Nucleoplasty for treating lumbar disk degenerative low back pain: an outcome prediction analysis

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Liliang PC

2016-10-01

Full Text Available Po-Chou Liliang,1 Kang Lu,1 Cheng-Loong Liang,1 Ya-Wen Chen,2,3 Yu-Duan Tsai,1 Yuan-Kun Tu4 1Department of Neurosurgery, E-Da Hospital, 2Department of Nursing, I-Shou University, 3School of Nursing, Kaohsiung Medical University, 4Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan Purpose: Nucleoplasty is a minimally invasive technique that is considered efficacious in alleviating lumbar disk degenerative low back pain (LBP. The efficacy of nucleoplasty and identified variables that can predict pain relief for nucleoplasty was reported. Patients and methods: Between December 2013 and November 2015, 47 nucleoplasty procedures on 47 lumbar disks in 31 consecutive patients were performed. The outcome was evaluated using a visual analog scale (VAS score. Improvements of ≥50% in VAS scores were considered substantial pain relief. The variables associated with pain relief after nucleoplasty included: 1 age; 2 sex; 3 body mass index; 4 hyperintensity zone at the rear of the disk; 5 hypointensity of the disk; 6 Modic changes of the end plates; 7 spinal instability pain; and 8 discography results. Results: Twenty-one patients (67.7% experienced substantial pain relief. The most common side effects following nucleoplasty were soreness at the needle puncture site (64.5%, numbness in the lower leg (12.9%, and increased intensity of back pain (9.7%. All side effects were transient. Multivariate analysis revealed that the discography results were the most critical predictor for substantial pain relief of nucleoplasty (P=0.03. The sensitivity and specificity of discography were 92.8% and 62.5%, respectively. Conclusion: Discography results could improve the success rate of nucleoplasty in the treatment of disk degenerative LBP. Keywords: low back pain, lumbar disk degenerative, nucleoplasty, discography 

Value of preoperative cervical discography

International Nuclear Information System (INIS)

Kwon, Jong Won; Kim, Sung Hyun; Lee, Joon Woo

2006-01-01

The aim of this study was to describe the method and the value of cervical discography as correlated with the MR findings. Twenty-one discs in 11 consecutive patients who underwent cervical discography were analyzed. MR and CT discography (CTD) were performed in all patients. Discography was performed after swallowing barium for visualizing the pharynx and the esophagus to prevent penetration. We also analyzed the preceding causes of the subjects' cervical pain. The results of the pain provocation test were classified into concordant pain, discordant pain and a negative test. MRI was analyzed according to the T2-signal intensity (SI) of the disc, disc height, annular bulging and disc herniation. The CTD was analyzed for degeneration or radial tear of the disc, epidural leakage of the contrast agent and pooling of the contrast agent at the periphery of the disc. The pain provocation tests were correlated with the MR and CTD findings. We used the chi-square test to analyze the results. Concordant pain was observed in 14 cases, discordant pain in 3 cases and there were negative tests in 4 cases. There were no complications related to the procedure. Four patients had undergone anterior cervical fusion and four patients that developed after traffic injuries. The decreased T2-SI and annular bulging on MRI, disc degeneration and peripheral pooling of the contrast agent on CT were significantly correlated with pain provocation. When the diagnosis of disc disease is difficult with performing MRI, cervical discography with using swallowed barium solution to reduce the penetration of the esophagus or hypopharynx may play be helpful. The decreased T2-SI and annular bulging on MRI correlated significantly with a positive result on the pain provocation test

Bony vibration stimulation test combined with magnetic resonance imaging. Can discography be replaced?

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Yrjämä, M; Tervonen, O; Kurunlahti, M; Vanharanta, H

1997-04-01

The results of two noninvasive methods, magnetic resonance imaging and a bony vibration test, were compared with discographic pain provocation findings. To evaluate whether the combination of magnetic resonance imaging and vibration pain provocation tests could be used to replace discography in low back pain diagnostics. Magnetic resonance imaging gives a wealth of visual information on anatomic changes of the spine with often unknown clinical significance. Discographic examination of the spine is still the only widely accepted diagnostic method that can relate the pathoanatomic changes to the patient's clinical pain. Internal anular rupture has been shown to be one of the sources of back pain. The bony vibration test of the spinal processes has been shown correlate well with discographic pain provocation tests in cases of internal anular rupture. The three lowest lumbar discs of 33 patients with back pain were examined by means of magnetic resonance imaging and a bony vibration stimulation test, and the results were compared with those from computed tomography-discography. In cases of intradiscal magnetic resonance imaging findings, the vibration provocation test showed a sensitivity of 0.88 and a specificity of 0.50 compared with the discographic pain provocation test. If the patients with previous back surgery were excluded, the specificity was 0.75. In the cases of total anular rupture, the sensitivity was 0.50, and the specificity was 0.33. The combination of the two noninvasive methods, vibration stimulation and magnetic resonance imaging, gives more information on the origin of the back pain than magnetic resonance imaging alone. The pathoanatomic changes seen in magnetic resonance imaging can be correlated with the patient's disorder more reliably using the vibration provocation test in the cases of partial anular ruptures. The use of discography can be limited mostly to cases with total anular ruptures detected by magnetic resonance imaging.

CT discography for cervical soft disc hernia

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Iwasa, Kenichi; Mizutani, Shigeru; Morimoto, Hiroyuki; Yamada, Hidehito; Iwasa, Satoru

1985-03-01

In this study the effectiveness of computed tomographic discography (CTD) in diagnosing cervical soft disc hernia was evaluated. Twenty-five intervertebral discs of 15 cases with cervical soft disc hernia were examined with a discography and then a CT scan. Results of the CT scan were as follows: three discs were protruded, 12 discs were prolapsed, 6 discs were extruded, and 4 discs were sequestrated. The findings were helpful in determining the location of soft disc hernias between the median and posterolateral discs. They were also valuable in classifying types of hernias and surgical approaches.

Study of discography (CTD) for the cervical disc disorders

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Tsuru, Takayuki; Maekawa, Kiyotsugu; Morita, Sunao; Mizuno, Hideo

1985-07-01

Twenty patients suffering from the cervical disc disorders were examined by CT scan after cervical discography. Cervical discs are situated in horizontal plane and contrast medium spreads in horizontal course. The horizontal analysis obtained by CT discography supplies several new findings useful to diagnosis and surgical treatment. Especially it can correct the false negative or the false positive findings of other radiological examinations.

CT discography for cervical soft disc hernia

International Nuclear Information System (INIS)

Iwasa, Kenichi; Mizutani, Shigeru; Morimoto, Hiroyuki; Yamada, Hidehito; Iwasa, Satoru

1985-01-01

In this study the effectiveness of computed tomographic discography (CTD) in diagnosing cervical soft disc hernia was evaluated. Twenty-five interververtebral discs of 15 cases with cervical soft disc hernia were examined with a discography and then a CT scan. Results of the CT scan were as follows: three discs were protruded, 12 discs were prolapsed, 6 discs were extruded, and 4 discs were sequestrated. The findings were helpful in determining the location of soft disc hernians between the median and posterolateral discs. They were also valuable in classifying types of hernians and surgical aproaches. (author)

In vivo effects of bupivacaine and gadobutrol on the intervertebral disc following discoblock and discography: a histological analysis.

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Strube, Patrick; Pfitzner, Berit M; Streitparth, Florian; Hartwig, Tony; Putzier, Michael

2017-01-01

The aim of the present study was to histologically compare chondrotoxicity in surgically harvested intervertebral discs (IVDs) of patients following discoblock, discography, or no preoperative intervention. Thirty patients (IVD degeneration Modic ≥ 2°, Pfirrmann 3° or 4°) at L4/5 or L5/S1 who were planned for anterior lumbar interbody fusion were randomly assigned to three groups (open MRI: group DG - discography with gadobutrol; group DB - discoblock with bupivacaine at 4 weeks prior to surgery; group C - no intervention). The intervertebral discs were histologically evaluated and compared using ANOVA and Bonferroni tests for cell count, apoptosis, and proliferation. A reduced cell count (groups DG vs. DB vs. C: 14.9 ± 7.1, 9.2 ± 3.8, and 16.6 ± 5.2 cells/mm 2 , respectively; p ANOVA  = 0.016), increased apoptosis (groups DG vs. DB vs. C: 34.9 ± 10.2, 47.4 ± 16.3, 32.6 ± 12.2 %, respectively; p ANOVA  = 0.039) and increased cell proliferation (post hoc pDB vs. DG or C p bupivacaine but not after gadobutrol administration. • Local bupivacaine administration to intervertebral discs leads to cell toxicity and proliferation. • Gadobutrol demonstrated no significant effect on cell count, apoptosis, or cell proliferation. • In vivo cytotoxicity was demonstrated histologically in humans for the first time. • Addition/administration of bupivacaine during discographies must be judged critically.

The diagnosis of internal disc disruption with CT discography

International Nuclear Information System (INIS)

Liu Miao; Chen Xingcan; Li Xiaohong; Pan Yongqin

2008-01-01

Objective: To study the value of diagnosis for internal disc disruption (IDD)with CT discography(CTD). Methods: 42 discs of 32 patients showing no disc herniation on CT or MRI, but suffering from chronic low back pain, were undertaken CTD to work out the types of CTD with correlation between contrast medium dosages and the induction of pain. Results: CTD demonstrated 4 types of IDD which was individually correlated with the contrast dosages and induced pain; furthermore the dosages for positive and negative disc cases showed significant differece (P<0.01). Conclusions: CTD can show the direct sign of internal disc disruption, providing more information than conventional discography. (authors)

Tuvan music and its discography (principal names, titles, issues of description

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Morten Abildsnes

2017-06-01

Full Text Available The article presents the author’s work on systematizing the discography of 20th century Tuvan music. The author has been collecting the material for many years and is planning to publish the separate edition of “Tuvan music on compact disks”. The aim of the project is to let all the interested parties, including the Tuvans, to learn about the distribution of Tuvan music around the world. Western CDs are comparatively rarely sold in Tuva. Recording and releasing such disks is usually associated with the tours of Tuvan musicians abroad. The discography starts with the records of Tuvan music on seven disks released by the Moscow Factory of Sound Recording in 1934. The second series of Tuvan music records, which appeared on 17 disks in 1958 is little known. In 1971 the first long-play disk with Tuvan tunes “Tyva aialgalar / Melodii Tuvy” was released. “Sayany” and “Ayan” ensembles recorded mini-albums in 1980’s. The last vinyl mini-albums of Tuvan music are probably the annexes to academic editions of Tuvan folklore. The full discography of CDs includes disks released outside of Tuva – in Western Europe, USA and Moscow. First CDs were released in 1989: a collection of concert records of Soviet artists and the collection of music related to the documentary about Tuva “The Herders of Mongun-Taiga” (Great Britain. The biggest discography of all the Tuvan artists belongs to Sainkho Namtchylak. Her disks are well represented in free international database Discogs, while information about other Tuvan artists is less complete. The article also presents samples of Tuvan throat-singing in the works of other musical collectives and names their disks. Among solo and joint projects in the discography, “Huun Huur Tu” and “Yat Kha” are represented widely. Commercial interest in Tuvan music peaked  in 1999, when one of the biggest labels “Warner Bros” released a solo CD of Kongar-ol Ondar. Since then number of Tuvan CDs has

Experience of computed tomographic myelography and discography in cervical problem

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Nakatani, Shigeru; Yamamoto, Masayuki; Uratsuji, Masaaki; Suzuki, Kunio; Matsui, Eigo [Hyogo Prefectural Awaji Hospital, Sumoto, Hyogo (Japan); Kurihara, Akira

1983-06-01

CTM (computed tomographic myelography) was performed on 15 cases of cervical lesions, and on 5 of them, CTD (computed tomographic discography) was also made. CTM revealed the intervertebral state, and in combination with CTD, providing more accurate information. The combined method of CTM and CTD was useful for soft disc herniation.

Magnetic resonance imaging of lumbar spinal disorders

International Nuclear Information System (INIS)

Nojiri, Hajime; Matsui, Norio; Fujiyoshi, Fuminori; Izumida, Makoto; Wakita, Sato; Sekiya, Isato

1991-01-01

In order to evaluate the stenotic condition of lumbar spinal canal, MRI was compared with myelogram and with discogram in 82 patients, all of whom underwent surgical exploration. Pathologic conditions were studied including herniated nucleus pulposus in 36, lumbar canal stenosis (central, peripheral portion, combined) in 35, and spondylisthesis (degenerative, spondylolytic, dysplastic) in 11. Correlation between T2 mid-sagittal image of the thecal sac and profile view of full-column myelogram was very high, but fine parts such as adhesive change or redundancy or anomalous condition of nerve roots were more clearly observed on myelogram than on MRI. And some of them were not detected on MRI. The stage of disc degeneration was classified in 5 grades according to signal intensity and irregularity of the disc on T2-weighted image. The evaluation of disc degeneration was similar to discogram. But MRI will not replace discography for identifying the source of pain in symptomatic patients. Although MRI is the most important imaging modality to diagnostic screening and to post-operative evaluation of the stenotic condition, determination of the strict indication and the method of the operation will need myelogram and/or discogram and so on. (author)

MR-guided discography using an open 1 Tesla MRI system

International Nuclear Information System (INIS)

Streitparth, Florian; Bucourt, M. de; Hamm, B.; Teichgraeber, U.; Hartwig, T.; Strube, P.; Putzier, M.; Schnackenburg, B.; Chopra, S.

2011-01-01

To evaluate the feasibility of MR-guided discography using an open 1 Tesla MRI system. 48 disc segments of 41 patients scheduled for intradiscal thermal treatment, total disc replacement or spondylodesis were examined. A 1.0-T open MRI was used for instrument guidance and imaging. After primary disc puncture under guidance of interactive PDw TSE imaging, 1-2 ml of gadolinium contrast saline mixture was injected into the disc. The occurrence of memory pain during injection was recorded. Axial and sagittal T1w TSE images with and without fat saturation were obtained. All MRI discograms were analysed by two readers, who were blinded to the clinical findings. Overall, the placement of the puncture needle in the targeted disc was accurate under real-time MR guidance. Injections were technically successful in all cases. No major complications occurred. The mean procedure time was 17 min (range 13-34 min). Image quality of contrast-enhanced MR discograms was excellent when using an optimized gadolinium contrast saline mixture of 1:600. Memory pain was detected in 16 out of 48 affected segments. MR-guided discography is accurate and safe. Multiplanar dynamic imaging facilitates the puncture of discs and provides high-quality MR discograms. (orig.)

In-vivo Intervertebral Disc Characterization using Magnetic Resonance Spectroscopy and T1ρ Imaging: Association with Discography and Oswestry Disability Index and SF-36

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Zuo, Jin; Joseph, Gabby B.; Li, Xiaojuan; Link, Thomas M.; Hu, Serena S.; Berven, Sigurd H.; Kurhanewitz, John; Majumdar, Sharmila

2011-01-01

Study Design An in vivo study of intervertebral disc degeneration using quantitative MRI and MRS. Objective To quantify water and proteoglycan (PG) content in the intervertebral disc using in vivo magnetic resonance spectroscopy (MRS), and to evaluate the relationship between MRS- quantified water/PG content, T1ρ, Pfirrmann score, clinical self-assessment, and discography. Summary of Background Data Previous in vitro studies have investigated the relationship between MRS-quantified water/PG content, and degenerative grade using cadaveric intervertebral discs. T1ρ has been shown to relate to Pfirmann grade and clinical self-assessment. However, the associations between MRS-quantified water/PG content, MR imaging-based T1ρ, self-assessment of health status and clinical response to discography have not been studied in vivo. Methods MRS and MR imaging were performed in 26 patients (70 discs) with symptomatic intervertebral degenerative disc (IVDD) and 23 controls (41 discs). Patients underwent evaluation of intervertebral discs with provocative discography. All subjects completed the SF-36 Health Survey and Oswestry Disability Index questionnaires. Results The water/PG peak area ratio was significantly elevated in a) patients (compared to controls) and in b) discs with positive discography (compared to negative discography). MR T1ρ exhibited similar trends. A significant association was found between T1ρ and normalized PG content (R2 = 0.61, p 0.05). The water/PG peak area ratio, normalized water, normalized PG, and Pfirrmann grade were significantly associated with patient self-assessment of disability and physical composite score, while disc height was not. Conclusion This study demonstrated a relationship between in vivo MRS spectroscopy (water content, PG content), imaging parameters (T1ρ, Pfirrmann Grade), discography results, and clinical self-assessment, suggesting that MRS-quantified water, PG and MR T1ρ relaxation time may potentially serve as

Magnetic resonance imaging of lumbar spine disc diseases. Frequency of false negatives

International Nuclear Information System (INIS)

Berthelot, J.M.; Maugars, Y.; Delecrin, Y.; Caillon, F.; Prost, A.

1995-01-01

Magnetic resonance imaging (MRI) has had an impressive impact on evaluation of degenerative diseases of the spine. Nevertheless, false negatives can occur on images involving lumbar discs. Degenerative disc diseases documented on discography and/or pathology examination of the discs can go unrecognized. Likewise sensitivity for the detection of protruding disc hernias is not totally satisfactory (20% false negatives). Finally, a magnetic resonance image visualizing displacement of the disc is not specific (10 to 15% false positives); images showing protrusion or hernia can be seen in 30% of asymptomatic patients. Although MRI gives slightly more information than other imaging techniques, false images do exist. Moreover, the usefulness of MRI to demonstrate disc disease in case of a negative CT-scan remains to be demonstrated. (authors). 26 refs

In vivo intervertebral disc characterization using magnetic resonance spectroscopy and T1ρ imaging: association with discography and Oswestry Disability Index and Short Form-36 Health Survey.

Science.gov (United States)

Zuo, Jin; Joseph, Gabby B; Li, Xiaojuan; Link, Thomas M; Hu, Serena S; Berven, Sigurd H; Kurhanewitz, John; Majumdar, Sharmila

2012-02-01

An in vivo study of intervertebral disc degeneration by using quantitative magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). To quantify water and proteoglycan (PG) content in the intervertebral disc by using in vivo MRS and to evaluate the relationship between MRS-quantified water/PG content, T1ρ, Pfirrmann score, clinical self-assessment, and discography. Previous in vitro studies have investigated the relationship between MRS-quantified water/PG content and degenerative grade by using cadaveric intervertebral discs. T1ρ has been shown to relate to Pfirrmann grade and clinical self-assessment. However, the associations between MRS-quantified water/PG content, MRI-based T1ρ, self-assessment of health status, and clinical response to discography have not been studied in vivo. MRS and MRI were performed in 26 patients (70 discs) with symptomatic intervertebral degenerative disc (IVDD) and 23 controls (41 discs). Patients underwent evaluation of intervertebral discs with provocative discography. All subjects completed the Short Form-36 Health Survey and Oswestry Disability Index questionnaires. The water/PG peak area ratio was significantly elevated in (a) patients (compared with controls) and in (b) discs with positive discography (compared with negative discography). Magnetic resonance (MR) T1ρ exhibited similar trends. A significant association was found between T1ρ and normalized PG content (R = 0.61, P 0.05). The water/PG peak area ratio, normalized water, normalized PG, and Pfirrmann grade were significantly associated with patient self-assessment of disability and physical composite score, while disc height was not. This study demonstrated a relationship between in vivo MRS spectroscopy (water content and PG content), imaging parameters (T1ρ and Pfirrmann grade), discography results, and clinical self-assessment, suggesting that MRS-quantified water, PG, and MR T1ρ relaxation time may potentially serve as biomarkers of

Diagnosis of cauda equina abnormalities by using electromyography, discography, and epidurography in dogs

International Nuclear Information System (INIS)

Sisson, A.F.; LeCouteur, R.A.; Ingram, J.T.; Park, R.D.; Child, G.

1992-01-01

Electromyography (EMG), L7-S1 discography and epidurography were investigated in 15 dogs with clinical signs of cauda equina dysfunction and in 7 control dogs without such clinical signs. Electromyography of paraspinal and pelvic limb muscles was done in 13 of 15 affected dogs. An L7-S1 discogram followed by an epidurogram was performed in all 22 dogs using 20% iopamidol. Results of discograms, epidurograms, and gross necropsy examinations were normal in six of seven control dogs. The one dog in which these studies were abnormal had a mild L7-S1 disc protrusion that did not result in nerve root compression at necropsy. Electromyographic analysis was 100% accurate in predicting the presence or absence of cauda equina disease. None of the results of discograms were falsely negative. Twelve of 15 discograms in clinically affected dogs indicated dorsal disc protrusion, but 2 of these protrusions were found to be noncompressive at surgery (13% error). Abnormal epidurograms occurred in 9 of 15 clinically affected dogs. There was one false positive and two false negatives (20% error). Electromyography was a sensitive screening technique for the presence of cauda equina disease. Discography may be more sensitive for detection of L7-S1 disc protrusion than epidurography. An abnormal radiographic contrast study of the cauda equina may only be useful when combined with an abnormal EMG

Prevention: Exercise

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Full Text Available ... and Intradural Tumors TREATMENTS Assessment Tools Lumbar and Cervical Discography Electrodiagnostic Testing MRI Radiographic Assessment for Back Pain Radiological Assessment of Spinal Disorders Repeated End-Range ...

Magnetic resonance imaging of lumbar spine disc diseases. Frequency of false negatives; Imagerie par resonance magnetique pour pathologie discale lombaire. Frequence des faux-negatifs

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Berthelot, J.M.; Maugars, Y.; Delecrin, Y.; Caillon, F.; Prost, A. [Hopital Hotel-Dieu de Nantes, 44 (France)

1995-10-01

Magnetic resonance imaging (MRI) has had an impressive impact on evaluation of degenerative diseases of the spine. Nevertheless, false negatives can occur on images involving lumbar discs. Degenerative disc diseases documented on discography and/or pathology examination of the discs can go unrecognized. Likewise sensitivity for the detection of protruding disc hernias is not totally satisfactory (20% false negatives). Finally, a magnetic resonance image visualizing displacement of the disc is not specific (10 to 15% false positives); images showing protrusion or hernia can be seen in 30% of asymptomatic patients. Although MRI gives slightly more information than other imaging techniques, false images do exist. Moreover, the usefulness of MRI to demonstrate disc disease in case of a negative CT-scan remains to be demonstrated. (authors). 26 refs.

Histological, magnetic resonance imaging, and discographic findings on cervical disc degeneration in cadaver spines. A comparative study

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Maruyama, Yuichiro [Juntendo Univ., Tokyo (Japan). School of Medicine

1995-11-01

A total of 210 cervical intervertebral discs were taken at autopsy from 36 cadavers, and underwent both magnetic resonance imaging (MRI) and discography to compare their diagnostic efficacies for investigating degenerative changes in the cervical spine. The age of the subjects had ranged from 43 to 92 years with an average of 68.1 years. Following the autopsy, MRI and discography were performed on the excised cervical spinal column, and the specimen was then prepared for histological examination. The findings were compared with those of the lumbar spine that had previously been reported by Yasuma et al. on 1238 lumbar discs from 197 cadavers ranging in age from 11 to 92 years. The results were as follows: Low intensity in the T2-weighted MRI was well correlated with histological degeneration in the cervical disc. The rate of appearance of the posterior protrusion of the cervical disc on the MRI was in accordance with the degree of histological disc degeneration, but it did not always correspond with histological posterior protrusion. There was a remarkably high incidence for false-positive posterior protrusion on the MRI, which should be kept in mind on reading the MRI. In the comparison of the MRI with the discography, a certain positive correlation was found as for disc degeneration, but not in complete accordance. There was a considerable difference in the patterns of degeneration and in posterior protrusion of the discs between the cervical spine and the lumbar spine. The posterior protrusion in the cervical disc was more likely related to horizontal fissure and hyalinization of the posterior annulus, while posterior protrusion in the lumbar disc was often related to reversed orientation of the bundles and myxomatous degeneration of the posterior annulus. This difference was attributed to the difference in the mechanical properties of the cervical and lumbar spines. (author).

Histological, magnetic resonance imaging, and discographic findings on cervical disc degeneration in cadaver spines. A comparative study

International Nuclear Information System (INIS)

Maruyama, Yuichiro

1995-01-01

A total of 210 cervical intervertebral discs were taken at autopsy from 36 cadavers, and underwent both magnetic resonance imaging (MRI) and discography to compare their diagnostic efficacies for investigating degenerative changes in the cervical spine. The age of the subjects had ranged from 43 to 92 years with an average of 68.1 years. Following the autopsy, MRI and discography were performed on the excised cervical spinal column, and the specimen was then prepared for histological examination. The findings were compared with those of the lumbar spine that had previously been reported by Yasuma et al. on 1238 lumbar discs from 197 cadavers ranging in age from 11 to 92 years. The results were as follows: Low intensity in the T2-weighted MRI was well correlated with histological degeneration in the cervical disc. The rate of appearance of the posterior protrusion of the cervical disc on the MRI was in accordance with the degree of histological disc degeneration, but it did not always correspond with histological posterior protrusion. There was a remarkably high incidence for false-positive posterior protrusion on the MRI, which should be kept in mind on reading the MRI. In the comparison of the MRI with the discography, a certain positive correlation was found as for disc degeneration, but not in complete accordance. There was a considerable difference in the patterns of degeneration and in posterior protrusion of the discs between the cervical spine and the lumbar spine. The posterior protrusion in the cervical disc was more likely related to horizontal fissure and hyalinization of the posterior annulus, while posterior protrusion in the lumbar disc was often related to reversed orientation of the bundles and myxomatous degeneration of the posterior annulus. This difference was attributed to the difference in the mechanical properties of the cervical and lumbar spines. (author)

Percutaneous automated diskectomy in the treatment of herniated lumbar disks

International Nuclear Information System (INIS)

Onik, G.; Mooney, V.; Wiltse, L.

1987-01-01

Described is a new automated lumbar disk aspiration technique in which a 2-mm suction cutting probe is used. The procedure allows rapid and safe removal of disk material percutaneously. The presentation describes the technique and the preliminary results of a cooperative study. The procedure is performed under local anesthesia and the aspiration probe is placed into the disk under fluoroscopic guidance and using a posterrolateral approach. One hundred twenty patients have met the study criteria, undergone the procedure, and had at least a 6-week follow-up. Of these, 74% have achieved good to excellent results, based on physician and patient satisfaction and three other criteria. Of 93 patients for whom 6-mont follow-up is available, 71% have achieved good to excellent results. No complications have been reported. The preliminary results indicate that percutaneous automated diskectomy is a low morbidity procedure that can be done on an outpatient basis and be used successfully to treat uncomplicated herniated lumbar disks

Monostotic fibrous dysplasia of a lumbar vertebral body with secondary aneurysmal bone cyst formation: a case report

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Snieders Marieke N

2009-06-01

Full Text Available Abstract We report the case of a 25-year-old Caucasian woman with symptomatic monostotic fibrous dysplasia of the fourth lumbar vertebral body. The patient suffered from a five-week history of progressive low back pain, radiating continuously to the left leg. Her medical history and physical and neurological examination did not demonstrate any significant abnormalities. Radiographs, computed tomography and magnetic resonance imaging revealed an osteolytic expansive lesion with a cystic component of the fourth lumbar vertebral body. Percutaneous transpedicular biopsy showed histological characteristics of fibrous dysplasia superimposed by the formation of aneurysmal bone cyst components. The patient was treated by subtotal vertebrectomy of the L4 vertebral body with anterior reconstruction and her postoperative course was uncomplicated. To our knowledge, this is the first reported case of a monostotic fibrous dysplasia with superimposed secondary aneurysmal bone cysts of a lumbar vertebral body.

Rehabilitation of children at the inpatient stage after surgical treatment of unstable fractures of the thoracolumbar and lumbar spine

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Alla V. Ovechkina

2017-12-01

Full Text Available Introduction. The modern approach to the treatment of unstable fractures of the thoracolumbar and lumbar spine in children is surgical stabilization at the early stages after trauma by using metal structures that quickly restore vertical functionality to the patient and shorten the period of inpatient treatment. However, the issues related to restorative treatment have not been sufficiently addressed. Aim. To develop an algorithm for restorative treatment of children at the inpatient stage after surgical treatment of unstable uncomplicated fractures of the thoracolumbar and lumbar spine. Material and methods. Based on the results of treatment of 73 patients aged 9 to 17 years with unstable uncomplicated vertebral fractures, an algorithm of stage-by-stage rehabilitation by means of therapeutic gymnastics depending on the severity of the injury, method of surgical stabilization of the spine, physical condition of the child, and time passed after the operation was developed. Results and discussion. The use of differentiated groups of respiratory gymnastics and isometric and dynamic exercises for muscle groups restored vertical functionality to patients in 1–3 days after surgery, restored spine and motor functions, and shortened the duration of inpatient treatment to a range of 10–14 days. Conclusion. The developed algorithm for physical rehabilitation of children after surgical treatment of unstable injuries of the thoracic and lumbar spine by using metal structures at the inpatient stage contributed to the selection of the most rational and effective program of restorative treatment.

Scoring system to distinguish uncomplicated from complicated acute appendicitis

NARCIS (Netherlands)

Atema, J. J.; van Rossem, C. C.; Leeuwenburgh, M. M.; Stoker, J.; Boermeester, M. A.

2015-01-01

Non-operative management may be an alternative for uncomplicated appendicitis, but preoperative distinction between uncomplicated and complicated disease is challenging. This study aimed to develop a scoring system based on clinical and imaging features to distinguish uncomplicated from complicated

Challenges in uncomplicated acute appendicitis

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Fernando Resende

2016-03-01

Full Text Available Acute appendicitis is one of the most common abdominal emergencies requiring surgery. It still represents, however, a challenging diagnosis. In order to facilitate this process, several scoring systems were developed, namely, the Alvarado score, acute inflammatory response and Raja Isteri Pengiran Anak Saleha Appendicitis scores, which are the most used in clinical practice. This clinical condition encompasses a wide spectrum of clinical presentations, from the uncomplicated form to the one with diffuse peritonitis. Treatment of uncomplicated acute appendicitis remains a matter of discussion. Although appendectomy has been regarded as the gold-standard, conservative management with antibiotics is gaining more and more acceptance. The approach to appendectomy constitutes another controversial issue, namely, its performance through an open or a laparoscopic approach, which seems to be establishing itself, in some centers, as the standard of care. With this paper, we intend to give some insight on the aforementioned topics, through a review of the available literature on uncomplicated appendicitis.

Absence of mucosal inflammation in uncomplicated diverticular disease.

Science.gov (United States)

Elli, Luca; Roncoroni, Leda; Bardella, Maria Teresa; Terrani, Claudia; Bonura, Antonella; Ciulla, Michele; Marconi, Stefano; Piodi, Luca

2011-07-01

Uncomplicated diverticular disease is a common condition in patients older than 50 years. Symptoms are aspecific and overlapping with those of irritable bowel syndrome. Nowadays, patients are often treated with antinflammatory drugs (5-aminosalicilic acid). Our purpose was to evaluate the presence of inflammation in the colonic mucosa of patients with symptomatic uncomplicated diverticular disease compared with subjects without diverticula. Endoscopic biopsies of colon from 10 patients with symptomatic uncomplicated diverticular disease and 10 from subjects without diverticula (controls) were taken. Specimens were homogenised and IL2, IL4, IL5, IL8, IL10, IL12p70, IL13, IFN gamma, TNF alfa (searchlight multiplex technique), TGF beta, transglutaminase type 2 and caspase 9 were measured. Histochemistry for transglutaminase type 2 and TUNEL were performed on the histological sections, in addition to morphologic evaluation, as markers of tissue remodelling and apoptosis. For statistical analysis Student's t test and Spearman correlation test were used. No histological differences were detected between the patients with an uncomplicated diverticular disease and controls. Mean values of mucosal cytokines and of the other tested parameters did not show statistically significant differences between patients with uncomplicated diverticular disease and controls. Even if based on a small number of patients, the study demonstrates the absence of inflammation in the mucosa of subjects affected by uncomplicated diverticular disease.

Antibiotics for uncomplicated diverticulitis

DEFF Research Database (Denmark)

Shabanzadeh, Daniel M; Wille-Jørgensen, Peer

2012-01-01

Diverticulitis is an inflammatory complication to the very common condition diverticulosis. Uncomplicated diverticulitis has traditionally been treated with antibiotics with reference to the microbiology, extrapolation from trials on complicated intra-abdominal infections and clinical experience....

Early versus delayed oral feeding after uncomplicated cesarean ...

African Journals Online (AJOL)

Objective: The objective of this study is to compare the safety of early versus delayed oral feeding after uncomplicated cesarean section (CS) under spinal anesthesia. Methods: This was a randomized, controlled trial that enrolled 152 women who had uncomplicated CS under spinal anesthesia between January 2014 and ...

Artemether-lumefantrine: an oral antimalarial for uncomplicated malaria in children

DEFF Research Database (Denmark)

Adjei, George O; Goka, Bamenla Q; Binka, Fred

2009-01-01

Artemether-lumefantrine (AL; Coartem, Riamet) is the first fixed-dose artemisinin combination therapy (ACT) regimen to be manufactured under Good Manufacturing Practice conditions, and is the most widely adopted ACT regimen used in malaria control programs. AL is approved for the treatment...... of uncomplicated malaria in adults, children and infants, and as treatment of uncomplicated malaria in nonimmune travelers returning from malarious areas. AL is efficacious for treating uncomplicated malaria in children and the frequency of associated adverse events is not higher than other available ACT regimens....... In this review, available evidence on efficacy and safety of AL in the treatment of uncomplicated malaria, with emphasis on children where appropriate, and focusing on characteristics that are potentially important for malaria control policy decisions, are presented and discussed....

Hydronephrosis in acute uncomplicated appendicitis.

Science.gov (United States)

Schok, T; Austen, S; Lewicz, R B C B; van der Zande, F H R; Peters, N A L R; Janzing, H M J

2015-01-01

Right-sided hydronephrosis as a sign of appendicitis occurs rarely in the literature. To our knowledge, this is the first published account of the occurrence of right-sided hydronephrosis as a result of uncomplicated appendicitis. We describe a 15 year old patient referred to the emergency department with suspected appendicitis. Additional ultrasound examination showed a right-sided hydronephrosis. This finding was discussed with the urologist who noted the hydronephrosis as a chance finding. Because of persistent clinical suspicion of appendicitis, a diagnostic laparoscopy was performed. A retrocaecal appendicitis with secondary hydronephrosis was found. Right-sided hydronephrosis may be a sign of acute uncomplicated (retrocaecal) appendicitis. It is important to keep sight of these findings, especially in view of the emphasis on imaging techniques in the current Dutch guideline on appendicitis. Copyright© Acta Chirurgica Belgica.

[Nitrofurantoin--clinical relevance in uncomplicated urinary tract infections].

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Stock, Ingo

2014-07-01

The nitrofuran derivative nitrofurantoin has been used for more than 60 years for the antibacterial therapy of uncomplicated urinary tract infections (UTI). Despite its long application, this antibiotic retained good activity against Escherichia coli and some other pathogens of uncomplicated urinary tract infections such as Staphylococcus saprophyticus and Enterococcus species. Nitrofurantoin therapy has been shown to be accompanied by numerous adverse drug effects. Among these, there are also serious side effects such as pulmonary reactions and polyneuropathy, which mainly occur in long-term use. Recent studies, however, have shown a good efficacy and tolerability of short-term nitrofurantoin therapy comparable to previous established standard therapeutic regimens applying cotrimoxazole or quinolones. Because of these data and the alarming resistance rates of uropathogenic Escherichia coli to cotrimoxazole and quinolones that have been increased markedly in several countries, the clinical significance ofnitrofurantoin has been raised again. In many current treatment guidelines, e. g., the international clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women published by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases, nitrofurantoin has been recommended as one first-line antibiotic of empiric antibacterial treatment of uncomplicated cystitis in otherwise healthy women. In Germany, however, nitrofurantoin should only be applied if more effective and less risky antibiotics cannot be used. Nitrofurantoin is contraindicated in the last three months of pregnancy and in patients suffering from renal impairment of each degree. Despite compatibility concerns, nitrofurantoin has also been recommended for the re-infection prophylaxis of recurrent uncomplicated urinary tract infections in Germany and several other countries.

Endoscopia lumbar póstero lateral con sistema YESS: reporte preliminar Endoscopia lombar póstero-lateral com sistema YESS: resultados preliminares Lumbar disc herniation treated with post lateral lumbar endoscopy by YESS system: preliminary results

Directory of Open Access Journals (Sweden)

Carlos Montes García

2009-06-01

cem pacientes com diagnóstico de hérnia de disco lombar, comprovada com ressonância magnética e discografia evocativa positiva. Todos os pacientes nunca tinham passado por um tratamento cirúrgico e foi feito um seguimento por dois anos. RESULTADOS: os resultados foram classificados em bons, regulares e ruins. Foram encontrados bons resultados em 82 pacientes, regulares em 10 e ruins em 8. CONCLUSÕES: os resultados do tratamento da hérnia de disco lombar, com a endoscopia lateral e com o sistema YESS são, até o momento, similares àqueles com abordagem posterior aberta, mesmo que o tempo de recuperação e a capacidade sejam menores, assim como também o custo, pois é um procedimento ambulatório.INTRODUCTION: in the patients with lumbar disc herniation, who are candidates to surgical procedures, the open diskectomy has been the gold standard for many years. Nevertheless, the complications of this procedure, in which the medullar canal is invaded, have caused other means to be developed. One of them is the YESS system (Young Endoscopic Spine System. OBJECTIVE: to examine the results of one hundred patients with lumbar disc herniation, treated with the YESS system. METHODS: it was studied one hundred patients with lumbar disc herniation, which was proved with magnetic resonance imaging and discography, and their results were positive. None of the patients had ever undergone a surgical procedure; therefore, they were tracked for two years. RESULTS: results were classified into good, regular, and bad. In 82 patients good results were found, 10 were regular, and 8 were bad. CONCLUSIONS: the results of the treatment for a lumbar disc herniation with the YESS system are so far similar to open back surgery, even though the time of recovery, disability, and costs are lower because it is an ambulatory procedure.

Public Reporting of MRI of the Lumbar Spine for Low Back Pain and Changes in Clinical Documentation.

Science.gov (United States)

Flug, Jonathan A; Lind, Kimberly E

2017-12-01

OP-8 is the Medicare imaging efficiency metric for MRI of the lumbar spine for low back pain in the outpatient hospital. We studied trends in exclusion criteria coding over time by site of service after implementation of OP-8 to evaluate provider's response to public reporting. We conducted a secondary data analysis using the Medicare Limited Data Set 5% sample for beneficiaries with MRI lumbar spine and lower back pain during 2009 to 2014. We evaluated the association between excluding condition prevalence and site by using generalized estimating equations regression. We produced model-based estimates of excluding condition prevalence by site and year. As a sensitivity analysis, we repeated the analysis while including additional conditions in the outcome measure. We included 285,911 MRIs of the lumbar spine for low back pain. Generalized estimating equations regression found that outpatient hospitals had a higher proportion of MRIs with at least one excluding condition documented compared with outpatient clinics (P low back pain. When accounting for all relevant conditions, the proportion of patients with low back pain considered uncomplicated and being measured by OP-8 would be small, reflecting a small proportion of patients with low back pain. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

[Lumbar spondylosis].

Science.gov (United States)

Seichi, Atsushi

2014-10-01

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

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

Science.gov (United States)

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

2016-06-01

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

Outcomes of Nonoperative Management of Uncomplicated Appendicitis.

Science.gov (United States)

Bachur, Richard G; Lipsett, Susan C; Monuteaux, Michael C

2017-07-01

Nonoperative management (NOM) of uncomplicated pediatric appendicitis has promise but remains poorly studied. NOM may lead to an increase in resource utilization. Our objective was to investigate the trends in NOM for uncomplicated appendicitis and study the relevant clinical outcomes including subsequent appendectomy, complications, and resource utilization. Retrospective analysis of administrative data from 45 US pediatric hospitals. Patients appendicitis between 2010 and 2016 were studied. NOM was defined by an ED visit for uncomplicated appendicitis treated with antibiotics and the absence of appendectomy at the index encounter. The main outcomes included trends in NOM among children with uncomplicated appendicitis and frequency of subsequent diagnostic imaging, ED visits, hospitalizations, and appendectomy during 12-month follow-up. 99 001 children with appendicitis were identified, with a median age of 10.9 years. Sixty-six percent were diagnosed with nonperforated appendicitis, of which 4190 (6%) were managed nonoperatively. An increasing number of nonoperative cases were observed over 6 years (absolute difference, +20.4%). During the 12-month follow-up period, NOM patients were more likely to have the following: advanced imaging (+8.9% [95% confidence interval (CI) 7.6% to 10.3%]), ED visits (+11.2% [95% CI 9.3% to 13.2%]), and hospitalizations (+43.7% [95% CI 41.7% to 45.8%]). Among patients managed nonoperatively, 46% had a subsequent appendectomy. A significant increase in NOM of nonperforated appendicitis was observed over 6 years. Patients with NOM had more subsequent ED visits and hospitalizations compared with those managed operatively at the index visit. A substantial proportion of patients initially managed nonoperatively eventually had an appendectomy. Copyright © 2017 by the American Academy of Pediatrics.

