WorldWideScience

Sample records for underwent lumbar spine

  1. Lumbar Spine CT scan

    Science.gov (United States)

    ... scanners can perform the exam without stopping.) A computer creates separate images of the spine area, called ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  2. 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...

  3. 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.

  4. 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... Lumbar spine flexure. (a) When subjected to continuously applied force in accordance with paragraph (b) of this section, the lumbar spine assembly shall flex by an amount that permits the thoracic spine to...

  5. Lumbar Spine Surgery in Patients with Parkinson Disease.

    Science.gov (United States)

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

    2015-10-21

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

  6. Segmental fracture of the lumbar spine.

    Science.gov (United States)

    O'hEireamhoin, Sven; Devitt, Brian; Baker, Joseph; Kiely, Paul; Synnott, Keith

    2010-10-01

    A case report is presented. To describe a rare, previously undescribed pattern of spinal injury. This seems to be a unique injury with no previously described injuries matching the fracture pattern observed. This is a case report based on the experience of the authors. The discussion includes a short literature review based on pubmed searches. We report the case of a 26-year-old female cyclist involved in a road traffic accident with a truck resulting in complete disruption of the lumbar spine. The cyclist was caught on the inside of a truck turning left and seems to have passed under the rear wheels. She was brought to the local emergency department where, after appropriate resuscitation, trauma survey revealed spinal deformity with complete neurologic deficit below T12 and fractured pubic rami, soft tissue injuries to the perineum and multiple abrasions. Plain radiology showed a segmental fracture dislocation of her lumbar vertebrae, extending from the L1 superior endplate through to L4-L5 disc space. The entire segment was displaced in both anteroposterior and lateral planes. Computed tomography confirmed these injuries and ruled out significant visceral injury. She was transferred to the national spinal unit (author unit), where she underwent reduction and fixation with rods and screws from T9-S1, using one cross-link. After her immediate postoperative recovery, she was referred to the national rehabilitation unit. Although so-called "en bloc" lumbar fractures have been previously described, the authors were unable to find any injury of this degree in the literature. This rare injury seems to show a pattern of spinal injury previously undescribed.

  7. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion

    OpenAIRE

    Kumar, Malhar; Baklanov, Andrei; Chopin, Daniel

    2001-01-01

    Adjacent segment degeneration following lumbar spine fusion remains a widely acknowledged problem, but there is insufficient knowledge regarding the factors that contribute to its occurrence. The aim of this study is to analyse the relationship between abnormal sagittal plane configuration of the lumbar spine and the development of adjacent segment degeneration. Eighty-three consecutive patients who underwent lumbar fusion for degenerative disc disease were reviewed retrospectively. Patients ...

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

    Science.gov (United States)

    ... 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? ...

  9. Operative treatment of degenerative lumbar spine spondylolisthesis.

    Science.gov (United States)

    Kaftandziev, I; Trpeski, S; Filipce, V; Arsovski, O; Hasani, I; Nikolov, L; Kaev, A

    2015-01-01

    Management of degenerative lumbosacral spondylolisthesis with spinal stenosis is still controversial. Surgery is widely used, as well as non-surgical treatment. To evaluate the clinical results and functional outcome after operative treatment in Grade II and III lumbar spine spondylolisthesis. Twelve patients with symptoms and image-confirmed degenerative spondylolisthesis entered the study. Mean patient age was 57 years. Spondylolisthesis Grade II or III, segment L4-L5 or L5-S1 were evaluated. All patients underwent similar protocols. Operative treatment was decompressive laminectomy, posterior one segment fixation, and fusion with autologous bone grafting. Functional outcome measures were Visual Analog Scale (VAS, 10-point scale) and Oswestry Disability Index (ODI, 100-percent scale) after 6 and 12 months. Patient follow-up was 12 months. Preoperatively, 7 patients had severe disability according to ODI, 4 had moderate disability. VAS measured 6 and 7 points in 6 patients, lowest score of 4 points and the highest score of 9. After 6 months, ODI showed 5 patients had minimal and 7 had moderate disability; 2 patients had 0 points on the VAS, 2 had a score of 1, 4 had a score of 2, highest score of 4 points. Treatment outcome effects after 1 year were 9 patients with minimal disability, 3 with moderate; VAS - 2 patients with O points, 3 with 1 point, 4 with 2 points. Patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and functional outcome during a period of 1 year.

  10. Pedicular stress fracture in the lumbar spine

    International Nuclear Information System (INIS)

    Chong, V.F.H.; Htoo, M.M.

    1997-01-01

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

  11. Pedicular stress fracture in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-08-01

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

  12. Physical rehabilitation of patients with lumbar spine dorsopathy at the hospital stage of treatment

    Directory of Open Access Journals (Sweden)

    Максим Валериевич Манин

    2015-07-01

    Full Text Available The aim of the work is an ascertainment of efficiency of the use of an offered way of the complex treatment of the lumbar spine dorsopathies at the hospital stage of treatment as the more effective one comparing to the standard method of the therapeutic physical training for patients with the lumbar spine dorsopathies. The object of research is the lumbar spine dorsopathies. The subject of research is the dynamics of the painful and musculo-tonic syndromes, mobility, degrees of the functional blocking of spine.Methods of research: questioning and interrogation, functional assays of the spine mobility, manual examination. 30 persons with lumbar spine dorsopathies with neurological manifestations took part in the research. 15 patients who underwent extended method of therapeutic physical training (TPT including the way of the complex treatment of the lumbar spine dopsopathies formed the main group. 15 persons who underwent the TPT by the standard method formed the control group. Results, received in testing the dynamics of indicators of the spine mobility blocking, painful, musculo-tonic syndrome at the end of physical rehabilitation reliably demonstrate the more significant increase of results in the main group comparing to the control one. It happened first of all due to the use of traction exercises, positions and traction massage that form the complex treatment of the lumbar spine dorsopathies.An offered way of the complex treatment of the lumbar spine dorsopathies had the more effective impact on an increase of the spine mobility, decrease of the painful syndrome comparing to the standard complex of physical rehabilitation. It gives the reasons to recommend this way for introduction into practice as the mean of special TPT at the hospital stage of treatment. 

  13. Adjacent level disease following lumbar spine surgery: A review

    Science.gov (United States)

    Epstein, Nancy E.

    2015-01-01

    Background: Instrumented lumbar spine surgery is associated with an increased risk of adjacent segment disease (ASD). Multiple studies have explored the various risk factors contributing to ASD that include; fusion length (especially, three or more levels), sagittal malalignment, facet injury, advanced age, and prior cephalad degenerative disease. Methods: In this selective review of ASD, following predominantly instrumented fusions for lumbar degenerative disease, patients typically underwent open versus minimally invasive surgery (MIS), transforaminal lumbar interbody fusions (TLIFs), posterior lumbar interbody fusions (PLIFs), or rarely posterolateral lumbar instrumented or noninstrumented fusions (posterolateral lumbar fusion). Results: The incidence of ASD, following open or MI lumbar instrumented fusions, ranged up to 30%; notably, the addition of instrumentation in different series did not correlate with improved outcomes. Alternatively, in one series, at 164 postoperative months, noninstrumented lumbar fusions reduced the incidence of ASD to 5.6% versus 18.5% for ASD performed with instrumentation. Of interest, dynamic instrumented/stabilization techniques did not protect patients from ASD. Furthermore, in a series of 513 MIS TLIF, there was a 15.6% incidence of perioperative complications that included; a 5.1% frequency of durotomy and a 2.3% instrumentation failure rate. Conclusions: The incidence of postoperative ASD (up to 30%) is greater following either open or MIS instrumented lumbar fusions (e.g., TLIF/PLIF), while decompressions with noninstrumented fusions led to a much smaller 5.6% risk of ASD. Other findings included: MIS instrumented fusions contributed to higher perioperative complication rates, and dynamic stabilization did not protect against ASD. PMID:26693387

  14. Reoperation Rates Following Instrumented Lumbar Spine Fusion.

    Science.gov (United States)

    Irmola, Tero Matti; Häkkinen, Arja; Järvenpää, Salme; Marttinen, Ilkka; Vihtonen, Kimmo; Neva, Marko

    2018-02-15

    A prospective cohort study. This study evaluated the cumulative reoperation rate and indications for reoperation following instrumented lumbar spine fusion (LSF). LSF reduces disability and improves health-related quality of life for patients with several spinal disorders. The rate of instrumented LSF has drastically increased over the last few decades. The increased incidence of LSF, however, has led to increased reoperation rates. The data are based on the prospective LSF database of Tampere University Hospital that includes all elective indications for LSF surgery. A total of 433 consecutive patients (64% women, mean age 62 years) who underwent LSF in Tampere University Hospital between 2008 and 2011 were evaluated and indications for reoperations were rechecked from patient records and radiographs. The most common diagnosis for the primary surgery was degenerative spondylolisthesis and the mean follow-up time was 3.9 years. The cumulative incidence of reoperations and the "time to event" survival rate was calculated by Kaplan-Meier analysis. By the end of 2013, 81 patients had undergone at least one reoperation. The cumulative reoperation rate at 2 years was 12.5% (95% confidence interval: 95% CI: 9.7-16.0) and at 4 years was 19.3% (95% CI: 15.6-23.8). The most common pathology leading to reoperation was adjacent segment pathology with a cumulative reoperation rate of 8.7% (95% CI: 6.1-12.5) at 4 years. The corresponding rates for early and late instrumentation failure were 4.4% (95% CI: 2.7-7.0) and 2.9% (95% CI: 1.9-7.1), respectively, and for acute complications, 2.5% (95% CI: 1.4-4.5). Although previous studies reported that early results of spinal fusion are promising, one in five patients required reoperation within 4 years after surgery. Patients and surgeons should be aware of the reoperation rates when planning fusion surgery. 4.

  15. Correlation between lumbar intervertebral disc height and lumbar spine sagittal alignment among asymptomatic Asian young adults.

    Science.gov (United States)

    Zhang, Feng; Zhang, Kai; Tian, Hai-Jun; Wu, Ai-Min; Cheng, Xiao-Fei; Zhou, Tang-Jun; Zhao, Jie

    2018-02-12

    To investigate the distribution and characteristics of the lumbar intervertebral disc height (IDH) in asymptomatic Asian population and to determine whether the lumbar IDH is related to the lumbar spine sagittal alignment. A cohort of 169 cases of asymptomatic volunteers was enrolled from January 2014 to July 2016. All participants underwent magnetic resonance imaging of the lumbar spine and panoramic radiography of the spine. Panoramic radiographs of the spine were taken to evaluate pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) using Surgimap® software. Roussouly classification was utilized to categorize all subjects according to the four subtypes of sagittal alignment. The IDH was measured on the MRI mid-saggital section of the vertebral body. The relationships between lumbar IDH and spine-pelvic parameters were also assessed using the Spearman correlation analysis. The reference value ranges of IDH in asymptomatic Asian volunteers between L1/2, L2/3, L3/4, L4/5, and L5/S1 were (6.25, 10.99), (6.97, 12.08), (7.42, 13.3), (7.76, 14.57),and (7.11, 13.12) mm, respectively. Based on the above reference value, the high lumbar intervertebral space is defined as more than 14 mm. According to the Roussouly Classification, there are 33 cases in type I, 48 in type II, 66 in type III, and 22 in type IV. According to the definition of the high IDH, there are two cases in type I, three in type II, nine in type III, and eight in type IV. The results indicated that people in the Roussouly III and IV subtypes had greater values for IDH compared to those of Roussouly I and II subtypes, and the spinopelvic parameters were partly correlated with IDH in different subtypes. In addition, levels L4-L5 showed the highest IDH for all four groups followed by the L3-L4 and L5-S1 levels, and the value of L3-L4 is equivalent to that of L5-S1. All type groups showed moderate and positive correlations between the PI and IDH except the level of L1-L2 in type IV. The IDH may

  16. 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

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

  18. 49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.

    Science.gov (United States)

    2010-10-01

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

  19. Repair of the spondylolysis in lumbar spine

    International Nuclear Information System (INIS)

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

    2005-01-01

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

  20. The effects of abdominal muscle coactivation on lumbar spine stability.

    Science.gov (United States)

    Gardner-Morse, M G; Stokes, I A

    1998-01-01

    A biomechanical model of the lumbar spine was used to calculate the effects of abdominal muscle coactivation on spinal stability. To estimate the effects of abdominal muscle coactivation on lumbar spine stability, muscle fatigue rate, and lumbar spine compression forces. The activation of human trunk muscles has been found to involve coactivation of antagonistic muscles, which has not been adequately predicted by biomechanical models. Antagonistic activation of abdominal muscles might produce flexion moments resulting from abdominal pressurization. Qualitatively, antagonistic activity also has been attributed to the need to stabilize the spine. Spinal loads and spinal stability were calculated for maximum and submaximum (40%, 60% and 80%) efforts in extension and lateral bending using a previously published, anatomically realistic biomechanical model of the lumbar spine and its musculature. Three different antagonistic abdominal muscle coactivation patterns were imposed, and results were compared with those found in a model with no imposed coactivation. Results were quantified in terms of the sum of cubed muscle stresses (sigma sigma m3, which is related to the muscle fatigue rate), the maximum compressive loading on the lumbar spine, and the critical value of the muscle stiffness parameter (q) required for the spine to be stable. Forcing antagonistic coactivation increased stability, but at the cost of an increase in sigma sigma m3 and a small increase in maximum spinal compression. These analyses provide estimates of the effects of antagonistic abdominal muscle coactivation, indicating that its probable role is to stabilize the spine.

  1. 49 CFR 572.187 - Lumbar spine.

    Science.gov (United States)

    2010-10-01

    ... performance requirements specified in paragraph (c) of this section. (b) Test procedure. (1) Soak the lumbar... Figure U2-A in appendix A to this subpart. Torque the lumbar hex nut (p/n 9000057) on to the lumbar cable...

  2. 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

  3. Complications in lumbar spine surgery: A retrospective analysis

    Directory of Open Access Journals (Sweden)

    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

  4. NONFUSION STABILIZATION IN THE DEGENERATIVE LUMBAR SPINE DISEASES

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    Matjaž Voršič

    2009-04-01

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

  5. 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.

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

    African Journals Online (AJOL)

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

  7. Clinical evaluation of patients undergoing dynamic pedicle fixation in lumbar spine

    OpenAIRE

    Figueiredo, Felipe José Vieira; Brum, Paulo Roberto; Monteiro, Rogério Frota Góes

    2015-01-01

    OBJECTIVE: To evaluate the preliminary clinical results and complications in patients undergoing dynamic pedicle fixation of the spine in the treatment of a specific group of degenerative lumbar disease.METHODS: In this preliminary retrospective study, we selected 14 patients who underwent surgery from January 2006 to July 2010. We selected only patients with spondylolisthesis without spondylolysis (Grade 1 Meyerding). All patients underwent surgery at one level and the levels mostly addresse...

  8. Influence of Physiological Loading on the Lumbar Spine of National Level Athletes in Different Sports.

    Science.gov (United States)

    Rozan, Mansoorehossadat; Rouhollahi, Vahid; Rastogi, Amit; Dureha, Dilip Kumar

    2016-04-01

    The lumbar spine is subjected to considerable stress during many athletic efforts. The purpose of this study was to assess the effects of physiological loading on the lumbar spine in national male players of different games, which may be predictive of the future development of low back pain and injury symptoms. Thirty-four national players (12 cricket players, 12 field hockey players, and 10 basketball players) underwent magnetic resonance imaging, and selected geometric variables including intervertebral disc angles, the Farfan ratio, the lumbar body index, the compression deformity ratio, the biconcave deformity ratio and the anterior wedge deformity ratio were measured using KINOVEA-0.8.15 software and syngo fast view software and calculated using specific formulas. The results indicated a significant difference in the intervertebral disc angle between the three groups at the L2/3, L3/4 and L4/5 levels. In relation to the lumbar vertebral body shape and size, significant differences were found in the lumbar index at the L2 level, in the biconcave deformity at the L1 and L2 levels and in relation to the anterior wedge deformity at L2 between the three selected groups. Our data suggest that the different physiological loadings in the selected sports play an important role in the development of degenerative changes of the lumbar spine, which may be considered a risk factor for future injury and/or low back pain in each specific sport because of the unique demands of each discipline.

  9. Obesity is associated with an increased rate of incidental durotomy in lumbar spine surgery.

    Science.gov (United States)

    Burks, Christopher A; Werner, Brian C; Yang, Scott; Shimer, Adam L

    2015-04-01

    Retrospective database analysis. To determine the impact of obesity on the rate of incidental durotomy in lumbar spine surgery. There is a paucity of data on the overall impact of obesity on the rate of incidental durotomy in lumbar spine surgery, specifically with regard to the type of procedure performed. A large administrative database was queried for all patients who underwent lumbar spine surgery for decompression and/or fusion. They were then stratified into separate cohorts on the basis of body mass index and by procedural codes. Documentation of incidental durotomy was noted. Patient demographics and associated comorbidities were assessed. Odds ratios and 95% confidence intervals were calculated and χ test was used to assess for statistical significance. The incidental durotomy ranged from 0.5% to 2.6%, with the highest rates observed in multilevel laminectomies and revision decompressions in the obese and morbidly obese groups. For patients who underwent decompression only procedures, nonobese patients had a significantly lower rate of durotomy than the obese and morbidly obese cohorts. For patients who underwent fusion with or without decompression, there was a significantly increased rate of durotomy in obese patients compared with nonobese patients. The morbidly obese cohort also had significantly higher rates of incidental durotomy than the nonobese cohort in both revision decompression and revision fusion procedures. This analysis of a large administrative database demonstrates that obesity is associated with increased rates of incidental durotomy in lumbar spine surgery. Furthermore, obesity, in association with increasing complexity of the procedure, increases the rate of incidental durotomy in lumbar spine surgery. Surgeons must be aware of these increased risks as the rate of obesity increases in the population. 3.

  10. Lateral Lumbar Interbody Fusion for Ossification of the Yellow Ligament in the Lumbar Spine: First Reported Case

    Directory of Open Access Journals (Sweden)

    Kengo Fujii

    2017-01-01

    Full Text Available When ossification of the yellow ligament (OYL occurs in the lumbar spine and extends to the lateral wall of the spinal canal, facetectomy is required to remove all of the ossified lesion and achieve decompression. Subsequent posterior fixation with interbody fusion will then be necessary to prevent postoperative progression of the ossification and intervertebral instability. The technique of lateral lumbar interbody fusion (LLIF has recently been introduced. Using this procedure, surgeons can avoid excess blood loss from the extradural venous plexus and detachment of the ossified lesion and the ventral dura mater is avoidable. We present a 55-year-old male patient with OYL at L3/4 and anterior spondylolisthesis of L4 vertebra, with concomitant ossification of the posterior longitudinal ligament, who presented with a severe gait disturbance. He underwent a 2-stage operation without complications: LLIF for L3/4 and L4/5 was performed at the initial surgery, and posterior decompression fixation using pedicle screws from L3 to L5 was performed at the second surgery. His postoperative progress was favorable, and his interbody fusion was deemed successful. Here, we present the first reported case of LLIF for OYL of the lumbar spine. This procedure can be a good option for OYL of the lumbar spine.

  11. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1982-08-01

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

  13. 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.

  14. A new diagnostic score to detect osteoporosis in patients undergoing lumbar spine MRI

    Energy Technology Data Exchange (ETDEWEB)

    Bandirali, Michele; Messina, Carmelo [Universita degli Studi di Milano, Scuola di Specializzazione in Radiodiagnostica, Milano (Italy); Di Leo, Giovanni; Papini, Giacomo Davide Edoardo [IRCCS Policlinico San Donato, Radiology Unit, San Donato Milanese (Italy); Sconfienza, Luca Maria; Sardanelli, Francesco [IRCCS Policlinico San Donato, Radiology Unit, San Donato Milanese (Italy); Universita degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, San Donato Milanese (Italy); Ulivieri, Fabio Massimo [IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Mineralometria Ossea Computerizzata e Ambulatorio Malattie Metabolismo Minerale e Osseo, Servizio di Medicina Nucleare, Milano (Italy)

    2015-10-15

    Signal intensity of lumbar-spine at magnetic resonance imaging (MRI) correlates to bone mineral density (BMD). Our aim was to define a quantitative MRI-based score to detect osteoporosis on lumbar-spine MRI. After Ethics Committee approval, we selected female patients who underwent both lumbar-spine MRI and dual-energy X-ray absorptiometry (DXA) and a reference group of 131 healthy females (20-29 years) who underwent lumbar-spine MRI. We measured the intra-vertebral signal-to-noise ratio in L1-L4. We introduced an MRI-based score (M-score), on the model of T-score. M-score diagnostic performance in diagnosing osteoporosis was estimated against DXA using receiver operator characteristic (ROC) analysis. We included 226 patients (median age 65 years), 70 (31 %) being osteoporotic at DXA. MRI signal-to-noise ratio correlated to BMD (r = -0.677, P < 0.001). M-score negatively correlated to T-score (r = -0.682, P < 0.001). Setting a 90 %-specificity, an M-score threshold of 5.5 was found, distinguishing osteoporosis from non-osteoporosis (sensitivity 54 %; ROC AUC 0.844). Thirty-one (14 %) patients had a fragility fracture, with osteoporosis detected in 15 (48 %) according to M-score and eight (26 %) according to T-score (P = 0.016). M-score obtained on lumbar spine MRI is a quantitative method correlating with osteoporosis. Its diagnostic value remains to be demonstrated on a large prospective cohort of patients. (orig.)

  15. Radiographic Morphometry of the Lumbar Spine in Munich Miniature Pigs†

    Science.gov (United States)

    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

  16. Surgical apgar score in patients undergoing lumbar fusion for degenerative spine diseases.

    Science.gov (United States)

    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.

  17. Cobb angle changes in thoracic and lumbar spine fractures ...

    African Journals Online (AJOL)

    Background: This is a retrospective study to evaluate the short-term clinical outcome of conservative treatment of all consecutive patients that were treated for closed thoracic and lumbar spine fractures following Road Traffic Injury (RTI) at the University of Abuja Teaching Hospital (UATH) Gwagwalada, Abuja Nigeria.

  18. Computer aided measurement of biomechanical characteristics of cadaverous lumbar spines

    Czech Academy of Sciences Publication Activity Database

    Bartoněk, L.; Keprt, Jiří; Charamza, J.; Hrabálek, L.

    2004-01-01

    Roč. 2, č. 3 (2004), s. 504-510 ISSN 1644-3608 R&D Projects: GA MŠk LN00A015 Institutional research plan: CEZ:AV0Z1010921 Keywords : lumbar spine * force gauges * specle interferometry * fast Fourier transform PACS Subject RIV: BH - Optics, Masers, Lasers Impact factor: 0.375, year: 2004

  19. Intradural hemangiopericytoma of the lumbar spine: a rare entity.

    Science.gov (United States)

    Fitzpatrick, D; Mahajan, J; Lewkowitz, M; Black, K; Setton, A; Woldenberg, R

    2009-01-01

    We report a case of a patient with an intradural hemangiopericytoma of the lumbar spine and the unusual MR angiography (MRA) and spinal angiography findings of arteriovenous shunting with spinal venous congestion. We highlight the concordance of the unusual MRA and angiographic findings and their relationship to combined endovascular and surgical therapy.

  20. [Finite element analysis on stress change of lumbar spine].

    Science.gov (United States)

    Yan, Jia-zhi; Wu, Zhi-hong; Wang, Xue-song; Xing, Ze-jun; Song, Hai-feng; Zhao, Yu; Zhang, Jian-guo; Wang, Yi-peng; Qiu, Gui-xing

    2009-05-05

    To build a 3D finite element model of whole lumbar spine and verify its efficiency and analyze the biomechanical change of L3-4 motion segment. L1-L5 segment data were obtained from computed tomography (CT) scans of the lumbar spine of a 40-year-old man with no abnormal findings. A three-dimensional finite element model of the human whole lumbar spine was built in the Mimics and the ABAQUS software. The model was composed of bony vertebrae, articulating facets, intervertebral disc and associated ligaments. The basic stress analysis of L3-4 motion segment was made under the considerations of different material properties of bone, ligaments and facet joints contacting frictional property. The stress on annulus fiber, nucleus pulposus, endplate and facet joints under axial pressure (0.3 MPa, 0.5 MPa, 1.0 MPa, 2.0 MPa & 4.0 MPa) were analyzed. A three-dimensional finite element model of human L3-L4 motion segment has 272, 619 elements, the stresses were higher in the posterior of annulus fiber, the Max pressure stress (S33) distributed in nucleus pulposus and the center of endplate. The stresses increased as axial pressure rose. 3D finite element model of whole lumbar spine and L3-4 motion segment were established successfully and the stress analyses were feasible and reliable.

  1. Adjacent segment mobility after rigid and semirigid instrumentation of the lumbar spine.

    Science.gov (United States)

    Cakir, Balkan; Carazzo, Charles; Schmidt, René; Mattes, Thomas; Reichel, Heiko; Käfer, Wolfram

    2009-05-20

    Retrospective radiographic analysis of lumbar spine range of motion (ROM) after monosegmental fusion and posterior dynamic stabilization at the level L4-L5. Comparison of segmental ROM at the index level and the cranial and caudal adjacent levels and of global lumbar spine ROM after monosegmental fusion and posterior dynamic stabilization. The postulated advantage of nonfusion technology compared with fusion is based on the assumption that preservation of motion at the treated segment reduces the incidence of adjacent segment effects. Therefore, it is imperative to provide evidence that dynamic stabilization devices avoid hypermobility at the adjacent segments because this might substantiate a protective effect on the adjacent segments. Twenty-six patients with low back pain and claudication due to degenerative instability at the level L4-L5 with concomitant spinal stenosis were treated either with decompression and Dynesys (n = 11) or with decompression and fusion (n = 15). All patients underwent flexion/extension radiographs before surgery and at latest follow-up. ROM was assessed at the index level (L4-L5), the cranial/caudal adjacent levels (L3-L4/L5-S1), and at the lumbar spine from L2 to S1. There was a significant reduction of the global ROM of the lumbar spine (L2-S1) and the segmental ROM at the index level (L4-L5) in the fusion group, whereas adjacent level ROM did not change significantly. In the Dynesys group, no significant changes of global lumbar spine ROM (L2-S1) and segmental ROM (index level and cranial/caudal adjacent levels) were seen. This study shows that neither monosegmental instrumented fusion nor monosegmental posterior dynamic stabilization with Dynesys alter the ROM of the cranial and caudal adjacent levels. Consequently, monosegmental posterior dynamic stabilization with Dynesys has no effect with regard to adjacent segment mobility compared with monosegmental fusion.

  2. 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.

  3. Lumbar spine stability after combined application of interspinous fastener and modified posterior lumbar interbody fusion: a biomechanical study.

    Science.gov (United States)

    Yu, Xiuchun; Zhu, Lei; Su, Qing

    2014-05-01

    Posterior lumbar interbody fusion (PLIF) and internal fixation are commonly performed for the treatment of lower back pain due to lumbar spinal degeneration. We have developed a novel interspinous fixation device, the interspinous fastener (ISF) for potential use in the surgical management of degenerative spinal disease. The aim of this study was to assess the in vitro biomechanical characteristics of calf lumbar spine specimens after ISF fixation with modified PLIF. Ten lumbar spine (L3-L6) specimens from ten fresh calf cadavers (8-10 weeks of age) were used. Each specimen underwent sequential testing for each of the following four groups: no instrumentation (INTACT); interspinous fusion device fixation + PLIF (ISF); unilateral pedicle screw and titanium rod fixation + PLIF (UPS); bilateral pedicle screw and titanium rod fixation + PLIF (BPS). Outcome measures included angular range of motion (ROM) during unloaded and loaded (8 Nm) flexion, extension, left bending, right bending, left torsion and right torsion. For all unloaded and loaded assessments, ROM was significantly higher in the INTACT group compared with all other groups (P < 0.05). Similarly, ROM was significantly higher in the UPS group (indicating decreased stability) compared with the ISF and BPS groups (P < 0.05). The only significant difference between the ISF and BPS groups was in the ROM with unloaded extension (higher in the BPS group, P = 0.006). We found that ISF fixation with PLIF of the lower lumbar spine provided biomechanical stability that was equivalent to that associated with bilateral pedicle screw/rod fixation with PLIF. The ISF shows potential as an alternative means of fixation in the surgical management of degenerative spinal disease.

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

    Science.gov (United States)

    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.

  5. 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.)

  6. Effects of unstable shoes on trunk muscle activity and lumbar spine kinematics.

    Science.gov (United States)

    Lisón, Juan F; Pérez-Soriano, Padro; Llana-Belloch, Salvador; Sánchez-Zuriaga, Daniel; Salvador-Coloma, Pablo

    2016-08-01

    In patients with neuromuscular disease and a forced vital capacity (FVC) of shoe was developed as a walking device to strengthen the lower extremity muscles and reduce joint loading. A large number of studies have reported increased electromyographic (EMG) activity throughout the gait cycle in most of the lower limb muscles, and significant kinematic changes in the lower extremity. However, no studies have investigated the effects of wearing unstable shoes on spine kinematics and trunk muscle activity during gait. To compare trunk muscle activity and lumbar spine range of motion (ROM) during gait using an unstable shoe and a conventional stable control shoe. Cross-sectional study. A Biomechanics laboratory. Forty-eight healthy voluntary participants (24.5±5.6 years and 22.7±6.8 kg/m2). Subjects underwent gait analysis while simultaneously collecting surface EMG data of erector spinae (ES) and rectus abdominis (RA) and lumbar spine sagittal plane ROM while treadmill walking wearing regular shoes and unstable shoes. The results showed that the unstable shoes resulted in significantly higher ES and RA EMG muscle activity levels in all gait phases compared to control shoes (Pshoe condition showed a significantly higher mean (mean difference: 3.1º; 95% CI 2.2º to 4º) and maximum (mean difference: 4.5º; 95% CI 2.6º to 6.5º) lumbar spine extension values (Pshoes increase trunk muscle activity (ES, RA) and lumbar lordosis during gait compared to control shoes. Based on these findings, the use of unstable shoes may have potential implications in promoting spine tissue health, particularly in strengthening trunk muscles in healthy population or in low back pain treatment.

  7. A generic detailed rigid-body lumbar spine model

    DEFF Research Database (Denmark)

    De Zee, Mark; Hansen, Lone; Wong, Christian

    2007-01-01

    The objective of this work is to present a musculo-skeletal model of the lumbar spine, which can be shared and lends itself to investigation in many locations by different researchers. This has the potential for greater reproducibility and subsequent improvement of its quality from the combined e...... is relatively easy to share and modify due to the use of a well-defined and self-contained scripting language. Validation is though still necessary for specific cases....... the literature. The work resulted in a detailed lumbar spine model with seven rigid segments with 18 degrees-of-freedom and 154 muscles. The model is able to produce a maximum extension moment of 238 Nm around L5/S1. Moreover, a comparison was made with in vivo intradiscal pressure measurements of the L4-5 disc...

  8. Intraoperative Computed Tomography Navigation for Transpedicular Screw Fixation to Treat Unstable Thoracic and Lumbar Spine Fractures

    Science.gov (United States)

    Lee, Ching-Yu; Wu, Meng-Huang; Li, Yen-Yao; Cheng, Chin-Chang; Hsu, Chu-Hsiang; Huang, Tsung-Jen; Hsu, Robert Wen-Wei

    2015-01-01

    Abstract Transpedicular screw (TPS) fixation in unstable thoracic and lumbar (TL) spine fractures remains technically difficult because of destroyed anatomical landmarks, unstable gross segments, and discrepancies in anatomic orientation using conventional anatomic landmarks, fluoroscopic guidance, or computed tomography (CT)-based navigation. In this study, we evaluated the safety and accuracy of TPS placement under intraoperative computed tomography (iCT) navigation in managing unstable TL spine fractures. From 2010 to 2013, we retrospectively reviewed the Spine Operation Registry records of patients who underwent posterior instrumented fusion to treat unstable TL spine fractures via the iCT navigation system. An unstable spine fracture was identified as AO/Magerl classification type B or type C. In all, 316 screws in 37 patients with unstable TL spine fractures were evaluated and involved 7 thoracic, 23 thoracolumbar junctional, and 7 lumbar fractures. The accuracy of TPS positioning in the pedicle without breach was 98% (310/316). The average number of iCT scans per patient was 2.1 (range 2–3). The average total radiation dose to patients was 15.8 mSv; the dose per single level exposure was 2.7 mSv. The TPS intraoperative revision rate was 0.6% (2/316) and no neurovascular sequela was observed. TPS fixation using the iCT navigation system obtained a 98% accuracy in stabilizing unstable TL spine fractures. A malplaced TPS could be revised during real-time confirmation of the TPS position, and no secondary operation was required to revise malplaced screws. The iCT navigation system provides accurate and safe management of unstable TL spine fractures. In addition, operating room personnel, including surgeons and nurses, did not need to wear heavy lead aprons as they were not exposed to radiation. PMID:25997042

  9. Concomitant lower thoracic spine disc disease in lumbar spine MR imaging studies.

    Science.gov (United States)

    Arana, Estanislao; Martí-Bonmatí, Luis; Dosdá, Rosa; Mollá, Enrique

    2002-11-01

    Our objective was to study the coexistence of lower thoracic-spine disc changes in patients with low back pain using a large field of view (FOV) in lumbar spine MR imaging. One hundred fifty patients with low back pain were referred to an MR examination. All patients were studied with a large FOV (27 cm), covering from the coccyx to at least the body of T11. Discs were coded as normal, protrusion, and extrusion (either epiphyseal or intervertebral). The relationship between disc disease and level was established with the Pearson chi(2) test. The T11-12 was the most commonly affected level of the lower thoracic spine with 58 disc cases rated as abnormal. Abnormalities of T11-12 and T12-L1 discs were significantly related only to L1-L2 disease ( p=0.001 and p=0.004, respectively) but unrelated to other disc disease, patient's gender, and age. No correlation was found between other discs. Magnetic resonance imaging of the lumbar spine can detect a great amount of lower thoracic disease, although its clinical significance remains unknown. A statistically significant relation was found within the thoracolumbar junctional region (T11-L2), reflecting common pathoanatomical changes. The absence of relation with lower lumbar spine discs is probably due to differences in their pathomechanisms.

  10. Concomitant lower thoracic spine disc disease in lumbar spine MR imaging studies

    International Nuclear Information System (INIS)

    Arana, Estanislao; Marti-Bonmati, Luis; Dosda, Rosa; Molla, Enrique

    2002-01-01

    Our objective was to study the coexistence of lower thoracic-spine disc changes in patients with low back pain using a large field of view (FOV) in lumbar spine MR imaging. One hundred fifty patients with low back pain were referred to an MR examination. All patients were studied with a large FOV (27 cm), covering from the coccyx to at least the body of T11. Discs were coded as normal, protrusion, and extrusion (either epiphyseal or intervertebral). The relationship between disc disease and level was established with the Pearson χ 2 test. The T11-12 was the most commonly affected level of the lower thoracic spine with 58 disc cases rated as abnormal. Abnormalities of T11-12 and T12-L1 discs were significantly related only to L1-L2 disease (p=0.001 and p=0.004, respectively) but unrelated to other disc disease, patient's gender, and age. No correlation was found between other discs. Magnetic resonance imaging of the lumbar spine can detect a great amount of lower thoracic disease, although its clinical significance remains unknown. A statistically significant relation was found within the thoracolumbar junctional region (T11-L2), reflecting common pathoanatomical changes. The absence of relation with lower lumbar spine discs is probably due to differences in their pathomechanisms. (orig.)

  11. Concomitant lower thoracic spine disc disease in lumbar spine MR imaging studies

    Energy Technology Data Exchange (ETDEWEB)

    Arana, Estanislao; Marti-Bonmati, Luis; Dosda, Rosa; Molla, Enrique [Department of Radiology, Quiron Clinic, Avd. Blasco Ibanez, 14, 46010 Valencia (Spain)

    2002-11-01

    Our objective was to study the coexistence of lower thoracic-spine disc changes in patients with low back pain using a large field of view (FOV) in lumbar spine MR imaging. One hundred fifty patients with low back pain were referred to an MR examination. All patients were studied with a large FOV (27 cm), covering from the coccyx to at least the body of T11. Discs were coded as normal, protrusion, and extrusion (either epiphyseal or intervertebral). The relationship between disc disease and level was established with the Pearson {chi}{sup 2} test. The T11-12 was the most commonly affected level of the lower thoracic spine with 58 disc cases rated as abnormal. Abnormalities of T11-12 and T12-L1 discs were significantly related only to L1-L2 disease (p=0.001 and p=0.004, respectively) but unrelated to other disc disease, patient's gender, and age. No correlation was found between other discs. Magnetic resonance imaging of the lumbar spine can detect a great amount of lower thoracic disease, although its clinical significance remains unknown. A statistically significant relation was found within the thoracolumbar junctional region (T11-L2), reflecting common pathoanatomical changes. The absence of relation with lower lumbar spine discs is probably due to differences in their pathomechanisms. (orig.)

  12. Trauma of the lumbar spine and the thoracolumbar junction

    International Nuclear Information System (INIS)

    Reith, W.; Harsch, N.; Kraus, C.

    2016-01-01

    Patients who have experienced high energy trauma have a particularly high risk of suffering from fractures of the thoracic and lumbar spine. The detection of spinal injuries and the correct classification of fractures before surgery are not only absolute requirements for the implementation of appropriate surgical treatment but they are also decisive for the choice of surgical procedure. By the application of spiral computed tomography (CT) crucial additional information on the morphology of the fracture can be gained in order to estimate the fracture type and possibly the indications for specific surgical treatment options. Magnetic resonance imaging (MRI) is ideally suited to provide valuable additional information regarding injuries to the discoligamentous structures of the spine. Magerl et al. developed a comprehensive classification especially for injuries of the thoracic and lumbar spine, which was adopted by the working group for osteosynthesis (AO). This is based on a 2-pillar model of the spinal column. The classification is based on the pathomorphological characteristics of fractures recognizable by imaging. The injury pattern is of particular importance. In spinal trauma a distinction is made between stable and unstable fractures. The treatment of spinal injuries depends on the severity of the overall injury pattern. Besides adequate initial treatment at the scene, a trauma CT should be immediately carried out in order that no injuries are overlooked and to ensure a rapid decision on the treatment procedure. (orig.) [de

  13. Effect of repetitive mckenzie lumbar spine exercises on cardiovascular system

    Directory of Open Access Journals (Sweden)

    Agrawal Sonal S

    2014-07-01

    Full Text Available Background & Purpose: McKenzie exercises for the lumbar spine, which are done repeatedly, such as flexion in standing (FIS, extension in standing flexion in lying (FIL & extension in lying (EIL have been used in the management of low back pain for over three decades. The cardiovascular effects of exercises that involve postural stabilization, arm exercises and of exercises performed in lying are well known, but there are seldom studies performed to assess the cardiovascular effects of these commonly used McKenzie exercises. Therefore the study focused on evaluating the effects of 4 commonly used McKenzie exercises on the cardiovascular system. Methods: 80 subjects in the age group of 20-59 years were randomly assigned into 4 groups according to their age, such that such that each group comprised of an equal number of subjects & equal number of males & females. Each subject performed all the 4 exercises (FIS, EIS, FIL & EIL for 10, 15 & 20 repetitions respectively. Heart rate, blood pressure & rate pressure product were recorded before & after each set of repetitions & after each type of exercise. Results: Repetitive McKenzie lumbar spine exercises had cardiovascular effects in apparently healthy subjects (both male & female. Exercises performed in lying were hemodynamically more demanding than that performed in standing, also exercises involving flexion of the lumbar spine elicited greater cardiovascular demand as compared to extension exercises i.e. FIL>EIL>FIS>EIS irrespective of the number of repetitions, 10, 15 or 20. The cardiovascular demand for a given subject increased as the number of repetitions increased, for all the 4 exercises. Conclusion: McKenzie exercises when done repetitively have cardiovascular effects in healthy subjects.

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

    International Nuclear Information System (INIS)

    Bermudez Munoz, Sonia; Charry Lopez, Marco Luciano

    1998-01-01

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

  15. Radiologic abnormalities of the thoraco-lumbar spine in athletes

    Energy Technology Data Exchange (ETDEWEB)

    Hellstroem, M.; Jacobsson, B.; Swaerd, L.; Peterson, L. (Sahlgrenska Sjukhuset, Goeteborg (Sweden). Dept. of Radiology Oestra Sjukhuset, Goeteborg (Sweden). Dept. of Orthopedics King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia). Dept. of Radiology)

    1990-03-01

    A radiologic study of the thoraco-lumbar spine was performed in 143 (117 male and 26 female) athletes (wrestlers, gymnasts, soccer players and tennis players), aged 14 to 25 years and 30 male nonathletes, aged 19 to 25 years. Film interpretation was made after mixing the films from all groups and without knowledge of the individual's identity. Various types of radiologic abnormalities occured in both athletes and non-athletes but were more common among athletes, especially male-gymnasts and wrestlers. Abnormalities of the vertebral ring apophysis occurred exclusively in athletes. Combinations of different types of abnormalities were most common in male gymnasts and wrestlers. (orig.).

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-10-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-05-01

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

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

    International Nuclear Information System (INIS)

    Yoshinaga, Haruhiko

    1984-01-01

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

  19. Anatomy and biomechanics of the back muscles in the lumbar spine with reference to biomechanical modeling

    DEFF Research Database (Denmark)

    Hansen, L.; Zee, M. de; Rasmussen, J.

    2006-01-01

    This article describes the development of a musculoskeletal model of the human lumbar spine with focus on back muscles. It includes data from literature in a structured form.......This article describes the development of a musculoskeletal model of the human lumbar spine with focus on back muscles. It includes data from literature in a structured form....

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

    Science.gov (United States)

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

    2010-12-01

    Sitting is a common aggravating factor in low back pain (LBP), and re-education of sitting posture is a common aspect of LBP management. However, there is debate regarding what is an optimal sitting posture. This pilot study had 2 aims; to investigate whether pain-free subjects can be reliably positioned in a neutral sitting posture (slight lumbar lordosis and relaxed thorax); and to compare perceptions of neutral sitting posture to habitual sitting posture (HSP). The lower lumbar spine HSP of seventeen pain-free subjects was initially recorded. Subjects then assumed their own subjectively perceived ideal posture (SPIP). Finally, 2 testers independently positioned the subjects into a tester perceived neutral posture (TPNP). The inter-tester reliability of positioning in TPNP was very good (intraclass correlation coefficient (ICC) = 0.91, mean difference = 3% of range of motion). A repeated measures ANOVA revealed that HSP was significantly more flexed than both SPIP and TPNP (p 0.05). HSP was more kyphotic than all other postures. This study suggests that pain-free subjects can be reliably positioned in a neutral lumbar sitting posture. Further investigation into the role of neutral sitting posture in LBP subjects is warranted. Copyright © 2010 Elsevier Ltd. All rights reserved.

  1. Flexible Stabilisation of the Degenerative Lumbar Spine Using PEEK Rods

    Directory of Open Access Journals (Sweden)

    Jacques Benezech

    2016-01-01

    Full Text Available Posterior lumbar interbody fusion using cages, titanium rods, and pedicle screws is considered today as the gold standard of surgical treatment of lumbar degenerative disease and has produced satisfying long-term fusion rates. However this rigid material could change the physiological distribution of load at the instrumental and adjacent segments, a main cause of implant failure and adjacent segment disease, responsible for a high rate of further surgery in the following years. More recently, semirigid instrumentation systems using rods made of polyetheretherketone (PEEK have been introduced. This clinical study of 21 patients focuses on the clinical and radiological outcomes of patients with lumbar degenerative disease treated with Initial VEOS PEEK®-Optima system (Innov’Spine, France composed of rods made from PEEK-OPTIMA® polymer (Invibio Biomaterial Solutions, UK without arthrodesis. With an average follow-up of 2 years and half, the chances of reoperation were significantly reduced (4.8%, quality of life was improved (ODI = 16%, and the adjacent disc was preserved in more than 70% of cases. Based on these results, combined with the biomechanical and clinical data already published, PEEK rods systems can be considered as a safe and effective alternative solution to rigid ones.

  2. Three-dimensional lumbar spine vertebral motion during running using indwelling bone pins.

    Science.gov (United States)

    MacWilliams, Bruce A; Rozumalski, Adam; Swanson, Andrew N; Wervey, Roy; Dykes, Daryll C; Novacheck, Tom F; Schwartz, Michael H

    2014-12-15

    Eight healthy volunteers participated in this observational study. Quantify 3-dimensional motions of the lumbar vertebrae during running via direct in vivo measurement and compare these motions to walking data from the same technique and running data from a skin-mounted technique. Lumbar spine motions in running are only reported in 1 series of articles using a skin-mounted technique subject to overestimation and only instrumented a single vertebra. Reflective marker triads were attached to Kirschner wires inserted into the spinous processes of L1-S1. Anatomic registration between each vertebra and attached triad was achieved using spinal computed tomographic scans. Skin-mounted trunk markers were used to assess thoracic motions. Subjects ran several times in a calibrated volume at self-selected speed while 3-dimensional motion data were collected. Lumbar spine flexion and pelvic rotation patterns in running were reversed compared with walking. Increased lumbar spine motions during running occurred at the most inferior segments. Thoracic spine, lumbar spine and pelvis exhibited significantly greater range of sagittal plane motion with running. The pelvis had significantly greater range of frontal plane motion, and the thoracic spine had significantly greater range of transverse plane motion with running. Skin-mounted studies reported as much as 4 times the motion range determined by the indwelling bone pin techniques, indicating that the skin motion relative to the underlying bone during running was greater than the motion of the underlying vertebrae. The lumbar spine acts as a distinct functional segment in the spine during running, chiefly contributing lateral flexion to balance the relative motions between the trunk and pelvis. The lumbar spine is also shown to oppose thoracic spine sagittal flexion. While the lumbar spine chiefly contributes to frontal plane motion, the thoracic spine contributes the majority of the transverse plane motion. N/A.

  3. Primary Epidural Peripheral Primitive Neuroectodermal Tumor of the Lumbar Spine: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Woo Jung; Lee, Seung Hun; Joo, Kyung Bin [Dept. of Radiology, Hanyang University Hospital, Seoul (Korea, Republic of); Paik, Seung Sam; Jun, Young Jin [Dept. of Pathology, Hanyang University Hospital, Seoul (Korea, Republic of); Lee, Young Ho [Dept. of Pediatrics, Hanyang University Hospital, Seoul (Korea, Republic of)

    2011-05-15

    A primitive neuroectodermal tumor (PNET) is a highly malignant tumor in children and young adults, and extremely rare in the spine. We report a case of a primary epidural peripheral PNET of the lumbar spine. The present extremely rare case of primary epidural peripheral PNET of the lumbar spine illustrates the unexpected occurrence and should be included in differential diagnoses for patients with spinal tumors.

  4. 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

  5. Subdural tuberculous abscess of the lumbar spine in a patient with chronic low back pain

    Directory of Open Access Journals (Sweden)

    Mikić Dragan

    2012-01-01

    Full Text Available Introduction. Despite modern imaging methods, tuberculous abscess in the subdural space of the spine can lead to misdiagnosis and to neurogical complications development, even more up to paraplegia. We presented an extremely rare case of subdural tuberculous abscess of the lumbar (L spine and paraparesis in imunocompetent a 49-year-old patient. Case report. A patient with chronic L syndrome and a history of intervertebral (IV disc L3 and L5 operations got severe back pain late in July 2007. At the same time the patient had a purulent collection in the left knee, and was treated with high doses of corticosteroids and antibiotics. Then, the patient got a high fever, the amplification of pain in the L spine and the development of paraparesis. Erythrocyte sedimentation rate was 108 mm/1 h, Creactive protein 106.0 mg/L, white blood cell (WBC 38.4 x 09/L with a left turn. Magnetic resonance imaging (MRI of the spine was registered expansive formation in the spinal canal, from the level of the IV disc L2 to the mid-L4 vertebral body. This finding is a “spoke” in favor of the extrusion and sequestration of IV disc L3 with the cranial and caudal migration. The patient underwent an emergency neurosurgical operation. The diagnosis of subdural staphylococcal abscess of L spine was made. According to the antibiogram antibiotic therapy was applied but without effect on the course of the disease. Control MRI of the L spine showed spondylodiscitis L3/L4, abscess collection in the spinal canal and paravertebral muscle abscess. Late in September 2007 the patient underwent needle biopsy of the L3 vertebral body guided by computed tomography and the acid-fast bacilli (AFB were found. Tuberculostatics were introduced in the therapy. Two years later the patient was without significant personal difficulties, and with normal clinical, laboratory and morphological findings. Conclusion. Subdural tuberculous abscess of the spine is extremely rare manifestation of

  6. AO spine injury classification system: a revision proposal for the thoracic and lumbar spine.

    Science.gov (United States)

    Reinhold, Maximilian; Audigé, Laurent; Schnake, Klaus John; Bellabarba, Carlo; Dai, Li-Yang; Oner, F Cumhur

    2013-10-01

    The AO Spine Classification Group was established to propose a revised AO spine injury classification system. This paper provides details on the rationale, methodology, and results of the initial stage of the revision process for injuries of the thoracic and lumbar (TL) spine. In a structured, iterative process involving five experienced spine trauma surgeons from various parts of the world, consecutive cases with TL injuries were classified independently by members of the classification group, and analyzed for classification reliability using the Kappa coefficient (κ) and for accuracy using latent class analysis. The reasons for disagreements were examined systematically during review meetings. In four successive sessions, the system was revised until consensus and sufficient reproducibility were achieved. The TL spine injury system is based on three main injury categories adapted from the original Magerl AO concept: A (compression), B (tension band), and C (displacement) type injuries. Type-A injuries include four subtypes (wedge-impaction/split-pincer/incomplete burst/complete burst); B-type injuries are divided between purely osseous and osseo-ligamentous disruptions; and C-type injuries are further categorized into three subtypes (hyperextension/translation/separation). There is no subgroup division. The reliability of injury types (A, B, C) was good (κ = 0.77). The surgeons' pairwise Kappa ranged from 0.69 to 0.90. Kappa coefficients κ for reliability of injury subtypes ranged from 0.26 to 0.78. The proposed TL spine injury system is based on clinically relevant parameters. Final evaluation data showed reasonable reliability and accuracy. Further validation of the proposed revised AO Classification requires follow-up evaluation sessions and documentation by more surgeons from different countries and backgrounds and is subject to modification based on clinical parameters during subsequent phases.

  7. Synovial cyst of the lumbar spine: CT and MR findings

    International Nuclear Information System (INIS)

    Vives, Daniel A.; Bauni, Carlos E.; Mendoza, Monica E.

    2000-01-01

    The purpose of this revision article is to show the images of intraspinal synovial cysts, using MR and CT. The synovial cyst is an infrequent entity that predominates in the lower lumbar spine. It shows a prevalence on the L4-L5 level, and is uncommon before the age of 30 years. The cyst communicates with the adjacent apophysial joint, and these joints are frequently altered by osteoarthritis. The simple X-ray and the myelography do not contribute to the diagnosis. The CT and MR are the most accurate methods for this anatomical alteration. The synovial cysts have similar behavior: iso-hypointense in T1 weighted and hyperintense in T2 weighted in the MR examinations and some of them show the classical calcification of their wall in the CT studies. (author)

  8. CT of lumbar spine disk herniation: correlation with surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Firooznia, H.; Benjamin, V.; Kricheff, I.I.; Rafii, M.; Golimbu, C.

    1984-03-01

    Computed tomography (CT) of the lumbar spine was performed with selectively positioned 5-mm-thick axial cross sections to examine each disk level from the top of the neural foramen to the pedicle of the next caudad vertebra. One hundred consecutive patients with 116 surgical disk explorations were reviewed. There was agreement between the CT and surgical findings in 89 patients (104 explorations) in determination of presence or absence of a herniated nucleus pulposus (HNP). Discrepancy occurred in 12 instances (11 patients): two because of incorrect interpretations, five in previously operated patients, three in spondylolisthesis, and two in spinal stenosis. There were 97 true-positives, eight false-negatives, seven true-negatives, and four false-positives. If nine previously operated patients are excluded from the study, then CT was accurate in detection of presence or absence of an HNP in 93% of the disk explorations.

  9. MR imaging of epidural hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Dorsay, Theodore A.; Helms, Clyde A. [Duke University Medical Center, Department of Radiology, Erwin Road, Room 1504, Durham, NC 27710 (United States)

    2002-12-01

    To bring attention to the MR imaging appearance of epidural hematoma (EDH) in the lumbar spine as a small mass often associated with disk herniation or an acute event. This paper will show our experience with this entity and describe criteria for its MR imaging appearance. Design and patients. Thirteen cases of prospectively diagnosed EDH of the lumbar spine were compared with 12 cases of prospectively diagnosed prominent epidural extrusion. Our criteria were retrospectively evaluated by the two authors for their presence or absence in each case. The chi-square test for nominal data was applied. MR imaging criteria utilized to distinguish EDH from disk herniation at our institution include: (1) signal different from disk, (2) high signal on T1-weighted images, either centrally or peripherally, (3) teardrop- or egg-shaped mass, in the sagittal plane, (4) size greater than half the vertebral body height in a craniocaudal dimension, (5) primarily retrosomatic epidural location, (6) plasticity - the mass is seen to conform closely to the contours of bone (e.g., in the lateral recess), (7) little or no disk space narrowing unless associated with disc herniation. Chi-square analysis demonstrated each criterion to significantly differentiate between EDH and extrusion. Only six of 13 EDH cases went to surgery in spite of their relatively large size. Two of six patients were diagnosed as having epidural clot consistent with hematoma at the time of surgery. The four patients who were not diagnosed at surgery revealed only small disk herniations or fragments of disk. The occurrence of EDH is more frequent than previously suspected. Spontaneous EDH is frequently associated with disk herniation and acute events such as sneezing or coughing. Most cases of spontaneous EDH will resolve prior to surgery with only the minority becoming chronic in order to be seen at surgery as an encapsulated mass. MR imaging can reliably identify EDH and distinguish between EDH and large disk

  10. The influences of bowel condition with lumbar spine BMD measurement

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Joon; Lee, Hoo Min; Lee, Jung Min; Kwon, Soon Mu; Cho, Hyung Wook [Dept. of Radiologic Technology, Dongnam Health College, Suwon (Korea, Republic of); Kim, Yun Min; Kang, Yeong Han; Kim, Boo Soon; Kim, Jung Soo [Dept. of Diagonostic Radiology, Samsung Medical Center, Seoul (Korea, Republic of)

    2014-12-15

    Bone density measurement use of diagnosis of osteoporosis and it is an important indicator for treatment as well as prevention. But errors in degree of precision of BMD can be occurred by status of patient, bone densitometer and radiological technologist. Therefore the author evaluated that how BMD changes according to the condition of the patient. As Lumbar region, which could lead to substantial effects on bone density by diverse factors such as the water, food, intentional bowels. We recognized a change of bone mineral density in accordance with the height of the water tank and in the presence or absence of the gas using the Aluminum Spine Phantom. We also figured out the influence of bone mineral density by increasing the water and food into a target on the volunteers. Measured bone mineral density through Aluminum Spine Phantom had statistically significant difference accordance with increasing the height of water tank(p=0.026). There was no significant difference in BMD according to the existence of the bowl gas(p=0.587). There was no significant difference in a study of six people targeted volunteers in the presence or absence of the food(p=0.812). And also there was no significant difference according to the existence of water(p=0.618). If it is not difficult to recognize the surround of bone in measuring BMD of lumbar bone, it is not the factor which has the great effect on bone mineral density whether the test is after endoscopic examination of large intestine and patient’s fast or not.

  11. The influences of bowel condition with lumbar spine BMD measurement

    International Nuclear Information System (INIS)

    Yoon, Joon; Lee, Hoo Min; Lee, Jung Min; Kwon, Soon Mu; Cho, Hyung Wook; Kim, Yun Min; Kang, Yeong Han; Kim, Boo Soon; Kim, Jung Soo

    2014-01-01

    Bone density measurement use of diagnosis of osteoporosis and it is an important indicator for treatment as well as prevention. But errors in degree of precision of BMD can be occurred by status of patient, bone densitometer and radiological technologist. Therefore the author evaluated that how BMD changes according to the condition of the patient. As Lumbar region, which could lead to substantial effects on bone density by diverse factors such as the water, food, intentional bowels. We recognized a change of bone mineral density in accordance with the height of the water tank and in the presence or absence of the gas using the Aluminum Spine Phantom. We also figured out the influence of bone mineral density by increasing the water and food into a target on the volunteers. Measured bone mineral density through Aluminum Spine Phantom had statistically significant difference accordance with increasing the height of water tank(p=0.026). There was no significant difference in BMD according to the existence of the bowl gas(p=0.587). There was no significant difference in a study of six people targeted volunteers in the presence or absence of the food(p=0.812). And also there was no significant difference according to the existence of water(p=0.618). If it is not difficult to recognize the surround of bone in measuring BMD of lumbar bone, it is not the factor which has the great effect on bone mineral density whether the test is after endoscopic examination of large intestine and patient’s fast or not

  12. Tertiary syphilis in the lumbar spine: a case report.

    Science.gov (United States)

    Bai, Yang; Niu, Feng; Liu, Lidi; Sha, Hui; Wang, Yimei; Zhao, Song

    2017-07-24

    The incidence of tertiary syphilis involvement in the spinal column with destructive bone lesions is very rare. It is difficult to establish the correct diagnosis from radiographs and histological examination alone. Limited data are available on surgical treatment to tertiary syphilitic spinal lesions. In this article, we report a case of tertiary syphilis in the lumbar spine with osteolytic lesions causing cauda equina compression. A 44-year-old man who suffered with low back pain for 6 months and progressive radiating pain at lower extremity for 1 week. Radiologic findings showed osteolytic lesion and new bone formation in the parts of the bodies of L4 and L5. Serum treponema pallidum hemagglutination (TPHA) test was positive. A surgery of posterior debridement, interbody and posterolateral allograft bone fusion with instrumentation from L3 to S1 was performed. The low back pain and numbness abated after operation. But the follow-up radiographs showed absorption of the bone grafts and failure of instrumentation. A Charcot's arthropathy was formed between L4 and L5. It is challenging to diagnose the tertiary syphilis in the spine. Surgery is a reasonable auxiliary method to antibiotic therapy for patients who suffered with neuropathy. Charcot's arthropathy should be considered as an operative complication.

  13. Adjacent Segment Disease in the Cervical and Lumbar Spine.

    Science.gov (United States)

    Tobert, Daniel G; Antoci, Valentin; Patel, Shaun P; Saadat, Ehsan; Bono, Christopher M

    2017-04-01

    Adjacent segment disease (ASD) is disappointing long-term outcome for both the patient and clinician. In contrast to adjacent segment degeneration, which is a common radiographic finding, ASD is less common. The incidence of ASD in both the cervical and lumbar spine is between 2% and 4% per year, and ASD is a significant contributor to reoperation rates after spinal arthrodesis. The etiology of ASD is multifactorial, stemming from existing spondylosis at adjacent levels, predisposed risk to degenerative changes, and altered biomechanical forces near a previous fusion site. Numerous studies have sought to identify both patient and surgical risk factors for ASD, but a consistent, sole predictor has yet to be found. Spinal arthroplasty techniques seek to preserve physiological biomechanics, thereby minimizing the risk of ASD, and long-term clinical outcome studies will help quantify its efficacy. Treatment strategies for ASD are initially nonoperative, provided a progressive neurological deficit is not present. The spine surgeon is afforded many surgical strategies once operative treatment is elected. The goal of this manuscript is to consider the etiologies of ASD, review its manifestations, and offer an approach to treatment.

  14. Development of a 3D multibody system of the human lumbar spine

    OpenAIRE

    Matos, Joana Filipa Ferreira de

    2013-01-01

    Dissertação de mestrado integrado em Engenharia Biomédica In the present work, a three-dimensional multibody model of the lumbar spine was developed to analyse the force and torques that each intervertebral disc (IVD) is subjected during daily movements. The first work’s stage summarizes the literature review of the state-of-the-art of the multibody models of the spine. It was also characterized the anatomy of the spine, detailing at the vertebrae of the lumbar spine and sac...

  15. Interobserver reproducibility of radiographic evaluation of lumbar spine instability.

    Science.gov (United States)

    Segundo, Saulo de Tarso de Sá Pereira; Valesin, Edgar Santiago; Lenza, Mario; Santos, Durval do Carmo Barros; Rosemberg, Laercio Alberto; Ferretti, Mario

    2016-01-01

    To measure the interobserver reproducibility of the radiographic evaluation of lumbar spine instability. Measurements of the dynamic radiographs of the lumbar spine in lateral view were performed, evaluating the anterior translation and the angulation among the vertebral bodies. The tests were evaluated at workstations of the organization, through the Carestream Health Vue RIS (PACS), version 11.0.12.14 Inc. 2009© system. Agreement in detecting cases of radiographic instability among the observers varied from 88.1 to 94.4%, and the agreement coefficients AC1 were all above 0.8, indicating excellent agreement. The interobserver analysis performed among orthopedic surgeons with different levels of training in dynamic radiographs of the spine obtained high reproducibility and agreement. However, some factors, such as the manual method of measurement and the presence of vertebral osteophytes, might have generated a few less accurate results in this comparative evaluation of measurements. Mensurar a reprodutibilidade interobservadores da avaliação radiográfica da instabilidade da coluna lombar. Foram realizadas mensurações das radiografias dinâmicas de coluna lombar na incidência em perfil, avaliando-se a translação anterior e a angulação entre os corpos vertebrais. Os exames foram avaliados em workstations da própria instituição, por meio do sistema Vue RIS (PACS) da Carestream Health, versão 11.0.12.14 Inc. 2009©. A proporção de concordância em detecção de casos de instabilidade radiográfica entre os observadores variou de 88,1 a 94,4%, e os coeficientes de concordância AC1 estiveram todos acima de 0,8, indicando concordância excelente. A análise interobservadores realizada entre médicos ortopedistas com diferentes níveis de treinamento em radiografias dinâmicas da coluna vertebral obteve elevada reprodutibilidade e concordância. No entanto, alguns fatores, como método manual de aferição e a presença de osteófitos vertebrais, podem

  16. Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine.

    Science.gov (United States)

    Hassan, Khaled; Elmorshidy, Essam

    2016-04-01

    The aim of this study is to compare the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis. A total number of 42 patients with tuberculous spondylodiscitis of the thoracic and lumbar spine treated surgically were included in this study. Twenty patients (group A) underwent anterior debridement, decompression and instrumentation by anterior approach. Twenty-two patients (group B) were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Operative parameters, clinical, radiographic and functional results for the two groups were analyzed and compared. The average follow-up period was 15 months (range 12-24) in both groups. The average operative time, blood loss and blood transfusion of anterior group were significantly less than the posterior one. There was significant better back pain relief, kyphotic angle correction and less angle loss in the posterior group than anterior. There was no significant difference between the two groups regarding neurological recovery, functional outcome and fusion rate. Both anterolateral and posterolateral approaches are sufficient for achieving the goals of surgical treatment of thoracic and lumbar Pott's disease but posterolateral approach allows significant better kyphotic angle correction, less angle loss, better improvement in back pain but unfortunately more operative time and blood loss.

