemotactic and mitogenic effect on mesenchymal stem cells and osteoblasts and may play a role in initiating bone healing. The purpose of this retrospective study is to review our results with AGF in lumbar spinal fusions. To date, AGF has been used in 39 patients having lumbar spinal fusion. The study group consisted of the first 19 consecutive cases to allow at least 6 months follow-up. The average follow-up was 13 months (range 6 to 18 months). Follow-up compliance was 91%. There were 7 men and 12 women. Average age was 52 years (range 30-72 years). Nine patients had prior back surgery. There were 8 smokers. AGF was used in posterior (n = 15) or anterior intradiscal (n = 4) fusions. AGF was used with autograft and coraline hydroxyapatite in all posterior fusions, and autograft, coral, and intradiscal spacer (carbon fiber spinal fusion cages or Synthes femoral ring) in intradiscal fusions. Posterior stabilization was used in all cases. Eight cases were single-level fusions, 6 were two-level, and 1 was a three-level fusion. Autologous iliac crest bone graft was taken in 14 cases and local autograft used in 5 cases. Posteriorly, a total of 23 levels were fused; of these, nine were at L5-S1, eight at L4-L5, five at L3-L4, and one at L2-L3. No impending pseudoarthroses were noted on plain radiographic examination at last follow-up visit. Solid fusion was confirmed in 3 patients having routine hardware removal, and in 2 patients who had surgery at an adjacent level. There was one posterior wound infection, which was managed without sequelae. When used as an adjunct to autograft, AGF offers theoretical advantages that need to be examined in controlled studies. Further study is necessary to determine whether coralline hydroxyapatite used as a

  20. Lumbar degenerative kyphosis: radiologic analysis and classifications.

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


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

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

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


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

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

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


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

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

    Guo, Shuguang; Sun, Junying; TANG, GENLIN


    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...

  4. Mini-open anterior lumbar interbody fusion.

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


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

  5. Lumbar vertebral pedicles: radiologic anatomy and pathology

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


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

  6. Routine screening for postpartum depression.

    Georgiopoulos, A M; Bryan, T L; Wollan, P; Yawn, B P


    Postpartum depression (PPD) is a common and often overlooked condition. Validated screening tools for PPD exist but are not commonly used. We present the 1-year outcome of a project to implement universal PPD screening at the 6-week postpartum visit. Universal screening with the Edinburgh Postnatal Depression Scale (EPDS) was implemented in all community postnatal care sites. One-year outcome assessments (diagnosis and treatment of PPD) were completed for a sample of the women screened using medical record review of all care they received during the first year postpartum. Sixty-eight (20%) of the 342 women whose medical records were reviewed had been given a documented diagnosis of postpartum depression, resulting in an estimated population rate of 10.7%. Depression was diagnosed in 35% of the women with elevated EPDS scores (> or =10) compared with 5% of the women with low EPDS scores (<10) in the first year postpartum. Treatment was provided for all women diagnosed with depression, including drug therapy for 49% and counseling for 78%. Four women were hospitalized for depression. Some degree of suicidal ideation was noted on the EPDS by 48 women but acknowledged in the chart of only 10 women, including 1 with an immediate hospitalization. The rate of diagnosis of postpartum depression in this community increased from 3.7% before the routine use of EPDS screening to 10.7% following screening. A high EPDS score was predictive of a diagnosis of postpartum depression, and the implementation of routine EPDS screening at 6 weeks postpartum was associated with an increase in the rate of diagnosed postpartum depression in this community.

  7. Haemostasis and Safety Measures before Lumbar Puncture in the Haematology Ward

    Møller, Anders; Bjerrum, Ole Weis; Afshari, Arash


    : An online survey with questions pertaining to precautions of haemostasis and application of fundoscopy was sent by e-mail to all 12 haematology wards in Denmark. RESULTS: Eleven sites participated. Five (45%) reported no pausation of antiplatelet drugs at all. The mean platelet limit prior to lumbar...... puncture was 50 × 10(9)/l (range 10-50 × 10(9)/l). Seven (64%) sites had an international normalised ratio limit of 1.5, and the remaining 4 had values between 1.0 and 2.5. Two (18%) reported occasional use of thromboelastography or platelet analysis to assess the bleeding risk. Fundoscopy is routinely...

  8. 42 CFR 493.931 - Routine chemistry.


    ... 42 Public Health 5 2010-10-01 2010-10-01 false Routine chemistry. 493.931 Section 493.931 Public... Proficiency Testing Programs by Specialty and Subspecialty § 493.931 Routine chemistry. (a) Program content and frequency of challenge. To be approved for proficiency testing for routine chemistry, a program...

  9. Evolutionary Dynamics of Digitized Organizational Routines

    Liu, Peng


    This dissertation explores the effects of increased digitization on the evolutionary dynamics of organizational routines. Do routines become more flexible, or more rigid, as the mix of digital technologies and human actors changes? What are the mechanisms that govern the evolution of routines? The dissertation theorizes about the effects of…

  10. Routines Are the Foundation of Classroom Management

    Lester, Robin Rawlings; Allanson, Patricia Bolton; Notar, Charles E.


    Classroom management is the key to learning. Routines are the foundation of classroom management. Students require structure in their lives. Routines provide that in all of their life from the time they awake until the time they go to bed. Routines in a school and in the classroom provide the environment for learning to take place. The paper is…

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

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

    ..., and numbers of segments fused with a mean follow-up of 84 months (61–142) (total n = 84). Several radiographic parameters were measured on pre- and postoperative radiographs, including lumbar lordosis measured (LL...

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

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


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

  13. Percutaneous fusion of lumbar facet with bone allograft

    Félix Dolorit Verdecia


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

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

    Zoe Quintero Delgado


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

  15. Effect of pelvic tilt on lumbar spine geometry.

    Delisle, A; Gagnon, M; Sicard, C


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

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

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


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

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

    Fan Yuan-zhi; Wu Yao-chi


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

  18. Lumbar Puncture for First Simple Febrile Seizure

    J Gordon Millichap


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

  19. Multiple lumbar arachnoid cysts. Case report.

    Pappalardo, S; Cassarino, A; Braidotti, P


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




    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

  1. A case of inferior lumbar hernia

    Vidhyasagar M. Sharma


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

  2. Lumbar segmental instability: a criterion-related validity study of manual therapy assessment

    Chapple Cathy


    Full Text Available Abstract Background Musculoskeletal physiotherapists routinely assess lumbar segmental motion during the clinical examination of a patient with low back pain. The validity of manual assessment of segmental motion has not, however, been adequately investigated. Methods In this prospective, multi-centre, pragmatic, diagnostic validity study, 138 consecutive patients with recurrent or chronic low back pain (R/CLBP were recruited. Physiotherapists with post-graduate training in manual therapy performed passive accessory intervertebral motion tests (PAIVMs and passive physiological intervertebral motion tests (PPIVMs. Consenting patients were referred for flexion-extension radiographs. Sagittal angular rotation and sagittal translation of each lumbar spinal motion segment was measured from these radiographs, and compared to a reference range derived from a study of 30 asymptomatic volunteers. Motion beyond two standard deviations from the reference mean was considered diagnostic of rotational lumbar segmental instability (LSI and translational LSI. Accuracy and validity of the clinical assessments were expressed using sensitivity, specificity, and likelihood ratio statistics with 95% confidence intervals (CI. Results Only translation LSI was found to be significantly associated with R/CLBP (p Conclusion This study provides the first evidence reporting the concurrent validity of manual tests for the detection of abnormal sagittal planar motion. PAIVMs and PPIVMs are highly specific, but not sensitive, for the detection of translation LSI. Likelihood ratios resulting from positive test results were only moderate. This research indicates that manual clinical examination procedures have moderate validity for detecting segmental motion abnormality.

  3. Interaction of viscoelastic tissue compliance with lumbar muscles during passive cyclic flexion-extension.

    Olson, Michael W; Li, Li; Solomonow, Moshe


    Human and animal models using electromyography (EMG) based methods have hypothesized that viscoelastic tissue properties becomes compromised by prolonged repetitive cyclic trunk flexion-extension which in turn influences muscular activation including the flexion-relaxation phenomenon. Empirical evidence to support this hypothesis, especially the development of viscoelastic tension-relaxation and its associated muscular response in passive cyclic activity in humans, is incomplete. The objective of this study was to examine the response of lumbar muscles to tension-relaxation development of the viscoelastic tissue during prolonged passive cyclic trunk flexion-extension. Activity of the lumbar muscles remained low and steady during the passive exercise session. Tension supplied by the posterior viscoelastic tissues decreased over time without corresponding changes in muscular activity. Active flexion, following the passive flexion session, elicited significant increase in paraspinal muscles EMG together with increase in the median frequency. It was concluded that reduction of tension in the lumbar viscoelastic tissues of humans occurs during cyclic flexion-extension and is compensated by increased activity of the musculature in order to maintain stability. It was also concluded that the ligamento-muscular reflex is inhibited during passive activities but becomes hyperactive following active cyclic flexion, indicating that moment requirements are the controlling variable. It is conceived that prolonged routine exposure to cyclic flexion minimizes the function of the viscoelastic tissues and places increasing demands on the neuromuscular system which over time may lead to a disorder and possible exposure to injury.

  4. Additional merit of coronal STIR imaging for MR imaging of lumbar spine

    Ranjana Gupta


    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.

  5. Tranexamic acid reduces perioperative blood loss of posterior lumbar surgery for stenosis or spondylolisthesis

    Shi, Houyin; Ou, Yunsheng; Jiang, Dianming; Quan, Zhengxue; Zhao, Zenghui; Zhu, Yong


    Abstract Background: A prospective, randomized, double-blind, placebo-controlled study was performed. The routine usage of TA in spinal surgery is controversial. Only a few studies have focused on patients undergoing posterior lumbar surgery for stenosis or spondylolisthesis, although a large clinical cohort exists in the population. This study aimed to evaluate the effect and safety of TA in reducing perioperative blood loss in posterior lumbar surgery for stenosis or spondylolisthesis. Methods: 100 eligible patients out of 126 were randomized to receive either a bolus dose of 30 mg/kg TA i.v, a maintenance dosage of 2 mg/kg/h TA, or an equivalent volume of normal saline. The pedicle screw system was used for fixing in all the patients, followed by decompression and posterior lumbar interbody fusion. The primary outcomes were intraoperative estimated blood loss and total blood loss. The secondary outcomes were receiving packed red blood cells and postoperative hemoglobin and hematocrit levels. Results: In total, 4 patients were excluded from the analyses, 50 patients were in the TA group, and 46 in the placebo group. The demographic and baseline data between the groups were not statistically different. The intraoperative estimated blood loss and the total blood loss were 33% and 41% lower in the TA group than the placebo group, respectively. The blood transfusion rate did not vary significantly (P = 0.191). Except a patient with a dural tear in the placebo group, no other complications were observed. Conclusion: TA significantly reduced the perioperative blood loss in patients undergoing posterior lumbar surgery for stenosis or spondylolisthesis. PMID:28072709

  6. Under Utilization of Local Anesthetics in Infant Lumbar Punctures

    Gorchynski, Julie


    Full Text Available Background: Lumbar Puncture (LP is an invasive procedure frequently used to diagnose meningitis among the pediatric population. Neonates and infants have not routinely received local anesthesia prior to LP. Study Objective: To determine whether emergency medicine physicians and pediatricians use local analgesics on neonates and infants prior to performing an LP and to identify which local anesthetics, if any, were used. Methods: Prospective, cohort study of all infants, six months of age or less, that received an LP in the emergency department (ED or inpatient pediatric units for suspected meningitis during a period of year at a university tertiary care hospital. Results: A total sample population of 111 infants that received an LP within the study period. A control population of 42 adults received an LP. Only 40.4% (45/111 of the infants received local analgesia prior to LP: either 1% lidocaine, EMLA or a combination of the two. Infants were less likely to receive lidocaine or EMLA prior to LP compared to adult subjects (OR= 0.27; 95% CI0.12 to 0.62. No neonates that were less than one month of age received local procedural anesthesia by emergency medicine or pediatric physicians. ED physicians’ use of local anesthesia prior to LP increased with increasing age of the infant. The pediatricians in this study used local anesthesia prior to LP when the infant was at least five months of age. Discussion: The data objectively support recent literature regarding the under use or lack of use of analgesia prior to LP among neonates and infants. Local anesthetics should be used routinely without exception prior to performing an LP in the pediatric population.

  7. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study

    Gugliotta, Marinella; da Costa, Bruno R; Dabis, Essam; Theiler, Robert; Jüni, Peter; Reichenbach, Stephan; Landolt, Hans; Hasler, Paul


    Objectives Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. Methods A prospective cohort study of a routine clinical practice registry consisting of 370 patients. Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life. Primary outcomes were back pain at 6 and 12 weeks. Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks. We filled in missing outcome variable values with multiple imputation, accounted for repeated measures within patients with mixed-effects models and adjusted baseline group differences in relevant prognostic indicators by inverse probability of treatment weighting. Results Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy (−0.97; 95% CI −1.89 to −0.09), were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks (48% vs 17%, risk difference: 0.34; 95% CI 0.16 to 0.47) and reported less physical function disability at 52 weeks (−3.7; 95% CI −7.4 to −0.1). The other assessments showed minimal between-group differences with CIs, including the null effect. Conclusions Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up. PMID:28003290

  8. Parental employment, family routines and childhood obesity.

    Anderson, Patricia M


    Using the Early Childhood Longitudinal Survey-Kindergarten Class of 1998-1999 (ECLS-K) data from kindergarten through eighth grade, this paper investigate the relationships among maternal employment, family routines and obesity. More hours worked by the mother tend to be negatively related to positive routines like eating meals as a family or at regular times, or having family rules about hours of television watched. Many of these same routines are significantly related to the probability of being obese, implying that family routines may be a mechanism by which maternal employment intensity affects children's obesity. However, inclusion of family routines in the obesity regression does not appreciably change the estimated effect of maternal employment hours. Thus, the commonly estimated deleterious effect of maternal employment on children's obesity cannot be explained by family routines, leaving the exact mechanisms an open question for further exploration. Copyright © 2012 Elsevier B.V. All rights reserved.

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

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


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

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

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


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

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

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


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

  12. Effect of exercise therapy on displacement of the center of rotation of lumbar vertebrae in patients with non-specific chronic low back pain

    Y. Javadian


    Full Text Available Background: The center of rotation (COR of the lumbar vertebrae is one of the important characteristics in evaluation of lumbar spine kinematics. Objective: The aim of this study was to investigate the effect of exercise therapy on displacement of the COR of lumbar vertebrae in patients with non-specific chronic low back pain. Methods: This interventional study was conducted in 30 patients with non-specific chronic low back pain referred to Shahid Beheshti hospital in Babol, 2012. The patients were randomly assigned to two equal groups. For 8 weeks, the patients in the intervention group performed routine plus stabilization exercises while the patients in the control group performed only routine exercises. Radiographic examination was performed in flexion, extension, and neutral views before and after the treatment and the followings were compared: the COR of each lumbar vertebra in global state (rotation of each vertebra relative to the sacrum and relative state (rotation of each vertebra relative to the lower vertebra and in full flexion-extension, flexion, and extension arcs. Data were analyzed using paired T-test and independent sample T-test. Findings: After treatment, the mean difference of the COR of the lumbar vertebrae was only significantly different between the two groups for relative measurement in L3 on y-axis in full flexion-extension arc. In flexion arc, the mean difference of the displacement of the COR was significantly different between the two groups for global measurement in L3 and L5 on y-axis and for relative measurement in L5 on y-axis. In extension arc, the mean difference of the COR of the lumbar vertebrae was not significantly different between the two groups for both global and relative measurements. Conclusion: With regards to the results, it is suggested to consider the displacement of the COR as an objective index in order to evaluate the effect of stabilization exercises.

  13. Oriental Medical Treatment of Lumbar Spinal Stenosis

    Hae-Yeon Lee


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

  14. Hemophilic pseudotumor of the first lumbar vertebra

    Gurusamy Nachimuthu


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

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

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


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

  16. Laparoscopic transabdominal extraperitoneal repair of lumbar hernia

    Sharma A


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

  17. Single incision endoscopic surgery for lumbar hernia.

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


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

  18. Costs and effects in lumbar spinal fusion

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


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

  19. Pedicular stress fracture in the lumbar spine

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


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

  20. Synovial chondromatosis in a lumbar apophyseal joint

    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)


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

  1. Lumbar discal cyst in an elite athlete.

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


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

  2. Subarachnoid hemorrhage due to retained lumbar drain.

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


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

  3. X-Ray parameters of lumbar spine

    Otabek Ablyazov


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

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

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


    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.

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

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


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

  6. Generalization and Alternatives of Kaprekar's Routine

    Smarandache, Florentin


    We extend Kaprekar's Routine for a large class of applications. We also give particular examples of this generalization as alternatives to Kaprekar's Routine and Number. Some open questions about the length of the iterations until reaching either zero or a constant or a cycle, and about the length of the cycles are asked at the end.

  7. Organisational sensemaking, strategy, structuring and routines

    Nielsen, Renate


    my focus will, more specifically, be on how sensemaking processes are transformed into strategy and policies to be applied in daily routines, especially sales/marketing strategy routines. By acquiring a broader comprehension of the structuring and strategising processes the intent is to improve...

  8. 10 CFR 1017.20 - Routine access.


    ... 10 Energy 4 2010-01-01 2010-01-01 false Routine access. 1017.20 Section 1017.20 Energy DEPARTMENT... INFORMATION Access to Unclassified Controlled Nuclear Information § 1017.20 Routine access. (a) Authorized... access to the UCNI, subject to limitations in paragraph (b) of this section, and who may...

  9. Unlearning Established Organizational Routines--Part I

    Fiol, Marlena; O'Connor, Edward


    Purpose: The purpose of this two-part paper is to develop a process model of unlearning established organizational routines. The model traces the interactions among three unlearning sub-processes: ostensive aspects of initial destabilization of an established routine; performative aspects of ongoing discarding-from-use of old behaviors and…

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

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


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

  11. Weightlifter Lumbar Physiology Health Influence Factor Analysis of Sports Medicine.

    Zhang, Xiangyang


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

  12. Elevated levels of phosphorylated neurofilament heavy subunit in the cerebrospinal fluid of patients with lumbar spinal stenosis: preliminary findings.

    Ohya, Junichi; Chikuda, Hirotaka; Kato, So; Hayakawa, Kentaro; Oka, Hiroyuki; Takeshita, Katsushi; Tanaka, Sakae; Ogata, Toru


    The phosphorylated neurofilament heavy subunit (pNfH) is an axon fiber structural protein that is released into the cerebrospinal fluid (CSF) after nerve damage. Although the previous studies have reported elevated CSF levels of pNfH in various neurological diseases, including amyotrophic lateral sclerosis, these levels have not been examined in patients with spinal stenosis. The purpose of this study was to investigate the CSF levels of pNfH in patients with lumbar spinal stenosis (LSS) and to examine the relationship between CSF levels of pNfH and the severity of LSS. This is a prospective observational study. We included consecutive patients with LSS who were undergoing myelography for preoperative evaluation. The CSF samples from patients with idiopathic scoliosis were used as the controls. Physiological measures: CSF levels of pNfH were measured using an enzyme-linked immunosorbent assay. The Zurich Claudication Questionnaire (ZCQ) and the Numerical Rating Scale (NRS) for sciatic pain were used to assess the clinical severity of LSS, and patients were grouped into tertiles according to their symptom severity and pain grading. Axial magnetic resonance imaging was used to evaluate the morphological severity of LSS, and patients were classified into three groups based on their morphological grading (using the CSF/rootlet ratio). Analysis of variance was used to examine the relationship between the CSF levels of pNfH and the severity of LSS. Thirty-three patients with LSS were included (13 men and 20 women and mean age 73.2 [range 58-88] years). Most patients (n=32) were positive for pNfH in their CSF (mean 1,344 [149-9,250] pg/mL), whereas all control subjects were negative for pNfH in their CSF. Regarding the association with clinical severity, patients in the third tertiles of ZCQ and NRS tended to have higher levels of pNfH compared with the other groups. There was no association between the CSF level of pNfH and the morphological severity of LSS. This study

  13. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: bone graft extenders and substitutes as an adjunct for lumbar fusion.

    Kaiser, Michael G; Groff, Michael W; Watters, William C; Ghogawala, Zoher; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Eck, Jason C; Sharan, Alok; Wang, Jeffrey C; Dhall, Sanjay S; Resnick, Daniel K


    In an attempt to enhance the potential to achieve a solid arthrodesis and avoid the morbidity of harvesting autologous iliac crest bone (AICB) for a lumbar fusion, numerous alternatives have been investigated. The use of these fusion adjuncts has become routine despite a lack of convincing evidence demonstrating a benefit to justify added costs or potential harm. Potential alternatives to AICB include locally harvested autograft, calcium-phosphate salts, demineralized bone matrix (DBM), and the family of bone morphogenetic proteins (BMPs). In particular, no option has created greater controversy than the BMPs. A significant increase in the number of publications, particularly with respect to the BMPs, has taken place since the release of the original guidelines. Both DBM and the calciumphosphate salts have demonstrated efficacy as a graft extender or as a substitute for AICB when combined with local autograft. The use of recombinant human BMP-2 (rhBMP-2) as a substitute for AICB, when performing an interbody lumbar fusion, is considered an option since similar outcomes have been observed; however, the potential for heterotopic bone formation is a concern. The use of rhBMP-2, when combined with calcium phosphates, as a substitute for AICB, or as an extender, when used with local autograft or AICB, is also considered an option as similar fusion rates and clinical outcomes have been observed. Surgeons electing to use BMPs should be aware of a growing body of literature demonstrating unique complications associated with the use of BMPs.

