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Sample records for underwent lumbar spine

  1. Lumbar spine chordoma

    Directory of Open Access Journals (Sweden)

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

    2014-01-01

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

  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 572.19 - Lumbar spine, abdomen and pelvis.

    Science.gov (United States)

    2010-10-01

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

  5. Gonadal dose reduction in lumbar spine radiography

    International Nuclear Information System (INIS)

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

    1983-01-01

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

  6. Axial loaded MRI of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-09-01

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

  7. 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.

  8. 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.

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

    Science.gov (United States)

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

  10. Sensitivity of lumbar spine loading to anatomical parameters

    DEFF Research Database (Denmark)

    Putzer, Michael; Ehrlich, Ingo; Rasmussen, John

    2016-01-01

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

  11. 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)

  12. 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.

  13. 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. 

  14. Synovial cysts of the lumbar spine

    International Nuclear Information System (INIS)

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

    2002-01-01

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

  15. 49 CFR 572.85 - Lumbar spine flexure.

    Science.gov (United States)

    2010-10-01

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

  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. Traumatic subdural hematoma in the lumbar spine.

    Science.gov (United States)

    Song, Jenn-Yeu; Chen, Yu-Hao; Hung, Kuang-Chen; Chang, Ti-Sheng

    2011-10-01

    Traumatic spinal subdural hematoma is rare and its mechanism remains unclear. This intervention describes a patient with mental retardation who was suffering from back pain and progressive weakness of the lower limbs following a traffic accident. Magnetic resonance imaging of the spine revealed a lumbar subdural lesion. Hematoma was identified in the spinal subdural space during an operation. The muscle power of both lower limbs recovered to normal after surgery. The isolated traumatic spinal subdural hematoma was not associated with intracranial subdural hemorrhage. A spinal subdural hematoma should be considered in the differential diagnosis of spinal cord compression, especially for patients who have sustained spinal trauma. Emergency surgical decompression is usually the optimal treatment for a spinal subdural hematoma with acute deterioration and severe neurological deficits. Copyright © 2011. Published by Elsevier B.V.

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

    Science.gov (United States)

    2010-10-01

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

  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. 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

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

    Science.gov (United States)

    2016-06-01

    AWARD NUMBER: W81XWH-13-2-0043 TITLE: Lumbar Spine Musculoskeletal Physiology and Biomechanics During Simulated Military Operations PRINCIPAL...31May2016 4. TITLE AND SUBTITLE Lumbar Spine Musculoskeletal Physiology and Biomechanics 5a. CONTRACT NUMBER During Simulated Military Operations 5b... Biomechanics , Cincinnati, 2015. § Website(s) or other Internet site(s) § Nothing to report § Technologies or techniques § Nothing to report

  2. Clostridium difficile colitis in patients undergoing lumbar spine surgery.

    Science.gov (United States)

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

    2014-09-01

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

  3. NONFUSION STABILIZATION IN THE DEGENERATIVE LUMBAR SPINE DISEASES

    Directory of Open Access Journals (Sweden)

    Matjaž Voršič

    2009-04-01

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

  4. 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

  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. Computed tomography as the primary radiological examination of lumbar spine

    International Nuclear Information System (INIS)

    Ilkko, E.; Laehde, S.

    1988-01-01

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

  7. 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 ...

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

    Science.gov (United States)

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

    2018-04-03

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

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

    Science.gov (United States)

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

    2017-05-01

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

  10. Magnetic resonance imaging of lumbar spine

    International Nuclear Information System (INIS)

    Murakami, Takamichi; Fujita, Norihiko; Harada, Koushi; Kozuka, Takahiro

    1989-01-01

    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 * -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)

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

    Science.gov (United States)

    Vicenzino, G; Twomey, L

    1993-01-01

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

  14. 3-dimensional reconstructions of computer tomograms of the lumbar spine

    International Nuclear Information System (INIS)

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

    1991-01-01

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

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    Joanna Siminska

    2017-06-01

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

  17. 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

  18. 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.)

  19. 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.

  20. MRI of degenerative cysts of the lumbar spine

    International Nuclear Information System (INIS)

    Khalatbari, K.; Ansari, H.

    2008-01-01

    Degenerative cysts of the lumbar spine encompass a heterogeneous group of cystic lesions that are presumed to share a common aetiology. Some of these cysts may be incidental findings, whereas others may produce acute or chronic symptoms. These cysts have been categorized using various combinations of topographic and pathological characteristics and by their attachment to or communication with a specific spinal structure

  1. MRI of degenerative cysts of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Khalatbari, K. [Department of MRI, Iran Gamma Knife Centre, Iran University of Medial Sciences-Kamrani Charity Foundation, Tehran (Iran, Islamic Republic of)], E-mail: khalatbarik@yahoo.com; Ansari, H. [Department of Orthopaedics, Rassoul Akram University Hospital, Tehran (Iran, Islamic Republic of)

    2008-03-15

    Degenerative cysts of the lumbar spine encompass a heterogeneous group of cystic lesions that are presumed to share a common aetiology. Some of these cysts may be incidental findings, whereas others may produce acute or chronic symptoms. These cysts have been categorized using various combinations of topographic and pathological characteristics and by their attachment to or communication with a specific spinal structure.

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

    Science.gov (United States)

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

    2018-02-08

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

  3. Imaging of the lumbar spine after diskectomy

    International Nuclear Information System (INIS)

    Laredo, J.D.; Wybier, M.

    1995-01-01

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

  4. 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.

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

    International Nuclear Information System (INIS)

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

    1998-01-01

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

  6. [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.

  7. 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.)

  8. Computed tomography of thoracic and lumbar spine fractures that have been treated with Harrington instrumentation

    International Nuclear Information System (INIS)

    Golimbu, C.; Firooznia, H.; Rafii, M.; Engler, G.; Delman, A.

    1984-01-01

    Twenty patients with fractures of the thoracic and lumbar spine underwent computed tomography (CT) following Harrington distraction instrumentation and a spinal fusion. CT was done to search for a cause of persistent cord or nerve root compression in those patients who failed to improve and completely recover their partial neurologic deficit (14 cases). The most common abnormality was the presence of residual bone fragments originating in the burst fracture of a vertebral body displaced posteriorly, into the spinal canal. In patients with complications in the late recovery period, CT found exuberant callus indenting the canal or lack of fusion of the bone grafts placed in the anterolateral aspect of the vertebral bodies. This experience indicates that CT is the modality of choice for spinal canal evaluation in those patients who fail to have an optimal clinical course following fractures of the thoracic and lumbar spine treated with Harrington rods

  9. Magnetic resonance imaging of canine degenerative lumbar spine diseases

    International Nuclear Information System (INIS)

    Karkkainen, M.; Punto, L.U.; Tulamo, R.M.

    1993-01-01

    Degenerative lumbar spine diseases, i.e., sacrolumbar stenosis, intervertebral disk degeneration and protrusion and spondylosis deformans of the canine lumbar spine were studied in eleven canine patients and three healthy controls using radiography and 0.02 T and 0.04 T low field magnetic resonance imaging. The T1 and T2 weighted images were obtained in sagittal and transverse planes. The loss of hydration of nucleus pulposus, taken as a sign of degeneration in the intervertebral disks, could be evaluated in both T1 and T2 weighted images. As a noninvasive method magnetic resonance imaging gave more exact information about the condition of intervertebral disks than did radiography. Sacrolumbar stenosis and compression of the spinal cord or cauda equina and surrounding tissue could be evaluated without contrast medium

  10. Bone mineral density of lumbar spine and femur in acromegaly

    International Nuclear Information System (INIS)

    Huebsch, P.; Kotzmann, H.; Svoboda, T.; Kainberger, F.M.; Bankier, A.; Seidl, G.

    1993-01-01

    Acromegaly is regarded as a cause for secondary osteoporosis, whereas recent papers suggest that growth hormone increases bone mineral density (BMD). In 16 patients with active acromegaly we found an increased BMD compared to normal controls in the lumbar spine and the proximal femur by means of dual energy X-ray absoptiometry. This increase in BMD was statistically significant in the femoral neck and in Ward's triangle (P=0.05). Moreover, no signs of osteoporosis were found radiologically. (orig.) [de

  11. 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.

  12. 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.)

  13. Biomechanical aspects of lumbar spine injuries in athletes: a review.

    Science.gov (United States)

    Alexander, M J

    1985-03-01

    One of the areas of the body which is very often injured by athletes is the lower lack, or the lumbar area of the spine. This problem is of some concern to physical educators, athletic therapists, coaches, athletes, and physicians. The type of injury which occurs in the lumbar spine is dependent on the direction, magnitude, and the point of application of the forces to the spine. This part of the body is susceptible to injury due to the large forces which must be supported, which include the body weight and any external weights, as well as the forces due to very high accelerations of the body parts. Since the lumbar spine is the only connecting column between the upper and lower parts of the body, all the forces must be transmitted via these structures. There are two general techniques of calculating the forces on the lumbar spinal structures, a static approach and a dynamic approach. The static approach may be useful to calculate compression and shear forces on the spine in stationary positions as may be seen in weightlifting. However, the dynamics approach should be used to calculate the effects of the various weights and inertial forces on spinal structures. The most common types of lower back injuries found in athletes were: muscle strains, ligament sprains, lumbar vertebral fractures, disc injuries, and neural arch fractures. The most common serious athletic injury to the lower back was found to be neural arch fractures at the pars interarticularis, or the isthmus between the superior and inferior articular processes. These fractures are known as spondylolysis, or defect in the pars interarticularis of one side of the vertebrae; and spondylolisthesis, a bilateral defect in the pars interarticularis, often accompanied by forward displacement of the vertebral body. The sports in which lower back injuries commonly occurred were also examined, and it was determined that gymnastics, weightlifting and football were the sports in which the lower back is at greatest

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

    Science.gov (United States)

    Zakondyrin, D E

    2015-01-01

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

  15. 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

  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. 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.).

  18. 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

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

    International Nuclear Information System (INIS)

    Hellstroem, M.; Jacobsson, B.; Swaerd, L.; Peterson, L.; Oestra Sjukhuset, Goeteborg; King Faisal Specialist Hospital and Research Centre, Riyadh

    1990-01-01

    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.)

  20. Osteoporosis or Low Bone Mass at the Femur Neck or Lumbar Spine in Older Adults: United States, 2005-2008

    Science.gov (United States)

    ... Osteoporosis or Low Bone Mass at the Femur Neck or Lumbar Spine in Older Adults: United States, ... on bone mineral density at either the femur neck or lumbar spine? Nine percent of persons aged ...

  1. 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....

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

    International Nuclear Information System (INIS)

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

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-06-15

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

  4. 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.)

  5. 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.

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

    Science.gov (United States)

    Elster, A D

    1989-12-01

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

  7. 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

  8. Cervical spine disease may result in a negative lumbar spinal drainage trial in normal pressure hydrocephalus: case report.

    Science.gov (United States)

    Komotar, Ricardo J; Zacharia, Brad E; Mocco, J; Kaiser, Michael G; Frucht, Stephen J; McKhann, Guy M

    2008-10-01

    In this case report, we present a patient with normal pressure hydrocephalus in whom a lumbar drainage trial yielded a false-negative result secondary to cervical spondylosis. An 80-year-old woman presented with classic symptoms of normal pressure hydrocephalus as well as evidence of cervical myelopathy. Magnetic resonance imaging of the brain and spine showed enlarged ventricles and single-level cervical canal narrowing. An initial lumbar drainage trial was performed, which revealed negative results. The patient then underwent cervical decompression and fusion. Despite this procedure, the patient's symptoms continued to worsen. A repeat lumbar drainage trial was performed with positive results. Subsequently, a ventriculoperitoneal shunt was placed, resulting in significant improvement of her symptoms. This case report illustrates how altered cerebrospinal fluid flow dynamics may impact the accuracy of the lumbar spinal drainage trial in patients with normal pressure hydrocephalus.

  9. [The influence of kinesiotaping on lumbar spine pain].

    Science.gov (United States)

    Ciosek, Zaneta; Kopacz, Lukasz; Samulak, Lukasz; Kaźmierczak, Agata; Rotter, Iwona

    2015-01-01

    Pain in the lumbosacral spine is currently one of the most common pain complaints among the elderly. About 72% of the Polish population younger than 40 years have at least once been treated by a doctor for back pain. Degenerative changes of intervertebral joints, overloads, intervertebral disc diseases, and dysfunction of spinal ligaments are very often responsible for the formation of back pain, which is basically a problem of the elderly, The study was conducted among 60 residents of a Nursing Home in Szczecin with chronic lumbar pain. The age range was 56-85 years. Subjects were randomly divided into two groups of 30 (study group, where KinesioTaping was used, and a control group without KinesioTaping application). To assess the degree of pain experienced by the patient a visual analogue scale (VAS) in the horizontal format from 0-10 was used, on which subjects scored the severity of pain. Flexion, extension, tilt and rotation were measured with a tape to assess spinal and trunk mobility. In all patients, who had a KinesioTaping patch applied on the lumbosacral spine pain measured by VAS reduced (p ≤ 0.001). Considering respondents' sex, the spine mobility in the tilting position improved in men in the study group in terms of tilting to both sides. In all patients, the application of a KinesioTaping patch significantly improved the rotation to the right side (p ≤ 0.05), scores in the "finger-floor" flexion test (p ≤ 0.01), and the extension range (p ≤ 0.01). KinesioTaping is a beneficial method reducing pain and improving the mobility in the lumbosacral spine. The improvement was independent of the sex of the respondents.

  10. Pre-existing lumbar spine diagnosis as a predictor of outcomes in National Football League athletes.

    Science.gov (United States)

    Schroeder, Gregory D; Lynch, T Sean; Gibbs, Daniel B; Chow, Ian; LaBelle, Mark; Patel, Alpesh A; Savage, Jason W; Hsu, Wellington K; Nuber, Gordon W

    2015-04-01

    It is currently unknown how pre-existing lumbar spine conditions may affect the medical evaluation, draft status, and subsequent career performance of National Football League (NFL) players. To determine if a pre-existing lumbar diagnosis affects a player's draft status or his performance and longevity in the NFL. Cohort study; Level 3. The investigators evaluated the written medical evaluations and imaging reports of prospective NFL players from a single franchise during the NFL Scouting Combine from 2003 to 2011. Players with a reported lumbar spine diagnosis and with appropriate imaging were included in this study. Athletes were then matched to control draftees without a lumbar spine diagnosis by age, position, year, and round drafted. Career statistics and performance scores were calculated. Of a total of 2965 athletes evaluated, 414 were identified as having a pre-existing lumbar spine diagnosis. Players without a lumbar spine diagnosis were more likely to be drafted than were those with a diagnosis (80.2% vs. 61.1%, respectively, P study suggest that athletes with pre-existing lumbar spine conditions were less likely to be drafted and that the diagnosis is associated with a decrease in career longevity but not performance. Players with lumbar fusion have achieved successful careers in the NFL. © 2015 The Author(s).

  11. Minimally invasive resection of large dumbbell tumors of the lumbar spine: Advantages and pitfalls.

    Science.gov (United States)

    Zairi, Fahed; Troux, Camille; Sunna, Tarek; Karnoub, Mélodie-Anne; Boubez, Ghassan; Shedid, Daniel

    2018-05-01

    The surgical management of dumbbell tumors of the lumbar spine remains controversial, because of their large volume and complex location, involving both the spinal canal and the retro peritoneum. While sporadically reported, our study aims to confirm the value of minimally invasive posterior access for the complete resection of large lumbar dumbbell tumors. In this prospective study, we included all consecutive patients who underwent the resection of a voluminous dumbbell tumor at the lumbar spine through a minimally invasive approach, between March 2015 and August 2017. There were 4 men and 4 women, with a mean age at diagnosis of 40.6 years (range 29-58 years). The resection was performed through a trans muscular tubular retractor by the same surgical team. Operative parameters and initial postoperative course were systematically reported. Clinical and radiological monitoring was scheduled at 3 months, 1 year and 2 years. The mean operative time was 144 min (range 58-300 minutes) and the mean estimated blood loss was 250 ml (range 100-500 ml). Gross total resection was achieved in all patients. No major complication was reported. The mean length of hospital stay was 3.1 days (range 2 to 6 days). Histological analysis confirmed the diagnosis of grade 1 schwannoma in all patients. The mean follow up period was 14.9 months (range 6 to 26 months), and 5 patients completed at least 1-year follow-up. At 6 months the Macnab was excellent in 6 patients, good in one patient and fair in one patient because of residual neuropathic pain requiring the maintenance of a long-term treatment. No tumor recurrence was noted to date. Lumbar dumbbell tumors can be safely and completely resected using a single-stage minimally invasive procedure, in a trained team. Copyright © 2018 Elsevier B.V. All rights reserved.

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

    International Nuclear Information System (INIS)

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

    1984-01-01

    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

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. [Muscle strength of the cervical and lumbar spine in triathletes].

    Science.gov (United States)

    Miltner, O; Siebert, C H; Müller-Rath, R; Kieffer, O

    2010-12-01

    The goal of this study was to analyse the muscle strength of the cervical and lumbar spine in ironman triathletes. The values were compared to the results obtained from a reference group. The test of the triathletes was carried out in an attempt to define a specific strength profile for these athletes. In this study, 20 long-distance triathletes (∅ 37.3 ± 7.6 years of age, ∅ 1.80 ± 0.1 m, ∅ 73.7 ± 6.0 kg) were evaluated with regard to their individual and sport-specific strengths of the cervical spine in 2 planes and of the trunk strengths in all 3 planes of motion. The trunk strength profile of the triathletes revealed good average results in the trunk extensors and the lateral flexors of the left trunk. The reference group is the data base of the company Proxomed®, Alzenau. It is based on results of 1045 untrained, symptom-free subjects of different ages. Lumbar extension: The extension of the force values shows no significant difference from the reference group. Lumbar flexion: The flexion tests show highly significantly lower force values (5.025 ± 0.81 N/kg vs. 6.67 ± 0.6 N/kg) than the reference group. Flexion/extension: In the sagittal plane values for the triathletes demonstrate an imbalance in muscle strength ratios. The abdominal muscles turn in relation to the back extensor muscles too weakly to be very significant. Lumbar rotation: The force values of the athletes in both directions (right: 6.185 ± 1.46 N/kg, left: 7.1 ± 1.57 N/kg vs. 10.05 ± 0.34 N/kg) are highly significantly (p ≤ 0.001) lower than the reference values. Ratio of rotation left/right: The ratio of left/right rotation in the reference group is set at 1 and thus shows an equally strong force level between the two sides. Lumbar lateral flexion: The triathletes do not show any significant differences between the force values. Compared to the reference group there is no significant difference to the left side flexion. In the lateral bending the athletes have significantly

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

    Science.gov (United States)

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

    2015-05-14

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

  20. 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.

  1. 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.

  2. 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

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

    Science.gov (United States)

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

    2014-08-01

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

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  5. Interrater and intrarater agreements of magnetic resonance imaging findings in the lumbar spine: significant variability across degenerative conditions.

    Science.gov (United States)

    Fu, Michael C; Buerba, Rafael A; Long, William D; Blizzard, Daniel J; Lischuk, Andrew W; Haims, Andrew H; Grauer, Jonathan N

    2014-10-01

    Magnetic resonance imaging (MRI) is frequently used in the evaluation of degenerative conditions in the lumbar spine. The relative interrater and intrarater agreements of MRI findings across different pathologic conditions are underexplored, as most studies are focused on specific findings. The purpose of this study was to characterize the interrater and intrarater agreements of MRI findings used to assess the degenerative lumbar spine. A retrospective diagnostic study at a large academic medical center was undertaken with a panel of orthopedic surgeons and musculoskeletal radiologists to assess lumbar MRIs using standardized criteria. Seventy-five subjects who underwent routine lumbar spine MRI at our institution were included. Each MRI study was assessed for 10 lumbar degenerative findings using standardized criteria. Lumbar vertebral levels were assessed independently, where applicable, for a total of 52 data points collected per study. T2-weighted axial and sagittal MRI sequences were presented in random order to the four reviewers (two orthopedic spine surgeons and two musculoskeletal radiologists) independently to determine interrater agreement. The first 10 studies were reevaluated at the end to determine intrarater agreement. Images were assessed using standardized and pilot-tested criteria to assess disc degeneration, stenosis, and other degenerative changes. Interrater and intrarater absolute percent agreements were calculated. To highlight the most clinically important MRI disagreements, a modified agreement analysis was also performed (in which disagreements between the lowest two severity grades for applicable conditions were ignored). Fleiss kappa coefficients for interrater agreement were determined. The overall absolute and modified interrater agreements were 76.9% and 93.5%, respectively. The absolute and modified intrarater agreements were 81.3% and 92.7%, respectively. Average Fleiss kappa coefficient was 0.431, suggesting moderate overall

  6. 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.

  7. 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.

  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. Recurrent back pain after diskectomy: MRI findings MR of the postoperative lumbar spine

    International Nuclear Information System (INIS)

    Aparicio, Rocio; Eguren, Leonor Z.; Schinder, Humberto; Stur, Mariela

    2008-01-01

    Purpose: To show the morphological changes in postoperative lumbar spine. Material and methods: We reviewed 128 Magnetic Resonance Imaging (MRI) studies of lumbar spine. All patients complained of low back pain and had a previous lumbar surgery (1 month to 8 years). All the examinations include axial and sagittal Gadopentate-dimeglumine enhanced T1 weighted imaging. Results: Only 7,8% have the normal appearance of the postoperative lumbar spine. Epidural scar was found in 69% of examinations; of this group, 72% showed radicular involvement, and 28% had no radicular involvement. Recurrent disc herniation was found in 14,8% of exams, using gadopentate-dimeglumine to assist the differentiation from epidural fibrosis; infections like spondylodiscitis and abscess in 12,5%. Other findings included arachnoiditis, pseudomeningoceles and seromas. Conclusions: MRI is a useful method to study the postoperative lumbar spine, specially when enhanced with gadopentate-dimeglumine. Enhanced images can differentiate two of the major complication like epidural fibrosis, and recurrent disc herniation. Spondylodiscitis are important and frequent too. Although the findings of complications in our series in the postoperative lumbar spine represent 92,18 %, these not always explain the symptomatology. Therefore, the interrelation is important with the surgeon to determine which abnormalities are clinically significant. (authors) [es

  10. Utilization and costs of lumbar and full spine radiography by Ontario chiropractors from 1994 to 2001.

    Science.gov (United States)

    Ammendolia, Carlo; Côté, Pierre; Hogg-Johnson, Sheilah; Bombardier, Claire

    2009-07-01

    In Ontario, chiropractors see one-third of patients who seek care for low back pain. Previous studies suggest that chiropractors have high utilization rates of lumbar and full spine radiography. There has been a proliferation of evidence-based guidelines recommending that plain film radiography be used only to assess high-risk patients with low back pain. Evidence for the use of full spine radiography, except for the evaluation of scoliosis is lacking. It is uncertain what impact the growing evidence against their use has had on radiography utilization by Ontario chiropractors. To describe the annual costs and use of lumbar and full spine plain film radiography among Ontario chiropractors between 1994 and 2001. Time-trend analysis of radiography utilization by Ontario chiropractors. Chiropractic claims data submitted to the Ontario Health Insurance Plan or the Workplace Safety & Insurance Board from 1994/1995 to 2000/2001. Change in the annual cost and proportion of claimants receiving lumbar and full spine radiography. Time-trend analysis of chiropractic claims submitted to the Ontario Health Insurance Plan (OHIP) or Workplace Safety & Insurance Board (WSIB) from 1994/1995 to 2000/2001 fiscal years. During the 7-year period, the proportion of OHIP claimants receiving lumbar spine radiography decreased from 4.54% to 3.25% and for full spine radiography from 3.87% to 3.04%. For WSIB claimants, lumbar spine radiography deceased from 6.49% to 3.30% of claimants and full spine radiography from 1.51% to 0.94%. OHIP payments for lumbar spine radiography decreased 12.7% to $562,944, whereas full spine radiography payments decreased 5.3% to $1,071,408. WSIB lumbar and full spine radiography payments decreased 44.2% and 34.3% to $31,202 and $11,713 respectively. Claims data from the two largest third-party payers of chiropractic services in Ontario, suggest that lumbar and full spine radiography, and their associated costs decreased steadily between 1994 and 2001.

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

    Science.gov (United States)

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

    2013-03-01

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

  12. 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.

  13. 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.

  14. 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.