  17. Usefulness of dynamic contrast enhanced lumbar spine MR imaging postoperative herniated lumbar disc

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Ji Eun; Chung, Tae Sub; Kim, Young Soo; Cho, Yong Eun; Park, Mi Suk [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1999-02-01

    To compare the usefulness of dynamic contrast enhanced lumbar spine MR imaging with that of conventional delayed contrast enhanced MR imaging in the assessment of postoperative herniated lumbar disc. Forty-one postoperative herniated lumbar disc (HLD) lesions of 32 patients with back pain were examined with MR imaging (1.5T, Vision, Siemens, Germany). Five-phase dynamic 2D FLASH sagittal images (TR/TE = 118.1msec/4.1msec) were obtained every 19 seconds with a 4 minutes delayed image after contrast injection. As seen on delayed images, the discs were assessed as recurred, fibrosis, or no change. On dynamic images, the pattern of enhancement was evaluated as follows : Type 1 (no change in peripheral disc enhancement between the early and late phases) ; or Type 2 (minimal internal extension of marginal smooth enhancement during the late phase) ; or Type 3 (marked internal extension of peripheral irregular enhancement). Dynamic and delayed imaging were compared, and early epidural space enhancement with rapid wash-out was also evaluated. Of 41 postoperative HLDs, 39 lesions showed peripheral contrast enhancement. Evaluation depended on delayed imaging, and was as follows : recurred HLD (n=27) ; fibrosis (n=5) ; no change in postoperative disc (n=7). On dynamic contrast-enhanced imaging, enhancement patterns were Type 1 (n=29), Type 2 (n=7), and Type 3 (n=3). In 29 Type 1 lesions, there were no significant differences in image findings between dynamic and delayed images. However, in ten lesions (type 2 : n=7, type 3 : n=3), findings additional to those revealed by delayed images were demonstrated by dynamic contrast-enhanced MR imaging. Nine of the ten Type 2 and 3 lesions were diagnosed as recurred HLD. On dynamic images, five lesions showed early epidural space enhancement. Dynamic contrast-enhanced lumbar spine MR imaging provided additional findings such as increased peripheral disc enhancement, and epidural space enhancement, which cannot be detected on

  18. Wound infiltration with local anesthetics for post-operative pain relief in lumbar spine surgery

    DEFF Research Database (Denmark)

    Kjærgaard, M; Møiniche, S; Olsen, K S

    2012-01-01

    In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery.......In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery....

  19. The value of magnetic resonance imaging in evaluation of postoperative lumbar spine

    International Nuclear Information System (INIS)

    Lakomiec, B.; Samson, B.; Zabek, M.; Walecki, J.; Krolicki, L.

    1996-01-01

    Extruded lumbar discs are common reasons of lumbar pain and required appropriate surgical treatment. In 10-40% patients appear postoperative complications (e.g. recurrent lumbar disc on the same or different level, scar tissues involving nerve roots, arachnoiditis, discitis, postoperative pseudomeningocele, wrong level laminectomy) resulting recurrent lumbar pain and neurological symptoms. In our study 20 out of 216 patients have suffered recurrent back pain: 12 patients due to scar tissues, 6 patients due to recurrent discs, 2 patients due to postoperative discitis. Authors try to show the role of magnetic resonance imaging in evaluation of postoperative lumbar spine, result of surgical treatment, analyze the reasons of recurrent back pain. (author)

  20. Magnetic resonance imaging of the lumbar spine: determining clinical impact and potential harm from overuse.

    Science.gov (United States)

    Wnuk, Nathan M; Alkasab, Tarik K; Rosenthal, Daniel I

    2018-04-18

    Lumbar spine MRI is frequently said to be "overused" in the evaluation of low-back pain, yet data concerning the extent of overuse and on potential harmful effects are lacking. To determine the proportion of examinations with a detectable impact on patient care (actionable outcomes). Retrospective cohort study PATIENT SAMPLE: 5,365 outpatient lumbar spine MR examinations OUTCOME MEASURES: Actionable outcomes included: 1) findings leading to an intervention making use of anatomical information such as surgery; 2) new diagnoses of cancer, infection, or fracture; or 3) following known lumbar spine pathology. Potential harm was assessed by identifying examinations where suspicion of cancer or infection was raised but no positive diagnosis made. A medical record aggregation/search system was used to identify lumbar spine MR examinations with positive outcome measures. Patient notes were examined to verify outcomes. A random sample was manually inspected to identify missed positive outcomes. The proportion of actionable lumbar spine MRIs was 13%, although 93% were appropriate according to American College of Radiology guidelines. Of 36 suspected cases of cancer/infection 81% were false positives. Further investigations were ordered on 59% of suspicious exams, 86% of which were false positives. The proportion of lumbar spine MR examinations that inform management is small. The false positive rate and proportion of false positives involving further investigation is high. Further study to improve the efficiency of imaging is warranted. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. 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.

  2. Epidural interlaminar injections in severe degenerative lumbar spine: fluoroscopy should not be a luxury.

    Science.gov (United States)

    Filippiadis, Dimitrios K; Rodt, Thomas; Kitsou, Maria-Chrysanthi; Batistaki, Chrysanthi; Kelekis, Nikolaos; Kostopanagiotou, Georgia; Kelekis, Alexis

    2017-09-12

    To assess technical efficacy, accuracy, and safety of epidural (interlaminar) injections performed blindly in patients with a severely degenerated lumbar spine. Over 12 consecutive months, 138 patients with a severe degenerative lumbar spine underwent epidural (interlaminar) injection as therapy for low back pain and neuralgia. Patients had already undergone a blind epidural infiltration with minimum or no pain reduction. The session was repeated in the angiography suite. Patients were placed in the lateral decubitus position. The injection was performed without image guidance by an anaesthesiologist; the target level was defined before the beginning of the procedure. Once air resistance loss was felt it was presumed that the needle was inside the epidural space. Verification of needle position was performed by injection of 1-3 mL of iodinated contrast medium under fluoroscopy in a lateral projection. Correct needle position inside the epidural space was documented in 82/138 cases (59.4%); unexpected extraepidural location was seen in 56/138 cases (40.6%). Target level was reached in 96/138 cases (69.6%); in 42/138 cases (30.4%) the needle was positioned in a non-target level. In 5/138 (3.6%) cases, there was inadvertent intradural position of the needle. Image guidance was subsequently used for correct positioning of the needle, which was feasible in all cases. Blind interlaminar epidural injections lack the accuracy of exact needle location that imaging guidance offers in approximately 40% of cases, when there is difficult spine anatomy and the initial epidural approach has failed to provide pain relief. Image guidance for interlaminar epidural injection ensures accurate needle placement, enhancing the safety and efficacy of the procedure. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Spinal reflex excitability changes after lumbar spine passive flexion mobilization.

    Science.gov (United States)

    Bulbulian, Ronald; Burke, Jeanmarie; Dishman, J Donald

    2002-10-01

    Flexion distraction has gained increased credibility as a therapeutic modality for treatment of low back pain. Although important work in the area has elucidated the intradiskal pressure profiles during flexion distraction, the accompanying neural responses have yet to be described. The purpose of this pilot study was to assess neural reflex responses to motion with 3 degrees of freedom applied to the lumbar spine and to evaluate H-reflex responses of the soleus. Subjects (n = 12) were measured for H-maximum reflexes determined from stimulus response recruitment curves measured in neutral prone position. The mean of 10 evoked H-waves (at H-maximum stimulus intensity) were measured in neutral position, flexion, left and right lateral flexion, and axial rotation of the trunk on an adjusting table. H-reflexes were expressed as a percentage of maximal M-wave for the criterion measure. Spinal range of motion was quantified by digitization. The data showed variation in some movement ranges, notwithstanding identical table positioning for all subjects. Mean H-reflex amplitude was decreased (15.2 +/- 5.8 mV to 13.8 +/- 5.8 mV), and the H/M ratio was also decreased in flexion compared with neutral (55.0% +/- 19.1% to 50.3% +/- 19.4%; P <.05). Trunk flexion is accompanied by inhibition of the motor neuron pool. Slight perturbations in numerous afferent receptors are known to significantly alter the H-reflex. The absence of measurable changes in lateral flexion and trunk rotation may indicate that both slow- and fast-adapting receptors could be involved in lumbar motion. These preliminary findings suggest the need for further dynamic motion studies of the flexion distraction neurophysiologic condition.

  4. 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

  5. Mortality Caused by Surgery for Degenerative Lumbar Spine.

    Science.gov (United States)

    Salmenkivi, Jyrki; Sund, Reijo; Paavola, Mika; Ruuth, Iiris; Malmivaara, Antti

    2017-07-15

    Register study. The purpose of this study was to assess the safety of lumbar spine surgery for degenerative disorders and to assess the predictive factors for mortality and causes of death. Growing numbers and relative indications of spine surgery emphasize the importance of patient safety. We assessed the incidence of mortality related to surgery, overall case fatality and factors predicting mortality in elective spinal surgery. A national database was utilized to assess patient characteristics, surgical procedures, and outcomes of degenerative spinal surgery in Finland. Patients were classified into four diagnostic categories: disc herniation, spinal stenosis, degenerative disc disease, and spondylolysis and spondylolisthesis. The mortality related to surgery and overall mortality in each diagnostic group was analyzed at 7 days, 30 days, 90 days, and 1 year after surgery. We categorized the deaths into medical errors, sequelae of surgery, surgery probably a contributing factor, and deaths not associated with surgery. Age, sex, comorbid conditions, and hospital characteristics were considered as potential risk factors for mortality. Out of 408 deaths (0.67% of total of 61,166 patients) deaths that occurred during the 1-year follow up, 49 deaths (12% of deaths, 0.08% of patients) were classified as having an association with surgery: two deaths by medical errors, 28 deaths by complications after surgery and 19 deaths related to the surgery. The surgery-related 1-year mortality was 0.08%. Age >75 years, male sex, diabetes, and hypertension showed an association with increased risk of death related to surgery. Mortality caused by elective spinal surgery is rare. Cardiovascular incidents are the most common reasons for deaths occurring soon after surgery. Consideration of expected gains and risks of surgery, prevention of unintended errors during surgery and recognition and treatment of complications once they occur are recommended. 3.

  6. SU-E-T-548: How To Decrease Spine Dose In Patients Who Underwent Sterotactic Spine Radiosurgery?

    International Nuclear Information System (INIS)

    Acar, H; Altinok, A; Kucukmorkoc, E; Kucuk, N; Caglar, H

    2014-01-01

    Purpose: Stereotactic radiosurgery for spine metastases involves irradiation using a single high dose fraction. The purpose of this study was to dosimetrically compare stereotactic spine radiosurgery(SRS) plans using a recently new volumetric modulated arc therapy(VMAT) technique against fix-field intensity-modulated radiotherapy(IMRT). Plans were evaluated for target conformity and spinal cord sparing. Methods: Fifteen previously treated patients were replanned using the Eclipse 10.1 TPS AAA calculation algorithm. IMRT plans with 7 fields were generated. The arc plans used 2 full arc configurations. Arc and IMRT plans were normalized and prescribed to deliver 16.0 Gy in a single fraction to 90% of the planning target volume(PTV). PTVs consisted of the vertebral body expanded by 3mm, excluding the PRV-cord, where the cord was expanded by 2mm.RTOG 0631 recommendations were applied for treatment planning. Partial spinal cord volume was defined as 5mm above and below the radiosurgery target volume. Plans were compared for conformity and gradient index as well as spinal cord sparing. Results: The conformity index values of fifteen patients for two different treatment planning techniques were shown in table 1. Conformity index values for 2 full arc planning (average CI=0.84) were higher than that of IMRT planning (average CI=0.79). The gradient index values of fifteen patients for two different treatment planning techniques were shown in table 2. Gradient index values for 2 full arc planning (average GI=3.58) were higher than that of IMRT planning (average GI=2.82).The spinal cord doses of fifteen patients for two different treatment planning techniques were shown in table 3. D0.35cc, D0.03cc and partial spinal cord D10% values in 2 full arc plannings (average D0.35cc=819.3cGy, D0.03cc=965.4cGy, 10%partial spinal=718.1cGy) were lower than IMRT plannings (average D0.35cc=877.4cGy, D0.03c=1071.4cGy, 10%partial spinal=805.1cGy). Conclusions: The two arc VMAT technique is

  7. Clinical evaluation of patients undergoing dynamic pedicle fixation in lumbar spine

    Directory of Open Access Journals (Sweden)

    Felipe José Vieira Figueiredo

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the preliminary clinical results and complications in patients undergoing dynamic pedicle fixation of the spine in the treatment of a specific group of degenerative lumbar disease.METHODS: In this preliminary retrospective study, we selected 14 patients who underwent surgery from January 2006 to July 2010. We selected only patients with spondylolisthesis without spondylolysis (Grade 1 Meyerding. All patients underwent surgery at one level and the levels mostly addressed were: L3-L4, L4-L5 or L5-S1. The approach was the same in all patients (posterior median approach with preservation of the posterior elements. All patients underwent intense conservative treatment without clinical response and the same research algorithm preoperatively.RESULTS: Retrospective analysis of Oswestry questionnaire after selection and publication of results of 14 patients with Grade 1 spondylolisthesis who underwent dynamic pedicle stabilization in a total of 56 pedicle screws, being all in one level. There was no fracture of any screws, the mean hospital stay was a day and a half, no patient required blood transfusion and there were no cases of infection, with significant improvement in the Oswestry questionnaire.CONCLUSION: In this study, the dynamic pedicle stabilization method proved to be an excellent treatment option when surgical criteria are strictly adhered to. There was an improvement in Oswestry values, lower hospital stay and low rate of complications, consisting of an alternative in motion preservation surgery.

  8. Appropriateness of lumbar spine magnetic resonance imaging in Spain

    International Nuclear Information System (INIS)

    Kovacs, Francisco M.; Arana, Estanislao; Royuela, Ana; Cabrera, Alberto; Casillas, Carlos

    2013-01-01

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

  9. Cistos sinoviais lombares Synovial cysts of the lumbar spine

    Directory of Open Access Journals (Sweden)

    Ana Cláudia Ferreira Rosa

    2002-10-01

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

  10. Appropriateness of lumbar spine magnetic resonance imaging in Spain

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-06-15

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

  11. A Minimally Invasive Endoscopic Surgery for Infectious Spondylodiscitis of the Thoracic and Upper Lumbar Spine in Immunocompromised Patients

    Directory of Open Access Journals (Sweden)

    Hsin-Chuan Chen

    2015-01-01

    Full Text Available This study evaluates the safety and effectiveness of computed tomography- (CT- assisted endoscopic surgery in the treatment of infectious spondylodiscitis of the thoracic and upper lumbar spine in immunocompromised patients. From October 2006 to March 2014, a total of 41 patients with infectious spondylodiscitis underwent percutaneous endoscopic surgery under local anesthesia, and 13 lesions from 13 patients on the thoracic or upper lumbar spine were selected for evaluation. A CT-guided catheter was placed before percutaneous endoscopic surgery as a guide to avoid injury to visceral organs, major vessels, and the spinal cord. All 13 patients had quick pain relief after endoscopic surgery without complications. The bacterial culture rate was 77%. Inflammatory parameters returned to normal after adequate antibiotic treatment. Postoperative radiographs showed no significant kyphotic deformity when compared with preoperative films. As of the last follow-up visit, no recurrent infections were noted. Traditional transthoracic or diaphragmatic surgery with or without posterior instrumentation is associated with high rates of morbidity and mortality, especially in elderly patients, patients with multiple comorbidities, or immunocompromised patients. Percutaneous endoscopic surgery assisted by a CT-guided catheter provides a safe and effective alternative treatment for infectious spondylodiscitis of the thoracic and upper lumbar spine.

  12. Reproducibility of kinematic measures of the thoracic spine, lumbar spine and pelvis during fast running.

    Science.gov (United States)

    Mason, D L; Preece, S J; Bramah, C A; Herrington, L C

    2016-01-01

    This study evaluated the reproducibility of the angular rotations of the thoracic spine, lumbar spine, pelvis and lower extremity during running. In addition, the study compared kinematic reproducibility between two methods for calculating kinematic trajectories: a six degrees of freedom (6DOF) approach and a global optimisation (GO) approach. With the first approach segments were treated independently, however with GO approach joint constraints were imposed to stop translation of adjacent segments. A total of 12 athletes were tested on two separate days whilst running over ground at a speed of 5.6ms(-1). The results demonstrated good between-day reproducibility for most kinematic parameters in the frontal and transverse planes with typical angular errors of 1.4-3°. Acceptable repeatability was also found in the sagittal plane. However, in this plane, although kinematic waveform shape was preserved between testing session, there were sometimes shifts in curve offset which lead to slightly higher angular errors, typically ranging from 1.9° to 3.5°. In general, the results demonstrated similar levels of reproducibility for both computational approaches (6DOF and, GO) and therefore suggest that GO may not lead to improved kinematic reproducibility during running. Copyright © 2013 Elsevier B.V. All rights reserved.

  13. The influence of muscle forces on the stress distribution in the lumbar spine

    DEFF Research Database (Denmark)

    Wong, C; Rasmussen, J; Simonsen, Erik B.

    2011-01-01

    Introduction: Previous studies of bone stresses in the human lumbar spine have relied on simplified models when modeling the spinal musculature, even though muscle forces are likely major contributors to the stresses in the vertebral bones. Detailed musculoskeletal spine models have recently become...... available and show good correlation with experimental findings. A combined inverse dynamics and finite element analysis study was conducted in the lumbar spine to investigate the effects of muscle forces on a detailed musculoskeletal finite element model of the 4th lumbar vertebral body. Materials...... muscles. Results: In general the von Mises stress was larger by 30 %, and even higher when looking at the von Mises stress distribution in the superio-anterior and central part of the vertebral body and in the pedicles. Conclusion: The application of spine muscles to a finite element model showed markedly...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-12-15

    The position of the torso and the magnitude of exertion are thought to influence the distribution pattern of intervertebral movements within the lumbar spine. Abnormal intervertebral movements have been correlated with the risk of spine injuries. Since the capability to measure movement distribution within the lumbar spine noninvasively is limited, a convenient method to diagnose joint motion function was proposed. The goal of this research was to test the efficacy of the instantaneous axis of rotation for assessment of the distribution of movement within the lumbar spine. The proposed method was evaluated in the bio mechanical model. The results showed that the location of instantaneous axis of rotation lowered with increased trunk exertion force, and slightly moved higher with increased trunk angle. Recognizing that abnormal location of the instantaneous axis of rotation correlated with spinal pain, these results suggest potential the location of the instantaneous axis of rotation relates to the risk of low back pain on distributed spinal kinematics.

  15. Effect of denosumab on recurrent giant cell reparative granuloma of the lumbar spine.

    Science.gov (United States)

    Akeda, Koji; Kasai, Yuichi; Sakakibara, Toshihiko; Matsumine, Akihiko; Takegami, Norihiko; Yamada, Junichi; Sudo, Akihiro

    2015-05-15

    A case of recurrent giant cell reparative granuloma (GCRG) of the lumbar spine successfully treated with denosumab is reported; a fully human monoclonal antibody against the receptor activator of nuclear factor kappa B (RANK) ligand (RANKL). To report the first case of recurrent GCRG of the lumbar spine treated with denosumab. GCRG is a non-neoplastic osteofibrous lesion usually found in the maxilla and mandible but rarely in the spine. It is clinically distinct from giant cell tumor of bone (GCTB), although common histological characteristics such as the proliferation of spindle-shaped stromal cells and multinucleated giant cells are shared. Denosumab has recently been reported to be effective for unresectable GCTB; however, there is only one report of its effect on GCRG. Moreover, the effect of denosumab on GCRG of the spine is unknown. The clinical course, radiological features, pathology, and treatment outcome of a patient with recurrent GCRG of the lumbar spine treated with denosumab are documented. Denosumab treatment was used for this patient with unresectable recurrent GCRG of the lumbar spine. Follow-up lumbar radiography showed significant bone formations in the tumor lesion after 3 months of treatment. On follow-up computerized tomography scans of the L2 and L3 vertebral lesions, the replacement of osoteolytic lesions by the formation of cortical-like bone tissue was clearly identified. We report the first case of recurrent GCRG of the spine successfully treated with denosumab. Treatment with denosumab induced significant bone formation in the unresectable lumbar lesion with stable clinical improvement during the 12-month follow-up period without apparent complications. Denosumab shows promise as a new alternative treatment option for osteoclastic giant cell-rich tumors, such as GCRG, especially for unresectable lesions of the spine. 4.

  16. Multiple noncontiguous injuries of the spine in a child: atlantooccipital dislocation and seat-belt injury of the lumbar spine.

    Science.gov (United States)

    Vedantam, R; Crawford, A H

    1997-03-01

    Multiple noncontiguous injuries of nonadjoining regions of the spine in children are rare. Such injuries can be overlooked as the neurological deficit caused by one injury can be masked by the other. The combination of atlantooccipital dislocation and a seat-belt injury of the spine in children is rare. We describe an unusual case of atlantooccipital dislocation in combination with a seat-belt injury of the lumbar spine in a surviving child. Early halo-vest immobilization was an effective treatment in this patient. Although survival with atlantooccipital injuries is becoming common, severe and persistent neurological deficits can result in high morbidity. A brief description of the pathomechanics, diagnosis and treatment of the atlantooccipital dislocation and lumbar seat-belt injury is given.

  17. Simulation of the Lumbar Spine as a Multi-Module Paralel Manipulator

    Directory of Open Access Journals (Sweden)

    M. Ceccarelli

    2011-01-01

    Full Text Available In this paper a simulation of movements of lumbar spine is proposed by using a model with serially connected parallel manipulators. An analysis has been computed for the human spine structure and its movements, in order to simulate the motions and forces that actuate a spine specifically in the lumbar segment. A mechanical model has been designed with available identified parameters of human spine, by using characteristics of parallel manipulators and spring stiffness. This model is suitable to properly simulate the trunk behavior at macroscopic level but also the smooth behavior of intervertebral discs and actuating motions of muscles and tendons. Simulation results for spring actions and joints reaction forces can give an evaluation of the forces that intervertebral discs supports during motions of a real spine.

  18. CT-discography in the evaluation of the post-operative lumbar spine. Preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Crenier, N.; Greselle, J.F.; Richard, O.; Houang, B.; Pinol-Daubisse, H.; Caille, J.M.; Vital, J.M.; Senegas, J.

    1988-06-01

    Thirty-three patients with recurrent sciatica after lumbar-disk surgery were studied for recurrent herniated nucleus pulposus (HNP) by CT alone and CT-discography (CTD). Twenty-six patients underwent surgical reexploration allowing correlation with CTD. CTD made a correct diagnosis of recurrent HNP in twenty-one patients showing an extravasation of the contrast medium from the disk space into the medullary canal. In two cases CTD was positive for recurrent HNP but surgery showed only fibrosis. The amount of contrast leak was very small in these two cases along the posterior common longitudinal ligament, and the junction with the disk was very narrow. Because of their clinical presentation three patients with negative studies were operated upon. One showed only fibrosis and the two others showed an associated disk fragment. Among the twenty-one true-positive cases, seven showed a combination of recurrent HNP and scarring. Contamination of CSF by the contrast medium through the dura was observed in two patients. Although a prospective comparative study between CTD and IV-contrast-enhanced CT is necessary, CTD appears to be a useful diagnostic procedure for recurrent HNP after surgery of the lumbar spine.

  19. Is it safe to perform lumbar spine surgery on patients over eighty five?

    Science.gov (United States)

    Bouloussa, Houssam; Alzakri, Abdulmajeed; Ghailane, Soufiane; Vergari, Claudio; Mazas, Simon; Vital, Jean-Marc; Coudert, Pierre; Gille, Olivier

    2017-10-01

    The purpose of this study was to evaluate the safety and tolerance of lumbar spine surgery in patients over 85. Patients over 85 years of age with LSS who underwent decompression surgery with or without fusion between February 2011 and July 2014 were included. Comorbidities, autonomy (Activities of Daily Life and Braden scales), surgical parameters and complications (Clavien-Dindo classification) were collected. A telephone survey was performed to assess survival and patients' satisfaction at last follow-up. Mean follow-up was 27.4 ± 7.6 months (range, 18-65). Mean age was 87.5 ± 2.7 years (range, 85-97). Mean ADLs and Braden scores were, respectively, 4.3 ± 1.2 and 20.2 ± 1.4. Fifteen patients had associated spondylolisthesis. Nineteen minor complications (grade I and II, 38.7%), five moderate complications (grade III, 10.2%) and six major complications (grade IV and V, 12.2%) occurred. The perioperative mortality rate was 0.02%. At last follow-up, 41 patients were very satisfied (83.7%), five patients were satisfied (10.2%) and three patients were not satisfied (6.1%). Fusion did not affect the incidence of complications (p = 0.3) nor the average number of complications per patient (p = 0.2). Advanced age should not be a contraindication to lumbar spine surgery provided careful preoperative selection is performed. This study reported a high satisfaction rate and a low mortality rate at the price of a high number of complications, most of which being minor.

  20. EXPERIMENTAL EVALUATION OF CORRECTION FEATURES OF POSTTRAUMATIC KYPHOSIS OF THORACIC AND LUMBAR SPINE

    Directory of Open Access Journals (Sweden)

    K. A. Nadulich

    2010-01-01

    Full Text Available Experimental biomechanical study was performed in 60 spine specimens. Anterior wedge osteotomy and fixation of a specimen in a kyphotic position modeled kyphotic deformity. Deformity correction with various instrumentation systems was firstly performed by maximal extension of segments adjacent to kyphosis-producing block, and carried on after crossing of intervertebral anatomical structures. The study resulted in defining rational approach to surgical correction of posttraumatic deformities in the thoracic and lumbar spine. Minor kyphotic deformities are effectively corrected by instrumentation without mobilization of the spine. Large unfixed kyphosis sometimes requires anterior mobilization. Cases with rigid posttraumatic kyphotic deformity should be operated on with combined mobilization of the spine.

  1. [Disc alterations of lumbar spine on magnetic resonance images in asymptomatic workers].

    Science.gov (United States)

    Quiroz-Moreno, Rocío; Lezama-Suárez, Gabriel; Gómez-Jiménez, Carlos

    2008-01-01

    to determine abnormal findings of the lumbar spine on magnetic resonance images in asymptomatic subjects. prospective, transverse and descriptive study, in workers of the Instituto Mexicano del Seguro Social without low back pain; they were invited to be observed with magnetic resonance images of lumbar spine. A total of 105 cases was interpreted by a radiologist, who did not know the patients' clinical conditions. 107 lumbar spine alterations studies were mixed in order to not influence in the results, and they were not included in the statistic analysis. 55 % of the cases had discal alterations, 38 % presented bulging disk and 17 % presented protrusion. Other alterations were Schmorl's nodule, osteocondrosis, espondilolistesis, and annular tears. bulging disk and discal protrusion frequency have high prevalence in magnetic resonance images in healthy individuals, so its presence in symptomatic patients is not necessarily cause of low back pain.

  2. Lumbar model generator: a tool for the automated generation of a parametric scalable model of the lumbar spine.

    Science.gov (United States)

    Lavecchia, C E; Espino, D M; Moerman, K M; Tse, K M; Robinson, D; Lee, P V S; Shepherd, D E T

    2018-01-01

    Low back pain is a major cause of disability and requires the development of new devices to treat pathologies and improve prognosis following surgery. Understanding the effects of new devices on the biomechanics of the spine is crucial in the development of new effective and functional devices. The aim of this study was to develop a preliminary parametric, scalable and anatomically accurate finite-element model of the lumbar spine allowing for the evaluation of the performance of spinal devices. The principal anatomical surfaces of the lumbar spine were first identified, and then accurately fitted from a previous model supplied by S14 Implants (Bordeaux, France). Finally, the reconstructed model was defined according to 17 parameters which are used to scale the model according to patient dimensions. The developed model, available as a toolbox named the lumbar model generator, enables generating a population of models using subject-specific dimensions obtained from data scans or averaged dimensions evaluated from the correlation analysis. This toolbox allows patient-specific assessment, taking into account individual morphological variation. The models have applications in the design process of new devices, evaluating the biomechanics of the spine and helping clinicians when deciding on treatment strategies. © 2018 The Author(s).

  3. Lumbar spine MRI in the elite-level female gymnast with low back pain

    International Nuclear Information System (INIS)

    Bennett, D. Lee; Nassar, Lawrence; DeLano, Mark C.

    2006-01-01

    Previous studies have shown increased degenerative disk changes and spine injuries in the competitive female gymnast. However, it has also been shown that many of these findings are found in asymptomatic athletic people of the same age. Previous magnetic resonance imaging (MRI) studies evaluating the gymnastic spine have not made a distinction between symptomatic and asymptomatic athletes. Our hypothesis is that MRI will demonstrate the same types of abnormalities in both the symptomatic and asymptomatic gymnasts. Olympic-level female gymnasts received prospectively an MRI exam of the lumbar spine. Each of the gymnasts underwent a physical exam by a sports medicine physician just prior to the MRI for documentation of low back pain. Each MRI exam was evaluated for anterior apophyseal ring avulsion injury, compression deformity of the vertebral body, spondylolysis, spondylolisthesis, degenerative disease, focal disk protrusion/extrusion, muscle strain, epidural mass, and bone-marrow edema. Nineteen Olympic-level female gymnasts (age 12-20 years) were evaluated prospectively in this study. All of these gymnasts were evaluated while attending a specific training camp. Anterior ring apophyseal injuries (9/19) and degenerative disk disease (12/19) were common. Spondylolysis (3/19) and spondylolisthesis (3/19) were found. Focal bone-marrow edema was found in both L3 pedicles in one gymnast. History and physical exam revealed four gymnasts with current low back pain at the time of imaging. There were findings confined to those athletes with current low back pain: spondylolisthesis, spondylolysis, bilateral pedicle bone-marrow edema, and muscle strain. (orig.)

  4. Lumbar spine MRI in the elite-level female gymnast with low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Bennett, D. Lee [Department of Radiology, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA (United States); Department of Radiology, Michigan State University, Colleges of Human Medicine and Osteopathic Medicine, East Lansing, MI (United States); Nassar, Lawrence [Department of Sports Medicine and Kinesiology, Michigan State University, College of Osteopathic Medicine, East Lansing, MI (United States); DeLano, Mark C. [Department of Radiology, Michigan State University, Colleges of Human Medicine and Osteopathic Medicine, East Lansing, MI (United States)

    2006-07-15

    Previous studies have shown increased degenerative disk changes and spine injuries in the competitive female gymnast. However, it has also been shown that many of these findings are found in asymptomatic athletic people of the same age. Previous magnetic resonance imaging (MRI) studies evaluating the gymnastic spine have not made a distinction between symptomatic and asymptomatic athletes. Our hypothesis is that MRI will demonstrate the same types of abnormalities in both the symptomatic and asymptomatic gymnasts. Olympic-level female gymnasts received prospectively an MRI exam of the lumbar spine. Each of the gymnasts underwent a physical exam by a sports medicine physician just prior to the MRI for documentation of low back pain. Each MRI exam was evaluated for anterior apophyseal ring avulsion injury, compression deformity of the vertebral body, spondylolysis, spondylolisthesis, degenerative disease, focal disk protrusion/extrusion, muscle strain, epidural mass, and bone-marrow edema. Nineteen Olympic-level female gymnasts (age 12-20 years) were evaluated prospectively in this study. All of these gymnasts were evaluated while attending a specific training camp. Anterior ring apophyseal injuries (9/19) and degenerative disk disease (12/19) were common. Spondylolysis (3/19) and spondylolisthesis (3/19) were found. Focal bone-marrow edema was found in both L3 pedicles in one gymnast. History and physical exam revealed four gymnasts with current low back pain at the time of imaging. There were findings confined to those athletes with current low back pain: spondylolisthesis, spondylolysis, bilateral pedicle bone-marrow edema, and muscle strain. (orig.)

  5. 3-dimensional reconstructions of computer tomograms of the lumbar spine. Dreidimensionale Rekonstruktionsverfahren in der lumbalen Computertomographie

    Energy Technology Data Exchange (ETDEWEB)

    Kern, A.; Waggershauser, T.; Zendel, W.; Astinet, A.; Felix, R. (Universitaetsklinikum Rudolf Virchow, Berlin (Germany). Strahlenklinik und Poliklinik); Hansen, K.; Lanksch, W.R. (Universitaetsklinikum Rudolf Virchow, Berlin (Germany). Neurochirurgische Klinik und Poliklinik)

    1991-08-01

    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).

  6. [Nursing Care of Lumbar Spine Fusion Surgery Using a Semi-Rigid Device (ISOBAR)].

    Science.gov (United States)

    Wu, Meng-Shan; Su, Shu-Fen

    2016-04-01

    Aging frequently induces degenerative changes in the spine. Patients who suffer from lumbar degenerative disease tend to have lower back pain, neurological claudication, and neuropathy. Furthermore, incontinence may be an increasing issue as symptoms become severe. Lumbar spine fusion surgery is necessary if clinical symptoms continue to worsen or if the patient fails to respond to medication, physical therapy, or alternative treatments. However, this surgical procedure frequently induces adjacent segment disease (ASD), which is evidenced by the appearance of pathological changes in the upper and lower sections of the spinal surgical sites. In 1997, ISOBAR TTL dynamic rod stabilization was developed for application in spinal fusion surgery to prevent ASD-related complications. The device has proven effective in reducing pain in the lower back and legs, decreasing functional disability, improving quality of life, and retarding disc degeneration. However, the effectiveness of this intervention in decreasing the incidence of ASD requires further research investigation, and relevant literature and research in Taiwan is still lacking. This article discusses lumbar degenerative disease, its indications, the contraindications of lumbar spine fusion surgery using ISOBAR, and related postoperative nursing care. We hope this article provides proper and new knowledge to clinical nurses for the care of patients undergoing lumbar spine fusion surgery with ISOBAR.

  7. The relationship between lumbar spine kinematics during gait and low-back pain in transfemoral amputees.

    Science.gov (United States)

    Morgenroth, David C; Orendurff, Michael S; Shakir, Ali; Segal, Ava; Shofer, Jane; Czerniecki, Joseph M

    2010-08-01

    Low-back pain is an important cause of secondary disability in transfemoral amputees. The primary aim of our study is to assess the differences in lumbar spine kinematics during gait between transfemoral amputees with and without low-back pain. Lumbar spine kinematics in three planes were measured when the subjects walked in a motion analysis laboratory. Nine transfemoral amputees with low-back pain, eight transfemoral amputees without low-back pain, and six healthy, nonamputee subjects participated. The Amputee Pain and Amputee No Pain groups were essentially the same in terms of all demographic and potentially confounding variable measures. Transfemoral amputees with low-back pain showed greater transverse plane rotational excursion in their lumbar spine during walking when compared with transfemoral amputees without low-back pain (P = 0.029; effect size = 1.03). There were no significant differences in sagittal or coronal plane lumbar spine excursions during walking between these two groups. Although our study design does not allow for proving causation, increased transverse plane rotation has been associated with intervertebral disc degeneration, suggesting that increased transverse plane rotation secondary to walking with a prosthetic limb may be a causative factor in the etiology of low-back pain in transfemoral amputees. Identifying differences in lumbar motion can lead to potential preventative and therapeutic intervention strategies.

  8. Electroneuromyographic estimation of the functional condition of the lumbar spine department

    Directory of Open Access Journals (Sweden)

    Nazarenko N.V.

    2017-03-01

    Full Text Available Purpose: to establish the nature of the change in the F-wave parameter in patients with degenerative spondylolis-thesis of the lumbar spine, radicular syndrome. Material and methods. 20 patients with a clinical diagnosis of degenerative spondylolisthesis, 20 patients with radicular syndrome due to herniation of intervertebral disc, 20 patients of the control group were examined. Results. Decreased F-wave latency in the group of patients with degenerative spondylolisthesis, no change in F-wave latency in the group of patients with radicular syndrome. Conclusion. A screening assessment of the functional state of the lumbar spine is possible by electroneuromyography

  9. Routine oblique radiography of the pediatric lumbar spine: is it necessary

    International Nuclear Information System (INIS)

    Roberts, F.F.; Kishore, P.R.S.; Cunningham, M.E.

    1978-01-01

    A series of 86 pediatric lumbar spine abnormalities was evaluated to determine the diagnostic benefit of radiography in oblique projection as compared to frontal-lateral projections alone. In only four patients was an abnormality apparent on the oblique view which had not already been demonstrated by the frontal-lateral series; each of these represented an isolated spondylolysis. Because the diagnostic yield was low at a patient cost of more than double the gonadal radiation dose, it is recommended that oblique views be eliminated in the routine radiography of the pediatric lumbar spine

  10. Biomechanical comparison of lumbar spine with or without spina bifida occulta. A finite element analysis.

    Science.gov (United States)

    Sairyo, K; Goel, V K; Vadapalli, S; Vishnubhotla, S L; Biyani, A; Ebraheim, N; Terai, T; Sakai, T

    2006-07-01

    Biomechanical study using finite element model (FEM) of lumbar spine. Very high coincidence of spina bifida occulta (SBO) has been reported more than in 60% of lumbar spondylolysis. The altered biomechanics due to SBO is one considerable factor for this coincidence. Thus, in this study, the biomechanical changes in the lumbar spine due to the presence of SBO were evaluated. United States of America (USA). An experimentally validated three-dimensional nonlinear FEM of the intact ligamentous L3-S1 segment was used and modified to simulate two kinds of SBO at L5. One model had SBO with no change in the length of the spinous process and the other had a small dysplastic spinous process. Von Mises stresses at pars interarticularis were analyzed in the six degrees of lumbar motion with 400 N axial compression, which simulates the standing position. The range of motion at L4/5 and L5/S1 were also calculated. It was observed that the stresses in all the models were similar, and there was no change in the highest stress value when compared to the intact model. The range of motion was also similar in all the models. The lumbar kinematics of SBO was thus shown to be similar to the intact model. SBO does not alter lumbar biomechanics with respect to stress and range of motion. The high coincidence of spondylolysis in spines with SBO may not be due to the mechanical factors.

  11. MRI-determined lumbar muscle morphometry in man and sheep: potential biomechanical implications for ovine model to human spine translation

    Science.gov (United States)

    Valentin, Stephanie; Licka, Theresia F; Elliott, James

    2015-01-01

    The sheep is a commonly used animal model for human lumbar spine surgery, but only in vitro investigations comparing the human and ovine spine exist. Spinal musculature has previously not been compared between man and sheep. This additional knowledge could further indicate to what extent these species are biomechanically similar. Therefore, the purpose of the study was to investigate spinal muscle morphometric properties using magnetic resonance imaging (MRI) in different age groups of healthy human participants and sheep in vivo. Healthy human participants (n = 24) and sheep (n = 17) of different age groups underwent T1-weighted MRI of the lumbar spine. Regions of interest of the muscles erector spinae (ES), multifidus (M) and psoas (PS) were identified. The ratio of flexor to extensor volume, ratio of M to ES volume, and muscle fat relative to an area of intermuscular fat were calculated. Sheep M to ES ratio was significantly smaller than in the human participants (sheep 0.16 ± 0.02; human 0.37 ± 0.05; P biomechanical and functional demands, which is an important consideration when translating to human surgical models. PMID:26200090

  12. 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...

  13. 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.

  14. Segmental in vivo vertebral motion during functional human lumbar spine activities.

    Science.gov (United States)

    Li, Guoan; Wang, Shaobai; Passias, Peter; Xia, Qun; Li, Gang; Wood, Kirkham

    2009-07-01

    Quantitative data on the range of in vivo vertebral motion is critical to enhance our understanding of spinal pathology and to improve the current surgical treatment methods for spinal diseases. Little data have been reported on the range of lumbar vertebral motion during functional body activities. In this study, we measured in vivo 6 degrees-of-freedom (DOF) vertebral motion during unrestricted weightbearing functional body activities using a combined MR and dual fluoroscopic imaging technique. Eight asymptomatic living subjects were recruited and underwent MRI scans in order to create 3D vertebral models from L2 to L5 for each subject. The lumbar spine was then imaged using two fluoroscopes while the subject performed primary flexion-extension, left-right bending, and left-right twisting. The range of vertebral motion during each activity was determined through a previously described imaging-model matching technique at L2-3, L3-4, and L4-5 levels. Our data revealed that the upper vertebrae had a higher range of flexion than the lower vertebrae during flexion-extension of the body (L2-3, 5.4 +/- 3.8 degrees ; L3-4, 4.3 +/- 3.4 degrees ; L4-5, 1.9 +/- 1.1 degrees , respectively). During bending activity, the L4-5 had a higher (but not significant) range of left-right bending motion (4.7 +/- 2.4 degrees ) than both L2-3 (2.9 +/- 2.4 degrees ) and L3-4 (3.4 +/- 2.1 degrees ), while no statistical difference was observed in left-right twisting among the three vertebral levels (L2-3, 2.5 +/- 2.3 degrees ; L3-4, 2.4 +/- 2.6 degrees ; and L4-5, 2.9 +/- 2.1 degrees , respectively). Besides the primary rotations reported, coupled motions were quantified in all DOFs. The coupled translation in left-right and anterior-posterior directions, on average, reached greater than 1 mm, while in the proximal-distal direction this was less than 1 mm. Overall, each vertebral level responds differently to flexion-extension and left-right bending, but similarly to the left

  15. In-Hospital Complications and Resource Utilization Following Lumbar Spine Surgery in Patients with Parkinson Disease: Evaluation of the National Inpatient Sample Database.

    Science.gov (United States)

    Baker, Joseph F; McClelland, Shearwood; Line, Breton G; Smith, Justin S; Hart, Robert A; Ames, Christopher P; Shaffrey, Chris; Bess, Shay

    2017-10-01

    Previous reports suggest that patients with Parkinson disease (PD) have elevated rates of complications following spine surgery; however, these reports are limited by small patient series. In this study, we used the National Inpatient Sample (NIS) database to compare in-hospital complications following elective lumbar spine surgery in patients with a diagnosis of PD and patients without PD. The NIS database was accessed to identify patients with PD and those without PD who underwent lumbar spine surgery. All patients identified had a diagnosis code consistent with degenerative lumbar spine pathology. The patients were evaluated for the presence or absence of PD and divided into 4 lumbar spine procedure groups: decompression alone, lateral fusion, posterior fusion, and anterior fusion technique. Propensity score matching (PSM) was performed for the PD versus non-PD patients in each procedure group to control for confounding demographic variables, and in-hospital complications were compared between the 2 groups. Between 2001 and 2012, a total of 613,522 lumbar spine surgery patient episodes were identified, of which 4492 (0.7%) involved a diagnosis of PD. Following PSM for patient age, sex, and race, the patients with PD were at increased risk for acute postoperative hemorrhagic anemia, increased blood transfusion requirements, and increased genitourinary, neurologic, and cardiac complications compared with the patients without PD. PSM analysis of the NIS database demonstrated that patients with PD are at increased risk for acute in-hospital complications and greater blood transfusion requirements than those without PD. Surgeons should be aware of the increased risks and differing requirements when treating spinal pathology in patients with PD. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. The Regionalization of Lumbar Spine Procedures in New York State: A 10-Year Analysis.

    Science.gov (United States)

    Jancuska, Jeffrey; Adrados, Murillo; Hutzler, Lorraine; Bosco, Joseph

    2016-01-01

    A retrospective review of an administrative database. The purpose of this study is to determine the current extent of regionalization by mapping lumbar spine procedures according to hospital and patient zip code, as well as examine the rate of growth of lumbar spine procedures performed at high-, medium-, and low-volume institutions in New York State. The association between hospital and spine surgeon volume and improved patient outcomes is well established. There is no study investigating the actual process of patient migration to high-volume hospitals. New York Statewide Planning and Research Cooperative System (SPARCS) administrative data were used to identify 228,695 lumbar spine surgery patients from 2005 to 2014. The data included the patients' zip code, hospital of operation, and year of discharge. The volume of lumbar spine surgery in New York State was mapped according to patient and hospital 3-digit zip code. New York State hospitals were categorized as low, medium, and high volume and descriptive statistics were used to determine trends in changes in hospital volume. Lumbar spine surgery recipients are widely distributed throughout the state. Procedures are regionalized on a select few metropolitan centers. The total number of procedures grew 2.5% over the entire 10-year-period. High-volume hospital caseload increased 50%, from 7253 procedures in 2005 to 10,915 procedures in 2014. The number of procedures at medium and low-volume hospitals decreased 30% and 13%, respectively. Despite any concerted effort aimed at moving orthopedic patients to high-volume hospitals, migration to high-volume centers occurred. Public interest in quality outcomes and cost, as well as financial incentives among medical centers to increase market share, potentially influence the migration of patients to high-volume centers. Further regionalization has the potential to exacerbate the current level of disparities among patient populations at low and high-volume hospitals. 3.

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  18. Correlation between Sagittal Spinopelvic Parametersand Oswestry Disability Indexafter Thoracal and Lumbar Spine Stabilization and Fusion

    Directory of Open Access Journals (Sweden)

    Yudistira Prama Tirta

    2017-04-01

    Full Text Available Spinopelvic parameter consists of sagittal vertical axis (SVA, pelvic incidence (PI, pelvic tilt (PT, sacral slope (SS which are measured by whole-spine-lateral-view radiograph in standing position. Measurement of the separameters is pivotalas the land mark analysis toachieve correct sagittal balance. The objective of the study is to analyze the correlation between PI, PT, SVA and SSwith theclinical outcomes which was measured usingOswestry Disability Index (ODI scoring system.This is a cross-sectional study involving 19 patients who underwent thoracal and lumbar fusion surgery in our centerduring 2012-2014. Radiographi cevaluation of SVA, PI, PT, and SS and ODI score were performed 1 year after surgery. Pearson test was conducted to determine the correlation between SVA, PI, PT, and SS with ODI score.There wasa strong correlation between ODI withSVA and PI (p<0.001,r=0.866; p=0.006; r=0.603, respectively. There was no correlation between other parameters with ODI.Based on this study, spinopelvic parameters that can represent the clinical outcome after thoracal and lumbar fusion and stabilization surgeries are SVA and PI. Keywords: spinopelvic parameter, post operation, vertebrae fusion.   Korelasi antara Parameter Luaran Spinopelvik Sagital dengan Oswestry Disability Index pasca Stabilisasi dan Fusi Vertebra Torakal dan Lumbar   Abstrak Parameter spinopelvis terdiri atas sagittal vertical axis (SVA, pelvic incidence (PI, pelvic tilt (PT, sacral slope (SS dan diukur menggunakan X-ray seluruh tulang belakang lateral yang diambil pada posisi berdiri. Pengukuran parameter ini penting sebagai dasar analisis keseimbangan sagital pada operasi rekonstruksi vertebra. Tujuan penelitian ini adalah untuk menganalisis korelasi antara PI, PT, SVA, dan SS pada luaran klinis berdasarkan sistem skoring oswestry disability index (ODI. Studi ini adalah studi potong lintang dengan 19 subjek yang menjalani fusi dan stabilisasi torakal dan lumbal di center kami

  19. Uninstrumented Posterior Lumbar Interbody Fusion: Have Technological Advances in Stabilizing the Lumbar Spine Truly Improved Outcomes?

    Science.gov (United States)

    Prolo, Laura M; Oklund, Sally A; Zawadzki, Nadine; Desai, Manisha; Prolo, Donald J

    2018-04-06

    Since 1980s numerous operations have replaced posterior lumbar interbody fusion (PLIF) with human bone. These often involve expensive implants and complex procedures. Escalating expenditures in lumbar fusion surgery warrant re-evaluation of classical PLIF with allogeneic ilium and without instrumentation. The purpose of this study was to determine the long-term fusion rate and clinical outcomes of allo-PLIF. Between 1981-2006 321 patients ages 12-80, underwent 339 one- or two-level allo-PLIFs for degenerative instability and were followed 1-28 years. Fusion status was determined by radiographs and as available, by CT scans. Clinical outcome was assessed by the Economic/Functional Outcome Scale. 308 of the 321 patients were followed postoperatively (average 6.7 years, range 1-28); 297 (96%) fused. Fusion rates were lower for patients with substance abuse (89%, p=0.007). Clinical outcomes in 87% of patients were excellent (52%) or good (35%). Economic/Functional Outcome Scale scores following initial allo-PLIF on average increased 5.2 points. Successful fusion correlated with nearly a 2-point gain in outcome score (p=0.001). A positive association between a patient characteristic and outcome was observed only with age 65 and greater; whereas negative associations in clinical outcomes were observed with mental illness, substance abuse, heavy stress to low back, or industrial injuries. Total complication rate was 7%. With three decades of follow-up we found successful clinical outcomes are highly correlated with solid fusion using only allogeneic iliac bone. Copyright © 2018. Published by Elsevier Inc.

  20. Lumbar spine and pelvic posture between standing and sitting: a radiologic investigation including reliability and repeatability of the lumbar lordosis measure.

    Science.gov (United States)

    De Carvalho, Diana E; Soave, David; Ross, Kim; Callaghan, Jack P

    2010-01-01

    Sitting has been identified as a cause of mechanical low back pain. The purpose of this study was to use plain film x-rays to measure lumbar spine and pelvic posture differences between standing and sitting. Eight male subjects were radiographed standing and sitting in an automobile seat. Measures of lumbar lordosis, intervertebral disk angles, lumbosacral angle, lumbosacral lordosis, and sacral tilt were completed. One-way analysis of variance (alpha = .05) was conducted on the variables stated above. A Bland-Altman analysis was conducted to assess agreement and repeatability of the lumbar lordosis angle using 2 raters. Lumbar lordosis values in standing (average, 63 degrees +/- 15 degrees ) and sacral inclination (average, 43 degrees +/- 10 degrees ) decreased by 43 degrees and 44 degrees , respectively, in sitting. Intervertebral joint angles in sitting underwent substantial flexion (L1/L2-5 degrees [+/-3 degrees ], L2/L3-7 degrees [+/-3 degrees ], L3/L4-8 degrees [+/-3 degrees ], L4/L5-13 degrees [+/-3 degrees ], and L5/S1-4 degrees [+/-10 degrees ]). Measures of lumbar lordosis; intervertebral disk angles between L2/L3, L3/L4, and L4/L5; lumbosacral lordosis; lumbosacral angle; and sacral tilt were significantly decreased between standing and sitting (P sitting further emphasize the range of motion experienced at vertebral levels in sitting. Based on the results of this study, interventions to return motion segments to a less flexed posture should be investigated because they may play a role in preventing injury and low back pain. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  1. The influence of muscle forces on the stress distribution in the lumbar spine

    DEFF Research Database (Denmark)

    Wong, C; Rasmussen, J; Simonsen, Erik B.

    2011-01-01

    Introduction: Previous studies of bone stresses in the human lumbar spine have relied on simplified models when modeling the spinal musculature, even though muscle forces are likely major contributors to the stresses in the vertebral bones. Detailed musculoskeletal spine models have recently beco...... larger von Mises stress responses in the central and anterior part of the vertebral body, which can be tolerated in the young and healthy spine, but it would increase the risk of compression fractures in the elderly, osteoporotic spine.......Introduction: Previous studies of bone stresses in the human lumbar spine have relied on simplified models when modeling the spinal musculature, even though muscle forces are likely major contributors to the stresses in the vertebral bones. Detailed musculoskeletal spine models have recently become...... muscles. Results: In general the von Mises stress was larger by 30 %, and even higher when looking at the von Mises stress distribution in the superio-anterior and central part of the vertebral body and in the pedicles. Conclusion: The application of spine muscles to a finite element model showed markedly...

  2. Prospective study of a new dynamic stabilisation system in the treatment of degenerative discopathy and instability of the lumbar spine.

    Science.gov (United States)

    Zagra, A; Minoia, L; Archetti, M; Corriero, A S; Ricci, K; Teli, M; Giudici, F

    2012-05-01

    Posterior dynamic stabilisation (PDS) aims at relieving lumbar discogenic pain and preserving adjacent levels from accelerated degeneration. To evaluate the results of a novel PDS system in 32 adult patients affected by chronic low back pain (CLBP) due to degenerative lumbar spine instability (DLSI). A progressive follow-up for 12 months of 32 patients, with collection of complete clinical (ODI and VAS back + leg) and radiological data (resting + functional radiographs and MRI). Mean ODI scores improved from 49 to 6%, VAS back from 5 to 1 and VAS leg from 7 to 2. Twenty-two patients underwent fusion of a lower lumbar segment and stabilisation of an upper segment (hybrid fusion) whereas ten underwent dynamic stabilisation. In 16/32 patients, decompression was added to treat radicular pain. Motion in non-fused instrumented levels was unrestricted on functional X-rays and MRIs did not show significant morphologic changes. Four patients (12.5%) had unchanged functional and pain scores while two (6.3%) suffered worsening low back pain necessitating implant removal and spinal fusion. No infection, no new neurologic deficit or implant failure was recorded. The 1 year follow-up shows that the tested PDS system is able to provide a significant improvement in pain and disability scores when applied to patients affected by DLSI. The system does not provide better clinical results when compared to similar trials on posterior fusion. Further follow-up is ongoing to investigate the potential preservation of adjacent levels from accelerated degeneration.

  3. Lumbar spine fusion surgery and stroke: a national cohort study.

    Science.gov (United States)

    Wu, Jau-Ching; Chen, Yu-Chun; Liu, Laura; Huang, Wen-Cheng; Thien, Peck-Foong; Chen, Tzeng-Ji; Cheng, Henrich; Lo, Su-Shun

    2012-12-01

    To investigate the incidence and risk of stroke after lumbar spinal fusion surgery. Study subjects were identified from a nationwide cohort of 1 million people from 2000 to 2005 and were divided into the lumbar spinal fusion group (n = 2,015), who received posterior lumbar spinal fusion surgery, and the comparison group (n = 16,120) composed of age-, sex-, and propensity score-matched control subjects. The matching process was intended to adjust for demographics, comorbidities, and other immeasurable covariates to minimize selection bias. All subjects were followed up for 3 years for stroke, including hemorrhagic and ischemic strokes. Kaplan-Meier and Cox regression analyses were performed. The overall incidence rate of stroke in the cohort was 9.99 per 1,000 person-year. The lumbar spinal fusion group was less likely to have any stroke (adjusted hazard ratio (HR) = 0.83, p = 0.293), hemorrhagic stroke (adjusted HR = 0.74, p = 0.739) and ischemic stroke (adjusted HR = 0.81, p = 0.250) than the comparison group, but without significance. Three years post-operatively, patients who received lumbar spinal fusion had stroke incidence rates similar to those without surgery. Posterior lumbar spinal fusion surgery is not associated with increased risks for any kind of stroke.

  4. Underbody blast effect on the pelvis and lumbar spine: A computational study.

    Science.gov (United States)

    Lei, Jianyin; Zhu, Feng; Jiang, Binhui; Wang, Zhihua

    2018-03-01

    Explosion from an anti-tank landmine under a military vehicle, known as underbody blast (UBB), may cause severe injury or even death for the occupants inside the vehicle. Severity and patterns of lower extremity, pelvis and lumbar spine injuries subjected to UBB have been found highly related to loading conditions, i.e. the vertical acceleration pulse. A computational human model has been developed and successfully simulated the tibia fracture under UBB in the previous study. In the present study, it was further improved by building a detailed lumbar spine and pelvis model with high biofidelity. The newly developed pelvis and lumbar spine were validated against component level test data in the literature. Then, the whole body model was validated with the published cadaver sled test data. Using the validated whole body model, parametric studies were conducted by adjusting the peak acceleration and time duration of pulses produced in the UBB to investigate the effect of waveform on the injury response. The critical values of these two parameters for pelvis and lumbar spine fracture were determined, and the relationship between injury pattern and loading conditions was established. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Contribution to differential diagnosis of lumbar spine disc hernia by computerized tomography

    International Nuclear Information System (INIS)

    Dolansky, J.

    1989-01-01

    The significance is discussed of computerized tomography in differential diagnosis of disc hernias of the lumbar spine. A simple technique is described that allows to differentiate disc hernias from epidural vein varices. It mostly includes repeat imaging of the same body section and/or the application of a contrast medium. (L.O.). 2 figs., 4 refs

  6. Minimally invasive lateral trans-psoas approach for tuberculosis of lumbar spine

    Directory of Open Access Journals (Sweden)

    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.

  7. Two cases of congenital defects within transverse processes of lumbar spine

    International Nuclear Information System (INIS)

    Malawski, S.; Sokolski, B.

    1993-01-01

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

  8. Analysis of bone mass density of lumbar spine zone of athletes ...

    African Journals Online (AJOL)

    The BMD values obtained by the measurements taken from each lumbar spine zone and T and Z scores were used in calculating statistical data. In the comparison with regard to BMD and T, Z scores, it was determined that the highest BMD and Z, T score belonged to the wrestlers and judo, taekwondo competitors, and ...

  9. Lumbar Spine X-Ray as a Standard Investigation for all Low back ...

    African Journals Online (AJOL)

    Background: Low back pain (LBP) has a prevalence of 84% in Africa. The commonest form of imaging is plain lumbar spine x-ray. It gives a radiation dose equivalent to 65 times a chest x-ray dose and sends one of the highest doses to the human reproductive organs. The commonest cause of LBP in Africa is degenerative ...

  10. Analysis of bone mass density of lumbar spine zone of athletes

    African Journals Online (AJOL)

    hope&shola

    2010-10-25

    Oct 25, 2010 ... This study was carried out to evaluate T-Z scores of lumbar spine zone (L1, L2, L3, L4, L1-L4) bone mass density (BMD) of elite active male athletes in different branches and to determine the differences between them. 42 healthy male athletes aged 18 - 25 competing in different branches (Taekwondo 12,.

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

    Science.gov (United States)

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

    2014-01-01

    A new methodological approach employing mechanical work (MW) determination and relative portion of its elemental analysis was applied to investigate the biomechanical causes of golf-related lumbar spine injuries. Kinematic and kinetic parameters at the lumbar and lower limb joints were measured during downswing in 18 golfers. The MW at the lumbar joint (LJ) was smaller than at the right hip but larger than the MWs at other joints. The contribution of joint angular velocity (JAV) to MW was much greater than that of net muscle moment (NMM) at the LJ, whereas the contribution of NMM to MW was greater rather than or similar to that of JAV at other joints. Thus, the contribution of JAV to MW is likely more critical in terms of the probability of golf-related injury than that of NMM. The MW-based golf-related injury index (MWGII), proposed as the ratio of the contribution of JAV to MW to that of NMM, at the LJ (1.55) was significantly greater than those at other joints ( < 1.05). This generally corresponds to the most frequent occurrence of golf-related injuries around the lumbar spine. Therefore, both MW and MWGII should be considered when investigating the biomechanical causes of lumbar spine injuries.

  12. An Automated Method for Landmark Identification and Finite-Element Modeling of the Lumbar Spine.

    Science.gov (United States)

    Campbell, Julius Quinn; Petrella, Anthony J

    2015-11-01

    The purpose of this study was to develop a method for the automated creation of finite-element models of the lumbar spine. Custom scripts were written to extract bone landmarks of lumbar vertebrae and assemble L1-L5 finite-element models. End-plate borders, ligament attachment points, and facet surfaces were identified. Landmarks were identified to maintain mesh correspondence between meshes for later use in statistical shape modeling. 90 lumbar vertebrae were processed creating 18 subject-specific finite-element models. Finite-element model surfaces and ligament attachment points were reproduced within 1e-5 mm of the bone surface, including the critical contact surfaces of the facets. Element quality exceeded specifications in 97% of elements for the 18 models created. The current method is capable of producing subject-specific finite-element models of the lumbar spine with good accuracy, quality, and robustness. The automated methods developed represent advancement in the state of the art of subject-specific lumbar spine modeling to a scale not possible with prior manual and semiautomated methods.

  13. FACET ORIENTATION AND TROPISM: ASSOCIATION WITH ACCELERATED DEGENERATION OF STABILIZING STRUCTURES IN LOWER LUMBAR SPINE.

    Science.gov (United States)

    Jelec, Vjekoslav; Turner, Rajka; Franić, Miljenko; Korušić, Anđelko; Rotim, Krešimir

    2016-03-01

    The influence of facet orientation and tropism on the process of spinal degeneration has been extensively studied during the last few decades, but there are still many controversies and conflicting results in this field of research. The biomechanical cause of accelerated degeneration of stabilizing structures in lower lumbar spine lies within the combination of several factors, but two most important ones are compressive load and more coronal facet orientation that offers less resistance against torsional loading. Axial rotation of lower lumbar spine is undoubtedly associated with higher strain in disc annulus, and enhanced range of secondary rotational movements may be even more significant for the progression of annular degeneration. Accordingly, more pronounced facet tropism could be having part in faster progression of disc degeneration in lower lumbar spine, as indicated by a number of recent studies. More sagittal facet orientation in patients with a higher facet osteoarthritis score at lower lumbar segments is very likely related to arthritic remodeling commonly seen in other synovial joints. There is also a possibility that it could be associated with the adaptation to partial loss of lumbar lordosis, as both coincide with advanced age.

  14. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

    Energy Technology Data Exchange (ETDEWEB)

    Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

    2016-02-15

    The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

  15. Rehabilitation of Football Players With Lumbar Spine Injury (Part 1 of 2).

    Science.gov (United States)

    Saal, J A; Johnson, E W

    1988-09-01

    In brief: Rehabilitation of football players with low back pain caused by injury is a comprehensive process. Accurate diagnosis followed by early intervention is necessary. The rehabilitation plan can be divided into two phases: the pain-control phase, discussed in this article, and the training phase, to be discussed in part 2 in a coming issue. The pain-control phase may include a variety of passive modalities, flexion or extension exercises, lumbar mobilization, traction, and selective (precise localization with precise center) injections. The author stresses the importance of understanding the anatomy and biomechanics of the lumbar spine, referred pain and potential pain generators, the stages of the degenerative process, and lumbar spine injuries when planning a rehabilitation program.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-12-01

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

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

    DEFF Research Database (Denmark)

    Putzer, Michael; Rasmussen, John; Penzkofer, Rainer

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

  18. Biomechanics of Posterior Dynamic Fusion Systems in the Lumbar Spine: Implications for Stabilization With Improved Arthrodesis.

    Science.gov (United States)

    Yu, Alexander K; Siegfried, Catherine M; Chew, Brandon; Hobbs, Joseph; Sabersky, Abraham; Jho, Diana J; Cook, Daniel J; Bellotte, Jonathan Brad; Whiting, Donald M; Cheng, Boyle C

    2016-08-01

    A comparative biomechanical human cadaveric spine study of a dynamic fusion rod and a traditional titanium rod. The purpose of this study was to measure and compare the biomechanical metrics associated with a dynamic fusion device, Isobar TTL Evolution, and a rigid rod. Dynamic fusion rods may enhance arthrodesis compared with a rigid rod. Wolff's law implies that bone remodeling and growth may be enhanced through anterior column loading (AL). This is important for dynamic fusion rods because their purpose is to increase AL. Six fresh-frozen lumbar cadaveric specimens were used. Each untreated specimen (Intact) underwent biomechanical testing. Next, each specimen had a unilateral transforaminal lumbar interbody fusion performed at L3-L4 using a cage with an integrated load cell. Pedicle screws were also placed at this time. Subsequently, the Isobar was implanted and tested, and finally, a rigid rod replaced the Isobar in the same pedicle screw arrangement. In terms of range of motion, the Isobar performed comparably to the rigid rod and there was no statistical difference found between Isobar and rigid rod. There was a significant difference between the intact and rigid rod and also between intact and Isobar conditions in flexion extension. For interpedicular displacement, there was a significant increase in flexion extension (P=0.017) for the Isobar compared with the rigid rod. Isobar showed increased AL under axial compression compared with the rigid rod (P=0.024). Isobar provided comparable stabilization to a rigid rod when using range of motion as the metric, however, AL was increased because of the greater interpedicular displacement of dynamic rod compared with a rigid rod. By increasing interpedicular displacement and AL, it potentially brings clinical benefit to procedures relying on arthrodesis.