  14. Lumbar disk herniation surgery: outcome and predictors.

    Sedighi, Mahsa; Haghnegahdar, Ali


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

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

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


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

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

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


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

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

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


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

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

    Yang, Hae-Sun; Yoo, Won-Gyu


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

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

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


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

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

    Huan-Chieh Chen


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

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

    Yang, Hae-sun; Yoo, Won-gyu


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

  2. 77 FR 41993 - Privacy Act of 1974; Proposed New Routine Use-HUD's Routine Use Inventory


    ... URBAN DEVELOPMENT Privacy Act of 1974; Proposed New Routine Use--HUD's Routine Use Inventory AGENCY... routine uses; and (3) reduce cost and duplication of effort in the publication and maintenance of HUD's.../DEPT-63 Secretary's Correspondence Control System. HUD/DEPT-64 Congregate Housing Services Program Data...

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

    Shapiro, Liza J; Simons, Cornelia V M


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

  4. Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial

    Koes Bart W; Arts Mark P; Brand Ronald; Peul Wilco C; Brouwer Patrick A; Berg Annette; van Buchem Mark A


    Abstract Background The usual surgical treatment of refractory sciatica caused by lumbar disc herniation, is open discectomy. Minimally invasive procedures, including percutaneous therapies under local anesthesia, are increasingly gaining attention. One of these treatments is Percutaneous Laser Disc Decompression (PLDD). This treatment can be carried out in an outpatient setting and swift recovery and return to daily routine are suggested. Thus far, no randomized trial into cost-effectiveness...

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

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


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

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

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


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

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

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


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

  8. Classification of the lumbar disc degeneration using MRI

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


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

  9. Taking medicine at home - create a routine

    ... page: // Taking medicine at home - create a routine To use the ... teeth. Find Ways to Help You Remember Your Medicines You can: Set the alarm on your clock, ...

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

    Lim, Jae Kwan; Kim, Sung Min


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

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

    Park, Chan-Hong; Lee, Sang-Ho


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

  12. Limbus lumbar and sacral vertebral fractures.

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


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

  13. Percutaneous treatment of lumbar disc herniation

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


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

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

    Thomsen, Thomas Laden; Roeder, Ole


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

  15. Routine environmental monitoring schedule, calendar year 1997

    Markes, B.M., Westinghouse Hanford


    This document provides the Environmental Restorations Contractor (ERC) and the Project Hanford Management Contractor.(PHMC) a schedule in accordance with the WHC-CM-7-5, Environmental Compliance` and BHI- EE-02, Environmental Requirements, of monitoring and sampling routines for the Near-Field Monitoring (NFM) program during calendar year (CY) 1997. Every attempt will be made to consistently follow this schedule; any deviation from this schedule will be documented by an internal memorandum (DSI) explaining the reason for the deviation. The DSI will be issued by the scheduled performing organization and directed to Near-Field Monitoring. The survey frequencies for particular sites are determined by the technical judgment of Near- Field Monitoring and may depend on the site history, radiological status, use, and general conditions. Additional surveys may be requested at irregular frequencies if conditions warrant. All radioactive wastes sites are scheduled to be surveyed at least annually. Any newly discovered wastes sites not documented by this schedule will be included in the revised schedule for CY 1998. The outside perimeter road surveys of 200 East and West Area and the rail survey from the 300 Area to Columbia Center will be performed in the year 2000 per agreement with Department of Energy. Richland Field Office. This schedule does not discuss staffing needs, nor does it list the monitoring equipment to be used in completing specific routines. Personnel performing routines to meet this schedule shall communicate any need for assistance in completing these routines to Radiological Control management and Near-Field Monitoring. After each routine survey is completed, a copy of the survey record, maps, and data sheets will be forwarded to Near-Field Monitoring. These routine surveys will not be considered complete until this documentation is received. At the end of each month, the ERC and PHMC radiological control organizations shall forward a copy of the Routine

  16. Sensitivity of lumbar spine loading to anatomical parameters

    Putzer, Michael; Ehrlich, Ingo; Rasmussen, John


    models for four different postures. The in uence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine were studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force......Musculoskeletal simulations of lumbar spine loading rely on a geometrical representation of the anatomy. However, this data has an inherent inaccuracy. This study evaluates the in uence of dened geometrical parameters on lumbar spine loading utilizing ve parametrized musculoskeletal lumbar spine...... were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most in uential. The results indicated that measuring these parameters from X-rays would be most important to morph an existing musculoskeletal...

  17. Improving care coordination using organisational routines.

    Prætorius, Thim


    The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can be replicated, the way they are influenced by the organisation and the way they influence health care professionals. Theory of routines is systematically applied to care pathways in order to develop theoretically derived propositions. Care pathways mirror routines by being recurrent, collective and embedded and specific to an organisation. In particular, care pathways resemble standard operating procedures that can give rise to recurrent collective action patterns. In all, 11 propositions related to five categories are proposed by building on these insights: care pathways and coordination, change, replication, the organisation and health care professionals. Research limitations/implications - The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research. The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals. Originality/value - Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.

  18. Chemoembolization for Hepatocellular Carcinoma Supplied by a Lumbar Artery

    Kim, Han Myun, E-mail: [Hallym University College of Medicine, Department of Radiology, Kangnam Sacred Heart Hospital (Korea, Republic of); Kim, Hyo-Cheol, E-mail:; Woo, Sungmin, E-mail: [Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Department of Radiology (Korea, Republic of); Son, Kyu Ri, E-mail: [Korea University College of Medicine, Department of Radiology, Korea University Medical Center (Korea, Republic of); Cho, Seong Whi, E-mail: [Kangwon National University College of Medicine, Department of Radiology, Kangwon National University Hospital (Korea, Republic of); Chung, Jin Wook, E-mail: [Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Department of Radiology (Korea, Republic of)


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

  19. Agreement in the Interpretation of Magnetic Resonance Images of the Lumbar Spine

    Kovacs, F.M. (Dept. Cientfico, Fundacin Kovacs, Palma de Majorca (Spain)); Royuela, A. (Spanish Back Pain Research Network, Fundacin Kovacs, Palma de Majorca (Spain)); Jensen, T.S. (Back Research Center, Backcenter Funen, Ringe (Denmark)) (and others)


    Background: Correlation between clinical features and magnetic resonance imaging (MRI) findings is essential in low-back-pain patients. Most previous studies have analyzed concordance in the interpretation of lumbar MRI among a few radiologists who worked together. This may have overestimated concordance. Purpose: To evaluate intra- and interobserver agreement in the interpretation of lumbar MRI performed in an open 0.2T system. Material and Methods: Seven radiologists from two different geographic settings in Spain interpreted the lumbar MRIs of 50 subjects representative of the general Danish population aged 40 years. The radiologists interpreted the images in routine clinical practice, having no knowledge of the clinical and demographic characteristics of the subjects and blinded to their colleagues' assessments. Six of the radiologists evaluated the same MRIs 14 days later, having no knowledge of the previous results. Data on the existence of disc degeneration, high-intensity zones, disc contour, Schmorl nodes, Modic changes, osteophytes, spondylolisthesis, and spinal stenosis were collected in the Nordic Modic Consensus Group Classification form. Intra- and interobserver agreement was analyzed for variables with a prevalence =10% and =90% by means of the kappa statistic. Results: Intra- and interobserver agreement was excellent for variables related to Modic changes, and fair to good for disc contour, high-intensity zones, and Schmorl nodes. The evaluations for disc degeneration and osteophytes were found to have fair to good intraobserver agreement and poor interobserver agreement. The agreement for the evaluations of spondylolisthesis and spinal stenosis was not analyzed because they were observed in <10% of reports. Conclusion: Images from 0.2T MRIs appear to lead to good agreement in the reporting of disc contour, high-intensity zones, Schmorl nodes, and, in particular, Modic changes, suggesting that they can possibly be reliably used for clinical

  20. Preoperative MRI findings predict two-year postoperative clinical outcome in lumbar spinal stenosis.

    Pekka Kuittinen

    Full Text Available To study the predictive value of preoperative magnetic resonance imaging (MRI findings for the two-year postoperative clinical outcome in lumbar spinal stenosis (LSS.84 patients (mean age 63±11 years, male 43% with symptoms severe enough to indicate LSS surgery were included in this prospective observational single-center study. Preoperative MRI of the lumbar spine was performed with a 1.5-T unit. The imaging protocol conformed to the requirements of the American College of Radiology for the performance of MRI of the adult spine. Visual and quantitative assessment of MRI was performed by one experienced neuroradiologist. At the two-year postoperative follow-up, functional ability was assessed with the Oswestry Disability Index (ODI 0-100% and treadmill test (0-1000 m, pain symptoms with the overall Visual Analogue Scale (VAS 0-100 mm, and specific low back pain (LBP and specific leg pain (LP separately with a numeric rating scale from 0-10 (NRS-11. Satisfaction with the surgical outcome was also assessed.Preoperative severe central stenosis predicted postoperatively lower LP, LBP, and VAS when compared in patients with moderate central stenosis (p<0.05. Moreover, severe stenosis predicted higher postoperative satisfaction (p = 0.029. Preoperative scoliosis predicted an impaired outcome in the ODI (p = 0.031 and lowered the walking distance in the treadmill test (p = 0.001. The preoperative finding of only one stenotic level in visual assessment predicted less postoperative LBP when compared with patients having 2 or more stenotic levels (p = 0.026. No significant differences were detected between quantitative measurements and the patient outcome.Routine preoperative lumbar spine MRI can predict the patient outcome in a two-year follow up in patients with LSS surgery. Severe central stenosis and one-level central stenosis are predictors of good outcome. Preoperative finding of scoliosis may indicate worse functional ability.

  1. Computed Tomography of the lumbar facet joints

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


    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. The reasons for delay lumbar puncture

    MH. Lotfi


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

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

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


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

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

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


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

  5. 49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.


    ... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine, abdomen, and pelvis assembly and...) ANTHROPOMORPHIC TEST DEVICES 6-Year-Old Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The lumbar spine, abdomen, and pelvis consist of...

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

    JIA Yu-hua; SUN Peng-fei


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


    Nicolas Scheverin


    Full Text Available Objective:To assess the prophylactic effects of local vancomycin on an infection of the surgical site in patients undergoing lumbar instrumented fusion.Methods:Retrospective study from January 2011 to June 2014 in patients with symptomatic and refractory lumbar spine stenosis and listhesis who underwent instrumented pedicle screw spinal fusion. Two groups of patient were analyzed, one using vancomycin on the surgical site, vancomycin group (VG and the control group (CG without topical vancomycin. The routine prophylactic procedures were performed in both groups: aseptic scrub technique, skin preparation, preoperative intravenous antibiotic therapy. The VG received a dose of 1g of vancomycin mixed with the bone graft every three spinal levels fused and the group consisted of 232 patients.Results:513 patients were analyzed, 232 in the VG and 281 in the CG. There was no statistical difference between the groups when the sex, mean surgery length, and mean bleeding volume were considered. The rate of infection for VG was reduced from 4.98% to 1.29% when compared with CG.Conclusion:The use of vancomycin added to the bone graft in posterior spinal fusion is associated with significantly lower rates of infection.

  8. Subjective refraction: the mechanism underlying the routine.

    Harris, W F


    The routine of subjective refraction is usually understood, explained and taught in terms of the relative positions of line or point foci and the retina. This paper argues that such an approach makes unnecessary and sometimes invalid assumptions about what is actually happening inside the eye. The only assumption necessary in fact is that the subject is able to guide the refractionist to (or close to) the optimum power for refractive compensation. The routine works even in eyes in which the interval of Sturm does not behave as supposed; it would work, in fact, regardless of the structure of the eye. The idealized subjective refraction routine consists of two steps: the first finds the best sphere (the stigmatic component) and the second finds the remaining Jackson cross-cylinder (the antistigmatic component). The model makes use of the concept of symmetric dioptric power space. The second part of the refraction routine can be performed with Jackson cross-cylinders alone. However, it is usually taught and practiced using spheres, cylinders and Jackson cross-cylinders in a procedure that is not easy to understand and learn. Recognizing that this part of the routine is equivalent to one involving Jackson cross-cylinders only allows one to teach and understand the procedure more naturally and easily.

  9. Ipsilateral pedicle screw placement with contralateral percutaneous facet screws: Early results with an alternative in lumbar arthrodesis

    Richard B Rhiew


    Full Text Available Richard B Rhiew, Sunil Manjila, Andrew M Lozen, David Hong, Murali Guthikonda, S S RengacharyDepartment of Neurosurgery, Wayne State University, Detroit, MI, USAAbstract: Transforaminal lumbar interbody fusion (TLIF is a widely used method of surgical treatment for a variety of lumbar spinal disorders. Bilateral transpedicular instrumentation is routinely used in conjunction with an interbody graft to provide additional stability. In this technical note, we describe our fusion construct using ipsilateral pedicle screw placement on the side of TLIF and contralateral facet screw placement. We performed this construct at six levels in four patients. Suggested advantages include: low morbidity, small incision and lower cost. Outcomes parameters included radiographic evidence of solid union at four months and improvement in Oswestry Disability Index. A mean improvement from a preoperative score of 73 to 26 after surgery was observed at one-year follow-up. There were no instrument-related complications. In conclusion, this hybrid screw system minimizes contralateral dissection and is an attractive alternative to standard bilateral pedicle screw fixation.Keywords: TLIF, facet screw, pedicle screw, lumbar spine fusion


    Luis Muñiz Luna


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

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

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


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

  12. Improving care coordination using organisational routines

    Prætorius, Thim


    Purpose: This conceptual article systematically applies theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can......: care pathways and (a) coordination, (b) change, (c) replication, (d) the organisation and (e) health care professionals. Research limitations/implications: The article is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point...... for empirical research. Practical implications: The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals...

  13. Routine Radiological Environmental Monitoring Plan. Volume 1

    Bechtel Nevada


    The U.S. Department of Energy manages the Nevada Test Site in a manner that meets evolving DOE Missions and responds to the concerns of affected and interested individuals and agencies. This Routine Radiological Monitoring Plan addressess complicance with DOE Orders 5400.1 and 5400.5 and other drivers requiring routine effluent monitoring and environmental surveillance on the Nevada Test Site. This monitoring plan, prepared in 1998, addresses the activities conducted onsite NTS under the Final Environmental Impact Statement and Record of Decision. This radiological monitoring plan, prepared on behalf of the Nevada Test Site Landlord, brings together sitewide environmental surveillance; site-specific effluent monitoring; and operational monitoring conducted by various missions, programs, and projects on the NTS. The plan provides an approach to identifying and conducting routine radiological monitoring at the NTS, based on integrated technical, scientific, and regulatory complicance data needs.

  14. Active stereo vision routines using PRISM-3

    Antonisse, Hendrick J.


    This paper describes work in progress on a set of visual routines and supporting capabilities implemented on the PRISM-3 real-time vision system. The routines are used in an outdoor robot retrieval task. The task requires the robot to locate a donor agent -- a Hero2000 -- which holds the object to be retrieved, to navigate to the donor, to accept the object from the donor, and return to its original location. The routines described here will form an integral part of the navigation and wide-area search tasks. Active perception is exploited to locate the donor using real-time stereo ranging directed by a pan/tilt/verge mechanism. A framework for orchestrating visual search has been implemented and is briefly described.

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

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


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

  16. Direction of the formation of anterior lumbar vertebral osteophytes

    Akeda Koji


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

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

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


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

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

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


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

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

    Yang Zhang

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

  20. Examination of the Circle Spline Routine

    Dolin, R. M.; Jaeger, D. L.


    The Circle Spline routine is currently being used for generating both two and three dimensional spline curves. It was developed for use in ESCHER, a mesh generating routine written to provide a computationally simple and efficient method for building meshes along curved surfaces. Circle Spline is a parametric linear blending spline. Because many computerized machining operations involve circular shapes, the Circle Spline is well suited for both the design and manufacturing processes and shows promise as an alternative to the spline methods currently supported by the Initial Graphics Specification (IGES).

  1. Absorptive routines and international patent performance

    Fernando E. García-Muiña


    We enrich the treatment of the absorptive capacity phases including the moderating effects between routines associated to the traditional potential-realized absorptive capacities. Taking into account external knowledge search strategies, the deeper external relationships, the better transference and appropriation of specific external knowledge. Nevertheless, when the moderating role of assimilation is included, cooperation agreements appear as the most efficient source of external knowledge. Finally, we show that technological tools let firms store and structure the information making easier its use for international patenting. This positive effect is reinforced in the presence of exploitation routines, since technological knowledge will better fit to the industry's key factors of success.

  2. Conversational routines in English convention and creativity

    Aijmer, Karin


    It is surprising how much of everyday conversation consists of repetitive expressions such as 'thank you', 'sorry', would you mind?' and their many variants. However commonplace they may be, they do have important functions in communication.This thorough study draws upon original data from the London-Lund Corpus of Spoken English to provide a discoursal and pragmatic account of the more common expressions found in conversational routines, such as apologising, thanking, requesting and offering.The routines studied in this book range from conventionalized or idiomatized phrases t


    WANG Zhan-hui


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

  4. Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

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


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

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

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


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

  6. Microendoscopic discectomy for treatment of lumbar disc herniation

    ARJUN Sinkemani; WU Xiao-tao


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

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

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


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

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

    Cleopatra Cabrera Cuellar


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

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

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


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

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

    Eun, Jong-Pil; Oh, Young-Min


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

  11. Manejo del síndrome doloroso lumbar Management of lumbar syndrome

    Rafael Rivas Hernández


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

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

    Gagne, Allison R; Hasson, Scott M


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

  13. Lumbar disc cyst with contralateral radiculopathy

    Kishore Tourani


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

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

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


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

  15. Minimal Access Spinal Technologies (Mast Fusion Procedures For The Treatment Of The Degenerative Lumbar Spine (A Part Of Multicentral Prospective Study

    Khoshab A.H.


    Full Text Available A prospective multicentral observational study of minimally invasive fusion to treat degenerative lumbar disorders, and to report outcomes of one or two level minimally invasive posterior lumbar interbody fusion (MLIF for degenerative lumbar disorders in a multi-center 1-year prospective study. We prospectively studied a group of 32 patients, mostly female 24 ( 75% female , and 8 males ( 25%. They underwent minimally invasive transforaminal lumbar interbody fusion (mTLIF, 21 of them monosegmental and 11 bisegmental. Patients demographics, intraoperative data and complications were recorded. Time to first ambulation, time to study-defined recovery, surgical duration, blood loss, fluoroscopy time and adverse events were recorded. Visual analogue scale (VAS of back and legs pain, Oswestry disability index (ODI and health-related questionnaire (EQ-5D were assessed preoperatively and at defined time points through 12 months postoperatively. Mean surgical duration, blood loss and intraoperative fluoroscopy time were 125 vs.175 minutes, 150 vs. 170 ml, and 105 vs. 145 seconds in one- and twolevel segments, respectively. Mean preoperative VAS back (6.5 and VAS leg (7.9 scores dropped significantly (p<0.0001 to 3.5 (2.6 and 2.1 (2.0 at discharge (6 weeks. At the end, this is the largest prospective multi-center observational study of MLIF to date, following routine local standard of practice and, MLIF demonstrated favourable clinical results with early and sustained improvement in patient reported outcomes and low major perioperative morbidity.

  16. Rehabilitation Nursing Experience of 105 Cases of Lumbar Disc Herniation%105例腰椎问盘突出症的康复护理体会



    目的寻找腰椎问盘突出症的康复护理方法。方法将105例腰椎间盘突出症患者,在常规康复治疗(针灸、动力灸、物理因子治疗等)的基础上,采用综合康复护理,观察效果。结果综合康复护理在腰椎问盘突出症的康复中取得了较好的效果。结论综合康复护理是腰椎问盘突出症康复的有效方法。%Objective To search for the lumbar intervertebral disc protrusion rehabilitation nursing method.Methods 105 cases of patients with lumbar disc herniation, in routine rehabilitation treatment (acupuncture, moxibustion, dynamic physical factor treatment etc.) basis, by comprehensive rehabilitation nursing, observe the ef ect.Results The comprehensive rehabilitation nursing disc herniation rehabilitation achieved good results in the lumbar spine.Conclusion The comprehensive rehabilitation nursing is lumbar intervertebral disc herniation of the ef ective method of rehabilitation.

  17. The (Proper) Microfoundations of Routines and Capabilities

    Felin, Teppo; Foss, Nicolai Juul


    Sidney Winter (2011), Brian Pentland (2011), and Geoffrey Hodgson and Thorbjørn Knudsen (2011) take issue with the arguments in Teppo Felin and Nicolai J. Foss (2011), along with more generally critiquing the ‘microfoundations project’ related to routines and capabilities. In this rejoinder we...

  18. Value of routine polysomnography in bariatric surgery

    de Raaff, C.A.L.; Pierik, A.S.; Coblijn, U.K.; de Vries, N.; Bonjer, H.J.; van Wagensveld, B.A.