LUMBAR CORSETS CAN DECREASE LUMBAR MOTION IN GOLF SWING

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Koji Hashimoto

2013-03-01

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

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

Science.gov (United States)

Hu, Boyi; Ning, Xiaopeng

2015-01-01

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

Hospitalization for uncomplicated hypertension: an ambulatory care sensitive condition.

Science.gov (United States)

Walker, Robin L; Chen, Guanmin; McAlister, Finlay A; Campbell, Norm R C; Hemmelgarn, Brenda R; Dixon, Elijah; Ghali, William; Rabi, Doreen; Tu, Karen; Jette, Nathalie; Quan, Hude

2013-11-01

Hospitalizations for ambulatory care sensitive conditions (ACSC) represent an indirect measure of access and quality of community care. This study explored hospitalization rates for 1 ACSC, uncomplicated hypertension, and the factors associated with hospitalization. A cohort of patients with incident hypertension, and their covariates, was defined using validated case definitions applied to International Classification of Disease administrative health data in 4 Canadian provinces between fiscal years 1997 and 2004. We applied the Canadian Institute for Health Information's case definition to detect all patients who had an ACSC hospitalization for uncomplicated hypertension. We employed logistic regression to assess factors associated with an ACSC hospitalization for uncomplicated hypertension. The overall rate of hospitalizations for uncomplicated hypertension in the 4 provinces was 3.7 per 1000 hypertensive patients. The risk-adjusted rate was lowest among those in an urban setting (2.6 per 1000; 95% confidence interval [CI], 2.3-2.7), the highest income quintile (3.4 per 1000; 95% CI, 2.8-4.2), and those with no comorbidities (3.6 per 1000; 95% CI, 3.2-3.9). Overall, Newfoundland had the highest adjusted rate (5.7 per 1000; 95% CI, 4.9-6.7), and British Columbia had the lowest (3.7 per 1000; 95% CI, 3.4-4.2). The adjusted rate declined from 5.9 per 1000 in 1997 to 3.7 per 1000 in 2004. We found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, which might reflect improvements in community care. Geographic variations in the rate of hospitalizations indicate disparity among the provinces and those residing in rural regions. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Therapeutic efficacy of sulfadoxine-pyrimethamine in uncomplicated ...

African Journals Online (AJOL)

Therapeutic efficacy of sulfadoxine-pyrimethamine in uncomplicated Plasmodium falciparum malaria 3 years after introduction in Mpumalanga. Aaron Mabuza, John Govere, David Durrheim, Nicros Mangomezulu, Barry Bredenkamp, Karen Barnes, Brian Sharp ...

Effect of aging and lumbar spondylosis on lumbar lordosis

Directory of Open Access Journals (Sweden)

Francis Osita Okpala

2018-01-01

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

Changes in Primary Care Health Care Utilization after Inclusion of Epidemiologic Data in Lumbar Spine MR Imaging Reports for Uncomplicated Low Back Pain.

Science.gov (United States)

Fried, Jessica G; Andrew, Angeline S; Ring, Natalie Y; Pastel, David A

2018-05-01

Purpose To determine whether inclusion of an epidemiologic statement in radiology reports of lumbar magnetic resonance (MR) imaging influences downstream health care utilization in the primary care population. Materials and Methods Beginning July 1, 2013, a validated epidemiologic statement regarding prevalence of common findings in asymptomatic patients was included in all lumbar MR imaging reports at a tertiary academic medical center. Data were collected from July 1, 2012, through June 30, 2014, and retrospective analysis was completed in September 2016. The electronic medical record was reviewed to capture health care utilization rates in patients for 1 year after index MR imaging. Of 4527 eligible adult patients with low back pain referred for lumbar spine MR imaging during the study period, 375 patients had their studies ordered by in-network primary care providers, did not have findings other than degenerative disease, and had at least one follow-up encounter within the system within 1 year of index MR imaging. In the before-and-after study design, a pre-statement-implementation cohort was compared with a post-statement-implementation cohort by using univariate and multivariate statistical models to evaluate treatment utilization rates in these groups. Results Patients in the statement group were 12% less likely to be referred to a spine specialist (137 of 187 [73%] vs 159 of 188 [85%]; P = .007) and were 7% less likely to undergo repeat imaging (seven of 187 [4%] vs 20 of 188 [11%]; P = .01) compared with patients in the nonstatement group. The intervention was not associated with any change in narcotic prescription (53 of 188 [28%] vs 54 of 187 [29%]; P = .88) or with the rate of low back surgery (24 of 188 [13%] vs 16 of 187 [9%]; P = .19). Conclusion In this study, inclusion of a simple epidemiologic statement in lumbar MR imaging reports was associated with decreased utilization in high-cost domains of low back pain management. © RSNA, 2018.

Can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection?

International Nuclear Information System (INIS)

Kang, Chang Ho; Kim, Yun Hwan; Kim, Jung Hyuk; Chung, Kyoo Byung; Sung, Deuk Jae; Lee, Sang-Heon; Derby, Richard

2009-01-01

To correlate magnetic resonance (MR) image findings with pain response by provocation discography in patients with discogenic low back pain, with an emphasis on the combination analysis of a high intensity zone (HIZ) and disc contour abnormalities. Sixty-two patients (aged 17-68 years) with axial low back pain that was likely to be disc related underwent lumbar discography (178 discs tested). The MR images were evaluated for disc degeneration, disc contour abnormalities, HIZ, and endplate abnormalities. Based on the combination of an HIZ and disc contour abnormalities, four classes were determined: (1) normal or bulging disc without HIZ; (2) normal or bulging disc with HIZ; (3) disc protrusion without HIZ; (4) disc protrusion with HIZ. These MR image findings and a new combined MR classification were analyzed in the base of concordant pain determined by discography. Disc protrusion with HIZ [sensitivity 45.5%; specificity 97.8%; positive predictive value (PPV), 87.0%] correlated significantly with concordant pain provocation (P < 0.01). A normal or bulging disc with HIZ was not associated with reproduction of pain. Disc degeneration (sensitivity 95.4%; specificity 38.8%; PPV 33.9%), disc protrusion (sensitivity 68.2%; specificity 80.6%; PPV 53.6%), and HIZ (sensitivity 56.8%; specificity 83.6%; PPV 53.2%) were not helpful in the identification of a disc with concordant pain. The proposed MR classification is useful to predict a disc with concordant pain. Disc protrusion with HIZ on MR imaging predicted positive discography in patients with discogenic low back pain. (orig.)

Side effects after diagnostic lumbar puncture and lumbar iohexol myelography

International Nuclear Information System (INIS)

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

1987-01-01

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

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

Science.gov (United States)

Chang, Han Soo

2018-01-01

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

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

Directory of Open Access Journals (Sweden)

Ding Zi-hai

2011-04-01

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

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

Science.gov (United States)

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

2011-04-14

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

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

International Nuclear Information System (INIS)

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

2004-01-01

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

Reduced risk of uncomplicated malaria episodes in children with a+-thalassemia in northeastern Tanzania

DEFF Research Database (Denmark)

Enevold, Anders; Lusingu, John P; Mmbando, Bruno

2008-01-01

the susceptibility to uncomplicated malaria. We compared the risk of suffering from febrile, uncomplicated malaria between individuals carrying three common RBC polymorphisms (sickle cell trait, alpha(+)-thalassemia, and glucose-6-phosphate-dehydrogenase deficiency) and controls. The study was performed in an area...... measured with flow cytometry and ELISA assays, respectively. Regression analyses showed that alpha(+)-thalassemia was associated with a reduced risk of uncomplicated malaria episodes and that this advantageous effect seemed to be more predominant in children older than 5 years of age, but was independent...

Direct composite restoration of permanent anterior teeth uncomplicated crown fractures

Directory of Open Access Journals (Sweden)

Ashley Evans Nicholas

2018-01-01

Full Text Available An uncomplicated crown fracture is a fracture that involves only the tooth enamel or the dentin and tooth enamel without any damage or exposure to the pulp. Crown fracture of the anterior teeth usually caused by traumatic forces such as falls, accidents, violence, or sports activities. Traumatic injuries of the oral region frequently involve the anterior teeth, especially maxillary incisors due to the anatomic factors which may affect the functional and aesthetical values of the teeth. The objective of this literature study was to know more about uncomplicated crown fracture of the anterior teeth and its restoration. This research was a literature study performed by researching, highlighting various interesting facts and compiling the relevant published journals. The most common and ideal direct restoration of the anterior teeth was the composite resin restoration. The anterior teeth restoration was considered to be a complex and challenging case to solves due to the fact that besides reconstructing the tooth and regaining the function, the aesthetical aspect was also becoming the main objectives. The permanent anterior teeth uncomplicated crown fracture was the most common case of tooth fractures which was mainly caused by traumatic injuries such as falls, accidents, excessive forces, violence, and also sports activities. Dental injuries of the anterior teeth also affected the aesthetical properties and the function of the tooth. Composite resin restoration was able to performed directly on the permanent anterior teeth uncomplicated crown fracture.

Biomechanical study of percutaneous lumbar diskectomy

International Nuclear Information System (INIS)

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

2003-01-01

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

Pharmacological properties of oral antibiotics for the treatment of uncomplicated urinary tract infections.

Science.gov (United States)

Novelli, Andrea; Rosi, Elia

2017-12-01

The therapeutic management of uncomplicated bacterial urinary tract infections (UTIs) is based on short-term courses of oral antibiotics. The preferred drugs are nitrofurantoin trimethoprim-sulfamethoxazole, fosfomycin trometamol, fluoroquinolones and β-lactam agents. The choice of agent for treating uncomplicated UTIs should be based on the pharmacokinetic characteristics of the molecule so that clinical benefit is optimized and the risk of antibacterial resistance is minimized. This article discusses the general pharmacokinetic-pharmacodynamic (PK/PD) aspects of antimicrobial chemotherapy, the PK/PD characteristics of oral antimicrobial agents for the treatment of uncomplicated UTIs and the pharmacological and therapeutic strategies for limiting or preventing bacterial resistance.

Medical Prescription Pitfalls of Uncomplicated Urinary Tract ...

African Journals Online (AJOL)

Objectives: The aim of this evaluation was to identify pitfalls in medical prescriptions of uncomplicated urinary tract infections in government healthcare facilities in Zambia. Design: This was a cross sectional and government healthcare facilities were conveniently sampled. Main outcome measures: Rate of compliance to ...

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

Science.gov (United States)

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

2018-04-03

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

Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis.

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Park, H C; Kim, M J; Lee, B H

2017-12-01

Uncomplicated appendicitis may resolve spontaneously or require treatment with antibiotics or appendicectomy. The aim of this randomized trial was to compare the outcome of a non-antibiotic management strategy with that of antibiotic therapy in uncomplicated appendicitis. Patients presenting to a university teaching hospital with CT-verified uncomplicated simple appendicitis (appendiceal diameter no larger than 11 mm and without any signs of perforation) were randomized to management with a no-antibiotic regimen with supportive care (intravenous fluids, analgesia and antipyretics as necessary) or a 4-day course of antibiotics with supportive care. The primary endpoint was rate of total treatment failure, defined as initial treatment failure within 1 month and recurrence of appendicitis during the follow-up period. Some 245 patients were randomized within the trial, and followed up for a median of 19 months. The duration of hospital stay was shorter (mean 3·1 versus 3·7 days; P antibiotics. There was no difference in total treatment failure rate between the groups: 29 of 124 (23·4 per cent) in the no-antibiotic group and 25 of 121 (20·7 per cent) in the antibiotic group (P = 0·609). Eighteen patients (9 in each group) had initial treatment failure, 15 of whom underwent appendicectomy and three received additional antibiotics. Thirty-six patients (20 in the no-antibiotic group, 16 in the antibiotic group) experienced recurrence, of whom 30 underwent appendicectomy and six received further antibiotics. Treatment failure rates in patients presenting with CT-confirmed uncomplicated appendicitis appeared similar among those receiving supportive care with either a no-antibiotic regimen or a 4-day course of antibiotics. Registration number: KCT0000124 ( http://cris.nih.go.kr). © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

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

Science.gov (United States)

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

2012-07-01

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

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

Science.gov (United States)

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

2014-05-01

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

Use of chloroquine in uncomplicated falciparum malaria ...

African Journals Online (AJOL)

Use of chloroquine in uncomplicated falciparum malaria chemotherapy: The past, the present and the future. ... regions. It was initially highly effective against the four Plasmodium species (P. falciparum, P. malaria, P. ovale and P. vivax) infecting human. It is also effective against gametocytes except those of P. falciparum.

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

Science.gov (United States)

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

2017-07-01

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

A clinical case study of long-term injury of the thoracic and lumbar spine

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Vladimir V Zaretskov

2016-06-01

Full Text Available Overestimation of the efficacy of conservative treatment of spine injuries children often leads to unsatisfactory long-term results. The effective correction of post-traumatic spinal column deformities occurs in patients who undergo the operation in the early post-traumatic period. While choosing treatment strategies for children, higher reparative opportunities, which provide early fracture consolidation, including those in faulty positions, should be considered. This study presents a case of surgical treatment for uncomplicated injury of the thoracic and lumbar spine, with long-term compression fragmental fracture of the L1 vertebra body in a 12-year-old child. Due to the long-standing character of the injury right thoraco-frenotomy was conducted with partial L1 vertebral body and resection of the adjacent discs, deformity correction of the thoracic and lumbar spine with a transpedicular system, and ventral spondylodesis with an autograft. This extensive intervention was justified by the peculiarities in the vertebral body damage and the post-traumatic segmental kyphotic deformity that resulted from delayed medical treatment. An anterior approach was chosen to achieve immobilization at the site of the damage before correction using the transpedicular system. Surgical correction of long-term spinal injuries in children, with the use of a combined approach, is usually laborious and traumatic. The prevention of rigid post-traumatic spine deformities with the help of timely diagnostics and appropriate treatment, including surgery, should be a priority to prevent such cases.

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

OpenAIRE

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

2017-01-01

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

Can classic metaphyseal lesions follow uncomplicated caesarean section?

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O' Connell, AnnaMarie [Children' s University Hospital, Radiology Department, Dublin 1 (Ireland); Donoghue, Veronica B. [Children' s University Hospital, Radiology Department, Dublin 1 (Ireland); National Maternity Hospital, Radiology Department, Dublin (Ireland)

2007-05-15

Classic metaphyseal lesion (CML) is the term given to a fracture that most often occurs in the posteromedial aspect of the distal femur, proximal tibia, distal tibia, and proximal humerus in infants; this finding is strongly associated with non-accidental injury. To demonstrate that the CML may occur following simple lower segment caesarean section (LSCS). A review of 22 years of an obstetric practice that delivers 8,500 babies per year. We identified three neonates born by elective LSCS, each with distal femoral metaphyseal fractures on postpartum radiographs. All caesarean sections were elective and uncomplicated. External cephalic version was not employed preoperatively. Postpartum radiographs demonstrated a fracture of the distal femoral metaphysis in each neonate, typical of a CML. We propose that a CML can occur in the setting of a simple, elective and uncomplicated LSCS where no external cephalic version is employed. (orig.)

Can classic metaphyseal lesions follow uncomplicated caesarean section?

International Nuclear Information System (INIS)

O'Connell, AnnaMarie; Donoghue, Veronica B.

2007-01-01

Classic metaphyseal lesion (CML) is the term given to a fracture that most often occurs in the posteromedial aspect of the distal femur, proximal tibia, distal tibia, and proximal humerus in infants; this finding is strongly associated with non-accidental injury. To demonstrate that the CML may occur following simple lower segment caesarean section (LSCS). A review of 22 years of an obstetric practice that delivers 8,500 babies per year. We identified three neonates born by elective LSCS, each with distal femoral metaphyseal fractures on postpartum radiographs. All caesarean sections were elective and uncomplicated. External cephalic version was not employed preoperatively. Postpartum radiographs demonstrated a fracture of the distal femoral metaphysis in each neonate, typical of a CML. We propose that a CML can occur in the setting of a simple, elective and uncomplicated LSCS where no external cephalic version is employed. (orig.)

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

Science.gov (United States)

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

2017-01-01

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

Medical prescription pitfalls of uncomplicated urinary tract infections ...

African Journals Online (AJOL)

user

1Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia. C. S. ABSTRACT. Objectives: The aim of this evaluation was to identify pitfalls in medical prescriptions of uncomplicated urinary ... competences such as principles of clinical pharmacology, knowledge, skill and critical. 1 judgement, among ...

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

Science.gov (United States)

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

2014-01-01

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

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

Directory of Open Access Journals (Sweden)

Tevfik Yilmaz

2014-01-01

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

Artemether-lumefantrine treatment of uncomplicated Plasmodium falciparum malaria

DEFF Research Database (Denmark)

Kofoed, Poul-Erik

2015-01-01

BACKGROUND: Achieving adequate antimalarial drug exposure is essential for curing malaria. Day 7 blood or plasma lumefantrine concentrations provide a simple measure of drug exposure that correlates well with artemether-lumefantrine efficacy. However, the 'therapeutic' day 7 lumefantrine concentr......BACKGROUND: Achieving adequate antimalarial drug exposure is essential for curing malaria. Day 7 blood or plasma lumefantrine concentrations provide a simple measure of drug exposure that correlates well with artemether-lumefantrine efficacy. However, the 'therapeutic' day 7 lumefantrine......-lumefantrine for uncomplicated Plasmodium falciparum malaria, to define therapeutic day 7 lumefantrine concentrations and identify patient factors that substantially alter these concentrations. A systematic review of PubMed, Embase, Google Scholar, ClinicalTrials.gov and conference proceedings identified all relevant studies...... lumefantrine concentrations ≥200 ng/ml and high cure rates in most uncomplicated malaria patients. Three groups are at increased risk of treatment failure: very young children (particularly those underweight-for-age); patients with high parasitemias; and patients in very low transmission intensity areas...

Systematic review of nonoperative versus operative treatment of uncomplicated appendicitis.

Science.gov (United States)

Gorter, Ramon R; The, Sarah-May M L; Gorter-Stam, Marguerite A W; Eker, Hasan H; Bakx, Roel; van der Lee, Johanna H; Heij, Hugo A

2017-08-01

To compare the risk of complications between initial nonoperative treatment and appendectomy of uncomplicated (simple) appendicitis in children. Systematic literature search. Eligible for inclusion were both and randomized controlled trials and cohort studies including children in which the outcome of nonoperative treatment of uncomplicated appendicitis was reported with a minimum follow-up period of one year. Two authors extracted data independently and assessed quality. Primary outcome parameter was the percentage of children experiencing complications. Secondary outcomes were early failures, recurrent appendicitis and appendectomies, for all indications and on request. Five of the 2051 articles screened were eligible for inclusion, including 147 children (nonoperative treatment) and 173 children (appendectomy) with one year follow-up. Percentage of children experiencing complications ranged from 0 to 13% versus 0-17% for nonoperative and appendectomy, respectively. Nonoperative treatment avoided an appendectomy in 62-81% of the children after one year follow-up. The evidence base for initial nonoperative treatment of acute uncomplicated appendicitis in children is by far insufficient. It suggests that the percentage of patients experiencing complications in the initial nonoperative treatment group is comparable to the appendectomy group, and it may avoid an appendectomy in the large majority of children after one year follow-up. Systematic review. 1. Copyright © 2017 Elsevier Inc. All rights reserved.

Lumbar lordosis.

Science.gov (United States)

Been, Ella; Kalichman, Leonid

2014-01-01

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

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

International Nuclear Information System (INIS)

Kunishi, Yoshihiko

2003-01-01

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

NEUROMUSCULAR CONTROL IN LUMBAR DISORDERS

Directory of Open Access Journals (Sweden)

Ville Leinonen

2004-03-01

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

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

International Nuclear Information System (INIS)

Wang Linyou; Li Yuan; Shao Yangtong

2004-01-01

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

Ibuprofen versus mecillinam for uncomplicated cystitis - a randomized controlled trial study protocol

DEFF Research Database (Denmark)

Vik, Ingvild; Bollestad, Marianne; Grude, Nils

2014-01-01

, controlled, double blind trial following the principles of Good Clinical Practice. Women between the ages of 18 to 60 presenting with symptoms of uncomplicated cystitis are screened for eligibility. 500 women from four sites in Norway, Sweden and Denmark are allocated to treatment with 600 mg ibuprofen three.......DiscussionIf treatment of uncomplicated cystitis with ibuprofen is as effective as mecillinam for symptom relief, we can potentially reduce the use of antibiotics on a global scale.Trial registrationEudraCTnr: 2012-002776-14. ClinicalTrials.gov: NCT01849926....

Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative patients

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Simao, Marcelo Novelino, E-mail: marcelo_simao@hotmail.com [Central de Diagnostico Ribeirao Preto (CEDIRP), Ribeirao Preto, SP (Brazil); Helms, Clyde A. [Radiology, Musculoskeletal Section, Duke University Medical Center, Durham, NC (United States); Richardson, William J. [Orthopedic Surgery, Spine Surgery Section, Duke University Medical Center, Durham, NC (United States)

2012-07-15

Objective: To demonstrate five discal cysts with detailed magnetic resonance imaging findings in nonsurgical and following postoperative microdiscectomy. Materials And Methods: Five discal cysts in four patients who underwent magnetic resonance imaging were found through a search in our database and referral from a single orthopedic spine surgeon. Computed tomography in two cases and computed tomography discography in one case were also performed. Results: Five discal cysts were present in four patients. Three patients had no history of previous lumbar surgery and the other patient presented with two discal cysts and recurrent symptoms after partial laminectomy and microdiscectomy. All were oval shaped and seated in the anterior epidural space. Four were ventrolateral, and the other one was centrally positioned in the anterior spinal canal. One showed continuity with the central disc following discography. Three were surgically removed. Conclusion: Magnetic resonance imaging can easily depict an epidural cyst and the diagnosis of a discal cyst should be raised when an homogeneous ventrolateral epidural cyst contiguous to a mild degenerated disc is identified. (author)

Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative patients

International Nuclear Information System (INIS)

Simao, Marcelo Novelino; Helms, Clyde A.; Richardson, William J.

2012-01-01

Objective: To demonstrate five discal cysts with detailed magnetic resonance imaging findings in nonsurgical and following postoperative microdiscectomy. Materials And Methods: Five discal cysts in four patients who underwent magnetic resonance imaging were found through a search in our database and referral from a single orthopedic spine surgeon. Computed tomography in two cases and computed tomography discography in one case were also performed. Results: Five discal cysts were present in four patients. Three patients had no history of previous lumbar surgery and the other patient presented with two discal cysts and recurrent symptoms after partial laminectomy and microdiscectomy. All were oval shaped and seated in the anterior epidural space. Four were ventrolateral, and the other one was centrally positioned in the anterior spinal canal. One showed continuity with the central disc following discography. Three were surgically removed. Conclusion: Magnetic resonance imaging can easily depict an epidural cyst and the diagnosis of a discal cyst should be raised when an homogeneous ventrolateral epidural cyst contiguous to a mild degenerated disc is identified. (author)

Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion.

Science.gov (United States)

Madan, S S; Boeree, N R

2003-12-01

Posterior lumbar interbody fusion (PLIF) restores disc height, the load bearing ability of anterior ligaments and muscles, root canal dimensions, and spinal balance. It immobilizes the painful degenerate spinal segment and decompresses the nerve roots. Anterior lumbar interbody fusion (ALIF) does the same, but could have complications of graft extrusion, compression and instability contributing to pseudarthrosis in the absence of instrumentation. The purpose of this study was to assess and compare the outcome of instrumented circumferential fusion through a posterior approach [PLIF and posterolateral fusion (PLF)] with instrumented ALIF using the Hartshill horseshoe cage, for comparable degrees of internal disc disruption and clinical disability. It was designed as a prospective study, comparing the outcome of two methods of instrumented interbody fusion for internal disc disruption. Between April 1994 and June 1998, the senior author (N.R.B.) performed 39 instrumented ALIF procedures and 35 instrumented circumferential fusion with PLIF procedures. The second author, an independent assessor (S.M.), performed the entire review. Preoperative radiographic assessment included plain radiographs, magnetic resonance imaging (MRI) and provocative discography in all the patients. The outcome in the two groups was compared in terms of radiological improvement and clinical improvement, measured on the basis of improvement of back pain and work capacity. Preoperatively, patients were asked to fill out a questionnaire giving their demographic details, maximum walking distance and current employment status in order to establish the comparability of the two groups. Patient assessment was with the Oswestry Disability Index, quality of life questionnaire (subjective), pain drawing, visual analogue scale, disability benefit, compensation status, and psychological profile. The results of the study showed a satisfactory outcome (scorelife questionnaire) score of 71.8% (28 patients) in

THE STRATEGY OF ANTIMICROBIAL THERAPY OF ACUTE UNCOMPLICATED PYELONEPHRITIS FROM THE POSITION OF ETIOLOGICAL DATA

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A. D. Kaprin

2015-01-01

Full Text Available Abstract:Acute pyelonephritis is one of the common diseases both in outpatient and in the hospital practice. The leading causative agent of this disease is E. coli. Obstructive uropathy, foreign body, vesicoureteral reflux, sexual activity, use of local contraceptives contribute to the upward development of urinary infection. The goals of antimicrobial therapy for acute uncomplicated pyelonephritis are: relief of symptoms, restoration of social activity, prevention of complications and relapse prevention. The choice of an antimicrobial agent in most cases is carried out empirically based on the data on the dominant pathogens and their regional resistance. In acute uncomplicated pyelonephritis duration of antimicrobial therapy should be 7–14 days. The drugs of choice for treatment of acute uncomplicated pyelonephritis non-severe in adults are ciprofloxacin and levofloxacin, ceftibuten and cefixime. Patients with acute uncomplicated pyelonephritis severe emergency hospitalization is shown in urological outpatient and parenteral antimicrobial therapy (carbapenems or protected aminopenicillins combined with or without amikacin with subsequent conversion to oral drugs and infusion therapy.

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

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Binbin Wu

2017-01-01

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

Lumbar lordosis in female collegiate dancers and gymnasts.

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

2014-12-01

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

Heart rate variability is reduced during acute uncomplicated diverticulitis

DEFF Research Database (Denmark)

Huang, Chenxi; Alamili, Mahdi; Rosenberg, Jacob

2016-01-01

BACKGROUND: The aim of the present study was to report the trajectory of heart rate variability (HRV) indices during a low-grade acute inflammation and their associations to biomarkers for infection. METHODS: Twelve patients with uncomplicated acute diverticulitis completed this observational study...

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

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

2007-10-01

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

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

International Nuclear Information System (INIS)

Shoda, Motoi; Kuno, Shigehiko; Inoue, Tatsushi

2009-01-01

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

Prospective risk of fetal death in uncomplicated monochorionic twins.

LENUS (Irish Health Repository)

Farah, Nadine

2012-03-01

A retrospective cohort study was carried out in a university teaching hospital to determine the prospective risk of unexpected fetal death in uncomplicated monochorionic diamniotic (MCDA) twin pregnancies after viability. All MCDA twins delivered at or after 24 weeks\\' gestation from July 1999 to July 2007 were included. Pregnancies with twin-twin transfusion syndrome, growth restriction, structural abnormalities, or twin reversed arterial perfusion sequence were excluded. Of the 144 MCDA twin pregnancies included in our analysis, the risk of intrauterine death was 4.9%. The prospective risk of unexpected intrauterine death was 1 in 43 after 32 weeks\\' gestation and 1 in 37 after 34 weeks\\' gestation. Our results demonstrate that despite close surveillance, the unexpected intrauterine death rate in uncomplicated MCDA twin pregnancies is high. This rate seems to increase after 34 weeks\\' gestation, suggesting that a policy of elective preterm delivery warrants evaluation.

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

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Surendra Mohan Tuli

2011-01-01

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

Efficacy of chloroquine for the treatment of uncomplicated Plasmodium falciparum malaria in Honduras.

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Mejia Torres, Rosa Elena; Banegas, Engels Ilich; Mendoza, Meisy; Diaz, Cesar; Bucheli, Sandra Tamara Mancero; Fontecha, Gustavo A; Alam, Md Tauqeer; Goldman, Ira; Udhayakumar, Venkatachalam; Zambrano, Jose Orlinder Nicolas

2013-05-01

Chloroquine (CQ) is officially used for the primary treatment of Plasmodium falciparum malaria in Honduras. In this study, the therapeutic efficacy of CQ for the treatment of uncomplicated P. falciparum malaria in the municipality of Puerto Lempira, Gracias a Dios, Honduras was evaluated using the Pan American Health Organization-World Health Organization protocol with a follow-up of 28 days. Sixty-eight patients from 6 months to 60 years of age microscopically diagnosed with uncomplicated P. falciparum malaria were included in the final analysis. All patients who were treated with CQ (25 mg/kg over 3 days) cleared parasitemia by day 3 and acquired no new P. falciparum infection within 28 days of follow-up. All the parasite samples sequenced for CQ resistance mutations (pfcrt) showed only the CQ-sensitive genotype (CVMNK). This finding shows that CQ remains highly efficacious for the treatment of uncomplicated P. falciparum malaria in Gracias a Dios, Honduras.

Lumbar stenosis: clinical case

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Pedro Sá

2014-08-01

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

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

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

2014-01-01

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

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

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Michaelis Martina

2009-05-01

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

Correlação clínica e radiológica de pacientes portadores de dor lombar crônica com a discografia Correlación de la clínica y radiología de pacientes portadores de dolor lumbar crónico con la discografia Clinical and radiological correlation in patients with low back pain submitted a discography

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Emiliano Neves Vialle

2009-03-01

ónico. MÉTODOS: análisis prospectiva de 33 discografías en 20 pacientes portadores de dolor lumbar crónico. La evaluación constó de un examen clínico y radiológico por medio de un protocolo que contiene datos de anamnesia, VAS, Oswestry y hallazgos de la RM. RESULTADOS: de los 33 discos examinados, 14 exámenes fueron positivos y 19 negativos. El promedio de edad de los pacientes con discografía positiva fue de 40.7 años y para discografía negativa fue de 43.14 años. Los pacientes con dolor lumbar asociado a dolor del ciático tuvieron discografía positiva en 87.5% de los casos, mientras pacientes con apenas lumbalgia fueron un 50% (p = 0.008. La positividad de la discografía fue de 88.9% para pacientes con mas de 4 episodios, mientras entre 1 a 4 episodios tuvieron positividad de 50% (p=0.004. El EVA (Escala Visual Analógica promedio y la evaluación conforme la escala de Oswestry no difirió de modo significativo. En relación a la RM fue evidenciada una positividad de 80% en los discos con HIZ (High Intensity Zone (p=0.045 y de 75% en los discos con alteraciones de Modic9 (p=0.083. El endpoint fue evaluado con o sin resistencia a la inyección intradiscal y los exámenes con resistencia tuvieron menor positividad (31.58%, p=0.0143. CONCLUSIÓN: pacientes con queja principal de dolor lumbar asociado con dolor del ciático, que tuvieron más de cuatro agudizaciones asociadas a la presencia de HIZ en la RM tienen mayor incidencia de positividad en la discografía. En la discografía endpoint con resistencia tiene mayor asociación con la incidencia de discos asintomáticos. Aunque sin diferencia estadísticamente significativa, existe una fuerte asociación entre las alteraciones tipo Modic9 con discografía positiva.OBJECTIVE: to correlate discography findings with patients symptoms and imaging studies. METHODS: thirty three discograms of 20 patients with chronic low back pain were prospectively evaluated comparing discography findings with clinical data

Role of symptomatic treatment in comparison to antibiotics in uncomplicated urinary tract infections

International Nuclear Information System (INIS)

Jamil, M.N.; Khan, R.M.; Sultan, B.; Farooq, U.

2017-01-01

Uncomplicated urinary tract infections (UTIs) are the most common bacterial infections among women presenting to primary care causing rapidly increasing strains of resistant bacteria to the growing antibiotic industry. Restricting antibiotics to necessary indications is the only solution. The objectives of the study were to compare the efficacy of symptomatic treatment vs antibiotic in patients with uncomplicated UTI, in terms of individual symptom score, i.e., frequency, urgency, dysuria, supra pubic pain scores and total symptoms scores. Methods: A randomized control trial (RCT) in 100 women (15-50 years) with symptoms of urinary frequency, urgency, dysuria and pain supra pubic region, associated with uncomplicated UTI, at Urology department, AMI, Abbottabad. Two treatment strategies were compared in uncomplicated UTI patient). Patients were randomized to antibiotic or symptomatic treatment groups on consecutive non-probability basis (50 in each group) given for 05 days. Efficacy of medications was assessed by comparing pre and post treatment symptom scores along with the post treatment scores of both groups compared to see statistical significance of difference by independent samples t-test. Results: There was a statistically significant difference in symptoms improvement in both treatment arms of all scores, i.e., p-value=0.000. Whereas only dysuria score was able to show a statistically significance of difference in post Rx scores comparison of both groups, p-value=0.004. Conclusions: Symptomatic treatment is not inferior to antibiotic treatment when proper patient selection is undertaken, resulting in decreased need for unnecessary antibiotics use. (author)

Reproduction of the lumbar lordosis

DEFF Research Database (Denmark)

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

2007-01-01

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

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

International Nuclear Information System (INIS)

Mou Ling

2009-01-01

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

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

International Nuclear Information System (INIS)

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

2001-01-01

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

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

Science.gov (United States)

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

2017-07-01

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

[Acute complicated and uncomplicated pyelonephritis in the emergency department: process-of-care indicators and outcomes].

Science.gov (United States)

Delgado Vicente, Miriam; Lecaroz Agara, Mª Concepción; Barrios Andrés, José Luis; Canut Blasco, Andrés

2017-02-01

To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health processof- care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study.

The bivariate probit model of uncomplicated control of tumor: a heuristic exposition of the methodology

International Nuclear Information System (INIS)

Herbert, Donald

1997-01-01

Purpose: To describe the concept, models, and methods for the construction of estimates of joint probability of uncomplicated control of tumors in radiation oncology. Interpolations using this model can lead to the identification of more efficient treatment regimens for an individual patient. The requirement to find the treatment regimen that will maximize the joint probability of uncomplicated control of tumors suggests a new class of evolutionary experimental designs--Response Surface Methods--for clinical trials in radiation oncology. Methods and Materials: The software developed by Lesaffre and Molenberghs is used to construct bivariate probit models of the joint probability of uncomplicated control of cancer of the oropharynx from a set of 45 patients for each of whom the presence/absence of recurrent tumor (the binary event E-bar 1 /E 1 ) and the presence/absence of necrosis (the binary event E 2 /E-bar 2 ) of the normal tissues of the target volume is recorded, together with the treatment variables dose, time, and fractionation. Results: The bivariate probit model can be used to select a treatment regime that will give a specified probability, say P(S) = 0.60, of uncomplicated control of tumor by interpolation within a set of treatment regimes with known outcomes of recurrence and necrosis. The bivariate probit model can be used to guide a sequence of clinical trials to find the maximum probability of uncomplicated control of tumor for patients in a given prognostic stratum using Response Surface methods by extrapolation from an initial set of treatment regimens. Conclusions: The design of treatments for individual patients and the design of clinical trials might be improved by use of a bivariate probit model and Response Surface Methods

Pivmecillinam versus sulfamethizole for short-term treatment of uncomplicated acute cystitis in general practice

DEFF Research Database (Denmark)

Bjerrum, Lars; Gahrn-Hansen, Bente; Grinsted, Per

2009-01-01

Objective. To investigate whether short-term treatment with pivmecillinam was more effective than sulfamethizole in patients with acute uncomplicated urinary tract infection (UTI). Design. Randomized controlled trial. Setting. General practice, Denmark. Subjects. Patients (n =167) with uncomplica......Objective. To investigate whether short-term treatment with pivmecillinam was more effective than sulfamethizole in patients with acute uncomplicated urinary tract infection (UTI). Design. Randomized controlled trial. Setting. General practice, Denmark. Subjects. Patients (n =167......) with uncomplicated UTI confirmed by positive urine phase-contrast microscopy. Main outcome measures. Drug efficacy based on clinical and bacteriological cure. Results. Urinary symptoms disappeared first in patients treated with pivmecillinam, but after five days there was no significant difference in clinical cure...... in 68.8% of patients randomized to pivmecillinam and in 77.9% randomized to sulfamethizole (difference -9.2%, CI -24.7%; 6.3%). Some 26.8% of patients randomized to pivmecillinam experienced a new UTI within 6 months after treatment compared with 18.4% of patients randomized to sulfamethizole...

Lumbar interspinous bursitis in active polymyalgia rheumatica.

Science.gov (United States)

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

2013-01-01

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

The Neandertal vertebral column 2: The lumbar spine.

Science.gov (United States)

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

2017-05-01

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

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

Science.gov (United States)

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

2014-12-01

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

No antibiotics in acute uncomplicated diverticulitis: does it work?

Science.gov (United States)

Isacson, Daniel; Andreasson, Kalle; Nikberg, Maziar; Smedh, Kenneth; Chabok, Abbas

2014-12-01

The first randomized multicenter study evaluating the need for antibiotic treatment in patients with acute uncomplicated diverticulitis (AUD) could not demonstrate any benefit gained from antibiotic use. The aim of this study was to review the application of the no antibiotic policy and its consequences in regard to complications and recurrence. This retrospective population-based cohort study included all patients diagnosed with all types of colonic diverticulitis during the year 2011 at Västmanland Hospital Västerås, Sweden. All medical records were carefully reviewed. Primary outcomes were the types of treatment adopted for diverticulitis, complications and recurrence. In total, 246 patients with computer tomography-verified diverticulitis were identified, 195 with primary AUD and 51 with acute complicated diverticulitis. Age, sex, and temperature at admission were similar between the groups but there was a significant difference in white blood cell count, C-reactive protein, and length of hospital stay. In the AUD group, 178 (91.3%) patients were not treated with antibiotics. In this group, there were six (3.4%) readmissions but only two developed an abscess. Of the remaining 17 patients (8.7%) who were treated with antibiotics in the AUD group, one developed an abscess. Twenty-five (12.8%) patients in the AUD group presented with a recurrence within 1 year. The no-antibiotic policy for AUD is safe and applicable in clinical practice. The previous results of a low complication and recurrence rate in AUD are confirmed. There is no need for antibiotic treatment for AUD. What does this paper add to the literature? Despite published papers with excellent results, there are still doubts about patient safety against the policy to not use antibiotics in acute uncomplicated diverticulitis. This is the first paper, in actual clinical practice, to confirm that the no antibiotic policy for acute uncomplicated diverticulitis is applicable and safe.

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

Science.gov (United States)

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

2018-06-01

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

Fuerza lumbar en jugadores de hockey hierba

OpenAIRE

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

2007-01-01

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

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

Science.gov (United States)

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

2014-11-01

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

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

OpenAIRE

GUO, SHUGUANG; SUN, JUNYING; TANG, GENLIN

2013-01-01

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

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

Science.gov (United States)

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

2017-08-01

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

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

International Nuclear Information System (INIS)

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

1986-01-01

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

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

Science.gov (United States)

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

2015-06-01

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

Remote cerebellar hemorrhage after lumbar spinal surgery

International Nuclear Information System (INIS)

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

2009-01-01

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

Lumbar dorsal ramus syndrome.

Science.gov (United States)

Bogduk, N

1980-11-15

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

Manejo del síndrome doloroso lumbar Management of lumbar syndrome

Directory of Open Access Journals (Sweden)

Rafael Rivas Hernández

2010-03-01

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

Analysis of the causes of postfilling pain in the treatment of uncomplicated caries

Directory of Open Access Journals (Sweden)

A V Yurkevich

2018-06-01

Full Text Available Aim. To analyze the incidence of postfilling pain in the treatment of uncomplicated caries with filling materials approved by the program of compulsory medical insurance (CMI. Methods. Retrospective analysis of medical records of patients of dental clinic of Far Eastern state medical university «Uni-Stom» treated for uncomplicated caries according to the program of compulsory medical insurance. Results. In patients’ group 1 where cementation was performed with zinc-phosphate cement, the average duration of postfilling pain was statistically calculated to be 13 days (M±0.8. In group 2 of patients seeking dental care who had permanent filling performed with composite material without cementation, significant decrease (t=9.4; p <0.001 of time course of postfilling pain relief to 4 days (M±0.6 was revealed. In group 3 compomer material was used as cement, postfilling pain relief occurred significantly earlier (t=11.6; p <0.001 by 2.5 days (M±0.4. The best measures were observed in the group where chemically cured glass ionomer cement was used as cement; postfilling pain was controlled in 1.5 day (M±1.2, being statistically significant (t=8.3; p <0.001. The dependence of postfilling pain on the selected filling material is observed after the treatment of uncomplicated caries; when using zinc-phosphate cement «Uniphase», a complete postfilling pain relief occurs on average on day 14, when using a light-curing composite «Charisma» - on day 4, «Isolain» - on days 2-3 and «Tsemion» - on day 1-2. Conclusion. Given the clinical results, positive qualities and low cost of glass-ionomer cement «Tsemion», its use is recommended for the treatment of uncomplicated caries in public dental practice.

Sensitivity of lumbar spine loading to anatomical parameters

DEFF Research Database (Denmark)

Putzer, Michael; Ehrlich, Ingo; Rasmussen, John

2016-01-01

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

49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

Science.gov (United States)

2010-10-01

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

Lumbar Vertebral Canal Diameters in Adult Ugandan Skeletons ...