  19. Neck posture during lifting and its effect on trunk muscle activation and lumbar spine posture.

    Science.gov (United States)

    Hlavenka, Thomas M; Christner, Vanessa F K; Gregory, Diane E

    2017-07-01

    Neck and head posture have been found to have a significant influence on the posture of the lower spine region during lifting and both an extended/upward gaze and a flexed/downward gaze have been hypothesized to lead to increased pain and/or overuse of the neck musculature. As a result, strength training recommendations have turned to the use of a retracted neck posture as being the safer posture to assume during lifting. This study examined trunk and neck muscle activity and lumbar spine posture in seven participants while performing moderate load lifts using a retracted neck posture (chin drawn in posteriorly; recently gaining popularity among coaches, trainers, and physical therapists to reduce neck pain during lifting, and freestyle neck posture (no instructions given). The retracted neck resulted in less lumbar spine flexion and increased lumbar erector spinae, external oblique, and sternocleidomastoid activity. The retracted posture also resulted in decreased activity in the thoracic erector spinae and dorsal neck musculature. The increased trunk and sternocleidomastoid activity and decreased spine flexion observed in the seven participants of this study when lifting with a retracted neck may have the potential to help lower the risk of spine pain/injury. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2018-01-19

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

  1. Gadolinium-DTPA enhancement of symptomatic nerve roots in MRI of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Tyrrell, P.N.M.; Cassar-Pullicino, V.N.; McCall, I.W. [Department of Diagnostic Imaging, The Institute of Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire SY10 7AG (United Kingdom)

    1998-02-01

    Disc prolapse presenting with sciatica may be associated with enhancement of the symptomatic nerve root following magnetic resonance imaging (MRI) with intravenous gadolinium (Gd)-DTPA. Previous studies have shown, however, that this does not occur in all cases. The aim of this study was to assess the incidence of nerve root enhancement in patients with sciatica and disc prolapse and to try to identify any specific features that might be associated with the phenomenon. A total of 227 patients presenting with low back pain and/or sciatica underwent a MRI study of the lumbar spine with intravenous contrast enhancement. Nineteen of 81 (23.5 %) patients with disc prolapse demonstrated nerve root enhancement. Nerve root enhancement had a highly significant association with sequestrated disc lesions (13/19, 68 %; P < 0.0005), and was primarily seen in the symptomatic ipsilateral nerve root (16/19, 84 %). The sensitivity of nerve root enhancement associated with disc prolapse was 23.5 % with a specificity of 95.9 %, a positive predictive value of 76 % and a negative predictive value of 69.3 %. Nerve root enhancement may be indicative of the symptomatic level but its poor sensitivity negates the routine use of Gd-DTPA in MRI for sciatica. (orig.) With 4 figs., 1 tab., 37 refs.

  2. SENILE DEGENERATIVE CHANGES IN ADULT LUMBAR SPINE! - A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Garjesh Singh

    2015-11-01

    Full Text Available : BACKGROUND: Low back pain (LBP is a common presenting complaint affecting mostly middle aged and older person and traditionally considered as ageing process, but now-a-days large number of younger people are also affected by this debilitating chronic disorder. The cause of early onset of degenerative spine disease is multifactorial, but genetical predisposition plays very important role. AIMS AND OBJECTIVE: To find out association between genetic predisposition and degenerative spine disease in adult patients and to assess the pattern of MRI findings of various degenerative diseases in lumbo-sacral spine. MATERIAL AND METHOD: The present cross-sectional study had been performed among 100 selected patients in 1yr period, who presented with chief complaint of chronic low back pain. After taking detailed clinical and professional history, MRI of lumbosacral spine had been performed. Total 100 patients were divided in two groups on the basis of genetical predisposition. Prevalence and spectrum of degenerative changes were compared between both groups. RESULTS: Hundred patients of 20 to 35-year age had been selected with mean age of 27yr. Out of 100 patients; 47 were male and 53 were female. The most common degenerative findings were desiccation of disc (95% followed by disc bulge, herniation, spinal canal stenosis, ligamentum flavum hypertrophy, facet joint hypertrophy and modic changes. L4-L5 and L5- S1 were the most commonly involved spinal levels for any degenerative pathology. CONCLUSION: Good association is seen between early onset of degenerative spine disease and genetical predisposition in patients who have history of similar type degenerative spine disease in one or more first degree relatives in comparison to those patients who do not have any genetical predisposition. So it can be concluded that heredity play important role in early onset of degenerative spine disease in adults.

  3. Spontaneous ligamentum flavum hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Keynan, Ory; Ashkenazi, Ely; Floman, Yizhar [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Smorgick, Yossi [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Assaf Harofeh Medical Center, Department of Orthopedic Surgery, Zerifin (Israel); Schwartz, Allan J. [Hadassah University Hospital, Department of Radiology, Section of Neuroradiology, Jerusalem (Israel)

    2006-09-15

    Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Sandén Bengt

    2009-07-01

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

  5. Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine.

    Science.gov (United States)

    Gorensek, M; Kosak, R; Travnik, L; Vengust, R

    2013-03-01

    Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction. Seventeen patients underwent clinical and radiological evaluation pre and postoperatively with latest follow-up at 19 months (8-56 months) after surgery. Parameters assessed were site of infection, causative organism, angle of deformity, blood loss, duration of surgery, ICU stay, deformity correction, time to solid bony fusion, ambulatory status, neurologic status (ASIA impairment scale), and functional outcome (Kirkaldy-Willis criteria). Mean operating time was 207 min and average blood loss 1,150 ml. Patients spent 2 (1-4) days in ICU and were able to walk unaided 1.6 (1-2) days after surgery. Infection receded in all 17 patients postoperatively. Solid bony fusion occurred in 15 out of 17 patients (88 %) on average 6.3 months after surgery. Functional outcome was assessed as excellent or good in 82 % of cases. Average deformity correction was 8 (1-18) degrees, with loss of correction of 4 (0-19) degrees at final follow-up. Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. It proved to be less invasive resulting in faster postoperative recovery.

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

    International Nuclear Information System (INIS)

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

    2008-01-01

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

  7. Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease.

    Science.gov (United States)

    Ou, Chien-Yu; Lee, Tao-Chen; Lee, Tsung-Han; Huang, Yu-Hua

    2015-04-01

    Adjacent segment disease is an important complication after fusion of degenerative lumbar spines. However, the role of body mass index (BMI) in adjacent segment disease has been addressed less. To examine the relationship between BMI and adjacent segment disease after lumbar fusion for degenerative spine diseases. For this retrospective study, we enrolled 190 patients undergoing lumbar fusion surgery for degeneration. BMI at admission was documented. Adjacent segment disease was defined by integration of the clinical presentations and radiographic criteria based on the morphology of the dural sac on magnetic resonance images. Adjacent segment disease was identified in 13 of the 190 patients, accounting for 6.8%. The interval between surgery and diagnosis as adjacent segment disease ranged from 21 to 66 months. Five of the 13 patients required subsequent surgical intervention for clinically relevant adjacent segment disease. In the logistic regression model, BMI was a risk factor for adjacent segment disease after lumbar fusion for degenerative spine diseases (odds ratio, 1.68; 95% confidence interval, 1.27-2.21; P disease rate by 67.6%. The patients were subdivided into 2 groups based on BMI, and up to 11.9% of patients with BMI ≥ 25 kg/m were diagnosed as having adjacent segment disease at the last follow-up. BMI is a risk factor for adjacent segment disease in patients undergoing lumbar fusion for degenerative spine diseases. Because BMI is clinically objective and modifiable, controlling body weight before or after surgery may provide opportunities to reduce the rate of adjacent segment disease and to improve the outcome of fusion surgery.

  8. Contribution of Lumbar Spine Pathology and Age to Paraspinal Muscle Size and Fatty Infiltration.

    Science.gov (United States)

    Shahidi, Bahar; Parra, Callan L; Berry, David B; Hubbard, James C; Gombatto, Sara; Zlomislic, Vinko; Allen, R Todd; Hughes-Austin, Jan; Garfin, Steven; Ward, Samuel R

    2017-04-15

    Retrospective chart analysis of 199 individuals aged 18 to 80 years scheduled for lumbar spine surgery. The purpose of this study was to quantify changes in muscle cross-sectional area (CSA) and fat signal fraction (FSF) with age in men and women with lumbar spine pathology and compare them to published normative data. Pathological changes in lumbar paraspinal muscle are often confounded by age-related decline in muscle size (CSA) and quality (fatty infiltration). Individuals with pathology have been shown to have decreased CSA and fatty infiltration of both the multifidus and erector spinae muscles, but the magnitude of these changes in the context of normal aging is unknown. Individuals aged 18 to 80 years who were scheduled for lumbar surgery for diagnoses associated with lumbar spine pain or pathology were included. Muscle CSA and FSF of the multifidus and erector spinae were measured from preoperative T2-weighted magnetic resonance images at the L4 level. Univariate and multiple linear regression analyses were performed for each outcome using age and sex as predictor variables. Statistical comparisons of univariate regression parameters (slope and intercept) to published normative data were also performed. There was no change in CSA with age in either sex (P > 0.05), but women had lower CSAs than men in both muscles (P muscles in both sexes (P pathology than published values for healthy controls (P = 0.03), and slopes tended to be steeper with pathology for both muscles in women (P  0.31). Lumbar muscle fat content, but not CSA, changes with age in individuals with pathology. In women, this increase is more profound than age-related increases in healthy individuals. 3.

  9. Evaluation of functional and structural changes affecting the lumbar spine in professional field hockey players.

    Science.gov (United States)

    Ogurkowska, Małgorzata Barbara; Kawałek, Krzysztof

    2017-01-01

    The aim of this study was to evaluate functional and structural changes in the lumbar spine which occurred as a consequence of playing field hockey. The research group consisted of 20 male professional field hockey players. Computed tomography scans were collected to define the radiological density of the vertebral bodies and to calculate Young's modulus. An electrogoniometer was used to measure the range of movement. Geometric parameters, such as Lumbar Lordosis Angle, Index of Lumbar Lordosis, Whitmann-Ferguson Angle and Anterior Pelvic Tilt, were also measured. The values describing lumbar lordosis increased linearly with years of training and were significantly greater than those reported in the literature. Field hockey players displayed a larger range of flexion, side bending and rotation to the right. An analysis of radiological density discovered significantly high values. An analysis of Young's modulus showed that the vertebral bodies become more fragile. The results show that overuse changes in the lumbar spine of field hockey players are severe and highly correlated with years of training.

  10. Evidence for surgery in degenerative lumbar spine disorders.

    NARCIS (Netherlands)

    Jacobs, W.C.; Rubinstein, S.M.; Koes, B.; van Tulder, M.W.; Peul, W.C.

    2013-01-01

    We aimed to evaluate the available evidence on the effectiveness of surgical interventions for a number of conditions resulting in low back pain (LBP) or spine-related irradiating leg pain. We searched the Cochrane databases and PubMed up to June 2013. We included systematic reviews and randomised

  11. Seizure-induced muscle force can caused lumbar spine fracture

    DEFF Research Database (Denmark)

    Mehlhorn, A T; Strohm, P C; Hausschildt, O

    2007-01-01

    of the mid-thoracic spine. We report a patient who had suffered from a tonic-clonic seizure during early morning hours. After a cracking sound the patient woke up in a state of post-ictal disorientation, loss of urine and tongue bite. He was admitted to our facilities with the suspected vertebral fracture...

  12. Infective lumbar discitis in a sickler - An occult 'typhoid' spine ...

    African Journals Online (AJOL)

    Pyogenic infection of the intervertebral disc (discitis) is a rare infection and the diagnosis often depends on a high index of suspicion. The cases of infective discitis described in the modern literature are similar to, if not identical with what was described as 'typhoid spine'. Salmoella infection of the musculoskeletal system on ...

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

    Directory of Open Access Journals (Sweden)

    Rong Wang

    2017-06-01

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

  14. From the international space station to the clinic: how prolonged unloading may disrupt lumbar spine stability.

    Science.gov (United States)

    Bailey, Jeannie F; Miller, Stephanie L; Khieu, Kristine; O'Neill, Conor W; Healey, Robert M; Coughlin, Dezba G; Sayson, Jojo V; Chang, Douglas G; Hargens, Alan R; Lotz, Jeffrey C

    2018-01-01

    Prolonged microgravity exposure is associated with localized low back pain and an elevated risk of post-flight disc herniation. Although the mechanisms by which microgravity impairs the spine are unclear, they should be foundational for developing in-flight countermeasures for maintaining astronaut spine health. Because human spine anatomy has adapted to upright posture on Earth, observations of how spaceflight affects the spine should also provide new and potentially important information on spine biomechanics that benefit the general population. This study compares quantitative measures of lumbar spine anatomy, health, and biomechanics in astronauts before and after 6 months of microgravity exposure on board the International Space Station (ISS). This is a prospective longitudinal study. Six astronaut crewmember volunteers from the National Aeronautics and Space Administration (NASA) with 6-month missions aboard the ISS comprised our study sample. For multifidus and erector spinae at L3-L4, measures include cross-sectional area (CSA), functional cross-sectional area (FCSA), and FCSA/CSA. Other measures include supine lumbar lordosis (L1-S1), active (standing) and passive (lying) flexion-extension range of motion (FE ROM) for each lumbar disc segment, disc water content from T2-weighted intensity, Pfirrmann grade, vertebral end plate pathology, and subject-reported incidence of chronic low back pain or disc injuries at 1-year follow-up. 3T magnetic resonance imaging and dynamic fluoroscopy of the lumbar spine were collected for each subject at two time points: approximately 30 days before launch (pre-flight) and 1 day following 6 months spaceflight on the ISS (post-flight). Outcome measures were compared between time points using paired t tests and regression analyses. Supine lumbar lordosis decreased (flattened) by an average of 11% (p=.019). Active FE ROM decreased for the middle three lumbar discs (L2-L3: -22.1%, p=.049; L3-L4: -17.3%, p=.016; L4-L5: -30.3%, p

  15. Limited effect of fly-wheel and spinal mobilization exercise countermeasures on lumbar spine deconditioning during 90 d bed-rest in the Toulouse LTBR study

    Science.gov (United States)

    Belavý, Daniel L.; Ohshima, Hiroshi; Bareille, Marie-Pierre; Rittweger, Jörn; Felsenberg, Dieter

    2011-09-01

    We examined the effect of high-load fly-wheel (targeting the lower-limb musculature and concurrent loading of the spine via shoulder restraints) and spinal movement countermeasures against lumbar spine muscle atrophy, disc and spinal morphology changes and trunk isokinetic torque loss during prolonged bed-rest. Twenty-four male subjects underwent 90 d head-down tilt bed-rest and performed either fly-wheel (FW) exercises every three days, spinal movement exercises in lying five times daily (SpMob), or no exercise (Ctrl). There was no significant impact of countermeasures on losses of isokinetic trunk flexion/extension ( p≥0.65). Muscle volume change by day-89 of bed-rest in the psoas, iliacus, lumbar erector spinae, lumbar multifidus and quadratus lumborum, as measured via magnetic resonance imaging (MRI), was statistically similar in all three groups ( p≥0.33). No significant effect on MRI-measures of lumbar intervertebral disc volume, spinal length and lordosis ( p≥0.09) were seen either, but there was some impact ( p≤0.048) on axial plane disc dimensions (greater reduction than in Ctrl) and disc height (greater increases than in Ctrl). MRI-data from subjects measured 13 and 90-days after bed-rest showed partial recovery of the spinal extensor musculature by day-13 after bed-rest with this process complete by day-90. Some changes in lumbar spine and disc morphology parameters were still persistent 90-days after bed-rest. The present results indicate that the countermeasures tested were not optimal to maintain integrity of the spine and trunk musculature during bed rest.

  16. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion

    OpenAIRE

    Huang, H.; Nightingale, R. W.; Dang, A. B. C.

    2018-01-01

    Objectives Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. Methods A previous...

  17. Optimal patient positioning for ligamentotaxis during balloon kyphoplasty of the thoracolumbar and lumbar spine.

    LENUS (Irish Health Repository)

    Cawley, D T

    2011-06-01

    Percutaneous balloon kyphoplasty aims to restore vertebral height, correct angular deformity and stabilize the spine in the setting of vertebral compression fractures. The patient is positioned prone with supports under the iliac crests and upper thorax to allow gravity to extend the spine. In the treatment of lumbar fractures, we evaluated patient positioning with the contribution of hip extension to increase anterior ligamentotaxis, thus facilitating restoration of vertebral height. Our positioning technique created a mean anterior height increase from 72% to 78% of the average height of the cranial and caudal vertebrae (p=0.037). Balloon inflation did not significantly further increase anterior or posterior vertebral height, or Cobb angle.

  18. Effect of intervertebral disc disease on scoliosis in the lumbar spine

    Directory of Open Access Journals (Sweden)

    Wojcik Gustaw

    2014-09-01

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

  19. Clinical significance of nerve root enhancement in contrast-enhanced MR imaging of the postoperative lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yeon Soo; Lee, Eun Ja; Kang, Si Won; Choi, Eun Seok [The Catholic Univ. of Korea, Taejon (Korea, Republic of); Song, Chang June; Kim, Jong Chul [Chungnam National Univ. School of Medicine, Taejon (Korea, Republic of)

    2001-09-01

    To determine the significance of nerve root contrast enhancement in patients with residual or recurrent symptomatic postoperative lumbar spine. Eighty-eight patients with 116 postoperative lumbar disc lesions causing radiating back pain underwent enhanced MR imaging. Intradural nerve root enhancement was quantified by pixel measurement, and affected nerve roots were compared before and after contrast administration. Extradural nerve root enhancement was assessed visually, and nerve root enhancement and clinical symptoms were correlated. Associated lesions such as recurrent disc herniation, scar tissue, nerve root thickening and nerve root displacement were also evaluated. Of 26 cases (22.4%) involving intradural nerve root enhancement, 22 (84.6%) showed significant clinical symptoms (p=0.002). and of 59 (50.9%) demonstrating extradural enhancement, clinical symptoms showed significant correlation in 47 (79.7%) (p=0.001). Nerve root enhancement, including eleven cases where this was both intra-and extradural, showed highly significant association with clinical symptoms in 74 of the 116 cases (63.8%) (p=0.000). Among 33 cases (28.4%) of recurrent disc herniation, nerve root enhancement was observed in 28 (84.8%) and in 24 of these 28 (85.7%), significant correlation with clinical symptoms was observed (p=0.000). Where epidural fibrosis was present, correlation between nerve root enhancement and clinical symptoms was not significant (p>0.05). Nerve root thickening and displaced nerve root were, however, significantly associated with symptoms (87.2% and 88.6%, respectively). In patients with postoperative lumbar spine, the association between nerve root enhancement revealed by MRI and clinical symptoms was highly significant.

  20. Clinical significance of nerve root enhancement in contrast-enhanced MR imaging of the postoperative lumbar spine

    International Nuclear Information System (INIS)

    Lee, Yeon Soo; Lee, Eun Ja; Kang, Si Won; Choi, Eun Seok; Song, Chang June; Kim, Jong Chul

    2001-01-01

    To determine the significance of nerve root contrast enhancement in patients with residual or recurrent symptomatic postoperative lumbar spine. Eighty-eight patients with 116 postoperative lumbar disc lesions causing radiating back pain underwent enhanced MR imaging. Intradural nerve root enhancement was quantified by pixel measurement, and affected nerve roots were compared before and after contrast administration. Extradural nerve root enhancement was assessed visually, and nerve root enhancement and clinical symptoms were correlated. Associated lesions such as recurrent disc herniation, scar tissue, nerve root thickening and nerve root displacement were also evaluated. Of 26 cases (22.4%) involving intradural nerve root enhancement, 22 (84.6%) showed significant clinical symptoms (p=0.002). and of 59 (50.9%) demonstrating extradural enhancement, clinical symptoms showed significant correlation in 47 (79.7%) (p=0.001). Nerve root enhancement, including eleven cases where this was both intra-and extradural, showed highly significant association with clinical symptoms in 74 of the 116 cases (63.8%) (p=0.000). Among 33 cases (28.4%) of recurrent disc herniation, nerve root enhancement was observed in 28 (84.8%) and in 24 of these 28 (85.7%), significant correlation with clinical symptoms was observed (p=0.000). Where epidural fibrosis was present, correlation between nerve root enhancement and clinical symptoms was not significant (p>0.05). Nerve root thickening and displaced nerve root were, however, significantly associated with symptoms (87.2% and 88.6%, respectively). In patients with postoperative lumbar spine, the association between nerve root enhancement revealed by MRI and clinical symptoms was highly significant

  1. [The functional status in patients with discopathy of the lumbar spine receiving only conservative therapy or operative therapy].

    Science.gov (United States)

    Radziszewski, Krzysztof R

    2008-01-01

    Discopathy of lumbar spine inevitably leads to decreased quality of life in patients. Decrease of the backbone dysfunction at the degree which makes leading a life close to the normal style of family, social and professional life impossible, is the key therapeutic task. Evaluation of the functional disability can be the objective method of evaluation of the treatment efficacy. The purpose of this study was to analyze of the functional state in patients with lumbar discopathy receiving either conservative therapy only or surgical treatment. 665 patients aged between 16 and 76 years with discopathy at L4-L5, L5-S1 levels have been enrolled into the study. In analyzed group 348 patients received only a conservative therapy whereas 317 patients underwent an operative procedure. Analysis has been performed based on four rating scores for evaluation of the functional status: Low Back Pain Rating Scale, Functional-Economic Outcome Rating Scale of Prolo, Oswestry Low Back Pain Disability Questionnaire, Low-Back Outcome Score. In preliminary examination approx. 40% decrease in parameters of evaluation of the functional status has been found in the group of patients receiving conservative therapy. Functional status of the patients within more than 10-year period of treatment was sufficiently stable and tended to progression in distant study. Ability to perform daily life activities was the strongest determined by backbone and limb pains as well as by the level of neurological deficits. In preliminary examination approx. 45% decrease in parameters of evaluation of the functional status has been found in the group of operated patients. Functional status significantly improved within immediate period post surgery. 1. Functional status in patients with discopathy of the lumbar spine in basic degree is determined by neurological status and intensification of the pain afflictions. 2. The operative intervention brings essential improvement of the patients' functional status. 3

  2. Biomechanical tolerance of whole lumbar spines in straightened posture subjected to axial acceleration.

    Science.gov (United States)

    Stemper, Brian D; Chirvi, Sajal; Doan, Ninh; Baisden, Jamie L; Maiman, Dennis J; Curry, William H; Yoganandan, Narayan; Pintar, Frank A; Paskoff, Glenn; Shender, Barry S

    2017-12-01

    Quantification of biomechanical tolerance is necessary for injury prediction and protection of vehicular occupants. This study experimentally quantified lumbar spine axial tolerance during accelerative environments simulating a variety of military and civilian scenarios. Intact human lumbar spines (T12-L5) were dynamically loaded using a custom-built drop tower. Twenty-three specimens were tested at sub-failure and failure levels consisting of peak axial forces between 2.6 and 7.9 kN and corresponding peak accelerations between 7 and 57 g. Military aircraft ejection and helicopter crashes fall within these high axial acceleration ranges. Testing was stopped following injury detection. Both peak force and acceleration were significant (p process for high rate load application. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  3. Intraoperative computed tomography navigation for transpedicular screw fixation to treat unstable thoracic and lumbar spine fractures: clinical analysis of a case series (CARE-compliant).

    Science.gov (United States)

    Lee, Ching-Yu; Wu, Meng-Huang; Li, Yen-Yao; Cheng, Chin-Chang; Hsu, Chu-Hsiang; Huang, Tsung-Jen; Hsu, Robert Wen-Wei

    2015-05-01

    Transpedicular screw (TPS) fixation in unstable thoracic and lumbar (TL) spine fractures remains technically difficult because of destroyed anatomical landmarks, unstable gross segments, and discrepancies in anatomic orientation using conventional anatomic landmarks, fluoroscopic guidance, or computed tomography (CT)-based navigation. In this study, we evaluated the safety and accuracy of TPS placement under intraoperative computed tomography (iCT) navigation in managing unstable TL spine fractures.From 2010 to 2013, we retrospectively reviewed the Spine Operation Registry records of patients who underwent posterior instrumented fusion to treat unstable TL spine fractures via the iCT navigation system. An unstable spine fracture was identified as AO/Magerl classification type B or type C.In all, 316 screws in 37 patients with unstable TL spine fractures were evaluated and involved 7 thoracic, 23 thoracolumbar junctional, and 7 lumbar fractures. The accuracy of TPS positioning in the pedicle without breach was 98% (310/316). The average number of iCT scans per patient was 2.1 (range 2-3). The average total radiation dose to patients was 15.8 mSv; the dose per single level exposure was 2.7 mSv. The TPS intraoperative revision rate was 0.6% (2/316) and no neurovascular sequela was observed. TPS fixation using the iCT navigation system obtained a 98% accuracy in stabilizing unstable TL spine fractures. A malplaced TPS could be revised during real-time confirmation of the TPS position, and no secondary operation was required to revise malplaced screws.The iCT navigation system provides accurate and safe management of unstable TL spine fractures. In addition, operating room personnel, including surgeons and nurses, did not need to wear heavy lead aprons as they were not exposed to radiation.

  4. Does the Addition of a Dynamic Pedicle Screw to a Fusion Segment Prevent Adjacent Segment Pathology in the Lumbar Spine?

    Science.gov (United States)

    Aygun, Hayati; Yaray, Osman; Mutlu, Muren

    2017-10-01

    Retrospective clinical cohort study. To investigate whether the combined use of dynamic pedicle screws and polyaxial pedicle screws was effective on adjacent segment pathology (ASP). Various screw and rod models have been recently developed for preventing adjacent segment disease, and hybrid systems have been described along with posterior instrumentation in the fusion segment. In the literature, although the success of dynamic systems has been demonstrated in non-fusion posterior instrumentation, it remains unclear whether the addition of a screw-based dynamic system to a fusion segment would successfully prevent ASP in the long term. The study included 101 patients who underwent surgery for degenerative spine diseases between 2007 and 2014 with lumbar stabilization that used either polyaxial pedicle screws alone or polyaxial pedicle screws plus dynamic stabilization screws (with hinged screw heads). These two patient groups were compared using retrospectively obtained postoperative new clinical findings, Oswestry disability index (ODI) scores, visual analog scale (VAS) scores, and radiological data. The proportion of patients with ASP who were radiologically assessed was low ( p 0.05). Although the combined use of dynamic screws and the static system was radiologically found to be effective for preventing ASP in patients who underwent lumbar fusion with posterior instrumentation, it did not completely eliminate ASP or result in a significant improvement in clinical ASP.

  5. Oblique lumbar spine radiographs: importance in young patients

    Energy Technology Data Exchange (ETDEWEB)

    Libson, E.; Bloom, R.A.; Dinari, G.; Robin, G.C.

    1984-04-01

    Spondylolysis is a direct precursor of spondylolisthesis and can lead to crippling back pain. Of 1,743 patients surveyed, including 936 who were asymptomatic and 807 with back pain, 165 (including 91 who were asymptomatic and 74 with back pain) had spondylolysis, which was seen only on oblique lumbar views in 20% of cases. Because of the high false-negative rate of AP and lateral views, oblique views are essential in children and young adults. As spondylolysis is rare above L3, radiographs can be limited to L3-S1. Significantly less spondylolysis was seen in persons older than 30 with back pain usually caused by disk degeneration.

  6. Oblique lumbar spine radiographs: importance in young patients

    International Nuclear Information System (INIS)

    Libson, E.; Bloom, R.A.; Dinari, G.; Robin, G.C.

    1984-01-01

    Spondylolysis is a direct precursor of spondylolisthesis and can lead to crippling back pain. Of 1,743 patients surveyed, including 936 who were asymptomatic and 807 with back pain, 165 (including 91 who were asymptomatic and 74 with back pain) had spondylolysis, which was seen only on oblique lumbar views in 20% of cases. Because of the high false-negative rate of AP and lateral views, oblique views are essential in children and young adults. As spondylolysis is rare above L3, radiographs can be limited to L3-S1. Significantly less spondylolysis was seen in persons older than 30 with back pain usually caused by disk degeneration

  7. Do positive MRI findings in the lumbar spine predict future seeking care for low back pain in young teenagers?

    DEFF Research Database (Denmark)

    Kjær, Per; Leboeuf-Yde, Charlotte; Korsholm, Lars

    in girls. However, multiple testing increases the probability of chance findings. Conclusion: Some positive MRI findings seem to predict future seeking care for LBP. However, when interpreting lumbar spine MRI from young teenagers in a clinical setting, gender variations and the lumbar level...

  8. COMPUTATIONAL ANALYSIS BASED ON ARTIFICIAL NEURAL NETWORKS FOR AIDING IN DIAGNOSING OSTEOARTHRITIS OF THE LUMBAR SPINE

    Science.gov (United States)

    Veronezi, Carlos Cassiano Denipotti; de Azevedo Simões, Priscyla Waleska Targino; dos Santos, Robson Luiz; da Rocha, Edroaldo Lummertz; Meláo, Suelen; de Mattos, Merisandra Côrtes; Cechinel, Cristian

    2015-01-01

    Objective: To ascertain the advantages of applying artificial neural networks to recognize patterns on lumbar spine radiographies in order to aid in the process of diagnosing primary osteoarthritis. Methods: This was a cross-sectional descriptive analytical study with a quantitative approach and an emphasis on diagnosis. The training set was composed of images collected between January and July 2009 from patients who had undergone lateral-view digital radiographies of the lumbar spine, which were provided by a radiology clinic located in the municipality of Criciúma (SC). Out of the total of 260 images gathered, those with distortions, those presenting pathological conditions that altered the architecture of the lumbar spine and those with patterns that were difficult to characterize were discarded, resulting in 206 images. The image data base (n = 206) was then subdivided, resulting in 68 radiographies for the training stage, 68 images for tests and 70 for validation. A hybrid neural network based on Kohonen self-organizing maps and on Multilayer Perceptron networks was used. Results: After 90 cycles, the validation was carried out on the best results, achieving accuracy of 62.85%, sensitivity of 65.71% and specificity of 60%. Conclusions: Even though the effectiveness shown was moderate, this study is still innovative. The values show that the technique used has a promising future, pointing towards further studies on image and cycle processing methodology with a larger quantity of radiographies. PMID:27027010

  9. COMPUTATIONAL ANALYSIS BASED ON ARTIFICIAL NEURAL NETWORKS FOR AIDING IN DIAGNOSING OSTEOARTHRITIS OF THE LUMBAR SPINE.

    Science.gov (United States)

    Veronezi, Carlos Cassiano Denipotti; de Azevedo Simões, Priscyla Waleska Targino; Dos Santos, Robson Luiz; da Rocha, Edroaldo Lummertz; Meláo, Suelen; de Mattos, Merisandra Côrtes; Cechinel, Cristian

    2011-01-01

    To ascertain the advantages of applying artificial neural networks to recognize patterns on lumbar spine radiographies in order to aid in the process of diagnosing primary osteoarthritis. This was a cross-sectional descriptive analytical study with a quantitative approach and an emphasis on diagnosis. The training set was composed of images collected between January and July 2009 from patients who had undergone lateral-view digital radiographies of the lumbar spine, which were provided by a radiology clinic located in the municipality of Criciúma (SC). Out of the total of 260 images gathered, those with distortions, those presenting pathological conditions that altered the architecture of the lumbar spine and those with patterns that were difficult to characterize were discarded, resulting in 206 images. The image data base (n = 206) was then subdivided, resulting in 68 radiographies for the training stage, 68 images for tests and 70 for validation. A hybrid neural network based on Kohonen self-organizing maps and on Multilayer Perceptron networks was used. After 90 cycles, the validation was carried out on the best results, achieving accuracy of 62.85%, sensitivity of 65.71% and specificity of 60%. Even though the effectiveness shown was moderate, this study is still innovative. The values show that the technique used has a promising future, pointing towards further studies on image and cycle processing methodology with a larger quantity of radiographies.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-06-01

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

  11. Postoperative stabilization of the posttraumatic thoracic and lumbar spine: a review of concepts and orthotic techniques.

    Science.gov (United States)

    Benzel, E C; Larson, S J

    1989-03-01

    A review of 109 case histories of patients who had undergone a spine fusion and/or posterior instrumentation procedure for thoracic and/or lumbar spine trauma was performed with respect to efficacy of several postoperative external splinting techniques. These data formed the basis for a review of external spinal splinting techniques. The type of orthosis that appears to offer the most efficacious immobilization and maximum patient comfort for fractures in the upper thoracic region in a body shell jacket extending from the submental and suboccipital regions to the lumbar region (modified Minerva jacket). To gain a lower point of fixation in patients with mid-to-low lumbar fractures, it was found that an extended body shell or an extension of a body jacket to one leg (hip spica) was necessary. Thoracic and thoracolumbar injuries may be stabilized with either a Jewett brace or a body jacket. The lack of maintenance of the cylindrical body shell, as well as excessive discomfort, make the Jewett brace and similar orthotic devices a second choice to body shell jackets for fractures in this region. The application of plastic polymer (Thermoplast) to spine splinting techniques offers the patient increased comfort and stability, as well as facilitating easy application and a more snug fit.

  12. Developing Criteria for Lumbar Spine Magnetic Resonance Imaging (MRI) Using RAND Appropriateness Method (RAM)

    International Nuclear Information System (INIS)

    Keshtkaran, Ali; Bagheri, Mohammad Hadi; Ostovar, Rahim; Salari, Hedayat; Farokhi, Majid Reza; Esfandiari, Atefeh; Yousefimanesh, Hossein

    2012-01-01

    Studies show that a large proportion of healthcare offered may be inappropriate or unnecessary. Magnetic resonance imaging (MRI) is a new and expensive diagnostic technology which has been increasingly used all over the world. Moreover, this trend has been more rapidly increasing in Iran. Low back pain is a common disorder all over the world and MRI technique is one of the several ways to assess its cause. The present study aims to develop scenarios for lumbar spine MRI. In the present study, the RAND Appropriateness Method (RAM) was used in order to reach consensus regarding developing scenarios for lumbar spine MRI. We generated scenarios from valid clinical guidelines as well as the experts’ opinion. The panel members included nine specialists from various medical specialties that had scored scenarios in two rounds, the first of which was without interaction, while the second one was with interaction. We extracted 97 scenarios for the lumbar spine MRI in the scenario extracting phase of the study and the panel members added 18 scenarios. After implementation of two rounds, the scenarios were categorized into three ranges. Sixty seven (58%) of the scenarios were considered as appropriate, 45 (39%) as uncertain, and three (2.6%) as inappropriate. RAM is useful for identifying stakeholder views in settings with limited resources. Since RAM has precise instructions for consensus developing, a large number of scenarios were considered as uncertain. Therefore, more research has to be conducted on the issue

  13. Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities.

    Science.gov (United States)

    Berjano, Pedro; Aebi, Max

    2015-01-01

    The narrow correlation between sagittal alignment parameters and clinical outcomes has been widely established, demonstrating that improper sagittal alignment is a clinical condition that is associated with increased pain and limitations in patients' functional ability. Lumbar pedicle subtraction osteotomy (PSO) is indicated in the treatment of large sagittal (more than 25° of rigid loss of lordosis) deformities of the lumbar spine or its combination with coronal deformity, especially when they are rigid. Indication should be based on careful assessment of the severity of symptoms, functional impairment, functional expectations of the patient, general clinical condition and surgical and anesthesiological team experience. Risk should be carefully assessed and discussed to obtain appropriate informed consent. Surgical planning includes selection of the safest levels for the upper and lower instrumented vertebra, site of the osteotomy, modality of fixation, and, most importantly angular value of the correction goal (target lumbar lordosis). Failure to adequately obtain the necessary amount of sagittal correction is the most frequent cause of failure and reoperation. PSO is a valuable surgical procedure in correction of severe hypolordosis (=relative kyphosis) in the lumbar spine. It is a demanding procedure for the surgeon, the anesthesiologist and the intensive care team. Although its complication rate is high, it has a substantial positive impact in the quality of life of patients, including the elderly.

  14. Effects of Lumbar Spine Assemblies and Body-Borne Equipment Mass on Anthropomorphic Test Device Responses During Drop Tests.

    Science.gov (United States)

    Aggromito, Daniel; Jaffrey, Mark; Chhor, Allen; Chen, Bernard; Yan, Wenyi

    2017-10-01

    When simulating or conducting land mine blast tests on armored vehicles to assess potential occupant injury, the preference is to use the Hybrid III anthropomorphic test device (ATD). In land blast events, neither the effect of body-borne equipment (BBE) on the ATD response nor the dynamic response index (DRI) is well understood. An experimental study was carried out using a drop tower test rig, with a rigid seat mounted on a carriage table undergoing average accelerations of 161 g and 232 g over 3 ms. A key aspect of the work looked at the various lumbar spine assemblies available for a Hybrid III ATD. These can result in different load cell orientations for the ATD which in turn can affect the load measurement in the vertical and horizontal planes. Thirty-two tests were carried out using two BBE mass conditions and three variations of ATDs. The latter were the Hybrid III with the curved (conventional) spine, the Hybrid III with the pedestrian (straight) spine, and the Federal Aviation Administration (FAA) Hybrid III which also has a straight spine. The results showed that the straight lumbar spine assemblies produced similar ATD responses in drop tower tests using a rigid seat. In contrast, the curved lumbar spine assembly generated a lower pelvis acceleration and a higher lumbar load than the straight lumbar spine assemblies. The maximum relative displacement of the lumbar spine occurred after the peak loading event, suggesting that the DRI is not suitable for assessing injury when the impact duration is short and an ATD is seated on a rigid seat on a drop tower. The peak vertical lumbar loads did not change with increasing BBE mass because the equipment mass effects did not become a factor during the peak loading event.

  15. 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.

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

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    Shulga А.Е.

    2015-12-01

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

  17. 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.

  18. Psychological attachment in patients with spondylosis of cervical and lumbar spine.

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    Pedziwiatr, Henryk

    2013-01-01

    Persons with spondylosis of the cervical spine have a low sense of security, difficulties in relationships with their mothers, difficulties in contact with their own body and in coping with dysphoric affect. The question arises: Are those problems the result of the current medical condition, or one of its causes? In order to find the answer one should look closer at the period of an individual's life when a sense of security and a pattern of emotional relationships are formed, and a sense of own body and defence attitudes are developed. The earliest period of life in which these processes occur is the initial relationship between the child and mother; the period of attachment and object relation. If the attachment style in the group studied does not deviate significantly from the control group, it ought to be assumed that the present problems are situational. The problems would then a result of a chronic difficult (stressful) situation which is spondylosis of cervical or lumbar spine. In an attempt to answer the above question, preliminary studies in a 90-person group were conducted. The group included 30 patients with spondylosis of the cervical spine, 30 patients with spondylosis of the lumbar spine, and 30 control persons without spondylosis.

  19. Incidence and predictive factors of spinal cord stimulation treatment after lumbar spine surgery

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    Vakkala M

    2017-10-01

    Full Text Available Merja Vakkala,1 Voitto Järvimäki,1 Hannu Kautiainen,2,3 Maija Haanpää,4,5 Seppo Alahuhta1 1Department of Anaesthesiology, Medical Research Center Oulu (MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, 2Primary Health Care Unit, Kuopio University Hospital, Kuopio, 3Folkhälsan Research Center, Helsinki, 4Department of Neurosurgery, Helsinki University Hospital, 5Mutual Insurance Company Etera, Helsinki, Finland Introduction: Spinal cord stimulation (SCS is recommended for the treatment of postsurgical chronic back and leg pain refractory to other treatments. We wanted to estimate the incidence and predictive factors of SCS treatment in our lumbar surgery cohort.Patients and methods: Three questionnaires (a self-made questionnaire, the Oswestry Low Back Pain Disability Questionnaire, and the Beck Depression Inventory were sent to patients aged 18–65 years with no contraindications for the use of SCS, and who had undergone non-traumatic lumbar spine surgery in the Oulu University Hospital between June 2005 and May 2008. Patients who had a daily pain intensity of ≥5/10 with predominant radicular component were interviewed by telephone.Results: After exclusions, 814 patients remained in this cohort. Of those, 21 patients had received SCS by the end of June 2015. Fifteen (71% of these received benefit and continued with the treatment. Complications were rare. The number of patients who replied to the postal survey were 537 (66%. Eleven of them had undergone SCS treatment after their reply. Features predicting SCS implantation were daily or continuous pain, higher intensities of pain with predominant radicular pain, more severe pain-related functional disability, a higher prevalence of depressive symptoms, and reduced benefit from pain medication. The mean waiting time was 65 months (26–93 months. One hundred patients were interviewed by telephone. Fourteen seemed to be potential SCS candidates. From the eleven patients who

  20. The immediate effect of bilateral self myofascial release on the plantar surface of the feet on hamstring and lumbar spine flexibility: A pilot randomised controlled trial.

    Science.gov (United States)

    Grieve, Rob; Goodwin, Faye; Alfaki, Mostapha; Bourton, Amey-Jay; Jeffries, Caitlin; Scott, Harriet

    2015-07-01

    Self myofascial release (SMR) via a tennis ball to the plantar aspect of the foot is widely used and advocated to increase flexibility and range of movement further along the posterior muscles of a proposed "anatomy train". To date there is no evidence to support the effect of bilateral SMR on the plantar aspect of the feet to increase hamstring and lumbar spine flexibility. The primary aim was to investigate the immediate effect of a single application of SMR on the plantar aspect of the foot, on hamstring and lumbar spine flexibility. The secondary aim was to evaluate the method and propose improvements in future research. A pilot single blind randomised control trial. Twenty four healthy volunteers (8 men, 16 women; mean age 28 years ± 11.13). Participants underwent screening to exclude hypermobility and were randomly allocated to an intervention (SMR) or control group (no therapy). Baseline and post intervention flexibility was assessed by a sit-and-reach test (SRT). A one way between groups analysis of covariance (ANCOVA) was conducted to compare between group outcome SRT measurements. Baseline pre-intervention and control SRT measurements were used as the covariate in the analysis. There was a significant increase (p = 0.03) in the intervention SRT outcome measurements compared to the control group, with a large effect size. An immediate clinical benefit of SMR on the flexibility of the hamstrings and lumbar spine was indicated and suggestions for methodological improvements may inform future research. Copyright © 2015. Published by Elsevier Ltd.

  1. Juxtafacet cysts of the lumbar spine: a positional MRI study

    International Nuclear Information System (INIS)

    Niggemann, Pascal; Kuchta, Johannes; Hoeffer, Janine; Beyer, Hans-Konrad; Grosskurth, Dieter; Delank, Karl-Stefan

    2012-01-01

    Juxtafacet cysts (JFC) are related to facet joint degeneration. Supine MRI is routinely used to evaluate JFC. However, some JFC are missed and found only intraoperatively. The present study addresses positional MRI features and factors leading to variation in the size of JFC. Fifty patients in whom positional MRI had been performed were investigated retrospectively and 67 distinct intraspinal or intraneuroforaminal were JFC found. Signal intensity, size of the JFC, the presence and variance of a vertebral slip and the angular movement of affected segments were assessed in supine, neutral sitting, flexion (sitting) and extension (standing). The overall movement of the spine and the lordosis angle in different positions were measured. JFC varied in size in segments with unstable slip and increased angular movement (variation of the angle in the affected segment in function: 13.3 degrees compared to 8.7 degrees). JFC with bright signals tended to vary in size compared to JFC with intermediate or low signal intensity (all: p < 0.001). Joint effusion and displacement of effusion lead to formation and variations in the size of JFC. JFC were most prominent in extension: 6.7 mm, less prominent in supine: 5.5 mm and in neutral sitting position: 4.6 mm (all p < 0.05). The detection rate for JFC was 97% for extension, 89% for supine and 78% for neutral sitting. The detection rate of JFC improves with increasing lordosis of the spine and under weight-bearing conditions, particularly when standing. Unstable slipping or increased angular movement affects the size of JFC. (orig.)

  2. Juxtafacet cysts of the lumbar spine: a positional MRI study

    Energy Technology Data Exchange (ETDEWEB)

    Niggemann, Pascal [University Hospital Bonn, Department of Radiology, Bonn (Germany); Kuchta, Johannes [Interdisziplinaeres Wirbelsaeulenzentrum, Bonn (Germany); Hoeffer, Janine; Beyer, Hans-Konrad [Upright MRT, Cologne (Germany); Grosskurth, Dieter; Delank, Karl-Stefan [Upright MRT, Cologne (Germany); University of Cologne, Department of Orthopaedic and Trauma Surgery, Cologne (Germany)

    2012-03-15

    Juxtafacet cysts (JFC) are related to facet joint degeneration. Supine MRI is routinely used to evaluate JFC. However, some JFC are missed and found only intraoperatively. The present study addresses positional MRI features and factors leading to variation in the size of JFC. Fifty patients in whom positional MRI had been performed were investigated retrospectively and 67 distinct intraspinal or intraneuroforaminal were JFC found. Signal intensity, size of the JFC, the presence and variance of a vertebral slip and the angular movement of affected segments were assessed in supine, neutral sitting, flexion (sitting) and extension (standing). The overall movement of the spine and the lordosis angle in different positions were measured. JFC varied in size in segments with unstable slip and increased angular movement (variation of the angle in the affected segment in function: 13.3 degrees compared to 8.7 degrees). JFC with bright signals tended to vary in size compared to JFC with intermediate or low signal intensity (all: p < 0.001). Joint effusion and displacement of effusion lead to formation and variations in the size of JFC. JFC were most prominent in extension: 6.7 mm, less prominent in supine: 5.5 mm and in neutral sitting position: 4.6 mm (all p < 0.05). The detection rate for JFC was 97% for extension, 89% for supine and 78% for neutral sitting. The detection rate of JFC improves with increasing lordosis of the spine and under weight-bearing conditions, particularly when standing. Unstable slipping or increased angular movement affects the size of JFC. (orig.)

  3. Effects of pilot hole preparation technique on pedicle screw fixation in different regions of the osteoporotic thoracic and lumbar spine.

    Science.gov (United States)

    Carmouche, Jonathan J; Molinari, Robert W; Gerlinger, Tad; Devine, John; Patience, Troy

    2005-11-01

    The authors evaluated the effects of pilot hole preparation technique on insertional torque and axial pullout resistance in osteoporotic thoracic and lumbar vertebrae. Using a probe technique and fluoroscopy, 102 pedicle screws were placed in 51 dual-energy x-ray absorptiometry-proven osteoporotic thoracic and lumbar levels. Screws were inserted using the same-size tapping, one-size-under tapping, or no-tapping technique. Insertional torque and axial pullout resistance were measured. Analysis of variance, Fisher exact test, and regression analysis were performed. Same-size tapping decreased pullout resistance in the lumbar spine. There was no effect on pullout resistance in the thoracic spine. Pullout resistance values were lower for all insertion techniques in the upper thoracic spine. Insertional torque and bone mineral density correlated with pullout resistance in the thoracic and lumbar spine. Tapping decreased pedicle screw pullout resistance in the osteoporotic human lumbar spine, although it did not affect pullout strength in the thoracic spine. Tapping decreased insertional torque in upper thoracic levels. Surgeons should optimize overall construct rigidity when placing thoracic pedicle screws in patients with spinal segment osteoporosis.

  4. Lumbar- and Cervicothoracic-Spine Loading During a Fast-Bowling Spell.

    Science.gov (United States)

    Greig, Matt; Nagy, Philip

    2017-07-01

    Epidemiological studies highlight a prevalence of lumbar vertebrae injuries in cricket fast bowlers, with governing bodies implementing rules to reduce exposure. Analysis typically requires complex and laboratory-based biomechanical analyses, lacking ecological validity. Developments in GPS microtechnologies facilitate on-field measures of mechanical intensity, facilitating screening toward prevention and rehabilitation. To examine the efficacy of using GPS-mounted triaxial accelerometers to quantify accumulated body load and to investigate the effect of GPS-unit placement in relation to epidemiological observations. Repeated measures, field-based. Regulation cricket pitch. 10 male injury-free participants recruited from a cricket academy (18.1 ± 0.6 y). Each participant was fitted with 2 GPS units placed at the cervicothoracic and lumbar spines to measure triaxial acceleration (100 Hz). Participants were instructed to deliver a 7-over spell of fast bowling, as dictated by governing-body guidelines. Triaxial total accumulated body and the relative uniaxial contributions were calculated for each over. There was no significant main effect for overs bowled, in either total load or the triaxial contributions to total load. This finding suggests no cumulative fatigue effect across the 10-over spell. However, there was a significant main effect for GPS-unit location, with the lumbar unit exposed to significantly greater load than the cervicothoracic unit in each of the triaxial planes. There was no evidence to suggest that accumulated load significantly increased as a result of spell duration. In this respect the governing-body guidelines for this age group can be considered safe, or potentially even conservative. However, the observation of higher body load at the lumbar spine than at the cervicothoracic spine supports epidemiological observations of injury incidence. GPS microtechnologies might therefore be considered in screening and monitoring of players toward

  5. Delayed radiographic diagnosis of osteoid osteoma in the lumbar spine

    International Nuclear Information System (INIS)

    Louis-Ugbo, J.; Reddy, A.S.; Heller, J.G.

    1998-01-01

    Study design: Case report and literature review. Objectives: Describe a case of delayed diagnosis of osteoid osteoma of the spine due to misinterpretation of initial imaging studies within two months of onset of pain, and discuss the relevant imaging characteristics and their pitfalls. Summary of background data. Several cases of delayed diagnosis have been previously reported. Only one false negative bone scan has been reported; however other imaging modalities established the diagnosis. In our patient, all of the imaging modalities were initially interpreted as negative hence the delay in diagnosis. Methods: History, physical examination and imaging studies (x-rays, bone scan, MRI) of the patient were employed to evaluate the differential diagnosis of low back pain and sciatica in a 16 yr old. Repeat bone scan and CT scan were done six months after onset of symptoms because of persistent clinical suspicion of osteoid osteoma. Results: The repeat bone scan and CT scan confirmed-the diagnosis missed, during the first round of imaging. An osteoid osteoma of the L5 pedicle was removed without incident. Conclusion: Technetium bone scans remain the main stay of early diagnosis of osteoid osteoma when plain films and other imaging modalities are normal. However, when faced with persistent unexplained musculoskeletal pain in an adolescent, further follow-up and diagnostic efforts are indicated; possibly repeating a bone scan if initially interpreted as negative. (author)

  6. Preoperative education for lumbar radiculopathy: A survey of US spine surgeons

    Science.gov (United States)

    Louw, Adriaan; Butler, David S.; Diener, Ina; Puentedura, Emilio J.

    2012-01-01

    Background We sought to determine current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Methods An online cross-sectional survey was used to study a random sample of spine surgeons in the United States. The Spinal Surgery Education Questionnaire (SSEQ) was developed based on previous related surveys and assessed for face and content validity by an expert panel. The SSEQ captured information on demographics, content, delivery methods, utilization, and importance of preoperative education as rated by surgeons. Descriptive statistics were used to describe the current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Results Of 200 surgeons, 89 (45% response rate) responded to the online survey. The majority (64.2%) provide preoperative education informally during the course of clinical consultation versus a formal preoperative education session. The mean time from the decision to undergo surgery to the date of surgery was 33.65 days. The highest rated educational topics are surgical procedure (96.3%), complications (96.3%), outcomes/expectations (93.8%), anatomy (92.6%), amount of postoperative pain expected (90.1%), and hospital stay (90.1%). Surgeons estimated spending approximately 20% of the preoperative education time specifically addressing pain. Seventy-five percent of the surgeons personally provide the education, and nearly all surgeons (96.3%) use verbal communication with the use of a spine model. Conclusions Spine surgeons believe that preoperative education is important and use a predominantly biomedical approach in preparing patients for surgery. Larger studies are needed to validate these findings. PMID:25694882

  7. Does the correlation between Schmorl's nodes and vertebral morphology extend into the lumbar spine?

    Science.gov (United States)

    Plomp, Kimberly; Roberts, Charlotte; Strand Vidarsdottir, Una

    2015-07-01

    Schmorl's nodes are depressions on vertebrae due to herniation of the nucleus pulposus of the intervertebral disc into the vertebral body. This study provides an extension of our previous study which analyzed the shape of the lower thoracic spine and found that vertebral morphology was associated with the presence of Schmorl's nodes. Ninety adult individuals from the late Medieval site of Fishergate House, York, and the Post-Medieval site of Coach Lane, North Shields, Tyne and Wear, England, were analysed using 2D geometric morphometrics to identify possible relationships between vertebral morphology and Schmorl's nodes at the thoraco-lumbar junction and in the lumbar spine. A significant correlation was found between vertebral shape and the presence of Schmorl's nodes in the twelfth thoracic vertebrae and the first to third lumbar vertebrae. The findings corroborate previous studies and suggest that vertebral shape may be an important factor in spinal health. It is hypothesized that the pedicle shape of affected vertebrae may not provide adequate structural support for the vertebral bodies, resulting in vertical disc herniation. © 2015 Wiley Periodicals, Inc.

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

    International Nuclear Information System (INIS)

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

    1987-01-01

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

  9. Evaluation of epidural scar formation in lumbar spine after TachoComb application - an experimental study.

    Science.gov (United States)

    Brzezicki, Grzegorz; Jankowski, Roman; Blok, Tomasz; Szymaś, Janusz; Huber, Juliusz; Szukała, Agnieszka; Nowak, Stanisław; Borejsza-Wysocki, Maciej

    2008-01-01

    Scar formation after spine surgery in the lumbosacral region may be the cause of failed back surgery syndrome. Therefore efforts are made to find materials preventing excessive scar formation at the site of surgery. The aim of the study was to evaluate the usefulness of TachoComb application in prevention of epidural scar formation in a rat experimental model. This paper additionally presents a review of literature concerning other methods of local suppression of scar formation after posterior approaches to the lumbar spine. The experimental study was carried out on 14 male Wistar rats. Rats were divided into 2 groups. Laminectomy was performed in the first group (control group: n=5). In the second group of animals (n=9) laminectomy was followed by TachoComb application on the exposed dura. Neurological condition of the studied animals was evaluated based on clinical observation, neurological tests and recording of somatosensory evoked potentials. Post mortem histological examination was the main method of assessment of the experimental material. Presence of scar in the vertebral canal, its extent and severity differed between experimental groups. Electrophysiological results were also different between studied groups. TachoComb prevents epidural scar formation after lumbar spine surgery. Its positive effect concerning neural transmission at the level of the medulla was proven by electrophysiological tests in which the amplitude of components I and II of SSEP in the TachoComb group were significantly higher than in the control group.

  10. Remote Hemorrhage in the Cerebellum and Temporal Lobe after Lumbar Spine Surgery

    Directory of Open Access Journals (Sweden)

    Shotaro Watanabe

    2015-01-01

    Full Text Available Cerebellar hemorrhage remote from the site of surgery can complicate neurosurgical procedures. However, this complication after lumbar surgery is rare. Furthermore, hemorrhage in both the cerebellum and the temporal lobe after spine surgery is rarer still. Herein we present a case of remote hemorrhage in both the cerebellum and the temporal lobe after lumbar spine surgery. A 79-year-old woman with a Schwannoma at the L4 level presented with low back and bilateral leg pain refractory to conservative management. Surgery was undertaken to remove the Schwannoma and to perform posterior fusion. During the surgery, the dura mater was removed in order to excise the Schwannoma. Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak. Five days after surgery, clouding of consciousness started gradually, and hemorrhage in the cerebellum and the temporal lobe was revealed by computed tomography. Emergent evacuation of the hemorrhage was performed and the patient recovered consciousness after the surgery. Leakage of cerebrospinal fluid may have induced this hemorrhage. While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

  11. The experimental study of selective arterial embolization in the lumbar spine of dogs

    International Nuclear Information System (INIS)

    Ni Caifang; Xu Ming; Liu Yizhi; Ding Yi; Yang Huilin; Tang Tiansi

    2002-01-01

    Objective: To establish the model of acute spinal infarction, to evaluate the relative factors affecting results in spinal embolization, and to provide the theoretical basis with the preoperative embolization of spinal tumors. Methods: Through the SAE of the lumbar arteries, the neuro-function of the posterior legs of dogs, MRI findings, and pathologic changes of the spinal specimen were observed in 12 dogs. The embolizing agents was gelfoam (GF). Results: The significant ischemia changes of spinal column and the corresponding muscles at the occluding spinal after embolizing more than one segmental arteries occurred in 9 dogs, but there were no paraplegia or obvious changes in 3 dogs having been embolized single lumbar arteries no matter they sent out the radiculomedullary artery (RA) or not. Paraplegia occurred in one dog after embolizing the multisegmental arteries. Conclusion: (1) The method of SAE in dog can be used to set up the experimental model of the acute ischemia of spine. (2) The occlusion in single-segmental arteries can not result in the infarction of the whole spine. (3) The serious complication may result from embolizing multisegmental spinal arteries (especially sending out RA). (4) The protecting embolization should be carried out in order to decrease the reaction during SAE in spine

  12. [Spine cord descompresion and instrumentation in a case of solid aneurysmal bone cyst in the lumbar spine].

    Science.gov (United States)

    Díaz-Martín, A A; Guerrero-Moyano, N; Guerado-Parra, E; Quesada-Rubio, J A

    2010-06-01

    We report a 8-year-old boy with two month history of pain and stiffness in his left lower extremity. On x-ray, MRI and scintigraphy examinations a lytic lesion affecting the body and posterior arc of his third lumbar vertebral become evident. The tumour was excised through a double, anterior and posterior approach; spinal fusion with posterior transpedicular instrumentation was also performed in the same procedure; in order to achieve solid fusion tricortical liofilized graft was also inserted. Histological studies evidenced finding compatible with aneurysmal bone cyst solid variant. Five years after surgery the patient is pain free and no recurrence is evident under diagnostic images tools. For the treatment of aneurysmal bone cyst of the spine we recommend complete excision of the tumour in a combined anterior and posterior one staged procedure, together with hardware instrumentation and bone graft, no recurrence or instability is seen after five years followup.

  13. Treatment of osteoid osteoma in the vertebral body of the lumbar spine by radiofrequency ablation

    International Nuclear Information System (INIS)

    Cristante, Alexandre Fogaca; Barros Filho, Tarcisio; Oliveira, Reginaldo Perilo de; Babrabrini, Almir F.; Teixeira, William G.J.

    2007-01-01

    A case of Osteoid osteoma, a rare bone tumor, is studied in a 44-year-old female patient. Scintigraphy using Tc 99m demonstrated increased uptake on the left side of the vertebral body of the fourth vertebra. Computed tomography of the lumbar spine revealed an area of hypoattenuation surrounded by an area of hyperattenuation (bone sclerosis), suggestive of an osteogenic tumor . Complementary examination using MRI demonstrated a signal alteration of 1 cm diameter in the vertebral body of the fourth lumbar vertebra, surrounded by an area of signal compatible with bone edema. The anamnesis data, physical evaluation, and complementary examinations suggested the presence of osteoid osteoma in the vertical body of the fourth lumbar vertebra. A tomography-guided biopsy was performed, and material was collected for cultures, pathological studies in paraffin, and fast freezing (in print). Pathological study of frozen sections ruled out the presence of neoplastic cells. At the same time, minimally invasive destruction of the tumor was performed through a pedicullar approach, via a radiofrequency probe. One year after the procedure, computed tomography did not demonstrate any tumor, and the patient did not report any lumbar pain. (MAC)

  14. Minimally Invasive Direct Repair of Bilateral Lumbar Spine Pars Defects in Athletes

    Directory of Open Access Journals (Sweden)

    Gabriel A. Widi

    2013-01-01

    Full Text Available Spondylolysis of the lumbar spine has traditionally been treated using a variety of techniques ranging from conservative care to fusion. Direct repair of the defect may be utilized in young adult patients without significant disc degeneration and lumbar instability. We used minimally invasive techniques to place pars interarticularis screws with the use of an intraoperative CT scanner in three young adults, including two athletes. This technique is a modification of the original procedure in 1970 by Buck, and it offers the advantage of minimal muscle dissection and optimal screw trajectory. There were no intra- or postoperative complications. The detailed operative procedure and the postoperative course along with a brief review of pars interarticularis defect treatment are discussed.

  15. Relationship of homocysteine levels with lumbar spine and femur neck BMD in postmenopausal women

    Directory of Open Access Journals (Sweden)

    Elton Bahtiri

    2015-10-01

    Full Text Available Objective: The focus of several studies in recent years has been the association between increased plasma concentrations of homocysteine (Hcy, reduced bone mineral density and increased risk of bone fractures. Nevertheless, inconsistencies persist in the literature. Thus, the objective of this study was to investigate the possible relationship between serum Hcy and vitamin B12 status, and bone mineral density, on a group of post-menopausal women. Materials and methods: One hundred thirty-nine postmenopausal women were recruited to enter this cross-sectional study. Bone mineral density (BMD of total hip, femoral neck and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA and serum Hcy, vitamin B12, parathyroid hormone (PTH, total calcium and magnesium levels were determined. In addition, we investigated the relationship of Hcy and vitamin B12 and BMD using a meta-analysis approach. Results: Serum Hcy levels were significantly higher in osteoporotic women when compared to other BMD groups, and were inversely related to lumbar spine BMD and femur neck BMD. Body mass index and serum Hcy levels were shown to be significant predictors of BMD at lumbar spine, femur neck and total hip. The performed meta-analysis showed that serum Hcy levels were significantly higher in osteoporotic subjects compared to normal BMD subjects. Conclusion: This study shows that Hcy status, but not vitamin B12 status, is associated with BMD in this cohort of postmenopausal women. We therefore confirm that high Hcy levels are an independent risk factor for osteoporosis. BMD evaluation in women at post menopause with high Hcy levels may be helpful in advising precautionary measures.

  16. Early clinical results with cortically based pedicle screw trajectory for fusion of the degenerative lumbar spine.

    Science.gov (United States)

    Glennie, R Andrew; Dea, Nicolas; Kwon, Brian K; Street, John T

    2015-06-01

    This study reviews the outcomes and revision rates of degenerative lumbar fusion surgery using cortical trajectory pedicle screws in lieu of traditional pedicle screw instrumentation. Pedicle screw fixation can be a challenge in patients with low bone mineral density. Wide posterior approaches to the lumbar spine exposing lateral to the facet joints and onto transverse processes causes an additional degree of muscular damage and blood loss not present with a simple laminectomy. A cortical bone trajectory pedicle screw has been proposed as an alternative to prevent screw pullout and decrease the morbidity associated with the wide posterior approach to the spine. We present a series of eight consecutive patients using a cortical bone trajectory instead of traditional pedicle screw fixation for degenerative conditions of the lumbar spine. A retrospective review of our institutional registry data identified eight patients who had cortical screws placed with the assistance of O-arm Stealth navigation (Medtronic Sofamor Danek, Memphis, TN, USA) from 2010-2013. We analyzed the need for revision, the maintenance of reduction and the incidence of screw pullout or breakage. Our review demonstrated that two of eight patients were revised at an average of 12months. The reasons for these revisions were pseudarthrosis and caudal adjacent segment failure. All patients who were revised had frank screw loosening. We present early clinical results of a new technique that has been shown to have a better fixation profile in laboratory testing. Our less than favorable early clinical results should be interpreted with caution and highlight important technical issues which should be considered. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Fibrohistiocitoma benigno ósseo na coluna lombar Benign fibrous histiocytoma of the lumbar spine

    Directory of Open Access Journals (Sweden)

    Osmar Avanzi

    2005-01-01

    Full Text Available CONTEXTO: O fibrohistiocitoma benigno intra-ósseo é uma neoplasia rara, caracterizada por proliferação fibroblástica e fibras colágenas. A dor na região lombar é uma queixa freqüente em muitos pacientes, mas, na maioria das vezes está relacionada com causa muscular ou degenerativa. RELATO DE CASO: Relata-se aqui o caso de um paciente com diagnóstico de fibrohistiocitoma benigno ósseo na coluna lombar que apresentava queixa de lombalgia há cinco meses antes do diagnóstico. Foi submetida à biópsia aberta transpedicular na quarta vértebra lombar ,e, posteriormente realizada curetagem da lesão via anterior retroperitonial e artrodese vertebral de L3-L5 com enxerto de fíbula. CONCLUSÃO: Apesar de raro, o fibrohistiocitoma benigno intra-ósseo deve ser uma das hipóteses quando observamos uma lesão primária na coluna vertebral.CONTEXT: Benign intraosseous fibrous histiocytoma is a rare neoplasia, characterized by fibroblastic and collagenous fiber proliferation. Pain in the lumbar region is a frequent complaint in many patients, but most of times it is associated to muscular or degenerative causes. CASE REPORT: Here we report a case of a patient diagnosed with benign bone fibrous histiocytoma in the lumbar spine who complained of lumbar pain dating five months prior to diagnosis. The patient was submitted to open transpedicular biopsy in the forth lumbar vertebra, and subsequently, lesion curettage was performed via anterior retroperitoneal and L3-L5 vertebral arthrodesis using a fibular graft. CONCLUSION: Although rare, benign intraosseous fibrohistiocytoma should be taken into consideration when a primary lesion is observed in the spine.