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

    OpenAIRE

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

    2001-01-01

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

  16. Reliability of movement control tests in the lumbar spine

    Directory of Open Access Journals (Sweden)

    de Bruin Eling D

    2007-09-01

    Full Text Available Abstract Background Movement control dysfunction [MCD] reduces active control of movements. Patients with MCD might form an important subgroup among patients with non specific low back pain. The diagnosis is based on the observation of active movements. Although widely used clinically, only a few studies have been performed to determine the test reliability. The aim of this study was to determine the inter- and intra-observer reliability of movement control dysfunction tests of the lumbar spine. Methods We videoed patients performing a standardized test battery consisting of 10 active movement tests for motor control in 27 patients with non specific low back pain and 13 patients with other diagnoses but without back pain. Four physiotherapists independently rated test performances as correct or incorrect per observation, blinded to all other patient information and to each other. The study was conducted in a private physiotherapy outpatient practice in Reinach, Switzerland. Kappa coefficients, percentage agreements and confidence intervals for inter- and intra-rater results were calculated. Results The kappa values for inter-tester reliability ranged between 0.24 – 0.71. Six tests out of ten showed a substantial reliability [k > 0.6]. Intra-tester reliability was between 0.51 – 0.96, all tests but one showed substantial reliability [k > 0.6]. Conclusion Physiotherapists were able to reliably rate most of the tests in this series of motor control tasks as being performed correctly or not, by viewing films of patients with and without back pain performing the task.

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

    Science.gov (United States)

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

    1992-01-01

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

  18. 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.

  19. CT-discography in the evaluation of the post-operative lumbar spine

    International Nuclear Information System (INIS)

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

    1988-01-01

    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. (orig.)

  20. 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.

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

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  2. Evidence against the use of lumbar spine radiography for low back pain

    International Nuclear Information System (INIS)

    Bosch, M.A.A.J. van den; Hollingworth, W.; Kinmonth, A.L.; Dixon, A.K.

    2004-01-01

    AIM: To review abnormalities reported on plain radiographic examination of the lumbar spine in patients referred with low back pain by general practitioners. Additionally, we evaluated and stratified the prevalence of these abnormalities by age. Finally, the diagnostic impact of lumbar spine radiography for the diagnosis of degenerative change, fracture, infection and possible tumour, was modelled. MATERIALS AND METHODS: A retrospective review of 2007 radiographic reports of patients referred with low back pain for lumbar spine radiography to a large radiology department was performed. The reports were classified into different diagnostic groups and subsequently stratified according to age. The potential diagnostic impact of lumbar spine radiography was modelled by using the prevalence of conditions studied as pre-test probabilities of disease. RESULTS: The prevalence of reported lumbar spine degeneration increased with age to 71% in patients aged 65-74 years. The overall prevalence of fracture, possible infection, possible tumour was low in our study population: 4, 0.8 and 0.7%, respectively. Fracture and possible infection showed no association with age. Possible tumour was only reported in patients older than 55 years of age. CONCLUSION: Although the prevalence of degenerative changes was high in older patients, the therapeutic consequences of diagnosing this abnormality are minor. The prevalence of possible serious conditions was very low in all age categories, which implies radiation exposure in many patients with no significant lesions

  3. Poor Nutrition Status and Lumbar Spine Fusion Surgery in the Elderly: Readmissions, Complications, and Mortality.

    Science.gov (United States)

    Puvanesarajah, Varun; Jain, Amit; Kebaish, Khaled; Shaffrey, Christopher I; Sciubba, Daniel M; De la Garza-Ramos, Rafael; Khanna, Akhil Jay; Hassanzadeh, Hamid

    2017-07-01

    Retrospective database review. To quantify the medical and surgical risks associated with elective lumbar spine fusion surgery in patients with poor preoperative nutritional status and to assess how nutritional status alters length of stay and readmission rates. There has been recent interest in quantifying the increased risk of complications caused by frailty, an important consideration in elderly patients that is directly related to comorbidity burden. Preoperative nutritional status is an important contributor to both sarcopenia and frailty and is poorly studied in the elderly spine surgery population. The full 100% sample of Medicare data from 2005 to 2012 were utilized to select all patients 65 to 84 years old who underwent elective 1 to 2 level posterior lumbar fusion for degenerative pathology. Patients with diagnoses of poor nutritional status within the 3 months preceding surgery were selected and compared with a control cohort. Outcomes that were assessed included major medical complications, infection, wound dehiscence, and mortality. In addition, readmission rates and length of stay were evaluated. When adjusting for demographics and comorbidities, malnutrition was determined to result in significantly increased odds of both 90-day major medical complications (adjusted odds ratio, OR: 4.24) and 1-year mortality (adjusted OR: 6.16). Multivariate analysis also demonstrated that malnutrition was a significant predictor of increased infection (adjusted OR: 2.27) and wound dehiscence (adjusted OR: 2.52) risk. Length of stay was higher in malnourished patients, though 30-day readmission rates were similar to controls. Malnutrition significantly increases complication and mortality rates, whereas also significantly increasing length of stay. Nutritional supplementation before surgery should be considered to optimize postoperative outcomes in malnourished individuals. 3.

  4. General practitioners' willingness to request plain lumbar spine radiographic examinations

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-01-01

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

  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. Techniques of lumbar-sacral spine fusion in spondylosis: systematic literature review and meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Umeta, Ricardo S G; Avanzi, Osmar

    2011-07-01

    Spine fusions can be performed through different techniques and are used to treat a number of vertebral pathologies. However, there seems to be no consensus regarding which technique of fusion is best suited to treat each distinct spinal disease or group of diseases. To study the effectiveness and complications of the different techniques used for spinal fusion in patients with lumbar spondylosis. Systematic literature review and meta-analysis. Randomized clinical studies comparing the most commonly performed surgical techniques for spine fusion in lumbar-sacral spondylosis, as well as those reporting patient outcome were selected. Identify which technique, if any, presents the best clinical, functional, and radiographic outcome. Systematic literature review and meta-analysis based on scientific articles published and indexed to the following databases: PubMed (1966-2009), Cochrane Collaboration-CENTRAL, EMBASE (1980-2009), and LILACS (1982-2009). The general search strategy focused on the surgical treatment of patients with lumbar-sacral spondylosis. Eight studies met the inclusion criteria and were selected with a total of 1,136 patients. Meta-analysis showed that patients who underwent interbody fusion presented a significantly smaller blood loss (p=.001) and a greater rate of bone fusion (p=.02). Patients submitted to fusion using the posterolateral approach had a significantly shorter operative time (p=.007) and less perioperative complications (p=.03). No statistically significant difference was found for the other studied variables (pain, functional impairment, and return to work). The most commonly used techniques for lumbar spine fusion in patients with spondylosis were interbody fusion and posterolateral approach. Both techniques were comparable in final outcome, but the former presented better rates of fusion and the latter the less complications. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. 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.)

  8. 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.)

  9. Tuning of automatic exposure control strength in lumbar spine CT.

    Science.gov (United States)

    D'Hondt, A; Cornil, A; Bohy, P; De Maertelaer, V; Gevenois, P A; Tack, D

    2014-05-01

    To investigate the impact of tuning the automatic exposure control (AEC) strength curve (specific to Care Dose 4D®; Siemens Healthcare, Forchheim, Germany) from "average" to "strong" on image quality, radiation dose and operator dependency during lumbar spine CT examinations. Two hospitals (H1, H2), both using the same scanners, were considered for two time periods (P1 and P2). During P1, the AEC curve was "average" and radiographers had to select one of two protocols according to the body mass index (BMI): "standard" if BMI 30.0 kg m(-2) (140 kV-280 mAs). During P2, the AEC curve was changed to "strong", and all acquisitions were obtained with one protocol (120 kV and 270 mAs). Image quality was scored and patients' diameters calculated for both periods. 497 examinations were analysed. There was no significant difference in mean diameters according to hospitals and periods (p > 0.801) and in quality scores between periods (p > 0.172). There was a significant difference between hospitals regarding how often the "large" protocol was assigned [13 (10%)/132 patients in H1 vs 37 (28%)/133 in H2] (p < 0.001). During P1, volume CT dose index (CTDIvol) was higher in H2 (+13%; p = 0.050). In both hospitals, CTDIvol was reduced between periods (-19.2% in H1 and -29.4% in H2; p < 0.001). An operator dependency in protocol selection, unexplained by patient diameters or highlighted by image quality scores, has been observed. Tuning the AEC curve from average to strong enables suppression of the operator dependency in protocol selection and related dose increase, while preserving image quality. CT acquisition protocols based on weight are responsible for biases in protocol selection. Using an appropriate AEC strength curve reduces the number of protocols to one. Operator dependency of protocol selection is thereby eliminated.

  10. 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.

  11. 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...

  12. Bone mineral density of lumbar spine and proximal femur in healthy males

    International Nuclear Information System (INIS)

    Akin, S.; Isikli, S.; Korkusuz, F.; Ungan, M.; Senkoylu, A.

    2004-01-01

    Relationship between BMD and age at lumbar spine and proximal femur in Turkish males was investigated. Two hundred ninety healthy males (aged 20-59 years) were investigated. BMD of the lumbar spine had its peak at ages 30-39, however, the peak for the proximal femur was between the ages of 20 and 29. There was a significant decrease in BMD at proximal femur after these peak values with increasing age. There was a significant correlation between age and the proximal femoral BMD in males and age has a strong predictive power on proximal femur BMD score. (author)

  13. 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

  14. 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

  15. Mini-open lateral retroperitoneal lumbar spine approach using psoas muscle retraction technique. Technical report and initial results on six patients.

    Science.gov (United States)

    Aghayev, Kamran; Vrionis, Frank D

    2013-09-01

    The main aim of this paper was to report reproducible method of lumbar spine access via a lateral retroperitoneal route. The authors conducted a retrospective analysis of the technical aspects and clinical outcomes of six patients who underwent lateral multilevel retroperitoneal interbody fusion with psoas muscle retraction technique. The main goal was to develop a simple and reproducible technique to avoid injury to the lumbar plexus. Six patients were operated at 15 levels using psoas muscle retraction technique. All patients reported improvement in back pain and radiculopathy after the surgery. The only procedure-related transient complication was weakness and pain on hip flexion that resolved by the first follow-up visit. Psoas retraction technique is a reliable technique for lateral access to the lumbar spine and may avoid some of the complications related to traditional minimally invasive transpsoas approach.

  16. Warrior Injury Assessment Manikin (WIAMan) Lumbar Spine Model Validation: Development, Testing, and Analysis of Physical and Computational Models of the WIAMan Lumbar Spine Materials Demonstrator

    Science.gov (United States)

    2016-08-01

    Fig. 13 Lumbar spine assembly in alignment fixture .......................................22 Fig. 14 Double -lap shear coupons before and after...Fig. 7). Strain data were determined from piston displacement, which was verified using a Vision Research Phantom v711 high-speed monochrome... piston would not engage the sample until it had reached the optimal velocity. The slot was around 5 inches in length and the ramp up travel was

  17. 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 the 1980s, numerous operations have replaced posterior lumbar interbody fusion (PLIF) with human bone. These operations 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 PLIF with allogeneic bone (allo-PLIF). Between 1981 and 2006, 321 patients aged 12-80 years underwent 339 1-level or 2-level allo-PLIFs for degenerative instability and were followed for 1-28 years. Fusion status was determined by radiographs and as available, by computed tomography scans. Clinical outcome was assessed by the Economic/Functional Outcome Scale. Of the 321 patients, 308 were followed postoperatively (average 6.7 years) and 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 after 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 years and greater, whereas negative associations in clinical outcomes were observed with mental illness, substance abuse, heavy stress to the low back, or industrial injuries. The total complication rate was 7%. With 3 decades of follow-up, we found that successful clinical outcomes are highly correlated with solid fusion using only allogeneic iliac bone. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Lumbar Spine Injury/Pathology as a Predictor of Outcomes in National Football League Athletes

    Science.gov (United States)

    Lynch, Thomas Sean; Schroeder, Greg; Gibbs, Daniel; Chow, Ian; LaBelle, Mark; Savage, Jason W.; Patel, Alpesh; Hsu, Wellington; Nuber, Gordon W.

    2014-01-01

    Objectives: The purpose of this study is to determine if a pre-existing lumbar diagnosis such as spondylosis, a herniated lumbar disc, or spondylolysis affects a football player’s draft status or his performance and longevity in the NFL. Methods: The written medical evaluations and imaging reports of prospective professional American football athletes from 2003-2011 from one NFL franchise during the NFL combine (annual college football player evaluation prior to the NFL draft) were compiled and evaluated. All players were evaluated for a pre-existing lumbar diagnosis which were compiled from previous injury/medical records including radiographic imaging reports. Those players with a lumbar spine diagnosis and with appropriate radiograph, MRI and CT imaging were included in this study. These athletes were then matched by age, position, year, and round drafted to control draftees without a lumbar spine diagnosis. Career statistics were compiled including length of play and number of games started. Additionally, a previously established “Performance Score” was calculated for all players excluding offensive linemen. The continuous variables of each cohort were compared using a two-sided (tailed) Student’s t-test for normally distributed data. A chi-squared analysis was performed to analyze the categorical data. Statistical significance was accepted with a p < 0.05. Results: Out of a total of 2,965 athletes evaluated from the NFL combine, 414 players were identified with a pre-existing lumbar spine diagnosis. Athletes who attended the NFL combine without a lumbar spine diagnosis were significantly more likely to be drafted than those with one (74% vs. 61% respectively, p < 0.01). There was no difference between the investigational and control group with regard to round drafted, age, year drafted, or position. Overall, athletes with a lumbar spine injury compared to the control group had no difference in the number of years played (4.0 vs. 4.3 years, respectively

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

    International Nuclear Information System (INIS)

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

    2008-01-01

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

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

    NARCIS (Netherlands)

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

    2018-01-01

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

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

    NARCIS (Netherlands)

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

    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,

  2. 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

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    Yolanda Más

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

  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. Psoas muscle and lumbar spine stability : a concept uniting existing controversies - Critical review and hypothesis

    NARCIS (Netherlands)

    Penning, L

    2000-01-01

    Psoas muscle (PM) function with regard to the lumbar spine (LS) is disputed. Electromyographic studies attribute to the PM a possible role as stabilizer. Anatomical textbooks describe the PM as an LS flexor, but not a stabilizer. According to more recent anatomical studies, the PM does not act on

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

    African Journals Online (AJOL)

    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, wrestling 8, Judo ...

  8. A short review on a complication of lumbar spine surgery: CSF leak.

    Science.gov (United States)

    Menon, Sajesh K; Onyia, Chiazor U

    2015-12-01

    Cerebrospinal fluid (CSF) leak is a common complication of surgery involving the lumbar spine. Over the past decades, there has been significant advancement in understanding the basis, management and techniques of treatment for post-operative CSF leak following lumbar spine surgery. In this article, we review previous work in the literature on the various factors and technical errors during or after lumbar spine surgery that may lead to this feared complication, the available options of management with focus on the various techniques employed, the outcomes and also to highlight on the current trends. We also discuss the presentation, factors contributing to its development, basic concepts and practical aspects of the management with emphasis on the different techniques of treatment. Different outcomes following various techniques of managing post-operative CSF leak after lumbar spine surgery have been well described in the literature. However, there is currently no most ideal technique among the available options. The choice of which technique to be applied in each case is dependent on each surgeon's cumulative experience as well as a clear understanding of the contributory underlying factors in each patient, the nature and site of the leak, the available facilities and equipment. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. 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)

  10. Aspergillus Spondylitis involving the Cervico-Thoraco-Lumbar Spine in an Immunocompromised Patient: a Case Report

    International Nuclear Information System (INIS)

    Son, Jeong-Min; Jee, Won-Hee; Jung, Chan-Kwon; Kim, Sang-Il; Ha, Kee-Yong

    2007-01-01

    Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient. spergillosis is a rare cause of spondylitis, and early diagnosis by MR imaging and adequate treatment are essential for a good outcome. Although the MR findings of bacterial spondylitis have been fully described, the findings of aspergillus spondylitis have been rarely described, and to the best of our knowledge multilevel involvement of cervico-thoraco-lumbar spine has not been previously reported. Here, we report the MR imaging findings of aspergillus spondylitis involving the cervico-thoraco-lumbar spine in a liver transplant recipient. In conclusion, aspergillus spondylitis should be considered in the differential diagnosis of immunocompromised patients with MR findings resembling those of tuberculous spondylitis

  11. [Research Progress and Prospect of Applications of Finite Element Method in Lumbar Spine Biomechanics].

    Science.gov (United States)

    Zhang, Zhenjun; Li, Yang; Liao, Zhenhua; Liu, Weiqiang

    2016-12-01

    Based on the application of finite element analysis in spine biomechanics,the research progress of finite element method applied in lumbar spine mechanics is reviewed and the prospect is forecasted.The related works,including lumbar ontology modeling,clinical application research,and occupational injury and protection,are summarized.The main research areas of finite element method are as follows:new accurate modeling process,the optimized simulation method,diversified clinical effect evaluation,and the clinical application of artificial lumbar disc.According to the recent research progress,the application prospects of finite element method,such as automation and individuation of modeling process,evaluation and analysis of new operation methods and simulation of mechanical damage and dynamic response,are discussed.The purpose of this paper is to provide the theoretical reference and practical guidance for the clinical lumbar problems by reviewing the application of finite element method in the field of the lumbar spine biomechanics.

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

    Science.gov (United States)

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

    2014-01-01

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

  13. 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...

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

    International Nuclear Information System (INIS)

    Ihara, Koichiro

    1989-01-01

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

  15. 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).

  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. 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

    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...... 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...

  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. Investigation of the Entrance Surface Dose and Dose to Different Organs in Lumbar Spine Imaging

    Directory of Open Access Journals (Sweden)

    Sina S

    2014-12-01

    Full Text Available Background: Dose assessment using proper dosimeters is especially important in radiation protection optimization and imaging justification in diagnostic radiology. Objective: The aim of this study is to obtain the Entrance Skin Dose (ESD of patients undergoing lumbar spine imaging using two thermoluminescence dosimeters TLD-100 (LiF: Mg, Ti and GR-200 (LiF: Mg, Cu, P and also to obtain the absorbed dose to different organs in lumbar spine imaging with several views. Methods: To measure the ESD values of the patients undergoing lumbar spine imaging, the two TLD types were put on their skin surface. The ESD values for different views of lumbar spine imaging were also measured by putting the TLDs at the surface of the Rando phantom. Several TLD chips were inserted inside different organs of Rando phantom to measure the absorbed dose to different organs in lumbar spine imaging. Results: The results indicate that there is a close agreement between the results of the two dosimeters. Based on the results of this experiment, the ESD dose of the 16 patients included in this study varied between 2.71 mGy and 26.29 mGy with the average of 11.89 mGy for TLD-100, and between 2.55 mGy and 27.41 mGy with the average of 12.32 mGy for GR-200 measurements. The ESDs obtained by putting the two types of TLDs at the surface of Rando phantom are in close agreement. Conclusion: According to the results, the GR200 has greater sensitivity than the TLD-100.

  20. Investigation of the Entrance Surface Dose and Dose to Different Organs in Lumbar Spine Imaging

    Science.gov (United States)

    Sina, S; Zeinali, B; Karimipoorfard, M; Lotfalizadeh, F; Sadeghi, M; Zamani, E; Faghihi, R

    2014-01-01

    Background: Dose assessment using proper dosimeters is especially important in radiation protection optimization and imaging justification in diagnostic radiology. Objective: The aim of this study is to obtain the Entrance Skin Dose (ESD) of patients undergoing lumbar spine imaging using two thermoluminescence dosimeters TLD-100 (LiF: Mg, Ti) and GR-200 (LiF: Mg, Cu, P) and also to obtain the absorbed dose to different organs in lumbar spine imaging with several views. Methods: To measure the ESD values of the patients undergoing lumbar spine imaging, the two TLD types were put on their skin surface. The ESD values for different views of lumbar spine imaging were also measured by putting the TLDs at the surface of the Rando phantom. Several TLD chips were inserted inside different organs of Rando phantom to measure the absorbed dose to different organs in lumbar spine imaging. Results: The results indicate that there is a close agreement between the results of the two dosimeters. Based on the results of this experiment, the ESD dose of the 16 patients included in this study varied between 2.71 mGy and 26.29 mGy with the average of 11.89 mGy for TLD-100, and between 2.55 mGy and 27.41 mGy with the average of 12.32 mGy for GR-200 measurements. The ESDs obtained by putting the two types of TLDs at the surface of Rando phantom are in close agreement. Conclusion: According to the results, the GR200 has greater sensitivity than the TLD-100. PMID:25599058

  1. Evidence for Policy Making: Clinical Appropriateness Study of Lumbar Spine MRI Prescriptions Using RAND Appropriateness Method

    Directory of Open Access Journals (Sweden)

    Hossein Yousefi Manesh

    2013-01-01

    Full Text Available MRI is a new and expensive diagnostic technology, which has been used increasingly all over the world. Low back pain is a worldwide prevalent disorder and MRI technique is one of the several ways to diagnose it. This paper aims to identify the appropriateness of lumbar spine MRI prescriptions in Shiraz teaching hospitals using standardized RAND Appropriateness Method (RAM criteria. Methods This study consisted of two phases. The first phase involved a qualitative enquiry and the second phase had a quantitative cross-sectional nature. In the first phase RAM was used for developing lumbar spine MRI indications and scenarios. In the second phase, the finalized scenarios were compared with the history and physical examination of 300 patients with low back pain. The rate of appropriateness of lumbar spine MRI prescription was then calculated. Results Of 300 cases of lumbar spine MRI prescriptions, approximately 167 (56% were considered inappropriate, 72 (24% were uncertain, and 61 (20% were deemed to be appropriate. The economic burden of inappropriate prescriptions was calculated at 88,009,000 Rials. In addition, the types of expertise and physical examination were considered as related factors to appropriateness of prescriptions. Conclusion In conclusion, a large proportion of lumbar spine MRI prescriptions, which result in financial burden on the insurance companies and the patients alike is unnecessary. This study suggests that policy makers consider this evidence while decision-making. Our findings highlight the imperative role of Health Technology Assessment (HTA and Clinical Practice Guidelines (CPGs. As a result, developing local clinical guidelines may create the commitment needed in physicians in prescribing appropriate prescriptions within the health sector. The study further recommends that appropriate scenarios should be considered as a criterion for payment and reimbursement.

  2. 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

  3. 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.

  4. 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.

  5. Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

    Science.gov (United States)

    Bonow, Robert H; Bales, James W; Morton, Ryan P; Levitt, Michael R; Zhang, Fangyi

    2016-03-01

    Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are traditionally believed to be associated with a poor neurological outcome. A 73-year-old man with a remote history of spinal fusion presented with syncope and was found to have small subdural hematomas on head CT studies. He was managed nonoperatively and discharged with a Glasgow Coma Scale score of 15, only to return 3 days later with obtundation, fixed downward gaze, anisocoria, and absent cranial nerve reflexes. A CT scan showed Duret hemorrhages and subtle enlargement of the subdural hematomas, though the hematomas remained too small to account for his poor clinical condition. Magnetic resonance imaging of the spine revealed a large lumbar pseudomeningocele in the area of prior fusion. His condition dramatically improved when he was placed in the Trendelenburg position and underwent repair of the pseudomeningocele. He was kept flat for 7 days and was ultimately discharged in good condition. On long-term follow-up, his only identifiable deficit was diplopia due to an internuclear ophthalmoplegia. Intracranial hypotension is a rare condition that can cause profound morbidity, including tonsillar herniation and brainstem hemorrhage. With proper identification and treatment of the CSF leak, patients can make functional recoveries.

  6. 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.

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

    International Nuclear Information System (INIS)

    Tyrrell, P.N.M.; Cassar-Pullicino, V.N.; McCall, I.W.

    1998-01-01

    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.)

  8. Effect of pelvic irradiation on the bone mineral content of lumbar spine in cervical cancer

    International Nuclear Information System (INIS)

    Youn, S. M.; Choi, T. J.; Koo, E. S.; Kim, O. B.; Lee, S. M.; Suh, S. J.