    Background: Obstructive sleep apnea (OSA), present in 60–70 % of bariatric surgery patients, is a potentially life-threatening condition when not detected and managed appropriately. The best available method to identify the severity of OSA is polysomnography. However, routine polysomnography

  19. On the stability of numerical integration routines.

    Glover, K.; Willems, J. C.


    Numerical integration methods for the solution of initial value problems for ordinary vector differential equations may be modelled as discrete time feedback systems. The stability criteria discovered in modern control theory are applied to these systems and criteria involving the routine, the step size and the differential equation are derived. Linear multistep, Runge-Kutta, and predictor-corrector methods are all investigated.

  20. Detecting asymptomatic coronary artery disease using routine ...


    Sep 1, 1990 ... ramp filter. Orthogonal reconstructions of the ... regarded as an end-point for the purpose of the algorithm and all patients were routinely ... years (mean 59 years) and the group consisted of 28 men and 4 women. Four patients ...

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

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


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

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

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


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

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

    Keyvan Mostofi


    Full Text Available Minimally invasive spine surgery prevents alteration of paraspinal muscles and avoids traditional open surgery, so in the majority of cases, recovery is much quicker and patients have less back pain after surgery. The authors describe an endoscopic approach to lumbar disc herniation by the Destandau's method originated in Bordeaux. Destandau designed ENDOSPINE for discectomy will be inserted, and the procedure will continue using endoscopy. The Endoscopic approach to lumbar disc herniation by Destandau's method offers a convenient access to lumbar disc herniation with less complications and negligible morbidity. It gives maximum exposure to the disc space with maximal angles and minimal cutaneous incision. Contrary to other minimally invasive approaches, the visual field in discectomy by Destandau technique is broad and depending on the workability of ENDOSPINE an adequate access to lumbar disc herniation is possible.

  4. Assessment of Residents Readiness to Perform Lumbar Puncture

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


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

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

    Rajendra Nath


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

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

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


    The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks.

  7. Lumbar puncture in patients using anticoagulants and antiplatelet agents

    Renan Domingues


    Full Text Available ABSTRACT The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks.

  8. Laparoscopic tension-free hernioplasty for lumbar hernia.

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


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

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

    Amelio Gianfranco


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

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

    Ana-Maria BOTEZAN


    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

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

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


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

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

    Žontar, Dejan; Škrk, Damijan; Mekiš, Nejc


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

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

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


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

  14. Cerebellar Herniation after Lumbar Puncture in Galactosemic Newborn

    Salih Kalay


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

  15. Iliac artery pseudoaneurysm after lumbar disc hernia operation

    Mehmet Atay


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

  16. Effect of Load Carriage on Lumbar Spine Kinematics


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

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

    Federico De Iure


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

  18. Lumbar puncture in patients using anticoagulants and antiplatelet agents

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


    ABSTRACT The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmaco...

  19. Reproducibility of tomographic evaluation of posterolateral lumbar arthrodesis consolidation

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


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

  20. Kidney herniation through lumbar triangle following open pyeloplasty

    Qais Al Hooti


    Full Text Available Kidney herniation through the lumbar triangle is an uncommon type of hernia which is classically managed surgically. Contrast enhanced computerised tomography revealed lower pole of the right kidney herniating through the lumbar triangle in a 60-year-old woman, 10 years after an open right pyeloplasty. Surgical intervention was advised, however, patient opted for non-surgical management. Patient was successfully treated conservatively in clinic requiring regular analgesics for relief of mild pain.

  1. Laparoscopic repair of left lumbar hernia after laparoscopic left nephrectomy.

    Gagner, Michel; Milone, Luca; Gumbs, Andrew; Turner, Patricia


    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair.

  2. Lumbar Spine Musculoskeletal Physiology and Biomechanics During Simulated Military Operations


    Significant decreases in lumbar lordosis were found through all levels except L1-L2 when sitting. When prone on elbows, the only increase in lumbar lordosis...was found at L5-S1. A caudal increase in fat fraction of the multifidus was observed, with no significant increase in the erector spine. No...proportional to Pfirrmann grade. No significant differences were found between volume, fat fraction, T2, or DTI in any of the muscles in subjects with disc

  3. Neutral lumbar spine sitting posture in pain-free subjects

    O'Sullivan, Kieran; O'Dea, Patrick; Dankaerts, Wim; O'Sullivan, Peter; Clifford, Amanda; O'Sullivan, Leonard


    Sitting is a common aggravating factor in low back pain (LBP), and re-education of sitting posture is a common aspect of LBP management. However, there is debate regarding what is an optimal sitting posture. This pilot study had 2 aims; to investigate whether pain-free subjects can be reliably positioned in a neutral sitting posture (slight lumbar lordosis and relaxed thorax); and to compare perceptions of neutral sitting posture to habitual sitting posture (HSP). The lower lumbar spine HSP o...

  4. Sensitivity of lumbar spine loading to anatomical parameters.

    Putzer, Michael; Ehrlich, Ingo; Rasmussen, John; Gebbeken, Norbert; Dendorfer, Sebastian


    Musculoskeletal simulations of lumbar spine loading rely on a geometrical representation of the anatomy. However, this data has an inherent inaccuracy. This study evaluates the influence of defined geometrical parameters on lumbar spine loading utilising five parametrised musculoskeletal lumbar spine models for four different postures. The influence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine was studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most influential. These parameters can be easily acquired from X-rays and should be used to morph a musculoskeletal lumbar spine model for subject-specific approaches with respect to bone geometry. Furthermore, the model was very sensitive to uncommon configurations and therefore, it is advised that stiffness properties of discs and ligaments should be individualised.

  5. [Lumbar herniated disks treated with a dynamic interspacer].

    Cueva-del Castillo Mendoza, J F; Franco-López, E A; Hinojosa-Sandoval, F; de León-Martínez, U A; Cueva-del Castillo Mendoza, F J


    Lumbar herniated disks result in lumbar pain with neurologic involvement. Medical treatment and rehabilitation provide improvement for this type of lumbar pain at the early stages. When conservative treatment fails, the surgical option offers the possibility of improving patients' health status. Moojen considers that the application of interspinous spacers provides good results. The purpose of this research is to assess the clinical and imaging results in patients with contained lumbar herniated disk treated with the DYNAMIC INTERSPACER interspinous spacer, a Mexican product. The efficacy of the interspinous device was assessed by means of a near-investigational and longitudinal study conducted at "General Ignacio Zaragoza" ISSSTE Regional Hospital in patients with a diagnosis of lumbar pain. The mean age of the sample is 46.1 years, with an age range of 26-55 years. The treated levels were 6 L5-S1 and 5 L4-L5; two levels were treated in two patients. The mean preoperative VAS score was 8.1. The mean VAS score at postoperative year three was 1.6. Multiple types and brands of foreign interspinous devices are applied in Mexico which results in patients' clinical improvement. We proved that the use of the Mexican interspinous device can clinically improve patients with lumbar pain due to herniated disk. A decrease in the compression of the sac or the nerve roots by the hernia was observed in the comparative preoperative and postoperative MRI images.

  6. Probability and statistics with integrated software routines

    Deep, Ronald


    Probability & Statistics with Integrated Software Routines is a calculus-based treatment of probability concurrent with and integrated with statistics through interactive, tailored software applications designed to enhance the phenomena of probability and statistics. The software programs make the book unique.The book comes with a CD containing the interactive software leading to the Statistical Genie. The student can issue commands repeatedly while making parameter changes to observe the effects. Computer programming is an excellent skill for problem solvers, involving design, prototyping, data gathering, testing, redesign, validating, etc, all wrapped up in the scientific method.See also: CD to accompany Probability and Stats with Integrated Software Routines (0123694698)* Incorporates more than 1,000 engaging problems with answers* Includes more than 300 solved examples* Uses varied problem solving methods

  7. External Agents' Effect on Routine Dynamics

    Busse Hansen, Nicolai

    over others. In producing an action, the relevant next action is projected. However the relevant next action is projected in a specific way and if this is not taken in to account then the routine becomes disrupted. Another core aspect is the notion of deontics that lends itself towards describing who...... and affiliation are central to how routines are maintained but also susceptible to disruption in case of mis- management. Also the paper contributes with a more fine-tuned understanding of action in terms of them being organized in accordance with preference, which basically means that some actions are preferred...... has the rights to constrict the relevant next action. As it is shown, the major portion of this resides on part of the interviewers. The added value of this endeavor is showing how detailed analyses of face-to-face interac- tion can provide a step towards a more detailed understanding of the social...

  8. Primary culture media for routine urine processing.

    Fung, J C; Lucia, B; Clark, E.; Berman, M.; Goldstein, J.; D'Amato, R F


    It has been recommended that routine microbiological processing of urine specimens include quantitative plating onto blood agar medium along with a selective and differential agar such as MacConkey agar for gram-negative organisms. Few data have been published to justify this combination. To evaluate the validity of this recommendation 2,553 midstream, clean-voided urine samples were quantitatively plated onto blood agar, MacConkey agar, and colistin-nalidixic acid agar, which is a selective ...

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

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


    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.

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

    Guo, Shuguang; Sun, Junying; Tang, Genlin


    The aim of this study was to observe the clinical effects of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability. The 48 patients comprised 27 males and 21 females, aged 47-72 years. Three cases had first and second degree lumbar spondylolisthesis and all received bilateral vertebral lamina fenestration for posterior lumbar interbody fusion (PLIF) using a threaded fusion cage (TFC), which maintains the three-column spinal stability. Attention was given to ensure the correct pre-operative fenestration, complete decompression and the prevention of adhesions. After an average follow-up of 26.4 months, the one year post-operative X-ray radiographs suggested that the successful fusion rate was 88.1%, and this was 100% in the two-year post-operative radiographs. Moreover, the functional recovery rate was 97.9%. Bilateral vertebral lamina fenestration for lumbar interbody fusion is an ideal surgical method for the treatment of lower lumbar instability. The surgical method retains the spinal posterior column and middle column and results in full decompression and reliable fusion by a limited yet effective surgical approach.

  11. Intervertebral disc degeneration and bone density in degenerative lumbar scoliosis: a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosis

    DING Wen-yuan; YANG Da-long; CAO Lai-zhen; SUN Ya-peng; ZHANG Wei; XU Jia-xin; ZHANG Ying-ze; SHEN Yong


    Background Degenerative lumbar scoliosis is common in older patients.Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis.A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed.The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.Methods From January 2001 to August 2010,96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls.Cobb angle,height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides,the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group.The height of L2/L3,L3/L4,L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group.The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups.The bone density of lumbar vertebrae was measured with dual-energy X-ray.Results In scoliosis group,the intervertebral disc height on the convex side was greater than the height on the concave side (P <0.001 ).The vertebral body height on the convex side was greater than the height on the concave side (P=0.016).There was a significant difference between the scoliosis group and the control group (P=0.003),and between T-value and the rate of osteoporosis between the two groups (both P <0.001).Results were verified using multiple linear regression analysis.Conclusions Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces.There is a positive correlation between the angle of scoliosis and

  12. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems.

    Li-Peng Yu

    Full Text Available BACKGROUND: To evaluate by MRI intervertebral disc degeneration in patients with lumbar degenerative disease using the Pfirrmann grading system and to determine whether Modic changes correlated with the Pfirrmann grades and modified Pfirrmann grades of disc degeneration. METHODS: The clinical data of 108 surgical patients with lumbar degenerative disease were reviewed and their preoperative MR images were analyzed. Disc degeneration was evaluated using the Pfirrmann grading system. Patients were followed up and low back pain was evaluated using the visual analog scale (VAS and the effect of back pain on the daily quality of life was assessed using Oswestry disability index (ODI. RESULTS: Forty-four cases had normal anatomical appearance (Modic type 0 and their Pfirrmann grades were 3.77±0.480 and their modified Pfirrmann grades were of 5.81±1.006. Twenty-seven cases had Modic type I changes and their Pfirrmann grades were 4.79±0.557 and their modified Pfirrmann grades were 7.00±0.832. Thirty-six cases exhibited Modic type II changes and their Pfirrmann grades and modified Pfirrmann grades were 4.11±0.398 and 6.64±0.867, respectively. One case had Modic type III changes. Kruskal-Wallis test revealed significant difference in modified Pfirrmann grade among Modic type 0, I and II changes (P0.05. Binary regression analysis showed that Modic changes correlated most strongly with disc degeneration. Follow up studies indicated that the VAS and ODI scores were markedly improved postoperatively. However, no difference was noted in VAS and ODI scores among patients with different Modic types. CONCLUSION: Modic changes correlate with the Pfirrmann and modified Pfirrmann grades of disc degeneration in lumbar degenerative disease. There is no significant correlation between Modic types and surgical outcomes.

  13. Minimally invasive percutaneous posterior lumbar interbody fusion.

    Khoo, Larry T; Palmer, Sylvain; Laich, Daniel T; Fessler, Richard G


    The wide exposure required for a standard posterior lumbar interbody fusion (PLIF) can cause unnecessary trauma to the lumbar musculoligamentous complex. By combining existing microendoscopic, percutaneous instrumentation and interbody technologies, a novel, minimally invasive, percutaneous PLIF technique was developed to minimize such iatrogenic tissue injury (MIP-PLIF). The MIP-PLIF technique was validated in three cadaveric torsos with six motion segments decompressed and fused. Preoperative variables measured from imaging included interpedicular distance, pedicular height and width, interspinous distance, lordosis, intervertebral height, Cobb angle, and foraminal height and volume. Using the METRx and MD spinal access systems (Medtronic Sofamor Danek, Memphis, TN), bilateral laminotomies were performed using a hybrid of microsurgical and microendoscopic techniques. The intervertebral disc spaces were then distracted and prepared with the Tangent (Medtronic Sofamor Danek) interbody instruments. Either a 10 or 12 by 22 mm interbody graft was then placed. Using the Sextant (Medtronic Sofamor Danek) system, percutaneous pedicle screw-rod fixation of the motion segment was completed. We then applied MIP-PLIF in three patients. For segments with preoperative intervertebral/foraminal height loss, MIP-PLIF was effective in restoring both heights in all cases. The amount of improvement (9.7 to 38% disc height increase; 7.7 to 29.9% foraminal height increase) varied directly with the size of the graft used and the original degree of disc and foraminal height loss. Segmental lordosis improved by 29% on average. Graft and screw placement was accurate in the cadavers, except for a single Grade 1 screw violation of one pedicle. The average operative time was 3.5 hours per level. In our three clinical cases, the MIP-PLIF procedure required a mean of 5.4 hours, estimated blood loss was 185 ml, and inpatient stay was 2.8 days, with no intravenous narcotic use after 2 days in

  14. Adolescent prolapsed lumbar intervertebral disc: Management strategies and outcome

    Pragyan Sarma


    Full Text Available Objective: Lumbar intervertebral disc herniation (LIVDH is rare in children and adolescents when compared to adults. In literature, children generally constitute around 0.5–3% of surgically treated LIVDH. Though much rarer, they are less likely to respond to conservative treatment than adults. In this study, we analyze our experience in the management of adolescent LIVDH (ALIVDH (age group 12–18 years including the demographic, clinico-radiological features; surgical management strategies and outcome. Materials and Methods: This retrospective analysis constituted all patients between 12 and 18 years, who underwent surgery for LIVDH at our institute over a period of 15 years from January 1999 to June 2014. The records of these patients were retrieved, and demographic features, clinical picture, radiological features, operative findings, and postoperative events were evaluated. Follow-up data were obtained either through direct clinical evaluation or mailed self-report questionnaire and telephone conversations. The long-term outcome was analyzed by using standardized and condition specific outcome scales in addition to routine clinical follow-up evaluation. The long-term outcome was analyzed by using the short form-36 (SF-36.Results: There were a total of 32 patients (26 males, eight females with an average age of 15.64 years. Trauma was a significant etiological factor 57.14% (n = 16/28. Vertebral anomalies were present in 35.7% (n = 10/28 cases. Majority had a neurological deficit at presentation (n = 20/28. The most commonly involved level was the L4–L5 level (n = 18/128 in this series. Multiple level disc degeneration was present in eight patients (28.6%. Immediate postoperative relief was achieved in all but one patient. At long-term follow-up twenty patients were pain-free (71.4%. At follow-up, the physical functioning scale of SF-36 was significantly lower in patients with gross motor deficit prior to surgery. Conclusions: Early

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

    Manchikanti L


    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


    Petrea Renato-Gabriel


    Full Text Available The purpose of this paper is to show the importance and utility of swimming within rehabilitation and therapeutic programs for posture deficiencies, in our context for the rehabilitation of lumbar hyperlordosis. We consider that, by using exercises specific to swimming and means specific to acquiring swimming procedures, we will reduce the range of lumbar hyperlordosis. More precisely, we believe that, through exercises specific to swimming, we will reduce the range of lumbar hyperlordosis by at least 15 mm. Our study comprise three subjects (young girls, who suffer from lumbar hyperlordosis. For establishing the diagnostic, the following examinations and tests took place: anamnesis; somatoscopy; somatometry; muscular testing; specific tests (Schõber, “finger-floor”. The therapeutic program applied included the following: exercises for learning and consolidating the swimming procedures of crawl, backstroke, breaststroke and butterfly. The rehabilitation program lasted five months and a half; we had two sessions per week, each session of 35-40 minutes; water temperature ranged between 29 and 31 degrees Celsius. Initial testing showed that the lordosis amplitude was 70 mm for subject A.B., 60 mm for subject R.A. and 55 mm for subject S.A. At the end of research the results of the lordosis amplitude were 52 mm for subject A.B., 45 mm for subject R.A. and 40 mm for subject S.A. The conclusion of this study underlines that the early and correct intervention through individualized rehabilitation programs for lumbar hyperlordosis leads to a decrease in the lumbar curvature, down to physiological values. In addition, the means used for acquiring and consolidating swimming procedures can constitute important means in the rehabilitation process for lumbar hyperlordosis.

  17. Lubrication regimes in lumbar total disc arthroplasty.

    Shaheen, A; Shepherd, D E T


    A number of total disc arthroplasty devices have been developed. Some concern has been expressed that wear may be a potential failure mode for these devices, as has been seen with hip arthroplasty. The aim of this paper was to investigate the lubrication regimes that occur in lumbar total disc arthroplasty devices. The disc arthroplasty was modelled as a ball-and-socket joint. Elastohydrodynamic lubrication theory was used to calculate the minimum film thickness of the fluid between the bearing surfaces. The lubrication regime was then determined for different material combinations, size of implant, and trunk velocity. Disc arthroplasties with a metal-polymer or metal-metal material combination operate with a boundary lubrication regime. A ceramic-ceramic material combination has the potential to operate with fluid-film lubrication. Disc arthroplasties with a metal-polymer or metal-metal material combination are likely to generate wear debris. In future, it is worth considering a ceramic-ceramic material combination as this is likely to reduce wear.

  18. Computed tomography in lumbar degenerative disease

    Isu, Toyohiko; Miyasaka, Kazuo; Abe, Satoru; Takei, Hidetoshi; Kaneda, Kiyoshi (Hokkaido Univ., Sapporo (Japan). School of Medicine)


    We reported the 18 patients which underwent surgical exploration and reviewed these CT findings. Method All CT scans were obtained on Somatom II, high resolution CT scanner, with the patient in the supine position. A lateral localizer image (Topogram) was used to select the appropriate intervertebral disk space. The slice thickness was 4 mm. Results 1) CT findings in lumbar degenerative diseases include bony canal stenosis (central canal stenosis, narrowed lateral recess), soft tissue abnormalities (herniated nucleus pulposus, bulging annulus, hypertrophy and/or ossification of ligamentum flavum, no delineation of nerve root in lateral recess), and spinal instability (spondylolisthesis, vacuum phenomenon). 2) The above three factors contribute to narrowing of spinal canal. 3) No delineation of nerve root or soft tissue replacement of epidural fat in lateral recess suggests that the nerve root may be compressed by some factors. 4) Herniated nucleus pulposus may cause nerve root compression with or without canal stenosis. Conclusion This study revealed that the CT findings correlated closely with the surgical findings and the site of nerve root compression could be determined.

  19. Clinical clerkship course for medical students on lumbar puncture using simulators.

    Adachi, Koji; Yoshimura, Akinobu; Aso, Ryoko; Miyashita, Tsuguhiro; Yoshida, Daizo; Teramoto, Akira; Shimura, Toshiro


    Lumbar puncture is a medical technique that physicians must learn and is, therefore, considered a basic medical procedure. The lumbar puncture simulators Lumbar-Kun (Lumbar Puncture Simulator) and Lumbar-Kun II (Lumbar Puncture Simulator II) (Kyoto Kagaku, Kyoto, Japan) are teaching aids designed for practicing spinal insertions. We describe and results of a lumbar puncture clerkship course, provided to 5th-year medical students during clinical clerkship activity. The aim of this study was to evaluate the effectiveness of the lumbar puncture clerkship course in the medical education program. Comprehension, technical achievement, and satisfaction were scored by students and instructors using a 6-point Likert scale. Scores for both comprehension and technical achievement were high, but technical achievement scores tended to be higher than comprehension scores. In addition, the scores students gave themselves were higher than the scores they were given by instructors. Student satisfaction was high. The lumbar puncture simulators, Lumbar-Kun and Lumbar-Kun II, achieved excellent overall impressions and represent useful tools for training in lumbar puncture procedures. In addition to the simulators, an appropriate preparatory text and a short lecture before training seemed to increase the educational effect of this lumbar puncture clerkship course for medical students.