  18. Shock attenuation in the human lumbar spine during walking and running.

    Science.gov (United States)

    Castillo, Eric R; Lieberman, Daniel E

    2018-04-05

    During locomotion, each step generates a shock wave that travels through the body toward the head. Without mechanisms for attenuation, repeated shocks can lead to pathology. Shock attenuation (SA) in the lower limb has been well studied, but little is known about how posture affects SA in the spine. To test the hypothesis that lumbar lordosis (LL) contributes to SA, 27 adults (14 male, 13 female) walked and ran on a treadmill. Two lightweight, tri-axial accelerometers were affixed to the skin overlying T12/L1 and L5/S1. Sagittal plane accelerations were analyzed using power spectral density analysis, and lumbar SA was assessed within the impact-related frequency range. 3-D kinematics quantified dynamic and resting LL. To examine the effects of intervertebral discs on spinal SA, supine MRI scans were used to measure disc morphology. Results showed no associations between LL and SA during walking, but LL correlated with SA during running (p<0.01, R 2 =0.30) resulting in as much as 64% reduction in shock signal power among individuals with the highest LL. Patterns of lumbar spinal motion partially explain differences in SA: larger amplitudes of LL angular displacement and slower angular displacement velocity during running were associated with greater lumbar SA (p=0.008, R 2 =0.41). Intervertebral discs were associated with greater SA during running (p=0.02, R 2 =0.22), but after controlling for disc thickness, LL remained strongly associated with SA (p=0.001, R 2 =0.44). These findings support the hypothesis that LL plays an important role in attenuating impact shocks transmitted through the human spine during high-impact, dynamic activities such as running. © 2018. Published by The Company of Biologists Ltd.

  19. MORPHOMETRIC STUDY OF THE AREOLAR SPACE BETWEEN THE GREAT VESSELS AND THE LUMBAR SPINE

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    Luis Marchi

    2015-12-01

    Full Text Available Objective : This work aims to study the areolar space anterior to the lumbar spine, and also the positioning of the large vessels focusing a lateral approach. Methods :This is a morphometric study of 108 cases based on T2 weighted-MRI images in the supine position. The following measurements were performed: lumbar and segmental lordosis; anteroposterior disc diameter; space between the disc/vertebral body and the vessels; bifurcation between the abdominal aorta and the common iliac veins confluence in relation to the lumbar level. Results :The areolar space with respect to the iliac veins, and with the vena cava increased cranially (p<0.001, starting from average 0.6mm at L4-L5 and reaching 8.4mm at L2, while the abdominal aorta showed no increase or decrease pattern across the different levels (p=0.135 ranging from 1.8 to 4.6mm. The diameter of the discs increased distally (p<0.01 as well as the lordosis (p<0.001. The disc diameter was 11% larger when compared to the adjacent vertebral bodies (p<0.001 and that resulted in a smaller distance of the vessels in the disc level than in the level of the adjacent vertebral bodies (p<0.001. The aortic bifurcation was generally ahead of L4 (52% and less frequently at L3-L4 (28% and L4-L5 (18%. The confluence of the veins was usually at the L4-L5 level (38% and at L5 (37%, and less frequently at L4 (26%. Conclusions : There is an identifiable plane between the great vessels and the lumbar spine which is particularly narrow in its distal portion. It is theoretically feasible to reach this plan, handle the anterior complex disc/ALL and protect the great vessels by lateral approach, however, it is challenging.

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

    International Nuclear Information System (INIS)

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

    1987-01-01

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

  1. Multidetector bone densitometer for supine lateral vertebral scanning of the lumbar spine

    International Nuclear Information System (INIS)

    Pommet, R.

    1990-01-01

    ORIS-ODX 240 bone densitometer is used to provide the density values of large group of women obtaining both frontal and lateral projection of the lumbar spine on each of them. This device is the prototype of Sophos L-XRA developed by CEA/DAMRI for SOPHA MEDICAL. It uses as photon source an X-ray tube with K-edge filtration (Neodyme oxide). The multidetector uses 24 NaI (Tl) scintillators, 24 PM tubes and 24 dual channel analyzers

  2. Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Vazquez-Barquero, A.; Pinto, J.I. [Univ. Hospital ' ' Marques de Valdecilla' ' , Santander (Spain). Dept. of Neurosurgery; Abascal, F.; Garcia-Valtuille, R.; Cerezal, L. [Hospital Mompia, Cantabria, (Spain). Dept. of Radiology; Figols, F.J. [Univ. Hospital Marques de Valdecilla, Santander (Spain). Dept. of Pathology

    2000-10-01

    An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2-L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. (orig.)

  3. Case report 357: Chordoma of the fourth lumbar vertebra metastasizing to the thoracic spine and ribs

    International Nuclear Information System (INIS)

    Abdelwahab, I.F.; Zwass, A.; O'Leary, P.F.; Lenox Hill Hospital, New York, NY; Beth Israel Medical Center, New York, NY; Steiner, G.C.

    1986-01-01

    In summary a fascinating case is presented in a 54-year-old man who developed a chordoma of the fourth lumbar vertebra which was treated by radiotherapy, with good results. The man remained asymptomatic relatively for several years and then presented with recurrence of back pain and neurological deficits. Plain films, CT and myelography showed considerable destruction of the body of L4 with a sclerotic pattern suggesting the effects of previous radiotherapy. A large paraspinal tissue mass extending into the spinal canal was present. Most interestingly the patient developed metastatic disease in the thoracic spine and ribs but no metastases other than in the skeleton. (orig./SHA)

  4. Multislice helical computed tomography in the evaluation of lumbar spine diseases

    International Nuclear Information System (INIS)

    Rosemberg, Laercio Alberto; Rios, Adriana Martins; Almeida, Milena Oliveira; Garbaccio, Viviane Ladeira; Kim, Nelson Ji Tae; Daniel, Mauro Miguel; Funari, Marcelo Buarque de Gusmao

    2003-01-01

    Multislice computed tomography has advantages in comparison to conventional computer tomography such as reduction in study time, lower radiation dose, fewer metal artifacts and high quality multiplanar reformatting and three-dimensional reconstructions. We reviewed approximately 300 lumbar spine examinations and selected the most illustrative cases including congenital anomalies, degenerative lesions, spinal infections, neoplasms traumatic injuries, spondylolysis and postoperative changes. In the majority of the cases the high quality multiplanar reformatted and volume reconstructions of multislice computed tomography allowed better evaluation of the lesions, particularly in the cases of complex anatomy (author)

  5. Doing Good, Feeling Good, and Having More: Resources Mediate the Health Benefits of Altruism Differently for Males and Females with Lumbar Spine Disorders

    NARCIS (Netherlands)

    Schwartz, Carolyn E.; Quaranto, Brian R.; Bode, Rita; Finkelstein, Joel A.; Glazer, Paul A.; Sprangers, Mirjam A. G.

    2012-01-01

    We evaluated whether resources mediate and/or moderate the relationship between altruism and health outcomes in adults with lumbar spine disorders. Hierarchical regression modeling on 243 persons with lumbar spine disorders evaluated gender differences and whether physical, emotional, and economic

  6. Lumbar stenosis: clinical case

    Directory of Open Access Journals (Sweden)

    Pedro Sá

    2014-08-01

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

  7. Outcomes and Complications of the Midline Anterior Approach 3 Years after Lumbar Spine Surgery

    Directory of Open Access Journals (Sweden)

    Charla R. Fischer

    2014-01-01

    Full Text Available Objective. The purpose of this study was to evaluate a new questionnaire to assess outcomes related to the midline anterior lumbar approach and to identify risk factors for negative patient responses. Methods. A retrospective review of 58 patients who underwent anterior lumbar surgery at a single institution for either degenerative disc disease or spondylolisthesis in 2009 was performed. The outcome measures included our newly developed Anterior Lumbar Surgery Questionnaire (ALSQ, ODI, and EQ-5D. Results. There were 58 patients available for followup, 27 women and 31 men. The average age at surgery was 50.8 years, with an average followup of 2.92 years. The average change in ODI was 34.94 (22.7 and EQ-5D was 0.28 (0.29. The rate of complications with the anterior approach was 10.3% and there was one male patient (3.2% with retrograde ejaculation. Determination of the effectiveness of the new ALSQ revealed that it significantly correlated to the EQ-5D and ODI (P<0.05. Smoking was associated with a negative response on thirteen questions. BMP use was not associated with a negative response on any sexual function questions. Conclusions. Our new Anterior Lumbar Surgery Questionnaire determines patient perceived complications related to the midline anterior lumbar surgical approach.

  8. Comparison of polymethylmethacrylate versus expandable cage in anterior vertebral column reconstruction after posterior extracavitary corpectomy in lumbar and thoraco-lumbar metastatic spine tumors.

    Science.gov (United States)

    Eleraky, Mohammed; Papanastassiou, Ioannis; Tran, Nam D; Dakwar, Elias; Vrionis, Frank D

    2011-08-01

    Single-stage posterior corpectomy for the management of spinal tumors has been well described. Anterior column reconstruction has been accomplished using polymethylmethacrylate (PMMA) or expandable cages (EC). The aim of this retrospective study was to compare PMMA versus ECs in anterior vertebral column reconstruction after posterior corpectomy for tumors in the lumbar and thoracolumbar spine. Between 2006 and 2009 we identified 32 patients that underwent a single-stage posterior extracavitary tumor resection and anterior reconstruction, 16 with PMMA and 16 with EC. There were no baseline differences in regards to age (mean: 58.2 years) or performance status. Differences between groups in terms of survival, estimated blood loss (EBL), kyphosis reduction (decrease in Cobb's angle), pain, functional outcomes, and performance status were evaluated. Mean overall survival and EBL were 17 months and 1165 ml, respectively. No differences were noted between the study groups in regards to survival (p = 0.5) or EBL (p = 0.8). There was a trend for better Kyphosis reduction in favor of the EC group (10.04 vs. 5.45, p = 0.16). No difference in performance status or VAS improvements was observed (p > 0.05). Seven patients had complications that led to reoperation (5 infections). PMMA or ECs are viable options for reconstruction of the anterior vertebral column following tumor resection and corpectomy. Both approaches allow for correction of the kyphotic deformity, and stabilization of the anterior vertebral column with similar functional and performance status outcomes in the lumbar and thoracolumbar area.

  9. [The use of axamon in the complex rehabilitation of patients with movement disorders in the pathology of lumbar spine].

    Science.gov (United States)

    Boĭko, A N; Batysheva, T T; Zaĭtsev, K A; Kostenko, E V; Klumov, L V; Matvievskaia, O V; Ryl'skiĭ, A V

    2008-01-01

    The authors review the use of axamon in the complex rehabilitation of neurological patients with movement disorders in the pathology of lumbar spine. Axamon (ipidacrine) stimulates neuromuscular transmission and excitement conduction via nerves and smooth muscles due to the blockade of potassium channels of the excited membrane and cholinesterase inhibition. Authors studied the efficacy of complex therapy of dorsopathy of lumbar spine in 90 patients using axamon, movalis, pantogamum in different combination and manual methodics. Patient's status has been measured clinically and with several scales. The results obtained allow to conclude that the combination of axamon and pantogamum exerts the best theraupetic effect without any side symptoms.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-12-15

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

  11. THE EXPERIENCE OF DECOMPRESSION-AND-STABILIZING SURGERIES IN PATIENTS WITH MULTIPLE MALIGNANT TUMORS OF THORACIC AND LUMBAR SPINE

    Directory of Open Access Journals (Sweden)

    V. M. Shapovalov

    2010-01-01

    Full Text Available The authors have analyzed the surgical treatment of 34 patients with multiple malignant, mainly metastases tumors of thorax and lumbar spine, using spinal implants. The results of the estimation of life quality, neurological status and survival after the surgery have shown the effectiveness of decompress and stabilization technologies at any variants of malignant tumor spine injuries, especially involving specific therapy. 27 patients were observed during the period from 10 months to 5 years.

  12. Measurement of lumbar spine bone mineral content using dual photon absorptiometry. Usefulness in metabolic bone diseases

    International Nuclear Information System (INIS)

    Delmas, P.D.; Duboeuf, F.; Braillon, P.; Meunier, P.J.

    1988-01-01

    Measurement of bone density using an accurate, non-invasive method is a crucial step in the clinical investigation of metabolic bone diseases, especially osteoporosis. Among the recently available techniques, measurement of lumbar spine bone mineral content (BMC) using dual photon absorptiometry appears as the primary method because it is simple, inexpensive, and involves low levels of radiation exposure. In this study, we measured the BMC in 168 normal adults and 95 patients. Results confirmed the good reproducibility and sensitivity of this technique for quantifying bone loss in males and females with osteoporosis. Significant bone loss was found in most females with primary hyperparathyroidism. Dual photon absorptiometry can also be used for quantifying increases in bone mass in Paget disease of bone and diffuse osteosclerosis. Osteomalacia is responsible for a dramatic fall in BMC reflecting lack of mineralization of a significant portion of the bone matrix, a characteristic feature in this disease. Furthermore, in addition to being useful for diagnostic purposes and for evaluation of the vertebral fracture risk, lumbar spine absorptiometry can be used for monitoring the effectiveness of bone-specific treatments [fr

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-07-01

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

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

    International Nuclear Information System (INIS)

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

    2002-01-01

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

  15. Evaluation of image quality of lumbar spine images: A comparison between FFE and VGA

    International Nuclear Information System (INIS)

    Tingberg, A.; Baath, M.; Haakansson, M.; Medin, J.; Besjakov, J.; Sandborg, M.; Alm-Carlsson, G.; Mattsson, S.; Maansson, L. G.

    2005-01-01

    Purpose: The aim of the present study is to compare two different methods for evaluation of the quality of clinical X-ray images. Methods: Based on fifteen lumbar spine radiographs, two new sets of images were created. A hybrid image set was created by adding two distributions of artificial lesions to each original image. The image quality parameters spatial resolution and noise were manipulated and a total of 210 hybrid images were created. A set of 105 disease-free images was created by applying the same combinations of spatial resolution and noise to the original images. The hybrid images were evaluated with the free-response forced error experiment (FFE) and the normal images with visual grading analysis (VGA) by nine experienced radiologists. Results: In the VGA study, images with low noise were preferred over images with higher noise levels. The alteration of the MTF had a limited influence on the VGA score. For the FFE study, the visibility of the lesions was independent of the sharpness and the noise level. No correlation was found between the two image quality measures. Conclusions: FFE is a precise method for evaluation of image quality, but the results are only valid for the type of lesion used in the study, whereas VGA is a more general method for clinical image quality assessment. The results of the FFE study indicate that there might be a potential to lower the dose levels in lumbar spine radiography without losing important diagnostic information. (authors)

  16. Predictors of long-term opioid use among patients with painful lumbar spine conditions

    Science.gov (United States)

    Krebs, Erin E.; Lurie, Jon D.; Fanciullo, Gilbert; Tosteson, Tor D.; Blood, Emily A.; Carey, Timothy S.; Weinstein, James N.

    2009-01-01

    Our objective was to assess predictors of self-reported opioid use among patients with back pain due to lumbar disc herniation or spinal stenosis. Data was from the Spine Patient Outcomes Research Trial (SPORT), a multi-site observational study and randomized trial. We examined characteristics shown or hypothesized to be associated with opioid use. Using generalized estimating equations, we modeled associations of each potential predictor with opioid use at 12 and 24 months. At baseline, 42% of participants reported opioid use. Of these participants, 25% reported continued use at 12 months and 21% reported use at 24 months. In adjusted models, smoking (RR=1.9, p<0.001 at 12 months; RR=1.5, p=0.043 at 24 months) and non-surgical treatment (RR=1.7, p<0.001 at 12 months; RR=1.8, p=0.003 at 24 months) predicted long-term opioid continuation. Among participants not using opioids at baseline, incident use was reported by 8% at 12 and 7% at 24 months. We found no significant predictors of incident use at 12 or 24 months in the main models. In conclusion, nonsurgical treatment and smoking independently predicted long-term continued opioid use. To our knowledge, this is the first longitudinal study to assess predictors of long-term and incident opioid use among patients with lumbar spine conditions. PMID:19628436

  17. Bone mineral density: correlation between the lumbar spine, proximal femur and Radius in northern Thai women.

    Science.gov (United States)

    Namwongprom, Sirianong; Ekmahachai, Molrudee; Vilasdechanon, Nonglak; Klaipetch, Alisa; Wongboontan, Chanpen; Boonyaprapa, Sombut

    2011-06-01

    To determine the correlation of bone mineral density (BMD) in lumbar spine, proximal femur and 1/3 radius in northern Thai women. The data of this study was collected from the medical records and the BMD results of 885 perimenopausal and postmenopausal women who had the BMD measurement in Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chiang Mai University between January and December 2007. BMD was measured using dual-energy X-ray absorptiometry (Hologic, QDR-4500C). Mean age (+/- SD) was 58.7 +/- 9.9 year. The lowest T-score was found 51.6% at lumbar spine (LS), 29.2% at 1/3 radius, 13.8% at femoral neck (FN), 2.9% at total femur (TF) and 2.5% at trochanter region (TR). We found a significant correlation between age, BMI, duration of menopause, and BMD at the LS, TFE FN, TR and 1/3 radius (p radius were 0.708, 0.667, 0.721 and 0.633, respectively (p < 0 01). Women with perimenopausal status had higher height and BMD values at all five observed sites than postmenopausal women (p < 0.01). The present found a good correlation of the BMD from various skeletal sites. Interestingly, the correlation was found highest between the LS vs. TR and TF vs. TR region. Clearly, estrogen-deficient plays important role on the low BMD values in all skeletal sites.

  18. Role of early minimal-invasive spine fixation in acute thoracic and lumbar spine trauma

    Directory of Open Access Journals (Sweden)

    Schmidt Oliver

    2007-01-01

    Full Text Available Polytraumatized patients following a severe trauma suffer from substantial disturbances of the immune system. Secondary organ dysfunction syndromes due to early hyperinflammation and late immunparalysis contribute to adverse outcome. Consequently the principle of damage control surgery / orthopedics developed in the last two decades to limit secondary iatrogenic insult in these patients. New percutaneous internal fixators provide implants for a damage control approach of spinal trauma in polytraumatized patients. The goal of this study is to evaluate the feasibility of minimal-invasive instrumentation in the setting of minor and major trauma and to discuss the potential benefits and drawbacks of this procedure. Materials and Methods: The present study is a prospective analysis of 76 consecutive patients (mean age 53.3 years with thoracolumbar spine fractures following major or minor trauma from August 2003 to January 2007 who were subjected to minimal-invasive dorsal instrumentation using CD Horizon ® Sextant TM Rod Insertion System and Longitude TM Rod Insertion System (Medtronic ® Sofamor Danek. Perioperative and postoperative outcome measures including e.g. local and systemic complications were assessed and discussed. Results: Forty-nine patients (64.5% suffered from minor trauma (Injury Severity Score < 16. Polytraumatized patients (n=27; 35.5% had associated chest (n=20 and traumatic brain injuries (n=22. For mono- and bisegmental dorsal instrumentation the Sextant TM was used in 60 patients, whereas in 16 longer ranging instrumentations the (prototype Longitude TM system was implanted. Operation time was substantially lower than in conventional approach at minimum 22.5 min for Sextant and 36.2 min for Longitude TM , respectively. Geriatric patients with high perioperative risk according to ASA classification benefited from the less invasive approach and lack of approach-related complications including no substantial blood loss

  19. Dynamic characteristics of osteoporotic lumbar spine under vertical vibration after cement augmentation.

    Science.gov (United States)

    Su, Xinlin; Shen, Hao; Shi, Weidong; Yang, Huilin; Lv, Feng; Lin, Jun

    2017-01-01

    Being beneficial in restoring stability and stiffness of osteoporotic vertebraes, cement augmentation techniques including vertebroplasty (VP) and kyphoplasty (KP) have been demonstrated to be effective for the treatment of patients with osteoporotic vertebral compressive fractures (OVCFs). However, it is unclear the influence of cement augmentation on the dynamics of pathologic and adjacent vertebraes under vibration condition. In this study, we developed a three-dimensional (3D) finite-element (FE) model of the spinal T12-Pelvis segment by using CT scan data of lumbar spine of an adult woman with no physical abnormalities. By modulating model parameters we further simulated osteoporotic conditions of the T12-Pelvis FE model with or without polymethyl methacrylate (PMMA) augmentation. Dynamic characteristics of the osteoporotic T12-Pelvis model were detected at the first order of vertical resonant frequencies (FOVRFs) under vertical vibration, which included vertical axial displacements, anteroposterior (AP) displacements and rotational angles of each vertebrae and intervertebral disc (IVD). The results showed that axial and AP displacements of both vertebraes and IVDs decreased in some point after PMMA augmentation. Axial displacements of the L4-L5 motion segment decreased most significantly and the changing ratios ranged from 20% to 30%. AP displacements of L5, D 1-2 (the IVD between vertebraes L1 and L2) and D 3-4 reduced most obviously after 1, 2 or 3 levels PMMA augmentation. No significant difference of axial or AP displacements of each vertebrae and IVD was observed between one-level and multilevel PMMA augmentation. Thus, we demonstrated that PMMA augmentation could reduce vertical axial and AP deformations of the osteoporotic lumbar motion segments under vertical vibration, especially for the inferior adjacent motion segments. However, the influence of the number of vertebraes with PMMA augmentation on the dynamics of osteoporotic lumbar spine was

  20. Symptomatic intraspinal synovial cysts of the lumbar spine: correlation of MR and surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Tillich, M.; Lindbichler, F. [Graz Univ. (Austria). Dept. of Radiology; Trummer, M.; Flaschka, G. [Dept. of Neurosurgery, Karl-Franzens Medical School and University Hospital (Austria)

    2001-12-01

    The purpose of the study was to determine the frequency of associated MR imaging findings in patients with symptomatic lumbar intraspinal synovial cysts, and to correlate MR with surgical findings. MR imaging studies of 18 patients with surgically and histopathologically proven lumbar intraspinal synovial cysts were retrospectively analyzed and correlated with surgical findings. The diameters of the synovial cysts ranged from 10 mm to 28 mm, with a mean of 16 mm. A nonhemorrhagic cyst was found in 15 patients (83%), and a hemorrhagic cyst in three patients (17%). Degenerative spondylolisthesis was found in six patients (33%) at the level of the synovial cyst, with displacement ranging from 3 to 5 mm, mean 4 mm. Surgery revealed instability and hypermobility of the facet joint at the level of the synovial cyst in all patients with degenerative spondylolisthesis, and in five additional patients. Symptomatic synovial cysts of the lumbar spine were associated with degenerative spondylolisthesis in six of 18 patients (33%) and with instability of the facet joint in 11 (61%). These findings may support the theory that increased segmental motion plays a role in the pathogenesis of synovial cysts. (orig.)

  1. CRP and leukocyte-count after lumbar spine surgery: fusion vs. nucleotomy.

    Science.gov (United States)

    Kraft, Clayton N; Krüger, Tobias; Westhoff, Jörn; Lüring, Christian; Weber, Oliver; Wirtz, Dieter C; Pennekamp, Peter H

    2011-08-01

    Despite the fact that C-reactive protein (CRP) levels and white blood cell (WBC) count are routine blood chemistry parameters for the early assessment of wound infection after surgical procedures, little is known about the natural history of their serum values after major and minimally invasive spinal procedures. Pre- and postoperative CRP serum levels and WBC count in 347 patients were retrospectively assessed after complication-free, single-level open posterior lumbar interlaminar fusion (PLIF) (n = 150) for disc degeneration and spinal stenosis and endoscopically assisted lumbar discectomy (n = 197) for herniated lumbar disc. Confounding variables such as overweight, ASA classification, arterial hypertension, diabetes mellitus, and perioperative antibiotics were recorded to evaluate their influence on the kinetics of CRP values and WBC count postoperatively. In both procedures, CRP peaked 2-3 days after surgery. The maximum CRP level was significantly higher after fusion: mean 127 (SD 57) (p 25 and long duration of surgery were associated with higher peak CRP values. WBC count did not show a typical and therefore interpretable profile. CRP is a predictable and responsive serum parameter in postoperative monitoring of inflammatory responses in patients undergoing spine surgery, whereas WBC kinetics is unspecific. We suggest that CRP could be measured on the day before surgery, on day 2 or 3 after surgery, and also between days 4 and 6, to aid in early detection of infectious complications.

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

    International Nuclear Information System (INIS)

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

    2000-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-12-01

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

  4. Normal functional range of motion of the lumbar spine during 15 activities of daily living.

    Science.gov (United States)

    Bible, Jesse E; Biswas, Debdut; Miller, Christopher P; Whang, Peter G; Grauer, Jonathan N

    2010-04-01

    Prospective clinical study. The purpose of this investigation was to quantify normal lumbar range of motion (ROM) and compare these results with those used to perform 15 simulated activities of daily living (ADLs) in asymptomatic subjects. Previous studies reporting the ROM of the lumbar spine during ADLs have been limited, only focusing on 4 ADLs. The purpose of this investigation was to quantify the extent of normal lumbar ROM and determine how much motion is necessary to perform 15 simulated ADLs. A noninvasive electrogoniometer and torsiometer were used to measure the ROM of the lumbar spine. The accuracy and reliability of the devices were confirmed by comparing the ROM values acquired from dynamic flexion/extension and lateral bending radiographs with those provided by the device that was activated while the radiographs were obtained. Intraobserver reliability was established by calculating the intraclass correlation coefficient for repeated measurements on the same subjects by 1 investigator on consecutive days. These tools were employed in a clinical laboratory setting to evaluate the full active ROM of the lumbar spines (ie, flexion/extension, lateral bending, and axial rotation) of 60 asymptomatic subjects (30 women and 30 men; age 20 to 75 y) and to assess the functional ROM required to complete 15 simulated ADLs. When compared with radiographic measurements, the electrogoniometer was found to be accurate within 2.3+/-2.6 degrees (mean+/-SD). The intraobserver reliabilities for assessing full and functional ROM were both excellent (intraclass correlation coefficient of 0.96 and 0.88, respectively). The absolute ROM and percentage of full active lumbar spinal ROM used during the 15 ADLs was 3 to 49 degrees and 4% to 59% (median: 9 degrees/11%) for flexion/extension, 2 to 11 degrees and 6% to 31% (6 degrees/17%) for lateral bending, and 2 to 7 degrees and 6% to 20% (5 degrees/13%) for rotation. Picking up an object from the ground, either using a bending

  5. Comparison of modic changes in the lumbar and cervical spine, in 3167 patients with and without spinal pain.

    Directory of Open Access Journals (Sweden)

    Li Sheng-yun

    Full Text Available There are few comparisons of Modic changes (MCs in the lumbar and cervical spine.Compare the prevalence of MCs in the lumbar and cervical spine, and determine how MC prevalence depends on spinal pain, age, disc degeneration, spinal level, and the presence or absence of kyphosis.Retrospective clinical survey.Magnetic resonance images (MRIs were compared from five patient groups: 1. 1223 patients with low-back pain/radiculopathy only; 2. 1023 patients with neck pain/radiculopathy only; 3. 497 patients with concurrent low-back and neck symptoms; 4. 304 asymptomatic subjects with lumbar MRIs; and 5. 120 asymptomatic subjects with cervical MRIs.The prevalence of MCs was higher in those with spinal pain than in those without, both in the lumbar spine (21.0% vs 10.5% and cervical spine (8.8% vs 3.3%. Type II MCs were most common and Type III were least common in all groups. The prevalence of lumbar MCs in people with back pain was little affected by the presence of concurrent neck pain, and the same was true for the prevalence of cervical MCs in people with neck pain with or without concurrent back pain. When symptomatic patients were reclassified into two groups (back pain, neck pain, the prevalence of lumbar MCs in people with back pain was greater than that of cervical MCs in people with neck pain. The prevalence of lumbar and cervical MCs increased with age, disc degeneration, (descending spinal level, and increased kyphosis.There is a significantly higher prevalence of MCs in patients with back and neck pain. The reported association with increased kyphosis (flat back is novel.

  6. Association between insurance status and patient safety in the lumbar spine fusion population.

    Science.gov (United States)

    Tanenbaum, Joseph E; Alentado, Vincent J; Miller, Jacob A; Lubelski, Daniel; Benzel, Edward C; Mroz, Thomas E

    2017-03-01

    Lumbar fusion is a common and costly procedure in the United States. Reimbursement for surgical procedures is increasingly tied to care quality and patient safety as part of value-based reimbursement programs. The incidence of adverse quality events among lumbar fusion patients is unknown using the definition of care quality (patient safety indicators [PSI]) used by the Centers for Medicare and Medicaid Services (CMS). The association between insurance status and the incidence of PSI is similarly unknown in lumbar fusion patients. This study sought to determine the incidence of PSI in patients undergoing inpatient lumbar fusion and to quantify the association between primary payer status and PSI in this population. A retrospective cohort study was carried out. The sample comprised all adult patients aged 18 years and older who were included in the Nationwide Inpatient Sample (NIS) that underwent lumbar fusion from 1998 to 2011. The incidence of one or more PSI, a validated and widely used metric of inpatient health-care quality and patient safety, was the primary outcome variable. The NIS data were examined for all cases of inpatient lumbar fusion from 1998 to 2011. The incidence of adverse patient safety events (PSI) was determined using publicly available lists of the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Logistic regression models were used to determine the association between primary payer status (Medicaid and self-pay relative to private insurance) and the incidence of PSI. A total of 539,172 adult lumbar fusion procedures were recorded in the NIS from 1998 to 2011. Patients were excluded from the secondary analysis if "other" or "missing" was listed for primary insurance status. The national incidence of PSI was calculated to be 2,445 per 100,000 patient years of observation, or approximately 2.5%. In a secondary analysis, after adjusting for patient demographics and hospital characteristics, Medicaid

  7. Effect of x-ray tube potential on image quality and patient dose for lumbar spine computed radiography examinations.

    Science.gov (United States)

    Brindhaban, A; Al Khalifah, K; Al Wathiqi, G; Al Ostath, H

    2005-12-01

    A study was conducted to investigate the effect of increasing x-ray tube voltage on patient dose and image quality during computed radiography (CR) examination of the lumbar spine. Images of a pelvis - lumbar spine phantom were obtained at three different tube voltages using two CR systems. The images were evaluated by image scores (IS) using the image quality criteria proposed by the Commission of the European Communities (CEC), by measuring the signal-to-noise ratio and the contrast-to-noise ratio. The entrance surface dose (ESD) to the phantom was also measured using ionisation chambers and the resulting gonad dose (G) and effective dose (E) were calculated. The CEC recommended tube voltages can be exceeded with CR systems for lumbar spine radiography. The ESD, G and E decreased by 25%-50% with both CR systems when tube voltage was increased. Although the decrease in IS was statistically significant (P tube voltages were diagnostically acceptable. The balance between image quality and patient dose can be optimised by using higher x-ray tube voltages for lumbar spine CR examinations.

  8. Osteoporosis and low bone mass at the femur neck or lumbar spine in older adults: United States, 2005-2008

    Science.gov (United States)

    Many current clinical guidelines recommend that assessment of osteoporosis or low bone mass, as defined by the World Health Organization (WHO) (1), be based on bone mineral density at either the femur neck region of the proximal femur (hip) or the lumbar spine (2,3). This data brief presents the mos...

  9. Two cases of congenital defects within transverse processes of lumbar spine; Dwa przypadki wad wrodzonych wyrostkow poprzecznych ledzwiowego odcinka kregoslupa

    Energy Technology Data Exchange (ETDEWEB)

    Malawski, S.; Sokolski, B. [Klinika Ortopedii, Centrum Medyczne Ksztalcenia Podyplomowego, Otwock (Poland)

    1993-12-31

    Two cases of congenital defects of transverse processes of lumbar spine causing lumbalgia are described. The first one was produced by direct contact of the elongated processes with subsequent pseudoarthrosis. Hypertrophied processes caused stenosis around intervertebral foramen and irritated posterior neural branch in the second case. Surgical resection of the hypertrophied transverse processes has brought the cure. (author). 4 refs, 6 figs.

  10. Do Obese and Extremely Obese Patients Lose Weight After Lumbar Spine Fusions? Analysis of a Cohort of 7303 Patients from the Kaiser National Spine Registry.

    Science.gov (United States)

    Akins, Paul T; Inacio, Maria Cs; Bernbeck, Johannas A; Harris, Jessica; Chen, Yuexin X; Prentice, Heather A; Guppy, Kern H

    2018-01-01

    MINI: The outcome of interest was ≥ 5% weight change 1 year postoperative from baseline. Seven thousand three hundred three lumbar fusions in the Kaiser Permanente Spine Registry between 2009 and 2013 were analyzed. Weight loss occurred in: body mass index Spine Registry. The aim of this study was to determine whether obese and extremely obese patients with lumbar spine fusions lost a clinically significant amount of weight (≥5%) 1 year after their surgery. Obesity in the United States has a prevalence of 35% and is a global health issue. Obesity is associated with lumbar spine disease. There is limited evidence regarding postsurgical weight loss after spine surgery. Adult patients in the Kaiser Permanente Spine Registry with lumbar fusions performed between 2009 and 2013 were included in the study sample (n = 7303). The outcome of interest was ≥5% weight change 1 year postoperative from baseline. Three body mass index (BMI) groups were analyzed (BMI spine surgery, 4456 (61%) had a BMI < 30, 2519 (34.5%) had a BMI between 30 and 39, 232 (3.2%) had a BMI ≥40, and 96 (1.3%) were missing their intraoperative BMI. We observed the following weight loss pattern: BMI < 30, 11.1%; BMI 30 to 39, 16.6%; BMI ≥40, 21.1%. We observed the following weight gain pattern: BMI < 30, 15.6%; BMI 30 to 39, 12.7%; BMI ≥40, 9.5%. After risk-adjustment, obese and extremely obese patients were more likely to lose a clinically significant amount of weight 1 year after surgery (BMI 30-39: OR = 1.42, 95% CI 1.22-1.65; BMI ≥40: OR = 1.73, 95% CI 1.21-2.47) compared with nonobese patients. In this large cohort of patients with lumbar spinal fusions, we observed more significant weight loss in obese and extremely obese patients than nonobese patients. Additional research is needed to determine whether this weight loss is due to improvements in back pain and increased physical activity. 3.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-11-01

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

  12. Prospective comparison of changes in lumbar spine MRI findings over time between individuals with acute low back pain and controls

    DEFF Research Database (Denmark)

    Panagopoulos, J.; Magnussen, J. S.; Hush, J.

    2017-01-01

    BACKGROUND AND PURPOSE: The clinical importance of lumbar MR imaging findings is unclear. This study was an exploratory investigation of whether lumbar spine MR imaging findings change more commonly during a 12-week period in individuals with acute low back pain compared with pain-free controls...... difference. For all other MR imaging findings, the proportions of subjects and controls in whom MR imaging findings were reported to change during 12 weeks were similar. CONCLUSIONS: Changes in MR imaging findings were observed in a similar proportion of the low back pain and control groups, except....... MATERIALS AND METHODS: Twenty individuals with recent-onset low back pain and 10 pain-free controls were recruited into an exploratory prospective cohort study. All participants had a lumbar spine MR imaging at baseline and repeat MR imaging scans at 1, 2, 6, and 12 weeks. The proportion of individuals who...

  13. Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level.

    Science.gov (United States)

    Karakaşlı, Ahmet; Ceçen, Berivan; Erduran, Mehmet; Taylan, Orçun; Hapa, Onur; Havıtcıoğlu, Hasan

    2014-01-01

    This study aims to examine the motion and stability of the adjacent segment following rigid fixation of the lumbar spine. The study included 17 fresh-frozen lamb lumbar spines (including the sacrum to T12). Biomechanical testing was performed using an axial compression testing machine. Axial compression was applied to all the specimens using a loading speed of 5 mm min-1. A specifically designed fixture was used to generate torque ≤8400 Nmm. The fixture was used with each specimen to achieve flexion and extension, axial neutral compression, and right and left bending. All specimens were tested intact, and again after implantation using posterior pedicle screws and rod fixation. During testing intervertebral displacement at the adjacent level (L5-S1) was recorded continuously via extensometry. Axial compression and superior-inferior displacement were lower in the adjacent segment (L5-S1) than anterior-posterior displacement following rigid fixation. Statistical analysis showed that there was a numerical difference and a significant change between the intact spine and the adjacent segment in the axial compression and extension positions (p<0.027). The intact spines demonstrated the maximum displacement and the difference in extension positions were significant (p<0.015). Rigid fixation of the lumbar spine altered the range of motion at the adjacent segment level. As such, abnormal stress on the adjacent segment causes spinal instability, which may subsequently cause facet joint degeneration and low back pain.

  14. The Influence of No Fault Compensation on Functional Outcomes After Lumbar Spine Fusion.

    Science.gov (United States)

    Montgomery, Alexander Sheriff; Cunningham, John Edward; Robertson, Peter Alexander

    2015-07-15

    Prospective cohort study and systematic literature review. To compare the functional outcomes for lumbar spinal fusion in both compensation and noncompensation patients in an environment of universal no fault compensation and then to compare these outcomes with those in worker's compensation and nonworkers compensation cohorts from other countries. Compensation has an adverse effect on outcomes in spine fusion possibly based on adversarial environment, delayed resolution of claims and care, and increased compensation associated with prolonged disability. It is unclear whether a universal no fault compensation system would provide different outcomes for these patients. New Zealand's Accident Compensation Corporation (ACC) provides universal no fault compensation for personal injury secondary to accident and offers an opportunity to compare results with differing provision of compensation. A total of 169 patients undergoing lumbar spinal fusion were assessed preoperatively, at 1 year, and at long-term follow-up out to 14 years, using functional outcome measures and health-related quality-of-life measures. Comparison was made between those covered and not covered by ACC for 3 distinct diagnostic categories. A systematic literature review comparing outcomes in Worker's Compensation and non-Compensation cohorts was also performed. The functional outcomes for both ACC and non-ACC cohorts were similar, with significant and comparable improvements over the first year that were then sustained out to long-term follow-up for both cohorts. At long-term follow-up, the health-related quality-of-life measures were the same between the 2 cohorts.The literature review revealed a marked difference in outcomes between worker's compensation and non-worker's compensation cohorts with a near universal inferior outcome for the compensation group. The similarities in outcomes of patients undergoing lumbar spine fusion under New Zealand's universal no fault compensation system, when

  15. Evaluation of the post-operative lumbar spine with MR imaging. The role of contrast enhancement and thickening in nerve roots

    Energy Technology Data Exchange (ETDEWEB)

    Grane, P.; Lindqvist, M. [Karolinska Hospital, Stockholm (Sweden). Dept. of Neuroradiology

    1997-11-01

    Purpose: Two new signs of lumbar nerve-root affection have been reported in recent years on the basis of MR examinations, namely: thickening in nerve roots; and contrast enhancement in nerve roots. The aim of this study was to assess contrast enhancement in nerve roots in a standardised way, and to evaluate the clinical significance of contrast enhancement and of nerve-root thickening in the symptomatic post-operative lumbar spine. Material and Methods: A total of 121 patients (who had previously been operated on for lumbar disc herniation) underwent 152 MR examinations, mainly on a 1.5 T system. Focal nerve-root enhancement was identified by visual assessment. Intradural enhancement was also quantified by pixel measurements that compared the affected nerve roots before and after contrast administration. Non-affected nerve roots were used as reference. Results: Enhanced nerve roots in the dural sac increased at least 40-50% in signal intensity after contrast administration compared to pre-contrast images and also compared to non-affected nerve roots. Intradural nerve-root enhancement was seen in 10% of the patients and focal enhancement in the root sleeve was seen in a further 26%. Nerve-root thickening was seen in 30%. Good correlation with clinical symptoms was found in 59% of the patients with intradural enhancement, in 84% with focal enhancement, and in 86% with nerve-root thickening. The combination of thickening and enhancement in the nerve root correlated with symptoms in 86% of the patients. Conclusion: Nerve-root enhancement (whether focal or intradural) and thickening in the nerve root are significant MR findings in the post-operative lumbar spine. In conbination with disc herniation or nerve-root displacement, these two signs may strengthen the indication for repeat surgery. However, root enhancement within 6 months of previous surgery may be a normal post-operative finding. (orig.).

  16. Comparative morphometry of L4 vertebrae: comparison of large animal models for the human lumbar spine.

    Science.gov (United States)

    McLain, Robert F; Yerby, Scott A; Moseley, Timothy A

    2002-04-15

    Anatomic analysis of L4 vertebral morphometry comparing specimens harvested from humans and five common large animal species. To compare fundamental structural similarities and differences in the vertebral bodies of commonly used experimental animals relative to human vertebrae. Animal models are commonly used for assessment of spine fusion, instrumentation techniques, and vertebral bone biology. Among the animals used, the lumbar vertebrae exhibit considerable anatomic variability. The goal of this study was to determine which of the animals commonly used for spine research is best suited as an anatomic model for the human lumbar spine. Morphometric features of the L4 vertebrae of five common research animals were compared with those of the human L4 vertebrae. Mature canines, immature pigs, mature micropigs, mature dairy goats, and mature sheep were analyzed. These species were chosen because they are commonly selected research animals, and most research facilities do not need to be modified to use them. The samples included ten L4 vertebrae of each animal species and seven human L4 vertebrae. Each specimen was meticulously cleaned of all soft tissue. The measurements were grouped into vertebral body parameters, neural canal dimensions, and pedicle and facet morphometery. The mean of each anatomic measurement was compared using a single factor analysis of variance and a Scheffe's post hoc test, with 0.05 denoting significance. The human vertebral body was significantly wider and deeper in the anteroposterior plane than any of the animals studied. However, the mean vertebral body height of the sheep and goat significantly exceeded that of the human specimens. The mean pedicle angle of every animal species was significantly greater than that of the human. The mean pedicle width of the micropig and goat were significantly narrower than the human pedicles, and the dog specimens lacked a definable pedicle altogether. There was no significant difference in mean pedicle

  17. Variation in outcomes across centers after surgery for lumbar stenosis and degenerative spondylolisthesis in the spine patient outcomes research trial.

    Science.gov (United States)

    Desai, Atman; Bekelis, Kimon; Ball, Perry A; Lurie, Jon; Mirza, Sohail K; Tosteson, Tor D; Zhao, Wenyan; Weinstein, James N

    2013-04-15

    Retrospective review of a prospectively collected database. To examine whether short- and long-term outcomes after surgery for lumbar stenosis (SPS) and degenerative spondylolisthesis (DS) vary across centers. Surgery has been shown to be of benefit for both SPS and DS. For both conditions, surgery often consists of laminectomy with or without fusion. Potential differences in outcomes of these overlapping procedures across various surgical centers have not yet been investigated. Spine Patient Outcomes Research Trial cohort participants with a confirmed diagnosis of SPS or DS undergoing surgery were followed from baseline at 6 weeks, 3, 6, and 12 months, and yearly thereafter, at 13 spine clinics in 11 US states. Baseline characteristics and short- and long-term outcomes were analyzed. A total of 793 patients underwent surgery. Significant differences were found between centers with regard to patient race, body mass index, treatment preference, neurological deficit, stenosis location, severity, and number of stenotic levels. Significant differences were also found in operative duration and blood loss, the incidence of durotomy, the length of hospital stay, and wound infection. When baseline differences were adjusted for, significant differences were still seen between centers in changes in patient functional outcome (Short Form-36 bodily pain and physical function, and Oswestry Disability Index) at 1 year after surgery. In addition, the cumulative adjusted change in the Oswestry Disability Index Score at 4 years significantly differed among centers, with Short Form-36 scores trending toward significance. There is a broad and statistically significant variation in short- and long-term outcomes after surgery for SPS and DS across various academic centers, when statistically significant baseline differences are adjusted for. The findings suggest that the choice of center affects outcome after these procedures, although further studies are required to investigate which

  18. [Unilateral spondylolysis with spina bifida occulta of lumbar spine--case report and review of the literature].

    Science.gov (United States)

    Kim, Kyongsong; Isu, Toyohiko; Matsumoto, Ryouji; Miyamoto, Michiyuki; Isobe, Masanori

    2005-11-01

    Unilateral spondylolysis and midline defects in the posterior spinal elements attributable to spina bifida occulta (SBO) result in the unilateral floating of the vertebral arch. We report a patient with unilateral spondylolysis associated with SBO in the lumbar spine and review the literature. This 71-year-old male experienced severe left leg pain and lumbago that worsened upon walking. Radiographic studies revealed SBO and unilateral spondylolysis of L5. The dural sac and left L5 nerve root were compressed by the organization of tissues around the spondylolysis. As his symptoms failed to respond to conservative treatment, he underwent unilateral laminectomy without fusion. At operation, the left lamina of L5 was floating and unstable; the right lamina was stable. Medial facetectomy at L4/5 and excision of the left floating lamina of L5 were performed. For satisfactory decompression of the dural sac and left L5 nerve root, the cartilaginous fibrous tissue around the lysis was removed. His symptoms disappeared immediately after surgery. Although long-term follow-up is necessary, we suggest that unilateral microdecompression without fusion is a useful method to treat patients with unilateral spondylolysis with SBO.

  19. Comparison of Two Methods for Evaluation of the Image Quality of Lumbar Spine Radiographs

    International Nuclear Information System (INIS)

    Tingberg, A.; Herrmann, C.; Lanhede, B.; Almn, A.; Besjakov, J.; Mattsson, S.; Sund, P.; Kheddache, S.; Maasson, L.G.

    2000-01-01

    Two methods for visual evaluation of image quality of clinical radiographs have been compared. In visual grading analysis (VGA) specified anatomical structures in an image are visually compared with the same structures in a reference image, and in a free-response forced error (FFE) experiment - an extension of conventional ROC (receiver operating characteristics) analysis - the objective is to localise known lesions correctly. The spatial resolution and noise of digitised clinical radiographs of the lumbar spine were altered by image processing, and pathological structures were added to the images for the FFE experiment. The images were printed to film and evaluated by seven European expert radiologists using VGA and FFE. The results of these two different methods showed a very good agreement. VGA methodology can be made as solid as the FFE experiment for evaluating image quality. The simplicity of VGA makes it very suitable for implementation in clinical practice. (author)

  20. 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

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

    Science.gov (United States)

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

    2013-12-01

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

  2. Serial MRI findings of osteoporotic vertebral fractures in the thoracic and lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Yoshitaka; Henmi, Tatsuhiko; Sakamoto, Rintaro; Hiasa, Masahiko [Health Insurance Naruto Hospital, Tokushima (Japan)

    1998-12-01

    The prognosis of osteoporotic vertebral fractures in the thoracic and lumbar spine was studied by serial MRI findings. This study covered 80 vertebrae in 69 patients treated conservatively and followed-up for more than six months (23 males and 46 females, average age 70 yrs). Group A, characterized by poor diagnostic imaging, consisted of patients who had both severely collapsed vertebra which was progressive in the lateral roentgenogram and delayed improvement in MRI signal intensities. Group B, consisting of poor clinical prognosis, comprised patients with persistent back pain. The predictive factors for Group A were found to be T{sub 1}-low finding over the entire vertebra within one month after injury and fractures of Th{sub 12} or L{sub 1} vertebra. Areas of T{sub 1}-low and T{sub 2}-low intensity adjacent to the vertebral disc presented no improvement in signal intensity and often caused persistent back pain. (author)

  3. Radiological Results and Clinical Patient Outcome After Implantation of a Hydraulic Expandable Vertebral Body Replacement following Traumatic Vertebral Fractures in the Thoracic and Lumbar Spine: A 3-Year Follow-Up.

    Science.gov (United States)

    Kreinest, Michael; Schmahl, Dorothee; Grützner, Paul A; Matschke, Stefan

    2017-04-15

    A prospective monocentric study. The aim of the current study was the analysis of patient outcome and radiological results 3 years after implantation of a hydraulic expandable vertebral body replacement (VBR) system. Around 70% to 90% of all traumatic spinal fractures are located in the thoracic and lumbar spine. Dorso-ventral stabilization is a frequently used procedure in traumatic vertebral body fracture treatment. VBR systems can be used to bridge bony defects. In the current study, a new VBR expanded by water pressure with adjustable endplates is used. All patients who suffered a singular traumatic fracture to a thoracic or lumbar vertebral body (Th 5-L 5) in the period from November 2009 to December 2010 and (i) underwent dorsal instrumentation and (ii) afterwards received the implantation of a hydraulic VBR were included in this study. The clinical outcome (visual analogue scale [VAS] spine score, questionnaire) and radiological findings (sagittal angle, implant subsidence, and implant position) 3 years after implantation were analyzed. The follow-up was successful for n = 47 patients (follow-up rate: 89%). Most of the patients (n = 40) were "generally/very satisfied" with their outcome. The mean rating of the VAS spine score was 65.2 ± 23.1 (range: 20.5-100.0). The analysis of the radiological data showed an average subsidence of the implants of 1.1 ± 1.2 mm (range 0.0-5.0 mm). After the initial operation, the local sagittal angle remained stable in the follow-up 3 years later both for the thoracic spine and lumbar spine. Furthermore, no change in the implant's position was observed. The implantation of a hydraulically expandable VBR allows a permanent stable fixation after traumatic fractures of the thoracic and lumbar spine. 2.

  4. The Relationship of Fat Distribution and Insulin Resistance with Lumbar Spine Bone Mass in Women.

    Directory of Open Access Journals (Sweden)

    Francisco J A de Paula

    Full Text Available Bone marrow harbors a significant amount of body adipose tissue (BMAT. While BMAT might be a source of energy for bone modeling and remodeling, its increment can also represent impairment of osteoblast differentiation. The relationship between BMAT, bone mass and insulin sensitivity is only partially understood and seems to depend on the circumstances. The present study was designed to assess the association of BMAT with bone mineral density in the lumbar spine as well as with visceral adipose tissue, intrahepatic lipids, HOMA-IR, and serum levels of insulin and glucose. This cross-sectional clinical investigation included 31 non-diabetic women, but 11 had a pre-diabetes status. Dual X-ray energy absorptiometry was used to measure bone mineral density and magnetic resonance imaging was used to assess fat deposition in BMAT, visceral adipose tissue and liver. Our results suggest that in non-diabetic, there is an inverse relationship between bone mineral density in lumbar spine and BMAT and a trend persists after adjustment for weight, age, BMI and height. While there is a positive association between visceral adipose tissue and intrahepatic lipids with serum insulin levels, there is no association between BMAT and serum levels of insulin. Conversely, a positive relationship was observed between BMAT and serum glucose levels, whereas this association was not observed with other fat deposits. These relationships did not apply after adjustment for body weight, BMI, height and age. The present study shows that in a group of predominantly non-obese women the association between insulin resistance and BMAT is not an early event, as occurs with visceral adipose tissue and intrahepatic lipids. On the other hand, BMAT has a negative relationship with bone mineral density. Taken together, the results support the view that bone has a complex and non-linear relationship with energy metabolism.

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

    Energy Technology Data Exchange (ETDEWEB)

    Rajeswaran, G.; Healy, J.C. [Chelsea and Westminster Hospital NHS Foundation Trust, Department of Radiology, London, England (United Kingdom); Turner, M. [The National Tennis Centre, Lawn Tennis Association, London (United Kingdom); Gissane, C. [St Mary' s University, Twickenham, Middlesex (United Kingdom)

    2014-07-15

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

  6. Computer-aided combined movement examination of the lumbar spine and manual therapy implications: Case report.

    Science.gov (United States)

    Monie, A P; Barrett, C J; Price, R I; Lind, C R P; Singer, K P

    2016-02-01

    Combined movement examination (CME) of the lumbar spine has been recommended for clinical examination as it confers information about mechanical pain patterns. However, little quantitative study has been undertaken to validate its use in manual therapy practice. This study used computer aided CME to develop a normal reference range, and to guide provisional diagnosis and management. Two cases were assessed, before and after manual therapy using CME, a pain Visual Analogue Scale, the Roland Morris Low Back Pain and Disability Questionnaire and the Short Form (SF-12) Health Survey. Diagnosis and management were guided by comparing each CME pattern with the age and gender matched reference range. Self-reports data and CME total change scores were markedly improved for both cases, particularly for the most painful and restricted CME directions. This report describes how computer-aided CME and a normal reference range may be used objectively to inform a diagnosis and as an outcome measure in cases of mechanical LBP. Future investigations of cases with specific lumbar pathologies are required to validate this concept. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Costs and quality of life for prehabilitation and early rehabilitation after surgery of the lumbar spine

    Directory of Open Access Journals (Sweden)

    Andreasen Jakob

    2008-10-01

    Full Text Available Abstract During the recent years improved operation techniques and administrative procedures have been developed for early rehabilitation. At the same time preoperative lifestyle intervention (prehabilitation has revealed a large potential for additional risk reduction. The aim was to assess the quality of life and to estimate the cost-effectiveness of standard care versus an integrated programme including prehabilitation and early rehabilitation. Methods The analyses were based on the results from 60 patients undergoing lumbar fusion for degenerative lumbar disease; 28 patients were randomised to the integrated programme and 32 to the standard care programme. Data on cost and health related quality of life was collected preoperatively, during hospitalisation and postoperatively. The cost was estimated from multiplication of the resource consumption and price per unit. Results Overall there was no difference in health related quality of life scores. The patients from the integrated programme obtained their postoperative milestones sooner, returned to work and soaked less primary care after discharge. The integrated programme was 1,625€ (direct costs 494€ + indirect costs 1,131€ less costly per patient compared to the standard care programme. Conclusion The integrated programme of prehabilitation and early rehabilitation in spine surgery is more cost-effective compared to standard care programme alone.

  8. Lateral retroperitoneal transpsoas approach to the lumbar spine for the treatment of spondylodiscitis.

    Science.gov (United States)

    Shepard, Matthew; Safain, Mina; Burke, Shane M; Hwang, Steven; Kryzanski, James; Riesenburger, Ron I

    2014-10-01

    Spondylodiscitis is an infection of the intervertebral disc and adjacent vertebrae. With the advent of minimally invasive spinal surgery, less invasive approaches have been considered for the treatment of discitis. To date, however, there have been no reported cases of a minimally invasive lateral retroperitoneal transpsoas approach for the treatment of spondylodiscitis. The authors report a case of medically refractory discitis in a patient with multiple comorbidities who underwent a successful limited debridement via a lateral transpsoas corridor. This case describes a minimally invasive approach used to treat a patient with lumbar discitis/osteomyelitis who was otherwise a suboptimal surgical candidate.

  9. Comparison of quality of life between men and women who underwent Transforaminal Percutaneous Endoscopic Discectomy for lumbar disc herniation.

    Science.gov (United States)

    Kapetanakis, Stylianos; Gkasdaris, Grigorios; Thomaidis, Tryfon; Charitoudis, Georgios; Kazakos, Konstantinos

    2017-01-01

    Studies describing the efficacy of TPED on shortness of recovery and improvement of postoperative quality of life are limited, especially regarding gender something that has never been reported before in the literature. The purpose of this study is to evaluate possible differences of the health-related quality of life in patients who underwent TPED for LDH in accordance with sex. Seventy-six patients diagnosed and treated with TPED for LDH with 1 year follow-up were selected and divided into two groups of equal number depending on sex. Their quality of life was evaluated by using the SF-36 before the operation, six weeks, three, six and twelve months postoperatively. A statistical analysis was conducted, in order to compare the 8 scaled scores of the SF-36 combining each time two chronological phases in the total of patients, in each group and between groups. Fifty-two (68.4%) patients were ≤63 years old, while the rest 24 (31,4%) were >63 years old (mean ±SD = 56,5 ±12,1 years). Apart from the PF domain, the scores were higher in every visit for the two groups, but the change between groups was not significant. Women had a significantly higher increase of PF score in 3 months after TPED and in the interval 6 weeks-3 months comparing with men. However, in the intervals 3 months-6 months and 3 months-12 months men presented significantly higher increase compared to women. Statistically significant improvement of the quality of life for both men and women was observed. Generally, there was no significant difference between the two groups. As regards to the physical functioning, it appears to be a significant difference which is counterpoised over time. 2. TPED for LDH does not present major differences in the improvement of quality of life regarding gender.

  10. The Correlation of Knee Osteoarthritis with Lumbar Spine, Proximal Femur and Distal Radius Bone Mineral Density

    Directory of Open Access Journals (Sweden)

    Gülgün Durlanık

    2003-03-01

    Full Text Available Although osteoporosis (OP and osteoarthritis (OA are both common conditions with high prevalence in older age group, they rarely coexist clinically. The aim of the study was to determine the possible inverse relation between osteoporosis (OP and osteoarthritis (OA by evaluating the association between bone mineral density (BMD and knee OA. BMD’s in proximal femur, lumbar spine and distal radius were measured by LUNAR-DEXA. Knee OA was assessed by a weight bearing anteroposterior radiograph and graded on a severity scale of 4 according to Kellgren-Lawrence. We compared the bone densities of each OA group with those without knee OA. 220 patients who were evaluated as primary OA and had no history or physical examination findings suggesting secondary OA were included in the study. The mean age was 64 years and the mean weight of the patients was 78 kg. Subjects that had no radyographically evident knee OA were included as the control group. There were 21 Grade 1 OA, 98 Grade 2 OA, 88 Grade 3 OA and 13 Grade 4 OA patients. Mean lumbar and femoral BMD’s of the Grade 1 and Grade 2 OA patients were %5-8 higher then those without OA (p<0,05. Lumbar and femoral BMD’s of the patients with Grade 3 and Grade 4 knee OA were also higher than the non-OA patients but the results were not statistically significant. There was no significant relation between distal radius BMD and knee OA. The results of this study support the negative correlation between OA and OP.

  11. Finite element analysis of the biomechanical effect of coflex™ on the lumbar spine.

    Science.gov (United States)

    Byun, Dong-Hak; Shin, Dong Ah; Kim, Jin-Myung; Kim, So-Hee; Kim, Hyoung-Ihl

    2012-09-01

    The biomechanical properties of the Coflex™ (Paradigm Spine, NY, USA), a device designed to provide dynamic stabilization without lumbar fusion, have not been clearly defined. The purpose of this study was to determine the efficacy and biomechanical effect of Coflex™ using finite element model (FEM). A 3D geometric model of the L3-L5 was created by integrating computerized tomography (CT) images. Based on the geometric model, a 3D FEM was created and the Coflex™ model was incorporated into the base model. Mechanical load dependent on the postural changes and boundary conditions, were imposed to simulate various 3D physiological states. The simulation analysis included stress and strain distributions, intervertebral disc deformation, and the range of motion of the facet joint and lumbar spinous process. Coflex™ significantly restrained displacement in extension, lateral bending and compression of joint between the L4-5 as one in the experimental group was observed -1.3% of flexion, -24.5% of extension, -44.5% of lateral bending and -37.2%. The average intradiscal pressure of the L4-5 decreased by 63% and the average facet contract force of the L4-5 decreased markedly by 34% in the experimental group. A load of 120 MPa from extension was observed at the base of spinous process in the experimental group. The Coflex™ can be safely used for achieving functional dynamic stabilization of the lumbar vertebral column while preserving the intactness of the other components. However, the fatigue fracture of the L4 spinous process should be carefully monitored.

  12. Functional recovery in lumbar spine surgery: a controlled trial of health behavior change counseling to improve outcomes.

    Science.gov (United States)

    Skolasky, Richard L; Riley, Lee H; Maggard, Anica M; Bedi, Saaniya; Wegener, Stephen T

    2013-09-01

    In 2001, the Institute of Medicine issued a challenge to the American health care system to improve the quality of care by focusing on six major areas: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. The patient-centered model of care directly addresses important limits of surgical care of the lumbar spine, i.e., the lack of effective methods for increasing patient participation and engagement in post-operative follow-up. Recent evidence indicates that post-surgical outcomes are better among those with higher patient activation. We therefore developed an intervention based on the principles of motivational interviewing to increase patient activation: the Functional Recovery in Lumbar Spine Surgery Health Behavior Change Counseling (HBCC) intervention. The HBCC was designed to maximize post-operative engagement and participation in physical therapy and home exercise, to improve functional recovery, and to decrease pain in individuals undergoing elective lumbar spine surgery. From December 2009 through October 2012, 120 participants were recruited and divided into two groups: those receiving (intervention group, 60) and not receiving (control group, 60) the HBCC intervention. The current manuscript provides a detailed description of the theoretical framework and study design of the HBCC and describes the implementation of this health behavior intervention in a university-based spine service. The HBCC provides a model for conducting health behavioral research in a real-world setting. © 2013 Elsevier Inc. All rights reserved.

  13. A Comparative Analysis of Lumbar Spine Mechanics During Barbell- and Crate-Lifting -Implications for Occupational Lifting Task Assessments.

    Science.gov (United States)

    Zehr, Jackie D; Carnegie, Danielle R; Welsh, Timothy N; Beach, Tyson A C

    2018-02-13

    To compare the effects of object handled and handgrip used on lumbar spine motion and loading during occupational lifting task simulations. Eight male and eight female volunteers performed barbell and crate lifts with a pronated (barbell) and neutral (crate) handgrip. The mass of barbells/crates lifted was identical across the objects and fixed at 11.6 kg and 9.3 kg for men and women, respectively. The initial heights of barbells/crates were individualized to mid-shank level. Body segment kinematics and foot-ground reaction kinetics were collected, and then input into an electromyography-assisted dynamic biomechanical model to quantify lumbar spine motion and loading. Lumbar compression and net lumbosacral moment magnitudes were 416 N and 17 Nm lower when lifting barbell than when lifting a crate (p 0.392) or flexion/extension velocities (p > 0.085). A crate- and barbell-lifting task can be used interchangeably if assessing lifting mechanics based on peak spine motion variables. If assessments are based on the spine loading responses to task demands, however, then crate- and barbell-lifting task cannot be used interchangeably.

  14. Trauma of the lumbar spine and the thoracolumbar junction; Trauma der Lendenwirbelsaeule und des thorakolumbalen Uebergangs

    Energy Technology Data Exchange (ETDEWEB)

    Reith, W.; Harsch, N.; Kraus, C. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2016-08-15

    Patients who have experienced high energy trauma have a particularly high risk of suffering from fractures of the thoracic and lumbar spine. The detection of spinal injuries and the correct classification of fractures before surgery are not only absolute requirements for the implementation of appropriate surgical treatment but they are also decisive for the choice of surgical procedure. By the application of spiral computed tomography (CT) crucial additional information on the morphology of the fracture can be gained in order to estimate the fracture type and possibly the indications for specific surgical treatment options. Magnetic resonance imaging (MRI) is ideally suited to provide valuable additional information regarding injuries to the discoligamentous structures of the spine. Magerl et al. developed a comprehensive classification especially for injuries of the thoracic and lumbar spine, which was adopted by the working group for osteosynthesis (AO). This is based on a 2-pillar model of the spinal column. The classification is based on the pathomorphological characteristics of fractures recognizable by imaging. The injury pattern is of particular importance. In spinal trauma a distinction is made between stable and unstable fractures. The treatment of spinal injuries depends on the severity of the overall injury pattern. Besides adequate initial treatment at the scene, a trauma CT should be immediately carried out in order that no injuries are overlooked and to ensure a rapid decision on the treatment procedure. (orig.) [German] Insbesondere bei Patienten, die Hochenergie- oder Rasanztraumata erfahren haben, besteht ein erhoehtes Risiko, Frakturen der BWS und LWS zu erleiden. Die Erkennung von Verletzungen der Wirbelsaeule und die korrekte Klassifikation der Frakturen vor der Operation sind nicht nur unbedingte Voraussetzungen fuer die Einleitung einer adaequaten, ggf. operativen Therapie, sondern mitentscheidend fuer die Wahl des operativen Verfahrens. Bei

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

    International Nuclear Information System (INIS)

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

    2013-01-01

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

  16. Radiation dose exposure for lumbar spine epidural steroid injections: a comparison of conventional fluoroscopy data and CT fluoroscopy techniques.

    Science.gov (United States)

    Hoang, Jenny K; Yoshizumi, Terry T; Toncheva, Greta; Gray, Linda; Gafton, Andreia R; Huh, Billy K; Eastwood, James D; Lascola, Christopher D; Hurwitz, Lynne M

    2011-10-01

    The purpose of this article is to compare the radiation dose of conventional fluoroscopy-guided lumbar epidural steroid injections (ESIs) and CT fluoroscopy (CTF)-guided lumbar ESI using both clinical data and anthropomorphic phantoms. We performed a retrospective review of dose parameters for 14 conventional fluoroscopy ESI procedures performed by one proceduralist and 42 CTF-guided ESIs performed by three proceduralists (14 each). By use of imaging techniques similar to those for our clinical cohorts, a commercially available anthropomorphic male phantom with metal oxide semiconductor field effect transistor detectors was scanned to obtain absorbed organ doses for conventional fluoroscopy-guided and CTF-guided ESIs. Effective dose (ED) was calculated from measured organ doses. The mean conventional fluoroscopy time for ESI was 37 seconds, and the mean procedural CTF time was 4.7 seconds. Calculated ED for conventional fluoroscopy was 0.85 mSv compared with 0.45 mSv for CTF. The greatest contribution to the radiation dose from CTF-guided ESI came from the planning lumbar spine CT scan, which had an ED of 2.90 mSv when z-axis ranged from L2 to S1. This resulted in a total ED for CTF-guided ESI (lumbar spine CT scan plus CTF) of 3.35 mSv. The ED for the CTF-guided ESI was almost half that of conventional fluoroscopy because of the shorter fluoroscopy time. However, the overall radiation dose for CTF-guided ESIs can be up to four times higher when a full diagnostic lumbar CT scan is performed as part of the procedure. Radiation dose reduction for CTF-guided ESI is best achieved by minimizing the dose from the preliminary planning lumbar spine CT scan.