    1997-01-01

    To evaluate the loss of bone mineral contents(BMC) in lumbar spine within the radiation field for cervical cancer treatment, BMC in the irradiated patient group was compared with that of a normal control group. Measurements of BMC in the trabecular bone in lumbar spines(L3-L5) were performed in the both patient and normal control groups. Investigators used dual-energy quantitative computerized tomography(DEQCD) using photon energy of 120 and 80kVp. The numbers of patient and control groups were 43 in each with age distribution of fifth to seventh decade of women. The numbers of control group were 22 in fifth, 10 in sixth, and 11 in seventh decade, those of patient group were 14 in fifth, 14 in sixth, and 15 in seventh decade of women. The radiation field was extended to L5 spine for pelvic irradiation with 45-54Gy of external radiation dose and 30Gy of high dose rate brachytherapy in cervical cancer. The BMC is decreased as increasing age in both control and patient groups. BMC in lumbar spine of patient group was decreased by about 13% to 40% maximally. The BMC of L3 and L4 a region that is out of a radiation field for the patient group demonstrated 119.5 ±30.6, 117.0 ±31.7 for fifth, 83.3 ± 37.8, 88.3 ± 46.8 for sixth and 61.5 ± 18.3, 56.2 ± 26.6 mg/cc for seventh. Contrasted by the normal control group has shown 148.0 ± 19.9, 153.2 ± 23.2 for fifth, 96.1 ± 30.2, 105.6 ± 26.5 for sixth and 73.9 ± 27.9, 77.2 ± 27.2 mg/cc for seventh decade, respectively. The BMC of patient group was decreased as near the radiation field, while the lower lumbar spine has shown more large amounts of BMC in the normal control group. In particular, the BMC of L5 within the radiation field was significantly decreased to 33%, 31%, 40% compared with the control group of the fifth, sixth and seventh decades, respectively. The pelvic irradiation in cervical cancer has much effected on the loss of bone mineral content of lumbar spine within the radiation field, as the lower

  9. 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.

  10. Diagnostic Reference Levels for Patient Radiation Doses in Pelvis and Lumbar spine Radiography in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kwang Yong; Lee, Byung Young; Lee, Jung Eun; Lee, Hyun Koo; Jung, Seunbg Hwan; Kim, Byung Woo; Kim, Hyeog Ju; Kim, Dong Sup [Radiation Safety Division National Institute of Food and Drug Safety Evaluation, Seoul (Korea, Republic of)

    2009-12-15

    Pelvis and lumbar spine radiography, among various types of diagnostic radiography, include gonads of the human body and give patients high radiation dose. Nevertheless, diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography has not yet been established in Korea. Therefore, the radiation dose that patients receive from pelvis and lumbar radiography is measured and the diagnostic reference level on patient radiation dose for the optimization of radiation protection of patients in pelvis and lumbar spine radiography was established. The conditions and diagnostic imaging information acquired during the time of the postero-anterior view of the pelvis and the postero-anterior and lateral view of the lumbar spine at 125 medical institutions throughout Korea are collected for analysis and the entrance surface dose received by patients is measured using a glass dosimeter. The diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography to be recommended to the medical institutes is arranged by establishing the dose from the patient radiation dose that corresponds to the 3rd quartile values as the appropriate diagnostic reference level for patient radiation dose. According to the results of the assessment of diagnostic imaging information acquired from pelvis and lumbar spine radiography and the measurement of patient entrance surface dose taken at the 125 medical institutes throughout Korea, the tube voltage ranged between 60-97 kVp, with the average use being 75 kVp, and the tube current ranged between 8-123 mAs, with the average use being 30 mAs. In the posteroanterior and lateral views of lumbar spine radiography, the tube voltage of each view ranged between 65-100 kVp (average use: 78 kVp) and 70-109 kVp (average use: 87 kVp), respectively, and the tube current of each view ranged between 10-100 mAs(average use: 35 mAs) and between 8.9-300 mAs(average use: 64 mAs), respectively. The measurements of

  11. Diagnostic Reference Levels for Patient Radiation Doses in Pelvis and Lumbar spine Radiography in Korea

    International Nuclear Information System (INIS)

    Lee, Kwang Yong; Lee, Byung Young; Lee, Jung Eun; Lee, Hyun Koo; Jung, Seunbg Hwan; Kim, Byung Woo; Kim, Hyeog Ju; Kim, Dong Sup

    2009-01-01

    Pelvis and lumbar spine radiography, among various types of diagnostic radiography, include gonads of the human body and give patients high radiation dose. Nevertheless, diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography has not yet been established in Korea. Therefore, the radiation dose that patients receive from pelvis and lumbar radiography is measured and the diagnostic reference level on patient radiation dose for the optimization of radiation protection of patients in pelvis and lumbar spine radiography was established. The conditions and diagnostic imaging information acquired during the time of the postero-anterior view of the pelvis and the postero-anterior and lateral view of the lumbar spine at 125 medical institutions throughout Korea are collected for analysis and the entrance surface dose received by patients is measured using a glass dosimeter. The diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography to be recommended to the medical institutes is arranged by establishing the dose from the patient radiation dose that corresponds to the 3rd quartile values as the appropriate diagnostic reference level for patient radiation dose. According to the results of the assessment of diagnostic imaging information acquired from pelvis and lumbar spine radiography and the measurement of patient entrance surface dose taken at the 125 medical institutes throughout Korea, the tube voltage ranged between 60-97 kVp, with the average use being 75 kVp, and the tube current ranged between 8-123 mAs, with the average use being 30 mAs. In the posteroanterior and lateral views of lumbar spine radiography, the tube voltage of each view ranged between 65-100 kVp (average use: 78 kVp) and 70-109 kVp (average use: 87 kVp), respectively, and the tube current of each view ranged between 10-100 mAs(average use: 35 mAs) and between 8.9-300 mAs(average use: 64 mAs), respectively. The measurements of

  12. 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.)

  13. 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.

  14. 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.

  15. 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.

  16. The use of radiological guidelines to achieve a sustained reduction in the number of radiographic examinations of the cervical spine, lumbar spine and knees performed for GPs

    International Nuclear Information System (INIS)

    Glaves, J.

    2005-01-01

    AIM: To determine if the use of request guidelines can achieve a sustained reduction in the number of radiographic examinations of the cervical spine, lumbar spine and knee joints performed for general practitioners (GPs). METHODS: GPs referring to three community hospitals and a district general hospital were circulated with referral guidelines for radiography of the cervical spine, lumbar spine and knee, and all requests for these three examinations were checked. Requests that did not fit the guidelines were returned to the GP with an explanatory letter and a further copy of the guidelines. Where applicable, a large-joint replacement algorithm was also enclosed. If the GP maintained the opinion that the examination was indicated, she or he had the option of supplying further justifying information in writing or speaking to a consultant radiologist. RESULTS: Overall the number of radiographic examinations fell by 68% in the first year, achieving a 79% reduction in the second year. For knees, lumbar spine and cervical spine radiographs the total reductions were 77%, 78% and 86%, respectively. CONCLUSION: The use of referral guidelines, reinforced by request checking and clinical management algorithms, can produce a dramatic and sustained reduction in the number of radiographs of the cervical spine, lumbar spine and knees performed for GPs

  17. 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...

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

    OpenAIRE

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

    2009-01-01

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

  19. Nonmetastatic Ewing’s Sarcoma of the Lumbar Spine in an Adult Patient

    Directory of Open Access Journals (Sweden)

    Maurizio Iacoangeli

    2012-01-01

    Full Text Available Although the spine is frequently involved in metastatic Ewing's sarcoma, primary involvement of the spine, beside sacrum, is much less frequent, especially in adult patients. Because of the low incidence of these tumors, there are currently no clinical guidelines outlining their management and a multitude of therapeutic strategies have been employed with varying success. The definitive management of Ewing's sarcoma of the spine, as in other locations, could include the combination of three main modalities: aggressive surgery, radiotherapy, and combined chemotherapy. Whenever possible, en bloc spondylectomy or extralesional resection is preferable, providing a better oncological result with a longer survival and a better preservation of the spine biomechanics. This is the lesson we learned about the case, we present here, of nonmetastatic lumbar localization by Ewing’s sarcoma in as adult patient.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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

  5. Entrance doses during lateral lumbar spine and antero-posterior abdomen examinations: generator waveform dependence

    International Nuclear Information System (INIS)

    Morrison, G.D.; Underwood, A.C.

    1995-01-01

    In North Trent, UK, an entrance dose survey of lateral lumbar spine and antero-posterior (AP) abdomen examinations has been carried out in 17 radiology departments. The survey comprised 294 lateral lumbar spine and 322 AP abdomen entrance dose measurements. The mean entrance doses were found to be approximately half of the relevant national reference entrance dose levels of 30 mGy and 10 mGy, respectively. The effect of generator waveform on entrance dose was studied by separating the generators into two types: ''pulsating potential'' (PP) generators and ''constant potential'' (CP) generators for each examination. PP generators comprised 23% of the total number of examinations. The mean entrance dose and radiographic exposure factors from CP generators were found to be significantly lower than those from PP generators. The use of CP type generators, together with low attenuation components can significantly reduce patient entrance doses for these examinations. (author)

  6. A practical laboratory study simulating the percutaneous lumbar transforaminal epidural injection: training model in fresh cadaveric sheep spine.

    Science.gov (United States)

    Suslu, Husnu

    2012-01-01

    Laboratory training models are essential for developing and refining treatment skills before the clinical application of surgical and invasive procedures. A simple simulation model is needed for young trainees to learn how to handle instruments, and to perform safe lumbar transforaminal epidural injections. Our aim is to present a model of a fresh cadaveric sheep lumbar spine that simulates the lumbar transforaminal epidural injection. The material consists of a 2-year-old fresh cadaveric sheep spine. A 4-step approach was designed for lumbar transforaminal epidural injection under C-arm scopy. For the lumbar transforaminal epidural injection, the fluoroscope was adjusted to get a proper oblique view while the material was stabilized in a prone position. The procedure then begin, using the C-arm guidance scopy. The model simulates well the steps of standard lumbar transforaminal epidural injections in the human spine. The cadaveric sheep spine represents a good method for training and it simulates fluoroscopic lumbar transforaminal epidural steroid injection procedures performed in the human spine.

  7. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

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

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

    International Nuclear Information System (INIS)

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

    2016-01-01

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

  10. The impact of the artificial intervertebral disc on functioning the lumbar spine

    Directory of Open Access Journals (Sweden)

    Mańsko M.

    2015-12-01

    Full Text Available In the hereby thesis the anatomy of the lumbar vertebra and intervertebral disc were presented. Functioning and kinematics of the spine and intervertebral forces were described.Full three – dimensional model of the lumbar vertebrae L2 – L4 was created. On the basis of it model of artificial intervertebral disc was constructed (between L2 and L3. The simplified model of vertebra L2 was formulated via finite elements method. Processed model has been used for biomechanical analysis.Strength calculations were made and appropriate conclusions were drawn. Presented results show behavior influenced of three – dimensional model of the lumbar vertebra with artificial intervertebral disc by operation of loads.

  11. 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

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

    Directory of Open Access Journals (Sweden)

    Ranjana Gupta

    2015-01-01

    Full Text Available Introduction: Back pain is a common clinical problem and is the frequent complaint for referral of lumbar spine magnetic resonance imaging (MRI. Coronal short tau inversion recovery sequence (STIR can provide diagnostically significant information in small percentage of patients. Materials and Methods: MRI examinations of a total of 350 patients were retrospectively included in the study. MR sequences were evaluated in two settings. One radiologist evaluated sagittal and axial images only, while another radiologist evaluated all sequences, including coronal STIR sequence. After recording the diagnoses, we compared the MRI findings in two subsets of patients to evaluate additional merit of coronal STIR imaging. Results: With addition of coronal STIR imaging, significant findings were observed in 24 subjects (6.8%. Twenty-one of these subjects were considered to be normal on other sequences and in three subjects diagnosis was changed with the addition of coronal STIR. Additional diagnoses on STIR included sacroiliitis, sacroiliac joint degenerative disease, sacral stress/insufficiency fracture/Looser′s zones, muscular sprain and atypical appendicitis. Conclusion: Coronal STIR imaging can provide additional diagnoses in a small percentage of patients presenting for lumbar spine MRI for back pain. Therefore, it should be included in the routine protocol for MR imaging of lumbar spine.

  13. Role of optimization criterion in static asymmetric analysis of lumbar spine load.

    Science.gov (United States)

    Daniel, Matej

    2011-10-01

    A common method for load estimation in biomechanics is the inverse dynamics optimization, where the muscle activation pattern is found by minimizing or maximizing the optimization criterion. It has been shown that various optimization criteria predict remarkably similar muscle activation pattern and intra-articular contact forces during leg motion. The aim of this paper is to study the effect of the choice of optimization criterion on L4/L5 loading during static asymmetric loading. Upright standing with weight in one stretched arm was taken as a representative position. Musculoskeletal model of lumbar spine model was created from CT images of Visible Human Project. Several criteria were tested based on the minimization of muscle forces, muscle stresses, and spinal load. All criteria provide the same level of lumbar spine loading (difference is below 25%), except the criterion of minimum lumbar shear force which predicts unrealistically high spinal load and should not be considered further. Estimated spinal load and predicted muscle force activation pattern are in accordance with the intradiscal pressure measurements and EMG measurements. The L4/L5 spine loads 1312 N, 1674 N, and 1993 N were predicted for mass of weight in hand 2, 5, and 8 kg, respectively using criterion of mininum muscle stress cubed. As the optimization criteria do not considerably affect the spinal load, their choice is not critical in further clinical or ergonomic studies and computationally simpler criterion can be used.

  14. 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

  15. Wheelchair pushing and turning: lumbar spine and shoulder loads and recommended limits.

    Science.gov (United States)

    Weston, Eric B; Khan, Safdar N; Marras, William S

    2017-12-01

    The objective of this study was to determine how simulated manual wheelchair pushing influences biomechanical loading to the lumbar spine and shoulders. Sixty-two subjects performed simulated wheelchair pushing and turning in a laboratory. An electromyography-assisted biomechanical model was used to estimate spinal loads. Moments at the shoulder joint, external hand forces and net turning torque were also assessed. Multiple linear regression techniques were employed to develop biomechanically based wheelchair pushing guidelines relating resultant hand force or net torque to spinal load. Male subjects experienced significantly greater spinal loading (p pushing (p pushing and turning can pose biomechanical risk to the lumbar spine and shoulders. Psychophysically determined maximum acceptable push forces do not appear to be protective enough of this biomechanical risk. Practitioner Summary: This laboratory study investigated biomechanical risk to the low back and shoulders during simulated wheelchair pushing. Manual wheelchair pushing posed biomechanical risk to the lumbar spine (in compression and A/P shear) and to the shoulders. Biomechanically determined wheelchair pushing thresholds are presented and are more protective than the closest psychophysically determined equivalents.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine

    International Nuclear Information System (INIS)

    Ganiyusufoglu, A.K.; Onat, L.; Karatoprak, O.; Enercan, M.; Hamzaoglu, A.

    2010-01-01

    Aim: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in stress fractures of the lumbar spine. Materials and methods: Radiological and clinical data from 57 adolescents and young adults with a diagnosis of stress injury of the lumbar spine were retrospectively reviewed. All cases had undergone both 1.5 T MRI and 16-section CT examinations. All MRI and CT images were retrospectively reviewed and evaluated in separate sessions. The fracture morphology (complete/incomplete, localization) and vertebral levels were noted at both the CT and MRI examinations. Bone marrow/peri-osseous soft-tissue oedema was also determined at MRI. Results: In total, 73 complete and 32 incomplete stress fractures were detected with CT. Sixty-seven complete, 24 incomplete fractures and eight stress reactions were detected using MRI in the same study group. Marrow oedema was also seen in eight of the complete and 20 of the incomplete fractures. The specificity, sensitivity, and accuracy of MRI in detecting fracture lines were 99.6, 86.7, and 97.2%, respectively. MRI was more accurate at the lower lumbar levels in comparison to upper lumbar levels. Conclusion: MRI has a similar diagnostic accuracy to CT in determining complete fractures with or without accompanying marrow oedema and incomplete fractures with accompanying marrow oedema, especially at the lower lumbar levels, which constitutes 94% of all fractures. At upper lumbar levels and in the incomplete fractures of the pars interarticularis with marked surrounding sclerosis, MRI has apparent limitations compared to CT imaging.

  18. Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Ganiyusufoglu, A.K., E-mail: kursady33@yahoo.co [Department of Radiology, Florence Nightingale Hospital, Istanbul (Turkey); Onat, L. [Department of Radiology, Florence Nightingale Hospital, Istanbul (Turkey); Karatoprak, O.; Enercan, M.; Hamzaoglu, A. [Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul (Turkey)

    2010-11-15

    Aim: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in stress fractures of the lumbar spine. Materials and methods: Radiological and clinical data from 57 adolescents and young adults with a diagnosis of stress injury of the lumbar spine were retrospectively reviewed. All cases had undergone both 1.5 T MRI and 16-section CT examinations. All MRI and CT images were retrospectively reviewed and evaluated in separate sessions. The fracture morphology (complete/incomplete, localization) and vertebral levels were noted at both the CT and MRI examinations. Bone marrow/peri-osseous soft-tissue oedema was also determined at MRI. Results: In total, 73 complete and 32 incomplete stress fractures were detected with CT. Sixty-seven complete, 24 incomplete fractures and eight stress reactions were detected using MRI in the same study group. Marrow oedema was also seen in eight of the complete and 20 of the incomplete fractures. The specificity, sensitivity, and accuracy of MRI in detecting fracture lines were 99.6, 86.7, and 97.2%, respectively. MRI was more accurate at the lower lumbar levels in comparison to upper lumbar levels. Conclusion: MRI has a similar diagnostic accuracy to CT in determining complete fractures with or without accompanying marrow oedema and incomplete fractures with accompanying marrow oedema, especially at the lower lumbar levels, which constitutes 94% of all fractures. At upper lumbar levels and in the incomplete fractures of the pars interarticularis with marked surrounding sclerosis, MRI has apparent limitations compared to CT imaging.

  19. Tophaceous gout of the lumbar spine in a renal transplant patient: a case report and literature review

    International Nuclear Information System (INIS)

    Thornton, Frank J.; Torreggiani, William C.; Brennan, Paul

    2000-01-01

    Tophaceous gout of the spine is rare. We report the case of a 27-year-old male, renal transplant recipient, who presented with an acute onset of lower back pain. Radiological, biochemical and histo-pathological findings confirmed a diagnosis of tophaceous gout of the lumbar spine. We present the case history with the radiological findings and discuss the literature

  20. Analysis of structure of lumbar spine dorsopathy morbidity in able-bodied age patients

    Directory of Open Access Journals (Sweden)

    Manin M.V.

    2015-06-01

    Full Text Available The analysis of structure of lumbar spine dorsopathy morbidity among able-bodied population of the Dnepropetrovsk area for substantiation of differentiated approach to the choice of exercise therapy methods was a research objective. The structure of dorsopathy morbidity in 371 patients in 2009-2013 period is analysed in the work. The paper presents analysis of the most frequent morphological changes in the structures of the spine, their localization and clinical course. Link of clinical manifestations of dorsopathy with structural changes of the backbone, the disease experience is revealed, efficiency of rehabilitation by means of physiotherapy exercises depending on qualitative and quantitative signs of disease is defined. Results of the research specify that more than 40% of patients were on repeated treatment, clinical manifestation in 62% of patients was observed at the most able-bodied age (from 30 to 50 years, according to the disease experience number of aggravations per a year increased, in 57,5% of cases administration of medical physical culture was limited due to development of an accompanying pathology, in 40% of cases against positive dynamics of painful syndrome insufficient changes in volume of movements of the spine segments throughout treatment were marked. It testifies to necessity of working out algorithm of differentiated approach to the choice of means medical physical culture in treatment of lumbar spine dorsopathy.

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

    Science.gov (United States)

    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.

  2. Minimally invasive surgical treatment options for patients with degenerative lumbar spine disease

    International Nuclear Information System (INIS)

    Durny, P.

    2014-01-01

    The most common cause of reduced activity in working people is degenerative disc disease and spondylosis of lumbar spine. The variety of clinical findings such as segmental lumbago or severe form of mixed radicular compression syndromes can be occurred. Neurosurgical intervention is indicated in case of failure of conservative treatment and graphical findings correlating with a clinical picture. Large decompressive surgical procedures can destabilize segments previously affected. Recommendations from recent years suggested the functional reconstruction of damaged parts of the vertebrae, intervertebral discs and joints. Continuously improving surgical procedures and instrumentations, intended for operative treatment of lumbar spine degenerative diseases is primarily an effort to improve the properties of implants while minimizing tissue damage during the approach to the target structure. To protect functions of active spine stabilizer and paraspinal muscles is an important factor for the final outcome of the operation. Depend on the nature and extent of the disease the approaches to the spine can be an anterior, lateral and posterior as open surgery or minimally invasive procedures. (author)

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. 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.)

  6. 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.)

  7. Clinical Gait Evaluation of Patients with Lumbar Spine Stenosis.

    Science.gov (United States)

    Sun, Jun; Liu, Yan-Cheng; Yan, Song-Hua; Wang, Sha-Sha; Lester, D Kevin; Zeng, Ji-Zhou; Miao, Jun; Zhang, Kuan

    2018-02-01

    The third generation Intelligent Device for Energy Expenditure and Activity (IDEEA3, MiniSun, CA) has been developed for clinical gait evaluation, and this study was designed to evaluate the accuracy and reliability of IDEEA3 for the gait measurement of lumbar spinal stenosis (LSS) patients. Twelve healthy volunteers were recruited to compare gait cycle, cadence, step length, velocity, and number of steps between a motion analysis system and a high-speed video camera. Twenty hospitalized LSS patients were recruited for the comparison of the five parameters between the IDEEA3 and GoPro camera. Paired t-test, intraclass correlation coefficient, concordance correlation coefficient, and Bland-Altman plots were used for the data analysis. The ratios of GoPro camera results to motion analysis system results, and the ratios of IDEEA3 results to GoPro camera results were all around 1.00. All P-values of paired t-tests for gait cycle, cadence, step length, and velocity were greater than 0.05, while all the ICC and CCC results were above 0.950 with P GoPro camera are highly consistent with the measurements with the motion analysis system. The measurements for IDEEA3 are consistent with those for the GoPro camera. IDEEA3 can be effectively used in the gait measurement of LSS patients. © 2018 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  8. Lumbar spine intervertebral disc gene delivery: a pilot study in lewis rats.

    Science.gov (United States)

    Damle, Sheela R; Rawlins, Bernard A; Boachie-Adjei, Oheneba; Crystal, Ronald G; Hidaka, Chisa; Cunningham, Matthew E

    2013-02-01

    Basic research toward understanding and treating disc pathology in the spine has utilized numerous animal models, with delivery of small molecules, purified factors, and genes of interest. To date, gene delivery to the rat lumbar spine has only been described utilizing genetically programmed cells in a matrix which has required partial disc excision, and expected limitation of treatment diffusion into the disc. This study was designed to develop and describe a surgical technique for lumbar spine exposure and disc space preparation, and use of a matrix-free method for gene delivery. Naïve or genetically programmed isogeneic bone marrow stromal cells were surgically delivered to adolescent male Lewis rat lumbar discs, and utilizing quantitative biochemical and qualitative immunohistological assessments, the implanted cells were detected 3 days post-procedure. Statistically significant differences were noted for recovery of the β-galactosidase marker gene comparing delivery of naïve or labeled cells (10(5) cells per disc) from the site of implantation, and between delivery of 10(5) or 10(6) labeled cells per disc at the site of implantation and the adjacent vertebral body. Immunohistology confirmed that the β-galactosidase marker was detected in the adjacent vertebra bone in the zone of surgical implantation. The model requires further testing in larger cohorts and with biologically active genes of interest, but the observations from the pilot experiments are very encouraging that this will be a useful comparative model for basic spine research involving gene or cell delivery, or other locally delivered therapies to the intervertebral disc or adjacent vertebral bodies in rats.

  9. Sagittal plane analysis of the spine and pelvis in degenerative lumbar scoliosis.

    Science.gov (United States)

    Han, Fei; Weishi, Li; Zhuoran, Sun; Qingwei, Ma; Zhongqiang, Chen

    2017-01-01

    Previous studies have reported the normative values of pelvic sagittal parameters, but no study has analyzed the sagittal spino-pelvic alignment in degenerative lumbar scoliosis (DLS) and its role in the pathogenesis. Retrospective analysis was applied to 104 patients with DLS, together with 100 cases of asymptomatic young adults as a control group and another control group consisting of 145 cases with cervical spondylosis. The coronal and sagittal parameters were measured on the anteroposterior and lateral radiograph of the whole spine in the DLS group as well as in the two control groups. Statistical analysis showed that the DLS group had a higher pelvic incidence (PI) value (50.5° ± 10.2°), than the normal control group (with PI 47.2° ± 8.8°) and the cervical spondylosis group (46.9° ± 9.1°). In DLS group, there were 38 cases (36.5%) complicated with degenerative lumbar spondylolisthesis, who had higher PI values than patients without it. Besides, the lumbar lordosis (LL) and sacral slope (SS) of DLS group were lower; the scoliosis Cobb's angle was correlated with pelvic tilt (PT); thoracic kyphosis was correlated with LL, SS, and PT; and LL was correlated with other sagittal parameters. Patients with DLS may have a higher PI, which may impact the pathogenesis of DLS. A high PI value is probably associated with the high prevalence of degenerative lumbar spondylolisthesis among DLS patients. In DLS patients, the lumbar spine maintains the ability of regulating the sagittal balance, and the regulation depends more on thoracic curve.