African Journals Online (AJOL)

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

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

OpenAIRE

Bogduk, N

1980-01-01

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

Exercise capacity in patients 3 days after acute, uncomplicated myocardial infarction

International Nuclear Information System (INIS)

Burek, K.A.; Kirscht, J.; Topol, E.J.

1989-01-01

In a randomized, controlled trial of early hospital discharge after acute myocardial infarction (MI), a heart rate, symptom-limited exercise thallium test was performed after the onset of MI. Patients' exercise capacity was evaluated by the exercise treadmill with accompanying thallium scintigraphy. Of 507 consecutive patients screened, the condition of 179 was classified as uncomplicated, which is defined as the absence of angina, heart failure, or serious arrhythmias at 72 hours from admission. Of the patients with uncomplicated conditions, 126 had an exercise test on day 3 and 53 did not exercise on day 3. Of the 126 patients who exercised on day 3, 36 had a positive test and 90 had a negative test for ischemia. The 36 patients with a positive test result exercised a mean time of 6.71 +/- 2.8 minutes, achieved a mean peak heart rate of 120.9 +/- 21.4 beats/min, reached a peak systolic blood pressure of 144.7 +/- 33.3 mm Hg, and achieved a double product (rate-pressure product) of 183.4 +/- 67.6. The 90 patients with a negative test result for ischemia exercised 9.45 +/- 12.7 minutes, achieved a peak heart rate of 130.2 +/- 14.4 beats/min, reached a mean systolic blood pressure of 155.5 +/- 29.4 mm Hg, and achieved a rate-pressure product of 210.5 +/- 44.0. Of the 90 patients with uncomplicated conditions who had a negative exercise test for ischemia, 85 patients received reperfusion therapy, which included thrombolysis or coronary angioplasty or both

The shape of the human lumbar vertebral canal

OpenAIRE

Zarzur,Edmundo

1996-01-01

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

Review article: uncomplicated diverticular disease of the colon.

Science.gov (United States)

Petruzziello, L; Iacopini, F; Bulajic, M; Shah, S; Costamagna, G

2006-05-15

Diverticular disease of the colon is the fifth most important gastrointestinal disease in terms of direct and indirect health care costs in western countries. Uncomplicated diverticular disease is defined as the presence of diverticula in the absence of complications such as perforation, fistula, obstruction and/or bleeding. The distribution of diverticula along the colon varies worldwide being almost always left-sided and directly related to age in western countries and right-sided where diet is rich in fibre. The pathophysiology of diverticular disease is complex and relates to abnormal colonic motility, changes in the colonic wall, chronic mucosal low-grade inflammation, imbalance in colonic microflora and visceral hypersensitivity. Moreover, there can be genetic factors involved in the development of colonic diverticula. The use of non-absorbable antibiotics is the mainstay of therapy in patients with mild to moderate symptoms, and the effect of fibre-supplementation alone does not appear to be significantly different from placebo, although no definite data are available. More recently, alternative treatments have been reported. Mesalazine acts as a local mucosal immunomodulator and has been shown to improve symptoms and prevent recurrence of diverticulitis. In addition, probiotics have also been shown to be beneficial by re-establishing a normal gut microflora. In this study, the current literature on uncomplicated diverticular disease of the colon is reviewed.

PARAMETRIC MODEL OF LUMBAR VERTEBRA

Directory of Open Access Journals (Sweden)

CAPPETTI Nicola

2010-11-01

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

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

Science.gov (United States)

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

2018-04-01

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

Urine Culture in Uncomplicated UTI: Interpretation and Significance.

Science.gov (United States)

Stapleton, Ann E

2016-05-01

Acute uncomplicated urinary tract infection (UTI) is a common clinical problem, accounting for millions of outpatient visits in the USA annually. Although routinely obtaining urine cultures in UTI is not recommended, there are circumstances in which obtaining a pre-therapy culture may be warranted or chosen by clinicians, such as when indicated by the need for careful antimicrobial stewardship. This review focuses on understanding reasons for obtaining a pre-therapy culture, methods of collection, and appropriately interpreting urine culture data.

Strengthening the technical research and clinical application for vertebral interventional radiology

International Nuclear Information System (INIS)

Wu Chungen; Cheng Yongde

2008-01-01

Interventional diagnostic and therapeutic techniques have developed rapidly in recent years with more and more practically and widely utilization as time goes by. The diagnostic procedures consist of percutaneous biopsy, CT discography, pressure measurement of intervertebral disc; and the therapeutic measures include percutaneous periradicular and joint therapy, decompression of sacral cyst, vertebroplasty, kyphoplasty, decompression of intervertebral disc, transarterial chemotherapy and embolization in spinal tumor, and newly developed percutaneous posterior lumbar intervertebral fusion. All above mentioned interventional techniques for spinal column diseases are developing day by day with a promising future and will play an important role in the field of interventional radiologist research. (authors)

Management of Lumbar Conditions in the Elite Athlete.

Science.gov (United States)

Hsu, Wellington K; Jenkins, Tyler James

2017-07-01

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

Antibiotic resistance rates and physician antibiotic prescription patterns of uncomplicated urinary tract infections in southern Chinese primary care

OpenAIRE

Wong, Carmen Ka Man; Kung, Kenny; Au-Doung, Philip Lung Wai; Ip, Margaret; Lee, Nelson; Fung, Alice; Wong, Samuel Yeung Shan

2017-01-01

Uncomplicated urinary tract infections (UTI) are common in primary care. Whilst primary care physicians are called to be antimicrobial stewards, there is limited primary care antibiotic resistance surveillance and physician antibiotic prescription data available in southern Chinese primary care. The study aimed to investigate the antibiotic resistance rate and antibiotic prescription patterns in female patients with uncomplicated UTI. Factors associated with antibiotic resistance and prescrip...

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

OpenAIRE

Grasso, Giovanni; Landi, Alessandro

2017-01-01

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

Weightlifter Lumbar Physiology Health Influence Factor Analysis of Sports Medicine.

Science.gov (United States)

Zhang, Xiangyang

2015-01-01

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

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

Science.gov (United States)

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

2016-01-01

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

Efficacies of artesunate plus either sulfadoxine-pyrimethamine or amodiaquine, for the treatment of uncomplicated, Plasmodium falciparum malaria in eastern Sudan

DEFF Research Database (Denmark)

Ibrahium, A M; Kheir, M M; Osman, M E

2007-01-01

Artemisinin-based combination therapy (ACT) is increasingly being adopted as the first-line treatment for malaria in sub-Saharan Africa. In September-November 2005, in New Halfa, eastern Sudan, the efficacy of artesunate-sulfadoxine-pyrimethamine (AS-SP) for the treatment of uncomplicated...... of uncomplicated, P. falciparum malaria in eastern Sudan....

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

DEFF Research Database (Denmark)

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

2015-01-01

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

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

Science.gov (United States)

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

2014-12-01

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

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

OpenAIRE

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

2009-01-01

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

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

Science.gov (United States)

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

2014-01-01

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

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

DEFF Research Database (Denmark)

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

2009-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2017-05-15

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

ISASS Policy Statement – Lumbar Artificial Disc

Science.gov (United States)

Garcia, Rolando

2015-01-01

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

Gonadal dose reduction in lumbar spine radiography

International Nuclear Information System (INIS)

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

1983-01-01

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

Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

Directory of Open Access Journals (Sweden)

Koshi Ninomiya

2014-01-01

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

General practitioners' willingness to request plain lumbar spine radiographic examinations

International Nuclear Information System (INIS)

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

2001-01-01

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

Tractography of lumbar nerve roots: initial results

Energy Technology Data Exchange (ETDEWEB)

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

2011-06-15

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

Tractography of lumbar nerve roots: initial results

International Nuclear Information System (INIS)

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

2011-01-01

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

Side effects after lumbar iohexol myelography

International Nuclear Information System (INIS)

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

1990-01-01

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

ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

OpenAIRE

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

2015-01-01

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

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

Science.gov (United States)

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

2013-12-01

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

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

Science.gov (United States)

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

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

Uncomplicated E Coli Urinary Tract Infection in College Women: A Follow-Up Study of E Coli Sensitivities to Commonly Prescribed Antibiotics

Science.gov (United States)

Ansbach, Robert K.; Dybus, Karen; Bergeson, Rachel

2005-01-01

Treatment of uncomplicated urinary tract infections (UTIs) has changed in the past few years with researchers advocating empiric treatment for shorter periods of time without the use of cultures. Researchers report that antibiotic resistance of Escherichia coli (E coli) to commonly prescribed antibiotics in uncomplicated UTIs has been increasing.…

Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial.

Science.gov (United States)

Salminen, Paulina; Paajanen, Hannu; Rautio, Tero; Nordström, Pia; Aarnio, Markku; Rantanen, Tuomo; Tuominen, Risto; Hurme, Saija; Virtanen, Johanna; Mecklin, Jukka-Pekka; Sand, Juhani; Jartti, Airi; Rinta-Kiikka, Irina; Grönroos, Juha M

2015-06-16

An increasing amount of evidence supports the use of antibiotics instead of surgery for treating patients with uncomplicated acute appendicitis. To compare antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis confirmed by computed tomography (CT). The Appendicitis Acuta (APPAC) multicenter, open-label, noninferiority randomized clinical trial was conducted from November 2009 until June 2012 in Finland. The trial enrolled 530 patients aged 18 to 60 years with uncomplicated acute appendicitis confirmed by a CT scan. Patients were randomly assigned to early appendectomy or antibiotic treatment with a 1-year follow-up period. Patients randomized to antibiotic therapy received intravenous ertapenem (1 g/d) for 3 days followed by 7 days of oral levofloxacin (500 mg once daily) and metronidazole (500 mg 3 times per day). Patients randomized to the surgical treatment group were assigned to undergo standard open appendectomy. The primary end point for the surgical intervention was the successful completion of an appendectomy. The primary end point for antibiotic-treated patients was discharge from the hospital without the need for surgery and no recurrent appendicitis during a 1-year follow-up period. There were 273 patients in the surgical group and 257 in the antibiotic group. Of 273 patients in the surgical group, all but 1 underwent successful appendectomy, resulting in a success rate of 99.6% (95% CI, 98.0% to 100.0%). In the antibiotic group, 70 patients (27.3%; 95% CI, 22.0% to 33.2%) underwent appendectomy within 1 year of initial presentation for appendicitis. Of the 256 patients available for follow-up in the antibiotic group, 186 (72.7%; 95% CI, 66.8% to 78.0%) did not require surgery. The intention-to-treat analysis yielded a difference in treatment efficacy between groups of -27.0% (95% CI, -31.6% to ∞) (P = .89). Given the prespecified noninferiority margin of 24%, we were unable to demonstrate noninferiority of

Therapeutic efficacy of hydro-kinesiotherapy Programs in lumbar spondylosis

Directory of Open Access Journals (Sweden)

Ana-Maria BOTEZAN

2015-12-01

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

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

Science.gov (United States)

Ahn, Kang; Jhun, Hyung-Joon

2015-04-22

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

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

OpenAIRE

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

2015-01-01

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

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

Science.gov (United States)

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

2016-05-01

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

Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

OpenAIRE

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

2016-01-01

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

Recurrent uncomplicated urinary tract infections in women: a review.

Science.gov (United States)

Nosseir, Sandy B; Lind, Lawrence R; Winkler, Harvey A

2012-03-01

Recurrent urinary tract infections most often present with symptoms of irritative voiding. In most cases, they are caused by reinfection with a previously isolated organism. Patients with one or more symptoms of uncomplicated recurrent urinary tract infection should undergo thorough examination and screening for underlying comorbidities that increase susceptibility. When frequent reinfections, empiric treatment relapse, persistent infections, or risk factors for complicated infections are encountered, patients may benefit from urodynamics, cystoscopy, renal ultrasound, intravenous urogram, or voiding cystourethrogram to evaluate for anatomic, functional, or metabolic abnormalities affecting the urinary tract (e.g., stones, stricture, obstruction, vesicoureteral reflux, lesions, detrusor underactivity). These patients may benefit from culture-guided empiric treatment and further evaluation by urology, nephrology, or infectious disease specialists. In patients with a history of uncomplicated urinary tract infections, empiric treatment guided by local antimicrobial resistance may efficiently treat a suspected recurrence. After successful treatment of the acute infection, postcoital prophylaxis, continuous prophylaxis, or self-start empiric treatment may be selected based on frequency of recurrent infections, temporal relation to intercourse, and patient characteristics. Ancillary measures such as probiotics, cranberry products, or local estrogen replacement may also be considered. This article will review the current definition, epidemiology, pathogenesis, diagnosis, work-up, treatment, treatment side effects, and prevention of recurrent urinary tract infections in women. A suggested algorithm for evaluation and treatment based on current literature is provided.

PLDD治疗腰椎间盘源性疼痛不同年龄段的疗效观察%Curative effect observation of PLDD in the treatment of lumbar discogenic pain in different age groups

Institute of Scientific and Technical Information of China (English)

弓臣; 潘贵超; 石可松; 屈亮

2014-01-01

目的：评估经皮激光椎间盘减压术(PLDD)治疗腰椎间盘源性疼痛不同年龄段的疗效差异。方法：对63位通过核磁共振和椎间盘造影检查明确诊断的腰椎间盘源性疼痛患者，进行 PLDD(采用 NE-YAG 激光)治疗。并参照MacNab手术评价标准评价术后疗效。术后随访3个月，观察不同年龄段的疗效。结果：在腰椎间盘源性疼痛的63位患者中，青年组显效率83.3%，明显高于年长组60.6%(P＜0.01)。青年组总有效率100%，高于年长组97%。且在3个月的随访中，未发现感染、血管损伤和临床严重合并症的病例。结论：使用NE-YAG激光的PLDD术是一种安全有效的治疗腰椎间盘源性疼痛方法，且针对较年轻患者更为适宜。%Objective:To evaluate the curative effect difference of lumbar discogenic pain treated with percutaneous laser disc decompression(PLDD) in different age groups.Methods:63 cases with lumbar discogenic pain who were confirmed by nuclear magnetic resonance and discography were selected.They were treated with PLDD(NE-YAG laser).We evaluated the postoperative curative effect according to MacNab operation evaluation standard.After surgery,follow-up time was 3 months.We observed the effect of different ages.Results:In the 63 cases with lumbar discogenic pain,the significant efficiency of youth group with 83.3%was higher than the older group with 60.6%(P<0.01).The efficiency of youth group with 100% was higher than the older group with 97%.And in the 3 months of follow-up,there was no infection,vascular injury and clinical serious complications.Conclusion:The PLDD using NE-YAG laser is a safe and effective treatment of lumbar discogenic pain,and it is more appropriate for younger patients.

The top 100 classic papers in lumbar spine surgery.

Science.gov (United States)

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

2015-05-15

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

Single photon emission computed tomography in lumbar degenerative spondylolisthesis

International Nuclear Information System (INIS)

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

1998-01-01

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

Optimizing Residents' Performance of Lumbar Puncture

DEFF Research Database (Denmark)

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

2018-01-01

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

Axial loaded MRI of the lumbar spine

Energy Technology Data Exchange (ETDEWEB)

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

2003-09-01

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

Uncomplicated Urinary Tract Infections in Women in a Sao Paulo Quaternary Care Hospital: Bacterial Spectrum and Susceptibility Patterns

Directory of Open Access Journals (Sweden)

Marcelo Hisano

2014-03-01

Full Text Available Uncomplicated urinary tract infections (UTI in women are very common. Regular analysis of bacterial flora is important to formulate updated guidelines. The objective of this study is to determine and compare the microbiology of UTIs and their susceptibility patterns in a quaternary care hospital. In a seven-year review, the urine culture results of 480 female patients with uncomplicated UTIs were analyzed. Patients were divided into three groups according to their diagnosis and treatment characteristics: Group 1, cystitis at outpatient basis; group 2, cystitis at the Emergency Unit; and group 3, pyelonephritis. Group 1 included older patients, with a higher incidence of concomitant diabetes mellitus and recurrent UTIs. E. coli was the most common pathogen, responsible for 75.1% of cases, mainly for pyelonephritis (87.3%. Of the oral antimicrobials tested for cystitis, amoxicillin/clavulanate and nitrofurantoin had the highest susceptibility profiles (84.4% and 87.3%, respectively. For E. coli only, their susceptibility profiles were as high as 90.8% and 97.4%, respectively. For pyelonephritis treatment, fluoroquinoles had a susceptibility profile <90%, while ceftriaxone and gentamicin had susceptibility >90%. Uncomplicated UTI treatment is becoming more challenging because the susceptibility profiles of oral antimicrobials are increasingly resistant. In our environment, cystitis can still be managed with nitrofurantoin. Uncomplicated pyelonephritis should be managed with ceftriaxone or gentamicin.

Lumbar supports for prevention and treatment of low back pain

DEFF Research Database (Denmark)

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

2000-01-01

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

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

Science.gov (United States)

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

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

African Journals Online (AJOL)

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

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

Directory of Open Access Journals (Sweden)

S.J MOUSAVI

2003-12-01

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

Lumbar total disc replacement from an extreme lateral approach: clinical experience with a minimum of 2 years' follow-up.

Science.gov (United States)

Pimenta, Luiz; Oliveira, Leonardo; Schaffa, Thomas; Coutinho, Etevaldo; Marchi, Luis

2011-01-01

current lumbar total disc replacement (TDR) devices require an anterior approach for implantation. This approach has inherent limitations, including risks to abdominal structures and the need for resection of the anterior longitudinal ligament (ALL). Placement of a TDR device from a true lateral (extreme lateral interbody fusion [XLIF]) approach is thought to offer a less invasive option to access the disc space, preserving the stabilizing ligaments and avoiding scarring of anterior vasculature. In this study, the authors attempted to quantify the clinical and radiographic outcomes of a lateral approach to lumbar TDR from a prospective, single-center experience. a TDR device designed for implantation through a true lateral, retroperitoneal, transpsoas approach (XLIF) was implanted in 36 patients with discography-confirmed 1- or 2-level degenerative disc disease. Clinical (pain and function) and radiographic (range of motion [ROM]) data were prospectively collected preoperatively, postoperatively, and serially for a minimum of 24 months' follow-up. thirty-six surgeries were performed in 16 men and 20 women (mean age 42.6 years). Surgeries included 15 single-level TDR procedures at L3-4 or L4-5, three 2-level TDR procedures spanning L3-4 and L4-5, and 18 hybrid procedures (anterior lumbar interbody fusion [ALIF]) at L5-S1 and TDR at L4-5 [17] or L3-4 [1]). Operative time averaged 130 minutes, with an average blood loss of 60 ml and no intraoperative complications. Postoperative radiographs showed good device placement. All patients were walking within 12 hours of surgery and all but 9 were discharged the next day (7 of 9 had hybrid TDR/ALIF procedures). Five patients (13.8%) had psoas weakness and 3 (8.3%) had anterior thigh numbness postoperatively, both resolving within 2 weeks. One patient (2.8%) demonstrated weakness of the leg ipsilateral to the approach side, which lasted through the 3-month visit but was resolved by the 6-month visit. One patient (2.8%) was

[A woman with a postoperative lumbar swelling].

Science.gov (United States)

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

2013-01-01

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

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

Science.gov (United States)

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

2017-09-01

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

Efficacy of monotherapies and artesunate-based combination therapies in children with uncomplicated malaria in Somalia.

Science.gov (United States)

Warsame, Marian; Atta, Hoda; Klena, John D; Waqar, Butt Ahmed; Elmi, Hussein Haji; Jibril, Ali Mohamed; Hassan, Hassan Mohamed; Hassan, Abdullahi Mohamed

2009-02-01

In order to guide the antimalarial treatment policy of Somalia, we conducted therapeutic efficacy studies of routinely used antimalarial monotherapies as well as artemisinin-based combination therapies (ACTs) for uncomplicated malaria in three sentinel sites during 2003-2006. Therapeutic efficacy of chloroquine (CQ), amodiaquine (AQ) and sulfadoxine/pyrimetahmine (SP) monotherapies, and artesunate plus SP (AS+SP) or AQ (AS+AQ) were evaluated in children 6 months to 10 years old with uncomplicated malaria. For the assessment of the monotherapies, 2003 WHO protocol with 14-day follow-up was used while the 2005 WHO protocol with 28-day follow-up was used for testing the ACTs. Of the monotherapies, CQ performed very poorly with treatment failures varying from 76.5% to 88% between the sites. AQ treatment failure was low except for Janale site with treatment failure of 23.4% compared to 2.8% and 8% in Jamame and Jowhar, respectively. For SP, treatment failures from 7.8% to 12.2% were observed. A 28-day test of artemisinin-based combinations, AS+SP and AS+AQ, proved to be highly efficacious with cure rates of 98-100% supporting the choice of AS+SP combination as first line treatment for uncomplicated malaria for Somalia.

Magnetic resonance imaging of normal lumbar intervertebral discs

International Nuclear Information System (INIS)

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

2001-01-01

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

49 CFR 572.85 - Lumbar spine flexure.

Science.gov (United States)

2010-10-01

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

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

Science.gov (United States)

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

2015-01-01

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

Predictors of clinical outcome following lumbar disc surgery

DEFF Research Database (Denmark)

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

2016-01-01

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

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

Science.gov (United States)

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

1995-08-01

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

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

OpenAIRE

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

2001-01-01

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

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

Science.gov (United States)

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

2015-08-01

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

Lumbar spinal stenosis

DEFF Research Database (Denmark)

Lønne, Greger; Fritzell, Peter; Hägg, Olle

2018-01-01

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

General practitioners' willingness to request plain lumbar spine radiographic examinations

Energy Technology Data Exchange (ETDEWEB)

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

2001-01-01

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

Hepatocellular Carcinoma Supplied by the Right Lumbar Artery

International Nuclear Information System (INIS)

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

2010-01-01

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

Physiological pattern of lumbar disc height

International Nuclear Information System (INIS)

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

1997-01-01

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

Return to Golf After Lumbar Fusion.

Science.gov (United States)

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

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

Partial Facetectomy for Lumbar Foraminal Stenosis

Directory of Open Access Journals (Sweden)

Kevin Kang

2014-01-01

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

Cirugía de la columna lumbar degenerativa

OpenAIRE

López-Sastre Núñez, Antonio; Menéndez Díaz, D.; Vaquero Morillo, F.

1998-01-01

En una realidad la gran demanda actual de fusiones de la columna lumbar. Los resultados clínicos obtenidos con la fusión posterolateral se ven claramente superados con las fusiones anteroposteriores. Se realiza una revisión bibliográfica de las diferentes formas de fusión de la columna lumbar y la reaparición del concepto de soporte de columna anterior. Se establecen las indicaciones y las ventajas de la fusión anteroposterior lumbar, describiéndose las posibles vías de abordaje posterior y a...

Morphometric and Histological Study of Osteophytes in Human Cadaveric Lumbar Vertebrae

OpenAIRE

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

2017-01-01

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

Headache characteristics of uncomplicated intracranial vertebral artery dissection and validation of ICHD-3 beta diagnostic criteria for headache attributed to intracranial artery dissection.

Science.gov (United States)

Kim, Jae-Gyum; Choi, Jeong-Yoon; Kim, Sung Un; Jung, Jin-Man; Kwon, Do-Young; Park, Moon Ho; Oh, Kyungmi

2015-05-01

Headache may be a warning sign of subsequent stroke in patients with vertebral artery dissection (VAD). Even though the headache characteristics of VAD have been described predominantly in patients with extracranial VAD and neurological complications, headache semiology is not well known in patients with uncomplicated intracranial vertebral artery dissection (ICVAD). In the present study, we attempt to identify the headache semiology that characterizes ICVAD and validate the revised version of the International Classification of Headache Disorders (ICHD-3 beta) criteria for headache attributed to intracranial artery dissection. Six patients with neurologically uncomplicated ICVAD presented at a participating medical center, and eight similar patients were reviewed in the literature. Combining these data, we analyzed headache characteristics of patients with uncomplicated ICVAD according to their pain onset and duration, nature, intensity, location, aggravating and relieving factors, associated symptoms, response to medication, and prognosis. Headache in uncomplicated ICVAD usually has an acute mode of onset (11/14) and persistent (10/14) temporal feature. Pain that has a throbbing quality (nine of 14) and severe intensity (13/14) on the ipsilesional (10/14) and occipitonuchal area (12/14) is a headache prototype in ICVAD. Additionally, headache was intensified by head flexion and rotation (three of six), and relieved by head extension and supine positioning (five of six). Headache of all patients in the present study fulfilled the ICHD-3 beta criteria. Headache semiology of uncomplicated ICVAD is mostly homogenous in the present study. These characteristics may be helpful in the diagnosis of uncomplicated ICVAD. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Lumbar disc excision through fenestration

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Sangwan S

2006-01-01

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

What determines providers' stated preference for the treatment of uncomplicated malaria?

Science.gov (United States)

Mangham-Jefferies, Lindsay; Hanson, Kara; Mbacham, Wilfred; Onwujekwe, Obinna; Wiseman, Virginia

2014-03-01

As agents for their patients, providers often make treatment decisions on behalf of patients, and their choices can affect health outcomes. However, providers operate within a network of relationships and are agents not only for their patients, but also other health sector actors, such as their employer, the Ministry of Health, and pharmaceutical suppliers. Providers' stated preferences for the treatment of uncomplicated malaria were examined to determine what factors predict their choice of treatment in the absence of information and institutional constraints, such as the stock of medicines or the patient's ability to pay. 518 providers working at non-profit health facilities and for-profit pharmacies and drug stores in Yaoundé and Bamenda in Cameroon and in Enugu State in Nigeria were surveyed between July and December 2009 to elicit the antimalarial they prefer to supply for uncomplicated malaria. Multilevel modelling was used to determine the effect of financial and non-financial incentives on their preference, while controlling for information and institutional constraints, and accounting for the clustering of providers within facilities and geographic areas. 69% of providers stated a preference for artemisinin-combination therapy (ACT), which is the recommended treatment for uncomplicated malaria in Cameroon and Nigeria. A preference for ACT was significantly associated with working at a for-profit facility, reporting that patients prefer ACT, and working at facilities that obtain antimalarials from drug company representatives. Preferences were similar among colleagues within a facility, and among providers working in the same locality. Knowing the government recommends ACT was a significant predictor, though having access to clinical guidelines was not sufficient. Providers are agents serving multiple principals and their preferences over alternative antimalarials were influenced by patients, drug company representatives, and other providers working at the

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

Science.gov (United States)

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

2015-09-01

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

Gametocyte clearance in uncomplicated and severe Plasmodium falciparum malaria after artesunate-mefloquine treatment in Thailand.

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Tangpukdee, Noppadon; Krudsood, Srivicha; Srivilairit, Siripan; Phophak, Nanthaporn; Chonsawat, Putza; Yanpanich, Wimon; Kano, Shigeyuki; Wilairatana, Polrat

2008-06-01

Artemisinin-based combination therapy (ACT) is currently promoted as a strategy for treating both uncomplicated and severe falciparum malaria, targeting asexual blood-stage Plasmodium falciparum parasites. However, the effect of ACT on sexual-stage parasites remains controversial. To determine the clearance of sexual-stage P. falciparum parasites from 342 uncomplicated, and 217 severe, adult malaria cases, we reviewed and followed peripheral blood sexual-stage parasites for 4 wk after starting ACT. All patients presented with both asexual and sexual stage parasites on admission, and were treated with artesunate-mefloquine as the standard regimen. The results showed that all patients were asymptomatic and negative for asexual forms before discharge from hospital. The percentages of uncomplicated malaria patients positive for gametocytes on days 3, 7, 14, 21, and 28 were 41.5, 13.1, 3.8, 2.0, and 2.0%, while the percentages of gametocyte positive severe malaria patients on days 3, 7, 14, 21, and 28 were 33.6, 8.2, 2.7, 0.9, and 0.9%, respectively. Although all patients were negative for asexual parasites by day 7 after completion of the artesunate-mefloquine course, gametocytemia persisted in some patients. Thus, a gametocytocidal drug, e.g., primaquine, may be useful in combination with an artesunate-mefloquine regimen to clear gametocytes, so blocking transmission more effectively than artesunate alone, in malaria transmission areas.

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

Science.gov (United States)

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

2018-05-01

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

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

Science.gov (United States)

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

2015-05-01

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

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

Science.gov (United States)

Tian, Yonghao; Liu, Xinyu

2016-10-01

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

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

Science.gov (United States)

Zakondyrin, D E

2015-01-01

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

Distribution and Determinants of 90-Day Payments for Multilevel Posterior Lumbar Fusion: A Medicare Analysis.

Science.gov (United States)

Jain, Nikhil; Phillips, Frank M; Khan, Safdar N

2018-04-01

A retrospective, economic analysis. The objective of this article is to analyze the distribution of 90-day payments, sources of variation, and reimbursement for complications and readmissions for primary ≥3-level posterior lumbar fusion (PLF) from Medicare data. A secondary objective was to identify risk factors for complications. Bundled payments represent a single payment system to cover all costs associated with a single episode of care, typically over 90 days. The dollar amount spent on different health service providers and the variation in payments for ≥3-level PLF have not been analyzed from a bundled perspective. Administrative claims data were used to study 90-day Medicare (2005-2012) reimbursements for primary ≥3-level PLF for deformity and degenerative conditions of the lumbar spine. Distribution of payments, sources of variation, and reimbursements for managing complications were studied using linear regression models. Risk factors for complications were studied by stepwise multiple-variable logistic regression analysis. Hospital payments comprised 73.8% share of total 90-day payment. Adjusted analysis identified several factors for variation in index hospital payments. The average 90-day Medicare payment for all multilevel PLFs without complications was $35,878 per patient. The additional average cost of treating complications with/without revision surgery within 90 days period ranged from $17,284 to $68,963. A 90-day bundle for ≥3-level PLF with readmission ranges from $88,648 (3 levels) to $117,215 (8+ levels). Rates and risk factors for complications were also identified. The average 90-day payment per patient from Medicare was $35,878 with several factors such as levels of surgery, comorbidities, and development of complications influencing the cost. The study also identifies the risks and costs associated with complications and readmissions and emphasize the significant effect these would have on bundled payments (additional burden of up

Fem Modelling of Lumbar Vertebra System

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Rimantas Kačianauskas

2014-02-01

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

Comparison of ketorolac 0.45% versus diclofenac 0.1% for macular thickness and volume after uncomplicated cataract surgery.

Science.gov (United States)

Lee, Tae Hee; Choi, Won; Ji, Yong Sok; Yoon, Kyung Chul

2016-05-01

To compare the effects of ketorolac 0.45% and diclofenac 0.1% on macular thickness and volume after uncomplicated cataract surgery. A total of 76 eyes of 76 patients who underwent uncomplicated cataract surgery were included. Patients were treated with either diclofenac 0.1% (38 eyes) or ketorolac 0.45% (38 eyes) after surgery. The macular thickness and volume were obtained with optical coherence tomography (OCT). Central subfield thickness (CST, OCT 1 mm zone), total foveal thickness (TFT, OCT 3 mm zone), total macular thickness (TMT, OCT 6 mm zone), average macular thickness (AMT) and total macular volume (TMV) were compared between the two study groups. No significant differences between groups were found in macular thickness or volume 1 month after cataract surgery. Two months after surgery, the ketorolac group had significantly lower CST, TFT, TMT and AMT than the diclofenac group (p diclofenac group. Following uncomplicated cataract surgery, topical ketorolac 0.45% was more effective than diclofenac 0.1% in preventing increases in macular thickness and volume. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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

International Nuclear Information System (INIS)

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

2010-01-01

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

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

Science.gov (United States)

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

2014-02-01

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

Angiogenesis in the degeneration of the lumbar intervertebral disc

OpenAIRE

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

2010-01-01

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

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

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Roberto Sérgio Martins

2011-08-01

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

FUNCTIONAL DISABILITY, SAGITTAL ALIGNMENT AND PELVIC BALANCE IN LUMBAR SPONDYLOLISTHESIS

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Luis Muñiz Luna

2016-03-01

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

Morphometric and Histological Study of Osteophytes in Human Cadaveric Lumbar Vertebrae

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Ashwini Aithal Padur

2017-10-01

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

ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

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Jefferson Coelho de Léo

2015-09-01

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

Comparison of interbody fusion approaches for disabling low back pain.

Science.gov (United States)

Hacker, R J

1997-03-15

This is a study comparing two groups of patients surgically treated for disabling low back pain. One group was treated with lumbar anteroposterior fusion (360 degrees fusion), the other with posterior lumbar interbody fusion and an interbody fixation device. To determine which approach provided the best and most cost-effective outcome using similar patient selection criteria. Others have shown that certain patients with disabling low back pain benefit from lumbar fusion. Although rarely reported, the costs of different surgical treatments appear to vary significantly, whereas the patient outcome may vary little. Since 1991, 75 patients have been treated Starting in 1993, posterior lumbar interbody fusion BAK was offered to patients as an alternative to 360 degrees fusion. The treating surgeon reviewed the cases. The interbody fixation device used (BAK; Spine-Tech, Inc., Minneapolis, MN) was part of a Food and Drug Administration study. Patient selection criteria included examination, response to conservative therapy, imaging, psychological profile, and discography. North American Spine Society outcome questionnaires, BAK investigation data radiographs, chart entries, billing records and patient interviews were the basis for assessment. Age, sex compensable injury history and history of previous surgery were similar. Operative time; blood loss, hospitalization time, and total costs were significantly different. There was a quicker return to work and closure of workers compensation claims for the posterior lumbar interbody fusion-BAK group. Patient satisfaction was comparable at last follow-up. Posterior lumbar interbody fusion-BAK achieves equal patient satisfaction but fiscally surpasses the 360 degrees fusion approach. Today's environment of regulated medical practice requires the surgeon to consider cost effectiveness when performing fusion for low back pain.

Population pharmacokinetics of dihydroartemisinin and piperaquine in pregnant and nonpregnant women with uncomplicated malaria.

Science.gov (United States)

Tarning, Joel; Rijken, Marcus J; McGready, Rose; Phyo, Aung Pyae; Hanpithakpong, Warunee; Day, Nicholas P J; White, Nicholas J; Nosten, François; Lindegardh, Niklas

2012-04-01

Pregnant women are particularly vulnerable to malaria. The pharmacokinetic properties of antimalarial drugs are often affected by pregnancy, resulting in lower drug concentrations and a consequently higher risk of treatment failure. The objective of this study was to evaluate the population pharmacokinetic properties of piperaquine and dihydroartemisinin in pregnant and nonpregnant women with uncomplicated malaria. Twenty-four pregnant and 24 matched nonpregnant women on the Thai-Myanmar boarder were treated with a standard fixed oral 3-day treatment, and venous plasma concentrations of both drugs were measured frequently for pharmacokinetic evaluation. Population pharmacokinetics were evaluated with nonlinear mixed-effects modeling. The main pharmacokinetic finding was an unaltered total exposure to piperaquine but reduced exposure to dihydroartemisinin in pregnant compared to nonpregnant women with uncomplicated malaria. Piperaquine was best described by a three-compartment disposition model with a 45% higher elimination clearance and a 47% increase in relative bioavailability in pregnant women compared with nonpregnant women. The resulting net effect of pregnancy was an unaltered total exposure to piperaquine but a shorter terminal elimination half-life. Dihydroartemisinin was best described by a one-compartment disposition model with a 38% lower relative bioavailability in pregnant women than nonpregnant women. The resulting net effect of pregnancy was a decreased total exposure to dihydroartemisinin. The shorter terminal elimination half-life of piperaquine and lower exposure to dihydroartemisinin will shorten the posttreatment prophylactic effect and might affect cure rates. The clinical impact of these pharmacokinetic findings in pregnant women with uncomplicated malaria needs to be evaluated in larger series.

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

NARCIS (Netherlands)

M.W. Berfelo

1989-01-01

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

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

African Journals Online (AJOL)

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

NONFUSION STABILIZATION IN THE DEGENERATIVE LUMBAR SPINE DISEASES

Directory of Open Access Journals (Sweden)

Matjaž Voršič

2009-04-01

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

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

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

2017-06-01

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

The association of spinal osteoarthritis with lumbar lordosis

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2010-01-01

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

Lumbar disc herniation in patients with chronic backache.

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

2013-01-01

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

Uncomplicated Depression, Suicide Attempt, and the DSM-5 Bereavement Exclusion Debate: An Empirical Evaluation

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Wakefield, Jerome C.; Schmitz, Mark F.

2014-01-01

Purpose: To evaluate the claim, made repeatedly during "Diagnostic and Statistical Manual of Mental Disorders", Fifth Edition debates over eliminating the bereavement exclusion (BE), that ''uncomplicated'' depressive reactions have elevated suicidality like other major depressive disorder (MDD), so exclusions risk…

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

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

1998-04-01

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

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

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

2018-06-01

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

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

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

2006-01-01

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

Fine needle diagnosis in lumbar osteomyelitis

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

1983-01-01

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

Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan.

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Rogers, Eleanor; Ali, Muhammad; Fazal, Shahid; Kumar, Deepak; Guerrero, Saul; Hussain, Imtiaz; Soofi, Sajid; Alvarez Morán, Jose Luis

2018-02-01

To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community. Cross-sectional quality-of-care study. The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model. LHW implementing treatment for uncomplicated SAM in the community. Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %. This quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.

The hybrid assisted limb (HAL) for Care Support, a motion assisting robot providing exoskeletal lumbar support, can potentially reduce lumbar load in repetitive snow-shoveling movements.

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Miura, Kousei; Kadone, Hideki; Koda, Masao; Abe, Tetsuya; Endo, Hirooki; Murakami, Hideki; Doita, Minoru; Kumagai, Hiroshi; Nagashima, Katsuya; Fujii, Kengo; Noguchi, Hiroshi; Funayama, Toru; Kawamoto, Hiroaki; Sankai, Yoshiyuki; Yamazaki, Masashi

2018-03-01

An excessive lumbar load with snow-shoveling is a serious problem in snowfall areas. Various exoskeletal robots have been developed to reduce lumbar load in lifting work. However, few studies have reported the attempt of snow-shoveling work using exoskeletal robots. The purpose of the present study was to test the hypothesis that the HAL for Care Support robot would reduce lumbar load in repetitive snow-shoveling movements. Nine healthy male volunteers performed repetitive snow-shoveling movements outdoors in a snowfall area for as long as possible until they were fatigued. The snow-shoveling trial was performed under two conditions: with and without HAL for Care Support. Outcome measures were defined as the lumbar load assessed by the VAS of lumbar fatigue after the snow-shoveling trial and the snow-shoveling performance, including the number of scoops, and snow shoveling time and distance. The mean of VAS of lumbar fatigue, the number of scoops, and snow-shoveling time and distance without HAL for Care Support were 75.4 mm, 50.3, 145 s, and 9.6 m, while with HAL for Care Support were 39.8 mm, 144, 366 s, and 35.4 m. The reduction of lumbar fatigue and improvement of snow-shoveling performance using HAL for Care Support were statistically significant. There was no adverse event during snow-shoveling with HAL for Care Support. In conclusion, the HAL for Care Support can reduce lumbar load in repetitive snow-shoveling movements. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

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

2017-11-22

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

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

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2010-10-01

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

Intracranial haemorrhage following lumbar myelography: case report and review of the literature

International Nuclear Information System (INIS)

Suess, O.; Stendel, R.; Baur, S.; Schilling, A.; Brock, M.

2000-01-01

We describe a subacute intracranial subdural haematoma following lumbar myelography. This rare but potentially life-threatening complication has been reported both after lumbar myelography and following lumbar puncture for spinal anaesthesia. We review 16 previously reported cases of intracranial haemorrhage following lumbar myelography, and discuss the pathogenesis. In all reported cases post-puncture headache was the leading symptom and should therefore be regarded as a warning sign. (orig.)

Clostridium difficile colitis in patients undergoing lumbar spine surgery.

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Skovrlj, Branko; Guzman, Javier Z; Silvestre, Jason; Al Maaieh, Motasem; Qureshi, Sheeraz A

2014-09-01

Retrospective database analysis. To investigate incidence, comorbidities, and impact on health care resources of Clostridium difficile infection after lumbar spine surgery. C. difficile colitis is reportedly increasing in hospitalized patients and can have a negative impact on patient outcomes. No data exist on estimates of C. difficile infection rates and its consequences on patient outcomes and health care resources among patients undergoing lumbar spine surgery. The Nationwide Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on International Classification of Diseases, Ninth Revision, Clinical Modification, procedural codes for lumbar spine surgery for degenerative diagnoses. Baseline patient characteristics were determined and multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality. The incidence of C. difficile infection in patients undergoing lumbar spine surgery is 0.11%. At baseline, patients infected with C. difficile were significantly older (65.4 yr vs. 58.9 yr, Pinfection. Small hospital size was associated with decreased odds (odds ratio [OR], 0.5; Pinfection. Uninsured (OR, 1.62; Pinfection. C. difficile increased hospital length of stay by 8 days (Pdifficile infection after lumbar spine surgery carries a 36.4-fold increase in mortality and costs approximately $10,658,646 per year to manage. These data suggest that great care should be taken to avoid C. difficile colitis in patients undergoing lumbar spine surgery because it is associated with longer hospital stays, greater overall costs, and increased inpatient mortality. 3.