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

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


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

  1. Congenital lumbar hernia associated to lumbar costovertebral syndrome. A case report. Hernia lumbar congénita asociada a síndrome lumbocostovertebral. Reporte de un caso.

    Yusimy Izaguirre Martínez


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

    Se reporta el caso de una paciente de color de piel blanca, de 6 años de edad, nacida de embarazo y parto normal que fue valorada en el Servicio de Cirugía del Hospital Pediátrico ¨Paquito González Cueto¨ debido a que presentaba aumento de volumen en ambas regiones lumbares, sin otra sintomatología asociada. Se diagnostica hernia lumbar bilateral congénita asociada a síndrome lumbocostovertebral, afección rara en la edad pediátrica.

  2. Is lumbar facet fusion biomechanically equivalent to lumbar posterolateral onlay fusion?

    Toth, Jeffrey M; Foley, Kevin T; Wang, Mei; Seim, Howard B; Simon Turner, A


    OBJECTIVE This study was designed with the following research objectives: 1) to determine the efficacy of facet fusion with recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS) in an ovine lumbar facet fusion model; 2) to radiographically and histologically compare the efficacy of lumbar facet fusion with rhBMP-2/ACS to facet fusion with an iliac crest bone graft (ICBG); and 3) to biomechanically compare lumbar facet fusion with rhBMP-2/ACS to lumbar posterolateral fusion (PLF) with ICBG. METHODS The efficacies of the 3 treatments to induce fusion were evaluated in an instrumented ovine lumbar fusion model. Eight sheep had 10 cm(3)/side ICBG placed as an onlay graft for PLF at L2-3. At the adjacent L3-4 level, 0.5 cm(3)/side ICBG was placed for facet fusion. Finally, 0.5 cm(3)/side rhBMP-2/ACS (0.43 mg/ml) was placed for facet fusion at L4-5. CT scans were obtained at 2, 4, and 6 months postoperatively with 2 reviewers conducting an evaluation of the 6-month results for all treated spinal levels. All 8 sheep were killed at 6 months, and all posterolateral instrumentation was removed at this time. The spines were then sectioned through L3-4 to allow for nondestructive unconstrained biomechanical testing of the L2-3 and L4-5 segments. All treated spinal levels were analyzed using undecalcified histology with corresponding microradiography. Statistical comparisons were made between the treatment groups. RESULTS The PLF with ICBG (ICBG PLF group) and the rhBMP-2 facet fusion (rhBMP-2 Facet group) treatment groups demonstrated similar levels of stiffness, with the rhBMP-2 Facet group having on average slightly higher stiffness in all 6 loading directions. All 8 levels in the autograft facet fusion treatment group demonstrated CT radiographic and histological fusion. All 8 levels in the rhBMP-2 Facet group showed bilateral CT radiographic and histological fusion. Six of 16 rhBMP-2/ACS-treated facet defects demonstrated small

  3. Cost-utility of routine cataract surgery

    Ryynänen Olli-Pekka


    Full Text Available Abstract Background If decisions on health care spending are to be as rational and objective as possible, knowledge on cost-effectiveness of routine care is essential. Our aim, therefore, was to evaluate the cost-utility of routine cataract surgery in a real-world setting. Methods Prospective assessment of health-related quality of life (HRQoL of patients undergoing cataract surgery. 219 patients (mean (SD age 71 (11 years entering cataract surgery (in 87 only first eye operated, in 73 both eyes operated, in 59 first eye had been operated earlier filled in the 15D HRQoL questionnaire before and six months after operation. Direct hospital costs were obtained from a clinical patient administration database and cost-utility analysis performed from the perspective of the secondary care provider extrapolating benefits of surgery to the remaining statistical life-expectancy of the patients. Results Mean (SD utility score (on a 0–1 scale increased statistically insignificantly from 0.82 (0.13 to 0.83 (0.14. Of the 15 dimensions of the HRQoL instrument, only seeing improved significantly after operation. Mean utility score improved statistically significantly only in patients reporting significant or major preoperative seeing problems. Of the subgroups, only those whose both eyes were operated during follow-up showed a statistically significant (p Conclusion Mean utility gain after routine cataract surgery in a real-world setting was relatively small and confined mostly to patients whose both eyes were operated. The cost of cataract surgery per quality-adjusted life year gained was much higher than previously reported and associated with considerable uncertainty.



    Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis. Methods From April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups. Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion. The two groups were compared for clinical and radiological outcomes. Results All patients were followed up for 12 to 72 months. In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24). Two cases suffered from residual symptoms. Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%. No infection or neurological complication occurred in this group. In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90. 5% ( 19/21 ). One case suffered from residual symptoms. Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%. Four cases of infection or neurological complication occurred in this group. Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during followup. But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.Conclusions The first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion. Only when patients suffer from severe preoperative disc

  5. Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain.

    Hildebrandt, Markus; Fankhauser, Gabriela; Meichtry, André; Luomajoki, Hannu


    Lumbar multifidus muscles (LMM) are important for spinal motion and stability. Low back pain (LBP) is often associated with fat infiltration in LMM. An increasing fat infiltration of LMM may lead to lumbar dysfunction. The purpose of this study was to investigate whether there is a correlation between the severity of lumbar dysfunction and the severity of fat infiltration of LMM. In a cross-sectional study, 42 patients with acute or chronic LBP were recruited. Their MRI findings were visually rated and graded using three criteria for fat accumulation in LMM: Grade 0 (0-10%), Grade 1 (10-50%) and Grade 2 (>50%). Lumbar sagittal range of motion, dynamic upright and seated posture control, sagittal movement control, body awareness and self-assessed functional disability were measured to determine the patients' low back dysfunction. The main result of this study was that increased severity of fat infiltration in the lumbar multifidus muscles correlated significantly with decreased range of motion of lumbar flexion (p = 0.032). No significant correlation was found between the severity of fat infiltration in LMM and impaired movement control, posture control, body awareness or self-assessed functional disability. This is the first study investigating the relationship between the severity of fat infiltration in LMM and the severity of lumbar dysfunction. The results of this study will contribute to the understanding of the mechanisms leading to fat infiltration of LMM and its relation to spinal function. Further studies should investigate whether specific treatment strategies are effective in reducing or preventing fat infiltration of LMM.

  6. Jogging gait kinetics following fatiguing lumbar paraspinal exercise.

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


    A relationship exists between lumbar paraspinal muscle fatigue and quadriceps muscle activation. The objective of this study was to determine whether hip and knee joint moments during jogging changed following paraspinal fatiguing exercise. Fifty total subjects (25 with self-reported history of low back pain) performed fatiguing, isometric lumbar extension exercise until a shift in EMG median frequency corresponding to a mild level of muscle fatigue was observed. We compared 3-dimensional external joint moments of the hip and knee during jogging before and after lumbar paraspinal fatigue using a 10-camera motion analysis system. Reduced external knee flexion, knee adduction, knee internal rotation and hip external rotation moments and increased external knee extension moments resulted from repetitive lumbar paraspinal fatiguing exercise. Persons with a self-reported history of LBP had larger knee flexion moments than controls during jogging. Neuromuscular changes in the lower extremity occur while resisting knee and hip joint moments following isolated lumbar paraspinal exercise. Persons with a history of LBP seem to rely more heavily on quadriceps activity while jogging.

  7. Importance of greenstick lamina fractures in low lumbar burst fractures

    Ersozlu, S.; Aydinli, U.


    Lumbar burst fractures (L3–L5) represent a small percentage of all spinal fractures. The treatment of fractures involving the lumbar spine has been controversial. Lamina fractures may be complete or of the greenstick type. Dural tears and nerve root entrapment may accompany these lamina fractures. The aim of this retrospective study was to determine the incidence of dural tear in patients who had lumbar burst fractures with greenstick lamina fractures and the importance of these lamina fractures when choosing the optimum treatment. Twenty-six patients with 28 lumbar burst fractures were treated from 1995 through 2002. The average follow-up was 60 months (range 32–110 months). The male to female ratio was 21:5 and the mean age was 37 years (17–64). Dural tear was detected in seven (25%) out of 28 burst fractures. The functional outcome of the entire study group was assessed using the Smiley-Webster Scale. Good to excellent results were obtained in 24 (92%) of 26 patients. Lumbar burst fractures with greenstick lamina fractures occur mostly in the L2–L4 area. In the surgical treatment, any reduction manoeuvre will close the fracture and crush the entrapped neural elements. Therefore, it may be better to explore the greenstick lamina fracture whether there is any neural entrapment or not, before any reduction manoeuvre is attempted. PMID:16501977

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

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


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

  9. Rapid prototyping drill guide template for lumbar pedicle screw placement

    LU Sheng; XU Yong-qing; ZHANG Yuan-zhi; LI Yan-bing; SHI Ji-hong; CHEN Guo-ping; CHEN Yu-bing


    To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods: A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engi-neering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its correspond-ing vertebra were manufactured using the rapid prototyping technique. Results: The accuracy of the drill template was con-firmed by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to cus-tomize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill tem-plate fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the per-sonalized template. During surgery, no additional computer assistance was needed.Conclusions: The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.

  10. Effects of interspinous spacers on lumbar degenerative disease.

    Zhou, Dong; Nong, Lu-Ming; DU, Rui; Gao, Gong-Ming; Jiang, Yu-Qing; Xu, Nan-Wei


    The present study aimed to evaluate the early effects of interspinous spacers on lumbar degenerative disease. The clinical outcomes of 23 patients with lumbar degenerative disease, treated using interspinous spacer implantation alone or combined with posterior lumbar fusion, were retrospectively studied and assessed with a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Pre-operative and post-operative interspinous distance, disc space height, foraminal width and height and segmental lordosis were determined. The early effects and complications associated with the interspinous spacers were recorded. The surgical procedures performed with the in-space treatment were easy and minimally invasive. The VAS scores and ODI were improved post-operatively compared with pre-operatively. Significant changes in the interspinous distance, disc space height, foraminal width and height and segmental lordosis were noted. In-space treatment for degenerative lumbar disease is easy and safe, with good early effects. The in-space system provides an alternative treatment for lumbar degenerative disease.

  11. Characterization of radiographic features of consecutive lumbar spondylolisthesis

    Sun, Yapeng; Wang, Hui; Yang, Dalong; Zhang, Nan; Yang, Sidong; Zhang, Wei; Ding, Wenyuan


    Abstract Radiographic features of consecutive lumbar spondylolisthesis were retrospectively analyzed in a total of 17 patients treated for this condition at the Third Hospital of Hebei Medical University from June 2005 to March 2012. To investigate the radiographic features, pelvic compensatory mechanisms, and possible underlying etiologies of consecutive lumbar spondylolisthesis. To the best of our knowledge, there is no previous report concerning the characteristics of consecutive lumbar spondylolisthesis. The Taillard index and the lumbar lordosis (LL), pelvic incidence (PI), sacrum slope (SS), and pelvic tilt (PT) were determined on lateral X-ray images, and the angular displacement was analyzed on flexion–extension X-ray images. Correlation between LL and various pelvic parameters and correlation between Taillard index and angular displacement were assessed by Pearson correlation analysis. A total of 20 cases of isthmic spondylolisthesis and 14 of degenerative spondylolisthesis were retrospectively studied in 17 patients. The Taillard index and the angular displacement in the lower vertebrae were both larger than those in the upper vertebrae. Statistical analysis revealed that LL was correlated with PI and PT, whereas PI was correlated with PT and SS. However, no correlation was identified between Taillard index and angular displacement. In consecutive lumbar spondylolisthesis, the degree of vertebral slip and the angular displacement of the lower vertebrae were both greater than those of the upper vertebrae, indicating that the compensatory mechanism of the pelvis plays an important role in maintaining sagittal balance. PMID:27861359

  12. Complex multilevel lumbar spine fractures with transverse sacral fracture

    Kshitij Chaudhary


    Full Text Available We report an unusual and complex case of spinal trauma in a 17-year-old boy who presented with a transverse sacral fracture associated with multiple-level lumbar fractures, paraparesis, and bladder involvement. A two-stage surgery was performed. The lumbar spine fractures were treated with posterior instrumented correction of displacements, followed by anterior instrumentation and fusion. The sacral fracture was left untreated. At 5-year followup, the patient had complete neurological recovery except for the right L5 root function. The long-segment lumbar fusion and the untreated displaced sacral fracture contributed to spinal imbalance, due to which the patient is now able to stand only in a crouched posture. Determining the optimal treatment for the case is presented due to the relative rarity of transverse sacral fracture and paucity of evidence-based treatment approaches. In patients with associated lumbar spine fractures that require extension of instrumentation to the upper lumbar spine, it is critical to restore sacropelvic alignment to achieve spinal balance. Adequate reduction of sacropelvic anatomy can be achieved with iliac screw fixation.

  13. Posterior lumbar interbody fusion via a unilateral approach.

    Shin, Hyun Chul; Yi, Seong; Kim, Keung Nyun; Kim, Sang Hyun; Yoon, Do Heum


    This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain.

  14. [Isokinetic and functional lumbar evaluation in workers pensioned with disability].

    Navarro-Trujillo, Luz Rocío; Mireles-Pérez, Ana Bárbara Isabel; Castañeda-Borrayo, Yaocihuatl; Plascencia-García, José Luis


    Introducción: en 2008 se formularon 13 371 dictámenes de invalidez en Jalisco, gran parte de ellos motivados por lesiones de la columna lumbar. La mayoría es de naturaleza definitiva y requiere evaluaciones completas de las capacidades lumbares. El objetivo de esta investigación fue evaluar la funcionalidad de la columna lumbar con el cuestionario de Oswestry y con el estudio isocinético en pensionados por lesiones lumbares. Métodos: estudio comparativo de 20 trabajadores con dictamen de invalidez por lesiones lumbares, a quienes se les solicitó realizar ejercicios isocinéticos y contestar el cuestionario de Oswestry. Resultados: con el cuestionario de Oswestry se determinó una discapacidad de 60 %. En cuanto a la evaluación isocinética, en la extensión se obtuvo un torque máximo de 44 Nw. En el trabajo fatiga se encontraron una media y una moda de cero. En la flexión, el torque máximo fue de -75.5 Nw. En la potencia, la moda fue de 40 V. En el trabajo-fatiga, la media y la moda fueron de cero. Conclusiones: la evaluación isocinética no fue normal en ninguno de los trabajadores, con lo que se corroboró la invalidez.

  15. Modified lumbar artery perforator flaps for gluteal pressure sore reconstruction.

    Yoon, Chi Sun; Yim, Ji Hong; Kim, Min Ho; Ha, Won; Kim, Kyu Nam


    Gluteal perforator flaps (GPFs) are the most useful for gluteal region pressure sore reconstruction. However, application is difficult if the surrounding area has scar tissue from previous operations or trauma, especially with recurrent sores. We describe the use of modified lumbar artery perforator flaps when GPFs cannot be used. Between May 2009 and April 2014, 51 patients underwent gluteal pressure sore reconstructions with gluteal (n = 39) or modified lumbar artery (n = 12) perforator flaps. Patients in the modified lumbar artery perforator group had scar tissue from trauma or previous surgery. In this retrospective review, we analyzed patient age and sex, defect size and location, operative time, follow-up duration, immediate postoperative issues, flap necrosis, dehiscence, re-operation, donor-site morbidity and recurrence. Complications and clinical outcomes were compared between groups. We found no significant differences in patient demographics, surgical complications or clinical outcomes. There were eight cases of temporary congestion (20.51%) and four of partial flap necrosis (10.25%) in the gluteal perforator group. In the modified lumbar artery perforator group, there were three cases of temporary congestion (25%) and one of partial flap necrosis (8.33%). No pressure sores recurred during follow-up in either group. GPFs are the gold standards for gluteal pressure sores, but modified lumbar artery perforator flaps are relatively easy and useful when GPFs cannot be used due to scar tissue. © 2016 Royal Australasian College of Surgeons.


    Emiliano Vialle


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

  17. Functional kyphosis and lumbar kyphosis in adolescent paddlers

    Pedro Ángel López-Miñarro


    Full Text Available The objective of this study was to evaluate the frequency of functional kyphosis and lumbar kyphosis in adolescent paddlers. A total of 140 paddlers (mean age: 13,67 ± 0,61 years participated in this study. The sagittal spinal curvatures (thoracic and lumbar curves in relaxed standing and in maximal trunk flexion with knees extended (sit-and-reach test were evaluated with an inclinometer. The analysis of angular values with respect to the normality references showed that 63% of athletes with normal thoracic curve in standing, while in maximal trunk flexion there were many athletes (91.2% with a moderate or slight kyphotic posture. With respect to lumbar curve, 68.5% of the subjects had normal values in standing, while 83.9% showed lumbar kyphotic postures in maximal trunk flexion. In conclusion, there was a high percentage of paddlers with normal angular values in relaxed standing, although when maximal trunk flexion with knees extended was performed there was a significant increase of kyphotic postures in both thoracic and lumbar curves. For this reason, the evaluation of sagittal spinal curvatures of paddlers is an important variable to include in training planning.

  18. The Effect of Early Initiation of Rehabilitation after Lumbar Spinal Fusion

    Oestergaard, Lisa Gregersen; Nielsen, Claus Vinther; Bünger, Cody E;


    examined patients' subsequent rehabilitation. Group-based rehabilitation is both efficient and cost-effective in rehabilitation of lumbar spinal fusion patients.Methods: Patients with degenerative disc diseases undergoing instrumented lumbar spinal fusion were randomly assigned to initiate...

  19. An audit of consent practices and perceptions of lumbar puncture, Botswana inpatient setting experience

    M.B. King


    Conclusion: Contrasting responses between doctors and patients indicates a need for standard consenting practices among doctors. Also, patients’ attitudes and receptiveness to lumbar punctures can be improved through education on lumbar puncture indications, benefits, and risks.

  20. Treatment of 34 Cases of Acute Lumbar Sprain with Electroacupuncture plus Cupping Therapy

    张力; 洪珏


    @@ Acute lumbar sprain due to improper exercise is very common in college students. The author has treated 34 patients with acute lumbar sprain by electroacupuncture plus cupping therapy, now it was presented as follows.


    Mukhergee G. S


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

  2. CPU timing routines for a CONVEX C220 computer system

    Bynum, Mary Ann


    The timing routines available on the CONVEX C220 computer system in the Structural Mechanics Division (SMD) at NASA Langley Research Center are examined. The function of the timing routines, the use of the timing routines in sequential, parallel, and vector code, and the interpretation of the results from the timing routines with respect to the CONVEX model of computing are described. The timing routines available on the SMD CONVEX fall into two groups. The first group includes standard timing routines generally available with UNIX 4.3 BSD operating systems, while the second group includes routines unique to the SMD CONVEX. The standard timing routines described in this report are /bin/csh time,/bin/time, etime, and ctime. The routines unique to the SMD CONVEX are getinfo, second, cputime, toc, and a parallel profiling package made up of palprof, palinit, and palsum.

  3. Just a routine operation: a critical discussion.

    McClelland, G; Smith, M B


    This article has summarised a critical discussion of the human factors that contributed to the death of a patient from a failure to respond appropriately to a 'can't intubate, can't ventilate' scenario. The contributory factors included the clinical team's inability to communicate, prioritise tasks and demonstrate effective leadership and assertive followership. The film Just a routine operation has now been in circulation for several years. When a system is designed and introduced with the intention of making a change to clinical practice, it can quickly become just another component of an organisation's architecture and complacency around its use can develop. This article has been written specifically for perioperative practitioners to renew the debate around the human factors that contribute to patient harm. By critically discussing Just a routine operation and attempting to review why the incident occurred, this article has attempted to emphasise that some of the conditions and behaviours that contributed to the death of Elaine Bromiley may be latent within our organisations and teams, and may continue to contribute to failures that affect patient safety.

  4. Radiation dose monitoring in the clinical routine

    Guberina, Nika [UK Essen (Germany). Radiology


    Here we describe the first clinical experiences regarding the use of an automated radiation dose management software to monitor the radiation dose of patients during routine examinations. Many software solutions for monitoring radiation dose have emerged in the last decade. The continuous progress in radiological techniques, new scan features, scanner generations and protocols are the primary challenge for radiation dose monitoring software systems. To simulate valid dose calculations, radiation dose monitoring systems have to follow current trends and stay constantly up-to-date. The dose management software is connected to all devices at our institute and conducts automatic data acquisition and radiation dose calculation. The system incorporates 18 virtual phantoms based on the Cristy phantom family, estimating doses in newborns to adults. Dose calculation relies on a Monte Carlo simulation engine. Our first practical experiences demonstrate that the software is capable of dose estimation in the clinical routine. Its implementation and use have some limitations that can be overcome. The software is promising and allows assessment of radiation doses, like organ and effective doses according to ICRP 60 and ICRP 103, patient radiation dose history and cumulative radiation doses. Furthermore, we are able to determine local diagnostic reference doses. The radiation dose monitoring software systems can facilitate networking between hospitals and radiological departments, thus refining radiation doses and implementing reference doses at substantially lower levels.