  10. 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)

  11. Three-dimensional motion analysis of the lumbar spine during "free squat" weight lift training.

    Science.gov (United States)

    Walsh, James C; Quinlan, John F; Stapleton, Robert; FitzPatrick, David P; McCormack, Damian

    2007-06-01

    Heavy weight lifting using a squat bar is a commonly used athletic training exercise. Previous in vivo motion studies have concentrated on lifting of everyday objects and not on the vastly increased loads that athletes subject themselves to when performing this exercise. Athletes significantly alter their lumbar spinal motion when performing squat lifting at heavy weights. Controlled laboratory study. Forty-eight athletes (28 men, 20 women) performed 6 lifts at 40% maximum, 4 lifts at 60% maximum, and 2 lifts at 80% maximum. The Zebris 3D motion analysis system was used to measure lumbar spine motion. Exercise was performed as a "free" squat and repeated with a weight lifting support belt. Data obtained were analyzed using SAS. A significant decrease (P free squat or when lifting using a support belt in any of the groups studied. Weight lifting using a squat bar causes athletes to significantly hyperextend their lumbar spines at heavier weights. The use of a weight lifting support belt does not significantly alter spinal motion during lifting.

  12. 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)

  13. Evaluation of an advanced-practice physiotherapist in triaging patients with lumbar spine pain: surgeon-physiotherapist level of agreement and patient satisfaction.

    Science.gov (United States)

    Robarts, Susan; Stratford, Paul; Kennedy, Deborah; Malcolm, Barry; Finkelstein, Joel

    2017-08-01

    Surgery for lumbar spine pain is indicated for specific etiologies. Given the majority of individuals referred to spine surgeons are not surgical candidates, care delivery is inefficient, with consultations being of limited value for most. Using specially trained physiotherapists in triage is a human resource strategy that may optimize surgeons' time and the patient experience. An advanced-practice physiotherapist (APP) and a surgeon assessed consecutive patients with lumbar spine pain presenting at an academic health centre's spine surgery clinic. The second assessor was blinded to the outcome of the first. We used the κ statistic to evaluate surgeon-APP level of chance-corrected agreement concerning patients' need for a surgical consultation. To assess satisfaction with the APP, patients completed a modified version of the validated Visit-specific Questionnaire. The sample included 102 participants (54 women) with a mean age of 54.3 ± 14.3 years and a mean Oswestry Disability Index score of 35.4 ± 16.6. The assessors' overall agreement was 86%. The κ coefficient for the need for a surgical consultation was 0.69 (95% confidence interval 0.54-0.84). The APP identified that 77% of patients did not require a surgical consultation. Twenty-one patients underwent surgery. Satisfaction scores for the APP were very high (mean score 92 out of 100). In triaging patients with lumbar spine pain, the APP and surgeon had a high level of agreement. An APP performing triage at a surgical centre can effectively reduce wait lists by 70%, reserving surgical consultations for those patients in whom they are indicated.

  14. 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

  15. Structural health monitoring (vibration) as a tool for identifying structural alterations of the lumbar spine

    DEFF Research Database (Denmark)

    Kawchuk, Gregory N; Hartvigsen, Jan; Edgecombe, Tiffany

    2016-01-01

    Structural health monitoring (SHM) is an engineering technique used to identify mechanical abnormalities not readily apparent through other means. Recently, SHM has been adapted for use in biological systems, but its invasive nature limits its clinical application. As such, the purpose of this pr......Structural health monitoring (SHM) is an engineering technique used to identify mechanical abnormalities not readily apparent through other means. Recently, SHM has been adapted for use in biological systems, but its invasive nature limits its clinical application. As such, the purpose...... of this project was to determine if a non-invasive form of SHM could identify structural alterations in the spines of living human subjects. Lumbar spines of 10 twin pairs were visualized by magnetic resonance imaging then assessed by a blinded radiologist to determine whether twin pairs were structurally...... concordant or discordant. Vibration was then applied to each subject's spine and the resulting response recorded from sensors overlying lumbar spinous processes. The peak frequency, area under the curve and the root mean square were computed from the frequency response function of each sensor. Statistical...

  16. 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)

  17. 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.

  18. 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.

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

    Science.gov (United States)

    Bahtiri, E; Islami, H; Rexhepi, S; Qorraj-Bytyqi, H; Thaçi, K; Thaçi, S; Karakulak, C; Hoxha, R

    2015-01-01

    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. 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. 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. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  2. A primary leiomyoma in the neural foramen of the lumbar spine: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Jong Chang; Kang, Byeong Seong; Kim, Young Min; Park, Moon Soo; Jeong, Ae Kyung; Yang, Myeon Jun; Hwang, Jae Cheol [University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan (Korea, Republic of)

    2007-12-15

    A primary leiomyoma in the neural foramen of the lumbar spine is a very rare condition. We examined a 23-year-old female presented with back and right flank pain. A plain radiography showed a well-defined, osteolytic lesion in the L3 body. In addition, MR images showed a mass lesion with intense enhancement, after intravenous injection with contrast material, in the right neural foramen at the L2/3 level. A histopathologic examination of the resected specimen revealed a benign leiomyoma.

  3. 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.)

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

    International Nuclear Information System (INIS)

    Vazquez-Barquero, A.; Pinto, J.I.; Abascal, F.; Garcia-Valtuille, R.; Cerezal, L.; Figols, F.J.

    2000-01-01

    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.)

  5. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Abdelwahab, I.F.; Zwass, A.; O' Leary, P.F.; Steiner, G.C.

    1986-03-01

    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).

  7. 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)

  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. 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.

  10. 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

  11. 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.)

  12. Myositis Ossificans of the Psoas Muscle After Compression Fracture of Lumbar Spine: CT and MR Imaging Findings

    International Nuclear Information System (INIS)

    Choi, Mi Nyong; Lee, Gyung Kyu; Suh, Kyung Jin

    2010-01-01

    Myositis ossificans is a benign, self-limiting and non-neoplastic development of heterotopic bone in skeletal muscle following trauma. Although myositis ossificans can occur anywhere in the body, psoas muscle involvement is very rare. To the best of our knowledge, CT and MR imaging findings of myositis ossificans in the psoas muscle secondary to lumbar spine fracture have not been reported in the radiological literature. In this article, we describe the CT and MR imaging findings of myositis ossificans of the psoas muscle after lumbar spine fracture in a 64-year-old man, and conduct a review of the relevant literature

  13. Myositis Ossificans of the Psoas Muscle After Compression Fracture of Lumbar Spine: CT and MR Imaging Findings

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Mi Nyong; Lee, Gyung Kyu [Hallym University College of Medicine, Hangang Sacred Heart Hospital, Seoul (Korea, Republic of); Suh, Kyung Jin [Dongguk University College of Medicine, Gyungju Hospital, Gyeongju (Korea, Republic of)

    2010-02-15

    Myositis ossificans is a benign, self-limiting and non-neoplastic development of heterotopic bone in skeletal muscle following trauma. Although myositis ossificans can occur anywhere in the body, psoas muscle involvement is very rare. To the best of our knowledge, CT and MR imaging findings of myositis ossificans in the psoas muscle secondary to lumbar spine fracture have not been reported in the radiological literature. In this article, we describe the CT and MR imaging findings of myositis ossificans of the psoas muscle after lumbar spine fracture in a 64-year-old man, and conduct a review of the relevant literature

  14. 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)

  15. Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol

    Directory of Open Access Journals (Sweden)

    Tarnanen Sami

    2012-07-01

    Full Text Available Abstract Background Lumbar spine fusion (LSF effectively decreases pain and disability in specific spinal disorders; however, the disability rate following surgery remains high. This, combined with the fact that in Western countries the number of LSF surgeries is increasing rapidly it is important to develop rehabilitation interventions that improve outcomes. Methods/design In the present RCT-study we aim to assess the effectiveness of a combined back-specific and aerobic exercise intervention for patients after LSF surgery. One hundred patients will be randomly allocated to a 12-month exercise intervention arm or a usual care arm. The exercise intervention will start three months after surgery and consist of six individual guidance sessions with a physiotherapist and a home-based exercise program. The primary outcome measures are low back pain, lower extremity pain, disability and quality of life. Secondary outcomes are back function and kinesiophobia. Exercise adherence will also be evaluated. The outcome measurements will be assessed at baseline (3 months postoperatively, at the end of the exercise intervention period (15 months postoperatively, and after a 1-year follow-up. Discussion The present RCT will evaluate the effectiveness of a long-term rehabilitation program after LSF. To our knowledge this will be the first study to evaluate a combination of strength training, control of the neutral lumbar spine position and aerobic training principles in rehabilitation after LSF. Trial registration ClinicalTrials.gov Identifier NCT00834015

  16. 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

  17. 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)

  18. 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)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-06-02

    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.

  20. Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization.

    Science.gov (United States)

    Yaldiz, Can; Yaldiz, Mahizer; Ceylan, Nehir; Kacira, Ozlem Kitiki; Ceylan, Davut; Kacira, Tibet; Kizilcay, Gokhan; Tanriverdi, Taner

    2015-07-01

    Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

  1. 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.)

  2. 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.)

  3. Accuracy of lumbar spine bone mineral content by dual photon absorptiometry

    International Nuclear Information System (INIS)

    Gotfredsen, A.; Podenphant, J.; Norgaard, H.; Nilas, L.; Nielsen, V.A.; Christiansen, C.

    1988-01-01

    The accuracy of measurement of the bone mineral content (BMC, g) and bone mineral density (BMD, g/cm 2 ) of the lumbar spine by dual photon absorptiometry (DPA) was estimated by means of two different spine scanners (a Nuclear Data 2100 and a Lunar Radiation DP3). The lumbar spines of 13 cadavers were used. BMC and BMD were measured in situ and on the excised vertebrae in a solution of water/ethanol; and covered with ox muscle/porcine muscle/lard. The actual mineral weight and areal density were determined after chemical maceration, fat extraction, drying to a constant weight, ashing for 24 hr at 600 degrees C, and correction for the transverse processes. The true are was measured by parallax free X rays and planimetry. All measurements of BMC or BMD were highly interrelated (r = 0.94-0.99). The standard error of estimate (s.e.e.) of BMC in situ versus BMC in water/ethanol was 5.2%. The agreement between the BMD values of the two scanners was very good (s.e.e. = 2.9%). BMC in situ predicted the actual vertebral mineral mass with an s.e.e. of 8.1%. BMD in situ and BMD in water/ethanol predicted the actual area density with s.e.e.s of 10.3% and 5.0%, respectively. This study discloses the correlation and accuracy error of spinal DPA measurements in situ in whole cadavers versus the actual BMC and BMD. The error, which is underestimated in in vitro studies, amounts to 10%

  4. Does football cause an increase in degenerative disease of the lumbar spine?

    Science.gov (United States)

    Gerbino, Peter G; d'Hemecourt, Pierre A

    2002-02-01

    Degenerative disease of the lumbar spine is exceedingly common. Whether any specific activity increases the likelihood of developing degenerative disc disease (DDD) or facet degeneration (FD) has enormous implications. Within the field of occupational medicine there are specific activities, occupations, and morphologic characteristics that have been related to low back pain. Several specific risk factors have been conclusively linked to low back pain, and in particular DDD and FD. Within the sport of American football, there has long been the feeling that many athletes have or will develop low back pain, DDD, and FD. Proving that certain risk factors present in football will predictably lead to an increase in LBP, DDD, and FD is more difficult. At this time, it can be said that football players, in general, increase their risk of developing low back pain, DDD, and FD as their years of involvement with their sport increase. Because specific spine injuries like fracture, disc herniation, and spondylolysis are more frequent in football players, the resulting DDD and FD are greater than that of the general population. The weightlifting and violent hyperextension that are part of American football are independent risk factors for degenerative spine disease.

  5. MRI of the lumbar spine. Technical aspect. T2-weighted fat saturation coronal dynamic MRI of the lumbar spine; IRM du rachis lombaire. Aspects techniques. Coupe coronales en T2 et saturation de graisse IRM dynamique du rachis lombaire

    Energy Technology Data Exchange (ETDEWEB)

    Clarisse, J; Francke, J P; Leclet, H; Bourgeois, Ph; Chastanet, P; Cotten, A [Hopital Roger Salengro, 59 - Lille (France)

    1998-06-01

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

  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. THE DIAGNOSTIC-VALUE OF INTERPEDICULATE DISTANCE ASSESSMENT ON PLAIN FILMS IN THORACIC AND LUMBAR SPINE INJURIES

    NARCIS (Netherlands)

    MARTIJN, A; VELDHUIS, EFM

    1991-01-01

    In a retrospective study of 107 fractured vertebrae in the thoracic and lumbar spine, the interpediculate distance could be accurately assessed on plain roentgenograms in 96%. When these findings were compared with those of conventional tomography, there were no false-positive or false-negative

  8. Inter-examiner reliability of passive assessment of intervertebral motion in the cervical and lumbar spine: A systematic review

    NARCIS (Netherlands)

    van Trijffel, E.; Anderegg, Q.; Bossuyt, P. M. M.; Lucas, C.

    2005-01-01

    A systematic review was conducted to determine inter-examiner reliability of passive assessment of segmental intervertebral motion in the cervical and lumbar spine as well as to explore sources of heterogeneity. Passive assessment of motion is used to decide on treatments for neck and low-back pain

  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. [Controversies about instrumented surgery and pain relief in degenerative lumbar spine pain. Results of scientific evidence].

    Science.gov (United States)

    Robaina-Padrón, F J

    2007-10-01

    studies in subgroups of patients. We still are needing randomized studies to compare the surgical results with the natural history of the disease, the placebo effect, or the conservative treatment. The European Guidelines for lumbar chronic pain management show a "strong evidence" indicating that complex and demanding spine surgery where different instrumentation is used, is not more effective than a simple, safer and cheaper posterolateral fusion without instrumentation. Recently, the literature published in this field is sending a message to use "minimally invasive techniques", abandon transpedicular fusions and clearly indicating that we must apply the knowledge accumulated at least along the last 20 years based on the scientific evidence. In conclusion, based in recent information, we must recommend the "abandon of the instrumented pathway" in a great number of present indications for degenerative spine surgery, and look for new strategies in the field of rehabilitation and conservative treatments correctly apply, using before the decompressive and instrumented surgery all the interventional and minimally invasive techniques that are presently offer in the field of modem lumbar chronic pain treatment.

  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. 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

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

    Directory of Open Access Journals (Sweden)

    Alla V. Ovechkina

    2017-12-01

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

  14. The effects of massage therapy after decompression and fusion surgery of the lumbar spine: a case study.

    Science.gov (United States)

    Keller, Glenda

    2012-01-01

    Spinal fusion and decompression surgery of the lumbar spine are common procedures for problems such as disc herniations. Various studies for postoperative interventions have been conducted; however, no massage therapy studies have been completed. The objective of this study is to determine if massage therapy can beneficially treat pain and dysfunction associated with lumbar spinal decompression and fusion surgery. Client is a 47-year-old female who underwent spinal decompression and fusion surgery of L4/L5 due to chronic disc herniation symptoms. The research design was a case study in a private clinic involving the applications of seven, 30-minute treatments conducted over eight weeks. Common Swedish massage and myofascial techniques were applied to the back, shoulders, posterior hips, and posterior legs. Outcomes were assessed using the following measures: VAS pain scale, Hamstring Length Test, Oswestry Disability Index, and the Roland-Morris Disability Questionnaire. Hamstring length improved (in degrees of extension) from pretreatment measurements in the right leg of 40° and left leg 65° to post-treatment measurement at the final visit, when the results were right 50° and left 70°. The Oswestry Disability Index improved 14%, from 50% to 36% disability. Roland-Morris Disability decreased 1 point, from 3/24 to 2/24. The VAS pain score decreased by 2 points after most treatments, and for three of the seven treatments, client had a post-treatment score of 0/10. Massage for pain had short-term effects. Massage therapy seemed to lengthen the hamstrings bilaterally. Massage therapy does appear to have positive effects in the reduction of disability. This study is beneficial for understanding the relationship between massage therapy and clients who have undergone spinal decompression and fusion. Further research is warranted.

  15. 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)

  16. Glucocorticoid-induced osteoporosis in the lumbar spine, forearm, and mandible of nephrotic patients

    DEFF Research Database (Denmark)

    Olgaard, K; Storm, Tina; van Wowern, N

    1992-01-01

    /day and tapered down to 20 mg/day for 1 year and DFZ was given in an equipotent dosage. Twenty-three patients completed 6 months of treatment, and 18 patients completed 12 months of treatment. Beside laboratory parameters to ensure the effect of treatment on the nephrotic syndrome, all had measurements......The long-term effects of high dose steroid treatment with either prednisone (PDN) or deflazacort (DFZ) were examined on various parts of the skeleton in 29 patients with nephrotic syndrome. All had normal skeleton at the start of the steroid treatment. At the beginning, PDN was given as 80 mg...... of the bone mineral content (BMC) at 0, 6, and 12 months of treatment. BMC was measured by single photon absorptiometry of both forearms and by dual photon absorptiometry of the mandible, forearms, and lumbar spine. The effect of DFZ was compared to that of PDN due to a potential "calcium sparing" effect...

  17. 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.

  18. 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

  19. Complaints of the lumbar spine: The value of myelography and computerized tomography

    International Nuclear Information System (INIS)

    Rittmeyer, K.; Dralle, A.

    1988-01-01

    In the radiological examination of the lumbar spine and vertebral canal there are currently two methods of choice, computer tomography and myelography. Comparing the advantages of one method over another reveals that computer tomography is particularly useful in especially diagnosing a lateral process of the intervertebral disk, whereas myelography is especially applicable in the case of an intervertebrals disk prolapse within the narrow confines of the spinal canal proper. Myelography also has the additional advantage of visualizing a number of segments at once, although repeated use increases the risk of arachnitis despite the high tolerance of current contrast medium. However, myelography should be performed, if there is clinical evidence of nerve root compression even though the computer tomography was negative. The reverse is also true. Myelography is also useful initially, due to the lower radiation dosis, if the clinical symptoms don't allow a specific localisation of the process. (orig.) [de

  20. Hybrid dynamic stabilization: a biomechanical assessment of adjacent and supraadjacent levels of the lumbar spine.

    Science.gov (United States)

    Mageswaran, Prasath; Techy, Fernando; Colbrunn, Robb W; Bonner, Tara F; McLain, Robert F

    2012-09-01

    The object of this study was to evaluate the effect of hybrid dynamic stabilization on adjacent levels of the lumbar spine. Seven human spine specimens from T-12 to the sacrum were used. The following conditions were implemented: 1) intact spine; 2) fusion of L4-5 with bilateral pedicle screws and titanium rods; and 3) supplementation of the L4-5 fusion with pedicle screw dynamic stabilization constructs at L3-4, with the purpose of protecting the L3-4 level from excessive range of motion (ROM) and to create a smoother motion transition to the rest of the lumbar spine. An industrial robot was used to apply continuous pure moment (± 2 Nm) in flexion-extension with and without a follower load, lateral bending, and axial rotation. Intersegmental rotations of the fused, dynamically stabilized, and adjacent levels were measured and compared. In flexion-extension only, the rigid instrumentation at L4-5 caused a 78% decrease in the segment's ROM when compared with the intact specimen. To compensate, it caused an increase in motion at adjacent levels L1-2 (45.6%) and L2-3 (23.2%) only. The placement of the dynamic construct at L3-4 decreased the operated level's ROM by 80.4% (similar stability as the fusion at L4-5), when compared with the intact specimen, and caused a significant increase in motion at all tested adjacent levels. In flexion-extension with a follower load, instrumentation at L4-5 affected only a subadjacent level, L5-sacrum (52.0%), while causing a reduction in motion at the operated level (L4-5, -76.4%). The dynamic construct caused a significant increase in motion at the adjacent levels T12-L1 (44.9%), L1-2 (57.3%), and L5-sacrum (83.9%), while motion at the operated level (L3-4) was reduced by 76.7%. In lateral bending, instrumentation at L4-5 increased motion at only T12-L1 (22.8%). The dynamic construct at L3-4 caused an increase in motion at T12-L1 (69.9%), L1-2 (59.4%), L2-3 (44.7%), and L5-sacrum (43.7%). In axial rotation, only the placement of

  1. 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)

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

    International Nuclear Information System (INIS)

    Hamada, Yoshitaka; Henmi, Tatsuhiko; Sakamoto, Rintaro; Hiasa, Masahiko

    1998-01-01

    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 1 -low finding over the entire vertebra within one month after injury and fractures of Th 12 or L 1 vertebra. Areas of T 1 -low and T 2 -low intensity adjacent to the vertebral disc presented no improvement in signal intensity and often caused persistent back pain. (author)

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  4. Posterior Lumbar Subcutaneous Edema on Spine Magnetic Resonance Images: What Is the Cause?

    Energy Technology Data Exchange (ETDEWEB)

    Han, Ga Jin; Lee, In Sook; Han, In Ho; Lee, Jung Sub [Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of); Moon, Tae Yong [Dept. of Radiology, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of); Song, Jong Woon [Dept. of Radiology, Inje University Haeundae Paik Hospital, Busan (Korea, Republic of)

    2013-04-15

    Posterior lumbar subcutaneous (PLS) edema on spine magnetic resonance (MR) images is a common incidental, though neglected finding. This study was undertaken to investigate the relations between PLS edema and pathologic conditions. Between January and December 2009, 138 patients with PLS edema, but without a spinal tumor or a history of recent surgery or trauma, and 80 infectious spondylitis patients without PLS edema were enrolled in this retrospective study. Available medical records and lumbar spine MR images were evaluated. The degree of edema was quantified using an arbitrary scoring system. Further, the correlations between the degree of edema and age, sex, body mass index (BMI), degeneration of posterior spinal structures (PSS) and infectious spondylitis were analyzed. Of the 93 cases with a calculable BMI, 61 (66%) had a BMI of > 23 kg/m2. Correlations between the degree of edema and sex, age and BMI grade were all statistically non-significant. Thirty-three cases (24%) had an underlying disease, such as heart problem, diabetes mellitus, liver cirrhosis, chronic renal failure, extra-spinal tumor or connective tissue disorder. The numbers of cases with infectious spondylitis and an idiopathic condition was 61 (44%) and 44 (32%), respectively. The grade of infectious spondylitis was not found to be significantly associated with the degree of edema (p = 0.084). In cases with an idiopathic condition, the correlation between the degree of edema and PSS degeneration was statistically significant (p = 0.042). Radiologists should not disregard PLS edema, because it is related to an underlying disease and thus may be of clinical significance.

  5. 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.

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

    Science.gov (United States)

    de Paula, Francisco J A; de Araújo, Iana M; Carvalho, Adriana L; Elias, Jorge; Salmon, Carlos E G; Nogueira-Barbosa, Marcello H

    2015-01-01

    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.

  7. Posterior Lumbar Subcutaneous Edema on Spine Magnetic Resonance Images: What Is the Cause?

    International Nuclear Information System (INIS)

    Han, Ga Jin; Lee, In Sook; Han, In Ho; Lee, Jung Sub; Moon, Tae Yong; Song, Jong Woon

    2013-01-01

    Posterior lumbar subcutaneous (PLS) edema on spine magnetic resonance (MR) images is a common incidental, though neglected finding. This study was undertaken to investigate the relations between PLS edema and pathologic conditions. Between January and December 2009, 138 patients with PLS edema, but without a spinal tumor or a history of recent surgery or trauma, and 80 infectious spondylitis patients without PLS edema were enrolled in this retrospective study. Available medical records and lumbar spine MR images were evaluated. The degree of edema was quantified using an arbitrary scoring system. Further, the correlations between the degree of edema and age, sex, body mass index (BMI), degeneration of posterior spinal structures (PSS) and infectious spondylitis were analyzed. Of the 93 cases with a calculable BMI, 61 (66%) had a BMI of > 23 kg/m2. Correlations between the degree of edema and sex, age and BMI grade were all statistically non-significant. Thirty-three cases (24%) had an underlying disease, such as heart problem, diabetes mellitus, liver cirrhosis, chronic renal failure, extra-spinal tumor or connective tissue disorder. The numbers of cases with infectious spondylitis and an idiopathic condition was 61 (44%) and 44 (32%), respectively. The grade of infectious spondylitis was not found to be significantly associated with the degree of edema (p = 0.084). In cases with an idiopathic condition, the correlation between the degree of edema and PSS degeneration was statistically significant (p = 0.042). Radiologists should not disregard PLS edema, because it is related to an underlying disease and thus may be of clinical significance.