Regional differences in lumbar spinal posture and the influence of low back pain

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Burnett Angus F

2008-11-01

Full Text Available Abstract Background Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP. Methods One hundred and seventy female undergraduate nursing students, with and without LBP, participated in this cross-sectional study. Lower lumbar (LLx, Upper lumbar (ULx and total lumbar (TLx spine angles were measured using an electromagnetic tracking system in static postures and across a range of functional tasks. Results Regional differences in lumbar posture and movement were found. Mean LLx posture did not correlate with ULx posture in sitting (r = 0.036, p = 0.638, but showed a moderate inverse correlation with ULx posture in usual standing (r = -0.505, p Conclusion This study supports the concept of regional differences within the lumbar spine during common postures and movements. Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. BMI influenced regional lumbar posture and movement, possibly representing adaptation due to load.

Lumbar puncture in patients using anticoagulants and antiplatelet agents

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Renan Domingues

2016-08-01

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

Multiple-level lumbar spondylolysis and spondylolisthesis.

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Liu, Xinyu; Wang, Lianlei; Yuan, Suomao; Tian, Yonghao; Zheng, Yanping; Li, Jianmin

2015-03-01

Lumbar spondylolysis and isthmic spondylolisthesis occur most commonly at only one spinal level. The authors report on 13 cases of lumbar spondylolysis with spondylolisthesis at multiple levels. During July 2007-March 2012, multiple-level spondylolysis associated with spondylolisthesis was diagnosed in 13 patients (10 male, 3 female) at Qilu Hospital of Shandong University. The mean patient age was 43.5 ± 14.6 years. The duration of low-back pain was 11.7 ± 5.1 months. Spondylolysis occurred at L-2 in 2 patients, L-3 in 4 patients, L-4 in all patients, and L-5 in 5 patients. Spondylolysis occurred at 3 spinal levels in 3 patients and at 2 levels in 10 patients. All patients had spondylolisthesis at 1 or 2 levels. Japanese Orthopaedic Association and visual analog scale scores were used to evaluate preoperative and postoperative neurological function and low-back pain. All patients underwent pedicle screw fixation and interbody fusion or direct pars interarticularis repair. Both low-back pain scores improved significantly after surgery (p spondylolysis and spondylolisthesis occurred more often in men. Most multiplelevel lumbar spondylolysis occurred at 2 spinal levels and was associated with sports, trauma, or heavy labor. Multiplelevel lumbar spondylolysis occurred mostly at L3-5; associated spondylolisthesis usually occurred at L-4 and L-5, mostly at L-4. The treatment principle was the same as that for single-level spondylolisthesis.

Differences between clinical "snap-shot" and "real-life" assessments of lumbar spine alignment and motion - What is the "real" lumbar lordosis of a human being?

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Dreischarf, Marcel; Pries, Esther; Bashkuev, Maxim; Putzier, Michael; Schmidt, Hendrik

2016-03-21

The individual lumbar lordosis and lumbar motion have been identified to play an important role in pathogenesis of low back pain and are essential references for preoperative planning and postoperative evaluation. The clinical "gold-standard" for measuring lumbar lordosis and its motion are radiological "snap-shots" taken while standing and during upper-body flexion and extension. The extent to which these clinically assessed values characterise lumbar alignment and its motion in daily life merits discussion. A non-invasive measurement-system was employed to measure lumbar lordosis and lumbar motion in 208 volunteers (age: 20-74yrs; ♀/♂: 115/93). For an initial short-term measurement, comparable with the clinical "snap-shot", lumbar lordosis and its motion were assessed while standing and during flexion and extension. Subsequently, volunteers were released to their daily lives while wearing the device, and measurements were performed during the following 24h. The average lumbar lordosis during 24h (8.0°) differed significantly from the standardised measurement while standing (33.3°). Ranges of motion were significantly different throughout the day compared to standing measurements. The influence of the factors age and gender on lordosis and its motion resulted in conflicting results between long- and short-term-measurements. In conclusion, results of short-term examinations differ considerably from the average values during real-life. These findings might be important for surgical planning and increase the awareness of the biomechanical challenges that spinal structures and implants face in real-life. Furthermore, long-term assessments of spinal alignment and motion during daily life can provide valid data on spinal function and can reveal the importance of influential factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Radiographic Morphometry of the Lumbar Spine in Munich Miniature Pigs†

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Engelke, Elisabeth C; Post, Christina; Pfarrer, Christiane D; Sager, Martin; Waibl, Helmut R

2016-01-01

The incidence of human spinal column disease remains high, and animal models still play important roles in prophylactic, diagnostic, and therapeutic research. Because of their similar size to humans, pigs remain an important spine model. For pigs to serve as a model for the human spine, basic similarities and differences must be understood. In this study, morphometric data of the lumbar spine of Munich miniature pigs (Troll) were recorded radiologically, evaluated, and compared with recorded human data. Whereas humans have a constant number of 5 lumbar vertebrae, Munich minipigs had 5 or 6 lumbar vertebrae. Compared with their human counterparts, the lumbar vertebral bodies of the minipigs were remarkably larger in the craniocaudal (superior–inferior) direction and considerably smaller in the dorsoventral and laterolateral directions. The porcine vertebral canal was smaller than the human vertebral canal. The spinal cord extended into the caudal part of the porcine lumbar vertebral canal and thus did not terminate as cranial, as seen in humans. The lumbar intervertebral spaces of the pig were narrower in craniocaudal direction than human intervertebral spaces. These differences need to be considered when planning surgical actions, not only to avoid pain and irreversible damage to the minipigs but also to achieve accurate scientific results. PMID:27177570

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

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Bokov A

2013-04-01

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

Lumbar hernia: A commonly misevaluated condition of the bilateral costoiliac spaces

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Yiji Suh

2017-09-01

Full Text Available Lumbar hernias develop through the weakening of the posterolateral abdominal wall associated with the Petit's triangle or the Grynfeltt-Lesshaft triangle. Clinicians are generally unfamiliar with the presentation of lumbar hernias, which frequently leads to misdiagnosis and delay of treatment. Prompt failure to diagnose and surgically correct lumbar hernias have resulted in increased morbidity. This review addresses the anatomical and clinical concepts associated with the bilateral costoiliac spaces, which may be implicated in the increased prevalence of left-sided hernias. Knowledge of the contents and boundaries of this enclosure can aid the physician in diagnosis. We explore the intraperitoneal and retroperitoneal diseases that present at the lumbocostal space, including lumbar hernias, which can be classified as congenital, acquired, traumatic, or iatrogenic in origin. In an evaluation, imaging is crucial for assessing musculofascial layer disruptions and hernia contents. Open and laparoscopic surgery, as well retromuscular lumbar hernia repair, are options to explore in surgical intervention, particularly if there are challenges in preliminary pain management. Keywords: Lumbar hernia, Costoiliac spaces, Petit's triangle, Grvnfeltt-lesshaft triangle, Lumbocostovertebral syndrome

[Discarthrosis with hyperalgic lumbar multileveled radicular syndrome].

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Sardaru, D; Tiţu, Gabriela; Pendefunda, L

2012-01-01

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

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

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Wang, Zhuo; Sakakibara, Toshihiko; Kasai, Yuichi

2013-01-01

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

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

Science.gov (United States)

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

2015-01-01

The aim of this study is to determine the feasibility and efficacy of surgical management of single-segment lumbar spinal tuberculosis (TB) by using single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. The mean follow-up was 36.9 months (range: 24-62 months). The kyphotic angle ranged from 15.2-35.1° preoperatively, with an average measurement of 27.8°. The American Spinal Injury Association (ASIA) score system was used to evaluate the neurological deficits and erythrocyte sedimentation rate (ESR) used to judge the activity of TB. Spinal TB was completely cured in all 17 patients. There was no recurrent TB infection. The postoperative kyphotic angle was 6.6-10.2°, 8.1° in average, and there was no significant loss of the correction at final follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation can be a feasible and effective method the in treatment of single-segment lumbar spinal TB.

Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction.

Science.gov (United States)

Mellor, F E; Thomas, P; Breen, A

2014-08-01

Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy. Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) ( n  = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA). The effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography. The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm 2 which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm 2 ), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm 2 ) is lower than for four view functional radiography (7.34 Gy cm 2 ). Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm 2 ) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data. Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased.

Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction

International Nuclear Information System (INIS)

Mellor, F.E.; Thomas, P.; Breen, A.

2014-01-01

Purpose: Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy. Methods: Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) (n = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA). Results and conclusion: The effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography. The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm 2 which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm 2 ), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm 2 ) is lower than for four view functional radiography (7.34 Gy cm 2 ). Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm 2 ) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data. Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased

Low plasma concentrations of interleukin 10 in severe malarial anaemia compared with cerebral and uncomplicated malaria

DEFF Research Database (Denmark)

Kurtzhals, J A; Adabayeri, V; Goka, B Q

1998-01-01

-back regulation of TNF, stimulates bone-marrow function in vitro and counteracts anaemia in mice. We investigated the associations of these cytokines with malarial anaemia. METHODS: We enrolled 175 African children with malaria into two studies in 1995 and 1996. In the first study, children were classified...... as having severe anaemia (n=10), uncomplicated malaria (n=26), or cerebral anaemia (n=41). In the second study, patients were classified as having cerebral malaria (n=33) or being fully conscious (n=65), and the two groups were subdivided by measured haemoglobin as normal (>110 g/L), moderate anaemia (60...... anaemia was 270 pg/mL (95% CI 152-482) compared with 725 pg/mL (465-1129) in uncomplicated malaria and 966 pg/mL (612-1526) in cerebral malaria (pcerebral...

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

OpenAIRE

S.J MOUSAVI; MOHAMMAD REZA NOURBAKHSH

2003-01-01

Introduction: The relationship between the degree of lumbar lordosis and chronic and purpose low back pain (LBP) has long been speculated, but there is discrepancy in findings of previous researchers. The purpose of this of this study was to drtermin differences between lumbar lordosis in asymptomatic and LBP subjects. Matherials: Lumbar lordosis of 420 patients with chronic LBP and 420 asymptomatic subjects was measured by two examiner. A flexible ruler was used to measure lumbar l...

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

Directory of Open Access Journals (Sweden)

Feng-Chun Kao

2014-04-01

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

Diagnosis of Lumbar Foraminal Stenosis using Diffusion Tensor Imaging.

Science.gov (United States)

Eguchi, Yawara; Ohtori, Seiji; Suzuki, Munetaka; Oikawa, Yasuhiro; Yamanaka, Hajime; Tamai, Hiroshi; Kobayashi, Tatsuya; Orita, Sumihisa; Yamauchi, Kazuyo; Suzuki, Miyako; Aoki, Yasuchika; Watanabe, Atsuya; Kanamoto, Hirohito; Takahashi, Kazuhisa

2016-02-01

Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed during nerve conduction studies. Computed tomography and magnetic resonance imaging indicated bilateral L5 lumbar foraminal stenosis. DTI imaging was done. The extraforaminal values were decreased and tractography was interrupted in the foraminal region. Bilateral L5 vertebral foraminal stenosis was treated by transforaminal lumbar interbody fusion and the pain in both legs disappeared. The case indicates the value of DTI for diagnosing vertebral foraminal stenosis.

Overpowering posterior lumbar instrumentation and fusion with hyperlordotic anterior lumbar interbody cages followed by posterior revision: a preliminary feasibility study.

Science.gov (United States)

Kadam, Abhijeet; Wigner, Nathan; Saville, Philip; Arlet, Vincent

2017-12-01

OBJECTIVE The authors' aim in this study was to evaluate whether sagittal plane correction can be obtained from the front by overpowering previous posterior instrumentation and/or fusion with hyperlordotic anterior lumbar interbody fusion (ALIF) cages in patients undergoing revision surgery for degenerative spinal conditions and/or spinal deformities. METHODS The authors report their experience with the application of hyperlordotic cages at 36 lumbar levels for ALIFs in a series of 20 patients who underwent revision spinal surgery at a single institution. Included patients underwent staged front-back procedures: ALIFs with hyperlordotic cages (12°, 20°, and 30°) followed by removal of posterior instrumentation and reinstrumentation from the back. Patients were divided into the following 2 groups depending on the extent of posterior instrumentation and fusion during the second stage: long constructs (≥ 6 levels with extension into thoracic spine and/or pelvis) and short constructs (lumbar lordosis increased from 44.3° to 59.8° (p lumbar levels that have pseudarthrosis from the previous posterior spinal fusion. Meticulous selection of levels for ALIF is crucial for safely and effectively performing this technique.

[Lumbar spinal angiolipoma].

Science.gov (United States)

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

2016-01-01

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

MRI of the lumbar spine. Technical aspect. T2-weighted fat saturation coronal dynamic MRI of the lumbar spine

International Nuclear Information System (INIS)

Clarisse, J.; Francke, J.P.; Leclet, H.; Bourgeois, Ph.; Chastanet, P.; Cotten, A.

1998-01-01

Assess the feasibility of 'dynamic' MRI of the lumbar spine and study the parameters of a single MRI sequence favorable for simultaneous imaging of the meningeal space and the epidural and foraminal venous system. Favor a decline in the number of sacco-radiculograms. Clinical assessment in the following circumstances: discordant clinical and and radiographic findings, difficulty in interpreting single or multiple disc-root conflicts, preoperative work-up in cases of narrow or stenotic lumbar canal. Dynamic MRI of the lumbar spine is possible if the hypothesis that the hyper-lordosis obtained in the supine position creates an anatomic and radiographic situation identical to the hyper-lordosis induced by the upright position is accepted. The 'radiculo-phlebographic' sequence gives images of the root sheaths and the epidural, foraminal and extra-foraminal veins simultaneously, particularly in the coronal plane. (authors)

A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice.

Science.gov (United States)

Daniels, Clinton J; Wakefield, Pamela J; Bub, Glenn A; Toombs, James D

2016-12-01

The purpose of this narrative review was to describe the most common spinal fusion surgical procedures, address the clinical indications for lumbar fusion in degeneration cases, identify potential complications, and discuss their relevance to chiropractic management of patients after surgical fusion. The PubMed database was searched from the beginning of the record through March 31, 2015, for English language articles related to lumbar fusion or arthrodesis or both and their incidence, procedures, complications, and postoperative chiropractic cases. Articles were retrieved and evaluated for relevance. The bibliographies of selected articles were also reviewed. The most typical lumbar fusion procedures are posterior lumbar interbody fusion, anterior lumbar interbody fusion, transforaminal interbody fusion, and lateral lumbar interbody fusion. Fair level evidence supports lumbar fusion procedures for degenerative spondylolisthesis with instability and for intractable low back pain that has failed conservative care. Complications and development of chronic pain after surgery is common, and these patients frequently present to chiropractic physicians. Several reports describe the potential benefit of chiropractic management with spinal manipulation, flexion-distraction manipulation, and manipulation under anesthesia for postfusion low back pain. There are no published experimental studies related specifically to chiropractic care of postfusion low back pain. This article describes the indications for fusion, common surgical practice, potential complications, and relevant published chiropractic literature. This review includes 10 cases that showed positive benefits from chiropractic manipulation, flexion-distraction, and/or manipulation under anesthesia for postfusion lumbar pain. Chiropractic care may have a role in helping patients in pain who have undergone lumbar fusion surgery.

3-dimensional reconstructions of computer tomograms of the lumbar spine

International Nuclear Information System (INIS)

Kern, A.; Waggershauser, T.; Zendel, W.; Astinet, A.; Felix, R.; Hansen, K.; Lanksch, W.R.

1991-01-01

In this study, 50 patients were examined by a Siemens 'Somatom Plus'; continuous 2 mm sections between the third lumbar and first sacral vertebra were obtained. All these imaging procedures were suitable for the diagnosis of osteochondrosis and chondrosis. Spondylosis was diagnosed more frequently on 3-D CT. Spondyloarthrosis, with narrowing of the invertebral foramina and root canals is shown particularly well by 3-D CT, since the entire extent of these structures can be seen. 3-D surface reconstruction of the lumbar spine is useful in the diagnosis of lumbar spondyloarthrosis with narrowing of the root canals and of the spinal canal. This method of axial CT is superior to conventional radiography of the lumbar spine in the usual two planes. (orig./GDG) [de

Influence of age, BMI, gender and lumbar level on T1ρ magnetic resonance imaging of lumbar discs in healthy asymptomatic adults

Energy Technology Data Exchange (ETDEWEB)

Guebitz, Raphael [Asklepios Hospital Altona, Hamburg (Germany). Dept. of Radiology and Neuroradiology; Lange, Tobias; Gosheger, Georg [University Hospital Muenster (Germany). Dept. of Orthopaedics and Tumor Orthopaedics; Heindel, Walter; Allkemper, Thomas [University Hospital Muenster (Germany). Dept. of Clinical Radiology; Stehling, Christoph [Sankt-Barbara Hospital Ham-Heessen, Hamm (Germany). Clinic for Radiology and Neuroradiology; Gerss, Joachim [Muenster Univ. (Germany). Inst. of Biostatistics and Clinical Research; Kanthak, Christian [Fraunhofer MEVIS, Bremen (Germany). Inst. for Medical Image Computing; Schulte, Tobias L. [Bochum Univ. St. Josef Hospital (Germany). Dept. of Orthopaedics and Trauma Surgery

2018-02-15

To assess the T1ρ range of lumbar intervertebral discs in healthy asymptomatic individuals at 1.5 T and to investigate the influence of age, body mass index (BMI), gender, and lumbar level on T1ρ relaxation. In a prospective study, a total of 81 volunteers aged 20 - 80 years were included in this study and divided into three age groups (A: 20 - 39y; B: 40 - 59y; C: 60 - 80y). All of the volunteers underwent magnetic resonance imaging (MRI) at 1.5 T with acquisition of sagittal T1ρ images. The calculated T1ρ relaxation times were correlated with age, BMI, gender, and lumbar level relative to the total disc, the annulus fibrosus, and the nucleus pulposus. Age had a significant influence on T1ρ relaxation times at all lumbar levels, with increasing age being associated with reduced relaxation times. There was also a significant difference between age groups A vs. C and B vs. C (P = 0.0008 and P = 0.0149, respectively). No significant differences in T1ρ relaxation time were observed between men and women (P > 0.05). BMI showed a significant negative correlation with T1ρ relaxation times (P < 0.0001). Analysis of the lumbar level revealed a significant decrease in relaxation times from L1/2 to L5 / S1 (P = 0.0013). Increasing age correlated significantly with advanced lumbar disc degeneration in asymptomatic individuals, particularly in those aged 60 or older. Increasing BMI correlated significantly with increasing degeneration. The lower discs showed more degeneration than the upper ones.

Influence of age, BMI, gender and lumbar level on T1ρ magnetic resonance imaging of lumbar discs in healthy asymptomatic adults

International Nuclear Information System (INIS)

Guebitz, Raphael; Lange, Tobias; Gosheger, Georg; Heindel, Walter; Allkemper, Thomas; Stehling, Christoph; Gerss, Joachim; Kanthak, Christian; Schulte, Tobias L.

2018-01-01

To assess the T1ρ range of lumbar intervertebral discs in healthy asymptomatic individuals at 1.5 T and to investigate the influence of age, body mass index (BMI), gender, and lumbar level on T1ρ relaxation. In a prospective study, a total of 81 volunteers aged 20 - 80 years were included in this study and divided into three age groups (A: 20 - 39y; B: 40 - 59y; C: 60 - 80y). All of the volunteers underwent magnetic resonance imaging (MRI) at 1.5 T with acquisition of sagittal T1ρ images. The calculated T1ρ relaxation times were correlated with age, BMI, gender, and lumbar level relative to the total disc, the annulus fibrosus, and the nucleus pulposus. Age had a significant influence on T1ρ relaxation times at all lumbar levels, with increasing age being associated with reduced relaxation times. There was also a significant difference between age groups A vs. C and B vs. C (P = 0.0008 and P = 0.0149, respectively). No significant differences in T1ρ relaxation time were observed between men and women (P > 0.05). BMI showed a significant negative correlation with T1ρ relaxation times (P < 0.0001). Analysis of the lumbar level revealed a significant decrease in relaxation times from L1/2 to L5 / S1 (P = 0.0013). Increasing age correlated significantly with advanced lumbar disc degeneration in asymptomatic individuals, particularly in those aged 60 or older. Increasing BMI correlated significantly with increasing degeneration. The lower discs showed more degeneration than the upper ones.

Computed tomography as the primary radiological examination of lumbar spine

Energy Technology Data Exchange (ETDEWEB)

Ilkko, E.; Laehde, S.

1988-10-01

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

Computed tomography as the primary radiological examination of lumbar spine

International Nuclear Information System (INIS)

Ilkko, E.; Laehde, S.

1988-01-01

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

Safety and tolerability of combination antimalarial therapies for uncomplicated falciparum malaria in Ugandan children

Science.gov (United States)

Maiteki-Sebuguzi, Catherine; Jagannathan, Prasanna; Yau, Vincent M; Clark, Tamara D; Njama-Meya, Denise; Nzarubara, Bridget; Talisuna, Ambrose O; Kamya, Moses R; Rosenthal, Philip J; Dorsey, Grant; Staedke, Sarah G

2008-01-01

Background Combination antimalarial therapy is recommended for the treatment of uncomplicated falciparum malaria in Africa; however, some concerns about the safety and tolerability of new regimens remain. This study compared the safety and tolerability of three combination antimalarial regimens in a cohort of Ugandan children. Methods A longitudinal, single-blind, randomized clinical trial of children was conducted between November 2004 and May 2007 in Kampala, Uganda. Upon diagnosis of the first episode of uncomplicated malaria, participants were randomized to treatment with amodiaquine + sulphadoxine-pyrimethamine (AQ+SP), artesunate + amodiaquine (AS+AQ), or artemether-lumefantrine (AL). Once randomized, participants received the same regimen for all subsequent episodes of uncomplicated malaria. Participants were actively monitored for adverse events for the first 14 days after each treatment, and then passively followed until their next study medication treatment, or withdrawal from study. Outcome measures included the risk of adverse events at 14 and 42 days after treatment. Results Of 601 enrolled children, 382 were diagnosed with at least one episode of uncomplicated malaria and were treated with study medications. The median age at treatment was 6.3 years (range 1.1 – 12.3 years). At 14 days of follow-up, AQ+SP treatment was associated with a higher risk of anorexia, weakness, and subjective fever than treatment with AL, and a higher risk of weakness, and subjective fever than treatment with AS+AQ. Treatment with AL was associated with a higher risk of elevated temperature. Repeated episodes of neutropaenia associated with AS+AQ were detected in one participant. Considering only children less than five years, those who received AQ+SP were at higher risk of developing moderate or severe anorexia and weakness than those treated with AL (anorexia: RR 3.82, 95% CI 1.59 – 9.17; weakness: RR 5.40, 95% CI 1.86 – 15.7), or AS+AQ (anorexia: RR 2.10, 95% CI 1

Safety and tolerability of combination antimalarial therapies for uncomplicated falciparum malaria in Ugandan children

Directory of Open Access Journals (Sweden)

Kamya Moses R

2008-06-01

Full Text Available Abstract Background Combination antimalarial therapy is recommended for the treatment of uncomplicated falciparum malaria in Africa; however, some concerns about the safety and tolerability of new regimens remain. This study compared the safety and tolerability of three combination antimalarial regimens in a cohort of Ugandan children. Methods A longitudinal, single-blind, randomized clinical trial of children was conducted between November 2004 and May 2007 in Kampala, Uganda. Upon diagnosis of the first episode of uncomplicated malaria, participants were randomized to treatment with amodiaquine + sulphadoxine-pyrimethamine (AQ+SP, artesunate + amodiaquine (AS+AQ, or artemether-lumefantrine (AL. Once randomized, participants received the same regimen for all subsequent episodes of uncomplicated malaria. Participants were actively monitored for adverse events for the first 14 days after each treatment, and then passively followed until their next study medication treatment, or withdrawal from study. Outcome measures included the risk of adverse events at 14 and 42 days after treatment. Results Of 601 enrolled children, 382 were diagnosed with at least one episode of uncomplicated malaria and were treated with study medications. The median age at treatment was 6.3 years (range 1.1 – 12.3 years. At 14 days of follow-up, AQ+SP treatment was associated with a higher risk of anorexia, weakness, and subjective fever than treatment with AL, and a higher risk of weakness, and subjective fever than treatment with AS+AQ. Treatment with AL was associated with a higher risk of elevated temperature. Repeated episodes of neutropaenia associated with AS+AQ were detected in one participant. Considering only children less than five years, those who received AQ+SP were at higher risk of developing moderate or severe anorexia and weakness than those treated with AL (anorexia: RR 3.82, 95% CI 1.59 – 9.17; weakness: RR 5.40, 95% CI 1.86 – 15.7, or AS

Mechanisms of action of lumbar supports : a systematic review

NARCIS (Netherlands)

van Poppel, M N; de Looze, M P; Koes, B W; Smid, T; Bouter, L M

2000-01-01

STUDY DESIGN: A systematic review and meta-analysis of studies on the putative mechanisms of action of lumbar supports in lifting activities. OBJECTIVE: To summarize the evidence bearing on the putative mechanisms of action of lumbar supports. SUMMARY OF BACKGROUND DATA: A restriction of trunk

Mechanisms of action of lumbar supports: a sytematic review

NARCIS (Netherlands)

van Poppel-Bruinvels, M.N.M.; de Looze, M.P.; Koes, B.W.; Smid, T.; Bouter, L.M.

2000-01-01

Study Design. A systematic review and meta-analysis of studies on the putative mechanisms of action of lumbar supports in lifting activities. Objective. To summarize the evidence bearing on the putative mechanisms of action of lumbar supports. Summary of Background Data. A restriction of trunk

Is it possible to preserve lumbar lordosis after hybrid stabilization? Preliminary results of a novel rigid-dynamic stabilization system in degenerative lumbar pathologies.

Science.gov (United States)

Formica, Matteo; Cavagnaro, Luca; Basso, Marco; Zanirato, Andrea; Felli, Lamberto; Formica, Carlo

2015-11-01

To evaluate the results of a novel rigid-dynamic stabilization technique in lumbar degenerative segment diseases (DSD), expressly pointing out the preservation of postoperative lumbar lordosis (LL). Forty-one patients with one level lumbar DSD and initial disc degeneration at the adjacent level were treated. Circumferential lumbar arthrodesis and posterior hybrid instrumentation were performed to preserve an initial disc degeneration above the segment that has to be fused. Clinical and spino-pelvic parameters were evaluated pre- and postoperatively. At 2-year follow-up, a significant improvement of clinical outcomes was reported. No statistically significant difference was noted between postoperative and 2-year follow-up in LL and in disc/vertebral body height ratio at the upper adjacent fusion level. When properly selected, this technique leads to good results. A proper LL should be achieved after any hybrid stabilization to preserve the segment above the fusion.

Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

International Nuclear Information System (INIS)

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

2009-01-01

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

Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

Energy Technology Data Exchange (ETDEWEB)

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

2009-12-15

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

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

Science.gov (United States)

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

2014-10-01

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

Embolization of Isolated Lumbar Artery Injuries in Trauma Patients

International Nuclear Information System (INIS)

Sofocleous, Constantinos T.; Hinrichs, Clay R.; Hubbi, Basil; Doddakashi, Satish; Bahramipour, Philip; Schubert, Johanna

2005-01-01

Purpose. The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. Methods. All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. Results. In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men) suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. Conclusions. In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery

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

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

2016-05-20

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

A prospective randomized controlled multicenter trial comparing antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis (APPAC trial).

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Paajanen, Hannu; Grönroos, Juha M; Rautio, Tero; Nordström, Pia; Aarnio, Markku; Rantanen, Tuomo; Hurme, Saija; Dean, Kirsti; Jartti, Airi; Mecklin, Jukka-Pekka; Sand, Juhani; Salminen, Paulina

2013-02-08

Although the standard treatment of acute appendicitis (AA) consists of an early appendectomy, there has recently been both an interest and an increase in the use of antibiotic therapy as the primary treatment for uncomplicated AA. However, the use of antibiotic therapy in the treatment of uncomplicated AA is still controversial. The APPAC trial is a randomized prospective controlled, open label, non-inferiority multicenter trial designed to compare antibiotic therapy (ertapenem) with emergency appendectomy in the treatment of uncomplicated AA. The primary endpoint of the study is the success of the randomized treatment. In the antibiotic treatment arm successful treatment is defined as being discharged from the hospital without the need for surgical intervention and no recurrent appendicitis during a minimum follow-up of one-year (treatment efficacy). Treatment efficacy in the operative treatment arm is defined as successful appendectomy evaluated to be 100%. Secondary endpoints are post-intervention complications, overall morbidity and mortality, the length of hospital stay and sick leave, treatment costs and pain scores (VAS, visual analoque scale). A maximum of 610 adult patients (aged 18-60 years) with a CT scan confirmed uncomplicated AA will be enrolled from six hospitals and randomized by a closed envelope method in a 1:1 ratio either to undergo emergency appendectomy or to receive ertapenem (1 g per day) for three days continued by oral levofloxacin (500 mg per day) plus metronidazole (1.5 g per day) for seven days. Follow-up by a telephone interview will be at 1 week, 2 months and 1, 3, 5 and 10 years; the primary and secondary endpoints of the trial will be evaluated at each time point. The APPAC trial aims to provide level I evidence to support the hypothesis that approximately 75-85% of patients with uncomplicated AA can be treated with effective antibiotic therapy avoiding unnecessary appendectomies and the related operative morbidity, also resulting

Overload pain but root differentiation discomfort in the lumbar spine

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Joanna Siminska

2017-06-01

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

Does change in isolated lumbar extensor muscle function correlate with good clinical outcome? A secondary analysis of data on change in isolated lumbar extension strength, pain, and disability in chronic low back pain.

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Steele, James; Fisher, James; Perrin, Craig; Conway, Rebecca; Bruce-Low, Stewart; Smith, Dave

2018-01-12

Secondary analysis of data from studies utilising isolated lumbar extension exercise interventions for correlations among changes in isolated lumbar extension strength, pain, and disability. Studies reporting isolated lumbar extension strength changes were examined for inclusion criteria including: (1) participants with chronic low back pain, (2) intervention ≥ four weeks including isolated lumbar extension exercise, (3) outcome measures including isolated lumbar extension strength, pain (Visual Analogue Scale), and disability (Oswestry Disability Index). Six studies encompassing 281 participants were included. Correlations among change in isolated lumbar extension strength, pain, and disability. Participants were grouped as "met" or "not met" based on minimal clinically important changes and between groups comparisons conducted. Isolated lumbar extension strength and Visual Analogue Scale pooled analysis showed significant weak to moderate correlations (r = -0.391 to -0.539, all p Disability Index pooled analysis showed significant weak correlations (r = -0.349 to -0.470, all p disability, isolated lumbar extension strength changes were greater for those "met" compared with those "not met" (p disability. This study shows significant correlations between increases in isolated lumbar extension strength and reductions in pain and disability. Strengthening of the lumbar extensor musculature could be considered an important target for exercise interventions.

AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion.

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Rapp, Steven M; Miller, Larry E; Block, Jon E

2011-01-01

Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF) system is a minimally invasive fusion device that accesses the lumbar (L4-S1) intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date.

Does team lifting increase the variability in peak lumbar compression in ironworkers?

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Faber, Gert; Visser, Steven; van der Molen, Henk F; Kuijer, P Paul F M; Hoozemans, Marco J M; Van Dieën, Jaap H; Frings-Dresen, Monique H W

2012-01-01

Ironworkers frequently perform heavy lifting tasks in teams of two or four workers. Team lifting could potentially lead to a higher variation in peak lumbar compression forces than lifts performed by one worker, resulting in higher maximal peak lumbar compression forces. This study compared single-worker lifts (25-kg, iron bar) to two-worker lifts (50-kg, two iron bars) and to four-worker lifts (100-kg, iron lattice). Inverse dynamics was used to calculate peak lumbar compression forces. To assess the variability in peak lumbar loading, all three lifting tasks were performed six times. Results showed that the variability in peak lumbar loading was somewhat higher in the team lifts compared to the single-worker lifts. However, despite this increased variability, team lifts did not result in larger maximum peak lumbar compression forces. Therefore, it was concluded that, from a biomechanical point of view, team lifting does not result in an additional risk for low back complaints in ironworkers.

Lumbar punction: comparison between an atraumatic and a traumatic punction needle

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Tina Bregant

2017-03-01

Full Text Available Background: Lumbar puncture is a standardized, routine diagnostic procedure in the diagnosis of neurological diseases. Post-duarl puncture headache (PDPH is a common complication which occurs in 10 to 30 % of patients. Although the incidence of PDPH is much lower with the use of small, non-cutting needles, neurologists in Slovenia routinely use the classical traumatic spinal needles.Methods: In the article we provide an overview of a research concerned with the use of traumatic and atraumatic needles in the procedure with the emphasis on complications of the lumbar puncture. We present American and European recommendations for lumbar puncture procedure.Conclusions: International recommendations for neurologists advise the use of atraumatic spinal needles for lumbar puncture. We recommend to Slovenian neurologists to start using the atraumatic needles for elective lumbar punctures and hence provide neurological patients with better quality and cheaper long-term care.

Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease.

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Wu, Haiting; Pang, Qingjiang; Jiang, Guoqiang

2017-10-01

Objective To compare the medium-term clinical and radiographic outcomes of Dynesys dynamic stabilization and posterior lumbar interbody fusion (PLIF) for treatment of multisegmental lumbar degenerative disease. Methods Fifty-seven patients with multisegmental lumbar degenerative disease underwent Dynesys stabilization (n = 26) or PLIF (n = 31) from December 2008 to February 2010. The mean follow-up period was 50.3 (range, 46-65) months. Clinical outcomes were evaluated using a visual analogue scale (VAS) and the Oswestry disability index (ODI). Radiographic evaluations included disc height and range of motion (ROM) of the operative segments and proximal adjacent segment on lumbar flexion-extension X-rays. The intervertebral disc signal change was defined by magnetic resonance imaging, and disc degeneration was classified by the Pfirrmann grade. Results The clinical outcomes including the VAS score and ODI were significantly improved in both groups at 3 months and the final follow-up, but the difference between the two was not significant. At the final follow-up, the disc height of stabilized segments in both groups was significantly increased; the increase was more notable in the Dynesys than PLIF group. The ROM of stabilized segments at the final follow-up decreased from 6.20° to 2.76° and 6.56° to 0.00° in the Dynesys and PLIF groups, respectively. There was no distinct change in the height of the proximal adjacent segment in the two groups. The ROM of the proximal adjacent segment in both groups increased significantly at the final follow-up; the change was significantly greater in the PLIF than Dynesys group. Only one case of adjacent segment degeneration occurred in the PLIF group, and this patient underwent a second operation. Conclusions Both Dynesys stabilization and PLIF can improve the clinical and radiographic outcomes of multisegmental lumbar degenerative disease. Compared with PLIF, Dynesys stabilization can maintain the mobility of the

Severity of complicated versus uncomplicated subthreshold depression: New evidence on the "Monotonicity Thesis" from the national comorbidity survey.

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Wakefield, Jerome C; Schmitz, Mark F

2017-04-01

"Complicated" subthreshold depression (CsD) includes at least one of six pathosuggestive "complicated" symptoms: >6 months duration, marked role impairment, sense of worthlessness, suicidal ideation, psychotic ideation, and psychomotor retardation. "Uncomplicated" subthreshold depression (UsD) has no complicated features. Whereas studies show that complicated (CMDD) versus uncomplicated (UMDD) major depression differ substantially in severity and prognosis, UsD and CsD severity has not been previously compared. This study evaluates UsD and CsD pathology validator levels and examines whether the complicated/uncomplicated distinction offers incremental concurrent validity over the standard number-of-symptoms dimension as a depression severity measure. Using nationally representative community data from the National Comorbidity Survey, seven depression lifetime history subgroups were identified: one MDD screener symptom (n=1432); UsD (n=430); CsD (n=611); UMDD (n=182); and CMDD with 5-6 symptoms (n=518), 7 symptoms (n=217), and 8-9 symptoms (n=291). Severity was evaluated using five concurrent pathology validators: suicide attempt, interference with life, help seeking, hospitalization, and generalized anxiety disorder. CsD validator levels are substantially higher than both UsD and UMDD levels, and similar to mild CMDD, disconfirming the "monotonicity thesis" that severity increase with symptom number. Complicated/uncomplicated status predicts severity, and when complicatedness is controlled, number of symptoms no longer predicts validator levels. Diagnoses were based on respondents' fallible retrospective symptom reports during a lay-administered structured interview, which may not yield diagnoses comparable to clinicians' assessments. CsD is more severe than UsD and comparable to mild MDD. Complicated status more validly indicates depression severity than the standard number-of-symptoms measure. Copyright © 2017 Elsevier B.V. All rights reserved.

Is lumbar lordosis related to low back pain development during prolonged standing?

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Sorensen, Christopher J; Norton, Barbara J; Callaghan, Jack P; Hwang, Ching-Ting; Van Dillen, Linda R

2015-08-01

An induced-pain paradigm has been used in back-healthy people to understand risk factors for developing low back pain during prolonged standing. The purposes of this study were to (1) compare baseline lumbar lordosis in back-healthy participants who do (Pain Developers) and do not (Non-Pain Developers) develop low back pain during 2 h of standing, and (2) examine the relationship between lumbar lordosis and low back pain intensity. Cross-sectional. First, participants stood while positions of markers placed superficial to the lumbar vertebrae were recorded using a motion capture system. Following collection of marker positions, participants stood for 2 h while performing light work tasks. At baseline and every 15 min during standing, participants rated their low back pain intensity on a visual analog scale. Lumbar lordosis was calculated using marker positions collected prior to the 2 h standing period. Lumbar lordosis was compared between pain developers and non-pain developers. In pain developers, the relationship between lumbar lordosis and maximum pain was examined. There were 24 (42%) pain developers and 33 (58%) non-pain developers. Lumbar lordosis was significantly larger in pain developers compared to non-pain developers (Mean difference = 4.4°; 95% Confidence Interval = 0.9° to 7.8°, Cohen's d = 0.7). The correlation coefficient between lumbar lordosis and maximum pain was 0.46 (P = 0.02). The results suggest that standing in more lumbar lordosis may be a risk factor for low back pain development during prolonged periods of standing. Identifying risk factors for low back pain development can inform preventative and early intervention strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Efficacy of transforaminal lumbar epidural steroid injections in patients with lumbar radiculopathy].

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Çetin, Mehmet Fatih; Karaman, Haktan; Ölmez Kavak, Gönül; Tüfek, Adnan; Baysal Yildirim, Zeynep

2012-01-01

This study looks into the efficacy and safety of the transforaminal lumbar epidural steroid injection (TLESI) applied to patients with radiculopathy due to lumbar disk herniation. The patients' files which were applied TLESI, were retrospectively scanned. Patients who did not respond to one-month conservative treatment and who were detected to have bulging or protruding lumbar disk herniation as a result of imaging methods were included in the study. All applications were performed with C-arm fluoroscopy under local anesthesia by outpatient method. In all cases, a mix of 80 mg triamsinolone and 0.25% bupivacaine, was transforaminally injected to the anterior epidural area. Initial VAS pain scores were compared with the values of the 1, 3 and 6th months after the application. Patient satisfaction was determined through scoring. Furthermore, early and late term complications were collected for evaluation. A total of 222 patients were administered TLESI 460 times (average: 2.1, repeat interval: 1-6 times). The applications were carried out most frequently at the levels of L4-L5 and L5-S1. While the initial VAS score average was 8.2±0.7, after TLESI, it was 5.0±1.6, 4.8±1.5 and 5.1±1.5 in the 1, 3 and 6th months, respectively. 63.9% of the patients (n=142) defined the treatment as 'good and excellent'. No major complications were experienced and the overall minor complication rate was 11.1%. It was seen that TLESI was an efficient and safe method in the short and medium term.

Updated CDC Recommendations for Using Artemether-Lumefantrine for the Treatment of Uncomplicated Malaria in Pregnant Women in the United States.

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Ballard, Sarah-Blythe; Salinger, Allison; Arguin, Paul M; Desai, Meghna; Tan, Kathrine R

2018-04-13

Malaria infection during pregnancy is associated with an increased risk for maternal and fetal complications. In the United States, treatment options for uncomplicated, chloroquine-resistant Plasmodium falciparum and P. vivax malaria in pregnant women are limited to mefloquine or quinine plus clindamycin (1). However, limited availability of quinine and increasing resistance to mefloquine restrict these options. Strong evidence now demonstrates that artemether-lumefantrine (AL) (Coartem) is effective and safe in the treatment of malaria in pregnancy. The World Health Organization (WHO) has endorsed artemisinin-based combination therapies (ACTs), such as AL, for treatment of uncomplicated malaria during the second and third trimesters of pregnancy and is currently considering whether to add ACTs, including AL, as an option for malaria treatment during the first trimester (2,3). This policy note reviews the evidence and updates CDC recommendations to include AL as a treatment option for uncomplicated malaria during the second and third trimesters of pregnancy and during the first trimester of pregnancy when other treatment options are unavailable. These updated recommendations reflect current evidence and are consistent with WHO treatment guidelines.