  5. Contribuição das projeções oblíquas em mielografias de pequenos animais para a localização de lesões medulares causadas por processo degenerativo do disco intervertebral Contribution of oblique projections in small animals myelography to the localization of spinal lesions caused by intervertebral disc degeneration

    Karen Maciel Zardo


    Full Text Available Mielografia é uma técnica radiográfica na qual se administra meio de contraste no espaço subaracnóideo para avaliar a medula espinhal. Múltiplas projeções radiográficas fornecem uma exploração circunferencial da medula, auxiliando na localização mais precisa de compressões nesta região. Objetivou-se demonstrar a contribuição das projeções oblíquas, pouco exploradas em exames de mielografia, para a localização de lesões medulares extradurais em cães e gatos causadas por processo degenerativo do disco intervertebral. Foram avaliadas 116 mielografias e observou-se que em 36,2% dos casos as projeções oblíquas foram imprescindíveis para a localização exata das lesões. A associação entre as projeções ventrodorsal e oblíquas se mostraram mais úteis para a localização da lesão do que quando avaliadas isoladamente e as projeções oblíquas esquerda e direita foram igualmente importantes.Myelography is a radiographic technique in which is administered contrast in the subarachnoid space to assess the spinal cord. Multiple radiographic projections provide a circumferential view of the spinal cord, aiding in more precise localization of compression in this region. This paper aimed to demonstrate the contribution of oblique projections, little explored in myelography, for the location of extradural spinal cord injuries in dogs and cats caused by degeneration of the intervertebral disc. It was evaluated 116 myelography and it was observed that in 36.2% of cases, oblique views were essential to the exact localization of lesions. The association between the oblique and ventrodorsal projections was more effective to find the lesion´s lateralization than when taken separately, and the left and right oblique view was equally important.

  6. Why Lumbar Artificial Disk Replacements (LADRs) Fail.

    Pettine, Kenneth; Ryu, Robert; Techy, Fernando


    A retrospective review of prospectively collected data. To determine why artificial disk replacements (ADRs) fail by examining results of 91 patients in FDA studies performed at a single investigational device exemption (IDE) site with minimum 2-year follow-up. Patients following lumbar ADR generally achieve their 24-month follow-up results at 3 months postoperatively. Every patient undergoing ADR at 1 IDE site by 2 surgeons was evaluated for clinical success. Failure was defined as Maverick, 25 patients; Charité, 31 patients; and Kineflex, 35 patients. All procedures were 1-level operations performed at L4-L5 or L5-S1. Demographics and inclusion/exclusion criteria were similar and will be discussed. Overall clinical failure occurred in 26% (24 of 91 patients) at 2-year follow-up. Clinical failure occurred in: 28% (Maverick) (7 of 25 patients), 39% (Charité) (12 of 31 patients), and 14% (Kineflex) (5 of 35 patients). Causes of failure included facet pathology, 50% of failure patients (12 of 24). Implant complications occurred in 5% of total patients and 21% of failure patients (5 of 24). Only 5 patients went from a success to failure after 3 months. Only 1 patient went from a failure to success after a facet rhizotomy 1 year after ADR. Seventy-four percent of patients after ADR met strict clinical success after 2-year follow-up. The clinical success versus failure rate did not change from their 3-month follow-up in 85 of the 91 patients (93%). Overall clinical success may be improved most by patient selection and implant type.

  7. Tuina Therapy for Prolapsed Lumbar Intervertebral Disc

    ZHANG Bi-meng; WU Huan-gan; SHEN Jian; XIAO Yuan-chun


    Recurrent low back pain and reflex sciatica of lower limbs are the two leading symptoms of prolapsed lumbar intervertebral disc, which can be confirmed in the history, symptoms, signs and imaging examination such as CT scan and MRI. It should be differentiated from those conditions characterized by lumbago and/or possible sciatica. Tuina was performed mostly on the Bladder Meridian,Gallbladder Meridian and Governor Vessel, as well as their acupoints such as Jiaji (Ex-B 2) points,Shenshu (BL 23), Dachangshu (BL 25), Yaoyangguan (GV 3), Huantiao (GB 30), Weizhong (BL 40),Chengshan (BL 57), Yanglingquan (GB 34) and Ashi points. Thumb-massaging manipulation, rolling manipulation, pulling manipulation, pressing manipulation, kneading manipulation and grasping manipulation are often performed.%反复下腰痛和下肢反射性坐骨神经痛是腰椎间盘突出症的两大症状.根据病史、症状、体征以及影像学(包括CT、MRI等)结果,可以确诊.需与以腰痛为主要表现的疾病,以腰痛伴坐骨神经痛为主要表现的疾病和以坐骨神经痛为主要表现的疾病相鉴别.推拿保守治疗多以足太阳膀胱经、足少阳胆经及督脉为主,取相应的夹脊穴、肾俞、大肠俞、腰阳关、环跳、委中、承山、阳陵泉及阿是穴等以一指禅推法、滚法、扳法、按法、揉法和拿法等进行治疗.


    Samo K. Fokter


    Full Text Available Background. Degenerative lumbar spinal stenosis (DLSS is a common cause of low back and leg pain in the elderly. Conservative treatment seldom results in sustained improvement.Methods. Fifty-six patients (33 women, 23 men older than 50 years (mean 67 years, range 51 to 82 years and with no prior low back surgery were treated from 1993 to 1999 for clinical and radiologic evidence of DLSS. The goal of this study was to describe the results of decompressive laminectomy with or without fusion in terms of reoperation, severity of back pain, leg pain and patient satisfaction. Answers to Swiss spinal stenosis questionnaires completed before surgery and one to five years afterwards were evaluated. Seven patients (12.5% with degenerative spondylolisthesis, scoliosis and/or more radical facetectomies received fusion.Results. Of the 56 patients in the original cohort, two were deceased and two had undergone reoperation by follow-up. Forty-eight patients answered questionnaires. Average duration of follow-up was 2.5 years. More than 70 percent of the respondents had no or only mild back or buttock pain at follow-up and more than 60 percent were able to walk more than 500 m. Added fusion reduced the incidence of low back pain and pain frequency, and increased walking distance (ANOVA.Conclusions. Eighty-one percent of patients were satisfied with the results of surgery and 87.5% would choose to have the operation again if they had the choice. Decompressive laminectomy for DLSS yields best results if instrumented fusion is included in the procedure.

  9. Long-Term Results of Endoscopic Lumbar Discectomy by "Destandau's Technique"

    Kamble, Bhavna; Patond, Kisan


    Study Design Prospective study. Purpose The aim of the study was to present long-term results from a 10-year follow-up after endoscopic lumbar discectomy (ELD) by "Destandau's technique". Overview of Literature Endoscopic disc surgery by Destandau's technique using ENDOSPINE Karl Storz system is a relatively new technique. It was introduced in 1993. It has been gaining popularity among the spine surgeons, as it is attractive for small skin incision and allows a gentle and excellent tissue dissection with excellent visualization. Many authors have published results of their own studies; however, in all these studies the long-term follow up of the patients has not been emphasized. Methods A total of 21 patients selected on basis of strict inclusion criteria's underwent ELD from November 2004 to March 2005. Surgery outcome was assessed by using "Prolo's Anatomic-Functional-Economic Rating System" (1986). Patients were followed up to 10 years. In addtion, we compared the results of our study with other studies. Results Outcomes were excellent in 17 patients (80.95%), good in 3 (14.28%) and fair in 1 (4.78%), with no patients having a poor result. In our study, 19 patients (90.47%) were able to resume their previous works/jobs, and only 2 (9.52%) needed to change their jobs for lighter work. No patient retired from his or her previous daily routine following the operation. Conclusions The initial and long-term results are very good for endoscopic lumbar discectomy by Destandau's technique. In properly selected patients it is a safe and minimally invasive technique, and we recommend ELD in properly selected patients. PMID:27114770

  10. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study

    Jacobsen, Steffen; Sonne-Holm, Stig; Rovsing, Hans;


    STUDY DESIGN: A cross-sectional epidemiological survey of 4151 participants of the Copenhagen Osteoarthritis Study. OBJECTIVE: To identify prevalences and individual risk factors for degenerative lumbar spondylolisthesis. SUMMARY OF BACKGROUND DATA: The Copenhagen Osteoarthritis Study has...... registered health parameters since 1976. In 1993, standardized, lateral radiographs of the lumbar spine were recorded. There were 1533 men and 2618 women. METHODS: Statistical correlations were made between degenerative spondylolisthesis, and physical, occupational, and general epidemiological data. RESULTS......: A total of 254 cases of lumbar slip were found (males 2.7%, females 8.4%). In females, no significant relationship between age at menopause or childbirths and the presence of degenerative spondylolisthesis were found. In women, relationships between body mass index (BMI) in 1976 and L4 olisthesis (P = 0...

  11. Low back pain and lumbar angles in Turkish coal miners

    Sarikaya, S.; Ozdolap, S.; Gumustas, S.; Koc, U. [Zonguldak Karaelmas University, Zonguldak (Turkey). Faculty of Medicine


    This study was designed to assess the incidence of low back pain among Turkish coal miners and to investigate the relationship between angles of the lumbar spine and low back pain in coal miners. Fifty underground workers (Group I) and 38 age-matched surface workers (Group II) were included in the study. All the subjects were asked about low back pain in the past 5 years. The prevalence of low back pain was higher in Group I than in Group II (78.0%, 32.4%, respectively, P {lt} 0.001). The results of the study showed that low back pain occurred in 78.0% of Turkish coal miners. Although the nature of the occupation may have influenced coal miners' lumbar spinal curvature, lumbar angles are not a determinant for low back pain in this population. Further extensive studies involving ergonomic measurements are needed to validate our results for Turkish coal mining industry.

  12. Multiexpandable cage for minimally invasive posterior lumbar interbody fusion

    Coe, Jeffrey D; Zucherman, James F; Kucharzyk, Donald W; Poelstra, Kornelis A; Miller, Larry E; Kunwar, Sandeep


    The increasing adoption of minimally invasive techniques for spine surgery in recent years has led to significant advancements in instrumentation for lumbar interbody fusion. Percutaneous pedicle screw fixation is now a mature technology, but the role of expandable cages is still evolving. The capability to deliver a multiexpandable interbody cage with a large footprint through a narrow surgical cannula represents a significant advancement in spinal surgery technology. The purpose of this report is to describe a multiexpandable lumbar interbody fusion cage, including implant characteristics, intended use, surgical technique, preclinical testing, and early clinical experience. Results to date suggest that the multiexpandable cage allows a less invasive approach to posterior/transforaminal lumbar interbody fusion surgery by minimizing iatrogenic risks associated with static or vertically expanding interbody prostheses while providing immediate vertebral height restoration, restoration of anatomic alignment, and excellent early-term clinical results. PMID:27729817

  13. Sex determination by discriminant function analysis of lumbar vertebrae.

    Ostrofsky, Kelly R; Churchill, Steven E


    Sex determination is critical for developing the biological profile of unidentified skeletal remains. When more commonly used elements (os coxa, cranium) for sexing are not available, methods utilizing other skeletal elements are needed. This study aims to assess the degree of sexual dimorphism of the lumbar vertebrae and develop discriminant functions for sex determination from them, using a sample of South African blacks from the Raymond A. Dart Collection (47 males, 51 females). Eleven variables at each lumbar level were subjected to univariate and multivariate discriminant function analyses. Univariate equations produced classification rates ranging from 57.7% to 83.5%, with the highest accuracies associated with dimensions of the vertebral body. Multivariate stepwise analysis generated classification rates ranging from 75.9% to 88.7%. These results are comparable to other methods for sexing the skeleton and indicate that measures of the lumbar vertebrae can be used as an effective tool for sex determination.

  14. Conservative management of psoas haematoma following complex lumbar surgery

    Sandesh Lakkol


    Full Text Available We report psoas hematoma communicating with extradural hematoma and compressing on lumbar nerve roots during the postoperative period in a patient who underwent L3/4 level dynamic stabilization and L4/5 and L5/S1 posterior lumbar interbody fusion. Persistent radicular symptoms occurring soon after posterior lumbar surgery are not an unknown entity. However, psoas hematoma communicating with the extradural hematoma and compressing on L4 and L5 nerve roots soon after surgery, leading to radicular symptoms has not been reported. In addition to the conservative approach in managing such cases, this case report also emphasizes the importance of clinical evaluation and utilization of necessary imaging techniques such as computed tomography (CT scan and magnetic resonance imaging (MRI scan to diagnose the cause of persistent severe radicular pain in the postoperative period.

  15. Regional lumbar motion and patient-rated outcomes

    Mieritz, Rune M; Bronfort, Gert; Hartvigsen, Jan


    OBJECTIVE: The purpose of this study was to examine the relationship in change scores between regional lumbar motion and patient-rated pain of the previous week and back-related function in chronic low back pain patients enrolled in a randomized clinical trial and treated with either exercise...... therapy or spinal manipulation using 6 different motion parameters. METHODS: Regional lumbar motions were sampled using a 6 degrees of freedom instrumented spatial linkage system in 199 participants at baseline and 12-week follow-up. The regional lumbar motion data were analyzed as a total cohort as well...... as relative to subgroup stratifications; back pain only vs back and leg pain, and treatment modality. For identifying clinically meaningful improvements in the measurements of back pain and back-related function, we used a 30% threshold. RESULTS: The relationship between change scores in patient...




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

  17. Decoupled pelvis adjustment to induce lumbar motion: A technique that controls low back load in sitting

    Geffen, van Paul; Reenalda, Jasper; Veltink, Peter H.; Koopman, Bart F.J.M.


    Static sitting in confined settings have been associated with low back pain in sedentary occupations such as office works and car driving. To prevent lumbar discomfort in prolonged static sitting, periodic motion of the lumbar spine is needed. Because the pelvis forms the basis for lumbar spine curv

  18. Transforaminal lumbar interbody fusion versus posterolateral fusion in degenerative lumbar spondylosis

    Zhang, Bin-Fei; Ge, Chao-Yuan; Zheng, Bo-Long; Hao, Ding-Jun


    Abstract Objective: The aim of the study was to evaluate the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) versus posterolateral fusion (PLF) in degenerative lumbar spondylosis. Methods: A systematic literature review was performed to obtain randomized controlled trials (RCTs) and observational studies (OSs) of TLIF and PLF for degenerative lumbar spondylosis. Trials performed before November 2015 were retrieved from the Medline, EMBASE, Cochrane library, and Chinese databases. Data extraction and quality evaluation of the trials were performed independently by 2 investigators. A meta-analysis was performed using STATA version 12.0. Results: Two RCTs and 5 OSs of 630 patients were included. Of these subjects, 325 were in the TLIF and 305 were in the PLF group. Results showed that TLIF did not increase the fusion rate based on RCTs (relative risk [RR] = 1.06; 95% confidence interval [CI]: 0.95–1.18; P = 0.321), but increased it based on OSs (RR = 1.14; 95% CI: 1.07–1.23; P = 0.000) and overall (RR = 1.11; 95% CI: 1.05–1.18; P = 0.001) as compared with PLF. TLIF was able to improve the clinical outcomes based on 1 RCT (RR = 1.33; 95% CI: 1.11–1.59, P = 0.002) and overall (RR = 1.19; 95% CI: 1.07–1.33; P = 0.001), but not based on OSs (RR = 1.11; 95% CI: 0.97–1.27; P = 0.129) as compared with PLF. There were no differences between TLIF and PLF in terms of visual analogue scale, Oswestry Disability Index, reoperation, complications, duration of surgical procedure, blood loss, and hospitalization. Conclusions: In conclusion, evidence is not sufficient to support that TLIF provides higher fusion rate than PLF, and this poor evidence indicates that TLIF might improve only clinical outcomes. Higher quality, multicenter RCTs are needed to better define the role of TLIF and PLF. PMID:27749558

  19. 枢经推拿治疗腰椎间盘突出症疗效观察%Efficacy Observation on Shujing Massage Treating Lumbar Disc Herniation

    唐宏亮; 庞军; 甘炜; 莫巧明; 王开龙; 李建敏; 甘振宝; 黄俊杰


    目的:观察枢经推拿治疗腰椎间盘突出症的疗效。方法:将120例腰椎间盘突出症患者随机分为枢经推拿组(60例)和常规推拿组(60例),分别施以枢经推拿和常规推拿,隔日1次,每次30min,共治疗21天,比较两组患者治疗前后的JOA评分变化情况。结果:治疗后,两组患者的JOA评分均显著提高(P<0.05),枢经推拿组高于常规推拿组(P<0.05)。结论:枢经推拿治疗腰椎间盘突出症疗效优于常规推拿治疗。%Objective:To observe the curative effects of Shujing massage treating lumbar disc herniation. Methods:120 cases of lumbar disc hernia-tion were randomly divided into Shujing massage group (60 cases) and routine massage group (60 cases), respectively with Shujing massage and rou-tine massage, a time every other day and each time of 30min with treating 21 days totally, changes of JOA score before and after treatment were com-pared between the two groups. Results:JOA scores of two groups after treatment both significantly increased (P<0.05), and that of Shujing massage group was higher than routine massage group (P<0.05). Conclusion:Efficacy of Shujing massage treating lumbar disc herniation is superior to con-ventional massage therapy.

  20. Genetic association studies in lumbar disc degeneration: a systematic review.

    Pasi J Eskola

    Full Text Available OBJECTIVE: Low back pain is associated with lumbar disc degeneration, which is mainly due to genetic predisposition. The objective of this study was to perform a systematic review to evaluate genetic association studies in lumbar disc degeneration as defined on magnetic resonance imaging (MRI in humans. METHODS: A systematic literature search was conducted in MEDLINE, MEDLINE In-Process, SCOPUS, ISI Web of Science, The Genetic Association Database and The Human Genome Epidemiology Network for information published between 1990-2011 addressing genes and lumbar disc degeneration. Two investigators independently identified studies to determine inclusion, after which they performed data extraction and analysis. The level of cumulative genetic association evidence was analyzed according to The HuGENet Working Group guidelines. RESULTS: Fifty-two studies were included for review. Forty-eight studies reported at least one positive association between a genetic marker and lumbar disc degeneration. The phenotype definition of lumbar disc degeneration was highly variable between the studies and replications were inconsistent. Most of the associations presented with a weak level of evidence. The level of evidence was moderate for ASPN (D-repeat, COL11A1 (rs1676486, GDF5 (rs143383, SKT (rs16924573, THBS2 (rs9406328 and MMP9 (rs17576. CONCLUSIONS: Based on this first extensive systematic review on the topic, the credibility of reported genetic associations is mostly weak. Clear definition of lumbar disc degeneration phenotypes and large population-based cohorts are needed. An international consortium is needed to standardize genetic association studies in relation to disc degeneration.

  1. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

    Kanthila Mahesha


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

  2. The association of spinal osteoarthritis with lumbar lordosis.

    Papadakis, Michael; Papadokostakis, Georgios; Kampanis, Nikos; Sapkas, Georgios; Papadakis, Stamatios A; Katonis, Pavlos


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

  3. The association of spinal osteoarthritis with lumbar lordosis

    Sapkas Georgios


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

  4. Sagittal spinal alignment in patients with lumbar disc herniation.

    Endo, Kenji; Suzuki, Hidekazu; Tanaka, Hidetoshi; Kang, Yupeng; Yamamoto, Kengo


    A retrospective cross-sectional study was designed to evaluate total sagittal spinal alignment in patients with lumbar disc herniation (LDH) and healthy subjects. Abnormal sagittal spinal alignment could cause persistent low back pain in lumbar disease. Previous studies analyzed sciatic scoliotic list in patients with lumbar disc herniation; but there is little or no information on the relationship between sagittal alignment and subjective findings. The study subjects were 61 LDH patients and 60 age-matched healthy subjects. Preoperative and 6-month postoperatively lateral whole-spine standing radiographs were assessed for the distance between C7 plumb line and posterior superior corner on the top margin of S1 sagittal vertical axis (SVA), lumbar lordotic angle between the top margin of the first lumbar vertebra and first sacral vertebra (L1S1), pelvic tilting angle (PA), and pelvic morphologic angle (PRS1). Subjective symptoms were evaluated by the Japanese Orthopedic Association (JOA) score for lower back pain (nine points). The mean SVA value of the LDH group (32.7 +/- 46.5 mm, +/- SD) was significantly larger than that of the control (2.5 +/- 17.1 mm), while L1S1 was smaller (36.7 +/- 14.5 degrees ) and PA was larger (25.1 +/- 9.0 degrees ) in LDH than control group (49.0 +/- 10.0 degrees and 18.2 +/- 6.0 degrees , respectively). At 6 months after surgery, the malalignment recovered to almost the same level as the control group. SVA correlated with the subjective symptoms measured by the JOA score. Sagittal spinal alignment in LDH exhibits more anterior translation of the C7 plumb line, less lumbar lordosis, and a more vertical sacrum. Measurements of these spinal parameters allowed assessment of the pathophysiology of LDH.

  5. Thoracic Meningioma In Combination With Severe Lumbar Spinal Stenosis Presenting With Atypical Neurological Deficit

    Kehayov Ivo I.


    Full Text Available We report on a case of a 47-year-old female patient with a long history of low back pain irradiating bilaterally to the legs. Twenty days before admission to our clinic, she had developed progressive weakness in the legs, more pronounced on the left side. The initial neurological examination revealed signs of damage to both the cauda equina and the spinal cord. The neuroimaging studies (computed tomography, myelography and magnetic-resonance tomography found spinal stenosis most severe at L4-L5 level, and right lateral thoracic intradural-extramedullary tumor at T9-T10 level.