  8. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-07-01

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

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

    Science.gov (United States)

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

    2017-12-01

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

  11. 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

  12. 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

    2018-03-19

    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 a neutral (crate) handgrip. The mass of barbells/crates lifted was identical across the objects and fixed at 11.6 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 a barbell than when lifting a crate (p  0.392) or flexion/extension velocities (p > 0.085). Crate- and barbell-lifting tasks 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 tasks cannot be used interchangeably.

  13. 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; 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.

  14. 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

  15. 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.

  16. Effect of Interbody Fusion on the Remaining Discs of the Lumbar Spine in Subjects with Disc Degeneration.

    Science.gov (United States)

    Ryu, Robert; Techy, Fernando; Varadarajan, Ravikumar; Amirouche, Farid

    2016-02-01

    To study effects (stress loads) of lumbar fusion on the remaining segments (adjacent or not) of the lumbar spine in the setting of degenerated adjacent discs. A lumbar spine finite element model was built and validated. The full model of the lumbar spine was a parametric finite element model of segments L 1-5 . Numerous hypothetical combinations of one-level lumbar spine fusion and one-level disc degeneration were created. These models were subjected to 10 Nm flexion and extension moments and the stresses on the endplates and consequently on the intervertebral lumbar discs measured. These values were compared to the stresses on healthy lumbar spine discs under the same load and fusion scenarios. Increased stress at endplates was observed only in the settings of L4-5 fusion and L3-4 disc degeneration (8% stress elevation at L2,3 in flexion or extension, and 25% elevation at L3,4 in flexion only). All other combinations showed less endplate stress than did the control model. For fusion at L3-4 and degeneration at L4-5 , the stresses in the endplates at the adjacent level inferior to the fused disc decreased for both loading disc height reductions. Stresses in flexion decreased after fusion by 29.5% and 25.8% for degeneration I and II, respectively. Results for extension were similar. For fusion at L2-3 and degeneration at L4-5 , stresses in the endplates decreased more markedly at the degenerated (30%), than at the fused level (14%) in the presence of 25% disc height reduction and 10 Nm flexion, whereas in extension stresses decreased more at the fused (24.3%) than the degenerated level (5.86%). For fusion at L3-4 and degeneration at L2-3 , there were no increases in endplate stress in any scenario. For fusion at L4-5 and degeneration at L3-4 , progression of degeneration from I to II had a significant effect only in flexion. A dramatic increase in stress was noted in the endplates of the degenerated disc (L3-4 ) in flexion for degeneration II. Stresses are greater

  17. 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.

  18. Quantitative comparison of ligament formulation and pre-strain in finite element analysis of the human lumbar spine.

    Science.gov (United States)

    Hortin, Mitchell S; Bowden, Anton E

    2016-11-01

    Data has been published that quantifies the nonlinear, anisotropic material behaviour and pre-strain behaviour of the anterior longitudinal, supraspinous (SSL), and interspinous ligaments of the human lumbar spine. Additionally, data has been published on localized material properties of the SSL. These results have been incrementally incorporated into a previously validated finite element model of the human lumbar spine. Results suggest that the effects of increased ligament model fidelity on bone strain energy were moderate and the effects on disc pressure were slight, and do not justify a change in modelling strategy for most clinical applications. There were significant effects on the ligament stresses of the ligaments that were directly modified, suggesting that these phenomena should be included in FE models where ligament stresses are the desired metric.

  19. 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...... a tendency to level off 3 years after the primary fracture....

  20. 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.

  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. Transpedicular screw fixation in the thoracic and lumbar spine with a novel cannulated polyaxial screw system

    Directory of Open Access Journals (Sweden)

    Lutz Weise

    2008-10-01

    Full Text Available Lutz Weise, Olaf Suess, Thomas Picht, Theodoros KombosNeurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Berlin, GermanyObjective: Transpedicular screws are commonly and successfully used for posterior fixation in spinal instability, but their insertion remains challenging. Even using navigation techniques, there is a misplacement rate of up to 11%. The aim of this study was to assess the accuracy of a novel pedicle screw system.Methods: Thoracic and lumbar fusions were performed on 67 consecutive patients for tumor, trauma, degenerative disease or infection. A total of 326 pedicular screws were placed using a novel wire-guided, cannulated, polyaxial screw system (XIA Precision®, Stryker. The accuracy of placement was assessed post operatively by CT scan, and the patients were followed-up clinically for a mean of 16 months.Results: The total medio-caudal pedicle wall perforation rate was 9.2% (30/326. In 19 of these 30 cases a cortical breakthrough of less than 2 mm occurred. The misplacement rate (defined as a perforation of 2 mm or more was 3.37% (11/326. Three of these 11 screws needed surgical revision due to neurological symptoms or CSF leakage. There have been no screw breakages or dislocations over the follow up-period.Conclusion: We conclude that the use of this cannulated screw system for the placement of pedicle screws in the thoracic and lumbar spine is accurate and safe. The advantages of this technique include easy handling without a time-consuming set up. Considering the incidence of long-term screw breakage, further investigation with a longer follow-up period is necessary.Keywords: spinal instrumentation, pedicle screws, misplacement, pedicle wall perforation

  4. 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.

  5. EFFICIENCY METHODS OF PHYSICAL REHABILITATION OF OSTEOCHONDROSIS OF THE LUMBAR SPINE

    Directory of Open Access Journals (Sweden)

    Кyreev IV

    2017-03-01

    Full Text Available Introduction. Osteochondrosis – the most common disease of the spine, which affects more than 70% of the population. Important is the social significance of osteochondrosis, in the structure of diseases of the musculoskeletal system as a whole the average primary disability of adult consequence of osteochondrosis – 1,7 to 10 000. It is important finding the most effective methods of complex treatment, and most importantly rehabilitation and recovery of patients with osteochondrosis. Material & methods. We selected 16 patients with osteochondrosis of the lumbar spine, men aged 29-42 years with disease duration from 2 to 9 years. To determine the effectiveness of the methods of physical rehabilitation of patients with lumbar osteochondrosis outside the period of exacerbation assessed the dynamics of three indicators: vertebral syndrome, extravertebral syndrome, subjective assessment of the general condition of patients by psychological testing. After the examination, the patients divided into two groups of 8 people. Patients of the first group received physical therapy (ultrasound therapy and massage therapy. Pharmacotherapy is not done. Patients of the second group received medications according to the recommendations received after discharge from hospital. Results & discussion. After the rehabilitation treatment severity of vertebral syndrome significantly decreased to 1,1±0,23 points (р < 0,05 in first group and to до 1,0±0,33 points in second group (р < 0,05 with no significant difference between groups of patients. These figures suggest that all patients there was a reduction in pain to a weak pain, but some patients even before its termination. After rehabilitation terms of pain rate in the first group significantly decreased to 1,1±0,03 (p <0,05 points; in the second group, the figure dropped significantly to 1,2±0,08 (p <0, 05 points. In patients who did not receive pharmacotherapy, improvement in psychological testing "HAM

  6. 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

  7. 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.

  8. 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

  9. 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.

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

    Science.gov (United States)

    Flug, Jonathan A; Lind, Kimberly E

    2017-12-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Mitra, D. [Department of Neuroradiology, Newcastle General Hospital, Westgate Road, NE4 6BE, Newcastle upon Tyne (United Kingdom); Cassar-Pullicino, V.N.; Mccall, I.W. [Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry (United Kingdom)

    2004-09-01

    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.)

  12. 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.)

  13. Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database.

    Science.gov (United States)

    Asher, Anthony L; Devin, Clinton J; McCutcheon, Brandon; Chotai, Silky; Archer, Kristin R; Nian, Hui; Harrell, Frank E; McGirt, Matthew; Mummaneni, Praveen V; Shaffrey, Christopher I; Foley, Kevin; Glassman, Steven D; Bydon, Mohamad

    2017-12-01

    OBJECTIVE In this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration. METHODS A total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD]). A retrospective analysis of the prospectively collected data was conducted. Patients were dichotomized as smokers (current smokers) and nonsmokers. Multivariable logistic regression analysis fitted for patient smoking status and subsequent measurement of variable importance was performed to identify the strongest patient characteristics associated with smoking status. Multivariable linear regression models fitted for 12-month Oswestry Disability Index (ODI) scores in subsets of smokers and nonsmokers was performed to investigate whether differential effects of risk factors by smoking status might be present. RESULTS In total, 18% (n = 1365) of patients were smokers and 82% (n = 6182) were nonsmokers. In a multivariable logistic regression analysis, the factors significantly associated with patients' smoking status were sex (p smoker (p = 0.0008), while patients with coronary artery disease had greater odds of being a smoker (p = 0.044). Patients' propensity for smoking was also significantly associated with higher American Society of Anesthesiologists (ASA) class (p smokers and nonsmokers. CONCLUSIONS Using a large, national, multiinstitutional registry, the authors described the profile of patients who undergo lumbar spine surgery and its association with their smoking status. Compared with nonsmokers, smokers were younger, male

  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. 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

  16. [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.

  17. Structural health monitoring (vibration) as a tool for identifying structural alterations of the lumbar spine: a twin control study.

    Science.gov (United States)

    Kawchuk, Gregory N; Hartvigsen, Jan; Edgecombe, Tiffany; Prasad, Narasimha; van Dieen, Jaap H

    2016-03-11

    Structural health monitoring (SHM) is an engineering technique used to identify mechanical abnormalities not readily apparent through other means. Recently, SHM has been adapted for use in biological systems, but its invasive nature limits its clinical application. As such, the purpose of this project was to determine if a non-invasive form of SHM could identify structural alterations in the spines of living human subjects. Lumbar spines of 10 twin pairs were visualized by magnetic resonance imaging then assessed by a blinded radiologist to determine whether twin pairs were structurally concordant or discordant. Vibration was then applied to each subject's spine and the resulting response recorded from sensors overlying lumbar spinous processes. The peak frequency, area under the curve and the root mean square were computed from the frequency response function of each sensor. Statistical analysis demonstrated that in twins whose structural appearance was discordant, peak frequency was significantly different between twin pairs while in concordant twins, no outcomes were significantly different. From these results, we conclude that structural changes within the spine can alter its vibration response. As such, further investigation of SHM to identify spinal abnormalities in larger human populations is warranted.

  18. 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.)

  19. 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.)

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. Dual-energy radiographic absorptiometry of the lumbar spine and proximal femur

    International Nuclear Information System (INIS)

    Moscona, A.; Gundry, C.; Sartoris, D.J.; Barrett-Connor, E.; Stein, J.A.; Resnick, D.

    1988-01-01

    Dual-energy radiographic absorptiometry (DRA), dual-photon absorptiometry (DPA), and single-photon absorptiometry (SPA) were used for comprehensive densitometry of 500 men and women aged 65-100 years, within an epidemiologic study of osteoporosis risk factors. DRA and DPA of the lumbar spine (L1-L4) and proximal femur were performed with a Hologic QDR-100 system and a Lunar DP3 system, respectively, and SPA of the 33% shaft and ultradistal forearm sites was performed with a Lunar SP2 system. DRA and DPA results showed high correlation at both sites (tau=.9,P<.001); data conversion factors were derived. SPA results for the ultradistal site correlated better with vertebral and femoral density (tau=.6,P<.1) than did those for the shaft site (tau=.4,P<.5) but neither forearm measurement was reliable predictive of axial mineral status. The various measurements displayed an age-dependent interrelationship. The DRA method offers the advantage of short examination times (about 5 minutes per site) and high precision (about 1%)

  5. Stress analysis in a pedicle screw fixation system with flexible rods in the lumbar spine.

    Science.gov (United States)

    Kim, Kyungsoo; Park, Won Man; Kim, Yoon Hyuk; Lee, SuKyoung

    2010-01-01

    Breakage of screws has been one of the most common complications in spinal fixation systems. However, no studies have examined the breakage risk of pedicle screw fixation systems that use flexible rods, even though flexible rods are currently being used for dynamic stabilization. In this study, the risk of breakage of screws for the rods with various flexibilities in pedicle screw fixation systems is investigated by calculating the von Mises stress as a breakage risk factor using finite element analysis. Three-dimensional finite element models of the lumbar spine with posterior one-level spinal fixations at L4-L5 using four types of rod (a straight rod, a 4 mm spring rod, a 3 mm spring rod, and a 2 mm spring rod) were developed. The von Mises stresses in both the pedicle screws and the rods were analysed under flexion, extension, lateral bending, and torsion moments of 10 Nm with a follower load of 400 N. The maximum von Mises stress, which was concentrated on the neck region of the pedicle screw, decreased as the flexibility of the rod increased. However, the ratio of the maximum stress in the rod to the yield stress increased substantially when a highly flexible rod was used. Thus, the level of rod flexibility should be considered carefully when using flexible rods for dynamic stabilization because the intersegmental motion facilitated by the flexible rod results in rod breakage.

  6. In Vitro Comparison of Dynesys, PEEK, and Titanium Constructs in the Lumbar Spine

    Science.gov (United States)

    Yeager, Matthew S.; Cook, Daniel J.; Cheng, Boyle C.

    2015-01-01

    Introduction. Pedicle based posterior dynamic stabilization systems aim to stabilize the pathologic spine while also allowing sufficient motion to mitigate adjacent level effects. Two flexible constructs that have been proposed to act in such a manner, the Dynesys Dynamic Stabilization System and PEEK rod, have yet to be directly compared in vitro to a rigid Titanium rod. Methods. Human lumbar specimens were tested in flexion extension, lateral bending, and axial torsion to evaluate the following conditions at L4-L5: Intact, Dynesys, PEEK rod, Titanium rod, and Destabilized. Intervertebral range of motion, interpedicular travel, and interpedicular displacement metrics were evaluated from 3rd-cycle data using an optoelectric tracking system. Results. Statistically significant decreases in ROM compared to Intact and Destabilized conditions were detected for the instrumented conditions during flexion extension and lateral bending. AT ROM was significantly less than Destabilized but not the Intact condition. Similar trends were found for interpedicular displacement in all modes of loading; however, interpedicular travel trends were less consistent. More importantly, no metrics under any mode of loading revealed significant differences between Dynesys, PEEK, and Titanium. Conclusion. The results of this study support previous findings that Dynesys and PEEK constructs behave similarly to a Titanium rod in vitro. PMID:26366303

  7. 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.

  8. The diagnostic value of axially loaded magnetic resonance imaging in patients with degenerative disorders of lumbar spine

    International Nuclear Information System (INIS)

    Liu Qingyu; Chen Jianyu; Shen Jun; Zhang Xiaoya; Liang Biling

    2008-01-01

    Objective: To evaluate the diagnostic value of axially loaded MR imaging with supine position in patients with degenerative disorders of lumbar spine. Methods Thirty asymptomatic volunteers and 89 patients were examined in psoas-relaxed position (PRP) and axially compressed supine position (ACE) of the lumbar spine. Sixty-one patients with low back pain, 19 with sciatica and 9 with neurogenic claudication were included in the symptomatic study group. The disc levels from L3 to S1 were examined. Results: In 30 asymptomatic volunteers, a significant decrease in dural sac cross-sectional area (DSCA) was found at 14 disc levels (15.6%)in 10 individuals(33.3% ) during ACE ( >15 mm 2 ). In 89 patients, a significant decrease in DSCA was found at 55 disc levels (20.6%) in 38 patients (42.7%) during ACE ( >15 mm 2 ), and the mean decrease was 28 mm 2 . During ACE, 32 disc levels with an increasing severity of disc herniation were noted in 26 patients, 16 disc levels with neural foramen stenosis were found in 12 patients, 11 disc levels with ligamentum flavum thickening were observed in 10 patients, 3 cases facet dislocation and 3 cases lumbar spondylolisthesis were also seen. In 22 of the 89 patients (24.7%), additional valuable information (AVI) was found during ACE, including 7 patients (7/9) with neurogenic claudication, 8 patients (8/19)with sciatica, and 11.5% (7/61) of the patients with low back pain. Conclusion: As compared with conventional imaging methods, axially loaded imaging provides AVI, and more occult lesions can be found during ACE. ACE MRI is a valuable tool in diagnosing degenerative disorders of lumbar spine. (authors)

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

    Science.gov (United States)

    Huang, H.; Nightingale, R. W.

    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 previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Results Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t-test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Conclusion Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article: H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone

  10. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study.

    Science.gov (United States)

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

    2018-01-01

    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. A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t -test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article : H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28-35. DOI: 10

  11. Effectiveness of a Rapid Lumbar Spine MRI Protocol Using 3D T2-Weighted SPACE Imaging Versus a Standard Protocol for Evaluation of Degenerative Changes of the Lumbar Spine.

    Science.gov (United States)

    Sayah, Anousheh; Jay, Ann K; Toaff, Jacob S; Makariou, Erini V; Berkowitz, Frank

    2016-09-01

    Reducing lumbar spine MRI scanning time while retaining diagnostic accuracy can benefit patients and reduce health care costs. This study compares the effectiveness of a rapid lumbar MRI protocol using 3D T2-weighted sampling perfection with application-optimized contrast with different flip-angle evolutions (SPACE) sequences with a standard MRI protocol for evaluation of lumbar spondylosis. Two hundred fifty consecutive unenhanced lumbar MRI examinations performed at 1.5 T were retrospectively reviewed. Full, rapid, and complete versions of each examination were interpreted for spondylotic changes at each lumbar level, including herniations and neural compromise. The full examination consisted of sagittal T1-weighted, T2-weighted turbo spin-echo (TSE), and STIR sequences; and axial T1- and T2-weighted TSE sequences (time, 18 minutes 40 seconds). The rapid examination consisted of sagittal T1- and T2-weighted SPACE sequences, with axial SPACE reformations (time, 8 minutes 46 seconds). The complete examination consisted of the full examination plus the T2-weighted SPACE sequence. Sensitivities and specificities of the full and rapid examinations were calculated using the complete study as the reference standard. The rapid and full studies had sensitivities of 76.0% and 69.3%, with specificities of 97.2% and 97.9%, respectively, for all degenerative processes. Rapid and full sensitivities were 68.7% and 66.3% for disk herniation, 85.2% and 81.5% for canal compromise, 82.9% and 69.1% for lateral recess compromise, and 76.9% and 69.7% for foraminal compromise, respectively. Isotropic SPACE T2-weighted imaging provides high-quality imaging of lumbar spondylosis, with multiplanar reformatting capability. Our SPACE-based rapid protocol had sensitivities and specificities for herniations and neural compromise comparable to those of the protocol without SPACE. This protocol fits within a 15-minute slot, potentially reducing costs and discomfort for a large subgroup of

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Lumbar spinal stenosis: comparison of surgical practice variation and clinical outcome in three national spine registries.

    Science.gov (United States)

    Lønne, Greger; Fritzell, Peter; Hägg, Olle; Nordvall, Dennis; Gerdhem, Paul; Lagerbäck, Tobias; Andersen, Mikkel; Eiskjaer, Søren; Gehrchen, Martin; Jacobs, Wilco; van Hooff, Miranda L; Solberg, Tore K

    2018-05-21

    Decompression surgery for lumbar spinal stenosis (LSS) is the most common spinal procedure in the elderly. To avoid persisting low back pain, adding arthrodesis has been recommended, especially if there is a coexisting degenerative spondylolisthesis. However, this strategy remains controversial, resulting in practice-based variation. The present study aimed to evaluate in a pragmatic study if surgical selection criteria and variation in use of arthrodesis in three Scandinavian countries can be linked to variation in treatment effectiveness. This is an observational study based on a combined cohort from the national spine registries of Norway, Sweden, and Denmark. Patients aged 50 and older operated during 2011-2013 for LSS were included. Patient-Reported Outcome Measures (PROMs): Oswestry Disability Index (ODI) (primary outcome), Numeric Rating Scale (NRS) for leg pain and back pain, and health-related quality of life (Euro-Qol-5D) were reported. Analysis included case-mix adjustment. In addition, we report differences in hospital stay. Analyses of baseline data were done by analysis of variance (ANOVA), chi-square, or logistic regression tests. The comparisons of the mean changes of PROMs at 1-year follow-up between the countries were done by ANOVA (crude) and analysis of covariance (case-mix adjustment). Out of 14,223 included patients, 10,890 (77%) responded at 1-year follow-up. Apart from fewer smokers in Sweden and higher comorbidity rate in Norway, baseline characteristics were similar. The rate of additional fusion surgery (patients without or with spondylolisthesis) was 11% (4%, 47%) in Norway, 21% (9%, 56%) in Sweden, and 28% (15%, 88%) in Denmark. At 1-year follow-up, the mean improvement for ODI (95% confidence interval) was 18 (17-18) in Norway, 17 (17-18) in Sweden, and 18 (17-19) in Denmark. Patients operated with arthrodesis had prolonged hospital stay. Real-life data from three national spine registers showed similar indications for decompression

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

    Science.gov (United States)

    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.

  15. Three-dimensional MR myelography of the lumbar spine: comparative case study to X-ray myelography

    International Nuclear Information System (INIS)

    Eberhardt, K.E.W.; Hollenbach, H.P.; Tomandl, B.; Huk, W.J.

    1997-01-01

    Conventional myelography was compared with a new type of MR technique using a fat-suppressing 3D fast imaging with steady precession (FISP) sequence for diagnosis of the lumbar root compression syndrome. 80 patients with discogenic disease in the lumbar spine were examined with a 1.0-T whole-body MR system (Siemens Magnetom Impact, Erlangen, Germany). A strongly T2 * -weighted 3D FISP sequence was applied in the sagittal orientation. To obtain fat suppression, a frequency-selective 1-3-3-1 prepulse was applied prior to the imaging sequence. The acquired 3D data set was evaluated using a maximum intensity projection (MIP) program. The measurement time was 7 min, 47 s. Magnetic resonance myelography has significant advantages over conventional myelography, particularly in cases of extreme spinal canal stenosis. Compared with the conventional method, this new MR technique shows comparable sensitivity in the visualization of the spinal nerve roots in the lumbar spine. (orig.). With 5 figs., 2 tabs

  16. Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

    Science.gov (United States)

    Ristagno, Giuseppe; Beluffi, Simonetta; Tanzi, Dario; Belloli, Federica; Carmagnini, Paola; Croci, Massimo; D’Aviri, Giuseppe; Menasce, Guido; Pastore, Juan C.; Pellanda, Armando; Pollini, Alberto; Savoia, Giorgio

    2018-01-01

    (1) Background: This study evaluated the perioperative red blood cell (RBC) transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2) Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3) Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6%) required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008), significantly older, with a higher ASA grade (p = 0.0002), and with lower pre-surgery hemoglobin (HB) level and hematocrit (p < 0.0001). In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI) 2.84 (2.11–3.82)), a higher ASA class (1.77 (1.03–3.05)) and a longer operative time (1.02 (1.01–1.02)) were independently associated with RBC transfusion. (4) Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation. PMID:29385760

  17. Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

    Directory of Open Access Journals (Sweden)

    Giuseppe Ristagno

    2018-01-01

    Full Text Available (1 Background: This study evaluated the perioperative red blood cell (RBC transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2 Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3 Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6% required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008, significantly older, with a higher ASA grade (p = 0.0002, and with lower pre-surgery hemoglobin (HB level and hematocrit (p < 0.0001. In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI 2.84 (2.11–3.82, a higher ASA class (1.77 (1.03–3.05 and a longer operative time (1.02 (1.01–1.02 were independently associated with RBC transfusion. (4 Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation.

  18. 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.

  19. Ultrasonic imaging of lumbar discs combined with vibration pain provocation compared with discography in the diagnosis of internal anular fissures of the lumbar spine.

    Science.gov (United States)

    Yrjämä, M; Tervonen, O; Vanharanta, H

    1996-03-01

    The diagnostic information achieved by a combination of ultrasonographic imaging of discs and local bony vibration of lumbar vertebrae was compared to that obtained by discographic imaging and pain provocation. The purpose of this study was to find a noninvasive method for spine diagnostics to replace expensive and invasive methods such as discography. Internal anular fissures of the lumbar discs have been shown to be a source of back pain. Intradiscal changes associated with disc degeneration can be imaged by ultrasonography. The bony vibration test of spinal processes has shown to correlate well with discographic pain provocation tests in cases of internal anular ruptures. Discographic examination of the spine is the only widely accepted diagnostic method that combines pathoanatomic changes and patients' pain. Patients with back pain in this study were examined by means of ultrasonography, bony vibration stimulation, and discography. The three lowest lumbar discs were examined. In the cases of intradiscal ultrasound findings, the vibration provocation test showed a sensitivity of 0.90 and a specificity of 0.75 compared to the discographic pain provocation test. In cases of total anular ruptures seen in ultrasound examination, the sensitivity and the specificity of the vibration pain provocation test were much lower, being 0.50 and 0.50, respectively. The combination of the two noninvasive methods provides a useful screening test for the evaluation of low back pain. The combination test can accurately depict painful disc degeneration with internal disc rupture and the use of discography can be limited to the cases suggesting total anular rupture in ultrasound examination.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  2. The effect of patient shield position on gonad dose during lumbar spine radiography

    International Nuclear Information System (INIS)

    Clancy, Conor L.; O'Reilly, Geraldine; Brennan, Patrick C.; McEntee, Mark F.