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

    International Nuclear Information System (INIS)

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

    2003-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Steinberg, E.L. E-mail: eli_st@netvision.net.il; Luger, E.; Arbel, R.; Menachem, A.; Dekel, S

    2003-12-01

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

  19. The efficacy of contrast-enhanced T1-weighted MR imaging of the lumbar spine in rheumatoid arthritis patients

    International Nuclear Information System (INIS)

    Saruhashi, Yasuo; Tanaka, Masanobu; Kawasaki, Taku; Ushiyama, Toshio; Takahashi, Shinobu; Matsusue, Yoshitaka; Hukuda, Sinsuke

    2004-01-01

    We investigated MR imaging of the lumbar spine in rheumatoid arthritis (RA) patients, including T1-weighted, T2-weighted, and contrast enhanced T1-weighted MR imaging in 20 patients with rheumatoid arthritis and in 23 controls. Lesions were found at spinous processes, facet joints, spinal bodies, end plates, and the limbus of spinal bodies. At least one lesion was found in 18 patients, and notably, 70% of patients had lesions in the spinous process and 75% of patients in the facet joints. The fat-suppression contrast-enhanced T1-weighted MR was very useful in lumbar lesions in RA patients. (author)

  20. The Effect of the Lumbar Vertebral Malpositioning on Bone Mineral Density Measurements of the Lumbar Spine by Dual-Energy X-Ray Absorptiometry.

    Science.gov (United States)

    Izadyar, Sina; Golbarg, Shima; Takavar, Abbas; Zakariaee, Seyed Salman

    2016-01-01

    A significant discrepancy between the results of previous human and phantoms studies is identified regarding the effects of vertebral positioning on bone mineral density (BMD) measurements. We aimed to evaluate the effects of lumbar vertebral positioning on BMD measurements by dual-energy X-ray absorptiometry in a human cadaveric spine phantom. A spine phantom was designed using L1-L4 vertebrae harvested from a 48-year-old male cadaver without coronal or sagittal deformity. The spine phantom was scanned by DEXXUM T bone densitometer in a constant scanning speed of 30 mm/s and resolution of 1.0 × 1.0 mm. BMD values were measured in a positive and negative lumbar lordosis and kyphosis tilt angles in the sagittal plane, from 0° to 35°, with 7° increments. Also BMD values were measured in axial and lateral rotations with 5° increments. Projectional dual-energy X-ray absorptiometry measurements are significantly affected by positioning of the lumbar spine, more severely affected by kyphotic curvature, but also by axial and lateral rotational scoliosis as well as lordotic curvature. Increasing the severity of lordosis and kyphosis curvatures leads to false reduction of BMD value up to 17.5% and 11.5%, respectively. Increasing the degree of lateral and axial rotational scolioses results in a false decrease in BMD measurements by up to 10.8% and 9.6%, respectively. To achieve the most accurate scanning results, error sources and abnormal positioning should be identified and minimized as much as possible. If not correctable, they should be taken into consideration while interpreting the results. Copyright © 2016 International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  1. Gender and age groups interactions in the quantification of bone marrow fat content in lumbar spine using 3T MR spectroscopy: A multivariate analysis of covariance (Mancova)

    International Nuclear Information System (INIS)

    Roldan-Valadez, Ernesto; Piña-Jimenez, Carlos; Favila, Rafael; Rios, Camilo

    2013-01-01

    Introduction: There is an age-related conversion of red to yellow bone marrow in the axial skeleton, with a gender-related difference less well established. Our purpose was to clarify the variability of bone marrow fat fraction (FF) in the lumbar spine due to the interaction of gender and age groups. Methods: 44 healthy volunteers (20 males, 30–65 years old and 24 females, 30–69 years old) underwent 3T magnetic resonance spectroscopy (MRS) and conventional MRI examination of the lumbar spine; single-voxel spectrum was acquired for each vertebral body (VB). After controlling body mass index (BMI), a two-way between-groups multivariate analysis of covariance (MANCOVA) assessed the gender and age group differences in FF quantification for each lumbar VB. Results: There was a significant interaction between gender and age group, p = .017, with a large effect size (partial η 2 = .330). However the interaction explained only 33% of the observed variance. Main effects were not statistically significant. BMI was non-significantly related to FF quantification. Conclusions: Young males showed a high FF content, which declined in the 4th decade, then increased the next 3 decades to reach a FF content just below the initial FF means. Females’ FF were low in the 3rd decade, depicted an accelerated increase in the 4th decade, then a gradual increase the next 3 decades to reach a FF content similar to males’ values. Our findings suggest that quantification of bone marrow FF using MRS might be used as a surrogate biomarker of bone marrow activity in clinical settings

  2. Gender and age groups interactions in the quantification of bone marrow fat content in lumbar spine using 3T MR spectroscopy: A multivariate analysis of covariance (Mancova)

    Energy Technology Data Exchange (ETDEWEB)

    Roldan-Valadez, Ernesto, E-mail: ernest.roldan@usa.net [Magnetic Resonance Unit, Medica Sur Clinic and Foundation, Mexico City (Mexico); Piña-Jimenez, Carlos [Magnetic Resonance Unit, Medica Sur Clinic and Foundation, Mexico City (Mexico); Favila, Rafael [GE Healthcare, Mexico City (Mexico); Rios, Camilo [Neurochemistry Department, Mexican National Institute of Neurology and Neurosurgery, Mexico City (Mexico)

    2013-11-01

    Introduction: There is an age-related conversion of red to yellow bone marrow in the axial skeleton, with a gender-related difference less well established. Our purpose was to clarify the variability of bone marrow fat fraction (FF) in the lumbar spine due to the interaction of gender and age groups. Methods: 44 healthy volunteers (20 males, 30–65 years old and 24 females, 30–69 years old) underwent 3T magnetic resonance spectroscopy (MRS) and conventional MRI examination of the lumbar spine; single-voxel spectrum was acquired for each vertebral body (VB). After controlling body mass index (BMI), a two-way between-groups multivariate analysis of covariance (MANCOVA) assessed the gender and age group differences in FF quantification for each lumbar VB. Results: There was a significant interaction between gender and age group, p = .017, with a large effect size (partial η{sup 2} = .330). However the interaction explained only 33% of the observed variance. Main effects were not statistically significant. BMI was non-significantly related to FF quantification. Conclusions: Young males showed a high FF content, which declined in the 4th decade, then increased the next 3 decades to reach a FF content just below the initial FF means. Females’ FF were low in the 3rd decade, depicted an accelerated increase in the 4th decade, then a gradual increase the next 3 decades to reach a FF content similar to males’ values. Our findings suggest that quantification of bone marrow FF using MRS might be used as a surrogate biomarker of bone marrow activity in clinical settings.

  3. Bone mineral density changes of lumbar spine and femur in osteoporotic patient treated with bisphosphonates and beta-hydroxy-beta-methylbutyrate (HMB): Case report.

    Science.gov (United States)

    Tatara, Marcin R; Krupski, Witold; Majer-Dziedzic, Barbara

    2017-10-01

    Currently available approaches to osteoporosis treatment include application of antiresorptive and anabolic agents influencing bone tissue metabolism. The aim of the study was to present bone mineral density (BMD) changes of lumbar spine in osteoporotic patient treated with bisphosphonates such as ibandronic acid and pamidronic acid, and beta-hydroxy-beta-methylbutyrate (HMB). BMD and volumetric BMD (vBMD) of lumbar spine were measured during the 6 year observation period with the use of dual-energy X-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). The described case report of osteoporotic patient with family history of severe osteoporosis has shown site-dependent response of bone tissue to antiosteoporotic treatment with bisphosphonates. Twenty-five-month treatment with ibandronic acid improved proximal femur BMD with relatively poor effects on lumbar spine BMD. Over 15-month therapy with pamidronic acid was effective to improve lumbar spine BMD, while in the proximal femur the treatment was not effective. A total of 61-week long oral administration with calcium salt of HMB improved vBMD of lumbar spine in the trabecular and cortical bone compartments when monitored by QCT. Positive effects of nearly 2.5 year HMB treatment on BMD of lumbar spine and femur in the patient were also confirmed using DEXA method. The results obtained indicate that HMB may be applied for the effective treatment of osteoporosis in humans. Further studies on wider human population are recommended to evaluate mechanisms influencing bone tissue metabolism by HMB.

  4. Risk of hip fracture after osteoporosis fractures. 451 women with fracture of lumbar spine, olecranon, knee or ankle

    DEFF Research Database (Denmark)

    Lauritzen, J B; Lund, B

    1993-01-01

    In a follow-up study during 1976-1984, the risk of a subsequent hip fracture was investigated in women aged 60-99 years, hospitalized for the following fractures: lumbar spine (n 70), olecranon (n 52), knee (n 129) and ankle (n 200). Follow-up ranged from 0 to 9 years. Observation time of the 4...... different fractures were 241, 180, 469, and 779, person-years, respectively. In women aged 60-79 years with one of the following fractures the relative risk of a subsequent hip fracture was increased by 4.8 (lumbar spine), 4.1 (olecranon), 3.5 (knee) and 1.5 (ankle). The relative risk of hip fracture showed...

  5. Effects of acceleration level on lumbar spine injuries in military populations.

    Science.gov (United States)

    Yoganandan, Narayan; Stemper, Brian D; Baisden, Jamie L; Pintar, Frank A; Paskoff, Glenn R; Shender, Barry S

    2015-06-01

    Clinical studies have indicated that thoracolumbar trauma occurs in the civilian population at its junction. In contrast, injury patterns in military populations indicate a shift to the inferior vertebral levels of the lumbar spine. Controlled studies offering an explanation for such migrations and the associated clinical biomechanics are sparse in literature. The goals of this study were to investigate the potential roles of acceleration loading on the production of injuries and their stability characteristics using a human cadaver model for applications to high-speed aircraft ejection and helicopter crashes. Biomechanical laboratory study using unembalmed human cadaver lumbar spinal columns. Thoracolumbar columns from post-mortem human surrogates were procured, x-rays taken, intervertebral joints and bony components evaluated for degeneration, and fixed using polymethylmethacrylate. The inferior end was attached to a platform via a load cell and uniaxial accelerometer. The superior end was attached to the upper metal platform via a semi-circular cylinder. The pre-flexed specimen was preloaded to simulate torso mass. The ends of the platform were connected to the vertical post of a custom-designed drop tower. The specimen was dropped inducing acceleration loading to the column. Axial force and acceleration data were gathered at high sampling rates, filtered, and peak accelerations and inertia-compensated axial forces were obtained during the loading phase. Computed tomography images were used to identify and classify injuries using the three-column concept (stable vs. unstable trauma). The mean age, total body mass, and stature of the five healthy degeneration-free specimens were 42 years, 73 kg, and 167 cm. The first two specimens subjected to peak accelerations of approximately 200 m/sec(2) were classified as belonging to high-speed aircraft ejection-type and the other three specimens subjected to greater amplitudes (347-549 m/sec(2)) were classified as

  6. Improvement in Pain After Lumbar Spine Surgery: The Role of Preoperative Expectations of Pain Relief.

    Science.gov (United States)

    Mancuso, Carol A; Reid, M C; Duculan, Roland; Girardi, Federico P

    2017-02-01

    Improvement in pain is a major expectation of patients undergoing lumbar spine surgery. Among 422 patients, the goal of this prospective study was to measure 2-year postoperative pain and to determine whether this outcome varied according to patient and clinical characteristics, including amount of pain relief expected preoperatively. Before surgery patients completed valid questionnaires that addressed clinical characteristics and expectations for pain improvement. Two years after surgery patients reported how much pain improvement they actually received. The mean age was 56 years old and 55% were men. Two years after surgery 11% of patients reported no improvement in pain, 28% reported a little to moderate improvement, 44% reported a lot of improvement, and 17% reported complete improvement. In multivariable analysis, patients reported less pain improvement if, before surgery, they expected greater pain improvement (odds ratio [OR] 1.4), had a positive screen for depression (OR 1.7), were having revision surgery (OR 1.6), had surgery at L4 or L5 (OR 2.5), had a degenerative diagnosis (OR 1.6), and if, after surgery, they had another surgery (OR 2.8) and greater back (OR 1.3) and leg (OR 1.1) pain (all variables P≤0.05). Pain is not uncommon after lumbar surgery and is associated with a network of clinical, surgical, and psychological variables. This study provides evidence that patients' expectations about pain are an independent variable in this network. Because expectations are potentially modifiable this study supports addressing pain-related expectations with patients before surgery through discussions with surgeons and through formal preoperative patient education.

  7. Biomechanical analysis of lateral interbody fusion strategies for adjacent segment degeneration in the lumbar spine.

    Science.gov (United States)

    Metzger, Melodie F; Robinson, Samuel T; Maldonado, Ruben C; Rawlinson, Jeremy; Liu, John; Acosta, Frank L

    2017-07-01

    Surgical treatment of symptomatic adjacent segment disease (ASD) typically involves extension of previous instrumentation to include the newly affected level(s). Disruption of the incision site can present challenges and increases the risk of complication. Lateral-based interbody fusion techniques may provide a viable surgical alternative that avoids these risks. This study is the first to analyze the biomechanical effect of adding a lateral-based construct to an existing fusion. The study aimed to determine whether a minimally invasive lateral interbody device, with and without supplemental instrumentation, can effectively stabilize the rostral segment adjacent to a two-level fusion when compared with a traditional posterior revision approach. This is a cadaveric biomechanical study of lateral-based interbody strategies as add-on techniques to an existing fusion for the treatment of ASD. Twelve lumbosacral specimens were non-destructively loaded in flexion, extension, lateral bending, and torsion. Sequentially, the tested conditions were intact, two-level transforaminal lumbar interbody fusion (TLIF) (L3-L5), followed by lateral lumbar interbody fusion procedures at L2-L3 including interbody alone, a supplemental lateral plate, a supplemental spinous process plate, and then either cortical screw or pedicle screw fixation. A three-level TLIF was the final instrumented condition. In all conditions, three-dimensional kinematics were tracked and range of motion (ROM) was calculated for comparisons. Institutional funds (Spine. The addition of a lateral interbody device superadjacent to a two-level fusion significantly reduced motion in flexion, extension, and lateral bending (pfusion construct, demonstrating ROM comparable with a traditional three-level TLIF. The data presented suggest that a lateral-based interbody fusion supplemented with additional minimally invasive instrumentation may provide comparable stability with a traditional posterior revision approach

  8. Compressive Loads on the Lumbar Spine During Lifting: 4D WATBAK versus Inverse Dynamics Calculations

    Directory of Open Access Journals (Sweden)

    M. H. Cole

    2005-01-01

    Full Text Available Numerous two- and three-dimensional biomechanical models exist for the purpose of assessing the stresses placed on the lumbar spine during the performance of a manual material handling task. More recently, researchers have utilised their knowledge to develop specific computer-based models that can be applied in an occupational setting; an example of which is 4D WATBAK. The model used by 4D WATBAK bases its predications on static calculations and it is assumed that these static loads reasonably depict the actual dynamic loads acting on the lumbar spine. Consequently, it was the purpose of this research to assess the agreement between the static predictions made by 4D WATBAK and those from a comparable dynamic model. Six individuals were asked to perform a series of five lifting tasks, which ranged from lifting 2.5 kg to 22.5 kg and were designed to replicate the lifting component of the Work Capacity Assessment Test used within Australia. A single perpendicularly placed video camera was used to film each performance in the sagittal plane. The resultant two-dimensional kinematic data were input into the 4D WATBAK software and a dynamic biomechanical model to quantify the compression forces acting at the L4/L5 intervertebral joint. Results of this study indicated that as the mass of the load increased from 2.5 kg to 22.5 kg, the static compression forces calculated by 4D WATBAK became increasingly less than those calculated using the dynamic model (mean difference ranged from 22.0% for 2.5 kg to 42.9% for 22.5 kg. This study suggested that, for research purposes, a validated three-dimensional dynamic model should be employed when a task becomes complex and when a more accurate indication of spinal compression or shear force is required. Additionally, although it is clear that 4D WATBAK is particularly suited to industrial applications, it is suggested that the limitations of such modelling tools be carefully considered when task-risk and employee

  9. Reducing Patient Radiation Exposure From CT Fluoroscopy-Guided Lumbar Spine Pain Injections by Targeting the Planning CT.

    Science.gov (United States)

    Amrhein, Timothy J; Schauberger, J Scott; Kranz, Peter G; Hoang, Jenny K

    2016-02-01

    CT fluoroscopy-guided lumbar spine pain injections typically include a preprocedural planning CT that contributes considerably to patient dose. The purpose of this study was to quantify the degree of radiation exposure reduction achieved by modifying only the planning CT component of the examination. A retrospective review was performed of 80 CT fluoroscopy-guided lumbar spine injections. Forty patients were scanned with a standard protocol using automatic tube current modulation (method A). Another 40 patients were scanned using a new technique that fixed the tube current of the planning CT to either 50 or 100 mA on the basis of the patient's anteroposterior diameter and that reduced the z-axis coverage (method B). Dose-length products (DLPs) were compared for the two methods. The mean maximal tube current for the planning CT was 435.0 mA for method A and 67.5 mA for method B. The mean z-axis was shorter for method B at 6.5 cm than for method A at 9.6 cm (p fluoroscopy components) was reduced by 78%. There was no significant difference between methods A and B in CT fluoroscopy time (p = 0.37). All procedures were technically successful. A nearly fivefold reduction in radiation exposure can be achieved in CT fluoroscopy-guided lumbar spine pain injections through modifications to the planning CT alone.

  10. Low back skin sensitivity has minimal impact on active lumbar spine proprioception and stability in healthy adults.

    Science.gov (United States)

    Beaudette, Shawn M; Larson, Katelyn J; Larson, Dennis J; Brown, Stephen H M

    2016-08-01

    The purpose of the current work was to (1) determine whether low back cutaneous sensitivity could be reduced through the use of a topical lidocaine-prilocaine anesthetic (EMLA(®)) to mirror reductions reported in chronic lower back pain (CLBP) patients, as well as to (2) identify whether reductions in cutaneous sensitivity resulted in decreased lumbar spine proprioception, neuromuscular control and dynamic stability. Twenty-eight healthy participants were divided equally into matched EMLA and PLACEBO treatment groups. Groups completed cutaneous minimum monofilament and two-point discrimination (TPD) threshold tests, as well as tests of sagittal and axial lumbar spine active repositioning error, seated balance and repeated lifting dynamic stability. These tests were administered both before and after the application of an EMLA or PLACEBO treatment. Results show that low back minimum monofilament and TPD thresholds were significantly increased within the EMLA group. Skin sensitivity remained unchanged in the PLACEBO group. In the EMLA group, decreases in low back cutaneous sensitivity had minimal effect on low back proprioception (active sagittal and axial repositioning) and dynamic stability (seated balance and repeated lifting). These findings demonstrate that treating the skin of the low back with an EMLA anesthetic can effectively decrease the cutaneous sensitivity of low back region. Further, these decreases in peripheral cutaneous sensitivity are similar in magnitude to those reported in CLBP patients. Within this healthy population, decreased cutaneous sensitivity of the low back region has minimal influence on active lumbar spine proprioception, neuromuscular control and dynamic stability.

  11. Safety of lumbar spine radiofrequency procedures in the presence of posterior pedicle screws: technical report of a cadaver study.

    Science.gov (United States)

    Gazelka, Halena M; Welch, Tasha L; Nassr, Ahmad; Lamer, Tim J

    2015-05-01

    To determine whether the thermal energy associated with lumbar spine radiofrequency neurotomy (RFN) performed near titanium and stainless steel pedicle screws is conducted to the pedicle screws or adjacent tissues, or both, thus introducing potential for thermal damage to those tissues. Cadaver study. Cadaver laboratory equipped with fluoroscopy, surgical spine implements, and radiofrequency generator. No live human subject; a fresh frozen (and thawed) cadaver torso was used for the study. Titanium and stainless steel pedicle screws were placed in the lumbar spine of a fresh frozen cadaver torso with real-time fluoroscopic guidance. Conventional RFN cannula placement was performed at the level of pedicle screws and a control (nonsurgically altered) lumbar level. Neurotomy was performed with conventional radiofrequency lesioning parameters. Temperatures were recorded at multiple sites through thermistor probes. Direct contact of the radiofrequency cannula with the pedicle screws during conventional RFN produced a substantial increase in temperature in the surrounding soft tissues. A small increase in temperature occurred at the same sites at the control level. Titanium and stainless steel pedicle screws are capable of sustaining large increases in temperature when the radiofrequency probe comes in contact with the screw. These results are suggestive that pedicle screws could serve as a possible source of tissue heating and thermal injury during RFN. Wiley Periodicals, Inc.

  12. 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 Documentation of excluding conditions and other clinically reasonable exclusions for OP-8 increased over time for outpatient hospitals and clinics. Increases in documentation of comorbidities may not translate to actual improvement in imaging appropriateness for 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.

  13. [Assessment of the correlation between histological degeneration and radiological and clinical parameters in a series of patients who underwent lumbar disc herniation surgery].

    Science.gov (United States)

    Munarriz, Pablo M; Paredes, Igor; Alén, José F; Castaño-Leon, Ana M; Cepeda, Santiago; Hernandez-Lain, Aurelio; Lagares, Alfonso

    The use of histological degeneration scores in surgically-treated herniated lumbar discs is not common in clinical practice and its use has been primarily restricted to research. The objective of this study is to evaluate if there is an association between a higher grade of histological degeneration when compared with clinical or radiological parameters. Retrospective consecutive analysis of 122 patients who underwent single-segment lumbar disc herniation surgery. Clinical information was available on all patients, while the histological study and preoperative magnetic resonance imaging were also retrieved for 75 patients. Clinical variables included age, duration of symptoms, neurological deficits, or affected deep tendon reflex. The preoperative magnetic resonance imaging was evaluated using Modic and Pfirrmann scores for the affected segment by 2 independent observers. Histological degeneration was evaluated using Weiler's score; the presence of inflammatory infiltrates and neovascularization, not included in the score, were also studied. Correlation and chi-square tests were used to assess the association between histological variables and clinical or radiological variables. Interobserver agreement was also evaluated for the MRI variables using weighted kappa. No statistically significant correlation was found between histological variables (histological degeneration score, inflammatory infiltrates or neovascularization) and clinical or radiological variables. Interobserver agreement for radiological scores resulted in a kappa of 0.79 for the Pfirrmann scale and 0.65 for the Modic scale, both statistically significant. In our series of patients, we could not demonstrate any correlation between the degree of histological degeneration or the presence of inflammatory infiltrates when compared with radiological degeneration scales or clinical variables such as the patient's age or duration of symptoms. Copyright © 2017 Sociedad Española de Neurocirug

  14. Characterization and prediction of rate-dependent flexibility in lumbar spine biomechanics at room and body temperature.

    Science.gov (United States)

    Stolworthy, Dean K; Zirbel, Shannon A; Howell, Larry L; Samuels, Marina; Bowden, Anton E

    2014-05-01

    The soft tissues of the spine exhibit sensitivity to strain-rate and temperature, yet current knowledge of spine biomechanics is derived from cadaveric testing conducted at room temperature at very slow, quasi-static rates. The primary objective of this study was to characterize the change in segmental flexibility of cadaveric lumbar spine segments with respect to multiple loading rates within the range of physiologic motion by using specimens at body or room temperature. The secondary objective was to develop a predictive model of spine flexibility across the voluntary range of loading rates. This in vitro study examines rate- and temperature-dependent viscoelasticity of the human lumbar cadaveric spine. Repeated flexibility tests were performed on 21 lumbar function spinal units (FSUs) in flexion-extension with the use of 11 distinct voluntary loading rates at body or room temperature. Furthermore, six lumbar FSUs were loaded in axial rotation, flexion-extension, and lateral bending at both body and room temperature via a stepwise, quasi-static loading protocol. All FSUs were also loaded using a control loading test with a continuous-speed loading-rate of 1-deg/sec. The viscoelastic torque-rotation response for each spinal segment was recorded. A predictive model was developed to accurately estimate spine segment flexibility at any voluntary loading rate based on measured flexibility at a single loading rate. Stepwise loading exhibited the greatest segmental range of motion (ROM) in all loading directions. As loading rate increased, segmental ROM decreased, whereas segmental stiffness and hysteresis both increased; however, the neutral zone remained constant. Continuous-speed tests showed that segmental stiffness and hysteresis are dependent variables to ROM at voluntary loading rates in flexion-extension. To predict the torque-rotation response at different loading rates, the model requires knowledge of the segmental flexibility at a single rate and specified

  15. Lumbar Disk Herniation in the Spine Patient Outcomes Research Trial (SPORT): Does Educational Attainment Impact Outcome?

    Science.gov (United States)

    Olson, Patrick R.; Lurie, Jon D.; Frymoyer, John; Walsh, Thomas; Zhao, Wenyan; Abdu, William A.; Weinstein, James N.

    2011-01-01

    Study Design Randomized trial with concurrent observational cohort. 1171 patients were divided into subgroups by educational attainment: high school or less, some college, and college degree or above. Objective To assess the influence of education level on outcomes for treatment of lumbar disk herniation. Summary of Background Data Educational attainment has been demonstrated to have an inverse relationship with pain perception, co-morbidities, and mortality. Methods The Spine Patient Outcomes Research Trial enrolled surgical candidates (imaging-confirmed disk herniation with at least 6 weeks of persistent signs and symptoms of radiculopathy) from 13 multidisciplinary spine clinics in 11 US states. Treatments were standard open diskectomy vs. non-operative treatment. Outcomes were changes from baseline for SF-36 bodily pain (BP) and physical function (PF) scales and the modified Oswestry Disability Index (ODI) at 6 weeks, 3 months, 6 months, and yearly through 4 years. Results Substantial improvement was seen in all patient cohorts. Surgical outcomes did not differ by level of education. For non-operative outcomes, however, higher levels of education were associated with significantly greater overall improvement over 4 years in BP (p=0.007), PF (p=0.001) and ODI (p=0.003). At 4 years a “dose-response” type relationship was shown for BP (high school or less 25.5; some college 31; college graduate or above 36.3; p= 0.004); results were similar for PF and ODI. The success of non-operative treatment in the more educated cohort resulted in an attenuation of the relative benefit of surgery. Conclusions Patients with higher educational attainment demonstrated significantly greater improvement with non-operative treatment while educational attainment was not associated with surgical outcomes. PMID:21311402

  16. Pain Sensitivity and Pain Catastrophizing are Associated with Persistent Pain and Disability after Lumbar Spine Surgery

    Science.gov (United States)

    Coronado, Rogelio A.; George, Steven Z.; Devin, Clinton J.; Wegener, Stephen T.; Archer, Kristin R.

    2015-01-01

    Objective To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Design Prospective observational cohort study. Setting Academic medical center. Participants Patients (N = 68, mean ± SD age = 57.9 ± 13.1 years, N female = 40 (58.8%)) undergoing spine surgery for a degenerative condition from March 1, 2012 to April 30, 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. Interventions Not applicable. Main Outcome Measure(s) The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥ 4 and Oswestry Disability Index scores ≥ 21 at all postoperative time points. Results From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity (OR = 2.0, 95% CI = 1.0; 4.1) after surgery. Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity (OR = 1.1, 95% CI = 1.0; 1.2), pain interference (OR = 1.1, 95% CI = 1.0; 1.2), and disability (OR = 1.3, 95% CI = 1.1; 1.4). An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes (p > 0.05). Conclusion(s) Findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing in order to identify patients at-risk for poor postoperative pain intensity, interference, and/or disability outcomes. Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors. PMID:26101845

  17. Effect of lumbar spine manipulation on asymptomatic cyclist sprint performance and hip flexibility.

    Science.gov (United States)

    Olson, Eric; Bodziony, Michael; Ward, John; Coats, Jesse; Koby, Bradley; Goehry, Doug

    2014-12-01

    The purpose of this study was to measure the impact of midlumbar spinal manipulation on asymptomatic cyclist sprint performance and hip flexibility. Twelve cyclists were equally randomized into an AB:BA crossover study design after baseline testing. Six participants were in the AB group, and 6 were in the BA group. The study involved 1 week of rest in between each of the 3 tested conditions: baseline testing (no intervention prior to testing), condition A (bilateral midlumbar spine manipulation prior to testing), and condition B (sham acupuncture prior to testing, as a control). Testing was blinded and involved a sit-and-reach test followed by a 0.5-km cycle ergometer sprint test against 4-kp resistance. Outcome measures were sit-and-reach distance, time to complete 0.5 km, maximum heart rate, and rating of perceived exertion. An additional 8 cyclists were recruited and used as a second set of controls that engaged in 3 testing sessions without any intervention to track test acclimation. An analysis of variance was used to compare dependent variables under each of the 3 conditions for the experimental group and control group #1, and a repeated-measures analysis of variance was used to analyze test acclimation in control group #2. Lumbar spine manipulation did not demonstrate statistically significant between-group changes in sit-and-reach (P = .765), 0.5-km sprint performance time (P = .877), maximum exercise heart rate (P = .944), or rating of perceived exertion (P = .875). The findings of this preliminary study showed that midlumbar spinal manipulation did not improve hip flexibility or cyclist power output of asymptomatic participants compared with an acupuncture sham and no-treatment control groups.

  18. Enhancing pedicle screw fixation in the lumbar spine using allograft bone plug interference fixation.

    Science.gov (United States)

    Chrea, Bopha; Malempati, Harsha; Campbell, Jeffrey R; Khan, Sonja; Ching, Randal P; Lee, Michael J

    2014-05-01

    A within-subjects controlled laboratory study. To examine a biological alternative to cement augmentation for pedicle screw fixation comparing bilateral axial pullout tests of augmented and nonaugmented (controls) pedicle screws. Fixation in the osteoporotic spine remains a difficult challenge with failure by loosening or backout. Pedicle screw augmentation has been attempted using polymethylmethacrylate and bioabsorbable calcium cements; however, the potential for extravasation and embolization of cement are becoming increasingly concerning and merit the search for alternative methods to improve screw-anchoring strength. Twenty-four (24) fresh human lumbar vertebrae were tested to compare the pullout strength of augmented and nonaugmented pedicle screws. Two different augmentation strategies were employed using allograft bone plugs (ABPs) and evaluated using 12 specimens per group. Bone mineral density of each specimen was obtained using dual-energy x-ray absorptiometry. The augmented versus nonaugmented pedicle was randomized for each vertebra, and bilateral testing enabled paired statistical analyses. Axial pullout tests were performed using an materials testing system servohydraulic test system, and peak force, failure displacement, and stiffness was obtained for each test and correlated with bone mineral density. Augmentation using 6-mm-diameter ABPs with 6.25-mm-diameter pedicle screws resulted in statistically weaker average pullout strength (775±455 N) than the nonaugmented controls (1233±826 N). When using smaller (5 mm diameter) AGPs with the same diameter screws, there was no statistical difference between average pullout strength for the augmented pedicle screws (1772±652 N) and the nonaugmented screws (1780±575 N). Preliminary study of pedicle screw augmentation using cannulated ABPs showed no improvement of fixation with pedicles in the spine. This was even true in osteoporotic specimens, where augmentation would seem to be of considerable benefit.

  19. Clinical experiences of dynamic stabilizers: Dynesys and Dynesys top loading system for lumbar spine degenerative disease

    Directory of Open Access Journals (Sweden)

    Cheng-Ta Hsieh

    2016-04-01

    Full Text Available Dynesys (Dynamic Neutralization System was designed to overcome the shortcomings of fusion. The Dynesys top loading (DTL system is a new alternative Dynesys system that can be applied via a minimally invasive procedure. This study aimed to ascertain whether DTL is a suitable device for motion preservation and prevention of instability, and to compare the clinical and radiological outcomes between DTL and Dynesys. In this study, 12 patients were treated with Dynesys and 21 patients were treated with DTL. Back and leg pain were evaluated using the visual analog scale. The Oswestry Disability Index was used to evaluate the patients' function. Range of motion (ROM at the operative level and for the whole lumbar spine was measured pre- and postoperatively. The length of wound, blood loss, length of hospital stay, and operation duration were also compared. All patients were followed up for 12–76 months. Scores on the visual analog scale and Oswestry Disability Index were significantly improved postoperatively. The median ROM of the whole spine and index level ROM in all patients showed 12.5% and 79.6% loss, respectively. The DTL group exhibited significantly better results in terms of blood loss, wound length, and operation duration, in addition to early ambulation. In conclusion, Dynesys and DTL are semirigid fixation systems that can significantly improve clinical symptoms and signs. Our results suggested that DTL was better than Dynesys as a result of it being a minimally invasive procedure. However, further study with large sample sizes and longer follow-up durations is required to validate the effects of these dynamic stabilizers.

  20. Disc height and anteroposterior translation in fused and adjacent segments after lumbar spine fusion

    Directory of Open Access Journals (Sweden)

    Frobin, Wolfgang

    2003-09-01

    Full Text Available In a series of 46 patients the effects of spinal fusion upon intervertebral height and sagittal alignment in operated and non-operated segments were retrospectively evaluated on digitized radiographs. Data was compared with age- and gender-normalized standard values. The objective was to evaluate the influence of different types of spine fusions primarily upon adjacent segments, particularly in terms of degeneration and sagittal profile of the lumbar spine. Incidence of adjacent segment degeneration (ASD is still highly controversial. However, not every degeneration adjacent to spinal fusion must be caused by the fusion and responsibility of the fusion for ASD may vary with its range and type. Distortion Corrected Roentgen Analysis (DCRA was utilized. DCRA is a proven valid, reliable, observer-independent, and accurate tool for assessment of these parameters over time and in comparison with "normal" cohorts. With this method the exact posture of the patients needs not to be known.There was little evidence for serious fusion-related ASD within an average of 40 months follow-up. No difference could be detected for rigid vs. non-rigid fusion and instrumented vs. non-instrumented techniques. Temporary postoperative distraction effects could be detected in operated and non-operated segments. Absolute preoperative values for intervertebral height and vertebral slip were age-related. Retrospectively, the choice of segments for fusion was clearly based upon radiological criteria. Thus we conclude that radiological parameters have an obvious clinical relevance for decision-making and need to be quantified. Within the limitations of this pilot study, true fusion related ASD seems to be infrequent.

  1. Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report

    Science.gov (United States)

    Uvaraj, Nalli R.; Bosco, Aju; Gopinath, Nalli R.

    2014-01-01

    Study Design Case report. Objective To analyze the surgical difficulties in restoring global spinal stability and to describe an effective surgical option for tuberculosis with extensive destruction of the lumbosacral spine. Advanced tuberculosis with destruction of the lumbosacral spine can result in a kyphosis or hypolordosis, leading to back pain, spinal instability, and neurological deficits. The conventional treatment goals of lumbosacral tuberculosis are to correct and prevent a lumbar kyphosis, treat or prevent a neurological deficit, and restore global spinal stability. Instrumentation at the lumbosacral junction is technically demanding due to the complex local anatomy, the unique biomechanics, and the difficult fixation in the surrounding diseased bone. Methods We report a 21-year-old woman with tuberculosis from L1 to S2 with back pain and spinal instability. The radiographs showed a kyphosis of the lumbar spine. The magnetic resonance imaging and computed tomography scans revealed extensive destruction of the lumbar and lumbosacral spine. Spinopelvic stabilization combined with anterior debridement and reconstruction with free fibular strut graft was performed. Results The radiographs at follow-up showed a good correction of the kyphosis and excellent graft incorporation and fusion. Conclusions Anterior column reconstruction with a fibular strut graft helps restore and maintain the vertebral height. Posterior stabilization with spinopelvic fixation can be an effective surgical option for reconstructing the spine in extensive lumbosacral tuberculosis with sacral body destruction, requiring long fusions to the sacrum. It augments spinal stability, prevents graft-related complications, and accelerates the graft incorporation and fusion, thereby permitting early mobilization and rehabilitation. In spinal tuberculosis, antitubercular therapy may have to be prolonged in cases with large disease load, based on the clinicoradiographic and laboratory

  2. Significant reduction of fluoroscopy repetition with lumbar localization system in minimally invasive spine surgery

    Science.gov (United States)

    Fan, Guoxin; Zhang, Hailong; Gu, Xin; Wang, Chuanfeng; Guan, Xiaofei; Fan, Yunshan; He, Shisheng

    2017-01-01

    Abstract The conventional location methods for minimally invasive spinal surgery (MISS) were mainly based on repeated fluoroscopy in a trial-and-error manner preoperatively and intraoperatively. Localization system mainly consisted of preoperative applied radiopaque frame and intraoperative guiding device, which has the potential to minimize fluoroscopy repetition in MISS. The study aimed to evaluate the efficacy of a novel lumbar localization system in reducing radiation exposure to patients. Included patients underwent minimally invasive transforaminal lumbar interbody fusion (MISTLIF) or percutaneous transforaminal endoscopic discectomy (PTED). Patients treated with novel localization system were regarded as Group A, and patients treated without novel localization system were regarded as Group B. For PTED, The estimated effective dose was 0.41 ± 0.13 mSv in Group A and 0.57 ± 0.14 mSv in Group B (P fluoroscopy exposure time of PTED was 22.18 ± 7.30 seconds in Group A and 30.53 ± 7.56 seconds in Group B (P fluoroscopy exposure time was 25.41 ± 5.52 seconds in Group A and 32.82 ± 5.03 seconds in Group B (P < .001); The estimated cancer risk was 24.90 ± 5.15 (10–6) in Group A and 31.96 ± 5.04 (10–6) in Group B (P < .001). There were also significant differences in localization time and operation time between the 2 groups either for MISTLIF or PTED. The lumbar localization system could be a potential protection strategy for minimizing radiation hazards. PMID:28538369

  3. Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine

    International Nuclear Information System (INIS)

    Mitra, D.; Cassar-Pullicino, V.N.; Mccall, I.W.

    2004-01-01

    The purpose of this study was to investigate the temporal evolution of type-1 end-plate changes on MRI in patients with degenerative disease of the lumbar spine and to evaluate whether any correlation exists between such evolution and the change in patients' symptoms. Forty-four patients with 48 Modic type-1 end-plate changes (low TI signal and high T2 signal) were studied. All patients had an initial and a follow-up non-contrast lumbar MRI with variable intervals between the studies (12-72 months). Severity of the end-plate changes was assessed by eyeball estimation. Correlation with patients' symptoms was studied with the help of the Visual Analogue Score (VAS), Oswestry Questionnaire Score (OQS) and patients' subjective assessment. Of the 48 disc levels with type-1 changes, 18 (37.5%) converted fully to type 2 (high T1 signal and intermediate to high T2 signal), 7 (14.6%) partially converted to type 2, 19 (39.6%) became worse (i.e. type 1 changes became more extensive) and 4 (8.3%) showed no change. Higher average VAS (5.7) and OQS (42.3) scores were noted in patients where there was worsening type-1 change and lower scores (3.8 and 27, respectively) were seen in those where there was conversion to type-2 change. These trends, however, did not reach statistical significance (P values 0.16 and 0.09 for VAS and OQS, respectively). The statistical relationship was stronger after exclusion of patients with confounding factors (i.e. changes in lumbar MRI other than end-plate changes that could independently explain the evolution of patients' symptoms) with P-values of 0.08 and 0.07 for VAS and OQS, respectively. Type-1 end-plate change represents a dynamic process and in a large majority of cases either converts to type-2 change or becomes more extensive. The evolution of type-1 change relates to change in patient's symptoms, but not to a statistically significant level. (orig.)

  4. [Multiple linear regression and ROC curve analysis of the factors of lumbar spine bone mineral density].

    Science.gov (United States)

    Zhang, Xiaodong; Zhao, Yinxia; Hu, Shaoyong; Hao, Shuai; Yan, Jiewen; Zhang, Lingyan; Zhao, Jing; Li, Shaolin

    2015-09-01

    To investigate the correlation between the lumbar vertebra bone mineral density (BMD) and age, gender, height, weight, body mass index, waistline, hipline, bone marrow and abdomen fat, and to explore the key factor affecting the BMD. A total of 72 cases were randomly recruited. All the subjects underwent a spectroscopic examination of the third lumber vertebra with single-voxel method in 1.5T MR. Lipid fractions (FF%) were measured. Quantitative CT were also performed to get the BMD of L3 and the corresponding abdomen subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). The statistical analysis were performed by SPSS 19.0. Multiple linear regression showed except the age and FF% showed significant difference (P0.05). The correlation of age and FF% with BMD was statistically negatively significant (r=-0.830, -0.521, P<0.05). The ROC curve analysis showed that the sensitivety and specificity of predicting osteoporosis were 81.8% and 86.9%, with a threshold of 58.5 years old. And it showed that the sensitivety and specificity of predicting osteoporosis were 90.9% and 55.7%, with a threshold of 52.8% for FF%. The lumbar vertebra BMD was significantly and negatively correlated with age and bone marrow FF%, but it was not significantly correlated with gender, height, weight, BMI, waistline, hipline, SAT and VAT. And age was the critical factor.

  5. Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI

    International Nuclear Information System (INIS)

    Knirsch, Walter; Kurtz, Claudia; Langer, Mathias; Haeffner, Nicole; Kececioglu, Deniz

    2005-01-01

    The definition of normal values is a prerequisite for the reliable evaluation of abnormality in the lumbar spine, such as spinal canal stenosis or dural ectasia in patients with Marfan syndrome. Values for vertebral body diameter (VBD) and dural sac diameter (DSD) for the lumbar spine have been published in adults. In children, normal values have been established using conventional radiography or myelography, but not by MRI. To define normal values for the sagittal diameter of the vertebral body and dural sac, and to calculate a dural sac ratio (DSR) in the lumbosacral spine (L1-S1) in healthy children using MRI. A total of 75 healthy children between 6 years and 17 years of age were examined using a sagittal T2-weighted sequence. Sagittal VBD and DSD were measured and a DSR was calculated. This was a retrospective and cross-sectional study. With increasing age there is a significant increase of VBD, a slight increase of DSD, and a slight decrease of DSR. There is no significant sex difference. DSR in healthy children is higher than in healthy adults. MRI is a reliable method demonstrating the natural shape of the lumbosacral spine and its absolute values. These normal values compare well with those established by conventional radiological techniques. Our data may serve as a reference for defining dural ectasia in children with Marfan syndrome. (orig.)

  6. Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Knirsch, Walter [University Children' s Hospital Freiburg, Department of Pediatric Cardiology, Freiburg (Germany); University Children' s Hospital Zurich, Division of Paediatric Cardiology, Zurich (Switzerland); Kurtz, Claudia; Langer, Mathias [University Hospital Freiburg, Department of Radiology, Freiburg (Germany); Haeffner, Nicole; Kececioglu, Deniz [University Children' s Hospital Freiburg, Department of Pediatric Cardiology, Freiburg (Germany)

    2005-04-01

    The definition of normal values is a prerequisite for the reliable evaluation of abnormality in the lumbar spine, such as spinal canal stenosis or dural ectasia in patients with Marfan syndrome. Values for vertebral body diameter (VBD) and dural sac diameter (DSD) for the lumbar spine have been published in adults. In children, normal values have been established using conventional radiography or myelography, but not by MRI. To define normal values for the sagittal diameter of the vertebral body and dural sac, and to calculate a dural sac ratio (DSR) in the lumbosacral spine (L1-S1) in healthy children using MRI. A total of 75 healthy children between 6 years and 17 years of age were examined using a sagittal T2-weighted sequence. Sagittal VBD and DSD were measured and a DSR was calculated. This was a retrospective and cross-sectional study. With increasing age there is a significant increase of VBD, a slight increase of DSD, and a slight decrease of DSR. There is no significant sex difference. DSR in healthy children is higher than in healthy adults. MRI is a reliable method demonstrating the natural shape of the lumbosacral spine and its absolute values. These normal values compare well with those established by conventional radiological techniques. Our data may serve as a reference for defining dural ectasia in children with Marfan syndrome. (orig.)

  7. Comparison of minimally invasive spine surgery using intraoperative computed tomography integrated navigation, fluoroscopy, and conventional open surgery for lumbar spondylolisthesis: a prospective registry-based cohort study.

    Science.gov (United States)

    Wu, Meng-Huang; Dubey, Navneet Kumar; Li, Yen-Yao; Lee, Ching-Yu; Cheng, Chin-Chang; Shi, Chung-Sheng; Huang, Tsung-Jen

    2017-08-01

    To date, the surgical approaches for the treatment of lumbar spondylolisthesis by transforaminal lumbar interbody fusion (TLIF) using minimally invasive spine surgery assisted with intraoperative computed tomography image-integrated navigation (MISS-iCT), fluoroscopy (MISS-FS), and conventional open surgery (OS) are debatable. This study compared TLIF using MISS-iCT, MISS-FS, and OS for treatment of one-level lumbar spondylolisthesis. This is a prospective, registry-based cohort study that compared surgical approaches for patients who underwent surgical treatment for one-level lumbar spondylolisthesis. One hundred twenty-four patients from January 2010 to March 2012 in a medical center were recruited. The outcome measures were clinical assessments, including Short-Form 12, visual analog scale (VAS), Oswestry Disability Index, Core Outcome Measurement Index, and patient satisfaction, and blood loss, hospital stay, operation time, postoperative pedicle screw accuracy, and superior-level facet violation. All surgeries were performed by two senior surgeons together. Ninety-nine patients (40M, 59F) who had at least 2 years' follow-up were divided into three groups according to the operation methods: MISS-iCT (N=24), MISS-FS (N=23), and OS (N=52) groups. Charts and surgical records along with postoperative CT images were assessed. MISS-iCT and MISS-FS demonstrated a significantly lowered blood loss and hospital stay compared with OS group (p2 mm) was found. However, a lower superior-level facet violation rate was observed in the MISS-iCT and OS groups (p=.049). MISS-iCT TLIF demonstrated reduced operation time, blood loss, superior-level facet violation, hospital stay, and improved functional outcomes compared with the MISS-FS and OS approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Lumbar spine radiography--poor collimation practices after implementation of digital technology.

    Science.gov (United States)

    Zetterberg, L G; Espeland, A

    2011-06-01

    The transition from analogue to digital radiography may have reduced the motivation to perform proper collimation, as digital techniques have made it possible to mask areas irradiated outside the area of diagnostic interest (ADI). We examined the hypothesis that collimation practices have deteriorated since digitalisation. After defining the ADI, we compared the proportion of the irradiated field outside the ADI in 86 digital and 86 analogue frontal lumbar spine radiographs using the Mann-Whitney test. 50 digital images and 50 analogue images were from a Norwegian hospital and the remainder from a Danish hospital. Consecutive digital images were compared with analogue images (from the hospitals' archives) produced in the 4 years prior to digitalisation. Both hospitals' standard radiographic procedures remained unchanged during the study. For digital images, the irradiated field was assessed using non-masked raw-data images. The proportion of the irradiated field outside the ADI was larger in digital than in analogue images (mean 61.7% vs 42.4%, p<0.001), and also in a subsample of 39 image pairs that could be matched for patient age (p<0.001). The mean total field size was 46% larger in digital than in analogue images (791 cm(2) vs 541 cm(2)). Following the implementation of digital radiography, considerably larger areas were irradiated. This causes unnecessarily high radiation doses to patients.

  9. Lumbar spine radiography — poor collimation practices after implementation of digital technology

    Science.gov (United States)

    Zetterberg, L G; Espeland, A

    2011-01-01

    Objectives The transition from analogue to digital radiography may have reduced the motivation to perform proper collimation, as digital techniques have made it possible to mask areas irradiated outside the area of diagnostic interest (ADI). We examined the hypothesis that collimation practices have deteriorated since digitalisation. Methods After defining the ADI, we compared the proportion of the irradiated field outside the ADI in 86 digital and 86 analogue frontal lumbar spine radiographs using the Mann–Whitney test. 50 digital images and 50 analogue images were from a Norwegian hospital and the remainder from a Danish hospital. Consecutive digital images were compared with analogue images (from the hospitals' archives) produced in the 4 years prior to digitalisation. Both hospitals' standard radiographic procedures remained unchanged during the study. For digital images, the irradiated field was assessed using non-masked raw-data images. Results The proportion of the irradiated field outside the ADI was larger in digital than in analogue images (mean 61.7% vs 42.4%, p<0.001), and also in a subsample of 39 image pairs that could be matched for patient age (p<0.001). The mean total field size was 46% larger in digital than in analogue images (791 cm2 vs 541 cm2). Conclusion Following the implementation of digital radiography, considerably larger areas were irradiated. This causes unnecessarily high radiation doses to patients. PMID:21606070

  10. Melanotic schwannoma of the lumbar spine: a case report and literature review

    Directory of Open Access Journals (Sweden)

    João Bernardo Sancio Rocha Rodrigues

    2015-06-01

    Full Text Available Schwannomas are benign tumors, usually solitary, encapsulated, slow-growing, which have their origin in differentiated neoplastic Schwann cells with extramedullary intradural usual development related to nerve roots. The melanotic schwannoma is a variant of these tumors whose location in almost one third of cases is on the posterior spinal nerve root, with a nonspecific clinical presentation. Magnetic resonance imaging is the most widely used test for the diagnosis, revealing hyperintense T1-weighted sequences and hypointense T2-weighted sequences. Diagnostic confirmation is obtained by histological and immunohistochemical studies, in which there is intense cytoplasmatic pigmentation. There are two distinct types of melanotic schwannomas: sporadic and psammomatous, the latter related to the called Carney complex, a form of multiple endocrine neoplasm with familiar character. In literature we found few cases of these neoplasms, the largest series consisting of five cases. The objective of this study is to report a rare case of melanotic schwannoma of the lumbar spine of the sporadic type of extramedullary location. We also present a brief review of the literature containing the main characteristics of the tumor, including its different forms, differential diagnoses, data from histological and immunohistochemical studies as well as the currently recommended approach in order to contribute to a better understanding of this neoplasm.

  11. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation.

    Science.gov (United States)

    Magerl, F P

    1984-10-01

    For stabilization of the lower thoracic and lumbar spine, an external spinal skeletal fixation (ESSF) system has been developed and clinically used since 1977. The system consists of two pairs of Schanz screws and an adjustable external fixation device. The Schanz screws are firmly anchored through the pedicles into the vertebral bodies. Application of ESSF offers some unique characteristics beneficial in the treatment of unstable spinal injuries and spinal osteomyelitis. In contrast to other fixation systems, the number of vertebrae immobilized can be reduced with ESSF. Versatility of the system allows application in every type of spinal instability. Stability obtained with ESSF suffices for early mobilization without major external support in every instance. In laboratory investigation, ESSF proved to be more secure than rod distraction systems and plate fixation. Since 1977, 65 patients were treated with ESSF. All 52 patients who were at least one year postsurgery were personally examined. This group included 42 patients with acute spinal trauma and eight patients with spinal osteomyelitis. Results achieved with ESSF have been encouraging, with no serious complications to date. Future modifications of ESSF application could lead to simplification and facilitation of treatment.

  12. Clinical study on treatment of HIVD of lumbar spine using Scolopendrid herbal acupuncture

    Directory of Open Access Journals (Sweden)

    Park, So-Yeong

    2001-12-01

    Full Text Available Objective: This study is performed for the purpose of examining into the efficacy of the scolopendrid(Scolopendra morsitans L which has been used among the Korean people for the H.I.V.D of lumbar spine. Methods & Results: Using the herbal acupuncture made of scolopendrid(Scolopendra morsitans L, we treated the 10 H.l. V.D patients for 1 week and operated 4 pre and post treatment test ; D.I.T.I, 6 kind of physical test, Oswestry disability index, and self-conscious pain rate. Trough Lite test, we saw 50-100% of efficacy rate in each test. Otherwise, only 5 of the 7 point in D.I.T.I and self-conscious pain rate showed statistically valuable change. Conclusion: we brought to the conclusion that the scolopendrid herbal acupuncture has possibility to be efficient to cure the H.I.V.D patients. So we suggest the possibility to use this new remedy for the H.I.V.D.

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

    Directory of Open Access Journals (Sweden)

    Suhail Ur Rehman

    2017-05-01

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

  14. Musculoskeletal modelling of the lumbar spine to explore functional interactions between back muscle loads and intervertebral disc multiphysics

    Directory of Open Access Journals (Sweden)

    Themis eToumanidou

    2015-08-01

    Full Text Available During daily activities, complex biomechanical interactions influence the biophysical regulation of intervertebral discs (IVDs, and transfers of mechanical loads are largely controlled by the stabilizing action of spine muscles. Muscle and other internal forces cannot be easily measured directly in the lumbar spine. Hence, biomechanical models are important tools for the evaluation of the loads in those tissues involved in low back disorders. Muscle force estimations in most musculoskeletal models mainly rely, however, on inverse calculations and static optimizations that limit the predictive power of the numerical calculations. In order to contribute to the development of predictive systems, we coupled a predictive muscle model with the passive resistance of the spine tissues, in a L3-S1 musculoskeletal finite element model with osmo-poromechanical IVD descriptions. The model included 46 fascicles of the major back muscles that act on the lower spine. The muscle model interacted with activity-related loads imposed to the osteoligamentous structure, as standing position and night rest were simulated through distributed upper body mass and free IVD swelling, respectively. Calculations led to intradiscal pressure values within ranges of values measured in vivo. Disc swelling led to muscle activation and muscle force distributions that seemed particularly appropriate to counterbalance the anterior body mass effect in standing. Our simulations pointed out a likely existence of a functional balance between stretch-induced muscle activation and IVD multiphysics towards improved mechanical stability of the lumbar spine under standing. This balance suggests that proper night rest contributes to mechanically strengthen the spine during day activity.

  15. DESCRIPTIVE STUDY ON SAGITTAL LUMBAR SPINE CHANGES IN STUDENTS OF THE FEDERAL EDUCATIONAL SYSTEM OF FLORIANÓPOLIS.

    Science.gov (United States)

    Group, Susane; Santos, Saray Giovana Dos; Moro, Antônio Renato Pereira

    2010-01-01

    The purpose of this study was to assess the prevalence of sagittal lumbar spine postural abnormalities and associated factors among students in the federal educational system in Florianópolis. 288 adolescents (156 males and 132 females), aged from 15 to 18 years, who were students in the federal educational system in Florianópolis, Santa Catarina, were evaluated. To gather data, photogrammetry was used following a specific protocol for postural assessment, and a questionnaire was used to identify the prevalence and frequency of pain, and the activities that triggered the problem. In the data analysis, descriptive statistics, Student's t-test for independent samples, chi-square test and Poisson's regression were used, with the significance level set at p<0.05 for all the tests. The prevalence of low back pain was 49.3%, with weekly frequency in 43.1% of the sample. The prevalence of deviation was 53.8%, and 90.9% corresponded to rectification of lumbar curvature, and this affected males more frequently. A significant difference in lumbar angle was found between the sexes; higher prevalence ratios of postural deviations were found in the male group. The prevalences of low back pain and lumbar postural deviation were high, but the relationship between these variables did not present significance. The main causes of the lumbar pain were sports practice or vigorous activities and remaining in a seated position for extended periods of time.

  16. [Giant cell tumor of the lumbar spine. Case report and review of the literature].

    Science.gov (United States)

    Zabalo, Gorka; Ortega, Rodrigo; Vázquez, Alfonso; Carballares, Ianire; Díaz, Jorge; Portillo, Eduardo

    2015-01-01

    We report the case of a 32-year-old patient complaining of chronic low back pain radiating to his left thigh. His MRI showed a lytic L1 vertebral body injury. A transpedicular biopsy confirmed the diagnosis of giant cell tumor. He underwent a L1 vertebrectomy and vertebral body replacement with a titanium cylinder using anterior approach, followed by the removal of the L1 posterior arch and the placement of pedicle screws through a posterior approach. The giant cell tumor is a rare benign primary bone tumor that can be locally aggressive and can potentially spread to other areas, usually to the lungs. Although it most frequently affects long bones, approximately 10% of tumors are located in the spine. To minimise the risk of recurrence, the elective management option is surgery. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  17. Bone mineral density in the lumbar spine as determined by dual-energy X-ray absorptiometry. Comparison of whole-body scans and dedicated regional scans

    Energy Technology Data Exchange (ETDEWEB)

    Nysom, K. [Section for Pediatric Haematology and Oncology, Copenhagen Univ. Hospital (Denmark); Moelgaard, C.; Fleischer Michaelsen, K. [Research Dept. of Human Nutrition, Royal Veterinary and Agricultural Univ., Fredriksberg (Denmark)]|[Centre for Advanced Food Studies, Royal Veterinary and Agricultural Univ., Fredriksberg (Denmark)

    1998-11-01

    Purpose: To compare bone mineral in the lumbar spine as measured by either consecutive regional or whole-body dual-energy X-ray absorptiometry (DXA), and to develop models that predict regional results from whole-body results. Material and Methods: In 180 children and young adults, bone mineral in the lumbar spine was measured by a Hologic QDR-1000/W DXA scanner, using either whole-body software (which can give data for the lumbar spine subregion) or dedicated lumbar spine software. Data on 139 persons were used to compare the two methods and to develop models that predict the result of a regional scan from the result of a whole-body scan. Data on the remaining 41 persons were used to control these models. Results: Bone mineral content, bone area, and bone mineral areal density (BMD{sub A}) of the lumbar spine were measured significantly lower by whole-body scans than by regional scans (p<0.0001). The difference was larger for the lower values of bone area and BMD{sub A}. We developed models that predicted lumbar spine BMD{sub A} from whole-body results. When these models were controlled in another group, the mean error between the methods was non-significant and the error was unrelated to the BMD{sub A} value. However, the variance of the error was only minimally reduced. Conclusions: Lumbar spine bone mineral was measured significantly lower by whole-body DXA than by regional DXA. Based on local data, models were developed that removed the significant difference between the methods. (orig.)

  18. An investigation of jogging biomechanics using the full-body lumbar spine model: Model development and validation.

    Science.gov (United States)

    Raabe, Margaret E; Chaudhari, Ajit M W

    2016-05-03

    The ability of a biomechanical simulation to produce results that can translate to real-life situations is largely dependent on the physiological accuracy of the musculoskeletal model. There are a limited number of freely-available, full-body models that exist in OpenSim, and those that do exist are very limited in terms of trunk musculature and degrees of freedom in the spine. Properly modeling the motion and musculature of the trunk is necessary to most accurately estimate lower extremity and spinal loading. The objective of this study was to develop and validate a more physiologically accurate OpenSim full-body model. By building upon three previously developed OpenSim models, the full-body lumbar spine (FBLS) model, comprised of 21 segments, 30 degrees-of-freedom, and 324 musculotendon actuators, was developed. The five lumbar vertebrae were modeled as individual bodies, and coupled constraints were implemented to describe the net motion of the spine. The eight major muscle groups of the lumbar spine were modeled (rectus abdominis, external and internal obliques, erector spinae, multifidus, quadratus lumborum, psoas major, and latissimus dorsi), and many of these muscle groups were modeled as multiple fascicles allowing the large muscles to act in multiple directions. The resulting FBLS model׳s trunk muscle geometry, maximal isometric joint moments, and simulated muscle activations compare well to experimental data. The FBLS model will be made freely available (https://simtk.org/home/fullbodylumbar) for others to perform additional analyses and develop simulations investigating full-body dynamics and contributions of the trunk muscles to dynamic tasks. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. A new classification system for degenerative spondylolisthesis of the lumbar spine.

    Science.gov (United States)

    Gille, Olivier; Bouloussa, Houssam; Mazas, Simon; Vergari, Claudio; Challier, Vincent; Vital, Jean-Marc; Coudert, Pierre; Ghailane, Soufiane

    2017-12-01

    There is no consensus for a comprehensive analysis of degenerative spondylolisthesis of the lumbar spine (DSLS). A new classification system for DSLS based on sagittal alignment was proposed. Its clinical relevance was explored. Health-related quality-of-life scales (HRQOLs) and clinical parameters were collected: SF-12, ODI, and low back and leg pain visual analog scales (BP-VAS, LP-VAS). Radiographic analysis included Meyerding grading and sagittal parameters: segmental lordosis (SL), L1-S1 lumbar lordosis (LL), T1-T12 thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Patients were classified according to three main types-1A: preserved LL and SL; 1B: preserved LL and reduced SL (≤5°); 2A: PI-LL ≥10° without pelvic compensation (PT < 25°); 2B: PI-LL ≥10° with pelvic compensation (PT ≥ 25°); type 3: global sagittal malalignment (SVA ≥40 mm). 166 patients (119 F: 47 M) suffering from DSLS were included. Mean age was 67.1 ± 11 years. DSLS demographics were, respectively: type 1A: 73 patients, type 1B: 3, type 2A: 8, type 2B: 22, and type 3: 60. Meyerding grading was: grade 1 (n = 124); grade 2 (n = 24). Affected levels were: L4-L5 (n = 121), L3-L4 (n = 34), L2-L3 (n = 6), and L5-S1 (n = 5). Mean sagittal parameter values were: PI: 59.3° ± 11.9°; PT: 24.3° ± 7.6°; SVA: 29.1 ± 42.2 mm; SL: 18.2° ± 8.1°. DSLS types were correlated with age, ODI and SF-12 PCS (ρ = 0.34, p < 0.05; ρ = 0.33, p < 0.05; ρ = -0.20, and p = 0.01, respectively). This classification was consistent with age and HRQOLs and could be a preoperative assessment tool. Its therapeutic impact has yet to be validated. 4.

  20. Effects of spine loading in a patient with post-decompression lumbar disc herniation: observations using an open weight-bearing MRI.

    Science.gov (United States)

    Mahato, Niladri Kumar; Sybert, Daryl; Law, Tim; Clark, Brian

    2017-05-01

    Our objective was to use an open weight-bearing MRI to identify the effects of different loading conditions on the inter-vertebral anatomy of the lumbar spine in a post-discectomy recurrent lumbar disc herniation patient. A 43-year-old male with a left-sided L5-S1 post-decompression re-herniation underwent MR imaging in three spine-loading conditions: (1) supine, (2) weight-bearing on standing (WB), and (3) WB with 10 % of body mass axial loading (WB + AL) (5 % through each shoulder). A segmentation-based proprietary software was used to calculate and compare linear dimensions, angles and cross sections across the lumbar spine. The L5 vertebrae showed a 4.6 mm posterior shift at L5-S1 in the supine position that changed to an anterior translation >2.0 mm on WB. The spinal canal sagittal thickness at L5-S1 reduced from supine to WB and WB + AL (13.4, 10.6, 9.5 mm) with corresponding increases of 2.4 and 3.5 mm in the L5-S1 disc protrusion with WB and WB + AL, respectively. Change from supine to WB and WB + AL altered the L5-S1 disc heights (10.2, 8.6, 7.0 mm), left L5-S1 foramen heights (12.9, 11.8, 10.9 mm), L5-S1 segmental angles (10.3°, 2.8°, 4.3°), sacral angles (38.5°, 38.3°, 40.3°), L1-L3-L5 angles (161.4°, 157.1°, 155.1°), and the dural sac cross sectional areas (149, 130, 131 mm 2 ). Notably, the adjacent L4-L5 segment demonstrated a retro-listhesis >2.3 mm on WB. We observed that with weight-bearing, measurements indicative of spinal canal narrowing could be detected. These findings suggest that further research is warranted to determine the potential utility of weight-bearing MRI in clinical decision-making.