  6. Diagnosis of hernia of lumbar intervertebral disk. Potentials and limits of MR imaging

    Beyer, H.K.; Uhlenbrock, D.; Steiner, G.


    CT and myelography are acknowledged techniques for the detection and diagnosis of hernia of intervertebral disk. After the development and successful testing of special surface coils, MR imaging is a serious competitor of the two methods, offering advantages such as absence of ionizing radiation, or any other hazard, possibility of making tomograms in various planes, the sagittal plane being preferably used. Spatial resolution of CT and MRI is about equal, but the contrast resolution of MRI is far better. The contribution in hand is the first communication of results of a comparative study.

  7. Episiotomy, must be a routine procedure?

    Tovar María Clara


    Full Text Available Introduction: The episiotomia as an obstetric procedure had it first roots at the start of the 18th century, when Stephen mentions how Old made for the first time the episiotomia for extremely difficult delivery. Since 1920 until today its used as a routine procedure of routine in primigestantes. Goals: Comparing the presence of some obstetric complications in nuliparas women after practicing either or not the episiotomia mediolateral. Methodology: The work was donde in the Carlos Holmes Trujillo hospital, that covers the attention of low risk deliveries it south eastern part of the city. An experimental design was made in the one that were selected two different groups of gestantes. The muestra was conformed by 34 patients for the group control (who received the rutinary management of making episiotomia and 30 patients for the experimental group (the ones that didn’t received the routine episiotomia. Results and discussion: The harm perception was a much more intense in thr control group with significatively different status; the pain was qualify form modered to severe. In none of the groups were presented desgarros (grade III and IV circumstances that can be related with the homogeneity that presented the groups according to the different variables associated with this factor, no matter what were some of them presented desgarros in grade I and II in the experimental group occurred in its mayority in the deliveries attended by the less experimented people. The harm associated with episiotomy valued in ten days post delivery were more in the control group against the experimental group, especially difficult to sit downand fear the restart sexual activity, finding frequencies until four timesigher in the control group, circumstances that can affect the process of cicatrisation in the partner relation. This findings are related with the surgical incision and the disagreement things produced in the puerperium. When evaluating the presence of

  8. Destructive discovertebral degenerative disease of the lumbar spine.

    Charran, A K; Tony, G; Lalam, R; Tyrrell, P N M; Tins, B; Singh, J; Eisenstein, S M; Balain, B; Trivedi, J M; Cassar-Pullicino, V N


    The uncommon variant of degenerative hip joint disease, termed rapidly progressive osteoarthritis, and highlighted by severe joint space loss and osteochondral disintegration, is well established. We present a similar unusual subset in the lumbar spine termed destructive discovertebral degenerative disease (DDDD) with radiological features of vertebral malalignment, severe disc resorption, and "bone sand" formation secondary to vertebral fragmentation. Co-existing metabolic bone disease is likely to promote the development of DDDD of the lumbar spine, which presents with back pain and sciatica due to nerve root compression by the "bone sand" in the epidural space. MRI and CT play a complimentary role in making the diagnosis.

  9. Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

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


    Background To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondylolisthesis on lumbar lordosis after an intraoperative prone position. Methods Sixty-seven patients, who underwent spinal fusion at the Department of Orthopaedic Surgery of Gwangmyeong Sungae Hospital between May 2007 and February 2012, were included in this study. The study compared lumbar lordosis on preoperative upright, intraoperative prone and postoperative upright lateral X-rays between the simple stenosis (SS) group and spondylolisthesis group. The average age of patients was 67.86 years old. The average preoperative lordosis was 43.5° (± 14.9°), average intraoperative lordosis was 48.8° (± 13.2°), average postoperative lordosis was 46.5° (± 16.1°) and the average change on the frame was 5.3° (± 10.6°). Results Among all patients, 24 patients were diagnosed with simple spinal stenosis, 43 patients with spondylolisthesis (29 degenerative spondylolisthesis and 14 isthmic spondylolisthesis). Between the SS group and spondylolisthesis group, preoperative lordosis, intraoperative lordosis and postoperative lordosis were significantly larger in the spondylolisthesis group. The ratio of patients with increased lordosis on the OSI frame compared to preoperative lordosis was significantly higher in the spondylolisthesis group. The risk of increased lordosis on frame was significantly higher in the spondylolisthesis group (odds ratio, 3.325; 95% confidence interval, 1.101 to 10.039; p = 0.033). Conclusions Intraoperative lumbar lordosis on the OSI frame with a prone

  10. Lumbo-Costo-Vertebral Syndrome with Congenital Lumbar Hernia

    Lucky Gupta


    Full Text Available Lumbo-costo-vertebral syndrome (LCVS is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side. Meshplasty was done.

  11. Pelvic retroversion: a compensatory mechanism for lumbar stenosis.

    Pourtaheri, Sina; Sharma, Akshay; Savage, Jason; Kalfas, Iain; Mroz, Thomas E; Benzel, Edward; Steinmetz, Michael P


    OBJECTIVE The flexed posture of the proximal (L1-3) or distal (L4-S1) lumbar spine increases the diameter of the spinal canal and neuroforamina and can relieve symptoms of neurogenic claudication. Distal lumbar flexion can result in pelvic retroversion; therefore, in cases of flexible sagittal imbalance, pelvic retroversion may be compensatory for lumbar stenosis and not solely compensatory for the sagittal imbalance as previously thought. The authors investigate underlying causes for pelvic retroversion in patients with flexible sagittal imbalance. METHODS One hundred thirty-eight patients with sagittal imbalance who underwent a total of 148 fusion procedures of the thoracolumbar spine were identified from a prospective clinical database. Radiographic parameters were obtained from images preoperatively, intraoperatively, and at 6-month and 2-year follow-up. A cohort of 24 patients with flexible sagittal imbalance was identified and individually matched with a control cohort of 23 patients with fixed deformities. Flexible deformities were defined as a 10° change in lumbar lordosis between weight-bearing and non-weight-bearing images. Pelvic retroversion was quantified as the ratio of pelvic tilt (PT) to pelvic incidence (PI). RESULTS The average difference between lumbar lordosis on supine MR images and standing radiographs was 15° in the flexible cohort. Sixty-eight percent of the patients in the flexible cohort were diagnosed preoperatively with lumbar stenosis compared with only 22% in the fixed sagittal imbalance cohort (p = 0.0032). There was no difference between the flexible and fixed cohorts with regard to C-2 sagittal vertical axis (SVA) (p = 0.95) or C-7 SVA (p = 0.43). When assessing for postural compensation by pelvic retroversion in the stenotic patients and nonstenotic patients, the PT/PI ratio was found to be significantly greater in the patients with stenosis (p = 0.019). CONCLUSIONS For flexible sagittal imbalance, preoperative attention should

  12. Diagnostic accuracy of magnetic resonance imaging of lumbar disc herniation

    Ikeda, Takashi; Nakamura, Takafumi; Kikuchi, Taro; Watanabe, Hiroyuki; Takagi, Katsumasa; Yoshizumi, Kazuhiro; Katahira, Kazuhiro [Kumamoto Univ. (Japan). School of Medicine


    We studied the accuracy of MRI in lumbar disc herniation, comparing the results with the operative findings in the assessment of the rupture of the posterior longitudinal ligament (PLL), and type of herniation. The MRI findings in 47 subjects who were operated on for lumbar disc herniation were retrospectively studied. The accuracy rate was 75.2% for the rupture of the PLL and 40.4% for the type of herniation respectively. It was hard to differentiate subligamentous extrusion from transligamentous extrusion on MRI. (author)

  13. Spontaneous ligamentum flavum hematoma in the lumbar spine

    Keynan, Ory; Ashkenazi, Ely; Floman, Yizhar [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Smorgick, Yossi [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Assaf Harofeh Medical Center, Department of Orthopedic Surgery, Zerifin (Israel); Schwartz, Allan J. [Hadassah University Hospital, Department of Radiology, Section of Neuroradiology, Jerusalem (Israel)


    Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome. (orig.)

  14. Laparoscopic management of inferior lumbar hernia (Petit triangle hernia).

    Ipek, T; Eyuboglu, E; Aydingoz, O


    Lumbar hernias are rare defects in the posterolateral abdominal wall that may be congenital or acquired. We present a case of laparoscopic approach to repair an acquired inferior triangle (Petit) lumbar hernia in a woman by using polytetrafluoroethylene mesh. The size of the hernia was 8 x 10 cm. The length of her hospital stay was 2 days. The patient resumed normal activities in less than 2 weeks. The main advantage of this approach is excellent operative visualization, thus avoiding injury to structures near the hernia during repair. Patients benefit from a minimally invasive approach with less pain, shortened hospital course, less analgesic requirements, better cosmetic result, and minimal life-style interference.

  15. Incarcerated small bowel within a spontaneous lumbar hernia.

    Teo, K A T; Burns, E; Garcea, G; Abela, J E; McKay, C J


    Lumbar hernias are rare, resulting from protrusion through the posterior abdominal wall that may be congenital, acquired or spontaneous. They very rarely present with acute bowel obstruction. We present a case of incarcerated small bowel within a spontaneous inferior (Petit's) lumbar hernia, treated by early open repair with mesh insertion. This case highlights the importance of thorough clinical examination and a high index of suspicion, even in the absence of previous surgery around the anatomical site of the suspected hernia, in order to effect an early repair before the onset of ischaemia in incarcerated contents.

  16. Lumbar Spine Musculoskeletal Physiology and Biomechanics During Simulated Military Operations


    l ationship between 3D geometry of the lumbar spine, under different l oading conditions and positions , and the pathophysiol ogy of the...Marines were scanned in a high- resolut i on 3T MRI scanner to quantify musc l e qua lity and I VD degeneration . Lumbar l ordos i s s i gnificantl y...measured using a force mat in a structure with the dimensions of the MRI scanner . 7 Figure 2. Photographs of the load distribution system used for

  17. Lumbo-costo-vertebral syndrome with congenital lumbar hernia.

    Gupta, Lucky; Mala, Tariq Ahmed; Gupta, Rahul; Malla, Shahid Amin


    Lumbo-costo-vertebral syndrome (LCVS) is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side. Meshplasty was done.

  18. Value of Perineural Edema/Inflammation Detected by Fat Saturation Sequences in Lumbar Magnetic Resonance Imaging of Patients with Unilateral Sciatica

    Sirvanci, M.; Duran, C. (Dept. of Radiology, Faculty of Medicine, Istanbul Bilim Univ., Istanbul (Turkey)); Kara, B.; Onat, L.; Ulusoy, O.L.; Mutlu, A. (Dept. of Radiology of Florence Nightingale Hospital, Istanbul (Turkey)); Ozturk, E. (Dept. of Radiology, GATA Haydarpasa Teaching Hospital, Istanbul (Turkey)); Karatoprak, O. (Dept. of Orthopeadic Surgery, Kadikoy Florence Nightingale Hospital, Istanbul (Turkey))


    Background: Routine lumbar spine magnetic resonance imaging (MRI) may not show any evidence of the cause of sciatica in some cases. The relationship between nerve root compression detected on lumbar MRI and sciatica is also sometimes uncertain. Purpose: To ascertain whether axial (and, when necessary, sagittal and coronal) short-tau inversion recovery or fat-saturated T2-weighted MRI findings can be used to study the level of sciatica in patients with a non-yielding routine MRI examination. Material and Methods: A total of 215 patients with unilateral sciatica underwent MRI. All patients were asked to complete pain drawing forms describing their pain dermatomal distributions. Perineural edema/inflammation corresponding to the pain location indicated by the pain drawings was sought on short-tau inversion recovery or fat-saturated T2-weighted images. Results: Routine MRI findings revealed that 110 of the 215 patients had nerve root compromise related to the patients' symptoms. Routine MRI could not ascertain the cause of these symptoms in the remaining 105 patients. In 31 (29.5%) of these 105 patients, short-tau inversion recovery or fat-saturated T2-weighted magnetic resonance images revealed perineural edema/inflammation surrounding the nerve roots related to the pain locations indicated in the pain drawings. Conclusion: Axial (and, when required, sagittal and coronal) short-tau inversion recovery or fat-saturated T2-weighted magnetic resonance images may be helpful for revealing additional findings in cases of unexplained sciatica in standard magnetic resonance imaging. However, the value of this imaging may be not great enough to justify routine use of these additional sequences to study the level of sciatica

  19. Adiponectin as a routine clinical biomarker.

    Kishida, Ken; Funahashi, Tohru; Shimomura, Iichiro


    Adiponectin is a protein synthesized and secreted predominantly by adipocytes into the peripheral blood. However, circulating adiponectin level is inversely related with body weight, especially visceral fat accumulation. The mechanism of this paradoxical relation remains obscure. Low circulating adiponectin concentrations (hypoadiponectinemia; metabolic syndrome, hyperuricemia), atherosclerosis (coronary artery disease, stroke, peripheral artery disease), sleep apnea, non-alcoholic fatty liver disease, gastritis and gastro-esophageal reflux disease, inflammatory bowel diseases, pancreatitis, osteoporosis, and cancer (endometrial cancer, postmenopausal breast cancer, leukemia, colon cancer, gastric cancer, prostate cancer). On the other hand, hyperadiponectinemia is associated with cardiac, renal and pulmonary diseases. This review article focuses on the significance of adiponectin as a clinical biomarker of obesity-related diseases. Routine measurement of adiponectin in patients with lifestyle-related diseases is highly recommended.

  20. Routine environmental monitoring schedule, calendar year 1995

    Schmidt, J.W.; Markes, B.M.; McKinney, S.M.


    This document provides Bechtel Hanford, Inc. (BHI) and Westinghouse Hanford Company (WHC) a schedule of monitoring and sampling routines for the Operational Environmental Monitoring (OEM) program during calendar year (CY) 1995. Every attempt will be made to consistently follow this schedule; any deviation from this schedule will be documented by an internal memorandum (DSI) explaining the reason for the deviation. The DSI will be issued by the scheduled performing organization and directed to Near-Field Monitoring. The survey frequencies for particular sites are determined by the technical judgment of Near-Field Monitoring and may depend on the site history, radiological status, use and general conditions. Additional surveys may be requested at irregular frequencies if conditions warrant. All radioactive wastes sites are scheduled to be surveyed at least annually. Any newly discovered wastes sites not documented by this schedule will be included in the revised schedule for CY 1995.

  1. Development of a fibre optic goniometer system to measure lumbar and hip movement to detect activities and their lumbar postures.

    Bell, J A; Stigant, M


    If sitting postures influence the risk of developing low back pain then it is important that quantification of sedentary work activities and simultaneous measurement of lumbar postural characteristics takes place. The objective of this study was to develop a system for identifying activities and their associated lumbar postures using fibre optic goniometers (FOGs). Five student subjects wore two FOGs attached to the lumbar spine and hip for 8 min while being recorded using a video camera when sitting, standing and walking. Observer Software was used to code the video recording, enabling the sagittal movement characteristics of each FOG to be described for individual activities. Results indicated that each activity produced unique data, and could be independently identified from their motion profiles by three raters (k = 1). The data will be used to develop algorithms to automate the process of activity detection. This system has the potential to measure behaviour in non-clinical settings.

  2. Is routine histopathology of tonsil specimen necessary?

    Agida S Adoga


    Full Text Available Background: Tonsillar diseases are common in paediatric and adult otolaryngological practice. These diseases require tonsillectomy. Specimens are subjected to histopathology routinely in my institution for fear of infections and tumour without consideration for risk factors. The financial burden is on the patients and waste of histopathologist′s man hour because other specimens are left un-attended. This study aims to find out the necessity of routine histopathology of tonsil specimens. Materials and Methods : A 2 year retrospective review of the histopathological results of two (paediatric and adult groups of 61 patients managed for tonsillar diseases at the ENT UNIT of Jos University Teaching Hospital from July 2005 to June, 2007. Data extracted included biodata, clinical features and histopathological diagnosis. Result : The 61 patients comprise 35 children and 26 adults. The youngest and oldest paediatric patients were 1 year and 3 months and 16 years respectively, a range of 1 year 3 months to 16 years. The youngest and oldest adults were 17 and 50 years with a range of 17-50 years. Groups mean ages were 5.1 and 28.5 years. The gender ratios were 1:2.7 and 1:1.9 respectively. One adult was HIV positive. The histopathological diagnosis were chronic nonspecific tonsillitis in 10(16.6%, follicular tonsillitis in 23(38.3%, chronic suppurative tonsillitis in 10(16.6%, lymphoid hyperplasia in 18(30.0% and lymphoma in 1(1.0% respectively. Conclusion : Histopathologic request for tonsillectomy specimens should be based on certain risk factors with consideration of the cost to patients and to spare the histopathologist′s man hour.


    G Taneja


    Full Text Available The Universal Immunization Programme is possibly the longest and one of the biggest public health intervention measures undertaken in India. To improve immunization coverage in the country various initiatives have been undertaken since the inception of the programme in 1985; key inputs being strengthening and expanding the cold chain system, establishing a network of outreach immunization sites, alternate vaccine delivery model, capacity building of health functionaries and medical officers and intensified polio control measures. Introduction of new and underutilized vaccines, drafting of the national vaccine policy, tracking of beneficiaries through the Maternal and Child Tracking system are some of the recent developments. However in spite of more than 25 years since inception the programme is still adversely impacted by challenges across key thematic areas of programme management, cold chain and vaccine management, recording and reporting and injection safety. To further strengthen and improve service delivery 2012-13 has been declared as the “Year of Intensification of Routine Immunization” with the objective of improving immunization coverage rates across poor performing districts and states so as to attain Global Immunization Vision and Strategy goals of 90% coverage at national and more than 80% coverage at district level. Key activities planned during the year include sustained advocacy at all levels, improved communication and social mobilization, robust and regular program reviews, comprehensive microplanning, strengthening cold chain and vaccine logistics system, special catch up rounds through immunization weeks, piloting the teeka express, improved surveillance systems, strengthened partnerships and operational research activities. The current review pertains to the existing scenario of Universal Immunization Program in the country with impetus on the existing challenges, progress achieved till date as a result of various

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

    Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar; Benyamin, Ramsin


    Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures), the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or discogenic pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the pain source.

  5. Effect of steerable cage placement during minimally invasive transforaminal lumbar interbody fusion on lumbar lordosis.

    Lindley, Timothy E; Viljoen, Stephanus V; Dahdaleh, Nader S


    Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is commonly used for the treatment of a variety of degenerative spine disorders. Recently, steerable interbody cages have been developed which potentially allow for greater restoration of lumbar lordosis. Here we describe a technique and radiographic results following minimally invasive placement of steerable cages through a bilateral approach. A retrospective review was conducted of the charts and radiographs of 15 consecutive patients who underwent 19 levels of bilateral MIS-TLIF with the placement of steerable cages. These were compared to 10 patients who underwent 16 levels of unilateral MIS-TLIF with the placement of bullet cages. The average age, body mass index, distribution of the levels operated and follow-up were similar in both groups. The average height of the steerable cage placed was 10.9 mm compared to 8.5mm for bullet cages. The preoperative focal Cobb's angle per level was similar between both groups with a mean of -5.3 degrees for the steerable cage group and -4.8 degrees for the bullet cage group. There was a significant improvement in postoperative Cobb's angle after placement of a steerable cage with a mean of -13.7 (p<0.01) and this persisted at the last follow-up with -13 degrees (p<0.01). There was no significant change in Cobb's angle after bullet cage placement with -5.7 degrees postoperatively and a return to the baseline preoperative Cobb's angle of -4.8 at the last follow-up. Steerable cage placement for MIS-TLIF improves focal lordosis compared to bullet cage placement.

  6. Attitude and perceptions of women on routine antenatal ultrasound ...

    Attitude and perceptions of women on routine antenatal ultrasound ... 16 (34.7%) felt that ultrasound should only be done on the doctor's request. ... df=2, P=0.00) were significantly, more favourably disposed to routine scan in pregnancy.

  7. A role for myelography in assessing paraparesis.

    Merwick, A


    Imaging of the spine is a fundamental part of assessment of paraparesis. Since the advent of MRI the indications for myelograms have diminished. However, a myelogram, although an invasive test, should still be considered a useful investigation for localising lesions in the spinal cord and for identifying rare causes of myelopathy. This case illustrates how a CT myelogram identified an arachnoid cyst, which is a potentially treatable cause of paraparesis.

  8. CT metrizamide myelography in intrathoracic meningocele

    Lee, Ki Man; Woo, Seong Ku; Kim, Ok Bae; Suh, Soo Jhi [Keimyung University Medical College, Daegu (Korea, Republic of)


    Intrathoracic meningocele is a protrusion of the spinal meninges through an intervertebral foramen into the thoracic cavity. The majority occur in association with neurofibromatosis. The authors experienced a case of intrathoracic meningocele in 26 years old male patient associated with neurofibromatosis, and present conventional CT and CT metrizamide myelographic findings.