    2010-01-01

    Background: In an effort to standardise radiological practices in the Republic of Ireland, current legislation states that 'written protocols for every type of standard radiological practice shall be established'. In order to fulfil this requirement the Irish Medical Council recommends the protocols issued by the Commission of European Communitees (CEC) for adoption in the country. Whilst this document does provide good guidance with regard to various radiographic factors, patient shielding instructions are notably ambiguous. The aim of this study was to remove some of this ambiguity by defining the optimal method of positioning patient shielding in antero-posterior (AP) and lateral lumbar spine radiographic examinations. These projections were chosen on the basis of their area of coverage being in close to and in some cases including the reproductive organs. They also represent the highest source of collective population dose of any conventional radiographic examination carried out in the UK. Method: A dosimetry study was devised to establish organ dose to the male testes and female ovaries using various clinically advocated methodologies for positioning patient shielding these included: no apron; tube-side apron; receptor-side apron and a wrap-around apron. The study was carried out using a direct digital radiography unit, an anthropomorphic phantom, various lead aprons and lithium thermoluminescent dosimeters (TLD). Results: For the AP projection, a statistically significant testes dose reduction of 42% (p ≤ 0.01) was observed when a tube-sided apron was used. No testes dose reductions were noted for the lateral projection. Ovary dose savings were not observed for any of the shielding methods investigated. Conclusion: This study found that the testes dose in AP examinations was reduced by 42% when patient shielding was positioned inferior to the imaged field and on the tube-side of the patient. This result validates the shielding methods used at the majority

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

    International Nuclear Information System (INIS)

    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

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

    Science.gov (United States)

    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.

  5. The effect of patient shield position on gonad dose during lumbar spine radiography

    Energy Technology Data Exchange (ETDEWEB)

    Clancy, Conor L.; O' Reilly, Geraldine [Department of Medical Physics and Bioengineering, Garden Hill House, St. James Hospital, James Street, Dublin (Ireland); Brennan, Patrick C. [Discipline of Medical Radiation Sciences, C42 - Cumberland Campus, The University of Sydney, Lidcombe NSW 2141 (Australia); McEntee, Mark F. [School of Medicine and Medical Science, Health Sciences Centre, University College Dublin, Belfield, Dublin 4 (Ireland)], E-mail: mark.mcentee@ucd.ie

    2010-05-15

    Background: In an effort to standardise radiological practices in the Republic of Ireland, current legislation states that 'written protocols for every type of standard radiological practice shall be established'. In order to fulfil this requirement the Irish Medical Council recommends the protocols issued by the Commission of European Communitees (CEC) for adoption in the country. Whilst this document does provide good guidance with regard to various radiographic factors, patient shielding instructions are notably ambiguous. The aim of this study was to remove some of this ambiguity by defining the optimal method of positioning patient shielding in antero-posterior (AP) and lateral lumbar spine radiographic examinations. These projections were chosen on the basis of their area of coverage being in close to and in some cases including the reproductive organs. They also represent the highest source of collective population dose of any conventional radiographic examination carried out in the UK. Method: A dosimetry study was devised to establish organ dose to the male testes and female ovaries using various clinically advocated methodologies for positioning patient shielding these included: no apron; tube-side apron; receptor-side apron and a wrap-around apron. The study was carried out using a direct digital radiography unit, an anthropomorphic phantom, various lead aprons and lithium thermoluminescent dosimeters (TLD). Results: For the AP projection, a statistically significant testes dose reduction of 42% (p {<=} 0.01) was observed when a tube-sided apron was used. No testes dose reductions were noted for the lateral projection. Ovary dose savings were not observed for any of the shielding methods investigated. Conclusion: This study found that the testes dose in AP examinations was reduced by 42% when patient shielding was positioned inferior to the imaged field and on the tube-side of the patient. This result validates the shielding methods used at the

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

    Science.gov (United States)

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

    2017-08-01

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

  7. Analysis of lumbar spine and hip motion during forward bending in subjects with and without a history of low back pain.

    Science.gov (United States)

    Esola, M A; McClure, P W; Fitzgerald, G K; Siegler, S

    1996-01-01

    This study analyzed two groups of subjects during forward bending. Group 1 (n = 20) contained subjects with a history of low back pain and Group 2 (n = 21) included subjects without a history of low back pain. The purposes of this study were to establish the amount and pattern of lumbar spine and hip motion during forward bending, and determine differences in motion in subjects with and without a history of low back pain. Reported values for lumbar spine motion during forward bending vary from 23.9 degrees to 60 degrees and hip motion during forward bending ranges from 26 degrees to 66 degrees. There has been no direct study of both lumbar spine and hip motion during forward bending in subjects with and without a history of low back pain to establish differences in total amounts or pattern of lumbar spine and hip motion during forward bending. A three-dimensional optoelectric motion analysis system was used to measure the amount and velocity of lumbar spine and hip motion during forward bending. Each subject performed three trials of forward bending that were averaged and used for statistical analysis. Hamstring flexibility was also assessed by two clinical tests, the passive straight leg raising and active knee extension tests. Mean total forward bending for all subjects was 111 degrees: 41.6 degrees from the lumbar spine and 69.4 degrees from the hips. There were no group differences for total amounts of lumbar spine and hip motion or velocity during forward bending. The pattern of motion was described by calculating lumbar-to-hip flexion ratios for early (0-30 degrees), middle (30-60 degrees), and late (60-90 degrees) forward bending. For all subjects, mean lumbar-to-hip ratios for early, middle, and late forward bending were 1.9, 0.9, and 0.4, respectively. Therefore, the lumbar spine had a greater contribution to early forward bending, the lumbar spine and hips contributed almost equally to middle forward bending, and the hips had a greater contribution to

  8. 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)

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Postoperative pain relief using intrathecal morphine for lumbar spine decompression and instrumentation surgery: A comparative study of two different doses

    Directory of Open Access Journals (Sweden)

    Priyanka Dhir

    2017-01-01

    Full Text Available Background and Aims: Patients undergoing lumbar spine instrumentation surgery suffer severe postoperative pain which is difficult to treat by conventional multimodal analgesic methods. We aimed to compare the analgesic effect of two different doses of intrathecal morphine (ITM 0.2 mg and 0.3 mg in patients undergoing lumbar spine decompression and instrumentation surgery. Design: This was a randomized, prospective, double-blinded study. Materials and Methods: After approval from the Institutional Ethics Committee, forty American Society of Anesthesiologists 1 and 2 patients of either sex aged 18 years or older undergoing lumbar spine surgery were randomly assigned to receive ITM either 0.2 mg (Group A, n = 20 or 0.3 mg (Group B, n = 20 in 2 ml saline before general anesthesia. A morphine intravenous patient-controlled analgesia (PCA device was used for rescue analgesia in the postoperative period. Assessment parameters included hemodynamics, sedation score, pain using numeric rating scale (NRS, total consumption of PCA morphine recorded for 24 h, and patient's satisfaction score. The data were analyzed using Chi-square test for categorical variables and Student's t-test for quantitative variables. Results: NRS score was significantly low in Group B at 4, 8, 12, and 24 h as compared to Group A (P < 0.05. Group B also had decreased requirement for rescue analgesia (P = 0.001 with higher patient satisfaction. There was no significant difference between the two groups in other studied parameters. Conclusions: 0.3 mg ITM provided superior analgesia postoperatively in terms of NRS score and higher patient satisfaction compared to 0.2 mg with no significant difference in the incidence of side effects.

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

    Science.gov (United States)

    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.

  13. Long constructs in the thoracic and lumbar spine with a minimally invasive technique.

    Science.gov (United States)

    Roldan, H; Perez-Orribo, L; Spreafico, M; Ginoves-Sierra, M

    2011-04-01

    Literature about long implants used together with a minimally invasive spine surgery (MISS) technique is scarce. Our objective is to contribute our surgical experience in this field and to specifically focus on several technical details. A digitally-dissected canal along the paravertebral muscles was created linking the stab wounds on each side in relation with the pedicles to be cannulated. Screws were inserted following the percutaneous technique. Long rods were modelled, threaded through the extender sleeves along the paravertebral canal and pushed into the screw heads with the reduction forceps. When fusion was needed, the facet complex was decorticated with a drill. To insert a cross-link, a canal between the 2 rods was digitally created and the spinous process was drilled. 8 patients underwent surgery (age range: 25-77 years). Indications were postosteomyelitis kyphosis in 3 patients, bone tumor in 3, and spine fracture in 2. No blood transfusions were necessary during or after surgery. A cross-link was inserted in 2 patients. Posterolateral bone fusion was attempted in 4, but radiologically identifiable in none. In one patient a cantilever manoeuvre was done to correct kyphosis. Mean duration of surgery was 4 h. There were no clinical complications related to the operation or the hardware (mean follow-up of 7.14 months, range: 1-15 months). The application of MISS techniques can be broadened to long spinal constructs to assess fractures, tumors or deformity, especially in elderly or debilitated patients. Nevertheless, posterolateral fusion is still a challenge through these limited exposures. © Georg Thieme Verlag KG Stuttgart · New York.

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

    Science.gov (United States)

    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

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

    International Nuclear Information System (INIS)

    Maris, Thomas G.; Damilakis, John; Sideri, Liana; Deimling, Michael; Papadokostakis, Georgios; Papakonstantinou, Olympia; Gourtsoyiannis, Nikos

    2004-01-01

    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

  16. 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.

  17. Bone mineral density of lumbar spine and femur in acromegaly. Knochendichte an Lendenwirbelsaeule und Femur bei Akromegalie

    Energy Technology Data Exchange (ETDEWEB)

    Huebsch, P. (Ludwig-Boltzmann-Institut fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria)); Kotzmann, H. (Universitaetsklinik fuer Innere Medizin 3, Vienna (Austria)); Svoboda, T. (Universitaetsklinik fuer Innere Medizin 3, Vienna (Austria)); Kainberger, F.M. (Ludwig-Boltzmann-Institut fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria)); Bankier, A. (Ludwig-Boltzmann-Institut fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria)); Seidl, G. (Ludwig-Boltzmann-Institut fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria))

    1993-08-01

    Acromegaly is regarded as a cause for secondary osteoporosis, whereas recent papers suggest that growth hormone increases bone mineral density (BMD). In 16 patients with active acromegaly we found an increased BMD compared to normal controls in the lumbar spine and the proximal femur by means of dual energy X-ray absoptiometry. This increase in BMD was statistically significant in the femoral neck and in Ward's triangle (P=0.05). Moreover, no signs of osteoporosis were found radiologically. (orig.)

  18. 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.)

  19. 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

  20. Is a drain tube necessary for minimally invasive lumbar spine fusion surgery?

    Science.gov (United States)

    Hung, Pei-I; Chang, Ming-Chau; Chou, Po-Hsin; Lin, Hsi-Hsien; Wang, Shih-Tien; Liu, Chien-Lin

    2017-03-01

    This study aimed to evaluate if closed suction wound drainage is necessary in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF). This is a prospective randomized clinical study. Fifty-six patients who underwent MIS TLIF were randomly divided into groups A (with a closed suction wound drainage) and B (without tube drainage). Surgical duration, intraoperative blood loss, timing of ambulation, length of hospital stay and complications were recorded. Patients were followed up for an average of 25.3 months. Clinical outcome was assessed using the Oswestry disability index and visual analogue scale (VAS). Fusion rate was classified with the Bridwell grading system, based on plain radiograph. Both groups had similar patient demographics. The use of drains had no significant influence on perioperative parameters including operative time, estimated blood loss, length of stay and complications. Patients in group B started ambulation 1 day earlier than patients in group A (p drain tube can lead to pain, anxiety and discomfort during the postoperative period. We conclude that drain tubes are not necessary for MIS TLIF. Patients without drains had the benefit of earlier ambulation than those with drains.

  1. Anterior debridement may not be necessary in the treatment of tuberculous spondylitis of the thoracic and lumbar spine in adults: a retrospective study.

    Science.gov (United States)

    Wang, S-T; Ma, H-L; Lin, C-P; Chou, P-H; Liu, C-L; Yu, W-K; Chang, M-C

    2016-06-01

    Many aspects of the surgical treatment of patients with tuberculosis (TB) of the spine, including the use of instrumentation and the types of graft, remain controversial. Our aim was to report the outcome of a single-stage posterior procedure, with or without posterior decompression, in this group of patients. Between 2001 and 2010, 51 patients with a mean age of 62.5 years (39 to 86) underwent long posterior instrumentation and short posterior or posterolateral fusion for TB of the thoracic and lumbar spines, followed by anti-TB chemotherapy for 12 months. No anterior debridement of the necrotic tissue was undertaken. Posterior decompression with laminectomy was carried out for the 30 patients with a neurological deficit. The mean kyphotic angle improved from 26.1° (- 1.8° to 62°) to 15.2° (-25° to 51°) immediately after the operation. At a mean follow-up of 68.8 months (30 to 144) the mean kyphotic angle was 16.9° (-22° to 54°), with a mean loss of correction of 1.6° (0° to 10°). There was a mean improvement in neurological status of 1.2 Frankel grades in those with a neurological deficit. Bony union was achieved in all patients, without recurrent infection. Long posterior instrumentation with short posterior or posterolateral fusion is effective in the treatment of TB spine. It controls infection, corrects the kyphosis, and maintains correction and neurological improvement over time. With effective anti-TB chemotherapy, a posterior only procedure without debridement of anterior lesion is effective in the treatment of TB spondylitis, and an anterior procedure can be reserved for those patients who have not improved after posterior surgery. Cite this article: Bone Joint J 2016;98-B:834-9. ©2016 The British Editorial Society of Bone & Joint Surgery.

  2. Tactile cues can change movement: An example using tape to redistribute flexion from the lumbar spine to the hips and knees during lifting.

    Science.gov (United States)

    Pinto, Brendan L; Beaudette, Shawn M; Brown, Stephen H M

    2018-05-14

    Given the appropriate cues, kinematic factors associated with low back injury risk and pain, such as spine flexion, can be avoided. Recent research has demonstrated the potential for tactile sensory information to change movement. In this study an athletic strapping tape was applied bilaterally along the lumbar extensor muscles to provide continuous tactile feedback information during a repeated lifting and lowering task. The presence of the tape resulted in a statistically significant reduction in lumbar spine flexion when compared to a baseline condition in which no tape was present. This reduction was further increased with the explicit instruction to pay attention to the sensations elicited by the tape. In both cases, the reduction in lumbar spine flexion was compensated for by increases in hip and knee flexion. When the tape was then removed and participants were instructed to continue lifting as if it was still present, the reduction in lumbar flexion and increases in hip and knee flexion were retained. Thus this study provides evidence that tactile cues can provide vital feedback information that can cue human lumbar spine movement to reduce kinematic factors associated with injury risk and pain. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. 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.

  4. Dual photon absorptiometry in patients with Paget disease (bone mineral contents of lumbar spine and femoral neck)

    International Nuclear Information System (INIS)

    Talbot, J.N.; Piketty, C.; Kiffel, T.; Coutris, G.; Milhaud, G.

    1988-01-01

    The bone mineral contents (BMC) of the lumbar spine (84 cases) and of one femoral neck (53 cases) were measured by dual photon absorptiometry (DPA) in patients suffering from Paget's disease of bone. The BMC of the patients and of 53 controls were compared, taking into account the occurrence of a scintigraphic hyperfixation, in each patient. A hyperfixation of the technetium labelled diphosphonate in the lumbar spine, more frequent in males, was associated with an elevated mean BMC value. The difference versus controls was significant in men but not in women. A hyperfixation of the femoral neck was associated with an elevated mean BMC value in both sexes. BMC values greater than the mean BMC of controls + 2 SD were observed in 83 per cent of these male patients and 50 per cent of the females. In contrast, BMC values lower than in controls were observed in non-pagetic areas. DPA allows the quantification of these abnormalities which cannot be evidenced by bone scintigraphy even if alkaline phosphatases levels are assayed [fr

  5. Magnetic resonance imaging and dual energy X-ray absorptiometry of the lumbar spine in professional wrestlers and untrained men.

    Science.gov (United States)

    Hu, M; Sheng, J; Kang, Z; Zou, L; Guo, J; Sun, P

    2014-08-01

    The aim of this study was to examine the relation between bone marrow adipose tissue (BMAT) and bone mineral density (BMD) of lumbar spine in male professional wrestlers and healthy untrained men. A total of 14 wrestlers (22.9±3.4 years) and 11 controls (24.4±1.6 years) were studied cross-sectionally. Body composition and BMD were measured by dual-energy X-ray absorptiometry. Magnetic resonance imaging of the lumbar spine was examined in a sagittal T1-weighted (T1-w) spin-echo (SE) sequence. The averaged bone marrow signal intensity (SI) of L2-L4 was related to the signal of an adjacent nondegenerative disk. Mean SI of T1-w SE in wrestlers was lower than controls (P=0.001), indicating L2-L4 BMAT in wrestlers was lower compared to controls. L2-L4 BMD in wrestlers was higher than controls (PBMAT and BMD was confirmed in this relatively small subject sample with narrow age range, which implies that exercise training is an important determinant of this association.

  6. 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)

  7. 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

  8. Risk factors for 30-day reoperation and 3-month readmission: analysis from the Quality and Outcomes Database lumbar spine registry.

    Science.gov (United States)

    Wadhwa, Rishi K; Ohya, Junichi; Vogel, Todd D; Carreon, Leah Y; Asher, Anthony L; Knightly, John J; Shaffrey, Christopher I; Glassman, Steven D; Mummaneni, Praveen V

    2017-08-01

    OBJECTIVE The aim of this paper was to use a prospective, longitudinal, multicenter outcome registry of patients undergoing surgery for lumbar degenerative disease in order to assess the incidence and factors associated with 30-day reoperation and 90-day readmission. METHODS Prospectively collected data from 9853 patients from the Quality and Outcomes Database (QOD; formerly known as the N 2 QOD [National Neurosurgery Quality and Outcomes Database]) lumbar spine registry were retrospectively analyzed. Multivariate binomial regression analysis was performed to identify factors associated with 30-day reoperation and 90-day readmission after surgery for lumbar degenerative disease. A subgroup analysis of Medicare patients stratified by age (readmission rate was 6.3%. Multivariate analysis demonstrated that higher ASA class (OR 1.46 per class, 95% CI 1.25-1.70) and history of depression (OR 1.27, 95% CI 1.04-1.54) were factors associated with 90-day readmission. Medicare beneficiaries had a higher rate of 90-day readmissions compared with those who had private insurance (OR 1.43, 95% CI 1.17-1.76). Medicare patients readmission included higher ASA class and a history of depression. The 90-day readmission rates were higher for Medicare beneficiaries than for those who had private insurance. Medicare patients < 65 years of age were more likely to undergo reoperation within 30 days and to be readmitted within 90 days after their index surgery.

  9. Adaptation of muscles of the lumbar spine to sudden imbalance in patients with lower back pain caused by military training.

    Science.gov (United States)

    Gao, Ying; Shi, Jian-guo; Ye, Hong; Liu, Zhi-rong; Zheng, Long-bao; Ni, Zhi-ming; Fan, Liang-quan; Wang, Jian; Hou, Zhen-hai

    2014-11-01

    This study aims to investigate the effects of sudden load changes (expected and unexpected imbalance) on the activity of muscles of the lumbar spine and their central motor control strategy in military personnel with or without chronic low back pain (LBP). Bilateral sudden imbalance was examined (2 × 2 factorial design). The 117th PLA Hospital, Hangzhou, China Twenty-one male subjects with lower back pain and 21 male healthy control subjects were active members of the Nanjing Military Region land forces. Independent variables: LBP vs. healthy controls and imbalance anticipation (expected and unexpected imbalance). rapid reaction time (RRT) and intensity of rapid reaction (IRR) of bilateral lumbar (L3-L4) erector spinae (ES), lumbar (L5-S1) multifidus (MF), and abdominal external oblique muscles. Results Under expected or unexpected sudden imbalance conditions, subjects with LBP demonstrated significantly greater IRR than healthy controls in ipsilateral and contralateral ES and MF, respectively (P imbalance prolonged RRT of selected trunk muscles in patients with chronic LBP. The activation amplitude increased. The results may provide a theoretical basis for a study on the pathogenesis of chronic LBP.

  10. A Cost-Utility Analysis of Lumbar Decompression With and Without Fusion for Degenerative Spine Disease in the Elderly.

    Science.gov (United States)

    Devin, Clinton J; Chotai, Silky; Parker, Scott L; Tetreault, Lindsay; Fehlings, Michael G; McGirt, Matthew J

    2015-10-01

    Value-based purchasing is rapidly being implemented to rein in the unsustainably rising costs of the US healthcare system. With a growing elderly population, it is vital to understand the value of spinal surgery in this group of individuals. To compare the cost-effectiveness of lumbar decompression with and without fusion for degenerative spine disease in elderly vs nonelderly patients. A total of 221 patients undergoing elective primary surgery for degenerative lumbar pathology who were enrolled in a prospective longitudinal registry were analyzed. Patient-reported outcomes of Oswestry Disability Index, numeric rating scale for back and leg pain, and quality-of-life scores (EuroQol-5D) were recorded. Two-year back-related medical resource use, missed work, and health-state values (quality-adjusted life-years [QALYs]) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost). Patient and caregiver workday losses were multiplied by gross-of-tax wage rate (indirect cost). Patients were divided into age groups <70 and ≥70 years. Mean cumulative 2-year QALYs gained were statistically similar between younger and older patients for both decompression alone (0.67 ± 0.65 vs 0.56 ± 0.65; P = .47) and decompression with fusion (0.56 ± 0.55 vs 0.59 ± 0.55; P = .26). Mean 2-year cost per QALY gained between younger and older patients was similar for both decompression alone ($24,365 vs $31,750 per QALY; P = .11) and decompression with fusion ($64,228 vs $60,183 per QALY; P = .09). Surgical treatment provided significant improvements in pain, disability, and quality of life for elderly patients with degenerative lumbar disease. Observed costs per QALY gained for lumbar decompression with and without fusion were similar for younger and older patients, demonstrating that lumbar spine surgery in the elderly is an equally cost-effective and valuable intervention.

  11. Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) of the whole spine and its association with lumbar spondylosis and knee osteoarthritis: the ROAD study.

    Science.gov (United States)

    Kagotani, Ryohei; Yoshida, Munehito; Muraki, Shigeyuki; Oka, Hiroyuki; Hashizume, Hiroshi; Yamada, Hiroshi; Enyo, Yoshio; Nagata, Keiji; Ishimoto, Yuyu; Teraguchi, Masatoshi; Tanaka, Sakae; Nakamura, Kozo; Kawaguchi, Hiroshi; Akune, Toru; Yoshimura, Noriko

    2015-03-01

    We aimed to assess the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and its association with lumbar spondylosis (LS) and knee osteoarthritis (KOA) using a population-based cohort study entitled Research on Osteoarthritis/osteoporosis Against Disability (ROAD). In the baseline ROAD study, which was performed between 2005 and 2007, 1,690 participants in mountainous and coastal areas underwent anthropometric measurements and radiographic examinations of the whole spine (cervical, thoracic, and lumbar) and both knees. They also completed an interviewer-administered questionnaire. Presence of DISH was diagnosed according to Resnick criteria, and LS and KOA were defined as Kellgren-Lawrence (KL) grade ≥3. Among the 1,690 participants, whole-spine radiographs of 1,647 individuals (97.5%; 573 men, 1,074 women; mean age, 65.3 years) were evaluated. Prevalence of DISH was 10.8% (men 22.0%, women 4.8%), and was significantly higher in older participants (presence of DISH 72.3 years, absence of DISH 64.4 years) and mainly distributed at the thoracic spine (88.7%). Logistic regression analysis revealed that presence of DISH was significantly associated with older age [+1 year, odds ratio (OR): 1.06, 95% confidence interval (CI): 1.03-1.14], male sex (OR: 5.55, 95% CI: 3.57-8.63), higher body mass index (+1 kg/m(2), OR: 1.08, 95% CI: 1.02-1.14), presence of LS (KL2 vs KL0: 1, OR: 5.50, 95% CI: 2.81-10.8) (KL ≥3 vs KL0: 1, OR: 4.09, 95% CI: 2.08-8.03), and presence of KOA (KL ≥3 vs KL0: 1, OR: 1.89, 95% CI: 1.14-3.10) after adjusting for smoking, alcohol consumption, and residential area (mountainous vs coastal). This cross-sectional population-based study clarified the prevalence of DISH in general inhabitants and its significant association with LS and severe KOA.