  1. The lumbar spine age-related degenerative disease influences the BMD not the TBS: the Osteolaus cohort.

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    Padlina, I; Gonzalez-Rodriguez, E; Hans, D; Metzger, M; Stoll, D; Aubry-Rozier, B; Lamy, O

    2017-03-01

    We evaluated the influence of degenerative disease and fractured vertebra on lumbar spine bone mineral density (BMD) and trabecular bone score (TBS) in 1500 women aged 50-80 years. TBS was not affected by a degenerative disease. While BMD increases after 62.5 years, TBS continues to decline. TBS should play a leading role in lumbar spine evaluation. After menopause, lumbar spine (LS) BMD and TBS values decrease. Degenerative disease (DD) increases with age and affect LS BMD. The aim of this study was to measure changes in LS BMD and TBS in women 50 to 80 years old, taking into account the impact of fractured vertebrae and DD. LS BMD, TBS, and vertebral fracture assessment were evaluated in the OsteoLaus cohort (1500 women, 50-80 years old). The exams were analyzed following ISCD guidelines to identify vertebrae with fractures or DD (Vex). 1443 women were enrolled: mean age 66.7 ± 11.7 years, BMI 25.7 ± 4.4. LS BMD and TBS were weakly correlated (r2 = 0.16). The correlation (Vex excluded) between age and BMD was +0.03, between age and TBS -0.34. According to age group, LS BMD was 1.2 to 3.2% higher before excluding Vex (p < 0.001). TBS had an insignificant change of <1% after excluding Vex. LS BMD (Vex) decreased by 4.6% between 52.5 and 62.5 years, and increased by 2.6% between 62.5 and 77.5 years. TBS (Vex excluded) values decreased steadily with age with an overall loss of 8.99% between 52.5 and 77.5 years. Spine TBS, femoral neck, and total hip BMD gradually decreased with age, reaching one SD between the oldest and youngest group. TBS is not affected by DD. While BMD increases after 62.5 years, TBS continues to decline. For lumbar spine evaluation, in view of its independence from DD, TBS should play a leading role in the diagnosis in complement to BMD.

  2. Comparative analysis of morphological and topometric parameters of lumbar spine in normal state and in degenerative-dystrophic changes

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    Anisimova Е.А.

    2015-12-01

    Full Text Available Objective: to carry out comparative analysis and identify patterns of topographic variation patterns of lumbar spine in normal and degenerative changes. Material and methods. CT- and MRT-grams for men and women I (M1-22-35 years; W — 21-35 years and II (M2-36-60 years; W2-36-55 years periods of mature age with no signs of trauma, scoliosis and systemic diseases of the spine (n=140 and CT- and MRT-grams in patients with revealed degenerative changes in the lumbar spine degree II-III (n=120. The pictures with digital PACS system measure the height of the vertebral body, intervertebral disc height, vertical, horizontal diameter and the area of intervertebral foramen. Results. The height of the lumbar vertebral bodies normally increased from27,90±0,38mmatthe level of L, to 29,93±0,33 mm Lm, and then decreased to 24,35±0,27 mm at level L^, in osteochondrosis it is statistically significantly lower at all levels on average by 20%. The height of the intervertebral disc with osteochondrosis below at all levels by an average of 25% of its value in the range 5,27±0,19 to 6,13±0,17mm, while the normal disc height varies from 6,88±030 to 9,36±0,28mm. The area of intervertebral holes normally ranging from 103,29±5,78 to 127,99±5,92mm2, with osteochondrosis aperture area is reduced to a greater extent by decreasing the vertical diameter in comparison with the horizontal. Conclusion. For the studied parameters characteristic topographic variability has been determined. The maximum values parameters are marked at the top of the lumbar lordosis, at chest height, lumbar and lumbosacral junctions sizes are reduced. In osteochondrosis the intervertebral disc height and the height of lumbar vertebral bodies are reduced; intervertebral foramina area is also reduced to a greater extent by reducing the vertical diameter than the horizontal one.

  3. Charcot arthropathy of the lumbar spine treated using one-staged posterior three-column shortening and fusion.

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    David, Kenny Samuel; Agarwala, Amit Omprakash; Rampersaud, Yoga Raja

    2010-06-15

    Case report. We present a case of lumbar Charcot arthropathy successfully treated surgically using posterior 3-column resection, spinal shortening, and fusion. The operative treatment of Charcot arthropathy of the spine has conventionally been a combination of anterior and posterior surgery. The morbidity associated with these surgical procedures can be considerable. A posterior-only approach to the problem would avoid the additional morbidity associated with an anterior approach. We present a case of lumbar Charcot arthropathy with deformity treated successfully using such a procedure. Discussion of the patient's clinical and radiologic history, the technical merits of the operative intervention and a review of the relevant background literature are presented. A multilevel, single-stage, posterior 3-column resection with primary shortening and instrumented fusion augmented with rhBMP2 in a multiply operated patient with deformity provided a optimal biologic and mechanical environment for healing of the Charcot arthropathy and improved the sagittal and coronal profile of the spine. A single-stage, multilevel, posterior 3-column resection and primary shortening can be a useful surgical strategy in symptomatic patients with Charcot arthropathy of the spine.

  4. [Impact of obesity in the pathophysiology of degenerative disk disease and in the morbidity and outcome of lumbar spine surgery].

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    Delgado-López, Pedro David; Castilla-Díez, José Manuel

    Obesity (BMI>30Kg/m 2 ) is a pandemic with severe medical and financial implications. There is growing evidence that relates certain metabolic processes within the adipose tissue, preferentially abdominal fat, with a low-intensity chronic inflammatory state mediated by adipokines and other substances that favor disk disease and chronic low back pain. Obesity greatly conditions both the preoperative evaluation and the spinal surgical technique itself. Some meta-analyses have confirmed an increase of complications following lumbar spine surgery (mainly infections and venous thrombosis) in obese subjects. However, functional outcomes after lumbar spine surgery are favorable although inferior to the non-obese population, acknowledging that obese patients present with worse baseline function levels and the prognosis of conservatively treated obese cohorts is much worse. The impact of preoperative weight loss in spine surgery has not been prospectively studied in these patients. Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Effects of Teriparatide and Sequential Minodronate on Lumbar Spine Bone Mineral Density and Microarchitecture in Osteoporosis.

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    Miyaoka, Daichi; Imanishi, Yasuo; Ohara, Masaya; Hayashi, Noriyuki; Nagata, Yuki; Yamada, Shinsuke; Mori, Katsuhito; Emoto, Masanori; Inaba, Masaaki

    2017-10-01

    The trabecular bone score (TBS) is a new surrogate for trabecular bone microarchitecture assessment, independent of bone mineral density (BMD), calculated from pixel gray-level variations in the lumbar spine (LS) dual-energy X-ray absorptiometry (DXA) image. Although Teriparatide (TPTD) increased LS-BMD as well as TBS in 2 years, the precise time-course of these parameters was not well known. The aim of this study was to determine the changes in LS-BMD and the TBS in osteoporotic patients treated with TPTD, followed by minodronate (MINO). Primary osteoporotic patients with a low LS-BMD (T-score < -2.5) and/or at least one vertebral fracture were treated with TPTD subcutaneously at 20 µg/day for 12-24 months, followed by MINO (orally at 50 mg/once monthly) for 12 months. LS-BMD and the TBS were measured at 0, 3, 6, 12, and 24 months after the initiation of TPTD treatment, and 12 months after the initiation of MINO. The increments of LS-BMD, significant at 6 months, increased until 12 months, whereas the increments of TBS, significant at 3 months (0.035 ± 0.011; p = 0.045 vs. the baseline), stabilized until 12 months. TPTD treatment, followed by 12 months of MINO, maintained both BMD and the TBS. Comparing the increments of the TBS to those of LS-BMD, our results indicate that TPTD treatment improved trabecular microarchitecture faster than mineralization. TPTD treatment, followed by MINO, can maintain both BMD and the TBS.

  6. Radiation doses of patients undergoing abdomen, pelvis and lumbar spine x-ray examinations in Nigeria

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    Ogundare, F.O.; Uche, C.Z.; Balogun, F.A.

    2003-01-01

    Full text: Thermoluminescence dosemeters (TLD) have been used to measure the entrance surface doses (ESD) of patients undergoing diagnostic x-ray examinations in Pelvis, Abdomen and Lumbar Spine in Nigeria. A total of 4 randomly selected public hospitals and 240 patients were included in this investigation. Age of the patients used is from 45 years and above. Mean, median, first and third quartiles of ESDs are reported. The results showed that in most cases, for each of the examinations, the mean ESDs are higher than the published reference doses and their corresponding values from other countries. Nevertheless the ESD of each of the patients fall within the ranges of ESDs that have been reported from other countries as quoted by UNSCEAR. The distribution of the ESDs was also found to be negatively skewed. This suggests that radiographic departments need to review their radiographic practices in order to bring their doses to optimum levels. Effective doses were also calculated from the ESD values. The importance of good regulatory activities and trained personnel is stressed in this work It is therefore suggested that further dose reduction program, while still having in focus ways of optimizing the various radiological parameters in order for patient to receive least dose and the radiologist having an acceptable image, should include emphasis on good regulatory control and use of well-trained personnel. Apart from the fact that the data provided in this work will be useful for the formulation of national guidance levels, it also provides patient dosimetry information on healthcare level IV countries

  7. Prediction of lumbar spine bone mineral density from the mandibular cortical width in postmenopausal women

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    Ehsan Hekmatin

    2013-01-01

    Full Text Available Background: Osteoporosis is one of the most common bone diseases that is characterized by a generalized reduction of the bone mass. Osteoporotic fractures are associated with morbidity, but can be a predictable condition if early diagnosis is made.The diagnosis is based on the World Health Organization′s (WHO T-score criteria. Panoramic images have been also used to predict low bone mineral density. The aim of the study was to evaluate the prediction of lumbar spine bone mineral density (BMD from the mandibular cortical width in postmenopausal women. Materials and Methods: On the panoramic radiographic images, the mandibular cortical width (MCW was measured by drawing a line parallel to the long axis of the mandible and another line tangential to the inferior border of mandible and a constructed line perpendicular to the tangent intersecting inferior border of mental foramen and analyzed the correlation of recorded MCW with BMD and T-score by using SPSS software and linear regression and bivariate correlation tests. Results: Bivariate correlation showed a significant correlation between BMD and MCW (r = 0.945 (P = 0. 000. There was also a significant correlation between T-score and MCW(r = 0.835 (P = 0. 000. To detect the accurate association between the BMD and MCW and also T-score and MCW, linear regression analyses tests showed two associations to predict the BMD and T-score from MCW with confidence interval of 95%. These associations were as follows: T-score= −7.087 + 1.497 Χ MCW BMD= 0.334 + 0.163 Χ MCW. Conclusion: The MCW is a good index to help the dentists to predict the osteoporosis by panoramic radiographs and have a significant role in patient screening and early diagnosis of osteoporosis.

  8. Measurement Properties of the Brazilian-Portuguese Version of the Lumbar Spine Instability Questionnaire.

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    Araujo, Amanda Costa; da Cunha Menezes Costa, Lucíola; de Oliveira, Crystian Bittencourt Soares; Morelhão, Priscila Kalil; de Faria Negrão Filho, Rúben; Pinto, Rafael Zambelli; Costa, Leonardo Oliveira Pena

    2017-07-01

    Cross-cultural adaptation and analysis of measurement properties. To translate and cross-culturally adapt the Lumbar Spine Instability Questionnaire (LSIQ) into Brazilian-Portuguese and to test its measurement properties in Brazilian patients with low back pain. The selection of subgroup of patients that respond better to specific interventions is the top research priority in the field of back pain. The LSIQ is a tool able to stratify patients with low back pain who responds better to motor control exercises. There is no Brazilian-Portuguese version of the LSIQ available. The original version of the LSIQ was translated and cross-culturally adapted. We collected data from 100 patients with low back pain. In addition to LSIQ, we also collected information about physical activity levels (measured by the International Physical Activity Questionnaire short version), disability (measured by the Roland Morris Disability Questionnaire), pain intensity (measured by the Pain numerical Rating Scale), kinesiophobia (measured by the Tampa Scale of Kinesiophobia), and depression (measured by the Beck Depression Inventory). The measurement properties tested were internal consistency, reproducibility (reliability and agreement), construct validity, and ceiling and floor effects. The Brazilian-Portuguese version of the LSIQ showed good measurement properties with a Cronbach alpha of 0.79, an intraclass correlation coefficient of 0.75, a standard error of measurement of 1.65 points, and a minimal detectable change of 3.54 points. We did not detect ceiling and floor effects. The construct validity analysis was observed a moderate correlation between the LSIQ and Pain Numerical Rating Scale r = 0.46, Roland Morris Disability Questionnaire r = 0.66, Tampa Scale of Kinesiophobia r = 0.49, and Beck Depression Inventory r = 0.44. The Brazilian-Portuguese version of LIQ has adequate measurement properties and can be used in clinical practice and research. NA.

  9. Thoracolumbar kyphoscoliosis with unilateral subluxation of the spine and postoperative lumbar spondylolisthesis in Hunter syndrome.

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    Roberts, Simon B; Tsirikos, Athanasios I

    2016-03-01

    Surgical correction for kyphoscoliosis is increasingly being performed for patients with mucopolysaccharidosis (MPS). Reported case series have predominantly included patients with Type I (Hurler) and Type IV (Morquio) MPS. To their knowledge, the authors describe the first case report of surgical management of thoracolumbar kyphoscoliosis in Hunter syndrome (MPS Type II) and the rare occurrence of lumbar spondylolisthesis following surgical stabilization. A 12-year-old boy with Hunter syndrome presented with severe thoracolumbar kyphoscoliosis and no associated symptoms. Spinal radiographs demonstrated kyphosis of 48° (T11-L3) and scoliosis of 22° (T11-L3) with an anteriorly hypoplastic L-1 vertebra. The deformity progressed to kyphosis of 60° and scoliosis of 42° prior to surgical intervention. Spinal CT scans identified left T12-L1 facet subluxation, causing anterior rotatory displacement of the spine proximal to L-1 and bilateral L-5 isthmic spondylolysis with no spondylolisthesis. A combined single-stage anterior and posterior instrumented spinal arthrodesis from T-9 to L-4 was performed. Kyphosis and scoliosis were corrected to 4° and 0°, respectively. Prolonged ventilator support and nasogastric feedings were required for 3 months postoperatively. At 2.5 years following surgery, the patient was asymptomatic, mobilizing independently, and had achieved a solid spinal fusion. However, he had also developed a Grade II spondylolisthesis at L4-5; this was managed nonoperatively in the absence of symptoms or further deterioration of the spondylolisthesis to the 3.5-year postoperative follow-up visit. Satisfactory correction of thoracolumbar kyphoscoliosis in Hunter syndrome can be achieved by combined anterior/posterior instrumented arthrodesis. The risk of developing deformity or instability in motion segments adjacent to an instrumented fusion may be greater in patients with MPS related to the underlying connective tissue disorder.

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

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

    2016-09-01

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

  11. Metastatic tumor of thoracic and lumbar spine: prospective study comparing the surgery and radiotherapy vs external immobilization with radiotherapy

    International Nuclear Information System (INIS)

    Falavigna, Asdrubal; Ioppi, Ana Elisa Empinotti; Grasselli, Juliana

    2007-01-01

    Bone metastases at the thoracic and lumbar segment of the spine are usually presented with painful sensation and medullar compression. The treatment is based on the clinical and neurological conditions of the patient and the degree of tumor invasion. In the present study, 32 patients with spinal metastasis of thoracic and lumbar segment were prospectively analyzed. These patients were treated by decompression and internal stabilization followed by radiotherapy or irradiation with external immobilization. The election of the groups was in accordance with the tumor radiotherapy sensitivity, clinical conditions, spinal stability, medullar or nerve compression and patient's decision. The Frankel scale and pain visual test were applied at the moment of diagnosis and after 1 and 6 months. The surgical group had better results with preserving the ambulation longer and significant reduction of pain.(author)

  12. Revision of the failed pedicle screw in osteoporotic lumbar spine: biomechanical comparison of kyphoplasty versus transpedicular polymethylmethacrylate augmentation.

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    Derinçek, Alihan; Türker, Mehmet; Cinar, Murat; Cetik, Ozgür; Kalaycioğlu, Bariş

    2012-01-01

    In this study, we aimed to compare of kyphoplasty versus transpedicular polymethylmethacrylate (PMMA) augmentation biomechanically in the revision of the failed pedicle screw in osteoporotic lumbar spine. Bone mineral density (BMD) of lumbar vertebrae collected from four bovines were measured. Each vertebra was decalcified with hydrochloric acid solution to obtain osteoporotic specimens. Primary polyaxial pedicle screws were inserted into the pedicles and pulled out until they failed. The pullout strength results of all specimens were recorded. Revision pedicle screws were randomly inserted into the same pedicles by either pedicle hole PMMA augmented (group 1) or kyphoplasty (Xvoid™) PMMA augmented pedicle screws (group 2). The pullout strength results of all specimens were re-recorded. The mean BMD significantly decreased from 1.686 ± 227.9 g/cm(2) to 1.432 ± 157.1 g/cm(2) following decalcification (posteoporotic bone, kyphoplasty augmented pedicle screw seems to be more effective method increasing the pullout strength.

  13. Impact of preoperative diagnosis on patient satisfaction following lumbar spine surgery.

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    Crawford, Charles H; Carreon, Leah Y; Bydon, Mohamad; Asher, Anthony L; Glassman, Steven D

    2017-06-01

    OBJECTIVE Patient satisfaction is a commonly used metric in the current health care environment. While factors that affect patient satisfaction following spine surgery are complex, the authors of this study hypothesized that specific diagnostic groups of patients are more likely to be satisfied after spine surgery and that this is reflected in patient-reported outcome measures. The purpose of this study was to determine if the preoperative diagnosis-disc herniation, stenosis, spondylolisthesis, adjacent segment degeneration, or mechanical disc collapse-would impact patient satisfaction following surgery. METHODS Patients enrolled in the Quality Outcomes Database, formerly known as the National Neurosurgery Quality and Outcomes Database (N 2 QOD), completed patient-reported outcome measures, including the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for back pain (NRS-BP) and leg pain (NRS-LP) preoperatively and 1-year postoperatively. Patients were stratified by diagnosis and by their response to the satisfaction question: 1) surgery met my expectations; 2) I did not improve as much as I hoped, but I would undergo the same operation for the same results; 3) surgery helped, but I would not undergo the same operation for the same results; or 4) I am the same or worse as compared with before surgery. RESULTS A greater proportion of patients with primary disc herniation or spondylolisthesis reported that surgery met expectations (66% and 67%, respectively), followed by recurrent disc herniation and stenosis (59% and 60%, respectively). A smaller proportion of patients who underwent surgery for adjacent segment degeneration or mechanical disc collapse had their expectations met (48% and 41%, respectively). The percentage of patients that would undergo the same surgery again, by diagnostic group, was as follows: disc herniation 88%, recurrent disc herniation 79%, spondylolisthesis 86%, stenosis 82%, adjacent segment disease 75%, and mechanical collapse

  14. Treatment of nocturnal leg cramps by blockade of the medial branch of the deep peroneal nerve after lumbar spine surgery

    Science.gov (United States)

    Imura, Takayuki; Inoue, Gen; Nakazawa, Toshiyuki; Miyagi, Masayuki; Saito, Wataru; Uchida, Kentaro; Namba, Takanori; Shirasawa, Eiki; Takahira, Naonobu; Takaso, Masashi

    2015-01-01

    Introduction Patients with lumbar spine disease sometimes complain of nocturnal leg cramps. We sought to investigate the effectiveness of blocking the medial branch of the deep peroneal nerve as treatment for nocturnal leg cramps after spinal surgery for lumbar spine disease. Methods We evaluated 66 postoperative patients in this prospective comparative study of a group of patients with a nerve block (n = 41) and a control group without (n = 25). In the block group, the medial branch of the deep peroneal nerve was blocked at the distal two-thirds of the interspace between the first and second metatarsals using 5.0 mL of 1.0% lidocaine. Results Two weeks after the block, the frequency of nocturnal leg cramps was reduced to less than a quarter of pretreatment baseline frequency in 61.0% of patients (n = 25) and less than half in 80.5% (n = 33). In the control group, the frequency of the leg cramps was reduced from baseline in 32.0% of patients (n = 8), and was unchanged or increased in 68.0% (n = 17) at 2 weeks. Cramp frequency was reduced to less than a quarter or less than half of baseline frequency in a significantly (P cramp was less in about two-thirds of patients (63.4%; n = 26) in the block group and was unchanged in one-third (31.7%; n = 13). Conclusions Blocking the medial branch of the peroneal nerve can be an effective, long-lasting, and simple treatment with low risk for nocturnal cramps sustained after lumbar spine surgery. PMID:26445706

  15. Comparative study of the results of heel ultrasound screening and DXA findings (lumbar spine and left hip of postmenopausal women

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    Amila Jaganjac

    2012-04-01

    Full Text Available Introduction: Osteoporosis is a silent and invisible disease of bone, great presence and is considered to suffer from osteoporosis at least 200 million women worldwide. The goal of this paper is to show average ageof postmenopausal respondents, values of anthropometric parameters (weight, height, BMI, anamnestic data on clinical symptoms, fractures of women in menopause, analysis of heel ultrasound screening results,analysis of lumbar spine DXA results, analysis of left hip DXA results.Methods: In retrospective study 61 respondents were involved, 33 to 79 years old, treated in u Center for Physical Medicine and Acupuncture “AD” in Sarajevo during the period from 01.01.2008 till 31.12.2009. Alldate are shown numerically and percentage account with calculation of mean value, expressed in the form of tables and charts.Results: Finding of heel ultrosound screening compared to T values of postmenopausal respondents indicates on osteoporosis in case of 17 (27,87%, in case of 44 (72,13% respondents osteopenia, while normalvalues were not found. T value with lumbar spine DXA method in postmenopausal female respondents correspond to 43 (70,5% respondents, in 15 respondents (24,6% finding corresponded to osteopenia, while 3 respondents (4,9% had physiological finding. Left hip DXA finding shows 36 (59% respondents corresponded osteoporosis, 19 (31,2% respondents corresponded osteopenia, while physiological finding was found in 6 respondents (9,8%. T value of lumbar spine DXA finding was - 2,71 ± 1,16; DXA finding of left hip -2,35 ±1,36; heel ultrasound screening -2,19 ± 0,54.Conclusion: Research results indicate that DXA finding in relation to the heel ultrasound screening confirms gold standard in diagnosing osteoporosis.

  16. Cognitive-Behavioral-Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial.

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    Archer, Kristin R; Devin, Clinton J; Vanston, Susan W; Koyama, Tatsuki; Phillips, Sharon E; George, Steven Z; McGirt, Matthew J; Spengler, Dan M; Aaronson, Oran S; Cheng, Joseph S; Wegener, Stephen T

    2016-01-01

    The purpose of this study was to determine the efficacy of a cognitive-behavioral-based physical therapy (CBPT) program for improving outcomes in patients after lumbar spine surgery. A randomized controlled trial was conducted on 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an education program occurred at 6 weeks after surgery. Assessments were completed pretreatment, posttreatment and at 3-month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10-Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared with the education group at the 3-month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at risk for poor recovery after spine surgery. This study investigated a targeted cognitive-behavioral-based physical therapy program for patients after lumbar spine surgery. Findings lend support to the hypothesis that incorporating cognitive-behavioral strategies into postoperative physical therapy may address psychosocial risk factors and improve pain, disability, general health, and physical performance outcomes. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  17. The Effect of Single-Level Disc Degeneration on Dynamic Response of the Whole Lumbar Spine to Vertical Vibration.

    Science.gov (United States)

    Guo, Li-Xin; Fan, Wei

    2017-09-01

    The objective of this study was to investigate the effect of single-level disc degeneration on dynamic response of the whole lumbar spine to vertical whole body vibration that is typically present when driving vehicles. Ligamentous finite element models of the lumbar L1-S1 motion segment in different grades of degeneration (healthy, mild, and moderate) at the L4-L5 level were developed with consideration of changing disc height and material properties of the nucleus pulpous. All models were loaded with a compressive follower preload of 400 N and a sinusoidal vertical vibration load of ±40 N. After transient dynamic analyses, computational results for the 3 models in terms of disc bulge, von-Mises stress in annulus ground substance, and nucleus pressure were plotted as a function of time and compared. All the predicted results showed a cyclic response with time. At the degenerated L4-L5 disc level, as degeneration progressed, maximum value of the predicted response showed a decrease in disc bulge and von-Mises stress in annulus ground substance but a slight increase in nucleus pressure, and their vibration amplitudes were all decreased. At the adjacent levels of the degenerated disc, there was a slight decrease in maximum value and vibration amplitude of these predicted responses with the degeneration. The results indicated that single-level disc degeneration can alter vibration characteristics of the whole lumbar spine especially for the degenerated disc level, and increasing the degeneration did not deteriorate the effect of vertical vibration on the spine. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. MRI of the lumbar spine at 7 Tesla in healthy volunteers and a patient with congenital malformations.

    Science.gov (United States)

    Grams, Astrid E; Kraff, Oliver; Umutlu, Lale; Maderwald, Stefan; Dammann, Philipp; Ladd, Mark E; Forsting, Michael; Gizewski, Elke R

    2012-05-01

    The aim of this study was to evaluate sequences that are established at lower magnetic field strengths for lumbar spine imaging at 7 Tesla (7 T) MR imaging. The lumbar spine of five healthy volunteers and a patient with spina bifida and meningocele were evaluated at 7 T. The examination included a T2-TSE (turbo spin echo), a 3D-DESS (double-echo steady-state sequence), a 3D-CISS (constructive interference in steady-state sequence), and a 3D-VIBE (volumetric interpolated breath hold examination) sequence. Imaging quality was evaluated by two raters on a three-level scale. The assessment included visualization of intraforaminal structures, the cauda equina, facet joints, and any abnormalities. Contrast ratios for intervertebral discs/vertebral bodies, vertebral bodies/cerebrospinal fluid (CSF) and CSF/spinal cord were calculated. The 3D-VIBE sequence provided best differentiation between intraforaminal structures. Visualization of the facet joints was reliable with VIBE, DESS, and CISS. Individual nerve roots of the cauda equina could only be delineated with the 3D-CISS sequence. CISS and DESS provided good contrast between vertebral bodies and intervertebral discs. Contrast between CSF and vertebral bodies was most pronounced for the T2-TSE sequence. Sufficient contrast between CSF and the spinal cord was only achieved with the T2-TSE sequence. VIBE and DESS sequences demonstrated best the bony malformations. Visualization of the meningocele was only possible with the 3D-CISS sequence. At 7 T most structures of the lumbar spine were visualized with a combination of sequences. At present, imaging quality is not superior to 1.5 T or 3 T, precluding routine clinical use.

  19. MRI of the lumbar spine at 7 Tesla in healthy volunteers and a patient with congenital malformations

    Energy Technology Data Exchange (ETDEWEB)

    Grams, Astrid E. [University Hospital Giessen and Marburg, Campus, Department of Neuroradiology, Giessen (Germany); University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Giessen, Justus Liebig University, Department of Neuroradiology, Giessen (Germany); Kraff, Oliver; Umutlu, Lale; Maderwald, Stefan; Ladd, Mark E.; Forsting, Michael [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Dammann, Philipp [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, Department of Neurosurgery, Essen (Germany); Gizewski, Elke R. [University Hospital Giessen and Marburg, Campus, Department of Neuroradiology, Giessen (Germany); University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany)

    2012-05-15

    The aim of this study was to evaluate sequences that are established at lower magnetic field strengths for lumbar spine imaging at 7 Tesla (7 T) MR imaging. The lumbar spine of five healthy volunteers and a patient with spina bifida and meningocele were evaluated at 7 T. The examination included a T2-TSE (turbo spin echo), a 3D-DESS (double-echo steady-state sequence), a 3D-CISS (constructive interference in steady-state sequence), and a 3D-VIBE (volumetric interpolated breath hold examination) sequence. Imaging quality was evaluated by two raters on a three-level scale. The assessment included visualization of intraforaminal structures, the cauda equina, facet joints, and any abnormalities. Contrast ratios for intervertebral discs/vertebral bodies, vertebral bodies/cerebrospinal fluid (CSF) and CSF/spinal cord were calculated. The 3D-VIBE sequence provided best differentiation between intraforaminal structures. Visualization of the facet joints was reliable with VIBE, DESS, and CISS. Individual nerve roots of the cauda equina could only be delineated with the 3D-CISS sequence. CISS and DESS provided good contrast between vertebral bodies and intervertebral discs. Contrast between CSF and vertebral bodies was most pronounced for the T2-TSE sequence. Sufficient contrast between CSF and the spinal cord was only achieved with the T2-TSE sequence. VIBE and DESS sequences demonstrated best the bony malformations. Visualization of the meningocele was only possible with the 3D-CISS sequence. At 7 T most structures of the lumbar spine were visualized with a combination of sequences. At present, imaging quality is not superior to 1.5 T or 3 T, precluding routine clinical use. (orig.)

  20. Development and testing of a moment-based coactivation index to assess complex dynamic tasks for the lumbar spine.

    Science.gov (United States)

    Le, Peter; Aurand, Alexander; Dufour, Jonathan S; Knapik, Gregory G; Best, Thomas M; Khan, Safdar N; Mendel, Ehud; Marras, William S

    2017-07-01

    Many methods exist to describe coactivation between muscles. However, most methods have limited capability in the assessment of coactivation during complex dynamic tasks for multi-muscle systems such as the lumbar spine. The ability to assess coactivation is important for the understanding of neuromuscular inefficiency. In the context of this manuscript, inefficiency is defined as the effort or level of coactivation beyond what may be necessary to accomplish a task (e.g., muscle guarding during postural stabilization). The objectives of this study were to describe the development of an index to assess coactivity for the lumbar spine and test its ability to differentiate between various complex dynamic tasks. The development of the coactivation index involved the continuous agonist/antagonist classification of moment contributions for the power-producing muscles of the torso. Different tasks were employed to test the range of the index including lifting, pushing, and Valsalva. The index appeared to be sensitive to conditions where higher coactivation would be expected. These conditions of higher coactivation included tasks involving higher degrees of control. Precision placement tasks required about 20% more coactivation than tasks not requiring precision, lifting at chest height required approximately twice the coactivation as mid-thigh height, and pushing fast speeds with turning also required at least twice the level of coactivity as slow or preferred speeds. Overall, this novel coactivation index could be utilized to describe the neuromuscular effort in the lumbar spine for tasks requiring different degrees of postural control. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Non-instrumented extradural lumbar spine surgery under low-dose acetylsalicylic acid: a comparative risk analysis study.

    Science.gov (United States)

    Soleman, Jehuda; Baumgarten, Peter; Perrig, Wolfgang Nicolas; Fandino, Javier; Fathi, Ali-Reza

    2016-03-01

    Coronary artery disease (CAD) affects over one-third of adults and is the leading cause of overall mortality and morbidity. Acetylsalicylic acid (ASA) is widely used in the prevention of CAD. As the population continues to mature, the number of patients presenting for spinal surgery that are under ASA treatment is rising. Studies investigating the outcome of lumbar spine surgeries without discontinuation of ASA therapy are lacking. The purpose of this study is to evaluate the peri- and postoperative bleeding and cardiovascular complication rates of patients undergoing non-instrumented, extradural, lumbar spine surgery with or without discontinuation of low-dose ASA. We retrospectively compared the intra- and postoperative blood loss, morbidity, mortality, blood transfusion requirements and hematologic findings in the ASA group (40 patients) and the control group (62 patients). The diagnosis in all patients was either lumbar disc herniation or spinal canal stenosis. Intraoperative blood loss was 221 ml in the ASA group and 140.16 ml in the control group, showing no statistical difference (p = 0.08). Postoperative blood loss was 146.58 and 167.97 ml in the ASA and control groups, respectively, also without statistical difference (p = 0.76). In the ASA group one patient developed a postoperative epidural hematoma needing revision surgery, while in the control group no postoperative epidural hematomas were seen (p = 0.40). In addition, blood transfusion requirements, hematologic findings, morbidity and mortality showed no significant difference. The continuation of ASA treatment in patients undergoing non-instrumented extradural lumbar spinal surgery seems to be safe and its perioperative continuation might therefore be recommended. Further studies confirming these results are needed.

  2. The Professional Athlete Spine Initiative: outcomes after lumbar disc herniation in 342 elite professional athletes.

    Science.gov (United States)

    Hsu, Wellington K; McCarthy, Kathryn J; Savage, Jason W; Roberts, David W; Roc, Gilbert C; Micev, Alan J; Terry, Michael A; Gryzlo, Stephen M; Schafer, Michael F

    2011-03-01

    Although clinical outcomes after lumbar disc herniations (LDHs) in the general population have been well studied, those in elite professional athletes have not. Because these athletes have different measures of success, studies on long-term outcomes in this patient population are necessary. This study seeks to define the outcomes after an LDH in a large cohort of professional athletes of American football, baseball, hockey, and basketball. Retrospective cohort study. A total of 342 professional athletes from four major North American sports from 1972 to 2008 diagnosed with an LDH were identified via a previously published protocol. Two hundred twenty-six players underwent lumbar discectomy, and 116 athletes were treated nonoperatively. Only those players who had at least 2 years of follow-up were included. Functional outcome measures as defined by successful return-to-play (RTP), career games, and years played for each player cohort were recorded both before and after treatment. Conversion factors based on games/regular season and expected career length (based on individual sport) were used to standardize the outcomes across each sport. Using Statistical Analysis Software v. 9.1, outcome measures were compared in each cohort both before and after treatment using linear and mixed regression analyses and Cox proportional hazards models. A Kaplan-Meier survivorship curve was calculated for career length after injury. Statistical significance was defined as pathletes successfully returned to sport 82% of the time, with an average career length of 3.4 years. Of the 226 patients who underwent surgical treatment, 184 successfully returned to play (81%), on average, for 3.3 years after surgery. Survivorship analysis demonstrated that 62.3% of players were expected to remain active 2 years after diagnosis. There were no statistically significant differences in outcome in the surgical and nonoperative cohorts. Age at diagnosis was a negative predictor of career length after

  3. Dual-energy X-ray absorptiometry in the lumbar spine, proximal femur and distal radius in children

    International Nuclear Information System (INIS)

    Tsukahara, H.; Sudo, M.; Umezaki, M.; Hiraoka, M.; Yamamoto, K.; Ishii, Y.; Haruki, S.

    1992-01-01

    Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD) in the lumbar spine, proximal femur and distal radius in 48 Japanese children aged 3-18 years. In the normal children (n=32), BMD increased with age in all locations, with a nearly twofold increase from preschool age to adolescence. Most of the children with chronic diseases known to affect bone metabolism (e.g., steroid osteoporosis) (n=16) had low BMD in every region, indicating that these disease states probably affect multiple sites of the skeleton in children. (orig.)

  4. Assessment of the skeletal status by MR relaxometry techniques of the lumbar spine: comparison with dual X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Maris, Thomas G. E-mail: tmaris@med.uoc.gr; Damilakis, John; Sideri, Liana; Deimling, Michael; Papadokostakis, Georgios; Papakonstantinou, Olympia; Gourtsoyiannis, Nikos

    2004-06-01

    Purpose: To measure lumbar spine T2*, T2, T2' and T1 MR relaxometry parameters and compare them with lumbar spine bone mineral density (BMD) in a group of postmenopausal women. Materials and methods: Lumbar spine T2*, T2, T2' and T1 MR relaxometry parameters and BMD values were assessed in 101 postmenopausal women (mean age: 61.8{+-}7.1 (1 S.D.) years); of them 63 referred to as control subjects (group A, BMD T-scores {>=} -2.5 S.D.) and 38 as osteoporotic (group B, BMD T-scores < -2.5 S.D.). All magnetic resonance imaging (MRI) examinations were performed on an 1.5 T imaging system using: (a) a 2D single slice multi echo (32 echoes) gradient echo (MEGRE) sequence (TR/TE1/TE32/FA: 160/2.7/74.93 ms/25 degree sign ) for the T2* measurement, (b) a respiratory gated 2D single slice Multi Echo (16 echoes) Spin Echo (MESE) sequence (TR/TE1/TE16/FA: 2000-2500/22.5/360 ms/90 degree sign ) for the T2 measurement and (c) a 2D single slice multi TI (18 repeats) turbo Fast Low Angle Shot (turbo FLASH) sequence (TR/TE/TI1/TI16/FA: 11/4.2/10/5000 ms/10 degree sign ) for the T1 measurement. T2' was calculated from its definition equation: (1/T2' = 1/T2* - 1/T2). Lumbar spine BMD was assessed using DXA. Results: All measured parameters showed statistically significant differences between groups A and B (from P<0.05 to <0.001). All parameters showed significant associations with subject's age ranging from r=0.245 (P<0.05) for the T2 up to r=0.377 (P<0.001) for the T2*. All parameters showed significant associations with subject's BMD measurements ranging from r=-0.184 (P<0.05) for the R1 = (1/T1) up to r=-0.345 (P<0.0005) for the T2. Conclusion: Among the MR relaxometry parameters studied, T2* and T2 showed better discrimination of patients with osteoporosis from control subjects.

  5. Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine.

    Science.gov (United States)

    Röllinghoff, Marc; Schlüter-Brust, Klaus; Groos, Daniel; Sobottke, Rolf; Michael, Joern William-Patrick; Eysel, Peer; Delank, Karl Stefan

    2010-03-20

    In the treatment of multilevel degenerative disorders of the lumbar spine, spondylodesis plays a controversial role. Most patients can be treated conservatively with success. Multilevel lumbar fusion with instrumentation is associated with severe complications like failed back surgery syndrome, implant failure, and adjacent segment disease (ASD). This retrospective study examines the records of 70 elderly patients with degenerative changes or instability of the lumbar spine treated between 2002 and 2007 with spondylodesis of more than two segments. Sixty-four patients were included; 5 patients had died and one patient was lost to follow-up. We evaluated complications, clinical/radiological outcomes, and success of fusion. Flexion-extension and standing X-rays in two planes, MRI, and/or CT scans were obtained pre-operatively. Patients were assessed clinically using the Oswestry disability index (ODI) and a Visual Analogue Scale (VAS). Surgery performed was dorsolateral fusion (46.9%) or dorsal fusion with anterior lumbar interbody fusion (ALIF; 53.1%). Additional decompression was carried out in 37.5% of patients. Mean follow-up was 29.4±5.4 months. Average patient age was 64.7±4.3 years. Clinical outcomes were not satisfactory for all patients. VAS scores improved from 8.6±1.3 to 5.6±3.0 pre- to post-operatively, without statistical significance. ODI was also not significantly improved (56.1±22.3 pre- and 45.1±26.4 post-operatively). Successful fusion, defined as adequate bone mass with trabeculation at the facets and transverse processes or in the intervertebral segments, did not correlate with good clinical outcomes. Thirty-five of 64 patients (54%) showed signs of pedicle screw loosening, especially of the screws at S1. However, only 7 of these 35 (20%) complained of corresponding back pain. Revision surgery was required in 24 of 64 patients (38%). Of these, indications were adjacent segment disease (16 cases), pedicle screw loosening (7 cases), and

  6. Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine

    Directory of Open Access Journals (Sweden)

    Marc Röllinghoff

    2010-01-01

    Full Text Available In the treatment of multilevel degenerative disorders of the lumbar spine, spondylodesis plays a controversial role. Most patients can be treated conservatively with success. Multilevel lumbar fusion with instrumentation is associated with severe complications like failed back surgery syndrome, implant failure, and adjacent segment disease (ASD. This retrospective study examines the records of 70 elderly patients with degenerative changes or instability of the lumbar spine treated between 2002 and 2007 with spondylodesis of more than two segments. Sixty-four patients were included; 5 patients had died and one patient was lost to follow-up. We evaluated complications, clinical/radiological outcomes, and success of fusion. Flexion-extension and standing X-rays in two planes, MRI, and/or CT scans were obtained pre-operatively. Patients were assessed clinically using the Oswestry disability index (ODI and a Visual Analogue Scale (VAS. Surgery performed was dorsolateral fusion (46.9% or dorsal fusion with anterior lumbar interbody fusion (ALIF; 53.1%. Additional decompression was carried out in 37.5% of patients. Mean follow-up was 29.4±5.4 months. Average patient age was 64.7±4.3 years. Clinical outcomes were not satisfactory for all patients. VAS scores improved from 8.6±1.3 to 5.6±3.0 pre- to post-operatively, without statistical significance. ODI was also not significantly improved (56.1±22.3 pre- and 45.1±26.4 post-operatively. Successful fusion, defined as adequate bone mass with trabeculation at the facets and transverse processes or in the intervertebral segments, did not correlate with good clinical outcomes. Thirty-five of 64 patients (54% showed signs of pedicle screw loosening, especially of the screws at S1. However, only 7 of these 35 (20% complained of corresponding back pain. Revision surgery was required in 24 of 64 patients (38%. Of these, indications were adjacent segment disease (16 cases, pedicle screw loosening (7 cases

  7. A review of the 2001 Volvo Award winner in clinical studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish lumbar spine study group.

    Science.gov (United States)

    Kwon, Brian; Katz, Jeffrey N; Kim, David H; Jenis, Louis G

    2006-01-15

    The current debate over the efficacy of lumbar fusion for low back pain has not been settled. Fritzell et al published a landmark paper entitled "Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish lumbar spine study group." Their goal was to provide objective evidence supporting lumbar fusion. While it was well designed and important to our knowledge base, it has limitations. We set out to review their work in an unbiased yet critical manner. Our goals are to summarize the strengths and weaknesses of the paper, place it in the context of current knowledge, and highlight its significance for present-day practice and research. From technical and study design perspectives, Fritzell et al were able to validate the use of lumbar fusion for the treatment of low back pain. However, their use of "usual nonoperative" care and nonspecific definition of low back pain precluded a truly genuine comparison of operative and nonoperative groups. We commend the Swedish lumbar spine study group and their remarkable efforts; they elevated the sophistication of spine research and spawned many more excellent works to help settle the ongoing controversy on the ideal treatment of low back pain.

  8. The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine1

    OpenAIRE

    Wright, Nicole C; Looker, Anne C; Saag, Kenneth G; Curtis, Jeffrey R; Delzell, Elizabeth S; Randall, Susan; Dawson-Hughes, Bess

    2014-01-01

    The goal of our study was to estimate the prevalence of osteoporosis and low bone mass based on bone mineral density (BMD) at the femoral neck and the lumbar spine in adults 50 years and older in the United States (US). We applied prevalence estimates of osteoporosis or low bone mass at the femoral neck or lumbar spine (adjusted by age, sex, and race/ethnicity to the 2010 Census) for the non-institutionalized population age 50 years and older from the National Health and Nutrition Examination...

  9. Routine oblique radiography of the pediatric lumbar spine: is it necessary. [Oblique radiography entails more than double the gonadal radiation dose of frontal-lateral projections

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, F.F.; Kishore, P.R.S.; Cunningham, M.E.

    1978-08-01

    A series of 86 pediatric lumbar spine abnormalities was evaluated to determine the diagnostic benefit of radiography in oblique projection as compared to frontal-lateral projections alone. In only four patients was an abnormality apparent on the oblique view which had not already been demonstrated by the frontal-lateral series; each of these represented an isolated spondylolysis. Because the diagnostic yield was low at a patient cost of more than double the gonadal radiation dose, it is recommended that oblique views be eliminated in the routine radiography of the pediatric lumbar spine.

  10. 1997 Volvo Award winner in biomechanical studies. Kinematic behavior of the porcine lumbar spine: a chronic lesion model.

    Science.gov (United States)

    Kaigle, A M; Holm, S H; Hansson, T H

    1997-12-15

    Experimental models of intervertebral disc and facet joint degeneration were created in vivo in the porcine lumbar spine for studying spinal kinematics, using a dynamic technique. To quantify the changes in spinal kinematics and the stabilizing capacity of the lumbar musculature caused by chronic lesions in the intervertebral disc and facet joints. Segmental kinematics are detrimentally altered by acute injury to passive structures of the motion segment. However, stimulation of the surrounding musculature adds stability to the motion segment. The in vivo kinematics of a degenerated lumbar motion segment and the stabilizing function of the surrounding musculature have not been quantified dynamically. Forty-four pigs were used in six chronic lesions models: sham, disc anulus, disc nucleus, facet capsule, facet joint slit, and facet joint wedge. Three months after injury, an instrumented linkage was used to measure continuously the sagittal kinematics of the L3-L4 motion segment during flexion-extension, with and without stimulation of the lumbar paraspinal musculature. Flexion-extension end point and maximum ranges of motion, and hysteresis were analyzed. Significant alterations in the kinematics caused by chronic lesions were observed, particularly when using the maximum range of motion and when comparing changes in axial translation. Muscular stimulation reduced the hysteresis in the sham, facet capsule, and disc nucleus groups; however, increased hysteresis was observed in the remaining lesion groups. The kinematic behavior of motion segments with chronic lesions was established. The maximum range of motion, which must be measured using a dynamic technique, was a more sensitive parameter for identifying changes in segmental kinematics caused by chronic lesions than was the end range of motion. The lumbar musculature was less efficient overall in stabilizing the motion segment, possibly because of altered mechanisms in the neuromuscular feedback system.

  11. Lateral Lumbar Interbody Fusion andin SituScrew Fixation for Rostral Adjacent Segment Stenosis of the Lumbar Spine.

    Science.gov (United States)

    Choi, Young Hoon; Kwon, Shin Won; Moon, Jung Hyeon; Kim, Chi Heon; Chung, Chun Kee; Park, Sung Bae; Heo, Won

    2017-11-01

    The purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease. The medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. The median follow-up period was 13 months (range, 3-48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved ( p fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients. This study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.

  12. Effectiveness of surgery for lumbar stenosis and degenerative spondylolisthesis in the octogenarian population: analysis of the Spine Patient Outcomes Research Trial (SPORT) data.

    Science.gov (United States)

    Rihn, Jeffrey A; Hilibrand, Alan S; Zhao, Wenyan; Lurie, Jon D; Vaccaro, Alexander R; Albert, Todd J; Weinstein, James

    2015-02-04

    The purpose of this study was to determine whether surgery is an effective option for the treatment of stenosis of the lumbar spine and degenerative spondylolisthesis in the octogenarian population. An as-treated analysis of patients with lumbar stenosis and degenerative spondylolisthesis enrolled in the Spine Patient Outcomes Research Trial (SPORT) was performed. Patients who were at least eighty years of age (n = 105) were compared with those younger than eighty years (n = 1130). Baseline patient and clinical characteristics were noted, and the difference in improvement from baseline between operative and nonoperative treatment was determined for each group at each follow-up time period up to four years. There were no significant baseline differences in the primary or secondary patient-reported clinical outcome measures between the two patient age groups. Patients at least eighty years of age had higher prevalences of multilevel stenosis, severe stenosis, and asymmetric motor weakness. Patients at least eighty years of age also had higher prevalences of hypertension, heart disease, osteoporosis, and joint problems at baseline, but they had a lower body mass index and lower prevalences of depression and smoking. Fifty-eight of the 105 patients at least eighty years of age and 749 of the 1130 younger patients underwent operative management. There were no differences in the rates of intraoperative or postoperative complications, reoperation, or postoperative mortality between the older and younger groups. Averaged over a four-year follow-up period, operatively treated patients at least eighty years of age had significantly greater improvement in all primary and secondary outcome measures compared with nonoperatively treated patients. The treatment effects in patients at least eighty years of age were similar to those in younger patients for all primary and secondary measures except the SF-36 (Short Form-36) bodily pain domain and the percentage who self-rated their

  13. Pathoanatomic Risk Factors for Instability and Adjacent Segment Disease in Lumbar Spine: How to Use Topping Off?

    Directory of Open Access Journals (Sweden)

    J. Bredow

    2017-01-01

    Full Text Available Purpose. The goal of this review is to identify criteria indicating implantation of hybrid system into lumbar spine and to evaluate general benefits of use. Methods. A systematic review of literature was performed using current randomized clinical trials, reviews, and meta-analyses. Data sources included relevant literature of human studies identified through searches of Medline Library until May 2015. Results. Predisposing factors for Adjacent Segment Disease (ASDi are discussed in literature: laminar horizontalization, insufficiency of fascia thoracolumbalis, facet tropism, and facet sagittalization. Currently there is no evidence for topping off. There are only 12 studies and these have no consistent statements about use of a hybrid system for avoidance of ASDi. Conclusion. Hybrid instrumentation of lumbar spine, either with pedicle-based technique or additional spacer, might possibly prevent ASDi from developing in previously damaged segment adjacent to a fusion. Good clinical data proving effectiveness of this new implant technique is as yet unavailable. Thus, currently one must speak of an unevaluated procedure. Various radiological classifications can assist in making a reliable decision as to whether hybrid instrumentation is an appropriate choice of therapy. Pathoanatomical conditions of facet joints and laminae as well as preservation of sagittal balance must also be considered.

  14. Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Wybier, Marc [Assistance Publique - Hopitaux de Paris, Musculoskeletal Radiology Department, Hopital Lariboisiere, Paris (France); Hopital Lariboisiere, Service de Radiologie Osteo-articulaire, Paris (France); Gaudart, Sandrine [Assistance Publique - Hopitaux de Paris, Radiology Department, Hopital Beaujon, Clichy (France); Petrover, David; Laredo, Jean-Denis [Assistance Publique - Hopitaux de Paris, Musculoskeletal Radiology Department, Hopital Lariboisiere, Paris (France); Houdart, Emmanuel [Assistance Publique - Hopitaux de Paris, Neuroradiology Department, Hopital Lariboisiere, Paris (France)

    2010-01-15

    Selective steroid injections of the lumbar spine carry a risk of paraplegia of sudden onset. Seven cases have been reported in the English literature since 2002. Five new cases have been analyzed, all coming from Paris area centers. Injections were performed between 2003 and 2008. The following items were searched for: location of a previous lumbar spine surgery if any, symptoms indicating the procedure, route of injection, imaging technique used for needle guidance, injection of a contrast medium, type of steroid, other drugs injected if any, paraplegia level, post-procedure MR findings. The current and reported cases were compared. MR findings were consistent with spinal cord ischemia of arterial origin. The high rate of patients who had been operated on in these cases does not correspond to that of patients undergoing injections. The presence of epidural scar might increase the risk. The foraminal route was the only one involved in nonoperated patients. Foraminal, interlaminar, or juxta-zygoapophyseal routes were used in operated-on patients. The high rate of French cases when compared to the literature might arise from the almost exclusive use of prednisolone acetate, a molecule with a high tendency to coalesce in macro-aggregates, putting the spinal cord at risk of arterial supply embolization. (orig.)

  15. Densitometer-Specific Differences in the Correlation Between Body Mass Index and Lumbar Spine Trabecular Bone Score.

    Science.gov (United States)

    Mazzetti, Gillian; Berger, Claudie; Leslie, William D; Hans, Didier; Langsetmo, Lisa; Hanley, David A; Kovacs, Christopher S; Prior, Jerrilyn C; Kaiser, Stephanie M; Davison, K Shawn; Josse, Robert; Papaioannou, Alexandra; Adachi, Jonathan R; Goltzman, David; Morin, Suzanne N

    Trabecular bone score (TBS) is a gray-level texture measure derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images that predicts fractures independent of bone mineral density (BMD). Increased abdominal soft tissue in individuals with elevated body mass index (BMI) absorbs more X-rays during image acquisition for BMD measurement and must be accommodated by the TBS algorithm. We aimed to determine if the relationship between BMI and TBS varied between 2 major manufacturers' densitometers, because different densitometers accommodate soft tissues differently. We identified 1919 women and 811 men, participants of the Canadian Multicentre Osteoporosis Study, aged ≥40 yr with lumbar spine DXA scans acquired on GE Lunar (4 centers) or Hologic (3 centers) densitometers at year 10 of follow-up. TBS was calculated for L1-L4 (TBS iNsight® software, version 2.1). A significant negative correlation between TBS and BMI was observed when TBS measurements were performed on Hologic densitometers in men (Pearson r = -0.36, p Hologic and GE Lunar densitometers in men and women. In conclusion, BMI significantly affects TBS values in men and women when measured on Hologic but not GE Lunar densitometers. This finding has implications for clinical and research applications of TBS, especially when TBS is measured sequentially on DXA densitometers from different manufacturers or when results from different machines are pooled for analysis. Copyright © 2016. Published by Elsevier Inc.

  16. MR imaging of the bone marrow in myeloid leukemia and myelodysplastic syndrome. Comparison of the lumbar spine and femur

    International Nuclear Information System (INIS)

    Tanaka, Osamu; Kobayashi, Yasuyuki; Ichikawa, Tamaki; Matsuura, Katsuhiko; Nagai, Jun; Takagi, Shojiro

    1995-01-01

    MR imaging of the lumber spine and the femur was performed with T1-weighted SE sequence and comparison of the MRI findings of the lumber vertebral body and the femoral marrow was made in 15 patients with acute myeloid leukemia (AML), 5 chronic myelogenous leukemia (CML), and 9 myelodysplastic syndrome (MDS). The MRI appearance of the bone marrow was classified into four patterns: 1) fatty marrow; 2) faint signal; 3) heterogeneous infiltration; and 4) diffuse infiltration. The MRI of the lumber vertebral body showed a diffuse marrow infiltration pattern in over the half of the cases of AML and MDS. On the MRI of the femoral marrow, the signal intensity alteration, a low signal on T1-weighted SE image, began in the proximal femurs almost symmetrically. The abnormal low signal intensity area tended to gradually extend towards the distal portion of the femoral marrow with progression of the disease in the patients with AML and MDS. M2 type of AML tended to be demonstrated as a faint signal pattern, which was significantly different from the other types of AML. In all the cases of CML, a diffuse cellular infiltration pattern was noted with total replacement of the fatty marrow on both lumbar spinal and femoral MRI, and the femoral marrow involvement was more downwardly extended than AML. We concluded that MRI of the femoral marrow was more efficient than that of the lumbar spine in the assessment of myeloid leukemia and MDS. (author)

  17. Pathoanatomic Risk Factors for Instability and Adjacent Segment Disease in Lumbar Spine: How to Use Topping Off?

    Science.gov (United States)

    Bredow, J; Löhrer, L; Oppermann, J; Scheyerer, M J; Sobottke, R; Eysel, P; Siewe, J

    2017-01-01

    The goal of this review is to identify criteria indicating implantation of hybrid system into lumbar spine and to evaluate general benefits of use. A systematic review of literature was performed using current randomized clinical trials, reviews, and meta-analyses. Data sources included relevant literature of human studies identified through searches of Medline Library until May 2015. Predisposing factors for Adjacent Segment Disease (ASDi) are discussed in literature: laminar horizontalization, insufficiency of fascia thoracolumbalis, facet tropism, and facet sagittalization. Currently there is no evidence for topping off. There are only 12 studies and these have no consistent statements about use of a hybrid system for avoidance of ASDi. Hybrid instrumentation of lumbar spine, either with pedicle-based technique or additional spacer, might possibly prevent ASDi from developing in previously damaged segment adjacent to a fusion. Good clinical data proving effectiveness of this new implant technique is as yet unavailable. Thus, currently one must speak of an unevaluated procedure. Various radiological classifications can assist in making a reliable decision as to whether hybrid instrumentation is an appropriate choice of therapy. Pathoanatomical conditions of facet joints and laminae as well as preservation of sagittal balance must also be considered.

  18. Pathoanatomic Risk Factors for Instability and Adjacent Segment Disease in Lumbar Spine: How to Use Topping Off?

    Science.gov (United States)

    Löhrer, L.; Sobottke, R.; Eysel, P.; Siewe, J.

    2017-01-01

    Purpose The goal of this review is to identify criteria indicating implantation of hybrid system into lumbar spine and to evaluate general benefits of use. Methods A systematic review of literature was performed using current randomized clinical trials, reviews, and meta-analyses. Data sources included relevant literature of human studies identified through searches of Medline Library until May 2015. Results Predisposing factors for Adjacent Segment Disease (ASDi) are discussed in literature: laminar horizontalization, insufficiency of fascia thoracolumbalis, facet tropism, and facet sagittalization. Currently there is no evidence for topping off. There are only 12 studies and these have no consistent statements about use of a hybrid system for avoidance of ASDi. Conclusion Hybrid instrumentation of lumbar spine, either with pedicle-based technique or additional spacer, might possibly prevent ASDi from developing in previously damaged segment adjacent to a fusion. Good clinical data proving effectiveness of this new implant technique is as yet unavailable. Thus, currently one must speak of an unevaluated procedure. Various radiological classifications can assist in making a reliable decision as to whether hybrid instrumentation is an appropriate choice of therapy. Pathoanatomical conditions of facet joints and laminae as well as preservation of sagittal balance must also be considered. PMID:28831392

  19. Comparison of patient radiation dose from chest and lumbar spine X-ray examinations in 10 hospitals in Ghana

    International Nuclear Information System (INIS)

    Ofori, E. K.; Antwi, W. K.; Arthur, L.; Duah, H.

    2012-01-01

    This study estimated the patient dose in chest and lumbar spine radiographic examinations in 10 hospitals in Ghana. Dose estimations were done on 1045 patients (aged, 39.6 ± 10.6 y; range 18-85 y) involving 501 (47.9 %) males and 544 (52.1 %) females for a total of 1495 individual projections. The entrance surface dose (ESD) for the patients was assessed by an indirect method, using the patient's anatomical data and exposure parameters utilised for the specific examination and a Quality Assurance Dose Database software developed by Integrated Radiological Services Ltd in Liverpool, UK. The study showed variations in the ESDs for chest examinations with five of the hospitals having values above the internationally recommended levels. ESDs for lumbar spine anterior-posterior and lateral projections were within acceptable limits. Diagnostic reference levels proposed by the International Commission on Radiological Protection based on patient dose data are imperative to the current Ghanaian situation and will lead to a reduction of the radiation dose. (authors)

  20. Architectural analysis and intraoperative measurements demonstrate the unique design of the multifidus muscle for lumbar spine stability.

    Science.gov (United States)

    Ward, Samuel R; Kim, Choll W; Eng, Carolyn M; Gottschalk, Lionel J; Tomiya, Akihito; Garfin, Steven R; Lieber, Richard L

    2009-01-01

    Muscular instability is an important risk factor for lumbar spine injury and chronic low-back pain. Although the lumbar multifidus muscle is considered an important paraspinal muscle, its design features are not completely understood. The purpose of the present study was to determine the architectural properties, in vivo sarcomere length operating range, and passive mechanical properties of the human multifidus muscle. We hypothesized that its architecture would be characterized by short fibers and a large physiological cross-sectional area and that it would operate over a relatively wide range of sarcomere lengths but would have very stiff passive material properties. The lumbar spines of eight cadaver specimens were excised en bloc from T12 to the sacrum. Multifidus muscles were isolated from each vertebral level, permitting the architectural measurements of mass, sarcomere length, normalized fiber length, physiological cross-sectional area, and fiber length-to-muscle length ratio. To determine the sarcomere length operating range of the muscle, sarcomere lengths were measured from intraoperative biopsy specimens that were obtained with the spine in the flexed and extended positions. The material properties of single muscle fibers were obtained from passive stress-strain tests of excised biopsy specimens. The average muscle mass (and standard error) was 146 +/- 8.7 g, and the average sarcomere length was 2.27 +/- 0.06 microm, yielding an average normalized fiber length of 5.66 +/- 0.65 cm, an average physiological cross-sectional area of 23.9 +/- 3.0 cm(2), and an average fiber length-to-muscle length ratio of 0.21 +/- 0.03. Intraoperative sarcomere length measurements revealed that the muscle operates from 1.98 +/- 0.15 microm in extension to 2.70 +/- 0.11 microm in flexion. Passive mechanical data suggested that the material properties of the muscle are comparable with those of muscles of the arm or leg. The architectural design (a high cross-sectional area and

  1. Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

    Science.gov (United States)

    Schoenfeld, Andrew J; Makanji, Heeren; Jiang, Wei; Koehlmoos, Tracey; Bono, Christopher M; Haider, Adil H

    2017-12-01

    Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated. (1) Were proportions of interbody fusions higher in the fee-for-service setting as opposed to the salaried Department of Defense setting? (2) Were the odds of interbody fusion increased in a fee-for-service setting after controlling for indications for surgery? Patients surgically treated for lumbar disc herniation, spinal stenosis, and spondylolisthesis (2006-2014) were identified. Patients were divided into two groups based on whether the surgery was performed in the fee-for-service setting (beneficiaries receive care at a civilian facility with expenses covered by TRICARE insurance) or at a Department of Defense facility (direct care). There were 28,344 patients in the entire study, 21,290 treated in fee-for-service and 7054 treated in Department of Defense facilities. Differences in the rates of fusion-based procedures, discectomy, and decompression between both healthcare settings were assessed using multinomial logistic regression to adjust for differences in case-mix and surgical indication. TRICARE beneficiaries treated for lumbar spinal disorders in the fee-for-service setting had higher odds of receiving interbody fusions (fee-for-service: 7267 of 21,290 [34%], direct care: 1539 of 7054 [22%], odds ratio [OR]: 1.25 [95% confidence interval 1.20-1.30], p service setting irrespective of the underlying diagnosis. These results speak to the existence of provider inducement within the field of spine surgery. This reality portends poor performance for surgical practices and hospitals in Accountable Care Organizations and bundled payment programs in which provider inducement is allowed to

  2. Risk of adjacent-segment disease requiring surgery after short lumbar fusion: results of the French Spine Surgery Society Series.

    Science.gov (United States)

    Scemama, Caroline; Magrino, Baptiste; Gillet, Philippe; Guigui, Pierre

    2016-07-01

    OBJECTIVE Adjacent-segment disease (ASD) is an increasingly problematic complication following lumbar fusion surgery. The purpose of the current study was to determine the risk of ASD requiring surgical treatment after short lumbar or lumbosacral fusion. Primary spinal disease and surgical factors associated with an increased risk of revision were also investigated. METHODS This was a retrospective cohort study using the French Spine Surgery Society clinical data that included 3338 patients, with an average follow-up duration of 7 years (range 4-10 years). Clinical ASD requiring surgery was the principal judgment criterion; the length of follow-up time and initial spinal disease were also recorded. Kaplan-Meier survival analysis was performed. The correlation between primary spinal disease and surgery with an increased risk of revision was investigated. RESULTS During the follow-up period, 186 patients required revision surgery for ASD (5.6%). The predicted risk of ASD requiring revision surgery was 1.7% (95% CI 1.3%-2.2%) at 2 years, 3.8% (95% CI 4.9%-6.7%) at 4 years, 5.7% (95% CI 4.9%-6.7%) at 6 years, and 9% (95% CI 8.7%-10.6%) at 8 years. Initial spinal disease affected the risk of ASD requiring surgery (p = 0.0003). The highest risk was observed for degenerative spondylolisthesis. CONCLUSIONS ASD requiring revision surgery was predicted in 5.6% of patients 7 years after index short lumbar spinal fusion in the French Spine Surgery Society retrospective series. An increased risk of ASD requiring revision surgery associated with initial spinal disease showed the significance of the influence of natural degenerative history on adjacent-segment pathology.

  3. Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013.

    Science.gov (United States)

    Bernstein, David N; Brodell, David; Li, Yue; Rubery, Paul T; Mesfin, Addisu

    2017-05-01

    Retrospective database analysis. The impact of the 2008-2009 economic downtown on elective lumbar spine surgery is unknown. Our objective was to investigate the effect of the economic downturn on the overall trends of elective lumbar spine surgery in the United States. The Nationwide Inpatient Sample (NIS) was used in conjunction with US Census and macroeconomic data to determine historical trends. The economic downturn was defined as 2008 to 2009. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), were used in order to identify appropriate procedures. Confidence intervals were determined using subgroup analysis techniques. From 2003 to 2012, there was a 19.8% and 26.1% decrease in the number of lumbar discectomies and laminectomies, respectively. Over the same time period, there was a 56.4% increase in the number of lumbar spinal fusions. The trend of elective lumbar spine surgeries per 100 000 persons in the US population remained consistent from 2008 to 2009. The number of procedures decreased by 4.5% from 2010 to 2011, 7.6% from 2011 to 2012, and 3.1% from 2012 to 2013. The R 2 value between the number of surgeries and the S&P 500 Index was statistically significant ( P ≤ .05). The economic downturn did not affect elective lumbar fusions, which increased in total from 2003 to 2013. The relationship between the S&P 500 Index and surgical trends suggests that during recessions, individuals may utilize other means, such as insurance, to cover procedural costs and reduce out-of-pocket expenditures, accounting for no impact of the economic downturn on surgical trends. These findings can assist multiple stakeholders in better understanding the interconnectedness of macroeconomics, policy, and elective lumbar spine surgery trends.