  9. MRI of the lumbar spine at 7 Tesla in healthy volunteers and a patient with congenital malformations

    Grams, Astrid E. [University Hospital Giessen and Marburg, Campus, Department of Neuroradiology, Giessen (Germany); University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Giessen, Justus Liebig University, Department of Neuroradiology, Giessen (Germany); Kraff, Oliver; Umutlu, Lale; Maderwald, Stefan; Ladd, Mark E.; Forsting, Michael [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Dammann, Philipp [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, Department of Neurosurgery, Essen (Germany); Gizewski, Elke R. [University Hospital Giessen and Marburg, Campus, Department of Neuroradiology, Giessen (Germany); University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany)


    The aim of this study was to evaluate sequences that are established at lower magnetic field strengths for lumbar spine imaging at 7 Tesla (7 T) MR imaging. The lumbar spine of five healthy volunteers and a patient with spina bifida and meningocele were evaluated at 7 T. The examination included a T2-TSE (turbo spin echo), a 3D-DESS (double-echo steady-state sequence), a 3D-CISS (constructive interference in steady-state sequence), and a 3D-VIBE (volumetric interpolated breath hold examination) sequence. Imaging quality was evaluated by two raters on a three-level scale. The assessment included visualization of intraforaminal structures, the cauda equina, facet joints, and any abnormalities. Contrast ratios for intervertebral discs/vertebral bodies, vertebral bodies/cerebrospinal fluid (CSF) and CSF/spinal cord were calculated. The 3D-VIBE sequence provided best differentiation between intraforaminal structures. Visualization of the facet joints was reliable with VIBE, DESS, and CISS. Individual nerve roots of the cauda equina could only be delineated with the 3D-CISS sequence. CISS and DESS provided good contrast between vertebral bodies and intervertebral discs. Contrast between CSF and vertebral bodies was most pronounced for the T2-TSE sequence. Sufficient contrast between CSF and the spinal cord was only achieved with the T2-TSE sequence. VIBE and DESS sequences demonstrated best the bony malformations. Visualization of the meningocele was only possible with the 3D-CISS sequence. At 7 T most structures of the lumbar spine were visualized with a combination of sequences. At present, imaging quality is not superior to 1.5 T or 3 T, precluding routine clinical use. (orig.)

  10. MRI of the lumbar spine at 7 Tesla in healthy volunteers and a patient with congenital malformations.

    Grams, Astrid E; Kraff, Oliver; Umutlu, Lale; Maderwald, Stefan; Dammann, Philipp; Ladd, Mark E; Forsting, Michael; Gizewski, Elke R


    The aim of this study was to evaluate sequences that are established at lower magnetic field strengths for lumbar spine imaging at 7 Tesla (7 T) MR imaging. The lumbar spine of five healthy volunteers and a patient with spina bifida and meningocele were evaluated at 7 T. The examination included a T2-TSE (turbo spin echo), a 3D-DESS (double-echo steady-state sequence), a 3D-CISS (constructive interference in steady-state sequence), and a 3D-VIBE (volumetric interpolated breath hold examination) sequence. Imaging quality was evaluated by two raters on a three-level scale. The assessment included visualization of intraforaminal structures, the cauda equina, facet joints, and any abnormalities. Contrast ratios for intervertebral discs/vertebral bodies, vertebral bodies/cerebrospinal fluid (CSF) and CSF/spinal cord were calculated. The 3D-VIBE sequence provided best differentiation between intraforaminal structures. Visualization of the facet joints was reliable with VIBE, DESS, and CISS. Individual nerve roots of the cauda equina could only be delineated with the 3D-CISS sequence. CISS and DESS provided good contrast between vertebral bodies and intervertebral discs. Contrast between CSF and vertebral bodies was most pronounced for the T2-TSE sequence. Sufficient contrast between CSF and the spinal cord was only achieved with the T2-TSE sequence. VIBE and DESS sequences demonstrated best the bony malformations. Visualization of the meningocele was only possible with the 3D-CISS sequence. At 7 T most structures of the lumbar spine were visualized with a combination of sequences. At present, imaging quality is not superior to 1.5 T or 3 T, precluding routine clinical use.

  11. Analysis of safety and effect of reconstructing anterior and middle columns by single posterior approach in treating lumbar burst fractures

    ZHANG Jing-wei; XIAO Bai-ping; XU Rong-ming; ZHAO Liu-jun; MA Wei-hu; RUAN Yong-ping


    Objective: To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures.Methods: From July 2005 to January 2007,22 cases (18 males and 4 females,aged 28-57 years,42.7years on average) of lumbar burst fractures were treated with surgical procedures in our hospital.Based on the routine posterior approach,one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebralbody.After all the displaced fracture fragments were cleared away and the spinal canal was decompressed,the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns.The adjacent above and below segments of the vetebral body were fixed with transpedicular screws.The operation time,intraoperative blood loss,vertebral height,degree of kyphotic deformity and comprised spinal canal were documented.Results: The average operation time was 3.5 hours (ranging 2.8-5.8 hours) and the average blood loss was 820 ml (ranging 650-2 100 ml).All the cases were followed up for 17.2 months on average (ranging 12-28 months).The height of the injured vetebral body was restored from 24% (12%-45%) preoperatively to 96% (95%-99%) postoperatively (P<0.05).The natural spinal curvatures and spinal canal were restored.Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively.Conclusions: The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures.

  12. Hallazgos degenerativos de columna lumbar en resonancia magnética de pacientes con dolor lumbar Edgar

    González Rodríguez, Edgar Iván


    El resumen es una presentación abreviada y precisa (la NTC 1486 de 2008 recomienda Introducción: Entre los padecimientos que mayor impacto genera en la población económicamente activa en todo el mundo se encuentra el dolor lumbar bajo también conocido como lumbago, lumbalgia o lumbociatalgia. Metodología: Estudio descriptivo retrospectivo de pacientes adultos con dolor lumbar y hallazgos degenerativos en RM. Resultados: La edad promedio fue de 50.8 años. El 86% de los pacientes...

  13. Hallazgos degenerativos de columna lumbar en resonancia magnética de pacientes con dolor lumbar Edgar

    González Rodríguez, Edgar Iván


    El resumen es una presentación abreviada y precisa (la NTC 1486 de 2008 recomienda Introducción: Entre los padecimientos que mayor impacto genera en la población económicamente activa en todo el mundo se encuentra el dolor lumbar bajo también conocido como lumbago, lumbalgia o lumbociatalgia. Metodología: Estudio descriptivo retrospectivo de pacientes adultos con dolor lumbar y hallazgos degenerativos en RM. Resultados: La edad promedio fue de 50.8 años. El 86% de los pacientes...

  14. Rituals and Routines: Supporting Infants and Toddlers and Their Families

    Gillespie, Linda; Petersen, Sandra


    The words "routine" and "ritual" are sometimes used interchangeably. Yet there are some important differences. Routines are repeated, predictable events that provide a foundation for the daily tasks in a child's life. Teachers can create a predictable routine in early childhood settings for infants and toddlers, and they can individualize those…

  15. [The controversy of routine articulator mounting in orthodontics].

    Wang, Li; Han, Xianglong; Bai, Ding


    Articulators have been widely used by clinicians of dentistry. But routine articulator mounting is still controversial in orthodontics. Orthodontists oriented by gnathology approve routine articulator mounting while nongnathologic orthodontists disapprove it. This article reviews the thoughts of orthodontist that they agree or disagree with routine articulator mounting based on the considerations of biting, temporomandibular disorder (TMD), periodontitis, and so on.

  16. 42 CFR 493.1210 - Condition: Routine chemistry.


    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Routine chemistry. 493.1210 Section 493....1210 Condition: Routine chemistry. If the laboratory provides services in the subspecialty of Routine chemistry, the laboratory must meet the requirements specified in §§ 493.1230 through 493.1256, § 493.1267...

  17. Warrior Injury Assessment Manikin (WIAMan) Lumbar Spine Model Validation: Development, Testing, and Analysis of Physical and Computational Models of the WIAMan Lumbar Spine Materials Demonstrator


    6400 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) US Army Research Laboratory ATTN: RDRL-DPW...Anthropomorphic Test Device (ATD) Lumbar Spine Materials Demonstrator. A primary objective of this work was to generate experimental data for FEM validation...Lumbar Spine Materials Demonstrator 1 1.2.1 WIAMan ATD Lumbar Spine Assembly 1 1.2.2 Materials Consideration 2 1.2.3 Test Method 3 2. Preliminary

  18. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

    Raspe, Heiner


    there is no dependable evidence-base to recommend their use in routine clinical practice. 2. To create such a dependable evidence-base further research in two directions is needed: a The studies need to include adequate patient populations, use realistic controls (e.g. standard operative procedures or continued conservative care and use standardised measurements of meaningful outcomes after adequate periods of time. b Studies that are able to report effectiveness of the procedures under everyday practice conditions and furthermore have the potential to detect rare adverse effects are needed. In Sweden this type of data is yielded by national quality registries. On the one hand their data are used for quality improvement measures and on the other hand they allow comprehensive scientific evaluations. 3. Since the year of 2000 a continuous rise in utilisation of minimally-invasive lumbar disc surgery is observed among statutory health insurers. Examples from other areas of innovative surgical technologies (e.g. robot assisted total hip replacement indicate that the rise will probably continue - especially because there are no legal barriers to hinder introduction of innovative treatments into routine hospital care. Upon request by payers or providers the "Gemeinsamer Bundesausschuss" may assess a treatments benefit, its necessity and cost-effectiveness as a prerequisite for coverage by the statutory health insurance. In the case of minimally-invasive disc surgery it would be advisable to examine the legal framework for covering procedures only if they are provided under evaluation conditions. While in Germany coverage under evaluation conditions is established practice in ambulatory health care only (“Modellvorhaben" examples from other European countries (Great Britain, Switzerland demonstrate that it is also feasible for hospital based interventions. In order to assure patient protection and at the same time not hinder the further development of new and promising

  19. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

    Lühmann, Dagmar; Burkhardt-Hammer, Tatjana; Borowski, Cathleen; Raspe, Heiner


    their use in routine clinical practice. To create such a dependable evidence-base further research in two directions is needed: a) The studies need to include adequate patient populations, use realistic controls (e.g. standard operative procedures or continued conservative care) and use standardised measurements of meaningful outcomes after adequate periods of time. b) Studies that are able to report effectiveness of the procedures under everyday practice conditions and furthermore have the potential to detect rare adverse effects are needed. In Sweden this type of data is yielded by national quality registries. On the one hand their data are used for quality improvement measures and on the other hand they allow comprehensive scientific evaluations. Since the year of 2000 a continuous rise in utilisation of minimally-invasive lumbar disc surgery is observed among statutory health insurers. Examples from other areas of innovative surgical technologies (e.g. robot assisted total hip replacement) indicate that the rise will probably continue - especially because there are no legal barriers to hinder introduction of innovative treatments into routine hospital care. Upon request by payers or providers the "Gemeinsamer Bundesausschuss" may assess a treatments benefit, its necessity and cost-effectiveness as a prerequisite for coverage by the statutory health insurance. In the case of minimally-invasive disc surgery it would be advisable to examine the legal framework for covering procedures only if they are provided under evaluation conditions. While in Germany coverage under evaluation conditions is established practice in ambulatory health care only (“Modellvorhaben") examples from other European countries (Great Britain, Switzerland) demonstrate that it is also feasible for hospital based interventions. In order to assure patient protection and at the same time not hinder the further development of new and promising technologies provision under evaluation conditions

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

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


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

  1. Decreasing the required lumbar extensor moment induces earlier onset of flexion relaxation.

    Zwambag, Derek P; De Carvalho, Diana E; Brown, Stephen H M


    Flexion relaxation (FR) is characterized by the lumbar erector spinae (LES) becoming myoelectrically silent near full trunk flexion. This study was designed to: (1) determine if decreasing the lumbar moment during flexion would induce FR to occur earlier; (2) characterize thoracic and abdominal muscle activity during FR. Ten male participants performed four trunk flexion/extension movement conditions; lumbar moment was altered by attaching 0, 5, 10, or 15lb counterweights to the torso. Electromyography (EMG) was recorded from eight trunk muscles. Lumbar moment, lumbar flexion and trunk inclination angles were calculated at the critical point of LES inactivation (CPLES). Results demonstrated that counterweights decreased the lumbar moment and lumbar flexion angle at CPLES (pactive throughout flexion. Abdominal muscles activated at the same instant as CPLES, except in the 15lb condition where abdominal muscles activated before CPLES resulting in a period of increased co-contraction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Complex rehabilitation of the invalids with lumbar radiculopathies


    In this article was researched clinical, instrumental and diagnostic criterion of definition of physical disability in the patients with lumbar radiculopathies, caused by osteochondrosis of the spine as well as were developed principles of medico-social and professional rehabilitation of this category of the patients and invalids.

  3. MRI of degenerative cysts of the lumbar spine

    Khalatbari, K. [Department of MRI, Iran Gamma Knife Centre, Iran University of Medial Sciences-Kamrani Charity Foundation, Tehran (Iran, Islamic Republic of)], E-mail:; Ansari, H. [Department of Orthopaedics, Rassoul Akram University Hospital, Tehran (Iran, Islamic Republic of)


    Degenerative cysts of the lumbar spine encompass a heterogeneous group of cystic lesions that are presumed to share a common aetiology. Some of these cysts may be incidental findings, whereas others may produce acute or chronic symptoms. These cysts have been categorized using various combinations of topographic and pathological characteristics and by their attachment to or communication with a specific spinal structure.

  4. Adjacent level disease following lumbar spine surgery: A review

    Nancy E Epstein


    Conclusions: The incidence of postoperative ASD (up to 30% is greater following either open or MIS instrumented lumbar fusions (e.g., TLIF/PLIF, while decompressions with noninstrumented fusions led to a much smaller 5.6% risk of ASD. Other findings included: MIS instrumented fusions contributed to higher perioperative complication rates, and dynamic stabilization did not protect against ASD.

  5. Ventricular Pneumocephalus with Meningitis after Lumbar Nerve Root Block

    Shin Ahn


    Full Text Available Lumbar nerve root block is a common modality used in the management of radiculopathy. Its complications are rare and usually minor. Despite its low morbidity, significant acute events can occur. Pneumocephalus is an accumulation of air in the intracranial space. It indicates a violation of the dura or the presence of infection. The object of this report is to describe the case of a patient with intraventricular pneumocephalus and bacterial meningitis after lumbar nerve root block. A 70-year-old female was brought into emergency department with severe headache and vomiting which developed during her sleep. She had received lumbar nerve block for her radiculopathy one day before her presentation. Cranial computed tomography scan revealed a few hypodense lesions in her left lateral ventricle frontal horn and basal cistern indicating ventricular pneumocephalus. Five hours later, she developed sudden hearing loss. Cerebrospinal fluid analysis showed bacterial meningitis, and she was treated with high dose steroid and antibiotics. However, her impaired hearing as a sequela from meningitis was persistent, and she is still in follow-up. Intracranial complications of lumbar nerve root block including meningitis and pneumocephalus can occur and should be considered as high-risk conditions that require prompt intervention.

  6. Lumbar facet stress fracture in a ballet dancer.

    Fehlandt, A F; Micheli, L J


    A frequent cause of back pain in athletes and dancers is stress injury to the posterior vertebral elements. Stress fractures affect the pars interarticularis and, rarely, other vertebral regions. The authors present their experience with the diagnosis and treatment of a fourth lumbar inferior articular facet stress fracture in a ballerina in this brief report and discuss the literature concerning posterior element stress fractures.

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

    Singh, Sanjay; Kaur, Simranjit; Wilson, Paul


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


    Rangalakshmi S


    Full Text Available OBJECTIVE Lumbar spinal surgeries have been performed with either spinal or general anaesthesia. In this study, we aimed to evaluate the superiority of either spinal or general anaesthesia on lumbar spine surgery. METHODS After approval of institutional ethical committee, we retrospectively analysed 270 patients (ASA I and II undergoing surgery of lumbar spine from 2009 to 2015 by one surgeon. Of these 150 patients underwent general anaesthesia with controlled ventilation, 120 patients were offered spinal anaesthesia with conscious sedation. Patient records were reviewed to obtain demographic features, type of anaesthesia, baseline heart rate, mean arterial pressure, intraoperative maximum heart rate, mean arterial pressure, duration of surgery, amount of intravenous fluids, intraoperative blood loss, incidence of perioperative complications such as bleeding, nausea, vomiting, hypotension, bradycardia, and postoperative analgesic consumption. RESULTS Patient characteristics including baseline/intraoperative mean arterial pressure and heart rate values did not differ between groups. However, the spinal anaesthesia group experienced significantly shorter durations in the operating room and had a lower incidence of nausea, vomiting. Analgesic consumptions in general anaesthesia group was significantly higher than in spinal anaesthesia group. CONCLUSION The present study revealed that spinal anaesthesia is a safe and effective alternative to general anaesthesia for patients undergoing single level or two level lumbar laminectomy, discectomy, or even instrumentation below L2 level and has the advantage of decreased nausea, antiemetic, analgesic requirements, and fewer complications. It also ensures better postoperative recovery when compared to general anaesthesia

  9. Treatment of Acute Lumbar Sprain by Acupuncture plus Cupping

    WANG Jun-ying; WANG Si-you


    Fifty cases of acute lumbar sprain were treated by the combination of acupuncture, cupping and kinesitherapy. Forty-three cases were cured and 7 cases improved, the total effective rate being 100%. This therapy has an exact effect with a short course of treatment.

  10. Roseomonas Spinal Epidural Abscess Complicating Instrumented Posterior Lumbar Interbody Fusion

    Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia


    The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

  11. A Rare Case of Pediatric Lumbar Spinal Ependymoma Mimicking Meningitis.

    Ekuma, Ezeali Mike; Ito, Kiyoshi; Chiba, Akihiro; Hara, Yosuke; Kanaya, Kohei; Horiuchi, Tetsuyoshi; Ohaegbulam, Samuel; Hongo, Kazuhiro


    Spontaneous acute subarachnoid hemorrhage (SAH) from lumbar ependymoma in children is rare. We report a case of a14-year-old boy who developed sudden radicular low back pain while playing baseball. He was initially managed conservatively in a local hospital for suspected lumbar disc herniation, but later developed meningeal symptoms and fever before being referred to our hospital. There he underwent a diagnostic lumbar puncture in the emergency room; his cerebrospinal fluid suggested an SAH. Physical examination showed meningeal signs and cauda equina features. Cerebrospinal fluid analysis was negative for bacterial meningitis. Lumbar magnetic resonance imaging revealed a mass characterized as a hemorrhagic lesion. The patient had an emergent evacuation of the mass via the posterior approach. Postoperatively, his symptoms resolved completely. The histological diagnosis was, surprisingly, an ependymoma (WHO grade II). This case is particularly interesting because of its rarity in children, and its pattern of presentation. Though bacterial or viral meningitis is the most frequent cause of meningeal features in children, SAH from a hemorrhagic spinal tumor should be considered. Ultimately, a high index of suspicion is needed for prompt diagnosis.

  12. Ergonomic lumbar risk analysis of construction workers by NIOSH method

    Cinara Caetano Pereira


    Full Text Available Work in construction has tasks directly connected with manual transport. One of the body segments suffering greater demand in works with these characteristics is the lumbar spine segment. The aim of this study was to analyze the level of risk of lumbar construction workers in the shipment of materials. The sample was composed of 74 construction workers. Were used as a research tool: the NIOSH method for lumbar risk verification expressed by weight limit recommended (WPR and the lifting Index (IL, Visual analogue scale (VAS for the evaluation of pain intensity, the e-1 Corlett.0 for the mapping of the pain and Borg to the subjective perception of the intensity of physical exertion. The present study identified the weight limit (WP of 8.707 for management activity of bags of cement for the load of 8.194 wheelbarrows used. These findings are 6 times under actual weights handled during the activities that revolve around 50 kg with the sacks and averaged 49.72 kg stands with mass. The dimensional settings found in the search are at high risk for ergonomic lumbar region, and measures of reconfiguration of workplaces and operation of auxiliary devices for lifting, transporting and unloading are fundamental, in addition to the need for reflection about the current logistical problems that induce producers to supply the cement sacks with 50 kg.

  13. A method for quantitative measurement of lumbar intervertebral disc structures

    Tunset, Andreas; Kjær, Per; Samir Chreiteh, Shadi


    There is a shortage of agreement studies relevant for measuring changes over time in lumbar intervertebral disc structures. The objectives of this study were: 1) to develop a method for measurement of intervertebral disc height, anterior and posterior disc material and dural sac diameter using MRI...

  14. Roseomonas spinal epidural abscess complicating instrumented posterior lumbar interbody fusion.

    Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia


    The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

  15. Residual complaints following lumbar disc surgery: prognostic indicators of outcome

    Ostelo, R.W.J.G.; Vlaeyen, J.W.S.; Brandt, van den P.A.; Vet, de H.C.W.


    Physical as well as psychological features might be important prognostic factors for residual complaints following lumbar disc surgery in primary care. No studies have yet investigated both factors simultaneously. The aim of this prospective cohort study was to identify indicators of the short and l

  16. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study

    Jacobsen, Steffen; Sonne-Holm, Stig; Rovsing, Hans


    : A total of 254 cases of lumbar slip were found (males 2.7%, females 8.4%). In females, no significant relationship between age at menopause or childbirths and the presence of degenerative spondylolisthesis were found. In women, relationships between body mass index (BMI) in 1976 and L4 olisthesis (P = 0...

  17. [Traumatic lumbar hernia of the Petit's triangle. A clinical case].