Antibacterial resistances in uncomplicated urinary tract infections in women: ECO·SENS II data from primary health care in Austria

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Kamenski Gustav

2012-09-01

Full Text Available Abstract Background Uncomplicated urinary tract infections (UTI are a frequent reason for consultation of women in primary health care. To avoid therapy failure and development of resistances, the choice of an antibiotic should be based on the knowledge of recent local resistance data but these data are scarce for the Austrian primary health care sector. Within the context of the ECO·SENS II study it was the aim to obtain appropriate and relevant local resistance data and describe the changes in the resistance pattern in comparison to the ECO·SENS study. Methods 23 GPs from different parts of Austria participated in the study between July 2007 and November 2008. According to the defined inclusion- and exclusion criteria female patients with symptoms of an uncomplicated UTI were included and a midstream urine sample was collected. In case of significant bacteriuria susceptibility testing of E. coli against 14 antibiotics was performed. Descriptive statistical methods were used. Results In 313 patients included in the study, a total of 147 E. coli isolates (47% were detected and tested. The resistance rates were in %: Mecillinam (0.0, nitrofurantoin (0.7, fosfomycin trometamol (0.7, gentamycin (1.4, cefotaxime (2.7, ceftazidime (2.7, Cephadroxil (4.1 and ciprofloxacin (4.1. Higher resistance rates were found in amoxicillin/clavulanic acid (8.9, nalidixic acid (9.6, trimethoprim/sulphamethoxazole (14.4, trimethoprim (15.8, sulphamethoxazole (21.2 and ampicillin (28.8. Additionally, the comparison of these results with the results of the ECO·SENS study demonstrated an increase in resistance rates of ampicillin, amoxicillin/clavulanic acid, nalidixic acid and ciprofloxacin. Conclusions The resistance data for E. coli in uncomplicated UTIs in women gained by this study are the most recent data for this disease in Austria at the moment. The increased resistance rates of amoxicillin/clavulanic acid, ciprofloxacin and nalidixic acid should be

Incidence and Management of Uncomplicated Recurrent Urinary Tract Infections in a National Sample of Women in the United States.

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Suskind, Anne M; Saigal, Christopher S; Hanley, Janet M; Lai, Julie; Setodji, Claude M; Clemens, J Quentin

2016-04-01

To determine the incidence and characteristics of women with uncomplicated recurrent urinary tract infections (UTIs) and to explore whether the use of culture-driven treatment affects rates of UTI-related complications and resource utilization. Using MarketScan claims from 2003 to 2011, we identified UTI-naive women ages 18-64 with incident-uncomplicated recurrent UTIs. Recurrent UTIs were defined as 3 UTI visits associated with antibiotics during a 12-month period. Cases were excluded if they had a UTI in the preceding year, or if they had any complicating factors (eg, abnormality of the urinary tract, neurologic condition, pregnancy, diabetes, or currently taking immunosuppression). We next assessed use of urine cultures, imaging, and cystoscopy, and performed propensity score matching with logistic regression to determine whether having a urine culture associated with >50% of UTIs affected rates of complications and downstream resource utilization. We identified 48,283 women with incident-uncomplicated recurrent UTIs, accounting for an overall incidence of 102 per 100,000 women, highest among women ages 18-34 and 55-64. Sixty-one percent of these women had at least 1 urine culture, 6.9% had imaging, and 2.8% had cystoscopy. Having a urine culture >50% of the time was associated with fewer UTI-related hospitalizations and lower rates of intravenous antibiotic use, whereas demonstrating higher rates of UTI-related office visits and pyelonephritis. The incidence of uncomplicated recurrent UTIs increases with age. Urine culture-directed care is beneficial in reducing high-cost services including UTI-related hospitalizations and intravenous antibiotic use, making urine cultures a valuable component to management of these patients. Copyright © 2016 Elsevier Inc. All rights reserved.

AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion

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Rapp SM

2011-08-01

Full Text Available Steven M Rapp1, Larry E Miller2,3, Jon E Block31Michigan Spine Institute, Waterford, MI, USA; 2Miller Scientific Consulting Inc, Biltmore Lake, NC, USA; 3Jon E. Block, Ph.D., Inc., San Francisco, CA, USAAbstract: Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF system is a minimally invasive fusion device that accesses the lumbar (L4–S1 intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date.Keywords: AxiaLIF, fusion, lumbar, minimally invasive, presacral

Incidental durotomy in lumbar spine surgery - incidence, risk factors and management

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Adam D.

2015-03-01

Full Text Available Incidental durotomy is a common complication of lumbar spine operations for degenerative disorders. Its incidence varies depending on several risk factors and regarding the intra and postoperative management, there is no consensus. Our objective was to report our experience with incidental durotomy in patients who were operated on for lumbar disc herniation, lumbar spinal stenosis and revision surgeries. Between 2009 and 2012, 1259 patients were operated on for degenerative lumbar disorders. For primary operations, the surgical approach was mino-open, interlamar, uni- or bilateral, as for recurrences, the removal of the compressive element was intended: the epidural scar and the disc fragment. 863 patients (67,7% were operated on for lumbar disc herniation, 344 patients (27,3% were operated on for lumbar spinal stenosis and 52 patients (5% were operated for recurrences. The operations were performed by neurosurgeons with the same professional degree but with different operative volume. Unintentional durotomy occurred in 20 (2,3% of the patients with herniated disc, in 14 (4,07% of the patients with lumbar spinal stenosis and in 12 (23% of the patients who were operated on for recurrences. The most frequent risk factors were: obesity, revised surgery and the physician’s low operative volume. Intraoperative dural fissures were repaired through suture (8 cases, by applying muscle, fat graft or by applying curaspon, tachosil. There existed 4 CSF fistulas which were repaired at reoperation. Incidental dural fissures during operations for degenerative lumbar disorders must be recognized and immediately repaired to prevent complications such as CSF fistula, osteodiscitis and increased medical costs. Preventing, identifying and treating unintentional durotomies can be best achieved by respecting a neat surgical technique and a standardized treatment protocol.

Safety and efficacy of dihydroartemisinin-piperaquine versus artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Zambian children

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Mulenga Modest

2011-02-01

Full Text Available Abstract Background Malaria in Zambia remains a public health and developmental challenge, affecting mostly children under five and pregnant women. In 2002, the first-line treatment for uncomplicated malaria was changed to artemether-lumefantrine (AL that has proved to be highly efficacious against multidrug resistant Plasmodium falciparum. Objective The study objective was to determine whether dihydroartemisinin-piperaquine (DHA/PQP had similar efficacy, safety and tolerability as AL for the treatment of children with uncomplicated P. falciparum malaria in Ndola, Zambia. Methods Between 2005 and 2006, 304 children (6-59 months old with uncomplicated P. falciparum were enrolled, randomized to AL (101 or DHA/PQP (203 and followed up for 42 days. Outcome of treatment was defined according to the standard WHO classification, i.e. early treatment failure (ETF, late clinical failure (LCF, late parasitological failure (LPF and adequate clinical and parasitological response (ACPR. Recurrent infections were genotyped to distinguish between recrudescence and new infection. Results No ETF was observed. At day 28, PCR-uncorrected ACPR was 92% in the DHA/PQP and 74% in the AL arm (OR: 4.05; 95%CI: 1.89-8.74; p Conclusion DHA/PQP was as efficacious, safe and well tolerated in treatment of uncomplicated malaria as AL, though in the latter group more new infections during the follow up were observed. DHA/PQP seems a potential candidate to be used as an alternative first-line or rescue treatment in Zambia. Trial Registration ISRCTN16263443, at http://www.controlled-trials.com/isrctn

Novel Approach to Treat Uncomplicated Sigmoid Volvulus Combining Minimally Invasive Surgery with Enhanced Recovery, in a Rural Hospital in Zambia.

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van der Naald, Niels; Prins, Marloes I; Otten, Kars; Kumwenda, Dayson; Bleichrodt, Robert P

2018-06-01

In sub-Saharan Africa, sigmoid volvulus is a frequent cause of bowel obstruction. The aim of this study was to evaluate the results of acute sigmoid resection and anastomosis via a mini-laparotomy in patients with uncomplicated sigmoid volvulus, following the principles of "Enhanced Recovery After Surgery (ERAS)", in a low-resource setting. Patients with uncomplicated sigmoid volvulus were operated acutely, via a mini-laparotomy, according to the principles of ERAS. Intraoperative complications, duration of operation, morbidity, mortality and length of hospital stay were evaluated, retrospectively. From 1 March 2012 to 1 September 2017, 31 consecutive patients were treated with acute sigmoid resection and anastomosis, via a mini-laparotomy. There were 29 men and 2 women, median age 57 (range 17-92) years. Patients were operated after a median period of 4 (range 1.5-18) hours. The median duration of the operative procedure was 50 (range 30-105) minutes. Two patients died (6.3%). One patient died during an uncomplicated operation. The cause of death is unknown. One patient with a newly diagnosed HIV infection had an anastomotic dehiscence. After Hartmann's procedure, he died on the 17th post-operative day as a result of a HIV-related double-sided pneumonia, without signs of abdominal sepsis. One patient had an urinary retention and 1 patient haematuria after bladder catheter insertion. Acute sigmoid resection and primary anastomosis via a mini-laparotomy for uncomplicated sigmoid volvulus, without preoperative endoscopic decompression is a safe procedure with a low morbidity and mortality.

Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials

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Varadhan, Krishna K; Neal, Keith R

2012-01-01

Objective To compare the safety and efficacy of antibiotic treatment versus appendicectomy for the primary treatment of uncomplicated acute appendicitis. Design Meta-analysis of randomised controlled trials. Population Randomised controlled trials of adult patients presenting with uncomplicated acute appendicitis, diagnosed by haematological and radiological investigations. Interventions Antibiotic treatment versus appendicectomy. Outcome measures The primary outcome measure was complications. The secondary outcome measures were efficacy of treatment, length of stay, and incidence of complicated appendicitis and readmissions. Results Four randomised controlled trials with a total of 900 patients (470 antibiotic treatment, 430 appendicectomy) met the inclusion criteria. Antibiotic treatment was associated with a 63% (277/438) success rate at one year. Meta-analysis of complications showed a relative risk reduction of 31% for antibiotic treatment compared with appendicectomy (risk ratio (Mantel-Haenszel, fixed) 0.69 (95% confidence interval 0.54 to 0.89); I2=0%; P=0.004). A secondary analysis, excluding the study with crossover of patients between the two interventions after randomisation, showed a significant relative risk reduction of 39% for antibiotic therapy (risk ratio 0.61 (0.40 to 0.92); I2=0%; P=0.02). Of the 65 (20%) patients who had appendicectomy after readmission, nine had perforated appendicitis and four had gangrenous appendicitis. No significant differences were seen for treatment efficacy, length of stay, or risk of developing complicated appendicitis. Conclusion Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. PMID:22491789

Congenital lumbar vertebrae agenesis in a lamb.

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Farajli Abbasi, Mohammad; Shojaei, Bahador; Azari, Omid

2017-01-01

Congenital agenesis of lumbar vertebrae was diagnosed in a day-old female lamb based on radiology and clinical examinations. There was no neurological deficit in hindlimb and forelimb associated with standing disability. Radiography of the abdominal region revealed absence of lumbar vertebrae. Necropsy confirmed clinical and radiographic results. No other anomaly or agenesis was seen macroscopically in the abdominal and thoracic regions as well as vertebral column. Partial absence of vertebral column has been reported in human and different animal species, as an independent occurrence or associated with other organs anomalies. The latter has been designated as caudal regression syndrome. Vertebral agenesis may arise from irregularity in the differentiation of somites to the sclerotome or sclerotome to the vertebral primordium. Most of the previously reported cases of agenesis were related to the lumbosacral region, lonely or along with other visceral absences. This case was the first report of congenital agenesis of lumbar vertebrae in a lamb.

Biomechanical implications of lumbar spinal ligament transection.

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Von Forell, Gregory A; Bowden, Anton E

2014-11-01

Many lumbar spine surgeries either intentionally or inadvertently damage or transect spinal ligaments. The purpose of this work was to quantify the previously unknown biomechanical consequences of isolated spinal ligament transection on the remaining spinal ligaments (stress transfer), vertebrae (bone remodelling stimulus) and intervertebral discs (disc pressure) of the lumbar spine. A finite element model of the full lumbar spine was developed and validated against experimental data and tested in the primary modes of spinal motion in the intact condition. Once a ligament was removed, stress increased in the remaining spinal ligaments and changes occurred in vertebral strain energy, but disc pressure remained similar. All major biomechanical changes occurred at the same spinal level as the transected ligament, with minor changes at adjacent levels. This work demonstrates that iatrogenic damage to spinal ligaments disturbs the load sharing within the spinal ligament network and may induce significant clinically relevant changes in the spinal motion segment.

Lower thoracic degenerative spondylithesis with concomitant lumbar spondylosis.

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

2014-03-01

Degenerative spondylolisthesis of the spine is less common in the lower thoracic region than in the lumbar and cervical regions. However, lower thoracic degenerative spondylolisthesis may develop secondary to intervertebral disc degeneration. Most of our patients are found to have concomitant lumbar spondylosis. By retrospective review of our cases, current diagnosis and treatments for this rare disease were discussed. We present a series of 5 patients who experienced low back pain, progressive numbness, weakness and even paraparesis. Initially, all of them were diagnosed with lumbar spondylosis at other clinics, and 1 patient had even received prior decompressive lumbar surgery. However, their symptoms continued to progress, even after conservative treatments or lumbar surgeries. These patients also showed wide-based gait, increased deep tendon reflex (DTR), and urinary difficulty. All these clinical presentations could not be explained solely by lumbar spondylosis. Thoracolumbar spinal magnetic resonance imaging (MRI), neurophysiologic studies such as motor evoked potential (MEP) or somatosensory evoked potential (SSEP), and dynamic thoracolumbar lateral radiography were performed, and a final diagnosis of lower thoracic degenerative spondylolisthesis was made. Bilateral facet effusions, shown by hyperintense signals in T2 MRI sequence, were observed in all patients. Neurophysiologic studies revealed conduction defect of either MEP or SSEP. One patient refused surgical management because of personal reasons. However, with the use of thoracolumbar orthosis, his symptoms/signs stabilized, although partial lower leg myelopathy was present. The other patients received surgical decompression in association with fixation/fusion procedures performed for managing the thoracolumbar lesions. Three patients became symptom-free, whereas in 1 patient, paralysis set in before the operation; this patient was able to walk with assistance 6 months after surgical decompression

Efficacy of different bone volume expanders for augmenting lumbar fusions.

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Epstein, Nancy E

2008-01-01

A wide variety of bone volume expanders are being used in performing posterolateral lumbar noninstrumented and instrumented lumbar fusions. This article presents a review of their efficacy based on fusion rates, complications, and outcomes. Lumbar noninstrumented and instrumented fusions frequently use laminar autografts and different bone graft expanders. This review presents the utility of multiple forms/ratios of DBMs containing allografts. It also discusses the efficacy of artificial bone graft substitutes, including HA and B-TCP. Dynamic x-ray and/or CT examinations were used to document fusion in most series. Outcomes were variously assessed using Odom's criteria or different outcome questionnaires (Oswestry Questionnaire, SF-36, Dallas Pain Questionnaire, and/or Low Back Pain Rating Scale). Performing noninstrumented and instrumented lumbar posterolateral fusions resulted in comparable fusion rates in many series. Similar outcomes were also documented based on Odom's criteria or the multiple patient-based questionnaires. However, in some studies, the addition of spinal instrumentation increased the reoperation rate, operative time, blood loss, and cost. Various forms of DBMs, applied in different ratios to autografts, effectively supplemented spinal fusions in animal models and patient series. beta-Tricalcium phosphate, which is used to augment autograft fusions addressing idiopathic scoliosis or lumbar disease, also proved to be effective. Different types of bone volume expanders, including various forms of allograft-based DBMs, and artificial bone graft substitutes (HA and B-TCP) effectively promote posterolateral lumbar noninstrumented and instrumented fusions when added to autografts.

Lumbar Nerve Root Occupancy in the Foramen in Achondroplasia

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

2008-01-01

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

Spinal CT scan, 2. Lumbar and sacral spines

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

1982-08-01

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

Endoscopic anatomy and features of lumbar discectomy by Destandau technique

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Keyvan Mostofi

2017-03-01

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

Constipation after thoraco-lumbar fusion surgery.

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Stienen, Martin N; Smoll, Nicolas R; Hildebrandt, Gerhard; Schaller, Karl; Tessitore, Enrico; Gautschi, Oliver P

2014-11-01

Thoraco-lumbar posterior fusion surgery is a frequent procedure used for patients with spinal instability due to tumor, trauma or degenerative disease. In the perioperative phase, many patients may experience vomiting, bowel irritation, constipation, or may even show symptoms of adynamic ileus possibly due to immobilization and high doses of opioid analgesics and narcotics administered during and after surgery. Retrospective single-center study on patients undergoing thoraco-lumbar fusion surgery for degenerative lumbar spine disease with instability in 2012. Study groups were built according to presence/absence of postoperative constipation, with postoperative constipation being defined as no bowel movement on postoperative days 0-2. Ninety-nine patients (39 males, 60 females) with a mean age of 57.1 ± 17.3 years were analyzed, of which 44 patients with similar age, gender, BMI and ASA-grades showed constipation (44.4%). Occurrence of constipation was associated with longer mean operation times (247 ± 62 vs. 214 ± 71 min; p=0.012), higher estimated blood loss (545 ± 316 vs. 375 ± 332 ml; pconstipation. One patient with constipation developed a sonographically confirmed paralytic ileus. Patients with constipation showed a tendency toward longer postoperative hospitalization (7.6 vs. 6.7 days, p=0.136). The rate of constipation was high after thoraco-lumbar fusion surgery. Moreover, it was associated with longer surgery time, higher blood loss, and higher postoperative morphine doses. Further trials are needed to prove if the introduction of faster and less invasive surgery techniques may have a positive side effect on bowel movement after spine surgery as they may reduce operation times, blood loss and postoperative morphine use. Copyright © 2014 Elsevier B.V. All rights reserved.

Imaging of the lumbar spine after diskectomy

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Laredo, J.D.; Wybier, M.

1995-01-01

The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy. (authors). 34 refs., 5 tabs

Evaluation of Coflex interspinous stabilization following decompression compared with decompression and posterior lumbar interbody fusion for the treatment of lumbar degenerative disease: A minimum 5-year follow-up study.

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Yuan, Wei; Su, Qing-Jun; Liu, Tie; Yang, Jin-Cai; Kang, Nan; Guan, Li; Hai, Yong

2017-01-01

Few studies have compared the clinical and radiological outcomes between Coflex interspinous stabilization and posterior lumbar interbody fusion (PLIF) for degenerative lumbar disease. We compared the at least 5-year clinical and radiological outcomes of Coflex stabilization and PLIF for lumbar degenerative disease. Eighty-seven consecutive patients with lumbar degenerative disease were retrospectively reviewed. Forty-two patients underwent decompression and Coflex interspinous stabilization (Coflex group), 45 patients underwent decompression and PLIF (PLIF group). Clinical and radiological outcomes were evaluated. Coflex subjects experienced less blood loss, shorter hospital stays and shorter operative time than PLIF (all pdisease was higher in the PLIF group, but this did not achieve statistical significance (11.1% vs. 4.8%, p=0.277). Both groups provided sustainable improved clinical outcomes for lumbar degenerative disease through at least 5-year follow-up. The Coflex group had significantly better early efficacy than the PLIF group. Coflex interspinous implantation after decompression is safe and effective for lumbar degenerative disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

Lumbar hernia - a case report and review of the literature

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D'Ippolito, Giuseppe; Yonamine, Claudia

1999-01-01

The authors present a case of lumbar hernia of inferior right space (Petit's triangle), classified as acquired hernia and diagnosed by clinical history and computed tomography. Lumbar hernia are quite rare. Authors have done a literature review of this disease. (author)

Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis.

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Ridgway, P F

2009-11-01

Despite the high prevalence of hospitalization for left iliac fossa tenderness, there is a striking lack of randomized data available to guide therapy. The authors hypothesize that an oral antibiotic and fluids are not inferior to intravenous (IV) antibiotics and \\'bowel rest\\' in clinically diagnosed acute uncomplicated diverticulitis.

Iliac artery pseudoaneurysm after lumbar disc hernia operation

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Mehmet Atay

2016-03-01

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

Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

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Kanthila Mahesha

2017-01-01

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

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

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

2018-06-01

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

Risk factors for acute surgical site infections after lumbar surgery: a retrospective study.

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Lai, Qi; Song, Quanwei; Guo, Runsheng; Bi, Haidi; Liu, Xuqiang; Yu, Xiaolong; Zhu, Jianghao; Dai, Min; Zhang, Bin

2017-07-19

Currently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery. We retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital's spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses. Twenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients' mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (p operative type in the acute surgical site infection group were significantly different than those in the non-acute surgical site infection group (p operative type, operative time, blood loss, and drainage time were independent predictors of acute surgical site infection following lumbar surgery. In order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.

Lumbar spine chordoma

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

2014-01-01

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

Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

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

2016-01-01

Background To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondylolisthesis on lumbar lordosis after an intraoperative prone position. Methods Sixty-seven patients, who underwent spinal fusion at the Department of Orthopaedic Surgery of Gwangmyeong Sungae Hospital between May 2007 and February 2012, were included in this study. The study compared lumbar lordosis on preoperative upright, intraoperative prone and postoperative upright lateral X-rays between the simple stenosis (SS) group and spondylolisthesis group. The average age of patients was 67.86 years old. The average preoperative lordosis was 43.5° (± 14.9°), average intraoperative lordosis was 48.8° (± 13.2°), average postoperative lordosis was 46.5° (± 16.1°) and the average change on the frame was 5.3° (± 10.6°). Results Among all patients, 24 patients were diagnosed with simple spinal stenosis, 43 patients with spondylolisthesis (29 degenerative spondylolisthesis and 14 isthmic spondylolisthesis). Between the SS group and spondylolisthesis group, preoperative lordosis, intraoperative lordosis and postoperative lordosis were significantly larger in the spondylolisthesis group. The ratio of patients with increased lordosis on the OSI frame compared to preoperative lordosis was significantly higher in the spondylolisthesis group. The risk of increased lordosis on frame was significantly higher in the spondylolisthesis group (odds ratio, 3.325; 95% confidence interval, 1.101 to 10.039; p = 0.033). Conclusions Intraoperative lumbar lordosis on the OSI frame with a prone

The Lumbar Lordosis in Males and Females, Revisited.

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Ori Hay

Full Text Available Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females.Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height.Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined.Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis. The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing.

The Lumbar Lordosis in Males and Females, Revisited.

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Hay, Ori; Dar, Gali; Abbas, Janan; Stein, Dan; May, Hila; Masharawi, Youssef; Peled, Nathan; Hershkovitz, Israel

2015-01-01

Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females. Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height. Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined). Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis). The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing.

Radiographic comparison between male and female patients with lumbar spondylolysis.

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Takao, Shoichiro; Sakai, Toshinori; Sairyo, Koichi; Kondo, Tadashi; Ueno, Junji; Yasui, Natsuo; Nishitani, Hiromu

2010-02-01

We studied the lumbar spines of 117 adults (39 women and 78 men) with spondylolysis unrelated to low back pain using multidetector computed tomography (CT). Of the 117 subjects with spondylolysis, including five with multiple-level spondylolysis, there were 124 vertebrae with spondylolysis. In adult lumbar spines with unilateral spondylolysis, there was no significant difference between the incidence of spondylolisthesis in female and male subjects. However, in those with bilateral spondylolysis, there was a significantly higher incidence of spondylolisthesis in female subjects (90.9%) than in males (66.2%). Furthermore, females with bilateral spondylolysis had significant more slippage than males. Lumbar index and lumbar lordosis were not significantly different between male and female subjects, and did not significantly correlate with slippage. In conclusion, to treat acute spondylolysis in adolescents, it is important to obtain bony union at least unilaterally, especially in female subjects, to prevent further slippage.

Surgical management for lumbar disc herniation in pregnancy.

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Kapetanakis, S; Giovannopoulou, E; Blontzos, N; Kazakos, G; Givissis, P

2017-12-01

Lumbar disc herniation is a common surgical spine pathology that may be presented during pregnancy. The state of pregnancy complicates the diagnosis and therapeutical management of this entity. Specific considerations rule the decision for surgical intervention, the optimal timing of it and the type of selected procedure in a pregnant patient, due to the potential risks for the fetus. In the last 30 years, evolution in the field of spine surgery has provided options other than open standard discectomy. The well-established concept of "minimal intervention" has led to the development of microdiscectomy and other innovative, full-endoscopic techniques for lumbar discectomy. The aim of the present study is to review the surgical management of lumbar disc herniation in pregnancy and investigate the potential role of minimally invasive spine surgery in this specific population. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

The values of MSCT multi-planar reconstruction in the diagnosis of lumbar spondylolysis

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Tan Qixuan; Zhu Gangming; Qian Huirong; Zhong Sheng

2007-01-01

Objective: To study the reasonable schedule and diagnostic values of MSCT multi-planar reconstruction in patients with lumbar spondylolysis. Methods: Volume scan ranging from T12 to S1 was done in 540 cases suffered from backleg pain without definite trauma. The lumbar disc axial and whole lumbar axial, sagital, coronal images were reconstructed from raw data of MSCT. Results: Of the 540 cases, 54 spondylolysis in isthmus of lumbar pedicle were demonstrated in 29 ones (29/540, 5.37%). 20 cases were accompanied with spondylolisthesis. The sagital multi-planar reconstruction was the best way to reveal the fissures of spondylolysis and accompanying abnormalities. The detectable ratio of fissures in lumbar disc with axial, whole lumbar axial, sagital and coronal multi-planer reconstruction images were 7.41%, 100%, 100% and 51.85% respectively. Conclusions: MSCT sagital multi-planar reconstruction is the best images to reveal the fissures of spondylolysis. It should be taken as routine item in MSCT examination for the patients with lower back pain. (authors)

Herpes zoster sciatica mimicking lumbar canal stenosis: a case report.

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Koda, Masao; Mannoji, Chikato; Oikawa, Makiko; Murakami, Masazumi; Okamoto, Yuzuru; Kon, Tamiyo; Okawa, Akihiko; Ikeda, Osamu; Yamazaki, Masashi; Furuya, Takeo

2015-07-29

Symptom of herpes zoster is sometimes difficult to distinguish from sciatica induced by spinal diseases, including lumbar disc herniation and spinal canal stenosis. Here we report a case of sciatica mimicking lumbar canal stenosis. A 74-year-old Chinese male patient visited our hospital for left-sided sciatic pain upon standing or walking for 5 min of approximately 1 month's duration. At the first visit to our hospital, there were no skin lesions. A magnetic resonance imaging showed spinal canal stenosis between the 4th and 5th lumbar spine. Thus, we diagnosed the patient with sciatica induced by spinal canal stenosis. We considered decompression surgery for the stenosis of 4th and 5th lumbar spine because conservative therapy failed to relieve the patient's symptom. At that time, the patient complained of a skin rash involving his left foot for several days. A vesicular rash and erythema were observed on the dorsal and plantar surfaces of the great toe and lateral malleolus. The patient was diagnosed with herpes zoster in the left 5th lumbar spinal nerve area based on clinical findings, including the characteristics of the pain and vesicular rash and erythema in the 5th lumbar spinal dermatome. The patient was treated with famciclovir (1,500 mg/day) and non-steroidal anti-inflammatory drugs. After 1 week of medication, the skin rash resolved and pain relief was obtained. In conclusion, spinal surgeons should keep in mind herpes zoster infection as one of the possible differential diagnoses of sciatica, even if there is no typical skin rash.

Diagnostic method for lumbar foraminal stenosis based on the clinical results of transforaminal lumbar interbody fusion (TLIF). Utility of the foraminal stenosis score

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Yamada, Katsutaka; Nakamura, Jun-ichiro; Mitsugi, Naoto; Sato, Masatsune; Saito, Tomoyuki

2010-01-01

In this study we analyzed 73 cases treated by transforaminal lumbar interbody fusion (TLIF) for lumbar foraminal stenosis or central canal stenosis and foraminal stenosis, and based on the perioperative findings and outcome of treatment, we considered the diagnostic procedure for lumbar foraminal stenosis in the future. In 25 cases (34.2%) cases there was actually no clear perioperative evidence of foraminal stenosis. We compared the preoperative clinical and imaging findings in the group with perioperative findings and the group without perioperative findings performed a multiple logistic regression analysis to identify factors associated with foraminal stenosis. We also calculated the odds ratio for the perioperative findings and proposed a foraminal stenosis scoring system. (author)

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

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

2012-11-01

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

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

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

2018-03-01

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

[Operative treatment of degenerative diseases of the lumbar spine].

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Czabanka, M; Thomé, C; Ringel, F; Meyer, B; Eicker, S-O; Rohde, V; Stoffel, M; Vajkoczy, P

2018-04-20

Degenerative diseases of the lumbar spine and associated lower back pain represent a major epidemiological and health-related economic challenge. A distinction is made between specific and unspecific lower back pain. In specific lower back pain lumbar disc herniation and spinal canal stenosis with or without associated segment instability are among the most frequent pathologies. Diverse conservative and operative strategies for treatment of these diseases are available. The aim of this article is to present an overview of current data and an evidence-based assessment of the possible forms of treatment. An extensive literature search was carried out via Medline plus an additional evaluation of the authors' personal experiences. Conservative and surgical treatment represent efficient treatment options for degenerative diseases of the lumbar spine. Surgical treatment of lumbar disc herniation shows slight advantages compared to conservative treatment consisting of faster recovery of neurological deficits and a faster restitution of pain control. Surgical decompression is superior to conservative measures for the treatment of spinal canal stenosis and degenerative spondylolisthesis. In this scenario conservative treatment represents an important supporting measure for surgical treatment in order to improve the mobility of patients and the outcome of surgical treatment. The treatment of specific lower back pain due to degenerative lumbar pathologies represents an interdisciplinary challenge, requiring both conservative and surgical treatment strategies in a synergistic treatment concept in order to achieve the best results for patients.

Complications of lumbar puncture in a child treated for leukaemia

International Nuclear Information System (INIS)

Staebler, Melanie; Delpierre, Isabelle; Damry, Nash; Christophe, Catherine; Azzi, Nadira; Sekhara, Tayeb

2005-01-01

Lumbar puncture may lead to neurological complications. These include intracranial hypotension, cervical epidural haematomas, and cranial and lumbar subdural haematomas. MRI is the modality of choice to diagnose these complications. This report documents MRI findings of such complications in a child treated for leukaemia. (orig.)

Cholecystectomy for uncomplicated gallbladder stones does not follow evidence-based recommendations

DEFF Research Database (Denmark)

Pedersen, Benjamin; Ellebæk, Mark B.; Dorfelt, Allan

2017-01-01

pain. The objective of the present study was to investigate whether the indication “socially debilitating pain” was reported in the patien’s file when he or she was referred to surgery. METHODS: Hospital files for all patients referred to surgical evaluation for uncomplicated gallbladder stones from......, the indication of socially debilitating pain was described in the patient files. CONCLUSIONS: Our results may represent overtreatment and/or incorrect selection of patients suitable for surgery. More and larger prospective cohort studies are warranted to elucidate the indications for cholecystectomy...

Anterior seromyotomy with posterior truncal vagotomy in uncomplicated chronic duodenal ulcer.

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Supe A

1995-07-01

Full Text Available Thirty cases of uncomplicated duodenal ulcer treated by anterior superficial lesser curvature seromyotomy and posterior truncal vagotomy were studied to evaluate the efficacy of this procedure. There was completeness of vagotomy in all the cases as shown by endoscopic Congo Red test. Twenty-seven cases were asymptomatic at 1-48 months (Mean 22.3 follow up, while 3 patients had controllable side effects such as dumping and diarrhoea. There was no mortality. This procedure is safe, effective and is a favourable alternative to highly selective vagotomy.

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

Energy Technology Data Exchange (ETDEWEB)

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

2002-12-01

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

The geometric curvature of the lumbar spine during restricted and unrestricted squats.

Science.gov (United States)

Hebling Campos, Mário; Furtado Alaman, Laizi I; Seffrin-Neto, Aldo A; Vieira, Carlos A; Costa de Paula, Marcelo; Barbosa de Lira, Claudio A

2017-06-01

The main purpose of this study was to analyze the behavior of the geometric curvature of the lumbar spine during restricted and unrestricted squats, using a novel investigative method. The rationale for our hypothesis is that the lumbar curvature has different patterns at different spine levels depending on the squat technique used. Spine motion was collected via stereo-photogrammetric analysis in nineteen participants (11 males, 8 females). The reconstructed spine points at the upright neutral position and at the deepest position of the squat exercise were projected onto the sagittal plane of the trunk, a polynomial was fitted to the data, and were quantified the two-dimensional geometric curvature at lower, central and higher lumbar levels, besides the inclination of trunk and lumbosacral region, the overall geometric curvature and overall angle of the lumbar spine. The mean values for each variable were analysed with paired t-test (Psquat techniques and these effects are also reduced in unrestricted squats. The data collected in the study are evidence that during barbell squats the lumbar curvature has different patterns at different spinal levels depending on the exercise technique. The lower lumbar spine appears to be less overloaded during unrestricted squats.

CHANGES IN RADIOGRAPHIC PARAMETERS AFTER MINIMALLY INVASIVE LUMBAR INTERBODY FUSION

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Emiliano Vialle

2015-12-01

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

Design of three-dimensional visualization based on the posterior lumbar pedicle screw fixation

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Kai XU

2011-09-01

Full Text Available Objective To establish a three-dimensional visualization model of posterior lumbar pedicle screw fixation.Methods A patient with lumbar intervertebral disc hernia and another patient with compression fracture of lumbar vertebra were involved in the present study.Both patients underwent multi-slice spiral CT scan before and after lumbar pedicle screw fixation.The degree of preoperative vertebral compression,vertebral morphology before and after surgery,postoperative pedicle screw position,and decompression effects were observed.The original data of the multi-slice spiral CT were inputted into the computer.The three-dimensional reconstructed images of the lumbar and implanted screws were obtained using the software Amira 4.1 to show the three-dimensional shape of the lumbar vertebrae before and after surgery and the location of the implanted screws.Results The morphology and structure of the lumbar vertebrae before and after surgery and of the implanted screws were reconstructed using the digital navigation platform.The reconstructed 3D images could be displayed in multicolor,transparent,or arbitrary combinations.In the 3D surface reconstruction images,the location and structure of the implanted screws could be clearly observed,and the decompression of the spinal cord or nerve roots and the severity of the fracture and the compression of lumbar vertebrae could be fully evaluated.The reconstructed images before operation revealed the position of the vertebral pedicles and provided reference for intraoperative localization.Conclusions The three-dimensional computerized reconstructions of lumbar pedicle screw fixation may be valuable in basic research,clinical experiment,and surgical planning.The software Amira is one of the bases of three-dimensional reconstruction.

Transforaminal lumbar interbody fusion versus posterolateral fusion in degenerative lumbar spondylosis

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Zhang, Bin-Fei; Ge, Chao-Yuan; Zheng, Bo-Long; Hao, Ding-Jun

2016-01-01

Abstract Objective: The aim of the study was to evaluate the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) versus posterolateral fusion (PLF) in degenerative lumbar spondylosis. Methods: A systematic literature review was performed to obtain randomized controlled trials (RCTs) and observational studies (OSs) of TLIF and PLF for degenerative lumbar spondylosis. Trials performed before November 2015 were retrieved from the Medline, EMBASE, Cochrane library, and Chinese databases. Data extraction and quality evaluation of the trials were performed independently by 2 investigators. A meta-analysis was performed using STATA version 12.0. Results: Two RCTs and 5 OSs of 630 patients were included. Of these subjects, 325 were in the TLIF and 305 were in the PLF group. Results showed that TLIF did not increase the fusion rate based on RCTs (relative risk [RR] = 1.06; 95% confidence interval [CI]: 0.95–1.18; P = 0.321), but increased it based on OSs (RR = 1.14; 95% CI: 1.07–1.23; P = 0.000) and overall (RR = 1.11; 95% CI: 1.05–1.18; P = 0.001) as compared with PLF. TLIF was able to improve the clinical outcomes based on 1 RCT (RR = 1.33; 95% CI: 1.11–1.59, P = 0.002) and overall (RR = 1.19; 95% CI: 1.07–1.33; P = 0.001), but not based on OSs (RR = 1.11; 95% CI: 0.97–1.27; P = 0.129) as compared with PLF. There were no differences between TLIF and PLF in terms of visual analogue scale, Oswestry Disability Index, reoperation, complications, duration of surgical procedure, blood loss, and hospitalization. Conclusions: In conclusion, evidence is not sufficient to support that TLIF provides higher fusion rate than PLF, and this poor evidence indicates that TLIF might improve only clinical outcomes. Higher quality, multicenter RCTs are needed to better define the role of TLIF and PLF. PMID:27749558

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

Science.gov (United States)

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

2017-12-19

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

The treatment of lumbar disc herniation: a comparison between percutaneous lumbar diskectomy combined with ozone and percutaneous lumbar diskectomy combined with collagenase

International Nuclear Information System (INIS)

Zhong Liming; Wei Xin; Hu Hong; You Jian; Zhao Xiaowei; Hu Kongqiong

2012-01-01

Objective: To evaluate the short-term curative effect and the incidence of postoperative adverse events of percutaneous lumbar diskectomy (PLD) combined with ozone or PLD combined with collagenase in treating lumbar disk herniation. Methods: A total of 223 patients with lumbar disk herniation were enrolled in this study. Patients in the study group (n=108) were treated with PLD combined with ozone, while patients in the control group (n=115) were treated with PLD combined with collagenase. The short-term effectiveness and the incidence of postoperative adverse events were documented. The results were analyzed and compared between the two groups. Results: In the study group, the excellent and good therapeutic results were achieved in 85.18% of the patients (n=92) and the occurrence of adverse events was 5.56%, while in the control group, the excellent and good therapeutic results were achieved in 80.00% of the patients (n=92) and the occurrence of adverse events was 13.04%. No significant difference in the short-term effectiveness existed between the two groups (Pearson Chi-Square =1.038, P=0.308). And the difference in the occurrence of postoperative adverse events was not significant between the two groups (Pearson Chi-Square =3.661, P=0.056). No disc infection occurred in the study group. Conclusion: The short-term curative effect of PLD combined with ozone is not significantly different from that of PLD combined with collagenase. In order to maintain decompression within the disc for a long period and to reduce the incidence of postoperative adverse events PLD combined with ozone ablation is an effective complementary treatment. (authors)

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

International Nuclear Information System (INIS)

Shen, W.C.; Lee, S.K.; Ho, Y.J.; Lee, K.R.

1993-01-01

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.)

Intrathecal ligaments and nerve root tension: possible sources of lumbar pain during spaceflight.

Science.gov (United States)

Kershner, David; Binhammer, Robert

2004-04-01

Lumbar intrathecal ligaments have recently been demonstrated to randomly bind dorsal nerve roots to the dura within the lumbar vertebral column. Lengthening of the vertebral column and associated lumbar back pain experienced by astronauts is common in microgravity. This study was designed to investigate the relationship of lumbar intrathecal ligaments in spinal lengthening as a possible mechanism for back pain. A two-part study was designed using 36 vertebral columns from embalmed cadavers. There were 12 vertebral columns studied in mid-sagittal section to demonstrate the possible movement of the spinal cord during lengthening of the vertebral column. The remainder were assessed for the amount of tension placed on a dorsal nerve root by the lumbar intrathecal ligament during lengthening of the vertebral column. The spinal cord moves in a cephalic direction approximately 2.8 mm with 4 cm lengthening of the vertebral column. During lengthening, a loss of thoracic and lordotic curvature was noted with an increase in disk height. Tension was significantly increased on the dorsal nerve roots being tethered by the lumbar intrathecal ligaments in comparison to non-tethered nerve roots during lengthening of the vertebral column. A significant amount of tension is placed on dorsal nerve roots tethered by intrathecal ligaments within the lumbar spine during spinal lengthening. These ligaments randomly bind dorsal nerve roots in the lumbar spine and may be involved in the back pain experienced by astronauts in microgravity.

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

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Hey Hwee Weng

2010-01-01

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

The Reliability of Lumbar Lordosis Measurements Using a Flexible-Rule.

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The purpose of this study was to examine the intra-rater and intra-rater reliability of lumbar lordosis measurements taken with a flexible-rule. Two...coefficients (ICC) were used to determine the degree of agreement between measurements. The results suggest that measurements of lumbar lordosis with a

Reliability and validity of subjective assessment of lumbar lordosis in ...

African Journals Online (AJOL)

Radiological assessment of lumbar lordotic curve aids in early diagnosis of conditions even before neurologic changes set in. Objective: To ascertain the level of reliability and validity of subjective assessment of lumbar lordosis in conventional radiography. Design: A blinded, repeated-measures diagnostic test was carried ...

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

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Manchikanti L

2012-08-01

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

TRIMETHOPRIM-SULFAMETHOXAZOLE RESISTANCE AND FOSFOMYCIN SUSCEPTIBILITY RATES IN UNCOMPLICATED URINARY TRACT INFECTIONS: TIME TO CHANGE THE ANTIMICROBIAL PREFERENCES.