  4. [Effect of table tilt and spine flexion-rotation on the acoustic window of the lumbar spine in pregnant women].

    Science.gov (United States)

    Sebbag, Ilana; Tang, Raymond; Gunka, Vit; Sahota, JagPaul; Vaghadia, Himat; Sawka, Andrew

    2018-04-06

    The purpose of this study was to assess whether application of dorsal table tilt and body rotation to a parturient seated for neuraxial anesthesia increased the size of the paramedian target area for neuraxial needle insertion. Labor and Delivery Room. Thirty term pregnant women, ASA I-II, scheduled for an elective C-section delivery. Lumbar ultrasonography was performed in four seated positions: (F) lumbar flexion; (FR) as in position F with right shoulder rotation; (FT) as in position F with dorsal table-tilt; (FTR) as in position F with dorsal table-tilt combined with right shoulder rotation. For each position, the size of the 'target area', defined as the visible length of the posterior longitudinal ligament was measured at the L3-L4 interspace. The mean posterior longitudinal ligament was 18.4±4mm in position F, 18.9±5.5mm in FR, 19±5.3mm in FT, and 18±5.2mm in FTR. Mean posterior longitudinal ligament length was not significantly different in the four positions. These data show that the positions studied did not increase the target area as defined by the length of the posterior longitudinal ligament for the purpose of neuraxial needle insertion in obstetric patients. The maneuvers studied will have limited use in improving spinal needle access in pregnant women. Copyright © 2018. Publicado por Elsevier Editora Ltda.

  5. A New Electromagnetic Navigation System for Pedicle Screws Placement: A Human Cadaver Study at the Lumbar Spine.

    Directory of Open Access Journals (Sweden)

    Patrick Hahn

    Full Text Available Technical developments for improving the safety and accuracy of pedicle screw placement play an increasingly important role in spine surgery. In addition to the standard techniques of free-hand placement and fluoroscopic navigation, the rate of complications is reduced by 3D fluoroscopy, cone-beam CT, intraoperative CT/MRI, and various other navigation techniques. Another important aspect that should be emphasized is the reduction of intraoperative radiation exposure for personnel and patient. The aim of this study was to investigate the accuracy of a new navigation system for the spine based on an electromagnetic field.Twenty pedicle screws were placed in the lumbar spine of human cadavers using EMF navigation. Navigation was based on data from a preoperative thin-slice CT scan. The cadavers were positioned on a special field generator and the system was matched using a patient tracker on the spinous process. Navigation was conducted using especially developed instruments that can be tracked in the electromagnetic field. Another thin-slice CT scan was made postoperatively to assess the result. The evaluation included the position of the screws in the direction of trajectory and any injury to the surrounding cortical bone. The results were classified in 5 groups: grade 1: ideal screw position in the center of the pedicle with no cortical bone injury; grade 2: acceptable screw position, cortical bone injury with cortical penetration ≤ 2 mm; grade 3: cortical bone injury with cortical penetration 2,1-4 mm, grad 4: cortical bone injury with cortical penetration 4,1-6 mm, grade 5: cortical bone injury with cortical penetration >6 mm.The initial evaluation of the system showed good accuracy for the lumbar spine (65% grade 1, 20% grade 2, 15% grade 3, 0% grade 4, 0% grade 5. A comparison of the initial results with other navigation techniques in literature (CT navigation, 2D fluoroscopic navigation shows that the accuracy of this system is

  6. Improved Accuracy of Minimally Invasive Transpedicular Screw Placement in the Lumbar Spine With 3-Dimensional Stereotactic Image Guidance: A Comparative Meta-Analysis.

    Science.gov (United States)

    Bourgeois, Austin C; Faulkner, Austin R; Bradley, Yong C; Pasciak, Alexander S; Barlow, Patrick B; Gash, Judson R; Reid, William S

    2015-11-01

    This study compares the accuracy rates of lumbar percutaneous pedicle screw placement (PPSP) using either 2-dimensional (2-D) fluoroscopic guidance or 3-dimensional (3-D) stereotactic navigation in the setting of minimally invasive spine surgery (MISS). This represents the largest single-operator study of its kind and first comprehensive review of 3-D stereotactic navigation in the setting of MISS. To examine differences in accuracy of lumbar pedicle screw placement using 2-D fluoroscopic navigation and 3-D stereotaxis in the setting of MISS. Surgeons increasingly rely upon advanced image guidance systems to guide minimally invasive PPSP. Three-dimensional stereotactic navigation with intraoperative computed tomography offers well-documented benefit in open surgical approaches. However, the utility of 3-D stereotaxis in the setting of MISS remains incompletely explored by few studies with limited patient numbers. A total of 599 consecutive patients underwent minimally invasive lumbar PPSP aided by 3-D stereotactic navigation. Postoperative imaging and medical records were analyzed for patient demographics, incidence and degree of pedicle breach, and other surgical complications. A total of 2132 screw were reviewed and compared with a meta-analysis created from published data regarding the placement of 4248 fluoroscopically navigated pedicle screws in the setting of MISS. In the 3-D navigation group, a total of 7 pedicle breaches occurred in 6 patients, corresponding to a per-person breach rate of 1.15% (6/518) and a per-screw breach rate of 0.33% (7/2132). Meta-analysis comprised of data from 10 independent studies showed overall breach risk of 13.1% when 2-D fluoroscopic navigation was utilized in MISS. This translates to a 99% decrease in odds of breach in the 3-D navigation technique versus the traditional 2-D-guided technique, with an odds ratio of 0.01, (95% confidence interval, 0.01-0.03), Pdimensional stereotactic navigation based upon intraoperative

  7. Should routine MRI of the lumbar spine be required prior to lumbar epidural steroid injection for sciatica pain?

    Science.gov (United States)

    Ghaly, Ramis F.; Lissounov, Alexei; Candido, Kenneth D.; Knezevic, Nebojsa Nick

    2015-01-01

    Background: We describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies and applied therapies. Case Description: We present three patients; two female patients (37 and 38 years old) undergoing LESI for remotely diagnosed disc herniations, and one 61-year-old male receiving an LESI for a presumed, unverified lumbar intervertebral disc disorder. Following a worsening of symptoms after LESI, neurosurgical consultations ultimately determined the presence of, respectively, an epidural hematoma, a neurilemoma, and a lung cancer metastasis to the sacrum as the source of symptoms, instead of being due to the intervertebral disc pathology. Conclusions: We would like to emphasize several principles in the diagnosis and use of imaging of the lumbosacral region prior to undertaking invasive neuraxial procedures. PMID:25883840

  8. Model studies on segmental movement in lumbar spine using a semi-automated program for volume fusion.

    Science.gov (United States)

    Svedmark, P; Weidenhielm, L; Nemeth, G; Tullberg, T; Noz, M E; Maguire, G Q; Zeleznik, M P; Olivecrona, H

    2008-01-01

    To validate a new non-invasive CT method for measuring segmental translations in lumbar spine in a phantom using plastic vertebrae with tantalum markers and human vertebrae. One hundred and four CT volumes were acquired of a phantom incorporating three lumbar vertebrae. Lumbar segmental translation was simulated by altering the position of one vertebra in all three cardinal axes between acquisitions. The CT volumes were combined into 64 case pairs, simulating lumbar segmental movement of up to 3 mm between acquisitions. The relative movement between the vertebrae was evaluated visually and numerically using a volume fusion image post-processing tool. Results were correlated to direct measurements of the phantom. On visual inspection, translation of at least 1 mm or more could be safely detected and correlated with separation between the vertebrae in three dimensions. There were no significant differences between plastic and human vertebrae. Numerically, the accuracy limit for all the CT measurements of the 3D segmental translations was 0.56 mm (median: 0.12; range: -0.76 to +0.49 mm). The accuracy for the sagittal axis was 0.45 mm (median: 0.10; range: -0.46 to +0.62 mm); the accuracy for the coronal axis was 0.46 mm (median: 0.09; range: -0.66 to +0.69 mm); and the accuracy for the axial axis was 0.45 mm (median: 0.05; range: -0.72 to + 0.62 mm). The repeatability, calculated over 10 cases, was 0.35 mm (median: 0.16; range: -0.26 to +0.30 mm). The accuracy of this non-invasive method is better than that of current routine methods for detecting segmental movements. The method allows both visual and numerical evaluation of such movements. Further studies are needed to validate this method in patients.

  9. The recent prevalence of Osteoporosis and low bone mass in the United States based on bone mineral density at the Femoral Neck or Lumbar Spine

    Science.gov (United States)

    The goal of our study was to estimate the prevalence of osteoporosis and low bone mass based on bone mineral density (BMD) at the femoral neck and the lumbar spine in adults 50 years and older in the United States (US). We applied prevalence estimates of osteoporosis or low bone mass at the femoral ...

  10. The effect of the grade of degenerative changes in the spine on the outcomes of surgery for lumbar discopathy with a radicular syndrome.

    Science.gov (United States)

    Styczyński, Tadeusz; Pyskło, Bohdan; Gasik, Robert

    2007-01-01

    The aim of the study was an evaluation of the influence of coexisting degenerative changes on surgical outcomes on patients with lumbar disc hernias (DH). A total of randomly selected 132 patients undergoing surgery for DH (classic discectomy with fenestration of the yellow ligament) were examined. Radiographic and MRI scans of the lumbar spine were obtained in all patients, who were subsequently divided into 6 groups depending on the grade and/or extent of degenerative changes. The patients self-evaluated treatment outcomes using a visual analogue scale (VAS). The attending doctors carried out a more detailed assessment of the outcomes by separately determining pain intensity (using a 4-grade scale), motor weakness (using a 3-grade scale) and range of lumbar spine movement (using a 3-grade scale). In general, patient self-evaluation of treatment outcomes did not reveal statistically significant differences between subgroups. In doctors' detailed assessment, treatment outcomes related to pain and motor weakness were not significantly different between groups with and without spondylosis. The range of motion in the lumbar spine was greater in patients without spondylosis (p<0.05). According to both subjective and objective assessments of the therapeutic effects of surgery for lumbar disc hernias, even severe degenerative changes do not worsen the treatment outcome.

  11. [Surgery for degenerative spondylolisthesis of the lumbar spine using intra-articular fusion. A prospective study].

    Science.gov (United States)

    Hrabálek, L; Wanek, T; Adamus, M; Cecháková, E; Buřval, S; Langová, K; Vaverka, M

    2014-01-01

    The aim of the study is to present our surgical method of treating degenerative spondylolisthesis, which includes radical bilateral laminectomy to relieve compression on the spinal cord, transpedicular fixation of the segment and arthrodesis by bilateral intra-articular fusion. This surgery was indicated in patients with grade I or grade II of degenerative sponylolisthesis with a 4-mm or more slippage. Our prospectively studied group consisted of 46 patients (17 men, 29 women; average age, 64.2 years; range, 39-84 years). Before surgery and at 1 year after the procedure, the intensity of axial pain and that of radicular pain were each assessed using the visual Analogue Scale (VAS). Difficulty in performing daily living activities was measured by the Oswestry Disability Index (ODI). The surgical procedure included laminectomy, partial medial facetectomy, foraminotomy to relieve pressure on the spinal nerve roots and transpedicular fixation to provide stability. Using a cutter, cartilage was separated off the cortical bone and, in order to facilitate fusion, bone cavities thus produced were filed with corticospongious grafts harvested from the removed vertebral arch with Kerrison forceps. At 1-year follow-up, dynamic X-ray was used to evaluate spine alignment and, on a CT scan, the degree of intra-articular fusion was assessed. Fusion was achieved when bone density measurement showed more than 350 Hounsfield Units (HU). For the measurements, the authors used their own modified method by means of a Region of Interest (ROI) analysis. The clinical and radiographic results were statistically evaluated. At 1 year after surgery, lumbar flexion-extension bending X-ray films revealed stability of the treated segments in all patients (100%). CT examination showed bone density higher than 350 HU at both joints, i.e., complete bone fusion, also in all 46 patients. The mean post-operative ODI score was significantly lower than its mean pre-operative value (23.6 vs 55.4), which

  12. Uso de morfina intratecal en artrodesis lumbar Uso da morfina intratecal na artrodese lombar Intrathecal morphine in lumbar spine fusion

    Directory of Open Access Journals (Sweden)

    Ronald Schulz Ibaceta

    2009-12-01

    Full Text Available OBJETIVO: determinar la eficacia y la seguridad del uso de morfina intratecal, en bajas dosis, en pacientes sometidos a cirugía de instrumentación y artrodesis lumbar. MÉTODOS: estudio prospectivo, randomizado, ciego y controlado. Fueron utilizados dos grupos de pacientes: Grupo Estudio, que recibió morfina intratecal al final de su cirugía, y Grupo Control que sólo recibió el protocolo de analgesia estándar. RESULTADOS: se encontraron diferencias significativas en la escala visual análoga (EVA entre los dos grupos a las 12 horas postoperatorias. La EVA en reposo promedio del Grupo Estudio fue de 2,15 cm y el del Grupo Control, 5 cm (p=0,013. En actividad, el Grupo Estudio presentó una EVA promedio de 4,36 cm, y el Grupo Control 6,9 cm (p=0,029. No se encontraron diferencias en relación a las complicaciones entre los dos grupos. CONCLUSIÓN: el uso de morfina intratecal, en bajas dosis, es seguro y efectivo en el control del dolor en las primeras 12 horas postoperatorias en cirugía de artrodesis lumbar.OBJETIVO: determinar a eficácia e a seguridade do uso da morfina intratecal, em baixas doses, em pacientes submetidos à cirurgia de instrumentação e artrodese lombar. MÉTODOS: estudo prospectivo, randomizado, cego e controlado. Foram utilizados dois grupos de pacientes: Grupo Estudo, que recebeu morfina intratecal no final da cirurgia e o Grupo Controle, que recebeu somente o protocolo de analgesia padrão. RESULTADOS: foram encontradas diferenças significativas na escala visual analógica (EVA entre os dois grupos às 12 horas pós-operatórias. A EVA em repouso, em média, do Grupo Estudo foi de 2,15 cm e do Grupo Controle, 5 cm (p=0,013. Durante atividade, o Grupo Estudo apresentou uma EVA de aproximadamente 4,36 cm e no Grupo Controle, 6,9 cm (p=0,029. Não foram encontradas diferenças com relação às complicações entre os dois grupos. CONCLUSÃO: o uso de morfina intratecal, em baixas doses, foi seguro e efetivo no

  13. Intramuscular Local Anesthetic Infiltration at Closure for Postoperative Analgesia in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Perera, Andrea P; Chari, Aswin; Kostusiak, Milosz; Khan, Akbar Ali; Luoma, Astri Mv; Casey, Adrian T H

    2017-07-15

    Systematic Review and Meta-Analysis OBJECTIVE.: To identify whether intramuscular local anesthetic infiltration prior to wound closure was effective in reducing postoperative pain and facilitating early discharge following lumbar spine surgery. Local anesthetic infiltration prior to wound closure may form part of the multimodal strategy for postoperative analgesia, facilitating early mobilization and discharge. Although there are a number of small studies investigating its utility, a quantitative meta-analysis of the data has never been performed. This review was conducted according the PRISMA statement and was registered with the PROSPERO database. Only randomized controlled trials were eligible for inclusion. Key outcomes of interest included time to first analgesic demand, total postoperative opiate usage in the first 24 hours, visual analogue score (VAS) at 1, 12 and 24 hours and postoperative length of stay. Eleven publications fulfilled the inclusion criteria. A total of 438 patients were include; 212 in the control group and 226 in the intervention group. Local anesthetic infiltration resulted in a prolonged time to first analgesic demand (mean difference (MD) 65.88 minutes, 95% confidence interval (95% CI) 23.70 to 108.06, P.0.002) as well as a significantly reduced postoperative opiate demand (M.D. -9.71 mg, 95% CI -15.07, -4.34, p = 0.0004). There was a small but statistically significant reduction in postoperative visual analogue score (VAS) at 1 hour (M.D. -0.87 95%CI -1.55, -0.20, p = 0.01), but no significant reduction at 12 or 24 hours (p = 0.93 and 0.85 respectively). This systematic review and meta-analysis provides evidence that postoperative intramuscular local anaesthetic infiltration reduces postoperative analgesic requirements and the time to first analgesic demands for patients undergoing lumbar spine surgery. Key research priorities include optimization of the choice and strength of local anaesthetic agent and health

  14. Parametric modeling of the intervertebral disc space in 3D: application to CT images of the lumbar spine.

    Science.gov (United States)

    Korez, Robert; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž

    2014-10-01

    Gradual degeneration of intervertebral discs of the lumbar spine is one of the most common causes of low back pain. Although conservative treatment for low back pain may provide relief to most individuals, surgical intervention may be required for individuals with significant continuing symptoms, which is usually performed by replacing the degenerated intervertebral disc with an artificial implant. For designing implants with good bone contact and continuous force distribution, the morphology of the intervertebral disc space and vertebral body endplates is of considerable importance. In this study, we propose a method for parametric modeling of the intervertebral disc space in three dimensions (3D) and show its application to computed tomography (CT) images of the lumbar spine. The initial 3D model of the intervertebral disc space is generated according to the superquadric approach and therefore represented by a truncated elliptical cone, which is initialized by parameters obtained from 3D models of adjacent vertebral bodies. In an optimization procedure, the 3D model of the intervertebral disc space is incrementally deformed by adding parameters that provide a more detailed morphometric description of the observed shape, and aligned to the observed intervertebral disc space in the 3D image. By applying the proposed method to CT images of 20 lumbar spines, the shape and pose of each of the 100 intervertebral disc spaces were represented by a 3D parametric model. The resulting mean (±standard deviation) accuracy of modeling was 1.06±0.98mm in terms of radial Euclidean distance against manually defined ground truth points, with the corresponding success rate of 93% (i.e. 93 out of 100 intervertebral disc spaces were modeled successfully). As the resulting 3D models provide a description of the shape of intervertebral disc spaces in a complete parametric form, morphometric analysis was straightforwardly enabled and allowed the computation of the corresponding

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-10-15

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

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

    International Nuclear Information System (INIS)

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

    2016-01-01

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

  17. The effect of kinesio taping in forward bending of the lumbar spine.

    Science.gov (United States)

    Lemos, Thiago Vilela; Albino, Anna Carolina Gonçalves; Matheus, Joao Paulo C; Barbosa, Aurélio de Melo

    2014-09-01

    [Purpose] The aim of this study was to evaluate the influence of a lumbar fascia Kinesio Taping(®) technique forward bending range of motion. [Subjects and Methods] This was a longitudinal study with a randomized clinical trial composed of 39 subjects divided into three groups (control, Kinesio Without Tension-KWT, and Kinesio Fascia Correction-KFC). The subjects were assessed by Schober and fingertip-to-floor tests and left the tape in place for 48 hours before being reassessed 24 hours, 48 hours and 30 days after its removal. [Results] In all three experimental groups no significant differences were observed with the Schober test, but it was possible to observe an increase in lumbar flexion after 30 days. With the fingertip-to-floor distance assessment, the KFC and KWT groups showed significantly improved flexibility 24 hours and 48 hours after tape removal. [Conclusion] The Kinesio Taping(®) influenced fascia mobility, allowing for slight improvement of lumbar flexibility.

  18. TBS (Trabecular Bone Score) Expands Understanding of Spaceflight Effects on the Lumbar Spine of Long Duration Astronauts

    Science.gov (United States)

    Sibonga, Jean D.; Smith, Scott A.; Hans, Didier; LeBlanc, Adrian; Spector, Elisabeth; Evans, Harlan; King, Lisa

    2014-01-01

    Background: Bone loss due to long-duration spaceflight has been characterized by both DXA and QCT serial scans. It is unclear if these spaceflight-induced changes in bone mineral density and structure result in increased fracture incidence. NASA astronauts currently fly on 5-6-month missions on the International Space Station (ISS) and at least one 12-month mission is planned. While NASA has measured areal BMD (by DXA) and volumetric BMD (by QCT), and has estimated hip strength (by finite element models of QCT data, no method has yet been used to examine bone microarchitecture from lumbar spine (LS). DXA scans are routinely performed pre- and post-flight on all ISS astronauts to follow BMD changes associated with space flight. Trabecular Bone Score (TBS) is a relatively new method that measures grey-scale-level texture information extracted from lumbar spine DXA images and correlates with 3D parameters of bone micro-architecture. We evaluated the ability of LS TBS to discriminate changes in astronauts who have flown on ISS missions and to determine if TBS can provide additional information compared to DXA. Methods: LS (L1-4) DXA scans from 51 astronauts (mean age, 47 +/- 4) were divided into 3 groups based on the exercise regimes performed while onboard the ISS. Pre-ARED (exercise using a load-limited resistive exercise device, Hologic Discovery W using the same technician for the pre- and postflight scans. LSC for the LS in our laboratory is 0.025 g/cm2. TBS was performed at the Mercy Hospital, Cincinnati, Ohio on a similar Hologic computer. TBS precision was calculated from 16 comparable test subjects (0.0XX g/cm2). Data were preliminary analyzed using a paired, 2-tailed t-test for the difference between pre- and postflight means.

  19. Imaging of the lumbar spine after diskectomy; Imagerie du rachis lombaire apres discectomie

    Energy Technology Data Exchange (ETDEWEB)

    Laredo, J.D.; Wybier, M. [Hopital Lariboisiere, 75 - Paris (France)

    1995-12-31

    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.

  20. Acute epidural lipedema: a novel entity and potential complication of bone morphogenetic protein use in lumbar spine fusion.

    Science.gov (United States)

    Merrick, Michael T; Hamilton, Kendall D; Russo, Scott S

    2013-10-01

    Bone morphogenetic proteins (BMPs) induce osteogenesis, making them useful for decreasing time to union and increasing union rates. Although the advantages of BMP-2 as a substitute for iliac crest graft have been elucidated, less is known about the safety profile and adverse events linked to their use in spinal fusion. An accumulation of reactive edema in the epidural fat may lead to neural compression and significant morbidity after lumbar spinal fusion. Bone morphogenetic protein has never been implicated as a cause of spinal epidural lipedema. We report on a case of rapid accumulation of edematous adipose tissue in the epidural space after lumbar spine decompression and fusion with bone morphogenic protein. Case report. The patient was a 45-year-old woman with chronic back pain, worsening bilateral L5 radiculopathy, and degenerative disc disease. Surgery consisting of a one-level transpedicular decompression, transforaminal lumbar interbody fusion, and posterolateral fusion was performed using BMP-2 as an adjunct for arthrodesis. Two days postoperatively, the patient developed progressive cauda equina syndrome. Lumbar magnetic resonance imaging revealed edematous epidural fat extending above the initial laminectomy, compromising the spinal canal, and compressing the thecal sac. Emergent laminectomies at L3, L4, and L5 were performed, and intraoperative pathology revealed edematous epidural adipose tissue. The patient's cauda equina syndrome resolved after spinal decompression and the removal of epidural fat. Final cultures were negative for infection, and histology report yielded an accumulation of edematous fibroadipose tissue. We present a case of rapid accumulation of edematous adipose tissue causing cauda equina syndrome after a lumbar decompression and fusion surgery. The acute nature and extensive development of the lipedema presented in this case indicate an intense inflammatory reaction. We hypothesize that there may be a link between the use of BMP-2

  1. Nonoperative Treatment of Thoracic and Lumbar Spine Fractures : A Prospective Randomized Study of Different Treatment Options

    NARCIS (Netherlands)

    Stadhouder, Agnita; Buskens, Erik; Vergroesen, Diederik A.; Fidler, Malcolm W.; de Nies, Frank; Oner, F. C.

    Objectives: To evaluate and compare nonoperative treatment methods for traumatic thoracic and lumbar compression fractures and burst fractures. Design: Prospective randomized controlled trial with long-term follow-up. Setting: Two general hospitals in the Netherlands. Patients/Participants: Patients

  2. Intra- and interobserver reproducibility of vertebral endplate signal (modic) changes in the lumbar spine

    DEFF Research Database (Denmark)

    Jensen, Tue Secher; Sorensen, Joan Solgaard; Kjær, Per

    2007-01-01

    BACKGROUND: The lumbar vertebral endplate is considered a potential cause of specific low back pain. However, in relation to future research, there is need for a reliable and detailed magnetic resonance imaging (MRI) protocol to be used in the evaluation of vertebral endplate signal changes. PURP...

  3. Nonlinear finite-element analysis and biomechanical evaluation of the lumbar spine

    DEFF Research Database (Denmark)

    Wong, Christian; Gehrchen, P Martin; Darvann, Tron

    2003-01-01

    A finite-element analysis (FEA) model of an intact lumbar disc-body unit was generated. The vertebral body of the FEA model consisted of a solid tetrahedral core of trabecular bone surrounded by a cortical shell. The disc consisted of an incompressible nucleus surrounded by nonlinear annulus fibe...

  4. The use of reference image criteria in X-ray diagnostics: an application for the optimisation of lumbar spine radiographs

    International Nuclear Information System (INIS)

    Almen, A.; Tingberg, A.; Mattsson, S.; Besjakov, J.

    2004-01-01

    To ensure that sufficient image quality is obtained in diagnostic radiology, the image quality of clinical radiographs has to be evaluated. We present two methods herein for evaluating antero-posterior (AP) radiographs of the lumbar spine. One was using image criteria, including six anatomical details (absolute method). In the other, the visibility of anatomical details relative to a reference radiograph was evaluated (visual grading analysis). In total, 14 technique groups were evaluated. The technique groups differed in tube voltage and detector system characteristics. Six different gradients of the H and D curves were simulated. The visual grading analysis showed larger differences in image quality compared with the absolute method. The influence on the image quality due to a variation in tube voltage was easier to detect than the influence on the image quality from the detector characteristics. The visibility of the anatomical details was significantly dependent on the location in the spine. The visual grading analysis was found to be the preferable evaluation method in studies such as the present; however, it is necessary to guide and train the observer before the evaluation is performed. (orig.)

  5. Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases.

    Science.gov (United States)

    Tschugg, Anja; Hartmann, Sebastian; Lener, Sara; Rietzler, Andreas; Sabrina, Neururer; Thomé, Claudius

    2017-12-01

    Minimally invasive surgical techniques have been developed to minimize tissue damage, reduce narcotic requirements, decrease blood loss, and, therefore, potentially avoid prolonged immobilization. Thus, the purpose of the present retrospective study was to assess the safety and efficacy of a minimally invasive posterior approach with transforaminal lumbar interbody debridement and fusion plus pedicle screw fixation in lumbar spondylodiscitis in comparison to an open surgical approach. Furthermore, treatment decisions based on the patient´s preoperative condition were analyzed. 67 patients with lumbar spondylodiscitis treated at our department were included in this retrospective analysis. The patients were categorized into two groups based on the surgical procedure: group (MIS) minimally invasive lumbar spinal fusion (n = 19); group (OPEN) open lumbar spinal fusion (n = 48). Evaluation included radiological parameters on magnetic resonance imaging (MRI), laboratory values, and clinical outcome. Preoperative MRI showed higher rates of paraspinal abscess (35.5 vs. 5.6%; p = 0.016) and multilocular location in the OPEN group (20 vs. 0%, p = 0.014). Overall pain at discharge was less in the MIS group: NRS 2.4 ± 1 vs. NRS 1.6 ± 1 (p = 0.036). The duration of hospital stay was longer in the OPEN than the MIS group (19.1 ± 12 days vs. 13.7 ± 5 days, p = 0.018). The open technique is effective in all varieties of spondylodiscitis inclusive in epidural abscess formation. MIS can be applied safely and effectively as well in selected cases, even with epidural abscess.

  6. Differences in kinematics of the lumbar spine and lower extremities between people with and without low back pain during the down phase of a pick up task, an observational study.

    Science.gov (United States)

    Gombatto, Sara P; D'Arpa, Natalie; Landerholm, Sarah; Mateo, Cassandra; O'Connor, Ryan; Tokunaga, Jana; Tuttle, Lori J

    2017-04-01

    Limited research exists on lumbar spine and lower extremity movement during functional tasks in people with and without low back pain (LBP). To determine differences in lumbar spine and lower extremity kinematics in people with and without LBP during the down phase of a pick up task. Cross-sectional, observational study. 35 people (14 M, 21 F, 26.9 ± 10.9 years, 24.8 ± 3.2 kg/m 2 ); 18 with and 17 without LBP were matched based on age, gender and BMI. Kinematics of the lumbar spine and lower extremities were measured using 3D motion capture, while subjects picked up an object off the floor. People with LBP were examined and assigned to movement-based LBP subgroups. Repeated measures ANOVA tests were conducted to determine the effect of group and region on lumbar spine and lower extremity kinematics. A secondary analysis was conducted to examine the effect of LBP subgroup on lumbar spine kinematics. Compared to controls, subjects with LBP displayed greater upper and less lower lumbar flexion (P  0.05). When evaluating movement during a functional task, the clinician should consider regional differences in the lumbar spine, pattern of movement, and lower extremity movement. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Effect of 6 months of whole body vibration on lumbar spine bone density in postmenopausal women: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Lai CL

    2013-12-01

    Full Text Available Chung-Liang Lai,1,2 Shiuan-Yu Tseng,1,2 Chung-Nan Chen,3 Wan-Chun Liao,2 Chun-Hou Wang,4 Meng-Chih Lee,1,5,* Pi-Shan Hsu5,* 1Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; 2Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; 3Department of Radiology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; 4School of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan; 5Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan*These authors contributed equally to this workBackground: The issue of osteoporosis-induced fractures has attracted the world's attention. Postmenopausal women are particularly at risk for this type of fracture. The nonmedicinal intervention for postmenopausal women is mainly exercise. Whole body vibration (WBV is a simple and convenient exercise. There have been some studies investigating the effect of WBV on osteoporosis; however, the intervention models and results are different. This study mainly investigated the effect of high-frequency and high-magnitude WBV on the bone mineral density (BMD of the lumbar spine in postmenopausal women.Methods: This study randomized 28 postmenopausal women into either the WBV group or the control group for a 6-month trial. The WBV group received an intervention of high-frequency (30 Hz and high-magnitude (3.2 g WBV in a natural full-standing posture for 5 minutes, three times per week, at a sports center. Dual-energy X-ray absorptiometry was used to measure the lumbar BMD of the two groups before and after the intervention.Results: Six months later, the BMD of the WBV group had significantly increased by 2.032% (P=0.047, while that of the control group had decreased by 0.046% (P=0.188. The comparison between the two groups showed that the BMD of the WBV group had increased significantly (P=0.016.Conclusion: This study found

  8. Comparison of Intervertebral ROM in Multi-Level Cadaveric Lumbar Spines Using Distinct Pure Moment Loading Approaches.

    Science.gov (United States)

    Santoni, Brandon; Cabezas, Andres F; Cook, Daniel J; Yeager, Matthew S; Billys, James B; Whiting, Benjamin; Cheng, Boyle C

    2015-01-01

    Pure-moment loading is the test method of choice for spinal implant evaluation. However, the apparatuses and boundary conditions employed by laboratories in performing spine flexibility testing vary. The purpose of this study was to quantify the differences, if they exist, in intervertebral range of motion (ROM) resulting from different pure-moment loading apparatuses used in two laboratories. Twenty-four (laboratory A) and forty-two (laboratory B) intact L1-S1 specimens were loaded using pure moments (±7.5 Nm) in flexion-extension (FE), lateral bending (LB) and axial torsion (AT). At laboratory A, pure moments were applied using a system of cables, pulleys and suspended weights in 1.5 Nm increments. At laboratory B, specimens were loaded in a pneumatic biaxial test frame mounted with counteracting stepper-motor-driven biaxial gimbals. ROM was obtained in both labs using identical optoelectronic systems and compared. In FE, total L1-L5 ROM was similar, on average, between the two laboratories (lab A: 37.4° ± 9.1°; lab B: 35.0° ± 8.9°, p=0.289). Larger apparent differences, on average, were noted between labs in AT (lab A: 19.4° ± 7.3°; lab B: 15.7° ± 7.1°, p=0.074), and this finding was significant for combined right and left LB (lab A: 45.5° ± 11.4°; lab B: 35.3° ± 8.5°, p < 0.001). To our knowledge, this is the first study comparing ROM of multi-segment lumbar spines between laboratories utilizing different apparatuses. The results of this study show that intervertebral ROM in multi-segment lumbar spine constructs are markedly similar in FE loading. Differences in boundary conditions are likely the source of small and sometimes statistically significant differences between the two techniques in LB and AT ROM. The relative merits of each testing strategy with regard to the physiologic conditions that are to be simulated should be considered in the design of a study including LB and AT modes of loading. An understanding of these differences also

  9. Comparison of standard fusion with a "topping off" system in lumbar spine surgery: a protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kaulhausen Thomas

    2011-10-01

    Full Text Available Abstract Background Fusion of lumbar spine segments is a well-established therapy for many pathologies. The procedure changes the biomechanics of the spine. Initial clinical benefits may be outweighed by ensuing damage to the adjacent segments. Various surgical devices and techniques have been developed to prevent this deterioration. "Topping off" systems combine rigid fusion with a flexible pedicle screw system to prevent adjacent segment disease (ASD. To date, there is no convincing evidence that these devices provide any patient benefits. Methods/Design The study is designed as a randomized, therapy-controlled trial in a clinical care setting at a university hospital. Patients presenting to the outpatient clinic with degenerative disc disease or spondylolisthesis will be assessed against study inclusion and exclusion criteria. After randomization, the control group will undergo conventional fusion. The intervention group will undergo fusion with a supplemental flexible pedicle screw system to protect the adjacent segment ("topping off". Follow-up examination will take place immediately after treatment during hospital stay, after 6 weeks, and then after 6, 12, 24 and 36 months. Subsequently, ongoing assessments will be performed annually. Outcome measurements will include quality of life and pain assessments using questionnaires (SF-36™, ODI, COMI. In addition, clinical and radiologic ASD, work-related disability, and duration of work disability will be assessed. Inpatient and 6-month mortality, surgery-related data (e.g., intraoperative complications, blood loss, length of incision, surgical duration, postoperative complications, adverse events, and serious adverse events will be documented and monitored throughout the study. Cost-effectiveness analysis will also be provided. Discussion New hybrid systems might improve the outcome of lumbar spine fusion. To date, there is no convincing published data on effectiveness or safety of these

  10. Correlations Between the SF-36, the Oswestry-Disability Index and Rolland-Morris Disability Questionnaire in Patients Undergoing Lumbar Decompression According to Types of Spine Origin Pain.

    Science.gov (United States)

    Ko, Sangbong; Chae, Seungbum

    2017-07-01

    Cross-sectional study. To determine the correlation between SF-36 (a measure for overall health status in patients) and Oswestry-Disability Index (ODI) or Rolland-Morris Disability Questionnaire (RMDQ) confined to spine according to the type of pain from the spine. Data showed moderate correlation between ODI and SF-36 Physical Component Score (PCS), Physical Functioning (PF) (r=-0.46), Physical Role Functioning (RP) (r=-0.284), Bodily Pain (BP) (r=-0.327), and Mental Component Score (MCS), Emotional Role Functioning (r=-0.250), Social Role Functioning (r=0.254), Vitality (r=0.296). Between January 1, 2008 and December 31, 2013, a total of 69 patients were enrolled in this study. They were diagnosed with lumbar spinal stenosis and underwent decompression surgery such as laminotomy in this hospital. The 3 standardized questionnaires (ODI, RMDQ, and SF-36) were given to these patients, at least 1 year after the surgery. ODI and SF-36 had a statistically significant (P=0.001) and moderate correlation. Small correlations were also seen between Physical Functioning (r=-0.46), Physical Role Functioning (r=-0.284), and Bodily Pain (r=-0.327) of SF-36 PCS and ODI, and between Emotional Role Functioning (r=-0.250), Social Role Functioning (r=-0.254), and Vitality (r=-0.296) of SF-36 Mental Component Score and ODI. Items in ODI for the level of pain while standing and traveling were mostly related to axial back pain, while item of lifting was related to referred buttock pain. Sleeping disturbance section in the ODI was mainly caused by radiated leg pain. In addition, RMDQ was also associated to the 3 types of pain. Moderate correlation was found between ODI or RMDQ as a condition-specific outcome and the SF-36, indicating overall health status. ODI was found to be a more adequate measure to evaluate axial back pain rather than referred pain or radiating pain. RMDQ was adequate to measure the health status and to evaluate the 3 types of spine pain. These 3 instruments could

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

    International Nuclear Information System (INIS)

    Lee, Sook Hi; Lee, Sang Seun

    1979-01-01

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

  12. Clinical and imaging characteristics of foraminal nerve root disorders of the lumbar spine

    International Nuclear Information System (INIS)

    Nishi, Tomio; Tani, Takayuki; Suzuki, Norio; Aonuma, Hiroshi

    2009-01-01

    We analyzed cases of lumbar nerve root compression at intervertebral foramina, by comparing 19 cases of foraminal stenosis (FS), and 38 cases of foraminal hernia (FH) with 21 cases of lumbar canal stenosis (LCS). Japan Orthopedic Association (JOA) scores, intervertebral disc degeneration, anatomical measurements of the nerve root foramina and the MRI findings were reviewed. The scores for pain in the lower extremities, and walking ability were both lowest in the FS group. The scores for low back pain, lower extremities, and sensory disturbances were lowest in the FH group. Anterior-posterior diameters of the nerve root foramina were smaller in the FS group and FH group than in the LCS group. More degenerated discs and short length of upper part of the nerve root foramina were seen in FS group than in the other groups. The MRI images of so-called black out nerve root foramina were positive in 63.6% of FS cases, 75% of FH cases. (author)

  13. [Dynamic instrumentation of the lumbar spine. Clinical and biomechanical analysis of success factors].

    Science.gov (United States)

    Charles, Y P; Walter, A; Schuller, S; Steib, J-P

    2011-08-01

    Total disc replacement and posterior dynamic stabilization represent alternatives to lumbar spinal fusion which should reduce the risk of adjacent segment degeneration. Disc replacement is indicated for pure discopathy without facet joint degeneration. Spinopelvic balance influences the implant's biomechanics. Therefore pelvic incidence, sacral slope, segmental lordosis and the mean axis of rotation need to be considered. Dynamic stabilization is indicated in moderate discopathy and facet joint degeneration, in degenerative spondylolisthesis grade I with a hypermobile segment and in dynamic lumbar stenosis. The combination of caudal fusion and cranial dynamic stabilization allows a better maintenance of lordosis with multiple level instrumentation and prevents adjacent segment degeneration. If pelvic incidence and sacral slope are high, L5-S1 should be fused because of elevated shear forces.

  14. 3-D MRI/CT fusion imaging of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-03-15

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

  15. Biomechanical analysis of the posterior bony column of the lumbar spine.

    Science.gov (United States)

    Li, Jiukun; Huang, Shuai; Tang, Yubo; Wang, Xi; Pan, Tao

    2017-09-15

    Each part of the rear bone structure can become an anchor point for an attachment device. The objective of this study was to evaluate the stiffness and strength of different parts of the rear lumbar bone structure by axial compression damage experiments. Five adult male lumbar bone structures from L2 to L5 were exposed. The superior and inferior articular processes, upper and lower edges of the lamina, and upper and lower edges of the spinous process were observed and isolated and then divided into six groups (n = 10). The specimens were placed between the compaction disc and the load platform in a universal testing machine, which was first preloaded to 5.0 N tension to eliminate water on the surface and then loaded to the specimen curve decline at a constant tension loading rate of 0.01 mm/s, until the specimens had been destroyed. Significant differences in mechanical properties were found among different parts of the rear lumbar bone structure. Compared with other parts, the lower edge of the lamina has good mechanical properties, which have a high modulus of elasticity; the superior and inferior articular processes have greater ultimate strength, which can withstand greater compressive loads; and the mechanical properties of the spinous process are poor, and it is significantly stiffer and weaker than the lamina and articular processes. These data can be useful in future spinal biomechanics research leading to better biomechanical compatibility and provide theoretical references for spinal implant materials.

  16. CHANGES FACETS JOINTS IN TRAUMA AND DEGENERATIVE DISEASES OF THE LUMBAR SPINE

    Directory of Open Access Journals (Sweden)

    V. V. Shchedrenok

    2011-01-01

    Full Text Available Produced spondilometric measurements of the lumbosacral spine is normal (20 cases and in patients with spinal cord injury and degenerative-dystrophic diseases of the spine (43 cases. The width of the facet joint space joints on both sides, its relation to the longitudinal axis of the body in degrees and another on the same level were studied. The width of the facet joint space at the lumbosacral level of 3.5–4.0 mm, the area of the intervertebral foramen varies from 96–132 mm2. Among the changes in the parameters of the vertebral-motor segment can distinguish moderate, marked and significant extent that is important in determining the amount of the alleged operation.

  17. Polymorphisms in the P2X7 receptor gene are associated with low lumbar spine bone mineral density and accelerated bone loss in post-menopausal women

    DEFF Research Database (Denmark)

    Gartland, Alison; Skarratt, Kristen K; Hocking, Lynne J

    2012-01-01

    the functional P2RX7 SNPs are associated with lumbar spine (LS) bone mineral density (BMD), a key determinant of vertebral fracture risk, in post-menopausal women. We genotyped 506 post-menopausal women from the Aberdeen Prospective Osteoporosis Screening Study (APOSS) for the above SNPs. Lumbar spine BMD...... SNPs (n=48) had nearly ninefold greater annualised percent change in LS-BMD than subjects who were wild type at the six SNP positions (n=84; rate of loss=-0.94%/year and -0.11%/year, respectively, P=0.0005, unpaired t-test). This is the first report that describes association of the c.946A (p.Arg307Gln...

  18. Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study

    Science.gov (United States)

    Sivasubramaniam, Vinothan; Patel, Hitesh C; Ozdemir, Baris A; Papadopoulos, Marios C

    2015-01-01

    Objectives Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their country's specific demographics and healthcare system. Considering England's specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources. Design Retrospective cohort study using Hospital Episode Statistics data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyse trends. Outcome measures Trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay. Results Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100 000, respectively, (pdisease, and highlight the need for services capable of dealing with the increased comorbidity burden associated with an ageing patient group. PMID:26671956

  19. Measurements of bone mineral density in the lumbar spine and proximal femur using lunar prodigy and the new pencil-beam dual-energy X-ray absorptiometry.

    Science.gov (United States)

    Choi, Dongil; Kim, Deog-Yoon; Han, Chung Soo; Kim, Seonwoo; Bok, Hae Sook; Huh, Wooseong; Ko, Jae-Wook; Hong, Sung Hwa

    2010-11-01

    We evaluated the correlation of the absolute bone mineral density (BMD) values of the lumbar spine and standard sites of the proximal femur obtained from a Lunar Prodigy and the newly developed pencil-beam dual-energy X-ray absorptiometry (Dexxum). Between June 2008 and December 2008, 79 Korean volunteers were enrolled. Measurements were obtained on the same day using both densitometers. The absolute BMD values (g/cm(2)) from the two densitometers were evaluated using Pearson's correlation analysis with Bonferroni's correction for the three clinically important sites. In order to evaluate precision, we performed duplicate Dexxum measurements, and calculated the within-subject coefficient of variation (WSCV). The Pearson's correlation coefficient (r) of BMD values for the total proximal femur, femoral neck, and lumbar spine by the two densitometers were 0.926, 0.948, and 0.955 respectively, and the null hypotheses of r = 0.8 were all rejected (p Prodigy.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-08-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-06-15

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

  2. Observer agreement in the reporting of knee and lumbar spine magnetic resonance (MR) imaging examinations: Selectively trained MR radiographers and consultant radiologists compared with an index radiologist

    International Nuclear Information System (INIS)

    Brealey, S.; Piper, K.; King, D.; Bland, M.; Caddick, J.; Campbell, P.; Gibbon, A.; Highland, A.; Jenkins, N.; Petty, D.; Warren, D.

    2013-01-01

    Purpose: To assess agreement between trained radiographers and consultant radiologists compared with an index radiologist when reporting on magnetic resonance imaging (MRI) examinations of the knee and lumbar spine and to examine the subsequent effect of discordant reports on patient management and outcome. Methods: At York Hospital two MR radiographers, two consultant radiologists and an index radiologist reported on a prospective, random sample of 326 MRI examinations. The radiographers reported in clinical practice conditions and the radiologists during clinical practice. An independent consultant radiologist compared these reports with the index radiologist report for agreement. Orthopaedic surgeons then assessed whether the discordance between reports was clinically important. Results: Overall observer agreement with the index radiologist was comparable between observers and ranged from 54% to 58%; for the knee it was 46–57% and for the lumbar spine was 56–66%. There was a very small observed difference of 0.6% (95% CI −11.9 to 13.0) in mean agreement between the radiographers and radiologists (P = 0.860). For the knee, lumbar spine and overall, radiographers’ discordant reports, when compared with the index radiologist, were less likely to have a clinically important effect on patient outcome than the radiologists’ discordant reports. Less than 10% of observer's reports were sufficiently discordant with the index radiologist's reports to be clinically important. Conclusion: Carefully selected MR radiographers with postgraduate education and training reported in clinical practice conditions on specific MRI examinations of the knee and lumbar spine to a level of agreement comparable with non-musculoskeletal consultant radiologists

  3. Anatomical variations of the iliolumbar vein with application to the anterior retroperitoneal approach to the lumbar spine: a cadaver study.

    Science.gov (United States)

    Unruh, Kenneth P; Camp, Christopher L; Zietlow, Scott P; Huddleston, Paul M

    2008-10-01

    Objectives of this study include identification of lumbosacral venous variations, designation of a critical area of dissection for surgical exposure, and comparison between both male/female and right/left-sided anatomy. Attempts were made to provide anatomic nomenclature that accurately describes these structures. Thirty-eight iliolumbar venous systems in 20 cadavers (11 females/9 males) were dissected. Each system was identified as one of three patterns of variation: common venous trunk (combining ascending lumbar and iliolumbar venous systems) with distal veins, common venous trunk without distal veins, and venous systems without a common venous trunk. Dimensions including distances to the inferior vena cava (IVC) confluence, the obturator nerve, and the lumbosacral trunk, and venous stem length were obtained to aid surgical dissection. Differences between males and females and those between right and left sides were compared. Anterior lumbosacral venous variations could be organized into three groups. A Type 1 venous system (common venous trunk with distal veins) was most common (53% of systems). The anatomical name "lateral lumbosacral veins" adequately describes the anatomical location of these veins and does not assume a direction of venous flow or the lack of individual distal veins. A critical area bordered by the obturator nerve anteriorly, the psoas muscle laterally, the spinal column medially, and sacrum posteriorly within 8.2 cm of the IVC confluence should be defined to adequately dissect the lateral lumbosacral veins. Differences in male and female lateral lumbosacral venous anatomy do not alter surgeon's approach to the anterior lumbar spine. (c) 2008 Wiley-Liss, Inc.

  4. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology.

    Science.gov (United States)

    Fardon, David F; Williams, Alan L; Dohring, Edward J; Murtagh, F Reed; Gabriel Rothman, Stephen L; Sze, Gordon K

    2014-11-01

    The paper ''Nomenclature and classification of lumbar disc pathology, recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology,'' was published in 2001 in Spine (© Lippincott, Williams & Wilkins). It was authored by David Fardon, MD, and Pierre Milette, MD, and formally endorsed by the American Society of Spine Radiology (ASSR), American Society of Neuroradiology (ASNR), and North American Spine Society (NASS). Its purpose was to promote greater clarity and consistency of usage of spinal terminology, and it has served this purpose well for over a decade. Since 2001, there has been sufficient evolution in our understanding of the lumbar disc to suggest the need for revision and updating of the original document. The revised document is presented here, and it represents the consensus recommendations of contemporary combined task forces of the ASSR, ASNR, and NASS. This article reflects changes consistent with current concepts in radiologic and clinical care. To provide a resource that promotes a clear understanding of lumbar disc terminology amongst clinicians, radiologists, and researchers. All the concerned need standard terms for the normal and pathologic conditions of lumbar discs that can be used accurately and consistently and thus best serve patients with disc disorders. This article comprises a review of the literature. A PubMed search was performed for literature pertaining to the lumbar disc. The task force members individually and collectively reviewed the literature and revised the 2001 document. The revised document was then submitted for review to the governing boards of the ASSR, ASNR, and NASS. After further revision based on the feedback from the governing boards, the article was approved for publication by the governing boards of the three societies, as representative of the consensus recommendations of the societies. The article provides a

  5. TBS (Trabecular Bone Score) Expands Understanding of Spaceflight Effects on the Lumbar Spine of Long-Duration Astronauts

    Science.gov (United States)

    Smith, Scott A.; Watts, Nelson; Hans, Didier; LeBlanc, Adrian; Spector, Elisabeth; King, Lisa; Sibonga, Jean

    2014-01-01

    Bone loss due to long-duration spaceflight has been characterized by both DXA and QCT serial scans. It is unclear if these spaceflight-induced changes in bone mineral density (BMD) and structure result in increased fracture incidence. NASA astronauts currently fly 5 to 6-month missions on the International Space Station (ISS) and at least one 12-month mission is planned. While NASA has measured areal BMD (by DXA) and volumetric BMD (by QCT) and has estimated hip strength (by finite element models of QCT data, no method has yet been used to examine bone micro-architecture from lumbar spine (LS). DXA scans are routinely performed pre- and postflight on all ISS astronauts to follow BMD changes associated with spaceflight. Trabecular Bone Score (TBS) is a relatively new method that measures grey-scale-level texture information extracted from LS DXA images and correlates with 3D parameters of bone micro-architecture. We evaluated the ability of LS TBS to discriminate changes in astronauts who have flown on ISS missions and to determine if TBS can provide additional information compared to DXA. Methods: Lumbar Spine (L1-4) DXA scans from 51 astronauts (mean age, 47 +/- 4 yrs) were divided into 3 groups based on the exercise regimens performed onboard the ISS. "Pre-ARED" (exercise using a load-limited resistive exercise device, Hologic Discovery W using the same technician for the pre- and post-flight scans. LSC for the LS in our laboratory is 0.025 g/sq. cm. TBS was performed at the Mercy Hospital, Cincinnati, Ohio on a similar Hologic computer. Data were analyzed using a paired, 2-tailed Student's t-test for the difference between pre- and postflight means. Percent change and % change per month are noted. Interpretation: Our data suggest that: TBS and DXA both detected significant decrements in the LS in these pre- ARED astronauts, not unexpected given the insufficient loads provided by this early exercise device. TBS did not detect significant changes in the ARED or

  6. Low-Load Very High-Repetition Resistance Training Attenuates Bone Loss at the Lumbar Spine in Active Post-menopausal Women.

    Science.gov (United States)

    Nicholson, Vaughan P; McKean, Mark R; Slater, Gary J; Kerr, Ava; Burkett, Brendan J

    2015-06-01

    This study determined the effect of 6 months of low-load very high-repetition resistance training on bone mineral density (BMD) and body composition in nonosteoporotic middle-aged and older women. Fifty healthy, active community-dwelling women aged 56-75 years took part in the two-group, repeated-measures randomized controlled trial. Participants either undertook 6 months of low-load very high-repetition resistance training in the form of BodyPump™ or served as control participants. Outcome measures included BMD at the lumbar spine, hip, and total body; total fat mass; fat-free soft tissue mass and maximal isotonic strength. Significant group-by-time interactions were found for lumbar spine BMD and maximal strength in favor of the BodyPump™ group. No favorable effects were found for hip BMD, total body BMD, total fat mass, or fat-free soft tissue mass. Three participants withdrew from the intervention group due to injury or fear of injury associated with training. Under the conditions used in this research, low-load very high-repetition resistance training is effective at attenuating losses in lumbar spine BMD compared to controls in healthy, active women aged over 55 years but did not influence hip and total body BMD or fat mass and fat-free soft tissue mass.

  7. Epidural fat interposition between dura mater and spinous process: a new sign for the diagnosis of spondylolysis on MR imaging of the lumbar spine

    International Nuclear Information System (INIS)

    Sherif, Hanan; Mahfouz, Ahmed-Emad

    2004-01-01

    The purpose of this study was to assess the diagnostic value of epidural fat interposition between the dura mater and spinous process of L5 as an indirect sign of spondylolysis on mid-sagittal MR imaging of the lumbar spine. Mid-sagittal T1-weighted MR images of the lumbar spine of 85 patients with spondylolysis and 93 patients without pars interarticularis fractures were randomized and evaluated by a masked reader. After a training sample of five cases, the reader was asked to note the presence or absence of epidural fat interposition between the dura mater and spinous process of L5 on the randomized images. The epidural fat interposition between the dura mater and spinous process of L5 was noted in 67 out of the 85 patients with spondylolysis (78.8%) and three of the patients without pars interarticularis fracture (3.2%). The difference was statistically significant (P<0.01). This sign has a specificity of 96.7%, sensitivity of 78.8%, positive predictive value of 95.7%, negative predictive value of 83.3% and accuracy of 88.2% for diagnosis of spondylolysis. Epidural fat interposition between the dura mater and spinous process may be a helpful sign for the diagnosis of spondylolysis on mid-sagittal MR imaging of the lumbar spine. (orig.)

  8. Epidural fat interposition between dura mater and spinous process: a new sign for the diagnosis of spondylolysis on MR imaging of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Sherif, Hanan; Mahfouz, Ahmed-Emad [Department of Radiology, Hamad Medical Corporation, P.O. Box 3050, Doha (Qatar)

    2004-06-01

    The purpose of this study was to assess the diagnostic value of epidural fat interposition between the dura mater and spinous process of L5 as an indirect sign of spondylolysis on mid-sagittal MR imaging of the lumbar spine. Mid-sagittal T1-weighted MR images of the lumbar spine of 85 patients with spondylolysis and 93 patients without pars interarticularis fractures were randomized and evaluated by a masked reader. After a training sample of five cases, the reader was asked to note the presence or absence of epidural fat interposition between the dura mater and spinous process of L5 on the randomized images. The epidural fat interposition between the dura mater and spinous process of L5 was noted in 67 out of the 85 patients with spondylolysis (78.8%) and three of the patients without pars interarticularis fracture (3.2%). The difference was statistically significant (P<0.01). This sign has a specificity of 96.7%, sensitivity of 78.8%, positive predictive value of 95.7%, negative predictive value of 83.3% and accuracy of 88.2% for diagnosis of spondylolysis. Epidural fat interposition between the dura mater and spinous process may be a helpful sign for the diagnosis of spondylolysis on mid-sagittal MR imaging of the lumbar spine. (orig.)

  9. The significance of both lateral bending view as functional myelography of lumbar spine

    International Nuclear Information System (INIS)

    Kim, Hack Jin; Ahn, Woo Hyun; Sol, Chang Hyo; Kim, Byung Soo

    1989-01-01

    CT and myelography are the most accurate diagnostic tools to define a lumbar herniated disc disease. But they may not demonstrated organic lesion of the cause of clinical symptoms or may not agree the site of lesion and lateralizing sign, so they may give a confusion to radiologist and clinicians. The purpose of this study is to estimate the value of lateral bending as functional myelography in the evaluation of the change of filling of nerve root sleeve compared with that of static myelography. We analysed 84 disc spaces of 28 patients of bulging disc or central HNP who had undergone both lumbar CT and functional myelography at Pusan National University Hospital from Aug.1987 to Aug.1988. The results were as follows: 1. In normal disc, there were tendencies of the same or increased filling of nerve root sleeve in the flexion site of lateral bending in functional myelography compared with that of static myelography, and of the same or decreased filling of nerve root sleeve in the extension site of lateral bending in functional myelography. 2. In bulging disc and central HNP, diagnostic method of functional myelography increased agreement of clinical symptoms and imaging diagnosis regarding the change of filling in nerve root sleeve in functional myelography from static one as a functional impairment of nerve root. 3. Lateral bending in functional myelography was expected as precise and genuine diagnostic tool that might represent functional impairment of nerve root

  10. The significance of both lateral bending view as functional myelography of lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hack Jin; Ahn, Woo Hyun; Sol, Chang Hyo; Kim, Byung Soo [Pusan National Unversity University College of Medicine, Pusan (Korea, Republic of)

    1989-04-15

    CT and myelography are the most accurate diagnostic tools to define a lumbar herniated disc disease. But they may not demonstrated organic lesion of the cause of clinical symptoms or may not agree the site of lesion and lateralizing sign, so they may give a confusion to radiologist and clinicians. The purpose of this study is to estimate the value of lateral bending as functional myelography in the evaluation of the change of filling of nerve root sleeve compared with that of static myelography. We analysed 84 disc spaces of 28 patients of bulging disc or central HNP who had undergone both lumbar CT and functional myelography at Pusan National University Hospital from Aug.1987 to Aug.1988. The results were as follows: 1. In normal disc, there were tendencies of the same or increased filling of nerve root sleeve in the flexion site of lateral bending in functional myelography compared with that of static myelography, and of the same or decreased filling of nerve root sleeve in the extension site of lateral bending in functional myelography. 2. In bulging disc and central HNP, diagnostic method of functional myelography increased agreement of clinical symptoms and imaging diagnosis regarding the change of filling in nerve root sleeve in functional myelography from static one as a functional impairment of nerve root. 3. Lateral bending in functional myelography was expected as precise and genuine diagnostic tool that might represent functional impairment of nerve root.

  11. Significant reduction of fluoroscopy repetition with lumbar localization system in minimally invasive spine surgery: A prospective study.

    Science.gov (United States)

    Fan, Guoxin; Zhang, Hailong; Gu, Xin; Wang, Chuanfeng; Guan, Xiaofei; Fan, Yunshan; He, Shisheng

    2017-05-01

    The conventional location methods for minimally invasive spinal surgery (MISS) were mainly based on repeated fluoroscopy in a trial-and-error manner preoperatively and intraoperatively. Localization system mainly consisted of preoperative applied radiopaque frame and intraoperative guiding device, which has the potential to minimize fluoroscopy repetition in MISS. The study aimed to evaluate the efficacy of a novel lumbar localization system in reducing radiation exposure to patients.Included patients underwent minimally invasive transforaminal lumbar interbody fusion (MISTLIF) or percutaneous transforaminal endoscopic discectomy (PTED). Patients treated with novel localization system were regarded as Group A, and patients treated without novel localization system were regarded as Group B.For PTED, The estimated effective dose was 0.41 ± 0.13 mSv in Group A and 0.57 ± 0.14 mSv in Group B (P fluoroscopy exposure time of PTED was 22.18 ± 7.30 seconds in Group A and 30.53 ± 7.56 seconds in Group B (P fluoroscopy exposure time was 25.41 ± 5.52 seconds in Group A and 32.82 ± 5.03 seconds in Group B (P < .001); The estimated cancer risk was 24.90 ± 5.15 (10) in Group A and 31.96 ± 5.04 (10) in Group B (P < .001). There were also significant differences in localization time and operation time between the 2 groups either for MISTLIF or PTED.The lumbar localization system could be a potential protection strategy for minimizing radiation hazards.

  12. Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish Lumbar Spine Study: a multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group.

    Science.gov (United States)

    Fritzell, Peter; Hägg, Olle; Jonsson, Dick; Nordwall, Anders

    2004-02-15

    A cost-effectiveness study was performed from the societal and health care perspectives. To evaluate the costs-effectiveness of lumbar fusion for chronic low back pain (CLBP) during a 2-year follow-up. A full economic evaluation comparing costs related to treatment effects in patients with CLBP is lacking. A total of 284 of 294 patients with CLBP for at least 2 years were randomized to either lumbar fusion or a nonsurgical control group. Costs for the health care sector (direct costs), and costs associated with production losses (indirect costs) were calculated. Societal total costs were identified as the sum of direct and indirect costs. Treatment effects were measured using patient global assessment of improvement, back pain (VAS), functional disability (Owestry), and return to work. The societal total cost per patient (standard deviations) in the surgical group was significantly higher than in the nonsurgical group: Swedish kroner (SEK) 704,000 (254,000) vs. SEK 636,000 (208,000). The cost per patient for the health care sector was significantly higher for the surgical group, SEK 123,000 (60,100) vs. 65,200 (38,400) for the control group. All treatment effects were significantly better after surgery. The incremental cost-effectiveness ratio (ICER), illustrating the extra cost per extra effect unit gained by using fusion instead of nonsurgical treatment, were for improvement: SEK 2,600 (600-5,900), for back pain: SEK 5,200 (1,100-11,500), for Oswestry: SEK 11,300 (1,200-48,000), and for return to work: SEK 4,100 (100-21,400). For both the society and the health care sectors, the 2-year costs for lumbar fusion was significantly higher compared with nonsurgical treatment but all treatment effects were significantly in favor of surgery. The probability of lumbar fusion being cost-effective increased with the value put on extra effect units gained by using surgery.

  13. Papillary thyroid carcinoma metastasis to the lumbar spine masquerading as a schmorl's node

    Energy Technology Data Exchange (ETDEWEB)

    Daignault, Cory P.; Palmer, Edwin L.; Scott, James A.; Swan, John S. [Dept. of Radiology, Massachusetts General Hospital, Boston (United States); Daniels, Gilbert H. [Dept. of Radiology, Division of Nuclear Medicine, UMass Memorial Medical Center, Worcester (United States)

    2015-09-15

    A Schmorl's node is a common incidental finding encountered during radiologic imaging. Despite the vertebral body being a common site of metastatic disease, a lytic lesion adjacent to an endplate with typical imaging features can often confidently be called a Schmorl's node. This is a case report of a patient with a single well-defined FDG-avid papillary thyroid carcinoma metastasis to the spine that had imaging findings characteristic of a Schmorl's node on CT and MRI. This case is important to consider as it demonstrates that the imaging characteristics of metastatic disease and Schmorl's nodes can overlap.

  14. Possibilities of Physiotherapy for chronical overload of the lumbar spine of female floorball players

    OpenAIRE

    SLADKÁ, Zuzana

    2016-01-01

    The Bachelor's work deals with the topic of women's floorball from the physiotherapeutic point of view. Due to the basic playing posture in a continuous forward bend and the one-sided holding of the floorball stick, the lower back is being overloaded in long term. Stabilization of this region is secured by the deep stabilization system that works based on the interaction of the spine extensors and flexors. Is the activity not balanced, muscle disbalance and micro trauma occur, which have a ne...

  15. Automated Detection, Localization, and Classification of Traumatic Vertebral Body Fractures in the Thoracic and Lumbar Spine at CT.

    Science.gov (United States)

    Burns, Joseph E; Yao, Jianhua; Muñoz, Hector; Summers, Ronald M

    2016-01-01

    To design and validate a fully automated computer system for the detection and anatomic localization of traumatic thoracic and lumbar vertebral body fractures at computed tomography (CT). This retrospective study was HIPAA compliant. Institutional review board approval was obtained, and informed consent was waived. CT examinations in 104 patients (mean age, 34.4 years; range, 14-88 years; 32 women, 72 men), consisting of 94 examinations with positive findings for fractures (59 with vertebral body fractures) and 10 control examinations (without vertebral fractures), were performed. There were 141 thoracic and lumbar vertebral body fractures in the case set. The locations of fractures were marked and classified by a radiologist according to Denis column involvement. The CT data set was divided into training and testing subsets (37 and 67 subsets, respectively) for analysis by means of prototype software for fully automated spinal segmentation and fracture detection. Free-response receiver operating characteristic analysis was performed. Training set sensitivity for detection and localization of fractures within each vertebra was 0.82 (28 of 34 findings; 95% confidence interval [CI]: 0.68, 0.90), with a false-positive rate of 2.5 findings per patient. The sensitivity for fracture localization to the correct vertebra was 0.88 (23 of 26 findings; 95% CI: 0.72, 0.96), with a false-positive rate of 1.3. Testing set sensitivity for the detection and localization of fractures within each vertebra was 0.81 (87 of 107 findings; 95% CI: 0.75, 0.87), with a false-positive rate of 2.7. The sensitivity for fracture localization to the correct vertebra was 0.92 (55 of 60 findings; 95% CI: 0.79, 0.94), with a false-positive rate of 1.6. The most common cause of false-positive findings was nutrient foramina (106 of 272 findings [39%]). The fully automated computer system detects and anatomically localizes vertebral body fractures in the thoracic and lumbar spine on CT images with a

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

    International Nuclear Information System (INIS)

    McKinney, A. M.; Gadani, S.; Palmer, C. S.; Vidarsson, L.