  12. 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 fee-for-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

  13. Differential wedging of vertebral body and intervertebral disc in thoracic and lumbar spine in adolescent idiopathic scoliosis – A cross sectional study in 150 patients

    Directory of Open Access Journals (Sweden)

    Kim Hak-Jun

    2008-08-01

    Full Text Available Abstract Background Hueter-Volkmann's law regarding growth modulation suggests that increased pressure on the end plate of bone retards the growth (Hueter and conversely, reduced pressure accelerates the growth (Volkmann. Literature described the same principle in Rat-tail model. Human spine and its deformity i.e. scoliosis has also same kind of pattern during the growth period which causes wedging in disc or vertebral body. Methods This cross sectional study in 150 patients of adolescent idiopathic scoliosis was done to evaluate vertebral body and disc wedging in scoliosis and to compare the extent of differential wedging of body and disc, in thoracic and lumbar area. We measured wedging of vertebral bodies and discs, along with two adjacent vertebrae and disc, above and below the apex and evaluated them according to severity of curve (curve 30° to find the relationship of vertebral body or disc wedging with scoliosis in thoracic and lumbar spine. We also compared the wedging and rotations of vertebrae. Results In both thoracic and lumbar curves, we found that greater the degree of scoliosis, greater the wedging in both disc and body and the degree of wedging was more at apex supporting the theory of growth retardation in stress concentration area. However, the degree of wedging in vertebral body is more than the disc in thoracic spine while the wedging was more in disc than body in lumbar spine. On comparing the wedging with the rotation, we did not find any significant relationship suggesting that it has no relation with rotation. Conclusion From our study, we can conclude that wedging in disc and body are increasing with progression on scoliosis and maximum at apex; however there is differential wedging of body and disc, in thoracic and lumbar area, that is vertebral body wedging is more profound in thoracic area while disc wedging is more profound in lumbar area which possibly form 'vicious cycle' by asymmetric loading to spine for the

  14. Differences in lumbar spine and lower extremity kinematics during a step down functional task in people with and people without low back pain.

    Science.gov (United States)

    Hernandez, Alejandra; Gross, Karlie; Gombatto, Sara

    2017-08-01

    When functional movements are impaired in people with low back pain, they may be a contributing factor to chronicity and recurrence. The purpose of the current study was to examine lumbar spine, pelvis, and lower extremity kinematics during a step down functional task between people with and without a history of low back pain. A 3-dimensional motion capture system was used to analyze kinematics during a step down task. Total excursion of the lumbar spine, pelvis, and lower extremity segments in each plane were calculated from the start to end of the task. Separate analysis of variance tests (α=0.05) were conducted to determine the effect of independent variables of group and plane on lumbar spine, pelvis, and lower extremity kinematics. An exploratory analysis was conducted to examine kinematic differences among movement-based low back pain subgroups. Subjects with low back pain displayed less lumbar spine movement than controls across all three planes of movement (P-values=0.001-0.043). This group difference was most pronounced in the sagittal plane. For the lower extremity, subjects with low back pain displayed more frontal and axial plane knee movement than controls (P-values=0.001). There were no significant differences in kinematics among movement-based low back pain subgroups. People with low back pain displayed less lumbar region movement in the sagittal plane and more off-plane knee movements than the control group during a step down task. Clinicians can use this information when assessing lumbar spine and lower extremity movement during functional tasks, with the goal of developing movement-based interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. 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.

  16. 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

  17. 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

  18. CREST Calcinosis Affecting the Lumbar and Cervical Spine and the Use of Minimally-Invasive Surgery

    OpenAIRE

    Faraj, Kassem; Perez-Cruet, Kristin; Perez-Cruet, Mick

    2017-01-01

    Calcinosis in CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome can affect the spinal and paraspinal areas. We present the first case to our knowledge where a CREST syndrome patient required surgery for spinal calcinosis in both the cervical and lumbar areas.?A 66-year-old female with a history of CREST syndrome presented with right-sided lower extremity radicular pain. A computed tomography (CT) scan showed bilateral lumbar masses (5...

  19. 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.

  20. Utilization of manual therapy to the lumbar spine in conjunction with traditional conservative care for individuals with bilateral lower extremity complex regional pain syndrome: A case series.

    Science.gov (United States)

    Walston, Zachary; Hernandez, Luis; Yake, Dale

    2018-06-06

    Conservative therapies for complex regional pain syndrome (CRPS) have traditionally focused on exercise and desensitization techniques targeted at the involved extremity. The primary purpose of this case series is to report on the potential benefit of utilizing manual therapy to the lumbar spine in conjunction with traditional conservative care when treating patients with lower extremity CRPS. Two patients with the diagnosis of lower extremity CRPS were treated with manual therapy to the lumbar spine in conjunction with education, exercise, desensitization, and soft tissue techniques for the extremity. Patient 1 received 13 sessions over 6 weeks resulting in a 34-point improvement in oswestry disability index (ODI) and 35-point improvement in lower extremity functional scale (LEFS). Patient 2 received 21 sessions over 12 weeks resulting in a 28-point improvement in ODI and a 41-point improvement in LEFS. Both patients exhibited reductions in pain and clinically meaningful improvements in function. Manual therapies when applied to the lumbar spine in these patients as part of a comprehensive treatment plan resulted in improved spinal mobility, decreased pain, and reduction is distal referred symptoms. Although one cannot infer a cause and effect relationship from a case series, this report identifies meaningful clinical outcomes potentially associated with manual physical therapy to the lumbar spine for two patients with complex regional pain syndrome type 1.

  1. 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

  2. Spinal sagittal contour affecting falls: cut-off value of the lumbar spine for falls.

    Science.gov (United States)

    Ishikawa, Yoshinori; Miyakoshi, Naohisa; Kasukawa, Yuji; Hongo, Michio; Shimada, Yoichi

    2013-06-01

    Spinal deformities reportedly affect postural instability or falls. To prevent falls in clinical settings, the determination of a cut-off angle of spinal sagittal contour associated with increase risk for falls would be useful for screening for high-risk fallers. The purpose of this study was to calculate the spinal sagittal contour angle associated with increased risk for falls during medical checkups in community dwelling elders. The subjects comprised 213 patients (57 men, 156 women) with a mean age of 70.1 years (range, 55-85 years). The upright and flexion/extension thoracic kyphosis and lumbar lordosis angles, and the spinal inclination were evaluated with SpinalMouse(®). Postural instability was evaluated by stabilometry, using the total track length (LNG), enveloped areas (ENV), and track lengths in the lateral and anteroposterior directions (X LNG and Y LNG, respectively). The back extensor strength (BES) was measured using a strain-gauge dynamometer. The relationships among the parameters were analyzed statistically. Age, lumbar lordosis, spinal inclination, LNG, X LNG, Y LNG, and BES were significantly associated with falls (Pfalls about lumbar lordosis angles revealed that angles of 3° and less were significant for falls. The present findings suggest that increased age, spinal inclination, LNG, X LNG, Y LNG, and decreased BES and lumbar lordosis, are associated with falls. An angle of lumbar lordosis of 3° or less was associated with falls in these community-dwelling elders. Copyright © 2012 Elsevier B.V. All rights reserved.

  3. 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.

  4. 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.

  5. Qualitative grading of disc degeneration by magnetic resonance in the lumbar and cervical spine: lack of correlation with histology in surgical cases.

    Science.gov (United States)

    Davies, B M; Atkinson, R A; Ludwinski, F; Freemont, A J; Hoyland, J A; Gnanalingham, K K

    2016-08-01

    Clinically, magnetic resonance (MR) imaging is the most effective non-invasive tool for assessing IVD degeneration. Histological examination of the IVD provides a more detailed assessment of the pathological changes at a tissue level. However, very few reports have studied the relationship between these techniques. Identifying a relationship may allow more detailed staging of IVD degeneration, of importance in targeting future regenerative therapies. To investigate the relationship between MR and histological grading of IVD degeneration in the cervical and lumbar spine in patients undergoing discectomy. Lumbar (N = 99) and cervical (N = 106) IVD samples were obtained from adult patients undergoing discectomy surgery for symptomatic IVD herniation and graded to ascertain a histological grade of degeneration. The pre-operative MR images from these patients were graded for the degree of IVD (MR grade) and vertebral end-plate degeneration (Modic Changes, MC). The relationship between histological and MR grades of degeneration were studied. In lumbar and cervical IVD the majority of samples (93%) exhibited moderate levels of degeneration (ie MR grades 3-4) on pre-operative MR scans. Histologically, most specimens displayed moderate to severe grades of degeneration in lumbar (99%) and cervical spine (93%). MR grade was weakly correlated with patient age in lumbar and cervical study groups. MR and histological grades of IVD degeneration did not correlate in lumbar or cervical study groups. MC were more common in the lumbar than cervical spine (e.g. 39 versus 20% grade 2 changes; p < 0.05), but failed to correlate with MR or histological grades for degeneration. In this surgical series, the resected IVD tissue displayed moderate to severe degeneration, but there is no correlation between MR and histological grades using a qualitative classification system. There remains a need for a quantitative, non-invasive, pre-clinical measure of IVD degeneration that

  6. 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.

  7. Spondylodiscitis of the lumbar spine in a non-immunocompromised host caused by Yersinia enterocolitica O:9.

    Science.gov (United States)

    Ellenrieder, Martin; Zautner, Andreas E; Podbielski, Andreas; Bader, Rainer; Mittelmeier, Wolfram

    2010-04-01

    Here presented is an extremely rare case of a spinal osteomyelitis (L5-S1) with epidural empyema in a non-immunocompromised 62-year-old man caused by Yersinia enterocolitica O:9. The infection occurred acutely and required immediate surgical treatment. Y. enterocolitica was cultured from the empyema fluid, wound swabs of the intervertebral disc L5-S1 and stool cultures. Following the surgical decompression and antibiotic treatment, the patient recovered completely, without neurological deficits. A review of the literature revealed only sparse cases of spondylodiscitis due to other Y. enterocolitica serogroups. To our knowledge, we report here the first case of a spondylodiscitis of the lumbar spine caused by Y. enterocolitica serovar O:9 in a non-immunocompromised patient.

  8. 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.)

  9. Sagittal Thoracic and Lumbar Spine Profiles in Upright Standing and Lying Prone Positions Among Healthy Subjects: Influence of Various Biometric Features.

    Science.gov (United States)

    Salem, Walid; Coomans, Ysaline; Brismée, Jean-Michel; Klein, Paul; Sobczak, Stéphane; Dugailly, Pierre-Michel

    2015-08-01

    A prospective study was performed on the assessment of both thoracic and lumbar spine sagittal profiles (from C7 to S1). To propose a new noninvasive method for measuring the spine curvatures in standing and lying prone positions and to analyze their relationship with various biometric characteristics. Modifications of spine curvatures (i.e. lordosis or kyphosis) are of importance in the development of spinal disorders. Studies have emphasized the development of new devices to measure the spine sagittal profiles using a noninvasive and low-cost method. To date, it has not been applied for analyzing both lumbar and thoracic alterations for various positioning. Seventy-five healthy subjects (mean 22.6 ± 4.3 yr) were recruited to participate in this study. Thoracic and lumbar sagittal profiles were assessed in standing and lying prone positions using a 3D digitizer. In addition, several biometric data were collected including maximal trunk isometric strength for flexion and extension movement. Statistical analysis consisted in data comparisons of spine profiles and a multivariate analysis including biometric features, to classify individuals considering low within- and high between-variability. Kyphosis and lordosis angles decreased significantly from standing to lying prone position by an average of 13.4° and 16.6°, respectively. Multivariate analysis showed a sample clustering of 3 homogenous subgroups. The first group displayed larger lordosis and flexibility, and had low data values for height, weight, and strength. The second group had lower values than the overall trend of the whole sample, whereas the third group had larger score values for the torques, height, weight, waist, body mass index, and kyphosis angle but a reduced flexibility. The present results demonstrate a significant effect of the positioning on both thoracic and lumbar spine sagittal profiles and highlight the use of cluster analysis to categorize subgroups after biometric characteristics

  10. 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...

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

    DEFF Research Database (Denmark)

    Kovacs, F M; Royuela, A; Jensen, Tue Secher

    2009-01-01

    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...

  12. 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

  13. Evaluation of degenerative disease of the lumbar spine: MR/MR myelography versus conventional myelography/post-myelography CT.

    Science.gov (United States)

    Shiban, Ehab; von Lehe, Marec; Simon, Matthias; Clusmann, Hans; Heinrich, Petra; Ringel, Florian; Wilhelm, Kai; Urbach, Horst; Meyer, Bernhard; Stoffel, Michael

    2016-08-01

    To compare the use of magnetic resonance (MR)/MR myelography (MRM) with conventional myelography/post-myelography CT (convM) for detailed surgery planning in degenerative lumbar disease. Twenty-six patients with suspected complex lumbar degenerative disease underwent MRM in addition to convM as preoperative workup. Surgery was planned based on convM-as usual at our department. Post hoc, surgical planning was repeated planned again-now based on MRM. Furthermore, the MRM-based planning was performed by six independent neurosurgeons (three groups) of different degrees of specialisation. In only 31 % of the patients, post hoc MRM-based planning resulted in the same surgical decision as originally performed, whereas in 69 % (n = 18) a different procedure was indicated. In patients with non-concurring convM- and MRM-based surgical plans, a less extended procedure was the result of MRM in six patients (23 %), a more extended one in five (19 %), and a related to side/level of decompression or nucleotomy different plan in six patients (23 %). In one patient (4 %), the MRM-based planning would have led to a completely different surgery compared to convM. Overall interobserver agreement on the MRM-based planning was substantial. Detailed planning of operative procedures for complex lumbar degenerative disease is highly dependent on the image modality used.

  14. 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.)

  15. 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

  16. Non traumatic fractures of the lumbar spine and seizures: case report

    Directory of Open Access Journals (Sweden)

    Moscote-Salazar Luis Rafael

    2015-12-01

    Full Text Available Injury-induced seizures may appear clinically asymptomatic and can be easily monitored by the absence of trauma and post-ictal impairment of consciousness. Patients with epilepsy have a higher risk of compression fractures, leading to serious musculoskeletal injuries, this type of non-traumatic compression fractures of the spine secondary to seizures are rare lesions, and is produced by the severe contraction of the paraspinal muscles that can achieve the thoracic spine fracture. Seizures induced lesions may appear clinically asymptomatic and can be easily monitored by the absence of trauma and post-ictal impairment of consciousness. We present a case report.

  17. Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases.

    Science.gov (United States)

    Flouzat-Lachaniette, Charles-Henri; Delblond, William; Poignard, Alexandre; Allain, Jérôme

    2013-04-01

    After a first anterior approach to the lumbar spine, formation of adhesions of soft tissues to the spine increases the surgical difficulties and potential for iatrogenic injury during the revision exposure. The objective of this study was to identify the intraoperative difficulties and postoperative complications associated with revision anterior lumbar spine procedures in a single institution. This is a retrospective review of 25 consecutive anterior revision lumbar surgeries in 22 patients (7 men and 15 women) operated on between 1998 and 2011. Patients with trauma or malignancies were excluded. The mean age of the patients at the time of revision surgery was 56 years (range 20-80 years). The complications were analyzed depending on the operative level and the time between the index surgery and the revision. Six major complications (five intraoperatively and one postoperatively) occurred in five patients (20 %): three vein lacerations (12 %) and two ureteral injuries (8 %), despite the presence of a double-J ureteral stent. The three vein damages were repaired or ligated by a vascular surgeon. One of the two ureteral injuries led to a secondary nephrectomy after end-to-end anastomosis failure; the other necessitated secondary laparotomy for small bowel obstruction. Anterior revision of the lumbar spine is technically challenging and is associated with a high rate of vascular or urologic complications. Therefore, the potential complications of the procedure must be weighted against its benefits. When iterative anterior lumbar approach is mandatory, exposure should be performed by an access surgeon in specialized centers that have ready access to vascular and urologic surgeons.

  18. Age-predicted values for lumbar spine, proximal femur, and whole-body bone mineral density: results from a population of normal children aged 3 to 18 years

    Energy Technology Data Exchange (ETDEWEB)

    Webber, C.E. [Hamilton Health Sciences, Dept. of Nuclear Medicine, Hamilton, Ontario (Canada); McMaster Univ., Dept. of Radiology, Hamilton, Ontario (Canada)]. E-mail: webber@hhsc.ca; Beaumont, L.F. [Hamilton Health Sciences, Dept. of Nuclear Medicine, Hamilton, Ontario (Canada); Morrison, J. [McMaster Children' s Hospital, Hamilton, Ontario (Canada); Sala, A. [McMaster Children' s Hospital, Hamilton, Ontario (Canada); McMaster Univ., Dept. of Pediatrics, Hamilton, Ontario (Canada); Univ. of Milan-Bicocca, Monza (Italy); Barr, R.D. [McMaster Children' s Hospital, Hamilton, Ontario (Canada); McMaster Univ., Dept. of Pediatrics, Hamilton, Ontario (Canada)

    2007-02-15

    We measured areal bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) at the lumbar spine and the proximal femur and for the total body in 179 subjects (91 girls and 88 boys) with no known disorders that might affect calcium metabolism. Results are also reported for lumbar spine bone mineral content (BMC) and for the derived variable, bone mineral apparent density (BMAD). Expected-for-age values for each variable were derived for boys and girls by using an expression that represented the sum of a steady increase due to growth plus a rapid increase associated with puberty. Normal ranges were derived by assuming that at least 95% of children would be included within 1.96 population standard deviations (SD) of the expected-for-age value. The normal range for lumbar spine BMD derived from our population of children was compared with previously published normal ranges based on results obtained from different bone densitometers in diverse geographic locations. The extent of agreement between the various normal ranges indicates that the derived expressions can be used for reporting routine spine, femur, and whole-body BMD measurements in children and adolescents. The greatest difference in expected-for-age values among the various studies was that arising from intermanufacturer variability. The application of published conversion factors derived from DXA measurements in adults did not account fully for these differences, especially in younger children. (author)

  19. Age-predicted values for lumbar spine, proximal femur, and whole-body bone mineral density: results from a population of normal children aged 3 to 18 years

    International Nuclear Information System (INIS)

    Webber, C.E.; Beaumont, L.F.; Morrison, J.; Sala, A.; Barr, R.D.

    2007-01-01

    We measured areal bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) at the lumbar spine and the proximal femur and for the total body in 179 subjects (91 girls and 88 boys) with no known disorders that might affect calcium metabolism. Results are also reported for lumbar spine bone mineral content (BMC) and for the derived variable, bone mineral apparent density (BMAD). Expected-for-age values for each variable were derived for boys and girls by using an expression that represented the sum of a steady increase due to growth plus a rapid increase associated with puberty. Normal ranges were derived by assuming that at least 95% of children would be included within 1.96 population standard deviations (SD) of the expected-for-age value. The normal range for lumbar spine BMD derived from our population of children was compared with previously published normal ranges based on results obtained from different bone densitometers in diverse geographic locations. The extent of agreement between the various normal ranges indicates that the derived expressions can be used for reporting routine spine, femur, and whole-body BMD measurements in children and adolescents. The greatest difference in expected-for-age values among the various studies was that arising from intermanufacturer variability. The application of published conversion factors derived from DXA measurements in adults did not account fully for these differences, especially in younger children. (author)

  20. 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)

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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.

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

    International Nuclear Information System (INIS)

    Kovacs, F.M.; Royuela, A.; Jensen, T.S.

    2009-01-01

    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 research

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

    Science.gov (United States)

    Wong, C K; Johnson, E K

    2012-09-01

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

  8. 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

  9. 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.

  10. 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

  11. 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

    Energy Technology Data Exchange (ETDEWEB)

    Brealey, S., E-mail: stephen.brealey@york.ac.uk [Department of Health Sciences, University of York, York YO10 5DD (United Kingdom); Piper, K., E-mail: keith.piper@canterbury.ac.uk [Department of Allied Health Professions, Canterbury Christ Church University, Canterbury, Kent CT1 1QU (United Kingdom); King, D., E-mail: david.g.king@york.nhs.uk [York Hospital, Wigginton Road, York YO31 8HE (United Kingdom); Bland, M., E-mail: martin.bland@york.ac.uk [Department of Health Sciences, University of York, York YO10 5DD (United Kingdom); Caddick, J., E-mail: Julie.Caddick@york.nhs.uk [York Hospital, Wigginton Road, York YO31 8HE (United Kingdom); Campbell, P., E-mail: peter.campbell@york.nhs.uk [York Hospital, Wigginton Road, York YO31 8HE (United Kingdom); Gibbon, A., E-mail: anthony.j.gibbon@york.nhs.uk [York Hospital, Wigginton Road, York YO31 8HE (United Kingdom); Highland, A., E-mail: Adrian.Highland@sth.nhs.uk [Sheffield Teaching Hospitals, Herries Road, Sheffield S5 7AU (United Kingdom); Jenkins, N., E-mail: neil.jenkins@york.nhs.uk [York Hospital, Wigginton Road, York YO31 8HE (United Kingdom); Petty, D., E-mail: daniel.petty@york.nhs.uk [York Hospital, Wigginton Road, York YO31 8HE (United Kingdom); Warren, D., E-mail: david.warren@york.nhs.uk [York Hospital, Wigginton Road, York YO31 8HE (United Kingdom)

    2013-10-01

    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.

  12. 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

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

    Science.gov (United States)

    Johnson, Erica N; Thomas, James S

    2010-07-01

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

  14. 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.)

  15. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-09-15

    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. 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

  18. 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

  19. 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.

  20. 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

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

    International Nuclear Information System (INIS)

    Reisinger, R.

    2003-03-01

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

  3. Comparison of T1-weighted fast spin-echo and T1-weighted fluid-attenuated inversion recovery images of the lumbar spine at 3.0 Tesla

    International Nuclear Information System (INIS)

    Lavdas, Eleftherios; Vlychou, Marianna; Arikidis, Nikos; Kapsalaki, Eftychia; Roka, Violetta; Fezoulidis, Ioannis V.

    2010-01-01

    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

  4. 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.

  5. Magnetic resonance imaging findings of the lumbar spine in elite horseback riders: correlations with back pain, body mass index, trunk/leg-length coefficient, and riding discipline.

    Science.gov (United States)

    Kraft, Clayton N; Pennekamp, Peter H; Becker, Ute; Young, Mei; Diedrich, Oliver; Lüring, Christian; von Falkenhausen, Makus

    2009-11-01

    Most orthopaedic problems experienced by competitive horseback riders are related to pain in the lower back, hip joint, and hamstring muscles. Riders-especially, show jumpers-are frequently hampered in their performance because of lumbar pain. To date, there has been no research into lumbar disk degeneration in elite competitive riders. Competitive horseback riding accelerates lumbar disk degeneration. Cross-sectional study; Level of evidence, 3. Fifty-eight elite riders (18 men, 40 women; mean age, 32.4 years) and a control group of 30 nonriding volunteers (17 men, 13 women; mean age, 28.7 years) were evaluated for lumbar disk degeneration, cross-sectional area of paraspinal muscles, spondylolysis, and spondylolisthesis, using magnetic resonance imaging (MRI). The prevalence of disk degeneration between the 2 groups was compared, and the relationship was investigated between low back pain (LBP), riding discipline, body mass index (BMI), trunk/leg-length coefficient, and MRI results. Eighty-eight percent of elite riders (n = 51) had a history of LBP, versus 33% of the controls (P back pain. Although riders have a high prevalence of LBP, there is no conclusive MRI evidence to suggest that the cause lies in undue disk degeneration, spondylolysis, spondylolisthesis, or pathologic changes of the paraspinal muscles of the lumbar spine.

  6. Intradural Solitary Fibrous Tumor of the Lumbar Spine: A Distinctive Case Report

    Directory of Open Access Journals (Sweden)

    Recep Basaran

    2015-01-01

    Full Text Available Background. Solitary fibrous tumors are ubiquitous mesenchymal neoplasms of putative fibroblastic origin. They were originally described in the pleura but subsequently have been reported in many extraserosal sites. Solitary fibrous tumors may also occur in the meninges, central nervous system parenchyma, and spinal cord. Case. A 67-year-old male patient with progressive lower extremity weakness, urinary urgency, and sexual dysfunction has been admitted to our hospital. On his lumbar MRI, we detected an intradural lesion posterior to the L3 vertebral corpus. We resected the lesion by L3 total laminectomy. Immunohistological findings revealed strong and diffuse immunopositivity with vimentin, CD34, and bcl-2. Ki-67 proliferation index was 5–8%. We did not detect any recurrence 12 months after his operation. Conclusion. SFT is mostly seen in young and middle-aged patients and should be considered among differential diagnosis in cases suffering from pain, hypoesthesia, and urinary dysfunction. Gross total resection should be primary treatment. Tumors that have high Ki-67 labeling should be followed up for potential recurrences.