Science.gov (United States)

Guneysel, Ozlem; Suman, Enes; Ozturk, Tuba Cimilli

2016-03-01

Urinary tract infections (UTIs) are among the most common bacterial infections in adult population. They are prevalent in all age groups both in women and men. Also, UTIs are the most frequent indication for empirical antibiotic treatment in emergency department. The aim of this study was to determine the antibiotic resistance rates in the treatment of uncomplicated UTIs. Adult patients admitted to emergency department with uncomplicated UTIs were included in this cross-sectional study. Mid-stream urine samples were obtained under sterile conditions and cultured quantitatively. After 24 hours, the samples showing 10(5) colony forming unit per milliliter (CFU/mL) were tested for antibiotic susceptibility. Resistance to fosfomycin-trometamol (FT), amoxicillin-clavulanic acid (AC), ciprofloxacin (CIP), trimethoprim-sulfamethoxazole (TMP-SMX) and cefpodoxime (CEF) was tested by Kirby-Bauer disc diffusion system. Escherichia (E.) coli accounted for the vast majority (93.4%) of the organisms isolated in the study. Among the E. coli positive patients, resistance to TMP-SMX was the most common antibiotic resistance. The E. coli species detected in our study group were least resistant to FT (2.4%). The resistance rates, especially to CEF, AC and CIP, were significantly higher in patients over 50 years of age. In conclusion, in the treatment of uncomplicated UTIs, TMP-SMX should be excluded from empirical treatment, while fosfomycin could be a viable option in all age groups.

Spinous Process Osteochondroma as a Rare Cause of Lumbar Pain

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Bárbara Rosa

2016-01-01

Full Text Available We present a case of a 5th Lumbar Vertebra (L5 spinous process osteochondroma as a rare cause of lumbar pain in an old patient. A 70-year-old male presented with progressive and disabling lower lumbar pain. Tenderness over the central and left paraspinal area of the lower lumbar region and a palpable mass were evident. CT scan showed a mass arising from the spinous process of L5. Marginal resection of the tumor was performed through a posterior approach. The histological study revealed an osteochondroma. After surgery, pain was completely relieved. After one year there was no evidence of local recurrence or symptoms. Osteochondromas rarely involve the spine, but when they do symptoms like pain, radiculopathy/myelopathy, or cosmetic deformity may occur. The imagiologic exam of election for diagnosis is CT scan. When symptomatic the treatment of choice is surgical resection. The most concerning complication of osteochondromas is malignant transformation, a rare event.

Use of Lumbar Punctures in the Management of Ocular Syphilis.

Science.gov (United States)

Reekie, Ian; Reddy, Yaviche

2018-01-01

Ocular syphilis has become rare in the developed world, but is a common presentation to ophthalmology departments in South Africa. We investigated the proportion of patients diagnosed with ocular syphilis who went on to receive lumbar punctures, and determined the fraction of these who had cerebrospinal fluid findings suggestive of neurosyphilis. We aimed to determine whether the use of lumbar punctures in ocular syphilis patients was beneficial in picking up cases of neurosyphilis. Retrospective study of case notes of patients admitted to two district hospitals in Durban, South Africa, with ocular syphilis over a 20-month period. A total of 31 of 68 ocular syphilis patients underwent lumbar puncture, and of these, eight (25.8%) had findings suggestive of neurosyphilis. Lumbar puncture in ocular syphilis patients should continue to be a routine part of the investigation of these patients; a large proportion of ocular syphilis patients show cerebrospinal fluid findings suggestive of neurosyphilis, are at risk of the complications of neurosyphilis, and should be managed accordingly.

Complications in lumbar spine surgery: A retrospective analysis

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Luca Proietti

2013-01-01

Full Text Available Background: Surgical treatment of adult lumbar spinal disorders is associated with a substantial risk of intraoperative and perioperative complications. There is no clearly defined medical literature on complication in lumbar spine surgery. Purpose of the study is to retrospectively evaluate intraoperative and perioperative complications who underwent various lumbar surgical procedures and to study the possible predisposing role of advanced age in increasing this rate. Materials and Methods: From 2007 to 2011 the number and type of complications were recorded and both univariate, (considering the patients′ age and a multivariate statistical analysis was conducted in order to establish a possible predisposing role. 133 were lumbar disc hernia treated with microdiscetomy, 88 were lumbar stenosis, treated in 36 cases with only decompression, 52 with decompression and instrumentation with a maximum of 2 levels. 26 patients showed a lumbar fracture treated with percutaneous or open screw fixation. 12 showed a scoliotic or kyphotic deformity treated with decompression, fusion and osteotomies with a maximum of 7.3 levels of fusion (range 5-14. 70 were spondylolisthesis treated with 1 or more level of fusion. In 34 cases a fusion till S1 was performed. Results: Of the 338 patients who underwent surgery, 55 showed one or more complications. Type of surgical treatment ( P = 0.004, open surgical approach (open P = 0.001 and operative time ( P = 0.001 increased the relative risk (RR of complication occurrence of 2.3, 3.8 and 5.1 respectively. Major complications are more often seen in complex surgical treatment for severe deformities, in revision surgery and in anterior approaches with an occurrence of 58.3%. Age greater than 65 years, despite an increased RR of perioperative complications (1.5, does not represent a predisposing risk factor to complications ( P = 0.006. Conclusion: Surgical decision-making and exclusion of patients is not justified only

Bias in the physical examination of patients with lumbar radiculopathy

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Katz Jeffrey N

2010-11-01

Full Text Available Abstract Background No prior studies have examined systematic bias in the musculoskeletal physical examination. The objective of this study was to assess the effects of bias due to prior knowledge of lumbar spine magnetic resonance imaging findings (MRI on perceived diagnostic accuracy of the physical examination for lumbar radiculopathy. Methods This was a cross-sectional comparison of the performance characteristics of the physical examination with blinding to MRI results (the 'independent group' with performance in the situation where the physical examination was not blinded to MRI results (the 'non-independent group'. The reference standard was the final diagnostic impression of nerve root impingement by the examining physician. Subjects were recruited from a hospital-based outpatient specialty spine clinic. All adults age 18 and older presenting with lower extremity radiating pain of duration ≤ 12 weeks were evaluated for participation. 154 consecutively recruited subjects with lumbar disk herniation confirmed by lumbar spine MRI were included in this study. Sensitivities and specificities with 95% confidence intervals were calculated in the independent and non-independent groups for the four components of the radiculopathy examination: 1 provocative testing, 2 motor strength testing, 3 pinprick sensory testing, and 4 deep tendon reflex testing. Results The perceived sensitivity of sensory testing was higher with prior knowledge of MRI results (20% vs. 36%; p = 0.05. Sensitivities and specificities for exam components otherwise showed no statistically significant differences between groups. Conclusions Prior knowledge of lumbar MRI results may introduce bias into the pinprick sensory testing component of the physical examination for lumbar radiculopathy. No statistically significant effect of bias was seen for other components of the physical examination. The effect of bias due to prior knowledge of lumbar MRI results should be considered

Bias in the physical examination of patients with lumbar radiculopathy

Science.gov (United States)

2010-01-01

Background No prior studies have examined systematic bias in the musculoskeletal physical examination. The objective of this study was to assess the effects of bias due to prior knowledge of lumbar spine magnetic resonance imaging findings (MRI) on perceived diagnostic accuracy of the physical examination for lumbar radiculopathy. Methods This was a cross-sectional comparison of the performance characteristics of the physical examination with blinding to MRI results (the 'independent group') with performance in the situation where the physical examination was not blinded to MRI results (the 'non-independent group'). The reference standard was the final diagnostic impression of nerve root impingement by the examining physician. Subjects were recruited from a hospital-based outpatient specialty spine clinic. All adults age 18 and older presenting with lower extremity radiating pain of duration ≤ 12 weeks were evaluated for participation. 154 consecutively recruited subjects with lumbar disk herniation confirmed by lumbar spine MRI were included in this study. Sensitivities and specificities with 95% confidence intervals were calculated in the independent and non-independent groups for the four components of the radiculopathy examination: 1) provocative testing, 2) motor strength testing, 3) pinprick sensory testing, and 4) deep tendon reflex testing. Results The perceived sensitivity of sensory testing was higher with prior knowledge of MRI results (20% vs. 36%; p = 0.05). Sensitivities and specificities for exam components otherwise showed no statistically significant differences between groups. Conclusions Prior knowledge of lumbar MRI results may introduce bias into the pinprick sensory testing component of the physical examination for lumbar radiculopathy. No statistically significant effect of bias was seen for other components of the physical examination. The effect of bias due to prior knowledge of lumbar MRI results should be considered when an isolated

Cerebellar Herniation after Lumbar Puncture in Galactosemic Newborn

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Salih Kalay

2011-09-01

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

Comparison of lumbar discectomy alone and lumbar discectomy with direct repair of pars defect for patients with disc herniation and spondylolysis at the nearby lumbar segment.

Science.gov (United States)

Lee, Gun Woo; Ryu, Ji Hyun; Kim, Jae-Do; Ahn, Myun-Whan; Kim, Ho-Joong; Yeom, Jin S

2015-10-01

It is unknown whether direct repair (DR) of pars defect after lumbar discectomy (LD) for patients with lumbar disc herniation (LDH) and spondylolysis leads to better outcomes than LD alone. The aim was to compare two surgical methods, LD alone and LD with DR, for LDH patients with spondylolysis at a nearby lumbar segment. This was a retrospective comparative study. This study enrolled 89 patients who were diagnosed with LDH and spondylolysis at the same or adjacent lumbar segment and were followed up for at least 1 year. The primary outcome was pain intensity of the lower back and lower extremities as measured with visual analog scale. Secondary outcomes included clinical outcomes as assessed with the Oswestry Disability Index and the 12-item short form health survey, radiologic outcomes as assessed with the gap distance and the union rate at the pars defect, surgical outcomes, and complications. Enrolled patients were classified into two groups: LD alone (Group A, 48 patients) and LD with DR (Group B, 41 patients). Pain intensity of the lower back and lower extremities and clinical outcomes were significantly improved 1 year after surgery compared with preoperative scores. However, the scores in the group receiving LD alone steadily worsened during follow-up, whereas the scores in the group receiving LD with DR did not deteriorate over time. The difference in the gap distance of the pars defect between baseline and 1 year after surgery was significantly different between the groups. The fusion rate of the pars defect was 59% (24/41). With the exception of surgical time, which was longer in Group B, surgical outcomes and complications did not differ significantly between the groups. At the 1-year follow-up, DR after LD was associated with better outcomes for LDH with spondylolysis than LD alone. Copyright © 2015 Elsevier Inc. All rights reserved.

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

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

2013-03-01

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

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

Science.gov (United States)

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

2014-07-01

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

Flexion relaxation of the hamstring muscles during lumbar-pelvic rhythm.

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Sihvonen, T

1997-05-01

This study investigated the simultaneous activity of back muscles and hamstring muscles during sagittal forward body flexion and extension in healthy persons. The study was cross-sectional. A descriptive study of paraspinal and hamstring muscle activity in normal persons during lumbar-pelvic rhythm. A university hospital. Forty healthy volunteers (21 men, 19 women, ages 17 to 48 years), all without back pain or other pain syndromes. Surface electromyography (EMG) was used to follow activities in the back and the hamstring muscles. With movement sensors, real lumbar flexion was separated from simultaneous pelvic motion by monitoring the components of motion with a two-inclinometer method continuously from the initial upright posture into full flexion. All signals were sampled during real-time monitoring for off-line analyses. Back muscle activity ceased (ie, flexion relaxation [FR] occurred) at lumbar flexion with a mean of 79 degrees. Hamstring activity lasted longer and EMG activity ceased in the hamstrings when nearly full lumbar flexion (97%) was reached. After this point total flexion and pelvic flexion continued further, so that the last part of lumbar flexion and the last part of pelvic flexion happened without back muscle activity or hamstring bracing, respectively. FR of the back muscles during body flexion has been well established and its clinical significance in low back pain has been confirmed. In this study, it was shown for the first time that the hip extensors (ie, hamstring muscles) relax during forward flexion but with different timing. FR in hamstrings is not dependent on or coupled firmly with back muscle behavior in spinal disorders and the lumbar pelvic rhythm can be locally and only partially disturbed.

Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis: Clinical article.

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Gologorsky, Yakov; Skovrlj, Branko; Steinberger, Jeremy; Moore, Max; Arginteanu, Marc; Moore, Frank; Steinberger, Alfred

2014-10-01

Transforaminal lumbar interbody fusion (TLIF) with segmental pedicular instrumentation is a well established procedure used to treat lumbar spondylosis with or without spondylolisthesis. Available biomechanical and clinical studies that compared unilateral and bilateral constructs have produced conflicting data regarding patient outcomes and hardware complications. A prospective cohort study was undertaken by a group of neurosurgeons. They prospectively enrolled 80 patients into either bilateral or unilateral pedicle screw instrumentation groups (40 patients/group). Demographic data collected for each group included sex, age, body mass index, tobacco use, and Workers' Compensation/litigation status. Operative data included segments operated on, number of levels involved, estimated blood loss, length of hospital stay, and perioperative complications. Long-term outcomes (hardware malfunction, wound dehiscence, and pseudarthrosis) were recorded. For all patients, preoperative baseline and 6-month postoperative scores for Medical Outcomes 36-Item Short Form Health Survey (SF-36) outcomes were recorded. Patient follow-up times ranged from 37 to 63 months (mean 52 months). No patients were lost to follow-up. The patients who underwent unilateral pedicle screw instrumentation (unilateral cohort) were slightly younger than those who underwent bilateral pedicle screw instrumentation (bilateral cohort) (mean age 42 vs. 47 years, respectively; p = 0.02). No other significant differences were detected between cohorts with regard to demographic data, mean number of lumbar levels operated on, or distribution of the levels operated on. Estimated blood loss was higher for patients in the bilateral cohort, but length of stay was similar for patients in both cohorts. The incidence of pseudarthrosis was significantly higher among patients in the unilateral cohort (7 patients [17.5%]) than among those in the bilateral cohort (1 patient [2.5%]) (p = 0.02). Wound dehiscence occurred for

Ureteral Stenting after Uncomplicated Ureteroscopy for Distal Ureteral Stones: A Randomized, Controlled Trial

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Y. El Harrech

2014-01-01

Full Text Available Objectives. We compared outcome and complications after uncomplicated ureteroscopic treatment of distal ureteral calculi with or without the use of ureteral stents. Materials and Methods. 117 patients, prospectively divided into three groups to receive a double j stent (group 1, 42 patients, ureteral stent (group 2, 37 patients, or no stent (group 3, 38 patients, underwent ureteroscopic treatment of distal ureteral calculi. Stone characteristics, operative time, postoperative pain, lower urinary tract symptoms (LUTS, analgesia need, rehospitalization, stone-free rate, and late postoperative complications were all studied. Results. There were no significant differences in preoperative data. There was no significant difference between the three groups regarding hematuria, fever, flank pain, urinary tract infection, and rehospitalisation. At 48 hours and 1 week, frequency/urgency and dysuria were significantly less in the nonstented group. When comparing group 1 and group 3, patients with double j stents had statistically significantly more bladder pain (P=0.003, frequency/urgency (P=0.002, dysuria (P=0.001, and need of analgesics (P=0.001. All patients who underwent imaging postoperatively were without evidence of obstruction or ureteral stricture. Conclusions. Uncomplicated ureteroscopy for distal ureteral calculi without intraoperative ureteral dilation can safely be performed without placement of a ureteral stent.

Recurrent back pain after diskectomy: MRI findings MR of the postoperative lumbar spine; Recurrencia del dolor lumbar en la columna operada: Hallazgos en Resonancia Magnetica

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Aparicio, Rocio; Eguren, Leonor Z; Schinder, Humberto; Stur, Mariela [CIMA, Sanatorio Mapaci, Rosario, Santa Fe (Argentina)

2008-07-01

Purpose: To show the morphological changes in postoperative lumbar spine. Material and methods: We reviewed 128 Magnetic Resonance Imaging (MRI) studies of lumbar spine. All patients complained of low back pain and had a previous lumbar surgery (1 month to 8 years). All the examinations include axial and sagittal Gadopentate-dimeglumine enhanced T1 weighted imaging. Results: Only 7,8% have the normal appearance of the postoperative lumbar spine. Epidural scar was found in 69% of examinations; of this group, 72% showed radicular involvement, and 28% had no radicular involvement. Recurrent disc herniation was found in 14,8% of exams, using gadopentate-dimeglumine to assist the differentiation from epidural fibrosis; infections like spondylodiscitis and abscess in 12,5%. Other findings included arachnoiditis, pseudomeningoceles and seromas. Conclusions: MRI is a useful method to study the postoperative lumbar spine, specially when enhanced with gadopentate-dimeglumine. Enhanced images can differentiate two of the major complication like epidural fibrosis, and recurrent disc herniation. Spondylodiscitis are important and frequent too. Although the findings of complications in our series in the postoperative lumbar spine represent 92,18 %, these not always explain the symptomatology. Therefore, the interrelation is important with the surgeon to determine which abnormalities are clinically significant. (authors) [Spanish] Objetivo: Mostrar los hallazgos evidenciados en Resonancia Magnetica (RM) en pacientes operados de columna lumbar. Material y metodos: Se evaluaron retrospectivamente 128 estudios de RM de columna lumbar. Todos los pacientes consultaron por dolor lumbar y tenian antecedentes quirurgicos de un tiempo de evolucion que variaba entre 1 mes y 8 anos. En todos los casos el protocolo de estudio incluyo secuencias axiales y sagitales T1 con gadolinio, ademas del protocolo habitual. Resultados: Solo el 7,8 % de los estudios mostro los hallazgos postoperatorios

Clinical And Surgical Anatomy Of Lumbar Hernia: A Review

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João Victor Souza Sanders

2017-10-01

Full Text Available Lumbar hernia is defined as the presence of failure in the transverse fascia or in the aponeurosis of the transverse abdominal muscle that results in the extrusion of intra or extra peritoneal organs through the discontinuity of the postero lateral abdominal wall. The aim of this study was to conduct a methodical review of the anatomy of the hernia form grynfelt dated from 2006 to 2017. For this, we performed a bibliographic review by means of electronic databases like SciELO, PubMed, Science Direct, LILACS and Bireme to get better approach to the subject. It has been found that the lumbar hernia is a disease little known by doctors whose diagnostics are often performed in the wrong way and for surgical correction needs a good anatomical knowledge. Lumbar hernias, although rare, must be taken into account, since ischemia of herniated intestinal segments can lead to the death of the patient, especially in the elderly. Knowledge about the anatomy of the lumbar region is of vital importance because it makes surgery safe and reduces risks of complications and recidivating of the hernia.

Assisted autogenic drainage in infants and young children hospitalized with uncomplicated pneumonia, a pilot study.

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Corten, Lieselotte; Jelsma, Jennifer; Human, Anri; Rahim, Sameer; Morrow, Brenda M

2018-01-01

Pneumonia is the most important respiratory problem in low-to-middle income countries. Airway clearance therapy continues to be used in children with pneumonia and secretion retention; however, there is lack of evidence to support or reject this treatment. This study aimed to investigate the feasibility of a randomized controlled trial (RCT) on the efficacy and safety of assisted autogenic drainage (AAD) compared to standard nursing care in children hospitalized with uncomplicated pneumonia. A single-blinded pilot RCT was conducted on 29 children (median age 3.5 months, IQR 1.5-9.4) hospitalized with uncomplicated pneumonia. The intervention group received standard nursing care with additional bi-daily AAD, for 10 to 30 min. The control group only received standard nursing care, unless otherwise deemed necessary by the physician or physiotherapist. The primary outcome measure was duration of hospitalization. The secondary outcome measures included days of fever and supplemental oxygen support; respiratory rate (RR) and heart rate adjusted for age; RR and oxygen saturation pre-, post-, and 1-hr post-treatment; oxygen saturation; adverse events; and mortality. No difference was found for duration of hospitalization (median 7.5 and 7.0 days for the control and intervention groups, respectively); however, Kaplan-Meier analysis revealed a strong tendency towards a shorter time to discharge in the intervention group (p = .06). No significant differences were found for the other outcome measures at time of discharge. No adverse events were reported. Within the intervention group, a significant reduction in RR adjusted for age was found. As no adverse events were reported, and AAD did not prolong hospitalization; AAD might be considered as safe and effective in young children with uncomplicated pneumonia. However, a larger multicentred RCT is warranted to determine the efficacy of AAD compared to standard nursing care. Copyright © 2017 John Wiley & Sons, Ltd.

Tophaceous gout causing lumbar stenosis: A case report.

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

2017-08-01

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

Lumbar Posterior Apophyseal Ring Fracture Combined with Spondylolysis in Pediatric Athletes: A Report of Three Cases.

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Tamaki, Shunsuke; Yamashita, Kazuta; Higashino, Kosaku; Sakai, Toshinori; Takata, Yoichiro; Sairyo, Koichi

2016-01-01

Lumbar posterior apophyseal ring fracture is an uncommon finding in children, but lumbar spondylolysis is a common disorder. Both disorders are prevalent in young athletes. We describe 3 adolescent athletes who showed both lumbar spondylolysis and lumbar posterior apophyseal ring fracture. Because lumbar spondylolysis is comparatively easy to diagnose, a concurrent posterior lumbar apophyseal ring fracture is likely to be overlooked. In patients with severe low back and radicular pain in whom spondylolysis is suspected, it is important to perform not only magnetic resonance imaging and radiography but also computed tomography for identifying posterior apophyseal ring fractures.

Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

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Ninomiya, Koshi; Iwatsuki, Koichi; Ohnishi, Yu-ichiro; Ohkawa, Toshika; Yoshimine, Toshiki

2014-01-01

A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to...

Solitary osteochondroma arising in lumbar spinous process: Case report

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Khaled Hadhri

2016-12-01

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

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

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Guang HAN

2016-04-01

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

The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes.

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Blizzard, Daniel J; Sheets, Charles Z; Seyler, Thorsten M; Penrose, Colin T; Klement, Mitchell R; Gallizzi, Michael A; Brown, Christopher R

2017-05-01

Concomitant spine and hip disease in patients undergoing total hip arthroplasty (THA) presents a management challenge. Degenerative lumbar spine conditions are known to decrease lumbar lordosis and limit lumbar flexion and extension, leading to altered pelvic mechanics and increased demand for hip motion. In this study, the effect of lumbar spine disease on complications after primary THA was assessed. The Medicare database was searched from 2005 to 2012 using International Classification of Diseases, Ninth Revision, procedure codes for primary THA and diagnosis codes for preoperative diagnoses of lumbosacral spondylosis, lumbar disk herniation, acquired spondylolisthesis, and degenerative disk disease. The control group consisted of all patients without a lumbar spine diagnosis who underwent THA. The risk ratios for prosthetic hip dislocation, revision THA, periprosthetic fracture, and infection were significantly higher for all 4 lumbar diseases at all time points relative to controls. The average complication risk ratios at 90 days were 1.59 for lumbosacral spondylosis, 1.62 for disk herniation, 1.65 for spondylolisthesis, and 1.53 for degenerative disk disease. The average complication risk ratios at 2 years were 1.66 for lumbosacral spondylosis, 1.73 for disk herniation, 1.65 for spondylolisthesis, and 1.59 for degenerative disk disease. Prosthetic hip dislocation was the most common complication at 2 years in all 4 spinal disease cohorts, with risk ratios ranging from 1.76 to 2.00. This study shows a significant increase in the risk of complications following THA in patients with lumbar spine disease. [Orthopedics. 2017; 40(3):e520-e525.]. Copyright 2017, SLACK Incorporated.

Deformation Measurement Of Lumbar Vertebra By Holographic Interferometry

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

1988-01-01

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

Effect of total lumbar disc replacement on lumbosacral lordosis.

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Kasliwal, Manish K; Deutsch, Harel

2012-10-01

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

Characteristics of lumbar spondylolysis in elementary school age children.

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Sakai, Toshinori; Goda, Yuichiro; Tezuka, Fumitake; Takata, Yoichiro; Higashino, Kosaku; Sato, Masahiro; Mase, Yasuyoshi; Nagamachi, Akihiro; Sairyo, Koichi

2016-02-01

Lumbar spondylolysis, a stress fracture of the pars interarticularis in the lumbar spine, is often precipitated by trauma, but there may be a congenital predisposition to this condition. There have been few studies on spondylolysis in young children, despite their suitability for studies on congenital defects. The aim of this study was to identify the clinical features of lumbar spondylolysis in elementary school age children in order to elucidate its pathogenesis. Thirty lumbar spondylolysis patients (23 boys, 7 girls, including a pair of twins; mean age 9.5 years, age range 5-12 years) were studied. Patient data on history of athletic activity, symptoms at first consultation, and radiological findings such as spinal level, stage of the stress fracture, and skeletal age were collected. Among the 30 patients, 27 (21 boys, 6 girls) had L5 spondylolysis (90.0 %). Only 2 patients had no history of athletic activity at the first consultation. All patients, except for 2 whose diagnosis was incidental, complained of low back pain. In the 27 patients with L5 spondylolysis, 17 (63.0 %) had terminal-stage fracture and 25 (92.6 %) had spina bifida occulta (SBO) involving the S1 lamina. Sixteen of the 27 (59.3 %) had SBO involving the affected lamina (L5) and S1 lamina. In contrast, the 3 patients with L3 or L4 spondylolysis had no evidence of SBO. With respect to skeletal age, 23 of the 27 L5 spondylolysis patients (85.2 %) were in the cartilaginous stage while the remaining 4 patients were in the apophyseal stage. Lumbar spondylolysis in elementary school age children was commonly a terminal-stage bone defect at L5, which was not necessarily related to history of athletic activity and was sometimes asymptomatic. It was often associated with SBO, indicating a possible congenital predisposition. These findings may provide further insight into the pathogenesis of lumbar spondylolysis.

Alternative approaches to conventional treatment of acute uncomplicated urinary tract infection in women.

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Foxman, Betsy; Buxton, Miatta

2013-04-01

The increasing resistance of uropathogens to antibiotics and recognition of the generally self-limiting nature of uncomplicated urinary tract infection (UTI) suggest that it is time to reconsider empirical treatment of UTI using antibiotics. Identifying new and effective strategies to prevent recurrences and alternative treatment strategies are a high priority. We review the recent literature regarding the effects of functional food products, probiotics, vaccines, and alternative treatments on treating and preventing UTI.

Incidence and etiology of lumbar spondylolysis: review of the literature.

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Sakai, Toshinori; Sairyo, Koichi; Suzue, Naoto; Kosaka, Hirofumi; Yasui, Natsuo

2010-05-01

Lumbar spondylolysis is a defect of the pars interarticularis known to occur as a stress fracture. Its incidence varies considerably depending on ethnicity, sex, and sports activity. However, there are few literature reviews describing its incidence in different ethnic groups or in people who engage in different sports. We reviewed the most relevant articles on spondylolysis published in scientific journals. First, we focused on its incidence in various ethnic groups distributed by sex, the familial occurrence, and in patients with relevant diseases. Second, we focused on the incidence of spondylolysis in relation to the sports practiced by the patients. Although placing special emphasis on the incidence of lumbar spondylolysis in the general population in Japan, we also reviewed the Japanese and English literature to investigate its incidence among those who engage in different sports. The incidence of lumbar spondylolysis in the general Japanese population was 5.9%. Most studies report that the incidence in higher in male subjects than in female subjects. We found that Japanese rugby and judo players were prone to suffer lumbar spondylolysis, at an incidence of about 20%. However, the incidence for Japanese professional soccer and baseball players was much higher, at 30%, which was more than five times the incidence in the general Japanese population. The incidence of lumbar spondylolysis varies depending on ethnicity, sex, family history, relevant disease, and sports activity.

[Effect evaluation of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for lumbar degenerative diseases].

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Wang, Chong; Ying, Jin-He; Xie, Pan-Pan; Wu, Xiao-Guang

2016-07-25

To evaluate the clinical effects of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion(TLIF) in treating lumbar degenerative diseases. The clinical data of 24 patients with lumbar degenerative disease underwent unilateral pedicle screw fixation with transforaminal lumbar interbody fusion from March 2007 to October 2009, were retrospectively analyzed. There were 13 males and 11 females, aged from 34 to 68 years old with an average of 52 years. Postoperative pain and functional results were analyzed by the visual analogue scale(VAS) and Oswestry Disability Index(ODI). Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and general complications. All patients were followed up from 5 to 8 years with an average of 6.7 years. VAS scores of low back pain and leg pain decreased from preoperative 7.82±0.71, 8.42±1.24 to postoperative 1.87±0.81, 2.23±1.62, respectively( P degenerative diseases according to over 5 year follow up, however, its indications should be well considered. But the problems such as intervertebral space height of operated side loss and adjacent segment degeneration after unilateral pedicle screw fixation need further clinical study.

Adherence to CDC Recommendations for the Treatment of Uncomplicated Gonorrhea - STD Surveillance Network, United States, 2016.

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Weston, Emily J; Workowski, Kimberly; Torrone, Elizabeth; Weinstock, Hillard; Stenger, Mark R

2018-04-27

Gonorrhea, the sexually transmitted disease (STD) caused by Neisseria gonorrhoeae, is the second most common notifiable disease in the United States after chlamydia; 468,514 cases were reported to state and local health departments in 2016, an increase of 18.5% from 2015 (1). N. gonorrhoeae has progressively developed resistance to most antimicrobials used to treat the infection (2). As a result, CDC recommends two antimicrobials (250 mg of ceftriaxone [IM] plus 1 g of azithromycin [PO]) for treating uncomplicated gonorrhea to improve treatment efficacy and, potentially, to slow the emergence and spread of antimicrobial resistance. To monitor adherence to the current CDC-recommended regimen for uncomplicated gonorrhea, CDC reviewed enhanced data collected on a random sample of reported cases of gonorrhea in seven jurisdictions participating in the STD Surveillance Network (SSuN) and estimated the proportion of patients who received the CDC-recommended regimen for uncomplicated gonorrhea, by patient characteristics and diagnosing facility type. In 2016, the majority of reported patients with gonorrhea (81%) received the recommended regimen. There were no differences in the proportion of patients receiving the recommended regimen by age or race/ethnicity; however, patients diagnosed with gonorrhea in STD (91%) or family planning/reproductive health (94%) clinics were more likely to receive this regimen than were patients diagnosed in other provider settings (80%). These data document high provider adherence to CDC gonorrhea treatment recommendations in specialty STD clinics, indicating high quality of care provided in those settings. Local and state health departments should monitor adherence with recommendations in their jurisdictions and consider implementing interventions to improve provider and patient compliance with gonorrhea treatment recommendations where indicated.

The neurological assessment in young children treated with artesunate monotherapy or artesunate-mefloquine combination therapy for uncomplicated Plasmodium falciparum malaria

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Singhasivanon Pratap

2009-09-01

Full Text Available Abstract Background Mefloquine and artesunate combination therapy is the recommended first-line treatment for uncomplicated malaria throughout much of south-east Asia. Concerns have been raised about the potential central nervous system (CNS effects of both drug components and there are no detailed reports in very young children. Methods Children, aged between three months and five years, with acute uncomplicated Plasmodium falciparum malaria were randomized to either 7 days of artesunate monotherapy or the same schedule of artesunate plus mefloquine on day 7 and 8. Neurological testing targeting coordination and behaviour was carried out at day 0, 7, 9, 10, 14 and 28. Non-febrile healthy control children from the same population were tested on days 0, 7, 14 and 28. Results From December 1994 to July 1997, 91 children with uncomplicated P. falciparum, 45 treated with artesunate monotherapy, 46 treated with mefloquine and artesunate combination therapy and 36 non-febrile controls, underwent neurological testing. Malaria and fever had a significant negative impact on testing performance. By contrast, the anti-malarial treatments were not associated with worsening performances in the various components of the test. Artesunate and mefloquine do not appear to have a significant influence on coordination and behaviour. Children treated with mefloquine were significantly less likely to suffer recurrent malaria infection during follow-up compared to those treated with artesunate alone (P = 0.033. Conclusion In keeping with the results of randomized controlled trials in adults, mefloquine was not associated with a decrease in specific items of neurological performance. Likewise, children treated with artesunate did not perform significantly differently to control children. This study does not exclude subtle or rare treatment CNS effects of artesunate or mefloquine. Treatment of acute uncomplicated malaria results in a significant improvement on items of

Economic evaluation of antibiotic therapy versus appendicectomy for the treatment of uncomplicated acute appendicitis from the APPAC randomized clinical trial.

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Sippola, S; Grönroos, J; Tuominen, R; Paajanen, H; Rautio, T; Nordström, P; Aarnio, M; Rantanen, T; Hurme, S; Salminen, P

2017-09-01

An increasing amount of evidence supports antibiotic therapy for treating uncomplicated acute appendicitis. The objective of this study was to compare the costs of antibiotics alone versus appendicectomy in treating uncomplicated acute appendicitis within the randomized controlled APPAC (APPendicitis ACuta) trial. The APPAC multicentre, non-inferiority RCT was conducted on patients with CT-confirmed uncomplicated acute appendicitis. Patients were assigned randomly to appendicectomy or antibiotic treatment. All costs were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis during the 1-year follow-up. The cost estimates were based on cost levels for the year 2012. Some 273 patients were assigned to the appendicectomy group and 257 to antibiotic treatment. Most patients randomized to antibiotic treatment did not require appendicectomy during the 1-year follow-up. In the operative group, overall societal costs (€5989·2, 95 per cent c.i. 5787·3 to 6191·1) were 1·6 times higher (€2244·8, 1940·5 to 2549·1) than those in the antibiotic group (€3744·4, 3514·6 to 3974·2). In both groups, productivity losses represented a slightly higher proportion of overall societal costs than all treatment costs together, with diagnostics and medicines having a minor role. Those in the operative group were prescribed significantly more sick leave than those in the antibiotic group (mean(s.d.) 17·0(8·3) (95 per cent c.i. 16·0 to 18·0) versus 9·2(6·9) (8·3 to 10·0) days respectively; P antibiotic therapy for uncomplicated appendicitis incurred lower costs than those who had surgery. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

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

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Altinkaya, Naime; Cekinmez, Melih

2016-01-01

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

The long-term therapeutic effect of central lumbar intervertebral disc herniation: a comparison between microendoscopy discectomy and percutaneous lumbar discectomy

International Nuclear Information System (INIS)

Li Yonggang; Wei Jinan; Lu Jun; Wang Chen; Wu Xiaotao; He Shicheng; Teng Gaojun

2012-01-01

Objective: To discuss the indications, long-term outcomes and complications of microendoscopy discectomy (MED) and percutaneous lumbar discectomy (PLD) in treating central lumbar intervertebral disc herniation, and to compare the advantages of the two procedures. Methods: During the period from Jan. 2001 to March 2002 surgical procedure was carried out in sixty-three patients with single central lumbar disc herniation. The surgeries included MED (n=23) and PLD (n=40). The clinical data were retrospectively analyzed. The lesion site, the operation time, the blood loss in operation, the time staying in bed, the hospitalization cost and the postoperative hospitalization days were recorded. Oswestry disability index (ODI) and MacNab score were determined. Statistical analysis was performed by using pair sample t-test, κ-test and Fisher exact test. All patients were followed up. Results: A mean follow-up time was (5.1±0.6) years for patients receiving MED and (6.6±0.7) years for patients receiving PLD. The ODI and MacNab scores of patients receiving MED were better than these of patients receiving PLD. The hospitalization cost and the postoperative hospitalization days of MED group was higher and longer than these of PLD group, the differences between the two groups were statistically significant. The occurrence of long-term complication in MED group was 3.49%, while no complication was seen in PLD group. Conclusion: For the treatment of central lumbar intervertebral disc herniation, both MED and PLD are safe and minimally-invasive procedures with satisfactory long-term effectiveness, and the patients recover from clinical symptoms quickly. The PLD has used more common than MED. The performance of MED needs more skill and experience. Therefore, an interventional radiologist has to follow a relatively long learning curve in order to get the sufficient training and practice before he or she can master the technique of MED with full confidence. However, the long

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

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

2017-01-01

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

Manual therapy treatment of lumbar radiculopathy: A single case report

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J.A. Riley

2011-01-01

Full Text Available Patients  with  lumbar  radiculopathy  are  often  managed with  manual therapy.  The  aim  of  this  single  case  study  was  to  describe  the outcome of manual therapy treatment of a patient with lumbar radiculopathy.  A 47-year-old female presented with acute, severe left buttock and postero-lateral thigh pain.  Symptom provocation occurred during lumbar flexion, coughing, sneezing, driving and prolonged sitting. her left straight leg raise neurodynamic test was limited and reproduced her pain, as did trigger points in the left lumbar and gluteal muscles. clinical neuro-conduction testing revealed weakness of the big and other toe extensors, as well as eversion and plantar flexion of the left ankle, and a diminished left ankle reflex. This indicated possible involvement of both the l5 and S1 nerve roots.   A  manual  therapy  treatment  approach including  lumbar rotation mobilisations (Maitland approach, massage, trigger point pressure release  and  Transversus  Abdominus muscle activation  was  used.   The  patient  was  symptom  free,  had  full pain-free  range  of  all  lumbar  movements,  a full  pain-free  left  straight leg  raise  neurodynamic  test  and  normal  neurological  conduction  six weeks  after  onset, following seven manual therapy treatments.  Although the results of this case report cannot be generalised, it describes the successful outcome of a patient with severe radicular pain and neurological deficits, whose signs and symptoms  had completely resolved following manual therapy treatment.

Prospective analysis of convalescence and early pain after uncomplicated laparoscopic fundoplication

DEFF Research Database (Denmark)

Bisgaard, T; Støckel, M; Klarskov, B

2004-01-01

fundoplication for gastro-oesophageal reflux disease. Patients were recommended to convalesce for 2 days after operation. Duration of convalescence, dysphagia, fatigue, nausea, vomiting and different pain components were registered daily during the first week and on days 10 and 30 after fundoplication. RESULTS...... or severe dysphagia during the study period. Fatigue scores were significantly increased for 6 days after surgery (P ... and dysphagia are significant problems after uncomplicated total laparoscopic fundoplication. The time taken off work and away from recreational activity exceeded the recommended 2 days of convalescence, justifying further efforts to optimize early clinical outcome after total laparoscopic fundoplication....

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

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Theodoros B. Grivas

2016-10-01

Full Text Available Abstract Background The historical view of scoliosis as a primary rotation deformity led to debate about the pathomechanic role of paravertebral muscles; particularly multifidus, thought by some to be scoliogenic, counteracting, uncertain, or unimportant. Here, we address lateral lumbar curves (LLC and suggest a pathomechanic role for quadrates lumborum, (QL in the light of a new finding, namely of 12th rib bilateral length asymmetry associated with idiopathic and small non-scoliosis LLC. Methods Group 1: The postero-anterior spinal radiographs of 14 children (girls 9, boys 5 aged 9–18, median age 13 years, with right lumbar idiopathic scoliosis (IS and right LLC less that 10°, were studied. The mean Cobb angle was 12° (range 5–22°. Group 2: In 28 children (girls 17, boys 11 with straight spines, postero-anterior spinal radiographs were evaluated similarly to the children with the LLC, aged 8–17, median age 13 years. The ratio of the right/left 12th rib lengths and it’s reliability was calculated. The difference of the ratio between the two groups was tested; and the correlation between the ratio and the Cobb angle estimated. Statistical analysis was done using the SPSS package. Results The ratio’s reliability study showed intra-observer +/−0,036 and the inter-observer error +/−0,042 respectively in terms of 95 % confidence limit of the error of measurements. The 12th rib was longer on the side of the curve convexity in 12 children with LLC and equal in two patients with lumbar scoliosis. The 12th rib ratios of the children with lumbar curve were statistically significantly greater than in those with straight spines. The correlation of the 12th rib ratio with Cobb angle was statistically significant. The 12th thoracic vertebrae show no axial rotation (or minimal in the LLC and no rotation in the straight spine group. Conclusions It is not possible, at present, to determine whether the 12th convex rib lengthening is

AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion

OpenAIRE

Block, Jon; Rapp,; Miller,Larry E.

2011-01-01

Steven M Rapp1, Larry E Miller2,3, Jon E Block31Michigan Spine Institute, Waterford, MI, USA; 2Miller Scientific Consulting Inc, Biltmore Lake, NC, USA; 3Jon E. Block, Ph.D., Inc., San Francisco, CA, USAAbstract: Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, post...

Technological advances and changing indications for lumbar puncture in neurological disorders

NARCIS (Netherlands)

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

2018-01-01

Technological advances have changed the indications for and the way in which lumbar puncture is done. Suspected CNS infection remains the most common indication for lumbar puncture, but new molecular techniques have broadened CSF analysis indications, such as the determination of neuronal

Lumbo-costo-vertebral syndrome with congenital lumbar hernia.

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Gupta, Lucky; Mala, Tariq Ahmed; Gupta, Rahul; Malla, Shahid Amin

2014-01-01

Lumbo-costo-vertebral syndrome (LCVS) is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side. Meshplasty was done.

Prevalence of lumbar spondylosis and its association with low back pain among community-dwelling Japanese women.