    Rosato, L; Paino, O; Ginardi, A


    Lumbar hernias are very rare and no more than 300 are reported in literature. They can be classified as congenital and acquired. The latter are in turn subdivided into primary and secondary. Secondary traumatic lumbar hernias account for 25% of all cases. The site of the formation of this hernia is mainly Grynfelt's triangle and, to a lesser extent, Petit's triangle. Traumatic lumbar hernia have very moderate symptoms and may be corrected surgically relatively easily, in particular with the use of Marlex nets. Recidivations can be easily identified owing to the lack of aponeurotic support structures in this anatomic site. Owing to their traumatic etiopathogenesis these hernias are of particular medicolegal importance for the purposes of indemnity. The case reported refers to a 46-years-old man involved in a road accident who sustained an injury caused by the explosion of hollow viscera in the abdomen and the subsequent onset of a hernia swelling through Petit's triangle in the right lumbar region. Owing to the width of the breach, plastic surgery was carried out using a Marlex graft. A large recidivation was observed around one year later.

  18. Spontaneous regression of lumbar herniated disc Case presentation

    Chiriac A.


    Full Text Available Intervertebral disc herniation is a common disease that usually requires surgical intervention. However, in some cases, neurological symptoms may improve with conservative treatment. In this article, we present a case with spontaneous regression of extruded lumbar herniated disc correlated with clinical improvement and documented with follow up MRI studies.

  19. Surgical treatment in thoraco-lumbar region fractures.

    Jorge Alberto Jerez Labrada


    Full Text Available Background: thoraco-lumbar fractures may affect people at any moment of their lives, especially at their most fruitful and useful stage. Its correct diagnosis and treatment may directly influence in the posterior evolution of the patients. Objectives: to evaluate the results of the surgical treatment in thoraco-lumbar region fractures. Methods: a descriptive retrospective correlational study of series cases which included 54 patients attended due to thoraco-lumbar region fractures in the University Hospital “Dr. Gustavo Aldereguía Lima” in Cienfuegos city, Cuba from January 1999 to June 2007. Age, sex, etiology of the fracture, type and level of the fractures, associated diseases, surgical techniques used for, pre and post operatory neurological damage, usage of metilprednisolone, complications and final results were the variables taken into consideration in this study. Results: most of the patients belonged to male sex under the age of 45. The totality of the cases had type IV fracture, and a great part of them had Denis type II fracture having surgical treatment. The causes of the lesions were traffic accidents, working accidents and height falls. The most useful surgical techniques were posterior decompression, instrumentation and fusion. Surgery improved the neurological damage in almost half of sick patients with this condition. Complications were minimum and rupture of the implant was predominant. Conclusion: surgical treatment in thoraco-lumbar region fractures had satisfactory results in our milieu.

  20. Manipulative physiotherapists can reliably palpate nominated lumbar spinal levels.

    Downey, B J; Taylor, N F; Niere, K R


    Palpating a nominated spinal level is a prerequisite to more complex tasks such as palpating the level most likely to be the source of the patient's symptoms. The aim of this study was to investigate the reliability of physiotherapists with a post-graduate qualification in manipulation (manipulative physiotherapists) in palpating the lumbar spines of patients in a clinical setting. Three pairs of manipulative physiotherapists palpated the randomly-nominated lumbar spinal levels of 20 patients presenting to their practices for treatment of low-back pain. Each therapist marked the skin overlying the spinous process of the nominated spinal level with an ultraviolet pen and these marks were transcribed onto transparencies for analysis. The therapists obtained an overall weighted kappa of 0.92 indicating almost perfect agreement for locating the nominated spinal level. The results of this study indicate that manipulative physiotherapists can reliably palpate nominated lumbar spinal levels, suggesting further training in spinal therapy enhances the palpatory skills of physiotherapists in palpating nominated lumbar spinal levels.

  1. Synovial cysts of the lumbar spine: a review.

    Radatz, M; Jakubowski, J; Cooper, J; Powell, T


    Four cases of synovial cyst (ganglion) arising from the facet joints of the lumbar spine are reported. A typical presenting feature was exacerbation of pain on standing or walking, mimicking vascular claudication. MRI proved in all four cases to be the definitive investigation and surgery the treatment of choice, producing excellent results.

  2. Laparoscopic surgery for treatment of incisional lumbar hernia

    M. Tobias-Machado


    Full Text Available OBJECTIVE: To present results obtained with laparoscopic correction of incisional lumbar hernia in patients with minimum follow-up of 1 year. MATERIALS AND METHODS: We prospectively studied 7 patients diagnosed with incisional lumbar hernia after physical examination and computerized tomography. We used laparoscopic transperitoneal access through 3 ports. One polypropylene mesh was introduced in the abdominal cavity and fixed by titanium clamps to the margins of the hernia ring following release of the peritoneum. RESULTS: All cases were successfully completed with no conversion required. Mean surgical time was 120 minutes and discharge from hospital occurred between the 1st and the 2nd postoperative days. There were no intraoperative complications or hernia recurrence in any case. Postoperatively, we had 2 minor complications: one case of seroma that resolved spontaneously after 60 days and one patient presenting lumbar pain that persisted until the 3rd postoperative month. The return to usual activities occurred on average 3 weeks following intervention. Of the 7 patients, 6 were satisfied with the esthetical and functional effect produced by the procedure. CONCLUSIONS: The surgical correction of incisional lumbar hernia by laparoscopic access is an excellent option for a minimally invasive treatment, with adequate long-term results.

  3. [Major vascular complications following surgery for a herniated lumbar disk].

    Abad, C; Martel, D; Feijóo, J J; Carreira, L


    Two cases of arterial injury of the iliac arteries during surgery of the lumbar disc are presented. Both patients were successfully operated, in the first case a primary repair was accomplished, the second patient was treated by means of an ileo-femoral bypass graft. A comment of the pathophysiology, diagnostic and surgical management of this unusual complication is presented.

  4. 49 CFR 572.43 - Lumbar spine and pelvis.


    ... vertical plane which is tangent to the back of the dummy's buttocks. (3) Align the test probe so that at... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) ANTHROPOMORPHIC TEST DEVICES Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a fully assembled dummy...

  5. Lumbar bone mass predicts low back pain in males

    Hoozemans, M.J.M.; Koppes, L.L.J.; Twisk, J.W.R.; Dieën, J.H. van


    STUDY DESIGN.: Longitudinal study of lumbar bone mass as predictor of low back pain (LBP). OBJECTIVE.: To investigate whether low bone mineral content (BMC) and bone mineral density (BMD) values at the age of 36 years are associated with the prevalence of LBP at the age of 42 years among the study p

  6. Spontaneous regression of lumbar herniated disc Case presentation

    Chiriac A.; Ion Giorgiana; Faiyad Z.; Poeata I.


    Intervertebral disc herniation is a common disease that usually requires surgical intervention. However, in some cases, neurological symptoms may improve with conservative treatment. In this article, we present a case with spontaneous regression of extruded lumbar herniated disc correlated with clinical improvement and documented with follow up MRI studies.

  7. Lumbar spinal mobility changes among adults with advancing age

    Ismaila Adamu Saidu


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

  8. Femoral Intertrochanteric Fracture With Spontaneous Lumbar Hernia: A Case Report



    Full Text Available Introduction The diagnosis of lumbar hernia can be easily missed, as it is a rare case to which most orthopedists are not exposed in their common clinical practice. Approximately 300 cases have been reported in the literature since it was first described by Barbette in 1672. Case Presentation A 76-year-old woman who had been diagnosed with a femoral intertrochanteric fracture was sent to our department. Physical examination revealed a smooth, soft, and movable mass, with no tenderness, palpable on her left flank, which had gradually increased during the last seven years and presented with a slight feeling of swelling. We initially misdiagnosed the case as a left lipoma combined with the femoral intertrochanteric fracture. However, after six hours, the patient presented with a sudden onset of nausea, vomiting, and abdominal distension. Afterward, computed tomography (CT examination confirmed that the mass was a spontaneous lumbar hernia. Conclusions A lumbar hernia may, on rare occasions, become incarcerated or strangulated, with the consequent complication of mechanical bowel obstruction. We suggest that a patient with a flank mass should always raise suspicions of a lumbar hernia.

  9. Femoral Intertrochanteric Fracture With Spontaneous Lumbar Hernia: A Case Report

    Luo, Peng; HE, Xing-Wen; Chen, Qing-Yun; Hong, Hao; Yang, Lei


    Introduction The diagnosis of lumbar hernia can be easily missed, as it is a rare case to which most orthopedists are not exposed in their common clinical practice. Approximately 300 cases have been reported in the literature since it was first described by Barbette in 1672. Case Presentation A 76-year-old woman who had been diagnosed with a femoral intertrochanteric fracture was sent to our department. Physical examination revealed a smooth, soft, and movable mass, with no tenderness, palpable on her left flank, which had gradually increased during the last seven years and presented with a slight feeling of swelling. We initially misdiagnosed the case as a left lipoma combined with the femoral intertrochanteric fracture. However, after six hours, the patient presented with a sudden onset of nausea, vomiting, and abdominal distension. Afterward, computed tomography (CT) examination confirmed that the mass was a spontaneous lumbar hernia. Conclusions A lumbar hernia may, on rare occasions, become incarcerated or strangulated, with the consequent complication of mechanical bowel obstruction. We suggest that a patient with a flank mass should always raise suspicions of a lumbar hernia.

  10. Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics

    Torsten Kluba


    Full Text Available This prospective study aimed to compare the efficacy of epidural (EDA versus intravenous (PCA application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal post-operative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA.

  11. Age-predicted values for lumbar spine, proximal femur, and whole-body bone mineral density: results from a population of normal children aged 3 to 18 years

    Webber, C.E. [Hamilton Health Sciences, Dept. of Nuclear Medicine, Hamilton, Ontario (Canada); McMaster Univ., Dept. of Radiology, Hamilton, Ontario (Canada)]. E-mail:; Beaumont, L.F. [Hamilton Health Sciences, Dept. of Nuclear Medicine, Hamilton, Ontario (Canada); Morrison, J. [McMaster Children' s Hospital, Hamilton, Ontario (Canada); Sala, A. [McMaster Children' s Hospital, Hamilton, Ontario (Canada); McMaster Univ., Dept. of Pediatrics, Hamilton, Ontario (Canada); Univ. of Milan-Bicocca, Monza (Italy); Barr, R.D. [McMaster Children' s Hospital, Hamilton, Ontario (Canada); McMaster Univ., Dept. of Pediatrics, Hamilton, Ontario (Canada)


    We measured areal bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) at the lumbar spine and the proximal femur and for the total body in 179 subjects (91 girls and 88 boys) with no known disorders that might affect calcium metabolism. Results are also reported for lumbar spine bone mineral content (BMC) and for the derived variable, bone mineral apparent density (BMAD). Expected-for-age values for each variable were derived for boys and girls by using an expression that represented the sum of a steady increase due to growth plus a rapid increase associated with puberty. Normal ranges were derived by assuming that at least 95% of children would be included within 1.96 population standard deviations (SD) of the expected-for-age value. The normal range for lumbar spine BMD derived from our population of children was compared with previously published normal ranges based on results obtained from different bone densitometers in diverse geographic locations. The extent of agreement between the various normal ranges indicates that the derived expressions can be used for reporting routine spine, femur, and whole-body BMD measurements in children and adolescents. The greatest difference in expected-for-age values among the various studies was that arising from intermanufacturer variability. The application of published conversion factors derived from DXA measurements in adults did not account fully for these differences, especially in younger children. (author)

  12. A study on the Efficacy of Muscle Energy Technique as compared to Conventional Therapy on Lumbar Spine Range of Motion in Chronic Low Back Pain of Sacroiliac Origin

    Supreet Bindra


    Full Text Available Sacroiliac joint dysfunction is a term often used to describe pain in and around the region of the joint that is presumed to be due to biomechanical disorders of the joint. Despite of high incidence, the contribution of sacroiliac joint to low back pain has been a matter of controversy. Physical therapists routinely assess spinal range of motion in patients with low back pain and believe that spinal range of motion and disability are closely linked. The present study was aimed to determine the relative efficacy of Muscle Energy Technique as compared to Conventional Therapy on lumbar spine range of motion in chronic low back pain of Sacroiliac origin. It was found that the subjects who were treated with Muscle Energy Technique showed greater improvements in lumbar spine range of motion as compared to Conventional Therapy Group. As far as reduction in pain and disability are concerned both the groups showed almost similar results. The study concluded that sacroiliac joint dysfunction affects lumbar spine range of motion and is a significant contributor to chronic low back pain.

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

    Khoo, L.A.L. E-mail:; Heron, C.; Patel, U.; Given-Wilson, R.; Grundy, A.; Khaw, K.T.; Dundas, D


    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.

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

    Marcelo de Paula Loureiro


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

  15. Sagittal endplate morphology of the lower lumbar spine.

    Lakshmanan, Palaniappan; Purushothaman, Balaji; Dvorak, Vlasta; Schratt, Walter; Thambiraj, Sathya; Boszczyk, Maximilian


    The sagittal profile of lumbar endplates is discrepant from current simplified disc replacement and fusion device design. Endplate concavity is symmetrical in the coronal plane but shows considerable variability in the sagittal plane, which may lead to implant-endplate mismatch. The aim of this investigation is to provide further analysis of the sagittal endplate morphology of the mid to lower lumbar spine study (L3–S1), thereby identifying the presence of common endplate shape patterns across these levels and providing morphological reference values complementing the findings of previous studies. Observational study. A total of 174 magnetic resonance imaging (MRI) scans of the adult lumbar spine from the digital archive of our centre, which met the inclusion criteria, were studied. Superior (SEP) and inferior (IEP) endplate shape was divided into flat (no concavity), oblong (homogeneous concavity) and ex-centric (inhomogeneous concavity). The concavity depth (ECD) and location of concavity apex (ECA) relative to endplate diameter of the vertebrae L3–S1 were determined. Flat endplates were only predominant at the sacrum SEP (84.5%). The L5 SEP was flat in 24.7% and all other endplates in less than 10%. The majority of endplates were concave with a clear trend of endplate shape becoming more ex-centric from L3 IEP (56.9% oblong vs. 37.4% ex-centric) to L5 IEP (4% oblong vs. 94.3% ex-centric). Ex-centric ECA were always found in the posterior half of the lumbar endplates. Both the oblong and ex-centric ECD was 2-3 mm on average with the IEP of a motion segment regularly possessing the greater depth. A sex- or age-related difference could not be found. The majority of lumbar endplates are concave, while the majority of sacral endplates are flat. An oblong and an ex-centric endplate shape can be distinguished, whereby the latter is more common at the lower lumbar levels. The apex of the concavity of ex-centric discs is located in the posterior half of the endplate

  16. Routine polysomnography in an epilepsy monitoring unit.

    Phillips, Matthew C L; Costello, Craig A; White, Elise J; Smit, Michelle; Carino, John; Strawhorn, Andrew; Jackson, Brianna; Kwan, Patrick; French, Christopher R; Yerra, S Raju; Tan, K Meng; O'Brien, Terence J; Goldin, Jeremy


    Up to 13% of patients with epilepsy have moderate or severe sleep-disordered breathing, in particular obstructive sleep apnea (OSA), a disorder associated with reduced quality of life, worsened seizure control, and increased cardiovascular morbidity and mortality. Combining video-EEG monitoring with polysomnography (VPSG) provides the opportunity to diagnose clinically significant OSA as well as relate the occurrence of seizures and the epilepsy diagnosis to the presence and severity of sleep-disordered breathing. We have established routine VPSG in our inpatient video-EEG monitoring unit and present our findings in 87 patients. Clinically significant sleep-disordered breathing was diagnosed in 19 of 87 (22%) patients. Patients with psychogenic non-epileptic seizures (PNES) had poorer sleep quality compared to patients with epilepsy and those with neither diagnosis, whereas the prevalence of clinically significant sleep-disordered breathing in patients with PNES (29%) did not differ significantly compared to patients with epilepsy (21%) and those with neither diagnosis (22%). The differences in sleep quality are not explained by differences in body mass index (BMI) or anti-epileptic drug (AED) effects.

  17. CULA: hybrid GPU accelerated linear algebra routines

    Humphrey, John R.; Price, Daniel K.; Spagnoli, Kyle E.; Paolini, Aaron L.; Kelmelis, Eric J.


    The modern graphics processing unit (GPU) found in many standard personal computers is a highly parallel math processor capable of nearly 1 TFLOPS peak throughput at a cost similar to a high-end CPU and an excellent FLOPS/watt ratio. High-level linear algebra operations are computationally intense, often requiring O(N3) operations and would seem a natural fit for the processing power of the GPU. Our work is on CULA, a GPU accelerated implementation of linear algebra routines. We present results from factorizations such as LU decomposition, singular value decomposition and QR decomposition along with applications like system solution and least squares. The GPU execution model featured by NVIDIA GPUs based on CUDA demands very strong parallelism, requiring between hundreds and thousands of simultaneous operations to achieve high performance. Some constructs from linear algebra map extremely well to the GPU and others map poorly. CPUs, on the other hand, do well at smaller order parallelism and perform acceptably during low-parallelism code segments. Our work addresses this via hybrid a processing model, in which the CPU and GPU work simultaneously to produce results. In many cases, this is accomplished by allowing each platform to do the work it performs most naturally.

  18. Lunate chondromalacia: evaluation of routine MRI sequences.

    Bordalo-Rodrigues, Marcelo; Schweitzer, Mark; Bergin, Diane; Culp, Randall; Barakat, Mohamed S


    Chondromalacia is a commonly encountered abnormality at arthroscopy and may be responsible for significant clinical symptoms and disability. In the wrist, the most common location for chondromalacia is the lunate bone. Consequently, we sought to study the accuracy of clinical MRI in the assessment of lunate articular cartilage. MR images of 34 patients who underwent arthroscopy and had an MRI examination within 1 month of surgery were evaluated by two reviewers for the presence and location of lunate cartilage defects and subchondral edema. Lunate cartilage defects were seen on MRI in 10 of the 13 patients with chondromalacia, but these defects were also incorrectly noted in three of 21 of patients without chondromalacia. The visible locations for cartilage defects were the ulnar aspect of the proximal lunate bone (n = 3), radial aspect of the proximal lunate bone (n = 4), ulnar aspect of the distal lunate bone (n = 2), and radial aspect of the distal lunate bone (n = 1). Subchondral marrow edema was observed in six of the 10 patients with chondromalacia seen on MRI; in all six patients, the edema was seen in the same quadrant as the cartilage defect. Marrow edema was detected in one patient without chondromalacia. We conclude that lunate chondromalacia can be accurately assessed using routine MRI sequences, although there are occasional false-positive interpretations.

  19. Merging ultrasound in the intensive care routine.

    Jakobson, Daniel J; Shemesh, Iftach


    Goal-oriented ultrasound examination is gaining a place in the intensive care unit. Some protocols have been proposed but the applicability of ultrasound as part of a routine has not been studied. To assess the influence of ultrasound performed by intensive care physicians. This retrospective descriptive clinical study was performed in a medical-surgical intensive care unit of a university-affiliated general hospital. Data were collected from patients undergoing ultrasound examinations performed by a critical care physician during the period 2010 to June 2011. A total of 299 ultrasound exams were performed in 113 mechanically ventilated patients (70 males, mean age 65 years). Exams included trans-cranial Doppler (n = 24), neck evaluation before tracheostomy (n = 15), chest exam (n = 83), focuse cardiac echocardiography (n = 60), abdominal exam (n = 41), and comprehensive screening at patient admission (n = 30). Ultrasound was used to guide invasive procedures for vascular catheter insertion (n = 42), pleural fluid drainage (n = 24), and peritoneal fluid drainage (n = 7). One pneumothorax was seen during central venous line insertion but no complications were observed after pleural or abdominal drainage. The ultrasound study provided good quality visualization in 86% (258 of 299 exams) and was a diagnostic tool that induced a change in treatment in 58% (132 of 226 exams). Bedside ultrasound examinations performed by critical care physicians provide an important adjunct to diagnostic and therapeutic performance, improving quality of care and patient safety.

  20. Epidural steroid injection for lumbar disc herniation in NFL athletes.

    Krych, Aaron J; Richman, Daniel; Drakos, Mark; Weiss, Leigh; Barnes, Ronnie; Cammisa, Frank; Warren, Russell F


    To our knowledge, there is no published information on the efficacy of epidural steroid injections for the treatment of lumbar disc herniation in an athletic population. The purpose of this study was to evaluate the efficacy of epidural corticosteroid injection for treatment of lumbar disc herniation in a group of National Football League (NFL) players. We retrospectively reviewed the records of all NFL players who underwent an epidural steroid injection at our institution for incapacitating pain secondary to an acute lumbar disc herniation (confirmed on magnetic resonance imaging) from 2003 to 2010. Our primary outcome was success of the injection, defined as return to play. The secondary outcome of the study was to evaluate risk factors for failure of this treatment approach. Seventeen players had a total of 37 injections for 27 distinct lumbar disc herniation episodes from 2003 to 2010. The success rate of returning an athlete to play for a given episode of disc herniation was 89% (24 of 27 episodes) with an average loss of 2.8 practices (range = 0-12) and 0.6 games (range = 0-2) after the injection. Four players required a repeat injection for the same episode. Three of these four players ultimately failed conservative management and required surgical intervention. Risk factors for failing injection therapy included sequestration of the disc herniation on magnetic resonance imaging (P = 0.01) and weakness on physical examination (P = 0.002). There were no complications reported. In this highly selective group of professional athletes, our results suggest that epidural steroid injections are a safe and effective therapeutic option in the treatment of symptomatic lumbar disc herniation.