    2008-01-01

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

  17. Repeated sugammadex reversal of muscle relaxation during lumbar spine surgery with intraoperative neurophysiological multimodal monitoring.

    Science.gov (United States)

    Errando, C L; Blanco, T; Díaz-Cambronero, Ó

    2016-11-01

    Intraoperative neurophysiological monitoring during spine surgery is usually acomplished avoiding muscle relaxants. A case of intraoperative sugammadex partial reversal of the neuromuscular blockade allowing adequate monitoring during spine surgery is presented. A 38 year-old man was scheduled for discectomy and vertebral arthrodesis throughout anterior and posterior approaches. Anesthesia consisted of total intravenous anesthesia plus rocuronium. Intraoperatively monitoring was needed, and the muscle relaxant reverted twice with low dose sugammadex in order to obtain adequate responses. The doses of sugammadex used were conservatively selected (0.1mg/kg boluses increases, total dose needed 0.4mg/kg). Both motor evoqued potentials, and electromyographic responses were deemed adequate by the neurophysiologist. If muscle relaxation was needed in the context described, this approach could be useful to prevent neurological sequelae. This is the first study using very low dose sugammadex to reverse rocuronium intraoperatively and to re-establish the neuromuscular blockade. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Failure to Launch: What the Rejection of Lumbar Total Disk Replacement Tells us About American Spine Surgery.

    Science.gov (United States)

    Hart, Robert A; DePasse, J Mason; Daniels, Alan H

    2017-07-01

    Spine surgeon survey. The objective was to investigate the failure of widespread adoption of lumbar total disk replacement (L-TDR) in the United States. L-TDR has been available for use in the United States since 2005. L-TDR has not gained wide acceptance as a treatment for degenerative disk disease despite substantial investments in product development and positive results in randomized controlled trials. Estimates of the number of L-TDR procedures performed in the United States from 2005 to 2010 were calculated using the Nationwide Inpatient Sample database. Insurance policies were assessed for L-TDR coverage through Internet search. Finally, an 18-question survey regarding surgeons' opinions toward L-TDR was distributed to the members of North American Spine Society. The estimated number of primary L-TDR procedures performed in the United States decreased from 3650 in 2005 to 1863 in 2010, whereas revision L-TDR procedures increased from 420 to 499. Of 14 major insurers, 11 (78.6%) do not cover L-TDR. In total, 613 spine surgeons responded to the survey. Over half of respondents (51.1%, 313/612) have performed L-TDR, although only 44.6% (136/305) of initial adopters currently perform the surgery. However, 81.5% (106/130) of those currently performing L-TDR have been satisfied with the results. When asked about their perceptions of L-TDR, 65.0% (367/565) indicated a lack of insurance coverage for L-TDR in their region, 54.9% (310/565) worry about long-term complications, and 52.7% (298/565) worry about the technical challenges of revision. Despite early enthusiasm for L-TDR, wide adoption has not occurred. A primary reason for this failure seems to be a lack of insurance coverage, despite intermediate-term clinical success. In addition, surgeons continue to express concerns regarding long-term outcomes and the technical difficulties of revision. This case study of a failed surgical innovation may signal increasing involvement of payers in clinical decision

  19. Chance fracture of the lumbar spine in an amateur snowboarder: a case report.

    Science.gov (United States)

    Hakozaki, M; Otani, K; Kikuchi, S; Konno, S

    2010-06-01

    "Chance fracture" is an unusual type of spinal fracture caused by flexion-distraction of the back. We describe herein a rare case of a male amateur snowboarder who suffered lumbar Chance fracture caused by a fall after freestyle jumping. Radiological findings of plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) showed a loss of vertebral height in the anterior L1 vertebral body with a horizontal splitting fracture extending across the vertebral body, bilateral pedicles, and lamina. On the basis of the aforementioned findings, the diagnosis of Chance fracture of the L1 vertebra was established. The fracture healed without any subsequent disabilities following conservative medical management with a thoracolumbar orthosis, and no impairments to activities of daily living were encountered, including job or sports performance. Although Chance fracture caused by a fall is rare, particularly in sports, the possibility of this fracture should be considered when diagnosing spinal injuries in snowboarders.

  20. Iterative design and testing of a modular anterior plate for lumbar spine fixation applications.

    Science.gov (United States)

    Demir, Teyfik

    2012-09-01

    In this study, a modular anterior lumbar plate is designed and tested in an iterative fashion. The study starts with a basic design that is built by combining same-sized modules; an approach that allow inventory costs to be decreased. The basic design is iteratively improved guided by the results of biomechanical tests performed on each new design. At the end of three iterations of improvements, the design is complete and the plate is of sufficient quality for it to be used in anterior surgical operations. Using these plates creates the advantage of being able to increase the size and slot count during surgical operations, even when some of the modules are already fixed to vertebrae. The designed modular plate is shown to be as safe for use as a rigid plate in terms of its static and fatigue biomechanical performances.

  1. Determination of dose levels for chest (PA), lumbar spine (AP and LAT) and mammography (CC and MLO) for Latin america

    International Nuclear Information System (INIS)

    Mora, P.; Ramirez, R.; Blanco, D. E.; Benavente, T. A.; Ortiz Lopez, P.; Giannone, C. A.; Gherco, J. T.; Mecca, F.; Kodlulovich, S.; Ramirez, A.; Anselmo Puerta, J. A.; Fonseca, L.; Cardenas, J.; Martinez, A.; Zorin, F. J.; Roas, N.; Garcia, F.; Caldeira, M. E.; Salazar, G.

    2006-01-01

    Under the auspices of the ARCAL Technical Cooperation Program of the IAEA, 11 countries in Latin American (Argentina, Brazil, Chile, Costa Rica, Cuba, Mexico, Nicaragua, Peru, Uruguay and Venezuela) motivated by the necessity to optimize the doses in diagnostic procedures, started the first regional pilot study to determine the guidance dose levels for chest (PA), lumbar spine (AP and LAT) and mammography (CC and MLO) procedures. A total of 33 hospitals participated with 54 diagnostic X-ray equipment and 18 mammography units. The entrance kerma and mean glandular doses were obtained through the output of the X-rays. A TLD intercomparison was carried out as a means to do quality control of all the process. A total of 2120 doses were estimated with the information of each patient (kVp, mAs, distance, etc.). Parallel to this, the image quality of the studies was evaluated using the criteria established by the European Community. The values of the entrance kerma an mean glandular doses for the 75% percentile are in general very compatible with the ones in Schedule III of the NBS. Although this study did not allow the establishment of guidance levels for the region, it did lay the foundations for optimization processes and the necessity of making better efforts that will improve medical practices. (Author)

  2. Wound infiltration with local anesthetics for post-operative pain relief in lumbar spine surgery: a systematic review.

    Science.gov (United States)

    Kjærgaard, M; Møiniche, S; Olsen, K S

    2012-03-01

    In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery. Medline, the Cochrane Library and Google Scholar were searched for appropriate trials. Qualitative analysis of post-operative effectiveness was evaluated by assessment of significant difference (P local anesthetic infiltration was observed averaging between 8 and 40 mm on a 100 mm visual analog scale. In six out of 12 comparisons, the local anesthetic infiltration significantly reduced the supplemental opioid consumption after surgery. Observed reductions in analgesic consumption over the first 24 h averaged between 2.5 mg and approximately 15 mg of morphine. Data on opioid-related adverse effects were incomplete and difficult to interpret. Interpretation of the results was difficult because of diversity of the studies. However, clinical significance was in general questionable, with only a few trials showing a small or a modest reduction in pain intensity, which was observed mainly immediately after the operation. Similarly, although more frequently observed, only a minor and probably not clinically relevant reduction in opioid consumption was shown. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

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

    DEFF Research Database (Denmark)

    Hansen, Bjarke B; Hansen, Philip; Christensen, Anders F

    2018-01-01

    with full access to supine MRI. In case lower grades or the degenerative findings were not present in the supine images, this was reported separately as position-dependent changes. A subsample of 20 pMRI examinations was reevaluated after two months. The reproducibility was assessed by inter- and intra......-reader reliability (kappa statistic) and absolute agreement between readers. RESULTS: Fifty-six patients were included in this study. There was fair-to-substantial inter-reader reliability (κ 0.47 to 0.82) and high absolute agreement (72.3% to 99.1%) for the pMRI findings. The intra-reader assessment showed similar...... reliability and agreement (κ 0.36 to 0.85; absolute agreement: 62.5% to 98.8%). Positional changes between the supine and standing position showed a fair-to-moderate inter- and intra-reader reliability (κ 0.25 to 0.52; absolute agreement: 97.0% to 99.1). CONCLUSION: Evaluation of the lumbar spine...

  4. Serum sclerostin levels associated with lumbar spine bone mineral density and bone turnover markers in patients with postmenopausal osteoporosis.

    Science.gov (United States)

    Xu, Xiao-juan; Shen, Lin; Yang, Yan-ping; Lu, Fu-rong; Zhu, Rui; Shuai, Bo; Li, Cheng-gang; Wu, Man-xiang

    2013-07-01

    Sclerostin, expressed exclusively by osteocytes, is a negative regulator of bone formation. To gain insights into the action of sclerostin in postmenopausal osteoporosis, we evaluated serum sclerostin levels in postmenopausal women and investigated its possible associations with bone turnover markers in patients with postmenopausal osteoporosis. We detected serum sclerostin, and measured lumbar spine bone mineral density in 650 Chinese postmenopausal women. We also assessed serum levels of β-isomerized C-terminal crosslinking of type I collagen, intact N-terminal propeptide of type I collagen, N-mid fragment of osteocalcin, 25-hydroxyvitamin D, and estradiol. Serum sclerostin levels were lower in postmenopausal osteoporotic women compared with non-osteoporotic postmenopausal women ((38.79 ± 7.43) vs. (52.86 ± 6.69) pmol/L, P osteoporosis. There was no significant association of serum sclerostin with age, body mass index, 25-hydroxyvitamin D, and estradiol (r = -0.004, P = 0.926; r = 0.067, P = 0.143; r = 0.063, P = 0.165; r = -0.045, P = 0.324; respectively). Sclerostin may be involved in the pathogenesis of postmenopausal osteoporosis and may play a role in bone turnover.

  5. Lumbar spine and hip flexibility and trunk strength in helicopter pilots with and without low back pain history.

    Science.gov (United States)

    Nagai, Takashi; Abt, John P; Sell, Timothy C; Keenan, Karen A; Clark, Nicholas C; Smalley, Brian W; Wirt, Michael D; Lephart, Scott M

    2015-01-01

    Low back pain (LBP) is one of the most common musculoskeletal issues facing military helicopter pilots. It is clinically important to identify differences in musculoskeletal characteristics between pilots with and without a LBP history for formulating effective interventions. To compare lumbar spine and hip flexibility and trunk strength in pilots with and without a LBP history. A total of 30 pilots with a LBP history were matched with pilots without a LBP history. An isokinetic dynamometer and a digital inclinometer were used to evaluate trunk and hip strength and a range-of-motion (ROM), respectively. All tests were performed bilaterally, if applicable, and agonist/antagonist ratios and side-to-side (low/high) symmetries were calculated. Paired t-tests or Wilcoxon tests were used to assess group differences (p hip rotation side-to-side asymmetry (p = 0.037). Given the results, specific exercises that are targeted to improve trunk strength, ROM, and side-to-side symmetries could be developed to reduce LBP in helicopter pilots.

  6. Comparison of T1-weighted fast spin-echo and T1-weighted fluid-attenuated inversion recovery images of the lumbar spine at 3.0 Tesla

    Energy Technology Data Exchange (ETDEWEB)

    Lavdas, Eleftherios; Vlychou, Marianna; Arikidis, Nikos; Kapsalaki, Eftychia; Roka, Violetta; Fezoulidis, Ioannis V. (Dept. of Radiology, Univ. Hospital of Larissa, Medical School of Thessaly, Mezourlo (Greece)), e-mail: mvlychou@med.uth.gr

    2010-04-15

    Background: T1-weighted fluid-attenuated inversion recovery (FLAIR) sequence has been reported to provide improved contrast between lesions and normal anatomical structures compared to T1-weighted fast spin-echo (FSE) imaging at 1.5T regarding imaging of the lumbar spine. Purpose: To compare T1-weighted FSE and fast T1-weighted FLAIR imaging in normal anatomic structures and degenerative and metastatic lesions of the lumbar spine at 3.0T. Material and Methods: Thirty-two consecutive patients (19 females, 13 males; mean age 44 years, range 30-67 years) with lesions of the lumbar spine were prospectively evaluated. Sagittal images of the lumbar spine were obtained using T1-weighted FSE and fast T1-weighted FLAIR sequences. Both qualitative and quantitative analyses measuring the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and relative contrast (ReCon) between degenerative and metastatic lesions and normal anatomic structures were conducted, comparing these sequences. Results: On quantitative evaluation, SNRs of cerebrospinal fluid (CSF), nerve root, and fat around the root of fast T1-weighted FLAIR imaging were significantly lower than those of T1-weighted FSE images (P<0.001). CNRs of normal spinal cord/CSF and disc herniation/ CSF for fast T1-weighted FLAIR images were significantly higher than those for T1-weighted FSE images (P<0.001). ReCon of normal spinal cord/CSF, disc herniation/CSF, and vertebral lesions/CSF for fast T1-weighted FLAIR images were significantly higher than those for T1-weighted FSE images (P<0.001). On qualitative evaluation, it was found that CSF nulling and contrast at the spinal cord (cauda equina)/CSF interface for T1-weighted FLAIR images were significantly superior compared to those for T1-weighted FSE images (P<0.001), and the disc/spinal cord (cauda equina) interface was better for T1-weighted FLAIR images (P<0.05). Conclusion: The T1-weighted FLAIR sequence may be considered as the preferred lumbar spine imaging

  7. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of lumbar spine x-ray for low back pain in UK primary care practice.

    Science.gov (United States)

    Grimshaw, Jeremy M; Eccles, Martin P; Steen, Nick; Johnston, Marie; Pitts, Nigel B; Glidewell, Liz; Maclennan, Graeme; Thomas, Ruth; Bonetti, Debbie; Walker, Anne

    2011-05-28

    Psychological models predict behaviour in a wide range of settings. The aim of this study was to explore the usefulness of a range of psychological models to predict the health professional behaviour 'referral for lumbar spine x-ray in patients presenting with low back pain' by UK primary care physicians. Psychological measures were collected by postal questionnaire survey from a random sample of primary care physicians in Scotland and north England. The outcome measures were clinical behaviour (referral rates for lumbar spine x-rays), behavioural simulation (lumbar spine x-ray referral decisions based upon scenarios), and behavioural intention (general intention to refer for lumbar spine x-rays in patients with low back pain). Explanatory variables were the constructs within the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Weinstein's Stage Model termed the Precaution Adoption Process (PAP), and knowledge. For each of the outcome measures, a generalised linear model was used to examine the predictive value of each theory individually. Linear regression was used for the intention and simulation outcomes, and negative binomial regression was used for the behaviour outcome. Following this 'theory level' analysis, a 'cross-theoretical construct' analysis was conducted to investigate the combined predictive value of all individual constructs across theories. Constructs from TPB, SCT, CS-SRM, and OLT predicted behaviour; however, the theoretical models did not fit the data well. When predicting behavioural simulation, the proportion of variance explained by individual theories was TPB 11.6%, SCT 12.1%, OLT 8.1%, and II 1.5% of the variance, and in the cross-theory analysis constructs from TPB, CS-SRM and II explained 16.5% of the variance in simulated behaviours. When predicting intention, the proportion of variance explained by individual

  8. Ultrasonography of the adult thoracic and lumbar spine for central neuraxial blockade.

    Science.gov (United States)

    Chin, Ki Jinn; Karmakar, Manoj Kumar; Peng, Philip

    2011-06-01

    The role of ultrasound in central neuraxial blockade has been underappreciated, partly because of the relative efficacy of the landmark-guided technique and partly because of the perceived difficulty in imaging through the narrow acoustic windows produced by the bony framework of the spine. However, this also is the basis for the utility of ultrasound: an interlaminar window that permits passage of sound waves into the vertebral canal also will permit passage of a needle. In addition, ultrasound aids in identification of intervertebral levels, estimation of the depth to epidural and intrathecal spaces, and location of important landmarks, including the midline and interlaminar spaces. This can facilitate neuraxial blockade, particularly in patients with difficult surface anatomic landmarks. In this review article, the authors summarize the current literature, describe the key ultrasonographic views, and propose a systematic approach to ultrasound imaging for the performance of spinal and epidural anesthesia in the adult patient.

  9. Reliability and validity of an iPhone® application for the measurement of lumbar spine flexion and extension range of motion

    Science.gov (United States)

    Pourahmadi, Mohammad Reza; Jannati, Elham; Mohseni-Bandpei, Mohammad Ali; Ebrahimi Takamjani, Ismail; Rajabzadeh, Fatemeh

    2016-01-01

    Background Measurement of lumbar spine range of motion (ROM) is often considered to be an essential component of lumbar spine physiotherapy and orthopedic assessment. The measurement can be carried out through various instruments such as inclinometers, goniometers, and etc. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for inclinometric functions. Purpose The main purpose was to investigate the reliability and validity of an iPhone® app (TiltMeter© -advanced level and inclinometer) for measuring standing lumbar spine flexion–extension ROM in asymptomatic subjects. Design A cross-sectional study was carried out. Setting This study was conducted in a physiotherapy clinic located at School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. Subjects A convenience sample of 30 asymptomatic adults (15 males; 15 females; age range = 18–55 years) was recruited between August 2015 and December 2015. Methods Following a 2–minute warm-up, the subjects were asked to stand in a relaxed position and their skin was marked at the T12–L1 and S1–S2 spinal levels. From this position, they were asked to perform maximum lumbar flexion followed by maximum lumbar extension with their knees straight. Two blinded raters each used an inclinometer and the iPhone ® app to measure lumbar spine flexion–extension ROM. A third rater read the measured angles. To calculate total lumbar spine flexion–extension ROM, the measurement from S1–S2 was subtracted from T12–L1. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. All of the measurements were conducted 3 times and the mean value of 3 repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter

  10. Reliability and validity of an iPhone(®) application for the measurement of lumbar spine flexion and extension range of motion.

    Science.gov (United States)

    Pourahmadi, Mohammad Reza; Taghipour, Morteza; Jannati, Elham; Mohseni-Bandpei, Mohammad Ali; Ebrahimi Takamjani, Ismail; Rajabzadeh, Fatemeh

    2016-01-01

    Measurement of lumbar spine range of motion (ROM) is often considered to be an essential component of lumbar spine physiotherapy and orthopedic assessment. The measurement can be carried out through various instruments such as inclinometers, goniometers, and etc. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for inclinometric functions. The main purpose was to investigate the reliability and validity of an iPhone(®) app (TiltMeter(©) -advanced level and inclinometer) for measuring standing lumbar spine flexion-extension ROM in asymptomatic subjects. A cross-sectional study was carried out. This study was conducted in a physiotherapy clinic located at School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. A convenience sample of 30 asymptomatic adults (15 males; 15 females; age range = 18-55 years) was recruited between August 2015 and December 2015. Following a 2-minute warm-up, the subjects were asked to stand in a relaxed position and their skin was marked at the T12-L1 and S1-S2 spinal levels. From this position, they were asked to perform maximum lumbar flexion followed by maximum lumbar extension with their knees straight. Two blinded raters each used an inclinometer and the iPhone (®) app to measure lumbar spine flexion-extension ROM. A third rater read the measured angles. To calculate total lumbar spine flexion-extension ROM, the measurement from S1-S2 was subtracted from T12-L1. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. All of the measurements were conducted 3 times and the mean value of 3 repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were

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

    OpenAIRE

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

    2016-01-01

    Background 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. Methods 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 L...

  12. Synovial cysts of the lumbar spine--pathological considerations and surgical strategy.

    Science.gov (United States)

    Ganau, Mario; Ennas, Franco; Bellisano, Giulia; Ganau, Laura; Ambu, Rossano; Faa, Gavino; Maleci, Alberto

    2013-01-01

    Symptomatic lumbar synovial cysts (LSCs) are a rare cause of degenerative narrowing of the spinal canal, with thecal sac or nerve root compression. True synovial cysts have a thick wall lined by synovial cells, containing granulation tissue, numerous histiocytes, and giant cells. In contrast, pseudo-cysts lack specialized epithelium, have a collagenous capsule filled with myxoid material, and may be classified into ganglion cysts, originating from periarticular fibrous tissues, and ligamentous cysts, arising from the ligamentum flavum or even from the posterior longitudinal ligament. Here we present the surgical series of the Chair of Neurosurgery at the University of Cagliari (Italy) including a total of 17 LSCs. Surgical technique consisted of facet sparing excision of LSC, achieved by simple hemilaminectomy/laminectomy, and diagnosis was always confirmed by histological specimen examination, which detected the typical synovial epithelium, the intracystic presence of hemosiderin, histiocytes, and calcifications. Further immunohistochemical investigation revealed positive staining for cytokeratin: CK5, CK6, and AE1/AE3. Clinically, our cohort experienced rapid and complete resolution of symptoms, without perioperative complications, or recurrence of cysts or vertebral instability at a median follow up of 28 months, when the MacNab score was generally excellent. A review of the literature, retrieving articles published from 1973, collected a total of 101 articles concerning all the cases of LSC scientifically described to date. Both clinical and histological findings described in our study support the theory of degenerative microtraumatic pathogenesis of synovial cysts.

  13. [Tomodensitometric image of the lumbar spine. Study of 150 patients hospitalized for discal sciatica].

    Science.gov (United States)

    Berthelot, J M; Guillot, P; Glémarec, J; Lopes, L; Bertrand-Vasseur, A; Maugars, Y; Prost, A

    1998-01-17

    There would be some discordance between patient expectations and expert recommendations concerning computed tomography (CT) of the spine for discal disorders. We analyzed patient opinion. At admission, a 25-item questionnaire was given to 150 patients hospitalized in a rheumatology unit for discal sciatica. Patients were asked to express their expectations concerning the CT exploration. Seventy percent of the patients had already undergone CT explorations requested by a general practitioner (55%) or a specialist (45%), 20% had had two CT explorations and 20% magnetic resonance imaging. Seventy-five percent felt they should have had a CT scan earlier, 85% thought a CT should be performed for back pain of less than one month duration and 96% in case of sciatica for 2 months or more. Patients felt their exploration came "late" because the physician was under financial pressure (52%), had incorrectly appreciated the patient's need (28%) or was incompetent in the matter (22%). Nevertheless, 15% of the patients recognized that the CT scan could be useless and 89% knew that all cases of hernia are not operable. Thirty percent recognized that hernias can go undetected on the CT scan and 78% that they may remain asymptomatic. Finally, 56% of the patients thought that the CT scan would not change their treatment and only 23% expected to undergo surgery sooner because of the CT exploration. Several factors would explain what patients expect from CT exploration of the spine: patient understanding that causes other than discal hernia can cause back pain (98%) or sciatic (77%); their fear of having another disorder (56% wanted to be reassured, which would explain in part why 27% hoped the CT would improve pain, 50% wanted to "see" their discal hernia, and 30 wanted to eliminate another cause of their pain); patient distrust of clinical diagnosis which they felt was less pertinent than CT (80% of the patients for generalists and 70% for specialists). Patient expectations did not

  14. Morphological changes of lumbar vertebral bodies and intervertebral discs associated with decrease in bone mineral density of the spine: a cross-sectional study in elderly subjects.

    Science.gov (United States)

    Kwok, Anthony W L; Wang, Yi-Xiang J; Griffith, James F; Deng, Min; Leung, Jason C S; Ahuja, Anil T; Leung, Ping Chung

    2012-11-01

    Cross-sectional study. To investigate changes in the morphology of the lumbar vertebrae and intervertebral discs associated with osteoporosis of the spine in elderly subjects. Osteoporosis is a common condition that primarily affects the elderly with significant impact on quality of life. How exactly osteopenia and osteoporosis influence vertebral and intervertebral disc morphology remains unknown and needs exploration. A total of 395 community-dwelling ambulatory adults from 67 to 89 years of age were studied. The lumbar bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry. T2-weighted sagittal images of the lumbar spine were obtained using a 1.5-T magnet. For each subject, the anterior height (Ha), middle height (Hm), posterior height (Hp), and anterior-posterior (AP) dimension of the 5 lumbar vertebrae (L1-L5) and 6 intervertebral discs (T12-L1 to L5-S1) were measured. To minimize the age effect, volume of these vertebrae and discs was measured in subgroups of 47 men (mean age = 74 yr, range: 73-75 yr) and 67 women (mean age = 72 yr, range: 71-73 yr). Continuous variables were examined by analysis of covariance after adjustment of height and age. There was no significant age difference between the groups of normal BMD, osteopenia, and osteoporosis. For the vertebral bodies, lower BMD was associated with a decrease of Ha, Hm, and Hp but not AP in both sexes, leading to an increased biconcavity index. For the discs, lower BMD was associated with a decrease of Ha and Hp, as well as AP, and an increase in Hm in both men and women. The disc biconvexity index was increased. Lower BMD is associated with an overall decrease in both vertebral volume and disc volume. Lower BMD is associated with a decreasing trend in both lumbar vertebral and disc volumes in elderly subjects but an increase in the Hm of the intervertebral discs.

  15. Radiation dose reduction in CT-guided periradicular injections in lumbar spine: Feasibility of a new institutional protocol for improved patient safety

    Directory of Open Access Journals (Sweden)

    Artner Juraj

    2012-08-01

    Full Text Available Abstract Background Image guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients. Methods We performed a retrospective analysis of a prospective database during a 4-month period (Oct-Dec 2011 at a German University hospital using a newly established low-dose-CT-protocol for periradicular injections in patients suffering from lumbar disc herniation and nerve root entrapment. Inclusion criteria were acute or chronic nerve root irritation due to lumbar disc hernia, age over 18, compliance and informed consent. Excluded were patients suffering from severe obesity (BMI > 30, coagulopathy, allergy to injected substances, infection and non-compliant patients. Outcome parameters consisted of the measured dose length product (mGycm2, the amount of scans, age, gender, BMI and the peri-interventional complications. The results were compared to 50 patients, treated in the standard-interventional CT-protocol for spinal injections, performed in June-Oct 2011, who met the above mentioned inclusion criteria. Results A total amount of 100 patients were enrolled in the study. A significant radiation dose reduction (average 85.31% was achieved using the institutional low-dose protocol compared to standard intervention mode in CT-guided periradicular injections in lumbar spine. Using the low-dose protocol did not increase the complications rate in the analyzed cohort. Conclusions Low-dose-CT-protocols for lumbar perineural injections significantly reduce the exposure to radiation of non-obese patients without an increase of complications. This increases long-time patient

  16. Predictors of extended length of stay, discharge to inpatient rehab, and hospital readmission following elective lumbar spine surgery: introduction of the Carolina-Semmes Grading Scale.

    Science.gov (United States)

    McGirt, Matthew J; Parker, Scott L; Chotai, Silky; Pfortmiller, Deborah; Sorenson, Jeffrey M; Foley, Kevin; Asher, Anthony L

    2017-10-01

    OBJECTIVE Extended hospital length of stay (LOS), unplanned hospital readmission, and need for inpatient rehabilitation after elective spine surgery contribute significantly to the variation in surgical health care costs. As novel payment models shift the risk of cost overruns from payers to providers, understanding patient-level risk of LOS, readmission, and inpatient rehabilitation is critical. The authors set out to develop a grading scale that effectively stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies. METHODS The Quality and Outcomes Database (QOD) registry prospectively enrolls patients undergoing surgery for degenerative lumbar spine disease. This registry was queried for patients who had undergone elective 1- to 3-level lumbar surgery for degenerative spine pathology. The association between preoperative patient variables and extended postoperative hospital LOS (LOS ≥ 7 days), discharge status (inpatient facility vs home), and 90-day hospital readmission was assessed using stepwise multivariate logistic regression. The Carolina-Semmes grading scale was constructed using the independent predictors for LOS (0-12 points), discharge to inpatient facility (0-18 points), and 90-day readmission (0-6 points), and its performance was assessed using the QOD data set. The performance of the grading scale was then confirmed separately after using it in 2 separate neurosurgery practice sites (Carolina Neurosurgery & Spine Associates [CNSA] and Semmes Murphey Clinic). RESULTS A total of 6921 patients were analyzed. Overall, 290 (4.2%) patients required extended LOS, 654 (9.4%) required inpatient facility care/rehabilitation on hospital discharge, and 474 (6.8%) were readmitted to the hospital within 90 days postdischarge. Variables that remained as independently associated with these unplanned events in multivariate analysis included age ≥ 70 years, American Society of Anesthesiologists Physical Classification System

  17. Dynamic posterior stabilization for degenerative lumbar spine disease: a large consecutive case series with long-term follow-up by additional postal survey.

    Science.gov (United States)

    Greiner-Perth, R; Sellhast, N; Perler, G; Dietrich, D; Staub, L P; Röder, C

    2016-08-01

    Dynamic stabilization of the degenerated spine was invented to overcome the negative side effects of fusion surgery like adjacent segment degeneration. Amongst various different implants DSS(®) is a pedicle-based dynamic device for stabilizing the spine and preserving motion. Nearly no clinical data of the implant have been reported so far. The current analysis presents results from a single spine surgeon who has been using DSS(®) for the past 5 years and recorded all treatment and outcome data in the international Spine Tango registry. From the prospectively documented overall patient pool 436 cases treated with DSS(®) could be identified. The analysis was enhanced with a mailing of COMI patient questionnaires for generating longer-term follow-ups up to 4 years. 387 patients (189 male, 198 female; mean age 67.3 years) with degenerative lumbar spinal disease including degenerative spondylolisthesis (6.1 %) could be evaluated. The type of degeneration was mainly spinal stenosis (89.9 %). After a mean follow-up of 1.94 years, the COMI score and NRS back and leg pain improved significantly and to a clinically relevant extent. The postoperative trend analysis could not determine a relevant deterioration of these outcomes until 4 years postoperative. 10 patients were revised (2.6 %) and the implant was removed; in most cases, a fusion was performed. Another 5 cases (1.3 %) had an extension of the dynamic stabilization system to the adjacent level. 84.2 % of patients rated that the surgery had helped a lot or had helped. The results of this large consecutive series with a follow-up up to 4 years could demonstrate a good and stable clinical outcome after posterior dynamic stabilization with DSS(®). For degenerative diseases of the lumbar spine, this treatment seems to be a valid alternative to fusion surgery.

  18. [TREATMENT OF POST-SPONDYLODESIS, ADJACENT-SEGMENT DISEASE WITH MINIMALLY INVASIVE, ANTEROLATERAL SURGERY ON THE LUMBAR SPINE: IS THERE IS NO NEED FOR DORSAL OPERATION?].

    Science.gov (United States)

    Schwarcz, Attila; Szakály, Péter; Büki, András; Dóczi, Tamás

    2015-07-30

    Adjacent segment disease (ASD) occurs with a probability of 30% in the lumbar spine following spinal fusion surgery. Usually advanced degenerative changes happen cranially to the fused lumbar segment. Thus, secondary spinal instability, stenosis, spodylolisthesis, foraminal stenosis can lead to the recurrence of the pain not always amenable to conservative measures. A typical surgical solution to treat ASD consists of posterior revision surgery including decompression, change or extension of the instrumentation and fusion to the rostral level. It results in a larger operation with considerable risk of complications. We present a typical case of ASD treated surgically with a new minimally invasive method not yet performed in Hungary. We use anterolateral abdominal muscle splitting approach to reach the lumbar spine through the retroperitoneum. A discectomy is performed by retracting the psoas muscle dorsally. The intervertebral bony fusion is achieved by implanting a cage with large volume that is stuffed with autologous bone or tricalcium phosphate. A cage with large volume results in excellent annulus fibrosus tension, immediate stability and provides large surface for bony fusion. A stand-alone cage construct can be supplemented with lateral screw/rod/plate fixation. The advantage of the new technique for the treatment of ASD includes minimal blood loss, short operation time, significantly less postoperative pain and much lower complication rate.

  19. Technetium-99m scintigraphy associated with spondylolysis of the lumbar spine in children

    International Nuclear Information System (INIS)

    Kubota, Wataru; Sudo, Nariomi; Nakazima, Kiyonori; Nakamura, Mitsutaka

    1987-01-01

    Eight children with spondylolysis, aged from 10 to 18 years of age, underwent bone scanning with technetium-99m methylene diphosphonic acid. Radioisotope (RI) uptake was significantly observed in the site marked by the separation of the pars interarticularis, compared with the other sites between the articular processes. This showed the increase in metabolic activity of bones, providing supplementary information in the initial diagnosis. At the completion of conservative treatment, RI uptake decreased, being seemingly attributable to the improvement of subjective symptoms. Bone scanning may, however, be unhelpful in detecting synostosis. (Namekawa, K.)

  20. Technetium-99m scintigraphy associated with spondylolysis of the lumbar spine in children

    Energy Technology Data Exchange (ETDEWEB)

    Kubota, W.; Sudo, N.; Nakazima, K.; Nakamura, M.

    1987-02-01

    Eight children with spondylolysis, aged from 10 to 18 years of age, underwent bone scanning with technetium-99m methylene diphosphonic acid. Radioisotope (RI) uptake was significantly observed in the site marked by the separation of the pars interarticularis, compared with the other sites between the articular processes. This showed the increase in metabolic activity of bones, providing supplementary information in the initial diagnosis. At the completion of conservative treatment, RI uptake decreased, being seemingly attributable to the improvement of subjective symptoms. Bone scanning may, however, be unhelpful in detecting synostosis.

  1. Mineralization and collagen orientation throughout aging at the vertebral endplate in the human lumbar spine.

    Science.gov (United States)

    Paietta, Rachel C; Burger, Evalina L; Ferguson, Virginia L

    2013-11-01

    The human vertebral body and intervertebral disc interface forms the region where the cartilaginous endplate, annulus fibrosis and bone of the vertebral body are connected through an intermediate calcified cartilage layer. While properties of both the vertebral body and components of the disc have been extensively studied, limited quantitative data exists describing the microstructure of the vertebral body-intervertebral disc interface in the spine throughout development and degeneration. Quantitative backscattered scanning electron and second harmonic generation confocal imaging were used to collect quantitative data describing the mineral content and collagen fiber orientation across the interface, respectively. Specimens spanned ages 56 days to 84 years and measurements were taken across the vertebral endplate at the outer annulus, inner annulus and nucleus pulposis. In mature and healthy endplates, collagen fibers span the calcified cartilage layer in all regions, including the endplate adjacent to the central nucleus pulposis. We also observed an abrupt transition from high mineral volume fractions (35-50%) to 0% over short distances measuring 3-15 microns in width across the transition from calcified cartilage to unmineralized cartilage. The alignment of collagen fibers at the outer annulus and thickness of the CC layer indicated that collagen fiber mineralization adjacent to the bone may serve to anchor the soft tissue without a gradual change in material properties. Combining backscattered scanning electron microscopy and second harmonic generation imaging on the same sections thus enable a novel assessment of morphology and properties in both mineralized and soft tissues at the vertebral body-intervertebral disc throughout development and aging. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. [Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 2: treatment of the thoracic disc hernia, spinal deformities, spinal tumors, infections and miscellaneous].

    Science.gov (United States)

    Verdú-López, Francisco; Beisse, Rudolf

    2014-01-01

    Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has evolved greatly since it appeared less than 20 years ago. It is currently used in a large number of processes and injuries. The aim of this article, in its two parts, is to review the current status of VATS of the thoracic and lumbar spine in its entire spectrum. After reviewing the current literature, we developed each of the large groups of indications where VATS takes place, one by one. This second part reviews and discusses the management, treatment and specific thoracoscopic technique in thoracic disc herniation, spinal deformities, tumour pathology, infections of the spine and other possible indications for VATS. Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of spinal deformities, spinal tumours, infections and other pathological processes, as well as the reconstruction of injured spinal segments and decompression of the spinal canal if lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in regard to morbidity of the approach and subsequent patient recovery. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  3. Inadequacy of 3-month Oswestry Disability Index outcome for assessing individual longer-term patient experience after lumbar spine surgery.

    Science.gov (United States)

    Asher, Anthony L; Chotai, Silky; Devin, Clinton J; Speroff, Theodore; Harrell, Frank E; Nian, Hui; Dittus, Robert S; Mummaneni, Praveen V; Knightly, John J; Glassman, Steven D; Bydon, Mohamad; Archer, Kristin R; Foley, Kevin T; McGirt, Matthew J

    2016-08-01

    OBJECTIVE Prospective longitudinal outcomes registries are at the center of evidence-driven health care reform. Obtaining real-world outcomes data at 12 months can be costly and challenging. In the present study, the authors analyzed whether 3-month outcome measurements sufficiently represent 12-month outcomes for patients with degenerative lumbar disease undergoing surgery. METHODS Data from 3073 patients undergoing elective spine surgery for degenerative lumbar disease were entered into a prospective multicenter registry (N(2)QOD). Baseline, 3-month, and 12-month follow-up Oswestry Disability Index (ODI) scores were recorded. The absolute differences between actual 12- and 3-month ODI scores was evaluated. Additionally, the authors analyzed the absolute difference between actual 12-month ODI scores and a model-predicted 12-month ODI score (the model used patients' baseline characteristics and actual 3-month scores). The minimal clinically important difference (MCID) for ODI of 12.8 points and the substantial clinical benefit (SCB) for ODI of 18.8 points were used based on the previously published values. The concordance rate of achieving MCID and SCB for ODI at 3-and 12-months was computed. RESULTS The 3-month ODI scores differed from 12-month scores by an absolute difference of 11.9 ± 10.8, and predictive modeling estimations of 12-month ODI scores differed from actual 12-month scores by a mean (± SD) of 10.7 ± 9.0 points (p = 0.001). Sixty-four percent of patients (n = 1982) achieved an MCID for ODI at 3 months in comparison with 67% of patients (n = 2088) by 12 months; 51% (n = 1731) and 61% (n = 1860) of patients achieved SCB for ODI at 3 months and 12 months, respectively. Almost 20% of patients had ODI scores that varied at least 20 points (the point span of an ODI functional category) between actual 3- and 12-month values. In the aggregate analysis of achieving MCID, 77% of patients were concordant and 23% were discordant in achieving or not achieving

  4. The effectiveness of surgical versus conservative treatment for symptomatic unilateral spondylolysis of the lumbar spine in athletes: a systematic review.

    Science.gov (United States)

    Scheepers, Morné Stephan; Streak Gomersall, Judith; Munn, Zachary

    2015-04-17

    Spondylolysis is a common cause of low back pain in athletes. Historically, spondylolysis injuries were thought to be mostly bilateral; however advances in lumbar spine imaging have shown that in certain athlete groups, unilateral spondylolysis is highly prevalent. It remains unclear whether athletes with unilateral spondylolysis who undergo surgical repair are able to return to sports as effectively or faster than if they had conservative treatment. To determine the effectiveness of surgical fixation performed after a trial period of conservative management, compared to the effectiveness of conservative management only for unilateral spondylolysis in athletes.   Athletes with symptomatic unilateral spondylolysis of the lumbar spine.  Types of intervention(s):  Surgical interventions which attempted a direct repair of the pars interarticularis, compared to conservative management.  Types of studies:  Experimental and epidemiological study designs were considered for inclusion. The majority of the studies reviewed consisted of descriptive epidemiological study designs including case series, individual case reports and descriptive cross sectional studies.  Types of outcomes:  The primary outcome of interest in this review was the ability to return to sport. The effectiveness of surgery on pain and overall function were secondary outcomes of interest. A three-step search strategy that aimed to find both published and unpublished studies was utilized. The search was limited to studies published in the English language between 1 January 1970 and 1 September 2013. The studies were critically appraised using one of the standardized critical appraisal instruments from The Joanna Briggs Institute. Details describing each study and results on effectiveness in promoting the outcomes of interest were extracted from papers included in the review using the standardized data extraction tool from The Joanna Briggs Institute. Due to heterogeneity in the included studies, the

  5. Three-dimensional trabecular bone architecture of the lumbar spine in bone metastasis from prostate cancer: comparison with degenerative sclerosis

    International Nuclear Information System (INIS)

    Tamada, Tsutomu; Sone, Teruki; Imai, Shigeki; Kajihara, Yasumasa; Fukunaga, Masao; Jo, Yoshimasa

    2005-01-01

    Prostate cancer frequently metastasizes to bone, inducing osteosclerotic lesions. The objective of this study was to clarify the three-dimensional (3D) trabecular bone microstructure in bone metastasis from prostate cancer by comparison with normal and degenerative sclerotic bone lesions, using microcomputed tomography (micro-CT). A total of 32 cancellous bone samples were excised from the lumbar spine of six autopsy patients: 15 metastatic samples (one patient), eight degenerative sclerotic samples (four patients) and the rest from normal sites (three patients). The samples were serially scanned cross-sectionally by micro-CT with a pixel size of 23.20 μm, slice thickness of 18.56 μm, and image matrix of 512 x 512. Each image data set consisted of 250 consecutive slices. The volumes of interest (96 x 96 x 120 voxels) were defined in the original image sets and 3D indices of the trabecular microstructure were determined. The trabecular thickness (Tb.Th) in degenerative sclerotic lesions was significantly higher than that in normal sites, whereas no significant difference was observed in trabecular number (Tb.N). By contrast, in metastatic lesions, the Tb.N was significantly higher with increased bone volume fraction (BV/TV) than in normal sites, and no significant difference was found in Tb.Th. The characteristics of the trabecular surface in the metastatic samples showed concave structural elements with an increase in BV/TV, indicating osteolysis of the trabecular bone. In 3D reconstructed images, increased trabecular bone with an irregular surface was observed in samples from metastatic sites, which were uniformly sclerotic on soft X-ray radiographs. These results support, through 3D morphological features, the strong bone resorption effect in bone metastasis from prostate cancer. (orig.)

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

    International Nuclear Information System (INIS)

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

    2018-01-01

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

  7. A predictive mechanical model for evaluating vertebral fracture probability in lumbar spine under different osteoporotic drug therapies.

    Science.gov (United States)

    López, E; Ibarz, E; Herrera, A; Puértolas, S; Gabarre, S; Más, Y; Mateo, J; Gil-Albarova, J; Gracia, L

    2016-07-01

    Osteoporotic vertebral fractures represent a major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture from bone mineral density (BMD) measurements. A previously developed model, based on the Damage and Fracture Mechanics, was applied for the evaluation of the mechanical magnitudes involved in the fracture process from clinical BMD measurements. BMD evolution in untreated patients and in patients with seven different treatments was analyzed from clinical studies in order to compare the variation in the risk of fracture. The predictive model was applied in a finite element simulation of the whole lumbar spine, obtaining detailed maps of damage and fracture probability, identifying high-risk local zones at vertebral body. For every vertebra, strontium ranelate exhibits the highest decrease, whereas minimum decrease is achieved with oral ibandronate. All the treatments manifest similar trends for every vertebra. Conversely, for the natural BMD evolution, as bone stiffness decreases, the mechanical damage and fracture probability show a significant increase (as it occurs in the natural history of BMD). Vertebral walls and external areas of vertebral end plates are the zones at greatest risk, in coincidence with the typical locations of osteoporotic fractures, characterized by a vertebral crushing due to the collapse of vertebral walls. This methodology could be applied for an individual patient, in order to obtain the trends corresponding to different treatments, in identifying at-risk individuals in early stages of osteoporosis and might be helpful for treatment decisions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Limited magnetic resonance imaging of the lumbar spine has high sensitivity for detection of acute fractures, infection, and malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Benjamin; Fintelmann, Florian J.; Kamath, Ravi S.; Kattapuram, Susan V.; Rosenthal, Daniel I. [Massachusetts General Hospital, Department of Radiology, Boston, MA (United States)

    2016-12-15

    The objective of this study is to determine how a limited protocol MR examination compares to a full conventional MR examination for the detection of non-degenerative pathology such as acute fracture, infection, and malignancy. A sample of 349 non-contrast MR exams was selected retrospectively containing a 3:1:1:1 distribution of negative/degenerative change only, acute fracture, infection, and malignancy. This resulted in an even distribution of pathology and non-pathology. A limited protocol MR exam was simulated by extracting T1-weighted sagittal and T2-weighted fat-saturated (or STIR) sagittal sequences from each exam and submitting them for blinded review by two experienced musculoskeletal radiologists. The exams were evaluated for the presence or absence of non-degenerative pathology. Interpretation of the limited exam was compared to the original report of the full examination. If either reader disagreed with the original report, the case was submitted for an unblinded adjudication process with the participation of a third musculoskeletal radiologist to establish a consensus diagnosis. There were five false negatives for a sensitivity of 96.9 % for the limited protocol MR exam. Infection in the psoas, paraspinal muscles, and sacroiliac joint, as well as acute fractures in transverse processes and sacrum were missed by one or more readers. No cases of malignancy were missed. Overall diagnostic accuracy was 96.0 % (335/349). MR imaging of the lumbar spine limited to sagittal T1-weighted and sagittal T2 fat-saturated (or STIR) sequences has high sensitivity for the detection of acute fracture, infection, or malignancy compared to a conventional MR examination. (orig.)

  9. Magnetic resonance imaging of lumbar spine. Comparison of multiple spin echo and low flip angle gradient echo imaging

    Energy Technology Data Exchange (ETDEWEB)

    Murakami, Takamichi; Fujita, Norihiko; Harada, Koushi; Kozuka, Takahiro (Osaka Univ. (Japan). Faculty of Medicine)

    1989-07-01

    Sixteen patients including 13 cases with disk herniation and 3 cases with spondylosis of lumbar spine were examined on a resistive MRI system operating at 0.1 T. All lesions were studied with both multiple spin echo (MSE) and low flip angle gradient echo (LF) techniques to evaluate which technique is more effective in detecting the disk degeneration and the indentation on subarachnoid space. MSE images were obtained with repetition time (TR) of 1100-1500 ms or cardiac gating, an echo time (TE) of 30, 60, 90, 120, 150, and 180 ms symmetrical 6 echoes, and total acquisition time of more than 281 sec. LF images were obtained with TR of 500, 250, and 100 ms, TE of 18 ms, a flip angle of 30 degree, and total acquisition time of 128 sec. Eleven lesions of spinal disk degeneration and 12 of indentation on subarachnoid space were detected with LF. On the other hand, 26 lesions of spinal disk degeneration and 38 of indentation on subarachnoid space were detected with MSE. Although the parameters of LF employed in this study were relatively effective to emphasize T2{sup *}-based contrast, the ability of LF in detection of spinal disk degeneration and indentation on subarachnoid space is less than that of MSE. Signal contrast to noise ratios for normal disk and degenerative disk, epidural-fat and disk herniated material, CSF and disk herniated material, and epidural-fat and CSF were less than 4 with LF, but more than 4 with MSE. This difference of contrast to noise ratio between MSE and LF was one of the main causes of the difference of the detection rate of spinal disk degeneration and indentation on subarachnoid space. (author).

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

    Science.gov (United States)

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

    2018-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2018-01-15

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

  12. Three-dimensional primary and coupled range of motions and movement coordination of the pelvis, lumbar and thoracic spine in standing posture using inertial tracking device.

    Science.gov (United States)

    Narimani, M; Arjmand, N

    2018-03-01

    Evaluation of spinal range of motions (RoMs) and movement coordination between its segments (thorax, lumbar, and pelvis) has clinical and biomechanical implications. Previous studies have not recorded three-dimensional primary/coupled motions of all spinal segments simultaneously. Moreover, magnitude/direction of the coupled motions of the thorax/pelvis in standing posture and lumbopelvic rhythms in the frontal/transverse planes have not been investigated. This study, hence, used an inertial tracking device to measure T1, T5, T12, total (T1-T12) thoracic, lower (T5-T12) and upper (T1-T5) thoracic, lumbar (T12-S1), and pelvis primary and coupled RoMs as well as their movement coordination in all anatomical planes/directions in twenty-two healthy individuals. RoMs were statistically compared between the anatomical planes and spinal segments as well as with available data in the literature. The spine had different primary RoMs in different planes/directions (flexion: lumbar: 55.4 ± 12.4°, pelvis: 42.8 ± 21.6°, and T1-T12 thoracic: 19.9 ± 6.4°, extension: lumbar: 23.4 ± 10.1°, thoracic: 11.7 ± 3.4°, and pelvis: 10.2 ± 6.4°, left/right lateral bending: thoracic: 24.5 ± 7.4°/26.5 ± 6.1°, lumbar: 16.4 ± 7.2°/18.3 ± 5.7°, and pelvis: 11.0 ± 4.4°/9.3 ± 6.2°, and left/right axial rotation: thoracic: 33.5 ± 10.0°/37.1 ± 11.7°, pelvis: 31.6 ± 12.5°/27.2 ± 12.0° and lumbar: 7.5 ± 4.5°/9.2 ± 7.3°). Pelvis, lumbar and thoracic spine had different/varying contributions/rhythms to generate total trunk (T1) movement, both within and between planes. Pattern of the coupled motions was inconsistent between subjects but side bending was generally associated with twisting to the same side at the thoracic spine and to the opposite side at the lumbar spine. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. [The assessment of therapeutic effectiveness of paravertebral blockades in patients with painful radicular syndromes in discopathy and in lumbar spine spondylosis].

    Science.gov (United States)

    Styczyński, T; Parnarauskiene, R; Zarski, S; Kaubrys, G; Klezys, V; Krzemińska-Dabrowska, I; Lesiak, A; Pasek, A; Piróg, A; Pyskło, B; Sadowski, A

    1997-01-01

    A group of 103 patients were examined for radicular painful syndromes in lumbar discopathy and lumbar spondylosis. Fifty-eight were treated by placing them in spine-decompressing position, traction and therapeutic exercises. The group of 45 patients had additionally paravertebral blockade (steroid + a local anaesthetic). In the blockade group the therapeutic effects were better, with rapid reduction of acute pain, with wellbeing improvement and better comfort, which facilitated further stages of the treatment. This made possible shortening of hospital stay by 20%, on average, as compared with the group without blockade. In patients with shorter lasting radicular pains (below 2 months) the results after paravertebral blockade were significantly better than in cases with longer duration of pains (2-6 months).

  14. The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine1

    Science.gov (United States)

    Wright, Nicole C; Looker, Anne C; Saag, Kenneth G; Curtis, Jeffrey R; Delzell, Elizabeth S; Randall, Susan; Dawson-Hughes, Bess

    2016-01-01

    The goal of our study was to estimate the prevalence of osteoporosis and low bone mass based on bone mineral density (BMD) at the femoral neck and the lumbar spine in adults 50 years and older in the United States (US). We applied prevalence estimates of osteoporosis or low bone mass at the femoral neck or lumbar spine (adjusted by age, sex, and race/ethnicity to the 2010 Census) for the non-institutionalized population age 50 years and older from the National Health and Nutrition Examination Survey 2005–2010 to 2010 US Census population counts to determine the total number of older US residents with osteoporosis and low bone mass. There were over 99 million adults 50 years and older in the US in 2010. Based on an overall 10.3% prevalence of osteoporosis, we estimated that in 2010 10.2 million older adults had osteoporosis. The overall low bone mass prevalence was 43.9%, from which we estimated that 43.4 million older adults had low bone mass. We estimated that 7.7 million non-Hispanic White, 0.5 million non-Hispanic Black, and 0.6 million Mexican American adults had osteoporosis and another 33.8, 2.9, and 2.0 million had low bone mass, respectively. When combined, osteoporosis and low bone mass at the femoral neck or lumbar spine affected an estimated 53.6 million older US adults in 2010. Although most of the individuals with osteoporosis or low bone mass were non-Hispanic White women, a substantial number of men and women from other racial/ethnic groups also had osteoporotic BMD or low bone mass. PMID:24771492

  15. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine.

    Science.gov (United States)

    Wright, Nicole C; Looker, Anne C; Saag, Kenneth G; Curtis, Jeffrey R; Delzell, Elizabeth S; Randall, Susan; Dawson-Hughes, Bess

    2014-11-01

    The goal of our study was to estimate the prevalence of osteoporosis and low bone mass based on bone mineral density (BMD) at the femoral neck and the lumbar spine in adults 50 years and older in the United States (US). We applied prevalence estimates of osteoporosis or low bone mass at the femoral neck or lumbar spine (adjusted by age, sex, and race/ethnicity to the 2010 Census) for the noninstitutionalized population aged 50 years and older from the National Health and Nutrition Examination Survey 2005-2010 to 2010 US Census population counts to determine the total number of older US residents with osteoporosis and low bone mass. There were more than 99 million adults aged 50 years and older in the US in 2010. Based on an overall 10.3% prevalence of osteoporosis, we estimated that in 2010, 10.2 million older adults had osteoporosis. The overall low bone mass prevalence was 43.9%, from which we estimated that 43.4 million older adults had low bone mass. We estimated that 7.7 million non-Hispanic white, 0.5 million non-Hispanic black, and 0.6 million Mexican American adults had osteoporosis, and another 33.8, 2.9, and 2.0 million had low bone mass, respectively. When combined, osteoporosis and low bone mass at the femoral neck or lumbar spine affected an estimated 53.6 million older US adults in 2010. Although most of the individuals with osteoporosis or low bone mass were non-Hispanic white women, a substantial number of men and women from other racial/ethnic groups also had osteoporotic BMD or low bone mass. © 2014 American Society for Bone and Mineral Research.

  16. Initial years of recreational artistic gymnastics training improves lumbar spine bone mineral accrual in 4- to 8-year-old females.

    Science.gov (United States)

    Laing, Emma M; Wilson, Alissa R; Modlesky, Christopher M; O'Connor, Patrick J; Hall, Daniel B; Lewis, Richard D

    2005-03-01

    Gymnasts' bone mineral characteristics are generally not known before starting their sport. Prepubertal females who enrolled in beginning artistic gymnastics (n = 65) had lower bone mineral than controls (n = 78). However, 2 years of gymnastics participation versus no participation led to a significantly greater accrual of forearm bone area and lumbar spine areal BMD. The skeletal response to exercise in children compared with adults is heightened because of the high bone turnover rate and the ability of bone to change its size and shape. Whereas child gymnasts generally have greater rates of bone mineral accrual compared with nongymnasts, it is unknown if some of these skeletal advantages are present before the onset of training or are caused entirely by training. Changes in bone area (BA; cm2), BMC (g), and areal BMD (aBMD; g/cm2) over 24 months were examined in prepubertal females, 4-8 years of age, who selected to perform recreational gymnastics (GYM; n = 65), nongymnastic activities, or no organized activity (CON; n = 78). Participants had essentially no lifetime history of organized athletic participation ( 0.05). Controlling for differences in race, baseline measures of body mass, height, and calcium intake, and change in breast development beyond stage II at 24 months, GYM had greater long-term (asymptotic) mean responses for total body aBMD and forearm BMC (p < 0.04) and greater rates of increase in the mean responses of lumbar spine aBMD and forearm BA compared with CON over 24 months. Over time, forearm BA increased to a greater extent in HLG compared with LLG (p < 0.01). Females participating in recreational gymnastics initiated during childhood have enhanced bone mineral gains at the total body, lumbar spine, and forearm over 24 months. Higher-level training promotes additional gains in forearm BA.

  17. The diagnostic value of axial loading imaging of the lumbar spine during CT and MR examination in patients with degeneration disorders

    International Nuclear Information System (INIS)

    Lei Xinwei; Yin Jianzhong; Xia Shuang; Chen Xinjuan; Wu Shengyong; Qi Ji

    2007-01-01

    Objective: To estimate the diagnostic value of axial loading imaging of the lumbar spine during CT and MRI examination in patients with degenerative disorders. Methods: One hundred patients were examined in psoas-relaxed position (PRP) and axially compressed in extension (ACE) supine position of the lumbar spine. Forty patients were examined with CT and 60 patients were with MRI. If a significant decrease (>15 mm 2 ) of dural sac cross-sectional area to values smaller than 75 mm 2 was found during examination in axial loading, or if a suspected disc herniation, narrow lateral recess, narrow intervertebral foramen, or intraspinal synovial cyst changed to being obvious at the axial loading examination, they were regarded as additional information. Results: After axial loading CT examination, AVI was found in 16 of 40 patients. A significant decrease of dural sac area was found in 13 patients. Intervertebral disc herniation was more severe in 7 patients, lateral recess or intervertebral foramen narrowed in 4 patients, no intraspinal synovial cyst was found. After axial loading MRI examination, AVI was found in 19 of 60 patients. A significant decrease of dural sac area was found in 13 patients. Intervertebral disc herniation became severe in 10 patients, lateral recess or intervertebral foramen narrowed in 8 patients, no intraspinal synovial cyst was found. AVI was found in 32 of 79(40.5%) patients with sciatica and 2 of 20(10.0%) patients with low back pain (χ 2 =7.45 P<0.05). Conclusion: Compared with PRP examination, the ACE of CT or MRI can reflect the status of disc, dural sac and lateral recess or intervertebral foramen of the lumbar spine in the erect position. (authors)

  18. Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): a value analysis of cost, pain, disability, and quality of life: clinical article.

    Science.gov (United States)

    Parker, Scott L; Godil, Saniya S; Mendenhall, Stephen K; Zuckerman, Scott L; Shau, David N; McGirt, Matthew J

    2014-08-01

    Current health care reform calls for a reduction of procedures and treatments that are less effective, more costly, and of little value (high cost/low quality). The authors assessed the 2-year cost and effectiveness of comprehensive medical management for lumbar spondylolisthesis, stenosis, and herniation by utilizing a prospective single-center multidisciplinary spine center registry in a real-world practice setting. Analysis was performed on a prospective longitudinal quality of life spine registry. Patients with lumbar spondylolisthesis (n = 50), stenosis (n = 50), and disc herniation (n = 50) who had symptoms persisting after 6 weeks of medical management and who were eligible for surgical treatment were entered into a prospective registry after deciding on nonsurgical treatment. In all cases, comprehensive medical management included spinal steroid injections, physical therapy, muscle relaxants, antiinflammatory medication, and narcotic oral agents. Two-year patient-reported outcomes, back-related medical resource utilization, and occupational work-day losses were prospectively collected and used to calculate Medicare fee-based direct and indirect costs from the payer and societal perspectives. The maximum health gain associated with medical management was defined as the improvement in pain, disability, and quality of life experienced after 2 years of medical treatment or at the time a patient decided to cross over to surgery. The maximum health gain in back pain, leg pain, disability, quality of life, depression, and general health state did not achieve statistical significance by 2 years of medical management, except for pain and disability in patients with disc herniation and back pain in patients with lumbar stenosis. Eighteen patients (36%) with spondylolisthesis, 11 (22%) with stenosis, and 17 (34%) with disc herniation eventually required surgical management due to lack of improvement. The 2-year improvement did not achieve a minimum clinically

  19. Spinal tuberculosis of the lumbar spine after percutaneous vertebral augmentation (vertebroplasty or kyphoplasty).

    Science.gov (United States)

    Zou, Ming-Xiang; Wang, Xiao-Bin; Li, Jing; Lv, Guo-Hua; Deng, You-Wen

    2015-06-01

    Spinal tuberculosis occurring after percutaneous vertebral augmentation has rarely been described. To date, only two such cases have been documented in the literature. Vertebral augmentation may reactivate a quiescent tuberculous lesion and promote the infective process in elderly patients with or without immunosuppression, thereby resulting in poor outcomes. The purposes of this study were to present two cases in which spinal tuberculosis occurred after vertebroplasty or kyphoplasty, to highlight the clinical features and need for early diagnosis of this pathology, and to postulate probable reasons for this association. This study is based on a clinical case series and literature review. In this report, we review the clinical histories of two old women undergoing vertebral augmentation with subsequent spinal tuberculosis. The first patient responded favorably to conservative treatment with multidrug antitubercular therapy and spinal braces. The second patient underwent surgical debridement through a posterior approach alone, without instrumentation, combined with adjuvant chemotherapy. By 1 year after treatment, both patients had experienced almost complete recovery and continued to be seen for follow-up visits. Suspicion should be high, and magnetic resonance imaging is warranted in cases with deteriorating clinical symptoms and signs of acute infection after vertebral augmentation. We propose obtaining exhaustive microbiologic and histologic evidence via needle biopsy or open surgery in a timely fashion to establish an accurate diagnosis because tubercular spondylitis occurring in such a situation may progress rapidly. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Computed tomography localization of the appendix in the pediatric population relative to the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Davis, John; Kopelman, Tammy R. [Maricopa Integrated Health System, Maricopa Medical Center Department of Surgery, Phoenix, AZ (United States); Roh, Albert T.; Matz, Samantha L.; Gridley, Daniel G.; Connell, Mary J. [Maricopa Integrated Health System, Maricopa Medical Center Department of Radiology, Phoenix, AZ (United States); Petterson, Matthew B. [University of Arizona College of Medicine, Phoenix, AZ (United States)

    2017-03-15

    Computed tomography (CT) is commonly used to evaluate suspected acute appendicitis. Although very effective, CT uses ionizing radiation, exposing patients to an increased risk of cancer. This study assessed the potential for decreasing the field of view of the CT (and therefore the dose to the patient) in the evaluation of suspected acute appendicitis in children. This study was a retrospective review of prospectively collected data from 212 consecutive patients who underwent CT for suspected acute appendicitis. The most superior aspect of the appendix with respect to vertebral bodies was recorded. Age, gender and diagnosis (negative, acute appendicitis or alternative diagnosis) were noted. The appendix was visualized in 190 of 212 subjects (89.6%). Overall, all visualized appendixes were located at or below the level of L1. Sixty-three of the subjects (29.7%) were diagnosed with acute appendicitis via CT imaging. All appendixes in patients with acute appendicitis were located at or below the level of the L3 vertebral body, predominating at the level of L5. Six subjects (3.1%) received alternative diagnoses, including pneumonia, pyelonephritis, small bowel obstruction and infected urachal cyst. There were no differences in appendix location with regard to diagnosis, gender, or age (P=0.664, 0.748 and 0.705, respectively). CT field of view may be decreased to the level of L1 or L3 superiorly, decreasing radiation dose without affecting the rate of appendix visualization. (orig.)

  1. Should we be more on the ball? The efficacy of accommodation training on lumbar spine posture, muscle activity, and perceived discomfort during stability ball sitting.

    Science.gov (United States)

    Jackson, Jennie A; Banerjee-Guénette, Priyanka; Gregory, Diane E; Callaghan, Jack P

    2013-12-01

    The aim of this study was to evaluate the efficacy of a 9-day accommodation protocol on reducing perceived discomfort while sitting on a stability ball (SB); trunk muscle activity levels and lumbar spinal postures were also considered. Previous studies have compared SB sitting with office chair sitting with few observed differences in muscle activity or posture; however, greater discomfort during SB sitting has been reported. These findings may indicate an accommodation period is necessary to acclimate to SB sitting. For this study, 6 males and 6 females completed two separate, 2-hr sitting sessions on an SB. Half the participants completed a 9-day accommodation period between the visits, whereas the other half did not use an SB during the time. On both occasions, self-reported perceived discomfort ratings were collected along with erector spinae and abdominal muscle activity and lumbar spinal postures. Discomfort ratings were reduced in female participants following the accommodation; no effects on muscle activation or lumbar spine postures were observed. Accommodation training may reduce perceived low-back discomfort in females.Trunk muscle activity and lumbar spine postures during seated office work on an SB did not differ between groups; however, greater sample power was required to conclusively address these variables. Regarding whether to use an SB in place of a standard office chair, this study indicates that females electing to use an SB can decrease discomfort by following an accommodation protocol; no evidence was found to indicate that SB chair use will improve trunk strength or posture, even following an accommodation period.

  2. Multislice helical computed tomography in the evaluation of lumbar spine diseases; Tomografia computadorizada 'multislice' no diagnostico das afeccoes da coluna lombar

    Energy Technology Data Exchange (ETDEWEB)

    Rosemberg, Laercio Alberto; Rios, Adriana Martins; Almeida, Milena Oliveira [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil)]. E-mail: laercio@einstein.br; Garbaccio, Viviane Ladeira;