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Tsujimoto, Ritsu; Abe, Yasuyo; Arima, Kazuhiko; Nishimura, Takayuki; Tomita, Masato; Yonekura, Akihiko; Miyamoto, Takashi; Matsubayashi, Shohei; Tanaka, Natsumi; Aoyagi, Kiyoshi; Osaki, Makoto

2016-12-01

Lumbar spondylosis is more prevalent among the middle-aged and elderly, but few population-based studies have been conducted, especially in Japan. The purpose of this study was to explore the prevalence of lumbar spondylosis and its associations with low back pain among community-dwelling Japanese women. Lateral radiographs of the lumbar spine were obtained from 490 Japanese women ≥ 40 years old, and scored for lumbar spondylosis using the Kellgren-Lawrence (KL) grade at lumbar intervertebral level from L1/2 to L5/S1. Height and weight were measured, and body mass index (BMI) was calculated. Low back pain in subjects was assessed using a self-administered questionnaire. Stiffness index (bone mass) was measured at the calcaneal bone using quantitative ultrasound. Prevalence of radiographic lumbar spondylosis for KL ≥ 2, KL ≥ 3 and low back pain were 76.7%, 38.8% and 20.0%, respectively. Age was positively associated with radiographic lumbar spondylosis (KL = 2, KL ≥ 3) and low back pain. Greater BMI was associated with lumbar spondylosis with KL = 2, but not with KL ≥ 3. Stiffness index was associated with neither radiographic lumbar spondylosis nor low back pain. Multiple logistic regression analysis identified radiographic lumbar spondylosis (KL ≥ 3) at L3/4, L4/5 and L5/S1 was associated with low back pain, independent of age, BMI and stiffness index. Severe lumbar spondylosis at the middle or lower level may contribute to low back pain.

Discography

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... older. Degeneration is associated with the loss of water in the disc and decreased disc height. These changes may be painful. Typical symptoms related to disc degeneration are neck or back pain and sometimes pain in the lower limbs. Severe degeneration may cause pain when the spine ...

Evidence for Dietary Fibre Modification in the Recovery and Prevention of Reoccurrence of Acute, Uncomplicated Diverticulitis: A Systematic Literature Review

Science.gov (United States)

Dahl, Camilla; Crichton, Megan; Jenkins, Julie; Nucera, Romina; Mahoney, Sophie; Marx, Wolfgang

2018-01-01

In practice, nutrition recommendations vary widely for inpatient and discharge management of acute, uncomplicated diverticulitis. This systematic review aims to review the evidence and develop recommendations for dietary fibre modifications, either alone or alongside probiotics or antibiotics, versus any comparator in adults in any setting with or recently recovered from acute, uncomplicated diverticulitis. Intervention and observational studies in any language were located using four databases until March 2017. The Cochrane Risk of Bias tool and GRADE were used to evaluate the overall quality of the evidence and to develop recommendations. Eight studies were included. There was “very low” quality evidence for comparing a liberalised and restricted fibre diet for inpatient management to improve hospital length of stay, recovery, gastrointestinal symptoms and reoccurrence. There was “very low” quality of evidence for using a high dietary fibre diet as opposed to a standard or low dietary fibre diet following resolution of an acute episode, to improve reoccurrence and gastrointestinal symptoms. The results of this systematic review and GRADE assessment conditionally recommend the use of liberalised diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis. It also strongly recommends a high dietary fibre diet aligning with dietary guidelines, with or without dietary fibre supplementation, after the acute episode has resolved. PMID:29382074

The impact of sarcopenia on the results of lumbar spinal surgery

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Hiroyuki Inose

2018-03-01

Full Text Available Objectives: As the population ages, the number of lumbar spinal surgeries performed on sarcopenic patients will increase. The purpose of this study was to investigate the prevalence of sarcopenia and evaluated its impact on the results of lumbar spinal surgery. Methods: This study included 2 groups: One group consisted of patients who underwent whole-body dual-energy X-ray absorptiometry (DXA scanning before the option of undergoing surgery for lumbar spinal disease (LSD group and a second group consisted of patients underwent DXA scanning for osteoporosis screening under hospital watch at the geriatric medicine department (control group. In order to evaluate the impact of sarcopenia on the clinical outcome of lumbar spinal surgery, the Japanese Orthopedic Association (JOA score, the recovery rate based on the JOA score, and visual analogue scale (VAS scores for lower back pain, lower extremity pain, and lower extremity numbness were compared within the LSD group. Results: The prevalence of sarcopenia showed no statistical difference between groups (control group, 50.7%; LSD group, 46.5%. In the LSD group, while the changes in VAS scores showed no statistical difference between the nonsarcopenia subgroup and sarcopenia subgroup, the sarcopenia subgroup demonstrated inferior JOA scores and recovery rates at the final follow-up when compared with the nonsarcopenia subgroup (P < 0.05. Conclusions: This study demonstrated a high prevalence of sarcopenia among the elderly populations in Japan and a negative impact of sarcopenia on clinical outcomes after lumbar spinal surgery. Keywords: Lumbar canal stenosis, Sarcopenia

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

Science.gov (United States)

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

2016-08-22

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

A fixed-dose 24-hour regimen of artesunate plus sulfamethoxypyrazine-pyrimethamine for the treatment of uncomplicated Plasmodium falciparum malaria in eastern Sudan

DEFF Research Database (Denmark)

Adam, Ishag; Magzoub, Mamoun; Osman, Maha E

2006-01-01

-sulfamethoxypyrazine-pyrimethamine (AS+SMP f) administered at time intervals of 12 hours for a 24-hour therapy was compared with the efficacy of the same drug given as a loose combination (AS+SMP l) with a dose interval of 24 hours for 3 days for the treatment of uncomplicated Plasmodium falciparum malaria in eastern Sudan. RESULTS...... of the patients. CONCLUSION: both regimens of AS+SMP were effective and safe for the treatment of uncomplicated P. falciparum malaria in eastern Sudan. Due to its simplicity, the fixed dose one-day treatment regimen may improve compliance and therefore may be the preferred choice....

Impact of Oral Zinc Sulfate on Uncomplicated Neonatal Jaundice

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SH Nabavizadeh

2015-09-01

Full Text Available Background & aim: Jaundice is one of the most significant problems to consider in the neonatal period. The aim of this study was to determine the impact of oral zinc sulfate on uncomplicated neonatal jaundice using comparison of effect of just phototherapy with the effect of combination of phototherapy and oral zinc sulfate.   Methods: The present double blind randomized clinical trial was carried out on 78 normal term neonates with the age of 2-7 days who were admitted for uncomplicated jaundice in neonatal ward of Imam Sajjad Hospital of Yasuj University of Medical Sciences. These infants were divided to experimental group (40 cases and control group (38 cases using block random allocation. In the control group, phototherapy was done alone and experimental group received elemental zinc orally as 10 mg daily for 5 days in combination with phototherapy.  The total bilirubin serum levels were measured at the beginning of the study , 6 hours, 12 hours, and 24 hours after the beginning of the study, discharge, and one week after discharge. The collected data were analyzed by the Chi Square test, independent t-test, and analysis of variance with repeated measurement.   Results: There were no significant statistical difference between the experimental group and control group in sex, age, birth weight, hemoglobin, reticulocyte percentage, G6PD deficiency, and of serum total bilirubin level at the beginning of study(p>0.05. Analysis of variance with repeated measurement showed that there were no significant statistical difference between the total bilirubin serum level at 6 hours, 12 hours, 24 hours after beginning of the study, discharge, and one week after discharge (p>0.05. Also, the mean of hospitalization duration was not significantly different between the two groups (p>0.05.   Conclusion: Although oral zinc salts inhibit the enterohepatic circulation of bilirubin, however probably not effective in the treatment of neonatal physiologic

Lumbar Spondylolysis and Spondylolytic Spondylolisthesis: Who Should Be Have Surgery? An Algorithmic Approach

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Ebrahimzadeh, Mohamad Hossein; Salari, Saman

2014-01-01

Lumbar spondylolysis and spondylolisthesis are common spinal disorders that most of the times are incidental findings or respond favorably to conservative treatment. In a small percentage of the patients, surgical intervention becomes necessary. Because too much attention has been paid to novel surgical techniques and new modern spinal implants, some of fundamental concepts have been forgotten. Identifying that small but important number of patients with lumbar spondylolysis or spondylolisthesis who would really benefit from lumbar surgery is one of those forgotten concepts. In this paper, we have developed an algorithmic approach to determine who is a good candidate for surgery due to lumbar spondylolysis or spondylolisthesis. PMID:25558333

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

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

2016-08-01

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

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

International Nuclear Information System (INIS)

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

2006-01-01

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

Diabetes Mellitus, a New Risk Factor for Lumbar Spinal Stenosis: A Case–Control Study

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Leila Asadian

2016-01-01

Full Text Available Objectives This study aimed to determine the prevalence of diabetes mellitus in patients with spinal stenosis and lumbar vertebral disk degeneration, and the correlation of diabetes with these diseases. Study Design This is a cross-sectional study. Methods This case–control study was performed during 2012–2014 with 110 patients suffering from lumbar spinal stenosis and 110 patients with lumbar disk herniation, who were diagnosed using clinical and radiological evidences. Additionally, 110 participants who were referred to the clinic and did not show clinical signs of degenerative diseases of the lumbar spine entered the study as a control group. Demographic data and medical histories of the patients were collected using checklists. Results A total of 50 patients (15.2% were diagnosed with diabetes, which comprised 32 (29.1% in the stenosis group, 7 (6.4% in the lumbar disk herniation group, and 11 (10% in the control group. The prevalence of diabetes in women with spinal stenosis and women with lumbar disk herniation was 35.9% and 10.3%, respectively, whereas prevalence of diabetes in women was 10.9% in the control group. This difference was statistically significant in the spinal stenosis group in comparison with the controls ( P < 0.0001. Conversely, no significant difference was found in men. Conclusions There is an association between diabetes and lumbar spinal stenosis. Diabetes mellitus may be a predisposing factor for the development of lumbar spinal stenosis.

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

Science.gov (United States)

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

2012-12-01

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

Does smoking affect the outcomes of lumbar decompression surgery?

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Mehta Radha

2017-01-01

Full Text Available Introduction: Lumbar decompressions and micro-discectomies are commonly performed non-complex spinal surgeries that do not involve the insertion of metalwork into the spine and are done for symptomatic disc prolapse and lumbar spinal stenosis, whereas complex-spinal surgery does require metalwork [1]. Studies of complex-spinal surgeries show that smoking has a significant negative impact on the outcome of the surgery [2] therefore, the cessation of smoking is advised prior to surgery [3]. There are evidences in the literature supportive as well as opposing this statement about continued smoking and poor outcome of decompressive spinal surgeries. Methods: We retrospectively reviewed 143 consecutive patients who have had either a micro-discectomy or a micro-decompression. Results: We found no statistical difference between smokers and non-smokers in the outcomes of lumbar decompression surgery. Both groups improved equally and significantly in terms of back pain, leg pain and functions. Out of 143 patients, only 2% more non-smokers had improved leg pain compared to smokers, 1% less non-smokers had improved back pain and 2% more non-smokers had an improved Oswestry Disability Index (ODI score. Discussion: We recommend that it is important to surgically treat both smokers and non-smokers in need of a lumbar spinal decompression.

Contemporary Review of Risk-Stratified Management in Acute Uncomplicated and Complicated Diverticulitis.

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Boermeester, Marja A; Humes, David J; Velmahos, George C; Søreide, Kjetil

2016-10-01

Acute colonic diverticulitis is a common clinical condition. Severity of the disease is based on clinical, laboratory, and radiological investigations and dictates the need for medical or surgical intervention. Recent clinical trials have improved the understanding of the natural history of the disease resulting in new approaches to and better evidence for the management of acute diverticulitis. We searched the Cochrane Library (years 2004-2015), MEDLINE (years 2004-2015), and EMBASE (years 2004-2015) databases. We used the search terms "diverticulitis, colonic" or "acute diverticulitis" or "divertic*" in combination with the terms "management," "antibiotics," "non-operative," or "surgery." Registers for clinical trials (such as the WHO registry and the https://clinicaltrials.gov/ ) were searched for ongoing, recruiting, or closed trials not yet published. Antibiotic treatment can be avoided in simple, non-complicated diverticulitis and outpatient management is safe. The management of complicated disease, ranging from a localized abscess to perforation with diffuse peritonitis, has changed towards either percutaneous or minimally invasive approaches in selected cases. The role of laparoscopic lavage without resection in perforated non-fecal diverticulitis is still debated; however, recent evidence from two randomised controlled trials has found a higher re-intervention in this group of patients. A shift in management has occurred towards conservative management in acute uncomplicated disease. Those with uncomplicated acute diverticulitis may be treated without antibiotics. For complicated diverticulitis with purulent peritonitis, the use of peritoneal lavage appears to be non-superior to resection.

Pre-existing lumbar spine diagnosis as a predictor of outcomes in National Football League athletes.

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Schroeder, Gregory D; Lynch, T Sean; Gibbs, Daniel B; Chow, Ian; LaBelle, Mark; Patel, Alpesh A; Savage, Jason W; Hsu, Wellington K; Nuber, Gordon W

2015-04-01

It is currently unknown how pre-existing lumbar spine conditions may affect the medical evaluation, draft status, and subsequent career performance of National Football League (NFL) players. To determine if a pre-existing lumbar diagnosis affects a player's draft status or his performance and longevity in the NFL. Cohort study; Level 3. The investigators evaluated the written medical evaluations and imaging reports of prospective NFL players from a single franchise during the NFL Scouting Combine from 2003 to 2011. Players with a reported lumbar spine diagnosis and with appropriate imaging were included in this study. Athletes were then matched to control draftees without a lumbar spine diagnosis by age, position, year, and round drafted. Career statistics and performance scores were calculated. Of a total of 2965 athletes evaluated, 414 were identified as having a pre-existing lumbar spine diagnosis. Players without a lumbar spine diagnosis were more likely to be drafted than were those with a diagnosis (80.2% vs. 61.1%, respectively, P study suggest that athletes with pre-existing lumbar spine conditions were less likely to be drafted and that the diagnosis is associated with a decrease in career longevity but not performance. Players with lumbar fusion have achieved successful careers in the NFL. © 2015 The Author(s).

Aggressive discectomy for single level lumbar disk herniation

Directory of Open Access Journals (Sweden)

Md. Kamrul Ahsan

2017-09-01

Full Text Available Aggressive open lumbar discectomy is the most commonly performed surgical procedure for patients with persistent low back and leg pain. In this retrospective study,  1,380 patients were evaluated for long-term results of aggressive discectomy for the single level lumbar disk herniation. Demographic data, surgical data, complications and reherniation rate were collected and clinical outcomes were assessed using visual analogue score (VAS, Oswestry disability index (ODI and modified Mcnab criteria. The mean follow-up period was 28.8 months. According to the modified Mcnab criteria, the long-term results were excellent in 640 cases, good in 445 cases, fair in 255 cases, and poor in 40 cases. The mean VAS scores for back and radicular pains and ODI at the end of 2 years were 1.1 ± 1.0, 1.5 ± 0.5 and 6.6 ± 3.1% respectively. The complications were foot drop (n=7, dural tear (n=14, superficial wound infection (n=17, discitis (n=37 and reherniation (n=64. The dural tear and superficial wound infections resolved after treatment but 28 discitis patients were treated by conservatively and the remaining 9 underwent surgery. Among reherniation patients, 58 underwent revision discectomy and 4 underwent transforaminal lumbar interbody fusion and stabilization. Aggressive discectomy is an effective treatment of lumbar disk herniation and maintains a lower incidence of reherniation but leads to a collapse of disc height and in long run gives rise to intervertebral instability and accelerates spondylosis.

Changes in cerebral haemodynamics in cases of post-lumbar puncture headache: a prospective transcranial Doppler ultrasound study

International Nuclear Information System (INIS)

Goebel, H.; Klostermann, H.; Lindner, V.; Schenkl, S.

1990-01-01

Transcranial Doppler ultrasonography was used in 45 patients to investigate if changes in haemodynamics in the major arteries of the brain base occurred after lumbar puncture and whether or not patients with or without post-lumbar puncture headache differ with respect to their cerebral haemodynamic parameters before and after lumbar puncture. Before lumbar puncture, patients with post-lumbar puncture headache differed from patients withoput post-lumbar puncture headache in that they showed significantly higher flow velocities and significant asymmetry of flow velocities with lateralization to the right. Patients without post-lumbar puncture headache, on the other hand, showed non-significant flow velocity lateralization to the left. Forty-eight hours after lumbar puncture, both groups demonstrated symmetrical flow velocities. In addition, only patients with post-lumbar puncture headache showed a significant reduction in the flow velocity of the right middle cerebral artery. These findings suggest that it is not only absolute flow velocity that plays a part in the event of headache; the interhemispheric relation of cerebral haemodynamics also plays a fundamental role. 14 refs., 3 figs., 2 tabs

Lumbar apophyseal ring fracture and disc herniation: CT and MRI manifestations

International Nuclear Information System (INIS)

Lee, Hyeon Kyeong; Kang, Heung Sik; Song, Chi Sung

1991-01-01

To understand CT and MR findings and, furthermore, the pathophysiology of the lumbar apophyseal ring fracture (LARF) associated with lumbar disc herniation in 31 cases of LARF (CT was performed in 23, MRI in 18, and both CT and MRI in 12), we studied the age and sex distribution of the patients, history of trauma, shape of bony fragment, number of lesions, lesion sites, associated lumbar disc herniations, and evidence of Scheuermann's disease. Twenty-three out of 31 patients were male, 6 were adolescents, 21 were young adults, and 4 were middled-aged. Arcuate or nodular bone fragment and/or bone defects were detected at the posterior margin of L1 in 2, L2 in 1, L3 in 1, L4 in 10, L5 in 20 and S1 in 7 patients. Eight patients showed multiple LARF, and 13 showed multiple lumbar disc herniations. Radiologic evidence of Scheuermann's disease was obvious in 9 patients. Only 6 patients had a history of evident trauma. CT and MRI showed a similar detection rate of bone fragments and defects. We concluded that LARF would be encountered in young male patients with multiple lumbar disc herniations and evidence of Scheuermann's disease

CONTRIBUTION OF HAMSTRING FATIGUE TO QUADRICEPS INHIBITION FOLLOWING LUMBAR EXTENSION EXERCISE

Directory of Open Access Journals (Sweden)

Joseph M. Hart

2006-03-01

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

Lumbar nerve root avulsions with secondary ipsilateral hip dysplasia in a child

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Polyzoidis, Konstandinos; Vranos, Georgios [Department of Neurosurgery, Medical School, University of Ioannina, 45110, Ioannina (Greece); Petropoulou, Calliope; Argyropoulou, Paraskevi I.; Argyropoulou, Maria I. [Department of Radiology, Medical School, University of Ioannina, 45110, Ioannina (Greece); Sarmas, Ioannis [Department of Neurology, Medical School, University of Ioannina, 45110, Ioannina (Greece)

2002-09-01

We report on an 8-year-old child with avulsions of the left L3, L4 and L5 nerve roots and traumatic meningoceles that were not associated with lumbar spine or pelvic girdle fractures. The patient had a history of a road traffic accident. Plain radiographs of the pelvis revealed left hip dysplasia. The magnetic resonance imaging findings of the lumbar spine are illustrated. The pathogenesis of lumbar nerve root avulsions and their association with ipsilateral hip dysplasia are discussed. (orig.)

Lumbar nerve root avulsions with secondary ipsilateral hip dysplasia in a child

International Nuclear Information System (INIS)

Polyzoidis, Konstandinos; Vranos, Georgios; Petropoulou, Calliope; Argyropoulou, Paraskevi I.; Argyropoulou, Maria I.; Sarmas, Ioannis

2002-01-01

We report on an 8-year-old child with avulsions of the left L3, L4 and L5 nerve roots and traumatic meningoceles that were not associated with lumbar spine or pelvic girdle fractures. The patient had a history of a road traffic accident. Plain radiographs of the pelvis revealed left hip dysplasia. The magnetic resonance imaging findings of the lumbar spine are illustrated. The pathogenesis of lumbar nerve root avulsions and their association with ipsilateral hip dysplasia are discussed. (orig.)

Mini-open transforaminal lumbar interbody fusion.

Science.gov (United States)

Tangviriyapaiboon, Teera

2008-09-01

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

Reversible audiometric threshold changes in children with uncomplicated malaria

DEFF Research Database (Denmark)

Adjei, George O; Goka, Bamenla Q; Kitcher, Emmanuel

2013-01-01

Background. Plasmodium falciparum malaria, as well as certain antimalarial drugs, is associated with hearing impairment in adults. There is little information, however, on the extent, if any, of this effect in children, and the evidence linking artemisinin combination therapies (ACTs) with hearing...... is inconclusive. Methods. Audiometry was conducted in children with uncomplicated malaria treated with artesunate-amodiaquine (n = 37), artemether-lumefantrine (n = 35), or amodiaquine (n = 8) in Accra, Ghana. Audiometry was repeated 3, 7, and 28 days later and after 9 months. Audiometric thresholds were compared...... evident between treated children and controls after 9 months. The hearing thresholds of children treated with the two ACT regimens were comparable but lower than those of amodiaquine-treated children during acute illness. Interpretation. Malaria is the likely cause of the elevated hearing threshold levels...

Patient management following uncomplicated elective gastrointestinal operations.

Science.gov (United States)

D'Costa, H; Taylor, E W

1990-12-01

The management of patients after uncomplicated elective gastrointestinal operations is frequently left to junior members of the surgical team once they have learnt their seniors' regimens. The use of nasogastric (N/G) tubes, the volume of intravenous (IV) fluid replacement and the reintroduction of oral fluids and solids are topics not generally covered in the surgical textbooks and so are learnt in hospital. A postal survey of all consultant general surgeons in Scotland was conducted to assess the variations in management of patients after cholecystectomy, right haemicolectomy and sigmoid colectomy. A completed questionnaire was received from 111 (81%) of the surgeons circulated. As might be expected, patient management varied widely from surgeon to surgeon, and from unit to unit. There would appear to be a need for prospective studies in this area of patient management. This may indicate that the use of N/G tubes could be further reduced and that oral fluids and solids could be reintroduced sooner after operation with improved patient comfort and reduced hospital stay, yet without detriment to patient care.

Multiplanar reformatted CT applications in the lumbar spine

International Nuclear Information System (INIS)

Ueda, Takafumi; Kojima, Shinsaburo; Araki, Nobuto; Miyauchi, Sumihiko

1986-01-01

Diagnostic value and limitations of multiplanar reformatted CT were evaluated in 55 patients with lumbar diseases. Reformatted images in coronal, sagittal, paraxial, and oblique planes were acquired from the transverse axial images, thereby allowing three-dimensional visualization of lesions in the lumbar spine. Oblique images that were reformmated along the nervous root were useful in visualizing lesions in the root canal, which were not available on either conventional myelography or transverse axial CT. A definitive plane determination is required for reformation of images, taking curvature of the spinal column into account. (Namekawa, K.)

Population Pharmacokinetics of Dihydroartemisinin and Piperaquine in Pregnant and Nonpregnant Women with Uncomplicated Malaria

OpenAIRE

Tarning, Joel; Rijken, Marcus J.; McGready, Rose; Phyo, Aung Pyae; Hanpithakpong, Warunee; Day, Nicholas P. J.; White, Nicholas J.; Nosten, François; Lindegardh, Niklas

2012-01-01

Pregnant women are particularly vulnerable to malaria. The pharmacokinetic properties of antimalarial drugs are often affected by pregnancy, resulting in lower drug concentrations and a consequently higher risk of treatment failure. The objective of this study was to evaluate the population pharmacokinetic properties of piperaquine and dihydroartemisinin in pregnant and nonpregnant women with uncomplicated malaria. Twenty-four pregnant and 24 matched nonpregnant women on the Thai-Myanmar boar...

Analysis of the indications for routine lumbar puncture and results of ...

African Journals Online (AJOL)

Lumbar puncture (LP) is an important diagnostic tool for investigating neurological conditions/diseases. This study was carried out to compare the indications for lumbar puncture and findings of cerebrospinal fluid examination in children admitted to Muhimbili National Hospital (MNH) in Dar-es-salaam, Tanzania and Kilifi ...

Ensayo clínico aleatorizado de electroanalgesia en el dolor lumbar

OpenAIRE

Maya Martin, Julián

2011-01-01

OBJETIVOS: Establecer y validar un procedimiento de electroterapia con corrientes interferenciales (CIF) en sujetos con dolor lumbar. Así como evaluar la disminución del dolor lumbar y el grado de discapacidad con la aplicación de una CIF. ... 0cm 0pt" c

Effect of Lumbar Disc Degeneration and Low-Back Pain on the Lumbar Lordosis in Supine and Standing: A Cross-Sectional MRI Study.

Science.gov (United States)

Hansen, Bjarke B; Bendix, Tom; Grindsted, Jacob; Bliddal, Henning; Christensen, Robin; Hansen, Philip; Riis, Robert G C; Boesen, Mikael

2015-11-01

Cross-sectional study. To examine the influence of low-back pain (LBP) and lumbar disc degeneration (LDD) on the lumbar lordosis in weight-bearing positional magnetic resonance imaging (pMRI). The lumbar lordosis increases with a change of position from supine to standing and is known as an essential contributor to dynamic changes. However, the lordosis may be affected by disc degeneration and pain. Patients with LBP >40 on a 0 to 100 mm Visual Analog Scale (VAS) both during activity and rest and a sex and age-decade matching control group without LBP were scanned in the supine and standing position in a 0.25-T open MRI unit. LDD was graded using Pfirrmann's grading-scale. Subsequently, the L2-to-S1 lumbar lordosis angle (LA) was measured. Thirty-eight patients with an average VAS of 58 (±13.8) mm during rest and 75 (±5.0) mm during activities, and 38 healthy controls were included. MRI findings were common in both groups, whereas, the summation of the Pfirrmann's grades (LDD-score) was significantly higher in the patients [(MD 1.44; 95% confidence intervals (CI) 0.80 to 2.10; P lordosis between the positions may be independent of pain. Decreasing lordosis change seems to be associated with age-related increasing disc degeneration in healthy individuals. 2.

Reliability and validity of the AutoCAD software method in lumbar lordosis measurement.

Science.gov (United States)

Letafatkar, Amir; Amirsasan, Ramin; Abdolvahabi, Zahra; Hadadnezhad, Malihe

2011-12-01

The aim of this study was to determine the reliability and validity of the AutoCAD software method in lumbar lordosis measurement. Fifty healthy volunteers with a mean age of 23 ± 1.80 years were enrolled. A lumbar lateral radiograph was taken on all participants, and the lordosis was measured according to the Cobb method. Afterward, the lumbar lordosis degree was measured via AutoCAD software and flexible ruler methods. The current study is accomplished in 2 parts: intratester and intertester evaluations of reliability as well as the validity of the flexible ruler and software methods. Based on the intraclass correlation coefficient, AutoCAD's reliability and validity in measuring lumbar lordosis were 0.984 and 0.962, respectively. AutoCAD showed to be a reliable and valid method to measure lordosis. It is suggested that this method may replace those that are costly and involve health risks, such as radiography, in evaluating lumbar lordosis.

Cost-effectiveness of different strategies for diagnosis of uncomplicated urinary tract infections in women presenting in primary care

NARCIS (Netherlands)

Bosmans, Judith E; Coupé, Veerle M H; Knottnerus, Bart J; Geerlings, Suzanne E; Moll van Charante, Eric P; Ter Riet, Gerben

2017-01-01

BACKGROUND: Uncomplicated Urinary Tract Infections (UTIs) are common in primary care resulting in substantial costs. Since antimicrobial resistance against antibiotics for UTIs is rising, accurate diagnosis is needed in settings with low rates of multidrug-resistant bacteria. OBJECTIVE: To compare

Cost-effectiveness of different strategies for diagnosis of uncomplicated urinary tract infections in women presenting in primary care

NARCIS (Netherlands)

Bosmans, Judith E.; Coupé, Veerle M. H.; Knottnerus, Bart J.; Geerlings, Suzanne E.; Moll van Charante, Eric P.; ter Riet, Gerben

2017-01-01

Uncomplicated Urinary Tract Infections (UTIs) are common in primary care resulting in substantial costs. Since antimicrobial resistance against antibiotics for UTIs is rising, accurate diagnosis is needed in settings with low rates of multidrug-resistant bacteria. To compare the cost-effectiveness

A retrospective study of epidural and intravenous steroids after percutaneous endoscopic lumbar discectomy for large lumbar disc herniation

Directory of Open Access Journals (Sweden)

Yang Zhang

2017-02-01

Conclusion: Patients who underwent PELD with epidural steroid administration for large lumbar disc herniation showed favorable curative effect compared with those who underwent PELD with intravenous steroid administration.

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

Directory of Open Access Journals (Sweden)

Ebru Ozan

2013-10-01

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

Surgical treatment of foraminal herniated disc of the lumbar spine

OpenAIRE

Halikov Shavkatbek; Abduhalikov Alimjon Karimjanovich

2017-01-01

Herniated lumbar intervertebral disc have a significant impact on both the patient’s life as well, and because of the high prevalence and economic impact on society as a whole. Designed scheduling algorithm foraminal hernia surgical treatment of lumbar intervertebral disc, based on the preoperative detection of compressing factors allows to define differentiated indications for decompressive or decompressive-stabilizing surgery.

Solitary osteochondroma arising in lumbar spinous process: Case report.

Science.gov (United States)

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

2016-12-01

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

Sideflexion induced lumbar spine conjunct rotation and its influencing factors.

Science.gov (United States)

Vicenzino, G; Twomey, L

1993-01-01

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

Randomized controlled clinical trial on the efficacy of fosfomycin trometamol for uncomplicated gonococcal urethritis in men.

Science.gov (United States)

Yuan, Z; He, C; Yan, S; Ke, Y; Tang, W

2016-06-01

We assessed the efficacy of fosfomycin trometamol in treating uncomplicated gonococcal urethritis in men. We conducted an open randomized controlled trial in 152 consecutive men with any main complaints suggestive of uncomplicated gonococcal urethritis in Dujiangyan Medical Center between 1 September 2013 and 31 August 2015. In total, 126 patients completed all aspects of this study. Sixty were provided therapy with fosfomycin trometamol 3 g orally on days 1, 3 and 5 in the intervention group; the other 61 were provided ceftriaxone 250 mg intramuscularly plus azithromycin 1 g orally simultaneously as a single dose in the control group. The primary outcomes involved clinical and microbiologic cure on days 7 and 14 after receipt of all the study medications. At the day 7 follow-up visit, all the 121 participants had complete resolution of clinical symptoms and signs. In addition, five patients (two in the intervention group and three in the control group) discontinued intervention because of unsuccessful treatment. After receipt of all the study medications, these five patients still had urethral purulent discharge and were switched to other unknown treatment regimens by other doctors. The bacterial smears and cultures of urethral or urine specimens in the 121 patients who completed all aspects of the study were negative on a test-of-cure visit. In the per-protocol analysis, both clinical and microbiologic cure were experienced by 96.8% (60/62 patients) in the intervention group and 95.3% (61/64 patients) in the control group. There were no recurrences at the day 14 test-of-cure visit. This trial indicates that fosfomycin trometamol exhibits excellent efficacy for treatment of uncomplicated gonococcal urethritis in men. Serious adverse effects are rare. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Radiographic measurement reliability of lumbar lordosis in ankylosing spondylitis.

Science.gov (United States)

Lee, Jung Sub; Goh, Tae Sik; Park, Shi Hwan; Lee, Hong Seok; Suh, Kuen Tak

2013-04-01

Intraobserver and interobserver reliabilities of the several different methods to measure lumbar lordosis have been reported. However, it has not been studied sofar in patients with ankylosing spondylitis (AS). We evaluated the inter and intraobserver reliabilities of six specific measures of global lumbar lordosis in patients with AS. Ninety-one consecutive patients with AS who met the most recently modified New York criteria were enrolled and underwent anteroposterior and lateral radiographs of whole spine. The radiographs were divided into non-ankylosis (no bony bridge in the lumbar spine), incomplete ankylosis (lumbar spines were partially connected by bony bridge) and complete ankylosis groups to evaluate the reliability of the Cobb L1-S1, Cobb L1-L5, centroid, posterior tangent L1-S1, posterior tangent L1-L5, and TRALL methods. The radiographs were composed of 39 non-ankylosis, 27 incomplete ankylosis and 25 complete ankylosis. Intra- and inter-class correlation coefficients (ICCs) of all six methods were generally high. The ICCs were all ≥0.77 (excellent) for the six radiographic methods in the combined group. However, a comparison of the ICCs, 95 % confidence intervals and mean absolute difference (MAD) between groups with varying degrees of ankylosis showed that the reliability of the lordosis measurements decreased in proportion to the severity of ankylosis. The Cobb L1-S1, Cobb L1-L5 and posterior tangent L1-S1 method demonstrated higher ICCs for both inter and intraobserver comparisons and the other methods showed lower ICCs in all groups. The intraobserver MAD was similar in the Cobb L1-S1 and Cobb L1-L5 (2.7°-4.3°), but the other methods showed higher intraobserver MAD. Interobserver MAD of Cobb L1-L5 only showed low in all group. These results are the first to provide a reliability analysis of different global lumbar lordosis measurement methods in AS. The findings in this study demonstrated that the Cobb L1-L5 method is reliable for measuring

Polyetheretherketone (PEEK) Rods in Lumbar Spine Degenerative Disease: A Case Series.

Science.gov (United States)

Ormond, D Ryan; Albert, Ladislau; Das, Kaushik

2016-08-01

Retrospective case series. The purpose of our study was to retrospectively review the results of posterior lumbar fusion using polyetheretherketone (PEEK) rods. Pedicle screw and rod instrumentation has become the preferred technique for performing stabilization and fusion in the lumbar spine for degenerative disease. Rigid fixation with titanium rods leads to high fusion rates, but may also contribute to stress shielding and adjacent segment degeneration (ASD). Thus, some have advocated using semirigid rods made of PEEK. Although the biomechanical properties of PEEK rods have shown improved stress-shielding characteristics and anterior load-sharing properties, there are very few clinical studies evaluating their application in the lumbar spine. We evaluated a retrospective cohort of 42 patients who underwent posterior lumbar fusion from 2007 to 2009 for the treatment of lumbar spine degenerative disease using PEEK rods. Reoperation rate was the primary outcome evaluated. Fusion rate was also evaluated. Eight of the 42 patients with PEEK rods required reoperation. Reasons for reoperation mainly included ASD (5/8) and nonunion with cage migration (3/8). Radiographically, documented fusion rate was 86%. Mean follow-up was 31.4 months. No statistical differences were found in fusion rates or reoperation between age above 55 years and younger than 55 years (P=1.00), male and female (P=0.110), single or multilevel fusion (P=0.67), and fusion with and without an interbody graft (P=0.69). Smokers showed a trend towards increased risk of reoperation for ASD or instrumentation failure (P=0.056). PEEK rods demonstrate a similar fusion and reoperation rate in comparison to other instrumentation modalities in the treatment of degenerative lumbar spine disease.

Recurrent back pain after diskectomy: MRI findings MR of the postoperative lumbar spine

International Nuclear Information System (INIS)

Aparicio, Rocio; Eguren, Leonor Z.; Schinder, Humberto; Stur, Mariela

2008-01-01

Purpose: To show the morphological changes in postoperative lumbar spine. Material and methods: We reviewed 128 Magnetic Resonance Imaging (MRI) studies of lumbar spine. All patients complained of low back pain and had a previous lumbar surgery (1 month to 8 years). All the examinations include axial and sagittal Gadopentate-dimeglumine enhanced T1 weighted imaging. Results: Only 7,8% have the normal appearance of the postoperative lumbar spine. Epidural scar was found in 69% of examinations; of this group, 72% showed radicular involvement, and 28% had no radicular involvement. Recurrent disc herniation was found in 14,8% of exams, using gadopentate-dimeglumine to assist the differentiation from epidural fibrosis; infections like spondylodiscitis and abscess in 12,5%. Other findings included arachnoiditis, pseudomeningoceles and seromas. Conclusions: MRI is a useful method to study the postoperative lumbar spine, specially when enhanced with gadopentate-dimeglumine. Enhanced images can differentiate two of the major complication like epidural fibrosis, and recurrent disc herniation. Spondylodiscitis are important and frequent too. Although the findings of complications in our series in the postoperative lumbar spine represent 92,18 %, these not always explain the symptomatology. Therefore, the interrelation is important with the surgeon to determine which abnormalities are clinically significant. (authors) [es

Value of the lumbar lordotic angle taken from CT scanogram as an index of back pain

Energy Technology Data Exchange (ETDEWEB)

Jeon, Hea Sang; Kim, Guk Hee; Kim, Dae Young [Kangnam General Hospital Public Corporation, Seoul (Korea, Republic of)

1986-10-15

'Normal' spinal posture is generally accepted as moderate lordosis of the cervical and the lumbar sections of spine and moderate kyphosis of the thoracic and sacrococcygeal sections. Among these normal range of the lumbar lordosis is less well defined. CT is very useful method to identified the bony structure and adjacent soft tissue of the spine, so it is very available method to detect accurate lumbar lordotic angle by using lateral Scanogram. Analysis and comparison of lumbar lordotic angles, crossing angle are drawn each parallel line to the superior end plate of body of 1st. lumbar vertebra and to the inferior end plate of the 5th. lumbar vertebra, in 174 cases with backache and 50 cases normal groups at Kangnam General Hospital Public Corporation, from Aug. 1985 to Jul 1986. Male and female were almostly same affected in backache group (1.1:1). And most lumbar lordotic angles were 10 to 40 between all backache age group. On backache group, over all mean lumbar lordotic angles were 24.7+-8.9 but no significant difference at mean value of the each diseases, such as HIVD, Degenerative Spondylosis or No Remarkable Findings group. On control group, over all mean ones were 29.2+-8.0. So, significant difference of lumbar lordotic angle between backache and control group, and most difference is at 5th. decade group (p 0.01).

Adherence to International Guidelines for the Treatment of Uncomplicated Urinary Tract Infections in Lebanon

Directory of Open Access Journals (Sweden)

Wissam K. Kabbara

2018-01-01

Full Text Available Objective. The purpose of this study is to evaluate antibiotic-prescribing practices and adherence to IDSA guidelines for the treatment of uncomplicated urinary tract infections in Lebanon. Methods. This observational prospective study was conducted in 15 community pharmacies in Lebanon over 1 year in adult females. A regimen of nitrofurantoin 100 mg bid for 5 days or fosfomycin 3 grams single dose were considered appropriate. For the bivariate analysis, the chi-square test was used. Results. A total of 376 patients were included in this study. The prescribed antibiotic was appropriate in 35 percent of the patients. Age (more than 50 years did not significantly affect the appropriateness of the prescribed antibiotic (p=0.508. The frequency of attacks per year (more than 3 negatively affected the choice of antibiotic (p=0.025. The dose and duration of the prescribed antibiotic was appropriate in 73 and 58 percent of the patients, respectively, with a significant inappropriate dose and duration with fluoroquinolones as compared to nitrofurantoin and fosfomycin (p<0.001 for the dose and p=0.014 for the duration of therapy. Conclusions. In an era of increasing bacterial resistance, interventions that improve physicians’ prescribing practices for uncomplicated urinary tract infections are needed.

Three Dimensional (3D Lumbar Vertebrae Data Set

Directory of Open Access Journals (Sweden)

H. Bennani

2016-08-01

Full Text Available 3D modelling can be used for a variety of purposes, including biomedical modelling for orthopaedic or anatomical applications. Low back pain is prevalent in society yet few validated 3D models of the lumbar spine exist to facilitate assessment. We therefore created a 3D surface data set for lumbar vertebrae from human vertebrae. Models from 86 lumbar vertebrae were constructed using an inexpensive method involving image capture by digital camera and reconstruction of 3D models via an image-based technique. The reconstruction method was validated using a laser-based arm scanner and measurements derived from real vertebrae using electronic callipers. Results show a mean relative error of 5.2% between image-based models and real vertebrae, a mean relative error of 4.7% between image-based and arm scanning models and 95% of vertices’ errors are less than 3.5 millimetres with a median of 1.1 millimetres. The accuracy of the method indicates that the generated models could be useful for biomechanical modelling or 3D visualisation of the spine.

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

Science.gov (United States)

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

2016-10-01

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

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

International Nuclear Information System (INIS)

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

2007-01-01

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

Spine imaging after lumbar disc replacement: pitfalls and current recommendations

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Sandén Bengt

2009-07-01

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

Neuromodulation of the lumbar spinal locomotor circuit.

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AuYong, Nicholas; Lu, Daniel C

2014-01-01

The lumbar spinal cord contains the necessary circuitry to independently drive locomotor behaviors. This function is retained following spinal cord injury (SCI) and is amenable to rehabilitation. Although the effectiveness of task-specific training and pharmacologic modulation has been repeatedly demonstrated in animal studies, results from human studies are less striking. Recently, lumbar epidural stimulation (EDS) along with locomotor training was shown to restore weight-bearing function and lower-extremity voluntary control in a chronic, motor-complete human SCI subject. Related animal studies incorporating EDS as part of the therapeutic regiment are also encouraging. EDS is emerging as a promising neuromodulatory tool for SCI. Copyright © 2014 Elsevier Inc. All rights reserved.

Clinical characterization of thoracolumbar and lumbar intervertebral disk extrusions in English Cocker Spaniels.

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Cardy, Thomas J A; Tzounos, Caitlin E; Volk, Holger A; De Decker, Steven

2016-02-15

To assess the anatomic distribution of thoracolumbar and lumbar intervertebral disk extrusions (IVDEs) in English Cocker Spaniels as compared with findings in Dachshunds and to characterize clinical findings in English Cocker Spaniels with thoracolumbar or lumbar IVDEs affecting various regions of the vertebral column. Retrospective observational study. 81 English Cocker Spaniels and 81 Dachshunds with IVDEs. Signalment, clinical signs, neurologic examination findings, and affected intervertebral disk spaces (IVDSs) were recorded for both breeds. Management methods and outcomes were recorded for English Cocker Spaniels. Lesions were categorized as thoracolumbar (IVDSs T9-10 through L1-2), midlumbar (L2-3 through L4-5), or caudal lumbar (L5-6 through L7-S1). Midlumbar and caudal lumbar IVDEs were significantly more common in English Cocker Spaniels than in Dachshunds. English Cocker Spaniels with caudal lumbar IVDEs had a longer median duration of clinical signs before evaluation and more commonly had unilateral pelvic limb lameness or spinal hyperesthesia as the predominant clinical sign than did those with IVDEs at other sites. Those with caudal lumbar IVDEs less commonly had neurologic deficits and had a higher median neurologic grade (indicating lesser severity), shorter mean postoperative hospitalization time, and faster mean time to ambulation after surgery than those with other sites affected. These variables did not differ between English Cocker Spaniels with thoracolumbar and midlumbar IVDEs. Caudal and midlumbar IVDEs were more common in English Cocker Spaniels than in Dachshunds. English Cocker Spaniels with caudal lumbar IVDE had clinical signs and posttreatment responses that differed from those in dogs with midlumbar or thoracolumbar IVDE.

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

International Nuclear Information System (INIS)

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

1989-01-01

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

Lumbar ultrasound: useful gadget or time-consuming gimmick?

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Gambling, D R

2011-10-01

Despite widespread enthusiasm for using lumbar ultrasound in obstetrics, there are some who believe it is expensive and time-consuming, with undetermined risks and uncertain benefits. For decades, anesthesiologists have striven to perfect the identification and cannulation of the epidural space using skills learned during training and early clinical practice. These skills include knowledge of the relevant anatomy and detection of subtle tactile clues that aid successful placement of an epidural catheter. Indeed, obstetric anesthesiologists have managed to do this with great success without using imaging techniques. There is a long learning curve associated with lumbar ultrasound and it is unclear from the literature if the success rates associated with its use are superior to clinical skill alone. Is it only a matter of time before regulators insist that lumbar ultrasound is used before inserting an epidural? Indeed, this has already happened for central vein catheters. The United States spent $2.2 trillion on health care in 2007, nearly twice the average of other developed nations. If rapid health cost growth persists, one out of every four dollars in the US national economy will be tied up in the health system by 2025. Do obstetric anesthesiologists want to add to these costs by using unnecessary and expensive equipment? Although many feel that diagnostic ultrasound in obstetrics is safe, some argue that we have yet to perform an appropriate risk analysis for lumbar ultrasound during pregnancy. The issue of ultrasound bio-safety needs to be considered before we all jump on the ultrasound bandwagon. Copyright © 2010 Elsevier Ltd. All rights reserved.

Spine imaging after lumbar disc replacement: pitfalls and current recommendations

OpenAIRE

Robinson, Yohan; Sand?n, Bengt

2009-01-01

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 reco...

Lumbar Spine Musculoskeletal Physiology and Biomechanics During Simulated Military Operations

Science.gov (United States)

2016-06-01

AWARD NUMBER: W81XWH-13-2-0043 TITLE: Lumbar Spine Musculoskeletal Physiology and Biomechanics During Simulated Military Operations PRINCIPAL...31May2016 4. TITLE AND SUBTITLE Lumbar Spine Musculoskeletal Physiology and Biomechanics 5a. CONTRACT NUMBER During Simulated Military Operations 5b... Biomechanics , Cincinnati, 2015. § Website(s) or other Internet site(s) § Nothing to report § Technologies or techniques § Nothing to report

Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting.

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Michelle T Hecker

Full Text Available To evaluate adherence to uncomplicated urinary tract infections (UTI guidelines and UTI diagnostic accuracy in an emergency department (ED setting before and after implementation of an antimicrobial stewardship intervention.The intervention included implementation of an electronic UTI order set followed by a 2 month period of audit and feedback. For women age 18-65 with a UTI diagnosis seen in the ED with no structural or functional abnormalities of the urinary system, we evaluated adherence to guidelines, antimicrobial use, and diagnostic accuracy at baseline, after implementation of the order set (period 1, and after audit and feedback (period 2.Adherence to UTI guidelines increased from 44% (baseline to 68% (period 1 to 82% (period 2 (P≤.015 for each successive period. Prescription of fluoroquinolones for uncomplicated cystitis decreased from 44% (baseline to 14% (period 1 to 13% (period 2 (P<.001 and P = .7 for each successive period. Unnecessary antibiotic days for the 200 patients evaluated in each period decreased from 250 days to 119 days to 52 days (P<.001 for each successive period. For 40% to 42% of cases diagnosed as UTI by clinicians, the diagnosis was deemed unlikely or rejected with no difference between the baseline and intervention periods.A stewardship intervention including an electronic order set and audit and feedback was associated with increased adherence to uncomplicated UTI guidelines and reductions in unnecessary antibiotic therapy and fluoroquinolone therapy for cystitis. Many diagnoses were rejected or deemed unlikely, suggesting a need for studies to improve diagnostic accuracy for UTI.

Diagnosis of Lumbar Foraminal Stenosis using Diffusion Tensor Imaging

OpenAIRE

Eguchi, Yawara; Ohtori, Seiji; Suzuki, Munetaka; Oikawa, Yasuhiro; Yamanaka, Hajime; Tamai, Hiroshi; Kobayashi, Tatsuya; Orita, Sumihisa; Yamauchi, Kazuyo; Suzuki, Miyako; Aoki, Yasuchika; Watanabe, Atsuya; Kanamoto, Hirohito; Takahashi, Kazuhisa

2016-01-01

Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed dur...

Do children with uncomplicated severe acute malnutrition need antibiotics? A systematic review and meta-analysis.

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Gabriel Alcoba

Full Text Available Current (1999 World Health Organization guidelines recommend giving routine antibiotics (AB for all children with severe acute malnutrition (SAM, even if they have uncomplicated disease with no clinically obvious infections. We examined the evidence behind this recommendation.OVID-MEDLINE, EMBASE, COCHRANE, GLOBAL-HEALTH, CINAHL, POPLINE, AFRICA-WIDE-NiPAD, and LILACS were searched for AB efficacy, bacterial resistance, and infection rates in SAM. Following PRISMA guidelines, a systematic review and meta-analysis were performed. Three randomised controlled trials (RCT, five Cochrane reviews, and 37 observational studies were identified. One cohort-study showed no increase in nutritional-cure and mortality in uncomplicated SAM where no AB were used. (p>0.05. However, an unpublished RCT in this setting did show mortality benefits. Another RCT did not show superiority of ceftriaxone over amoxicilllin for these same outcomes, but adressed SAM children with and without complications (p = 0.27. Another RCT showed no difference between amoxicillin and cotrimoxazole efficacies for pneumonia in underweight, but not SAM. Our meta-analysis of 12 pooled susceptibility-studies for all types of bacterial isolates, including 2767 stricly SAM children, favoured amoxicillin over cotrimoxazole for susceptibility medians: 42% (IQR 27-55% vs 22% (IQR 17-23% and population-weighted-means 52.9% (range 23-57% vs 35.4% (range 6.7-42%. Susceptibilities to second-line AB were better, above 80%. Prevalence of serious infections in SAM, pooled from 24 studies, ranged from 17% to 35.2%. No study infered any association of infection prevalence with AB regimens in SAM.The evidence underlying current antibiotic recommendations for uncomplicated SAM is weak. Susceptibility-studies favour amoxicillin over cotrimoxazole. However, given that these antibiotics have side-effects, costs, and risks as well as benefits, their routine use needs urgent testing. With reliable

Relationship between stent characteristics and treatment outcomes in endoscopic transmural drainage of uncomplicated pancreatic pseudocysts.

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Bang, Ji Young; Wilcox, C Mel; Trevino, Jessica M; Ramesh, Jayapal; Hasan, Muhammad; Hawes, Robert H; Varadarajulu, Shyam

2014-10-01

Transmural stents are placed at endoscopy to drain pancreatic fluid collections. This study evaluated the relationship between stent placement and treatment outcomes in patients undergoing endoscopic transmural drainage of uncomplicated pancreatic pseudocysts. This is a retrospective study of all patients who underwent endoscopic drainage of uncomplicated pancreatic pseudocysts over a 10-year period. After dilating the transmural tracts in the range of 8-15 mm, single or multiple, 7 or 10Fr double-pigtail plastic stents were deployed. The main outcome measure was to evaluate the relationship between stent characteristics and the number of endoscopic interventions required to achieve resolution of the pancreatic pseudocyst (treatment success). Of 122 patients, 45 (36.9%) had 10Fr stents of which 30 patients (66.7%) had more than one stent; the remaining 77 (63.1%) patients had 7Fr stents of which 56 (72.7%) had more than one stent. The overall treatment success was 94.3%. Treatment was successful in 102 patients (83.6%) with one intervention; 13 patients (10.7%) required re-intervention for successful drainage and 7 patients (5.7%) failed endoscopic treatment. There was no significant difference in the number of interventions required for treatment success between patients with 7 or 10Fr stents (one intervention required in 87.7 vs. 90.5%, respectively; p = 0.766) and between patients with 1 or >1 stent (one intervention required in 88.9 vs. 88.6%, respectively; p = 0.999). On multiple logistic regression analysis, the stent size (OR 1.54; 95% CI 0.23-10.4) and number (OR 1.15; 95% CI 0.25-5.25) were not associated with the number of interventions required for treatment success when adjusted for pseudocyst size, location, drainage modality, the presence or absence of pancreatic duct stent and luminal compression. There appears to be no relationship between the number of interventions required for treatment success and stent characteristics in patients undergoing

RADIOLOGICAL STUDY OF HUMAN LUMBAR VERTEBRAL CANAL IN VIDHARBHA REGION

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Shruti

2015-06-01

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

Value of the lumbar lordotic angle taken from CT scanogram as an index of back pain

International Nuclear Information System (INIS)

Jeon, Hea Sang; Kim, Guk Hee; Kim, Dae Young

1986-01-01

'Normal' spinal posture is generally accepted as moderate lordosis of the cervical and the lumbar sections of spine and moderate kyphosis of the thoracic and sacrococcygeal sections. Among these normal range of the lumbar lordosis is less well defined. CT is very useful method to identified the bony structure and adjacent soft tissue of the spine, so it is very available method to detect accurate lumbar lordotic angle by using lateral Scanogram. Analysis and comparison of lumbar lordotic angles, crossing angle are drawn each parallel line to the superior end plate of body of 1st. lumbar vertebra and to the inferior end plate of the 5th. lumbar vertebra, in 174 cases with backache and 50 cases normal groups at Kangnam General Hospital Public Corporation, from Aug. 1985 to Jul 1986. Male and female were almostly same affected in backache group (1.1:1). And most lumbar lordotic angles were 10 to 40 between all backache age group. On backache group, over all mean lumbar lordotic angles were 24.7±8.9 but no significant difference at mean value of the each diseases, such as HIVD, Degenerative Spondylosis or No Remarkable Findings group. On control group, over all mean ones were 29.2±8.0. So, significant difference of lumbar lordotic angle between backache and control group, and most difference is at 5th. decade group (p 0.01).

Value of the lumbar lordotic angle taken from CT scanogram as an index of back pain

Energy Technology Data Exchange (ETDEWEB)

Jeon, Hea Sang; Kim, Guk Hee; Kim, Dae Young [Kangnam General Hospital Public Corporation, Seoul (Korea, Republic of)

1986-10-15

'Normal' spinal posture is generally accepted as moderate lordosis of the cervical and the lumbar sections of spine and moderate kyphosis of the thoracic and sacrococcygeal sections. Among these normal range of the lumbar lordosis is less well defined. CT is very useful method to identified the bony structure and adjacent soft tissue of the spine, so it is very available method to detect accurate lumbar lordotic angle by using lateral Scanogram. Analysis and comparison of lumbar lordotic angles, crossing angle are drawn each parallel line to the superior end plate of body of 1st. lumbar vertebra and to the inferior end plate of the 5th. lumbar vertebra, in 174 cases with backache and 50 cases normal groups at Kangnam General Hospital Public Corporation, from Aug. 1985 to Jul 1986. Male and female were almostly same affected in backache group (1.1:1). And most lumbar lordotic angles were 10 to 40 between all backache age group. On backache group, over all mean lumbar lordotic angles were 24.7+-8.9 but no significant difference at mean value of the each diseases, such as HIVD, Degenerative Spondylosis or No Remarkable Findings group. On control group, over all mean ones were 29.2+-8.0. So, significant difference of lumbar lordotic angle between backache and control group, and most difference is at 5th. decade group (p 0.01).

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

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Truumees, Eeric

2015-06-01

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

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

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

2014-01-01

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

[Research Progress and Prospect of Applications of Finite Element Method in Lumbar Spine Biomechanics].

Science.gov (United States)

Zhang, Zhenjun; Li, Yang; Liao, Zhenhua; Liu, Weiqiang

2016-12-01

Based on the application of finite element analysis in spine biomechanics,the research progress of finite element method applied in lumbar spine mechanics is reviewed and the prospect is forecasted.The related works,including lumbar ontology modeling,clinical application research,and occupational injury and protection,are summarized.The main research areas of finite element method are as follows:new accurate modeling process,the optimized simulation method,diversified clinical effect evaluation,and the clinical application of artificial lumbar disc.According to the recent research progress,the application prospects of finite element method,such as automation and individuation of modeling process,evaluation and analysis of new operation methods and simulation of mechanical damage and dynamic response,are discussed.The purpose of this paper is to provide the theoretical reference and practical guidance for the clinical lumbar problems by reviewing the application of finite element method in the field of the lumbar spine biomechanics.

MR imaging with gadolinium in patients with and without post-lumbar puncture headache

International Nuclear Information System (INIS)

Hannerz, J.; Ericson, K.; Bro Skejoe, H.P.

1999-01-01

Purpose: To study frequency and extent of meningeal enhancement in patients with and without post-lumbar puncture headache (PLPH) with cerebral MR with Gd-DTPA. Material and methods: Ten consecutive patients with PLPH and 9 consecutive patients without PLPH were included in the study. Nine of the PLPH patients were reinvestigated when the PLPH was over and all non-PLPH patients during the week after the lumbar puncture. Results: Eight of the 9 patients with PLPH showed more enhancement of meningeal structures during PLPH than when PLPH had disappeared. The differences were slight in 5, more marked in 2, and pronounced in 1 patient. The 9th patient showed no change at all. In the 9 patients without PLPH, there was mainly slight enhancement before lumbar puncture and no change in enhancement after lumbar puncture as compared with before. Conclusion: PLPH is related to increased Gd-DTPA enhancement of the meninges, although the increase in enhancement during PLPH is minor in most cases. Pronounced enhancement of the meninges after lumbar puncture may predict long duration of the PLPH. (orig.)

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

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Jones, Katrina Elizabeth

2016-04-27

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

Minimally invasive lateral trans-psoas approach for tuberculosis of lumbar spine

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Nitin Garg

2014-01-01

Full Text Available Anterior, posterolateral and posterior approaches are used for managing lumbar tuberculosis. Minimally invasive methods are being used increasingly for various disorders of the spine. This report presents the utility of lateral trans-psoas approach to the lumbar spine (LS using minimal access techniques, also known as direct lateral lumbar interbody fusion in 2 cases with tuberculosis of LS. Two patients with tuberculosis at L2-3 and L4-5 presented with back pain. Both had destruction and deformity of the vertebral body. The whole procedure comprising debridement and placement of iliac crest graft was performed using tubular retractors and was augmented by posterior fixation using percutaneous transpedicular screws. Both patients recovered well with no significant procedure related morbidity. Post-operative computed tomography scans showed appropriate position of the graft and instrumentation. At follow-up, both patients are ambulant with no progression of the deformity. Minimal access direct lateral transpsoas approach can be used for debridement and reconstruction of ventral column in tuberculous of Lumbar spine. This paper highlights the growing applications of minimal access surgery for spine.

The predictive value of the baseline Oswestry Disability Index in lumbar disc arthroplasty.

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Deutsch, Harel

2010-06-01

The goal of the study was to determine patient factors predictive of good outcome after lumbar disc arthroplasty. Specifically, the paper examines the relationship of the preoperative Oswestry Disability Index (ODI) to patient outcome at 1 year. The study is a retrospective review of 20 patients undergoing a 1-level lumbar disc arthroplasty at the author's institution between 2004 and 2008. All data were collected prospectively. Data included the ODI, visual analog scale scores, and patient demographics. All patients underwent a 1-level disc arthroplasty at L4-5 or L5-S1. The patients were divided into 2 groups based on their baseline ODI. Patients with an ODI between 38 and 59 demonstrated better outcomes with lumbar disc arthroplasty. Only 1 (20%) of 5 patients with a baseline ODI higher than 60 reported a good outcome. In contrast, 13 (87%) of 15 patients with an ODI between 38 and 59 showed a good outcome (p = 0.03). The negative predictive value of using ODI > 60 is 60% in patients who are determined to be candidates for lumbar arthroplasty. Lumbar arthroplasty is very effective in some patients. Other patients do not improve after surgery. The baseline ODI results are predictive of outcome in patients selected for lumbar disc arthroplasty. A baseline ODI > 60 is predictive of poor outcome. A high ODI may be indicative of psychosocial overlay.

Surgical apgar score in patients undergoing lumbar fusion for degenerative spine diseases.

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Ou, Chien-Yu; Hsu, Shih-Yuan; Huang, Jian-Hao; Huang, Yu-Hua

2017-01-01

Lumbar fusion is a procedure broadly performed for degenerative diseases of spines, but it is not without significant morbidities. Surgical Apgar Score (SAS), based on intraoperative blood loss, blood pressure, and heart rate, was developed for prognostic prediction in general and vascular operations. We aimed to examine whether the application of SAS in patients undergoing fusion procedures for degeneration of lumbar spines predicts in-hospital major complications. One hundred and ninety-nine patients that underwent lumbar fusion operation for spine degeneration were enrolled in this retrospective study. Based on whether major complications were present (N=16) or not (N=183), the patients were subdivided. We identified the intergroup differences in SAS and clinical parameters. The incidence of in-hospital major complications was 8%. The duration of hospital stay for the morbid patents was significantly prolonged (p=0.04). In the analysis of multivariable logistic regression, SAS was an independent predicting factor of the complications after lumbar fusion for degenerative spine diseases [p=0.001; odds ratio (95% confidence interval)=0.35 (0.19-0.64)]. Lower scores were accompanied with higher rates of major complications, and the area was 0.872 under the receiver operating characteristic curve. SAS is an independent predicting factor of major complications in patients after fusion surgery for degenerative diseases of lumbar spines, and provides good risk discrimination. Since the scoring system is relatively simple, objective, and practical, we suggest that SAS be included as an indicator in the guidance for level of care after lumbar fusion surgery. Copyright © 2016 Elsevier B.V. All rights reserved.

Polyetheretherketone (PEEK) rods: short-term results in lumbar spine degenerative disease.

Science.gov (United States)

Colangeli, S; Barbanti Brodàno, G; Gasbarrini, A; Bandiera, S; Mesfin, A; Griffoni, C; Boriani, S

2015-06-01

Pedicle screw and rod instrumentation has become the preferred technique for performing stabilization and fusion in the surgical treatment of lumbar spine degenerative disease. Rigid fixation leads to high fusion rates but may also contribute to stress shielding and adjacent segment degeneration. Thus, the use of semirigid rods made of polyetheretherketone (PEEK) has been proposed. Although the PEEK rods biomechanical properties, such as anterior load sharing properties, have been shown, there are few clinical studies evaluating their application in the lumbar spine surgical treatment. This study examined a retrospective cohort of patients who underwent posterior lumbar fusion for degenerative disease using PEEK rods, in order to evaluate the clinical and radiological outcomes and the incidence of complications.

Assessment of the therapeutic efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in northern KwaZulu-Natal: an observational cohort study

OpenAIRE

Vaughan-Williams Charles H; Raman Jaishree; Raswiswi Eric; Immelman Etienne; Reichel Holger; Gate Kelly; Knight Steve

2012-01-01

Abstract Background Recent malaria epidemics in KwaZulu-Natal indicate that effective anti-malarial therapy is essential for malaria control. Although artemether-lumefantrine has been used as first-line treatment for uncomplicated Plasmodium falciparum malaria in northern KwaZulu-Natal since 2001, its efficacy has not been assessed since 2002. The objectives of this study were to quantify the proportion of patients treated for uncomplicated P. falciparum malaria with artemether-lumefantrine w...

Translaminar screw fixation in the lumbar spine: technique, indications, results

OpenAIRE

Grob, D.; Humke, T.

1998-01-01

Translaminar screw fixation of the lumbar spine represents a simple and effective technique for short segment fusion in the degenerative spine. Clinical experience with 173 patients who underwent translaminar screw fixation revealed a fusion rate of 94%. The indications for translaminar screw fixation as a primary fixation procedure are: segmental dysfunction, lumbar spinal stenosis with painful degenerative changes, segmental revision surgery after discectomies, and painful disc-related synd...

Radiographic comparison between male and female patients with lumbar spondylolysis

OpenAIRE

Takao, Shoichiro; Sakai, Toshinori; Sairyo, Koichi; Kondo, Tadashi; Ueno, Junji; Yasui, Natsuo; Nishitani, Hiromu

2010-01-01

We studied the lumbar spines of 117 adults (39 women and 78 men) with spondylolysis unrelated to low back pain using multidetector computed tomography (CT). Of the 117 subjects with spondylolysis, including five with multiple-level spondylolysis, there were 124 vertebrae with spondylolysis. In adult lumbar spines with unilateral spondylolysis, there was no significant difference between the incidence of spondylolisthesis in female and male subjects. However, in those with bilateral spondyloly...

Does team lifting increase the variability in peak lumbar compression in ironworkers?

NARCIS (Netherlands)

Faber, Gert; Visser, Steven; van der Molen, Henk F.; Kuijer, P. Paul F. M.; Hoozemans, Marco J. M.; van Dieën, Jaap H.; Frings-Dresen, Monique H. W.

2012-01-01

Ironworkers frequently perform heavy lifting tasks in teams of two or four workers. Team lifting could potentially lead to a higher variation in peak lumbar compression forces than lifts performed by one worker, resulting in higher maximal peak lumbar compression forces. This study compared

In vivo reconstruction of lumbar erector spinae architecture using diffusion tensor MRI

NARCIS (Netherlands)

Sieben, Judith M.; Van Otten, Ilse; Lataster, Arno; Froeling, Martijn; Nederveen, Aart J.; Strijkers, Gustav J.; Drost, Maarten R.

2016-01-01

Study Design: Diffusion tensor magnetic resonance imaging (DTMRI) reconstruction of lumbar erector spinae (ES) compared with cadaver dissection. Objective: The aim of this study was to reconstruct the human lumbar ES from in vivo DT-MRI measurements and to compare the results with literature and

Influence of uncomplicated phacoemulsification on central macular thickness in diabetic patients: a meta-analysis.

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Jianping Liu

Full Text Available To evaluate the effect of uncomplicated phacoemulsification on central macular thickness (CMT and best corrected visual acuity (BCVA in both diabetic patients without diabetic retinopathy (DR and diabetic patients with mild to moderate non-proliferative diabetic retinopathy (NPDR.Potential prospective observational studies were searched through PubMed and EMBASE. Standardized mean difference (SMD and 95% confidence interval (CI for changes in CMT and BCVA were evaluated at postoperative 1, 3 and 6 months. The pooled effect estimates were calculated in the use of a random-effects model.A total of 10 studies involving 190 eyes of diabetic patients without diabetic retinopathy and 143 eyes of diabetic patients with NPDR were identified. CMT values demonstrated a statistically significant increase after uncomplicated phacoemulsification at 1 month (SMD, -0.814; 95%CI, -1.230 to -0.399, 3 months (SMD, -0.565; 95%CI, -0.927 to -0.202 and 6 months (SMD, -0.458; 95%CI, -0.739 to -0.177 in diabetic patients with NPDR. There was no statistical difference in CMT values at postoperative 1 month (SMD, -1.206; 95%CI, -2.433 to 0.021and no statistically significant increase in CMT values at postoperative3 months (SMD, -0.535; 95%CI, -1.252 to 0.182 and 6 months (SMD, -1.181; 95%CI, -2.625 to 0.263 in diabetic patients without DR.BCVA was significantly increased at postoperative 1 month (SMD, 1.149; 95%CI, 0.251 to 2.047; and SMD,1.349; 95%CI, 0.264 to 2.434, respectively and 6 months (SMD, 1.295; 95%CI, 0.494 to 2.096; and SMD, 2.146; 95%CI, 0.172 to 4.120, respectively in both diabetic patients without DR and diabetic patients with NPDR. Sensitivity analysis showed that the results were relatively stable and reliable.Uncomplicated phacoemulsification in diabetic patients with mild to moderate NPDR seemed to influence significantly the subclinical thickening of the macular zones at postoperative 1, 3 and 6 months compared with diabetic patients without DR

REHABILITATION THERAPY VERSUS DRUG THERAPY IN PATIENTS WITH LUMBAR DISC DEGENERATION

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BROSCATEAN, Emanuela-Flavia

2013-12-01

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

Oriental Medical Treatment of Lumbar Spinal Stenosis

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Hae-Yeon Lee

2003-12-01

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

Prevalence of lumbar spondylosis and its association with low back pain among community-dwelling Japanese women

OpenAIRE

Tsujimoto, Ritsu; Abe, Yasuyo; Arima, Kazuhiko; Nishimura, Takayuki; Tomita, Masato; Yonekura, Akihiko; Miyamoto, Takashi; Matsubayashi, Shohei; Tanaka, Natsumi; Aoyagi, Kiyoshi; Osaki, Makoto

2016-01-01

Background: Lumbar spondylosis is more prevalent among the middle-aged and elderly, but few population-based studies have been conducted, especially in Japan. The purpose of this study was to explore the prevalence of lumbar spondylosis and its associations with low back pain among community-dwelling Japanese women. Methods: Lateral radiographs of the lumbar spine were obtained from 490 Japanese women ≥ 40 years old, and scored for lumbar spondylosis using the Kellgren-Lawrence (KL) grade at ...

Lumbar facet anatomy changes in spondylolysis: a comparative skeletal study

Science.gov (United States)

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

2007-01-01

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

Interference of detection rate of lumbar disc herniation by socioeconomic status.

Science.gov (United States)

Ji, Gyu Yeul; Oh, Chang Hyun; Jung, Nak-Yong; An, Seong Dae; Choi, Won-Seok; Kim, Jung Hoon

2013-03-01

Retrospective study. The objective of the study is to evaluate the relationship between the detection rate of lumbar disc herniation and socioeconomic status. Income is one important determinant of public health. Yet, there are no reports about the relationship between socioeconomic status and the detective rate of disc herniation. In this study, 443 cases were checked for lumbar computed tomography for lumbar disc herniation, and they reviewed questionnaires about their socioeconomic status, the presence of back pain or radiating pain and the presence of a medical certificate (to check the medical or surgical treatment for the pain) during the Korean conscription. Without the consideration for the presence of a medical certificate, there was no difference in spinal physical grade according to socioeconomic status (p=0.290). But, with the consideration of the presence of a medical certificate, the significant statistical differences were observed according to socioeconomic status in 249 cases in the presence of a medical certificate (p=0.028). There was a lower detection rate in low economic status individuals than those in the high economic class. The common reason for not submitting a medical certificate is that it is neither necessary for the people of lower socioeconomic status nor is it financially affordable. The prevalence of lumbar disc herniation is not different according to socioeconomic status, but the detective rate was affected by socioeconomic status. Socioeconomic status is an important factor for detecting lumbar disc herniation.

Postoperative braces for degenerative lumbar diseases

NARCIS (Netherlands)

Machado, Andre N.; Ayala, Ana Patricia; Rubinstein, Sidney M.; El Dib, Regina; Rodrigues, Luciano M.; Gotfryd, Alberto Ofenhejm; Tamaoki, Marcel Jun; Belloti, João Carlos

2017-01-01

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective is to evaluate the effectiveness of orthosis following lumbar spinal surgery for people with degenerative disease on pain reduction and improvement of functional status. Secondary objectives

Open-label trial on efficacy of artemether/lumefantrine against the uncomplicated Plasmodium falciparum malaria in Metema district, Northwestern Ethiopia

Directory of Open Access Journals (Sweden)

Wudneh F

2016-08-01

Full Text Available Feven Wudneh,1,2 Ashenafi Assefa,3 Desalegn Nega,3 Hussien Mohammed,3 Hiwot Solomon,4 Tadesse Kebede,2 Adugna Woyessa,3 Yibeltal Assefa,3 Amha Kebede,3 Moges Kassa3 1Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, 2Biomedical Department, College of Health Sciences and Medicine, Dilla University, Dilla, 3Malaria and Other Parasitological and Entomological Research Team, Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, 4Malaria Research Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia Purpose: Following the increased Plasmodium falciparum resistance to chloroquine and sulfadoxine/pyrimethamine, Ethiopia adopted artemether/lumefantrine (AL as the first-line treatment for uncomplicated P. falciparum in 2004. According to the recommendation of the World Health Organization, this study was carried out for regular monitoring of the efficacy of AL in treating the uncomplicated P. falciparum malaria in Metema district, Gondar Zone, Northwest Ethiopia.Patients and methods: This is a one-arm prospective 28-day in vivo therapeutic efficacy study among the uncomplicated P. falciparum malaria patients aged 6 months and older. The study was conducted from October 2014 to January 2015, based on the revised World Health Organization protocol of 2009 for surveillance of antimalarial drug therapeutic efficacy study. Standard six-dose regimen of AL was given twice daily for 3 days, and then the treatment outcomes were assessed on days 0, 1, 2, 3, 7, 14, 21, 28, and any other unscheduled day for emergency cases.Results: There were 91 study subjects enrolled in this study, of whom 80 study subjects completed the full follow-up schedules and showed adequate clinical and parasitological responses on day 28, with no major adverse event. Per protocol analysis, the unadjusted

LONG-TERM INTRAOCULAR PRESSURE AFTER UNCOMPLICATED PARS PLANA VITRECTOMY FOR IDIOPATHIC EPIRETINAL MEMBRANE.

Science.gov (United States)

Tognetto, Daniele; Pastore, Marco R; Cirigliano, Gabriella; DʼAloisio, Rossella; Borelli, Massimo; De Giacinto, Chiara

2017-11-16

To investigate long-term intraocular pressure trends after uncomplicated pars plana vitrectomy for idiopathic epiretinal membrane. Three hundred and sixty-eight eyes of 368 consecutive patients were enrolled. Changes in intraocular pressure 1, 3, 6, and 12 months after surgery and during the final follow-up visit were evaluated in vitrectomized eyes and nonvitrectomized fellow eyes. The median follow-up period was 36 months (range 12-92 months). Longitudinal data analysis evidenced a 2.5-mmHg (2.2 mmHg; 2.7 mmHg, 95% confidence interval) statistically significant difference in intraocular pressure 30 days after surgery between treated and fellow untreated eyes, gradually recovering to a not significant 0.2-mmHg (-0.1 mmHg; 0.4 mmHg, 95% confidence interval) difference within 26 months. The incidence of late-onset ocular hypertension was 5.7% (21 over 347, 2%; 12%, 95% confidence interval) without difference between the treated eyes and the group control. No significant difference in the incidence of late-onset ocular hypertension and sex, lens status, or gauge of vitrectomy instruments was detected. Only patient's age was significantly higher (mean difference 4.2 years; 0.1-8.0 years, Monte Carlo, 95% confidence interval) in those who developed late-onset ocular hypertension in the vitrectomized eye. Uncomplicated pars plana vitrectomy for idiopathic epiretinal membrane seems not to increase the risk of late-onset ocular hypertension or open-angle glaucoma development.

Postoperative dysesthesia in lumbar three-column resection osteotomies.

Science.gov (United States)

Zhang, Zhengfeng; Wang, Honggang; Zheng, Wenjie

2016-08-01

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

Two-year outcomes of transforaminal lumbar interbody fusion.

Science.gov (United States)

Poh, Seng Yew; Yue, Wai Mun; Chen, Li-Tat John; Guo, Chang-Ming; Yeo, William; Tan, Seang-Beng

2011-08-01

To evaluate the outcomes, fusion rates, complications, and adjacent segment degeneration associated with transforaminal lumbar interbody fusion (TLIF). 32 men and 80 women aged 15 to 85 (mean, 57) years underwent 141 fusions (84 one-level, 27 2-level, and one 3-level) and were followed up for 24 to 76 (mean, 33) months. 92% of the patients had degenerative lumbar disease, 15 of whom had had previous lumbar surgery. Radiographic and clinical outcomes were assessed at 2 years. The short-form 36 (SF-36) health survey, visual analogue scale (VAS) for pain, and the modified North American Spine Society (NASS) Low Back Pain Outcome Instrument were used. Of the 141 levels fused, 110 (78%) were fused with remodelling and trabeculae (grade I), and 31 (22%) had intact grafts but were not fully incorporated (grade II). No patient had pseudoarthroses (grade III or IV). For one-level fusions, poorer radiological fusion grades correlated with higher VAS scores for pain (p<0.01). All components of the SF-36, the VAS scores for pain, and the NASS scores improved significantly after TLIF (p<0.01), except for general health in the SF-36 (p=0.59). Improvement from postoperative 6 months to 2 years was not significant, except for physical function (p<0.01) and role function (physical) [p=0.01] in the SF-36. Two years after TLIF, 50% of the patients reported returning to full function, whereas 72% were satisfied. 26 (23%) of the patients had adjacent segment degeneration, but only 4 of them were symptomatic. TLIF is a safe and effective treatment for degenerative lumbar diseases.

Lumbar gibbus in storage diseases and bone dysplasias

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Levin, T.L. [Department of Radiology, Division of Pediatric Radiology, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, NY (United States); Berdon, W.E. [Department of Radiology, Division of Pediatric Radiology, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, NY (United States); Lachman, R.S. [International Skeletal Dysplasia Registry, Los Angeles, CA (United States); Anyane-Yeboa, K. [Department of Pediatrics, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, NY (United States); Ruzal-Shapiro, C. [Department of Radiology, Division of Pediatric Radiology, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, NY (United States); Roye, D.P. Jr. [Department of Orthopedic Surgery, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, NY (United States)

1997-04-01

Objective. The objective of this study was to review the problem of lumbar gibbus in children with storage diseases and bone dysplasias utilizing plain films and MR imaging. Materials and methods. Clinical histories and radiographic images in five patients with storage diseases [four mucopolysaccharidosis (MPS) and one mucolipidosis] and two with achondroplasia were reviewed. The International Skeletal Dysplasia Registry (Los Angeles, Calif.), surveyed for all patients with lumbar gibbus and skeletal dysplasias, provided 12 additional cases. Results. All patients had localized gibbus of the upper lumbar spine, characterized by anterior wedging and posterior displacement of the vertebrae at the apex of the curve, producing a beaked appearance. The curve, exaggerated in the sitting or standing position, was most severe in the two patients with MPS-IV (one of whom died). Both developed severe neurologic signs and symptoms requiring surgical intervention. In four patients, MR images demonstrated the apex of the curve to be at or below the conus. Two patients demonstrated anterior herniation of the intervertebral discs at the apex of the curve, though the signal intensity of the intervertebral discs was normal. Conclusion. Lumbar gibbus has important neurologic and orthopedic implications, and is most severe in patients with MPS. The etiology of the gibbus with vertebral beaking is multifactorial and includes poor truncal muscle tone, weight-bearing forces, growth disturbance and anterior disc herniation. The curve is generally at or below the conus. Neurologic complications are unusual, although orthopedic problems can arise. Due to their longer survival, patients with achondroplasia or Morquio`s disease are more vulnerable to eventual gibbus-related musculoskeletal complications. (orig.). With 6 figs., 2 tabs.

Lumbar gibbus in storage diseases and bone dysplasias

International Nuclear Information System (INIS)

Levin, T.L.; Berdon, W.E.; Lachman, R.S.; Anyane-Yeboa, K.; Ruzal-Shapiro, C.; Roye, D.P. Jr.

1997-01-01

Objective. The objective of this study was to review the problem of lumbar gibbus in children with storage diseases and bone dysplasias utilizing plain films and MR imaging. Materials and methods. Clinical histories and radiographic images in five patients with storage diseases [four mucopolysaccharidosis (MPS) and one mucolipidosis[ and two with achondroplasia were reviewed. The International Skeletal Dysplasia Registry (Los Angeles, Calif.), surveyed for all patients with lumbar gibbus and skeletal dysplasias, provided 12 additional cases. Results. All patients had localized gibbus of the upper lumbar spine, characterized by anterior wedging and posterior displacement of the vertebrae at the apex of the curve, producing a beaked appearance. The curve, exaggerated in the sitting or standing position, was most severe in the two patients with MPS-IV (one of whom died). Both developed severe neurologic signs and symptoms requiring surgical intervention. In four patients, MR images demonstrated the apex of the curve to be at or below the conus. Two patients demonstrated anterior herniation of the intervertebral discs at the apex of the curve, though the signal intensity of the intervertebral discs was normal. Conclusion. Lumbar gibbus has important neurologic and orthopedic implications, and is most severe in patients with MPS. The etiology of the gibbus with vertebral beaking is multifactorial and includes poor truncal muscle tone, weight-bearing forces, growth disturbance and anterior disc herniation. The curve is generally at or below the conus. Neurologic complications are unusual, although orthopedic problems can arise. Due to their longer survival, patients with achondroplasia or Morquio's disease are more vulnerable to eventual gibbus-related musculoskeletal complications. (orig.). With 6 figs., 2 tabs

A case of lumbar pain after intraoperative radiotherapy

International Nuclear Information System (INIS)

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

1996-01-01

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

Epidural fat image in lumbar magnetic resonance image

International Nuclear Information System (INIS)

Nishijima, Yuichiro; Yamasaki, Yasuo; Higashida, Norihiko; Okada, Masato

1993-01-01

To examine epidural fat images, lumbar magnetic resonance (MR) images were retrospectively reviewed in a total of 103 patients with surgically proven lumbar disc herniation (DH, n=57) and lumbar canal stenosis (LCS, n=46). Epidural fat images consisted of middorsal epidural fat (MDF), paramedian ventral fat (PVF) and intervertebral foraminal fat (IFF) ones. In the group of DH, the thickness of MDF image did not correlate with that of subcutaneous fat, suggesting that epidural fat was not affected by body fat. From the pathophysiological point of view, decrease and disappearance of MDF images correlated with compression of the epidural canal. Decrease and disappearance of PVF images lead to suspicious compression of the traversing root. In addition, asymmetrical PVF images were useful for the bilateral diagnosis of herniation. Abnormal findings of IFF images were suggestive of compression of the exiting nerve root at the intervertebral foramen. This was also seen frequently at the non-responsible level in patients over the age of 50. Degenerative and sequentrated spondylolistheses in the group of LCS were more frequently associated with a higher incidence of abnormal findings of IFF images, suggesting the presence of existing nerve root compression. (N.K.)

A radiological study on lumbar disc herniation in Korean

International Nuclear Information System (INIS)

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

1979-01-01

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

A radiological study on lumbar disc herniation in Korean

Energy Technology Data Exchange (ETDEWEB)

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

1979-12-15

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

A radiological study on lumbar disc herniation in Korean

Energy Technology Data Exchange (ETDEWEB)

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

1979-12-15

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

Sciatica from a Foraminal Lumbar Root Schwannoma: Case Report and Review of Literature

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Tarush Rustagi

2012-01-01

This case report describes lumbar foraminal schwannoma as an unusual cause of radiculopathy, presenting clinically as a lumbar disc prolapse. The diagnosis was confirmed on MRI scan. Patient had complete symptomatic recovery following surgical enucleation of the tumour mass from the L5 nerve root. This case report is of particular interest as it highlights the diagnostic confusion, which is bound to arise, because the clinical presentation closely mimics a lumbar PID. This often leads to delay in diagnosis and “failure of conservative treatment.”

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

Energy Technology Data Exchange (ETDEWEB)

Kido, Kenji

1987-07-01

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

Lumbar myelography with omnipaque (iohexol)

International Nuclear Information System (INIS)

Lilleaas, F.; Weber, H.

1986-01-01

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

Lumbar myelography with Omnipaque (iohexol)

Energy Technology Data Exchange (ETDEWEB)

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

1986-07-01

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

Weightlifter Lumbar Physiology Health Influence Factor Analysis of Sports Medicine

OpenAIRE

Zhang, Xiangyang

2015-01-01

Chinese women's weightlifting project has been in the advanced world level, suggests that the Chinese coaches and athletes have many successful experience in the weight lifting training. Little weight lifting belongs to high-risk sports, however, to the lumbar spine injury, some young good athletes often due to lumbar trauma had to retire, and the national investment and athletes toil is regret things. This article from the perspective of sports medicine, weightlifting athletes training situa...

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

Science.gov (United States)

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

2016-01-01

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