  7. 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

  8. Normal lumbar spine bone mineral densities with single-energy CT

    International Nuclear Information System (INIS)

    Hendrick, R.E.; Ritenour, E.R.; Geis, J.R.; Thickman, D.; Freeman, K.

    1988-01-01

    The authors report trabecular spine densities determined by single-energy CT in 267 healthy women, aged 22 to 75 years. Volunteers were scanned at eight sites with use of identical fourth-generation CT scanners, postpatient calibration phantoms, and analysis software that accounts for beam hardening as a function of patient size. Results indicate that a cubic polynomial best represents the decrease in bone density (in milligrams per milliliter of K 2 HPO 4 ) with age (in years): Bone Density = 140.9 + 4.44(Age) - 0.133(Age) 2 + 0.0008(Age) 3 , with statistical significance over the best linear and quadratic polynomial fits (P < .001). The mean bone densities of healthy women above age 30 years are found to be lower by an average of 8 mg/mL than reported by Cann et al, whose data indicate that the greatest loss in trabecular bone density in healthy women occurs in the 50-59-year group, while out data indicate greatest loss in the 60-75 year age group

  9. Anatomy of the Spine

    Science.gov (United States)

    ... curve of the neck is described as a lordosis or lordotic curve, and looks like a “C” ... like the cervical spine, creating a normal lumbar lordosis. The five lumbar vertebral bodies are the weight- ...

  10. 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.)

  11. 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.

  12. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-08-01

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

  14. Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures compared with open technique.

    Science.gov (United States)

    Paredes, Igor; Panero, Irene; Cepeda, Santiago; Castaño-Leon, Ana M; Jimenez-Roldan, Luis; Perez-Nuñez, Ángel; Alén, Jose A; Lagares, Alfonso

    2018-06-14

    This study aimed to compare the accuracy of screw placement between open pedicle screw fixation and percutaneous pedicle screw fixation (MIS) for the treatment of thoracolumbar spine fractures (TSF). Forty-nine patients with acute TSF who were treated with transpedicular screw fixation from January 2013 to December 2016 were retrospectively reviewed. The patients were divided into Open and MIS groups. Laminectomy was performed in either group if needed. The accuracy of the screw placement, the evolution of the Cobb sagital angle postoperatively and at 12-month follow up and the neurological status were recorded. AO type of fracture and TLICS score were also recorded. Mean age was 42 years old. Mean TLICS score was 6,29 and 5,96 for open and MIS groups respectively. Twenty five MIS and 24 open surgeries were performed, and 350 (175 in each group) screws were inserted (7,14 per patient). Twenty-four and 13 screws were considered ̈out ̈ in the open and MIS groups respectively (Odds ratio 1,98. 0,97-4,03 p=0,056). The Cobb sagittal angle went from 13,3o to 4,5o and from 14,9o to 8,2o in the Open and MIS groups respectively (both popen and MIS groups respectively. No neurological worsening was observed. For the treatment of acute thoracolumbar fractures, the MIS technique seems to achieve similar results to the open technique in relation to neurological improvement and deformity correction, while placing the screws more accurately.

  15. 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.

  16. 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

  17. 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

  18. [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.

  19. 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).

  20. 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.)

  1. Limited magnetic resonance imaging of the lumbar spine has high sensitivity for detection of acute fractures, infection, and malignancy

    International Nuclear Information System (INIS)

    Wang, Benjamin; Fintelmann, Florian J.; Kamath, Ravi S.; Kattapuram, Susan V.; Rosenthal, Daniel I.

    2016-01-01

    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.)

  2. 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.)

  3. 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.)

  4. 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.)

  5. 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.

  6. 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

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

    Science.gov (United States)

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

    2016-03-21

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

  8. Parameters and functional analysis of the deep epaxial muscles in the thoracic, lumbar and sacral regions of the equine spine.

    Science.gov (United States)

    García Liñeiro, J A; Graziotti, G H; Rodríguez Menéndez, J M; Ríos, C M; Affricano, N O; Victorica, C L

    2018-04-30

    The epaxial muscles produce intervertebral rotation in the transverse, vertical and axial axes. These muscles also counteract the movements induced by gravitational and inertial forces and movements produced by antagonistic muscles and the intrinsic muscles of the pelvic limb. Their fascicles are innervated by the dorsal branch of the spinal nerve, which corresponds to the metamere of its cranial insertion in the spinous process. The structure allows the function of the muscles to be predicted: those with long and parallel fibres have a shortening function, whereas the muscles with short and oblique fibres have an antigravity action. In the horse, the multifidus muscle of the thoracolumbar region extends in multiple segments of two to eight vertebral motion segments (VMS). Functionally, the multifidus muscle is considered a spine stabiliser, maintaining VMS neutrality during spine rotations. However, there is evidence of the structural and functional heterogeneity of the equine thoracolumbar multifidus muscle, depending on the VMS considered, related to the complex control of the required neuromuscular activity. Osteoarticular lesions of the spine have been directly related to asymmetries of the multifidus muscle. The lateral (LDSM) and medial (MDSM) dorsal sacrocaudal muscles may be included in the multifidus complex, the function of which is also unclear in the lumbosacral region. The functional parameters of maximum force (F max ), maximum velocity of contraction (V max ) and joint moment (M) of the multifidus muscles inserted in the 4th, 9th, 12th and 17th thoracic and 3rd and 4th lumbar vertebrae of six horses were studied postmortem (for example: 4MT4 indicates the multifidus muscle that crosses four metameres with cranial insertion in the T4 vertebra). Furthermore, the structural and functional characteristics of LDSM and MDSM were determined. Data were analysed by analysis of variance (anova) in a randomised complete block design (P ≤ 0.05). For some

  9. 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.)

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

    Science.gov (United States)

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

    2018-05-01

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

  11. 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; Kim, Nelson Ji Tae; Daniel, Mauro Miguel; Funari, Marcelo Buarque de Gusmao [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil). Dept. de Imagem

    2003-06-01

    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)

  12. Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: a prospective single-institution experience.

    Science.gov (United States)

    Adogwa, Owoicho; Elsamadicy, Aladine A; Vuong, Victoria D; Moreno, Jessica; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

    2017-12-01

    OBJECTIVE Geriatric patients undergoing lumbar spine surgery have unique needs due to the physiological changes of aging. They are at risk for adverse outcomes such as delirium, infection, and iatrogenic complications, and these complications, in turn, contribute to the risk of functional decline, nursing home admission, and death. Whether preoperative and perioperative comanagement by a geriatrician reduces the incidence of in-hospital complications and length of in-hospital stay after elective lumbar spine surgery remains unknown. METHODS A unique model of comanagement for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Perioperative Optimization of Senior Health (POSH) program was launched with the aim of improving outcomes in elderly patients (> 65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, in addition to performing routine preoperative anesthesia surgical screening, and comanages them daily throughout the course of their hospital stay to manage medical comorbid conditions and coordinate multidisciplinary rehabilitation along with the neurosurgical team. The first 100 cases were retrospectively reviewed after initiation of the POSH protocol and compared with the immediately preceding 25 cases to assess the incidence of perioperative complications and clinical outcomes. RESULTS One hundred twenty-five patients undergoing lumbar decompression and fusion were enrolled in this pilot program. Baseline characteristics were similar between both cohorts. The mean length of in-hospital stay was 30% shorter in the POSH cohort (6.13 vs 8.72 days; p = 0.06). The mean duration of time between surgery and patient mobilization was significantly shorter in the POSH cohort compared with the non-POSH cohort (1.57 days vs 2.77 days; p = 0.02), and the number of steps ambulated on day of discharge was 2-fold higher in the POSH cohort (p = 0

  13. Modic (endplate) changes in the lumbar spine: bone micro-architecture and remodelling.

    Science.gov (United States)

    Perilli, Egon; Parkinson, Ian H; Truong, Le-Hoa; Chong, Kuan C; Fazzalari, Nicola L; Osti, Orso L

    2015-09-01

    In the literature, inter-vertebral MRI signal intensity changes (Modic changes) were associated with corresponding histological observations on endplate biopsies. However, tissue-level studies were limited. No quantitative histomorphometric study on bone biopsies has yet been conducted for Modic changes. The aim of this study was to characterise the bone micro-architectural parameters and bone remodelling indices associated with Modic changes. Forty patients suffering from disabling low back pain, undergoing elective spinal surgery, and exhibiting Modic changes on MRI (Modic 1, n = 9; Modic 2, n = 25; Modic 3, n = 6), had a transpedicular vertebral body biopsy taken of subchondral bone. Biopsies were first examined by micro-CT, for 3D morphometric analysis of bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation, trabecular number, and structure model index. Then, samples underwent histological analysis, for determination of bone remodelling indices: osteoid surface to bone surface ratio (OS/BS), eroded surface to bone surface (ES/BS) and osteoid surface to eroded surface ratio (OS/ES). Micro-CT analysis revealed significantly higher BV/TV (up to 70% increase, p < 0.01) and Tb.Th (up to +57%, p < 0.01) in Modic 3 biopsies, compared to Modic 1 and 2. Histological analysis showed significantly lower OS/BS in Modic 2 biopsies (more than 28% decrease, p < 0.05) compared to 1 and 3. ES/BS progressively decreased from Modic 1 to 2 to 3, whereas OS/ES progressively increased with significantly higher values in Modic 3 (up to 159% increase, p < 0.05) than in Modic 1 and 2. Significant differences were found in bone micro-architectural parameters and remodelling indices among Modic types. Modic 1 biopsies had evidence of highest bone turnover, possibly due to an inflammatory process; Modic 2 biopsies were consistent with a reduced bone formation/remodelling stage; Modic 3 biopsies suggested a more stable sclerotic phase, with significantly

  14. FokI polymorphism in the vitamin D receptor gene (VDR and its association with lumbar spine pathologies in the Italian population: a case-control study.

    Directory of Open Access Journals (Sweden)

    Alessandra Colombini

    Full Text Available Alterations in vitamin D homeostasis, mainly involving its nuclear receptor (VDR, could have a role in the pathophysiology of the spine. The association between VDR polymorphisms and spine disorders has been analyzed in different ethnic groups, focusing on the functional FokI polymorphism. However, so far, inconsistent findings were reported. The aims of this study were to evaluate, in the Italian white population, the VDR FokI polymorphism frequencies distribution in subjects with clearly defined lumbar spinal pathologies compared to asymptomatic controls and to analyze the interplay of genetic and conventional risk factors. Using a case-control design, 267 patients with spinal disorders and 220 asymptomatic controls were enrolled, evaluating their exposition to putative risk factors. Patients' clinical assessment was performed by Magnetic Resonance Imaging. FokI polymorphism (rs2228570 was detected by PCR-RFLP. Genotypes were designated by a lowercase letter (f allele, T nucleotide for the presence of the restriction site and by a capital letter (F allele, C nucleotide for its absence. Family history, higher age and BMI, exposure to vibration, physical job demand, smoking habit and lower practice of leisure physical activity were associated with spinal disorders. The FF genotype and F allele represented approximately 2-fold risk factors to develop discopathies and/or osteochondrosis concomitant with disc herniation, while f allele was protective. In conclusion, the link we observed between VDR FokI variants and specific lumbar spine pathologies suggests that spinal tissue degeneration is influenced by the genetic background. Future studies should evaluate the signaling pathways involving alterations in VDR and influencing the development and/or progression of spine disorders.

  15. A comparative study on BMD of lumbar spine and proximal femur in post-menopausal women using dual energy X-ray absorptiometry

    International Nuclear Information System (INIS)

    Yoon, Han Sik; Mo, Eun Hee

    1999-01-01

    Osteoporosis, which causes mainly fracture of the spine, proximal femur and distal radius by minimal trauma, is a major public health problem and its prevalence is steadily increasing in Korea according to the development of public health care. There are reliable methods for diagnosis based on bone densitometry. Early detection and intervention are important for reducing the incidence of fractures. A consensus definition of osteoporosis, based on bone density measurement, has been developed by the World Health Organization(WHO). In this study, bone mineral density(BMD) was measured by dual energy x-ray absorptiometry(DEXA) at the proximal femur and lumbar spine in 132 post-menopausal women. The purpose of this study is to find influential factors on the BMD of the proximal femur and the lumbar spine and to analyze correlation between BMD and the problematic factors. We obtained the following results : 1. Mean BMD score, T-score and Z-score of the proximal femur were 0.81(g/cm 2 ), -2.45(S.D.) and -2.09(S.D.) respectively and in the lumber spine were 0.83(g/cm 2 ), -2.02(S.D.), -2.43(S.D.) respectively. 2. In correlation analysis between BMD and many factors, correlation coefficients were -0.467, 0.212, -0.321 and 0.241 in age, height, duration after menopause respectively. BMI and the residuals were comparatively small. 3. Correlation coefficients to age matched BMD, in height and body weight were 0.222 and 0.241, in age and duration after menopause were -0.268, -0.282. 4. The fracture threshold of proximal femur BMD to the 90th percentile was 0.845(g/cm 2 ). 5. At the result of multiple regression analysis, age, body weight, BMI(kg/m 2 ) and duration after menopause described as significant variables

  16. A comparative study on BMD of lumbar spine and proximal femur in post-menopausal women using dual energy X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Han Sik [Wonkwang Health Science College, Iksan (Korea, Republic of); Mo, Eun Hee [College of Medicine, Wonkwang Univ., Iksan (Korea, Republic of)

    1999-04-01

    Osteoporosis, which causes mainly fracture of the spine, proximal femur and distal radius by minimal trauma, is a major public health problem and its prevalence is steadily increasing in Korea according to the development of public health care. There are reliable methods for diagnosis based on bone densitometry. Early detection and intervention are important for reducing the incidence of fractures. A consensus definition of osteoporosis, based on bone density measurement, has been developed by the World Health Organization(WHO). In this study, bone mineral density(BMD) was measured by dual energy x-ray absorptiometry(DEXA) at the proximal femur and lumbar spine in 132 post-menopausal women. The purpose of this study is to find influential factors on the BMD of the proximal femur and the lumbar spine and to analyze correlation between BMD and the problematic factors. We obtained the following results : 1. Mean BMD score, T-score and Z-score of the proximal femur were 0.81(g/cm{sup 2}), -2.45(S.D.) and -2.09(S.D.) respectively and in the lumber spine were 0.83(g/cm{sup 2}), -2.02(S.D.), -2.43(S.D.) respectively. 2. In correlation analysis between BMD and many factors, correlation coefficients were -0.467, 0.212, -0.321 and 0.241 in age, height, duration after menopause respectively. BMI and the residuals were comparatively small. 3. Correlation coefficients to age matched BMD, in height and body weight were 0.222 and 0.241, in age and duration after menopause were -0.268, -0.282. 4. The fracture threshold of proximal femur BMD to the 90th percentile was 0.845(g/cm{sup 2}). 5. At the result of multiple regression analysis, age, body weight, BMI(kg/m{sup 2}) and duration after menopause described as significant variables.

  17. [Lumbar spondylosis].

    Science.gov (United States)

    Seichi, Atsushi

    2014-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Bokov A

    2013-04-01

    of a particular technology be taken into consideration but also the rate of false negative results. Acceptable diagnostic criteria should be based on a rational balance of sensitivity and specificity. Keywords: diagnostic strategy, lumbar spine, noncompressive pain, sensitivity, specificity

  19. Effects of age and weight on the metabolic activities of the cervical, thoracic and lumbar spines as measured by fluorine-18 fluorodeoxyglucose-positron emission tomography in healthy males

    DEFF Research Database (Denmark)

    Ayubcha, Cyrus; Zadeh, Mahdi Zirakchian; Rajapakse, Chamith S

    2018-01-01

    -145kg) were selected from the CAMONA study. A global assessment methodology was applied to the subjects' 18F-FDG 180 minute scans, where each region of the spine (cervical, thoracic and lumbar) was individually encapsulated in a single region of interest, and standardized uptake value (SUVmean......) was calculated per respective region. RESULTS: SUVmean increased significantly with weight in both the thoracic spine (Slope=0.0066, P=0.001) and lumbar spine (Slope=0.0087, Pcervical spine. There were no significant correlations between age and SUVmean in all three regions. The cervical...... provided evidence of weight dependent metabolic activity, likely related to inflammation. This study offers a methodological precedent that can be applied to studies in populations with back pain....

  20. 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

    International Nuclear Information System (INIS)

    Choi, Dongil; Kim, Deog-Yoon; Han, Chung Soo; Kim, Seonwoo; Bok, Hae Sook; Huh, Wooseong; Ko, Jae-Wook; Hong, Sung Hwa

    2010-01-01

    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 < 0.001 by one-sided Z-test with Fisher's z-transformation for each site). The T-scores (r ≥ 0.842) and Z-scores (r ≥ 0.709) also showed strong positive correlations. The duplicate BMD values of Dexxum showed a high level of precision (WSCV ≤ 4.27%). Dexxum measurements of BMD, T-scores, and Z-scores showed a strong linear correlation with those measured on Lunar Prodigy. (orig.)

  1. A Clinical Pilot Study Comparing Sweet Bee Venom parallel treatment with only Acupuncture Treatment in patient diagnosed with lumbar spine sprain

    Directory of Open Access Journals (Sweden)

    Shin Yong-jeen

    2011-06-01

    Full Text Available Objectives: This study was carried out to compare the Sweet Bee Venom (referred to as Sweet BV hereafter acupuncture parallel treatment to treatment with acupuncture only for the patient diagnosed with lumbar spine sprain and find a better treatment. Methods: The subjects were patients diagnosed with lumbar spine sprain and hospitalized at Suncheon oriental medical hospital, which was randomly divided into sweet BV parallel treatment group and acupuncture-only group, and other treatment conditions were maintained the same. Then,VAS (Visual Analogue Scale was used to compare the difference in the treatment period between the two groups from VAS 10 to VAS 0, from VAS 10 to VAS 5, and from VAS 5 to VAS 0. Result & Conclusion: Sweet BV parallel treatment group and acupuncture-only treatment group were compared regarding the respective treatment period, and as the result, the treatment period from VAS 10 to VAS 5 was significantly reduced in sweet BV parallel treatment group compared to the acupuncture-only treatment group, but the treatment period from VAS 5 to VAS 0 did not show a significant difference. Therefore, it can be said that sweet BV parallel treatment is effective in shortening the treatment period and controlling early pain compared to acupuncture-only treatment.

  2. Determination of the Oswestry Disability Index score equivalent to a "satisfactory symptom state" in patients undergoing surgery for degenerative disorders of the lumbar spine-a Spine Tango registry-based study.

    Science.gov (United States)

    van Hooff, Miranda L; Mannion, Anne F; Staub, Lukas P; Ostelo, Raymond W J G; Fairbank, Jeremy C T

    2016-10-01

    The achievement of a given change score on a valid outcome instrument is commonly used to indicate whether a clinically relevant change has occurred after spine surgery. However, the achievement of such a change score can be dependent on baseline values and does not necessarily indicate whether the patient is satisfied with the current state. The achievement of an absolute score equivalent to a patient acceptable symptom state (PASS) may be a more stringent measure to indicate treatment success. This study aimed to estimate the score on the Oswestry Disability Index (ODI, version 2.1a; 0-100) corresponding to a PASS in patients who had undergone surgery for degenerative disorders of the lumbar spine. This is a cross-sectional study of diagnostic accuracy using follow-up data from an international spine surgery registry. The sample includes 1,288 patients with degenerative lumbar spine disorders who had undergone elective spine surgery, registered in the EUROSPINE Spine Tango Spine Surgery Registry. The main outcome measure was the ODI (version 2.1a). Surgical data and data from the ODI and Core Outcome Measures Index (COMI) were included to determine the ODI threshold equivalent to PASS at 1 year (±1.5 months; n=780) and 2 years (±2 months; n=508) postoperatively. The symptom-specific well-being item of the COMI was used as the external criterion in the receiver operating characteristic (ROC) analysis to determine the ODI threshold equivalent to PASS. Separate sensitivity analyses were performed based on the different definitions of an "acceptable state" and for subgroups of patients. JF is a copyright holder of the ODI. The ODI threshold for PASS was 22, irrespective of the time of follow-up (area under the curve [AUC]: 0.89 [sensitivity {Se}: 78.3%, specificity {Sp}: 82.1%] and AUC: 0.91 [Se: 80.7%, Sp: 85.6] for the 1- and 2-year follow-ups, respectively). Sensitivity analyses showed that the absolute ODI-22 threshold for the two follow-up time-points were

  3. Comparison of Natural Language Processing Rules-based and Machine-learning Systems to Identify Lumbar Spine Imaging Findings Related to Low Back Pain.

    Science.gov (United States)

    Tan, W Katherine; Hassanpour, Saeed; Heagerty, Patrick J; Rundell, Sean D; Suri, Pradeep; Huhdanpaa, Hannu T; James, Kathryn; Carrell, David S; Langlotz, Curtis P; Organ, Nancy L; Meier, Eric N; Sherman, Karen J; Kallmes, David F; Luetmer, Patrick H; Griffith, Brent; Nerenz, David R; Jarvik, Jeffrey G

    2018-03-28

    To evaluate a natural language processing (NLP) system built with open-source tools for identification of lumbar spine imaging findings related to low back pain on magnetic resonance and x-ray radiology reports from four health systems. We used a limited data set (de-identified except for dates) sampled from lumbar spine imaging reports of a prospectively assembled cohort of adults. From N = 178,333 reports, we randomly selected N = 871 to form a reference-standard dataset, consisting of N = 413 x-ray reports and N = 458 MR reports. Using standardized criteria, four spine experts annotated the presence of 26 findings, where 71 reports were annotated by all four experts and 800 were each annotated by two experts. We calculated inter-rater agreement and finding prevalence from annotated data. We randomly split the annotated data into development (80%) and testing (20%) sets. We developed an NLP system from both rule-based and machine-learned models. We validated the system using accuracy metrics such as sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). The multirater annotated dataset achieved inter-rater agreement of Cohen's kappa > 0.60 (substantial agreement) for 25 of 26 findings, with finding prevalence ranging from 3% to 89%. In the testing sample, rule-based and machine-learned predictions both had comparable average specificity (0.97 and 0.95, respectively). The machine-learned approach had a higher average sensitivity (0.94, compared to 0.83 for rules-based), and a higher overall AUC (0.98, compared to 0.90 for rules-based). Our NLP system performed well in identifying the 26 lumbar spine findings, as benchmarked by reference-standard annotation by medical experts. Machine-learned models provided substantial gains in model sensitivity with slight loss of specificity, and overall higher AUC. Copyright © 2018 The Association of University Radiologists. All rights reserved.

  4. Knowledge-based iterative model reconstruction technique in computed tomography of lumbar spine lowers radiation dose and improves tissue differentiation for patients with lower back pain

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Cheng Hui [Department of Medical Imaging, Pojen General Hopsital, Taipei, Taiwan (China); School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Wu, Tung-Hsin [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (China); Lin, Chung-Jung, E-mail: bcjlin@me.com [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China); Chiou, Yi-You; Chen, Ying-Chou; Sheu, Ming-Huei; Guo, Wan-Yuo; Chiu, Chen Fen [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China)

    2016-10-15

    Highlights: • Knowledge-based IMR improves tissue differentiation in CT of L-spine better than hybrid IR (iDose{sup 4}). • Higher strength IMR improves image qualities of the IVD and IVF in spinal stenosis. • IMR provides diagnostic lower dose CT of L-spine. - Abstract: Purpose: To evaluate the image quality and diagnostic confidence of reduced-dose computed tomography (CT) of the lumbar spine (L-spine) reconstructed with knowledge-based iterative model reconstruction (IMR). Materials and methods: Prospectively, group A consisted of 55 patients imaged with standard acquisition reconstructed with filtered back-projection. Group B consisted of 58 patients imaged with half tube current, reconstructed with hybrid iterative reconstruction (iDose{sup 4}) in Group B1 and knowledge-based IMR in Group B2. Signal-to-noise ratio (SNR) of different regions, the contrast-to-noise ratio between the intervetebral disc (IVD) and dural sac (D-D CNR), and subjective image quality of different regions were compared. Higher strength IMR was also compared in spinal stenosis cases. Results: The SNR of the psoas muscle and D-D CNR were significantly higher in the IMR group. Except for the facet joint, subjective image quality of other regions including IVD, intervertebral foramen (IVF), dural sac, peridural fat, ligmentum flavum, and overall diagnostic acceptability were best for the IMR group. Diagnostic confidence of narrowing IVF and IVD was good (kappa = 0.58–0.85). Higher strength IMR delineated IVD better in spinal stenosis cases. Conclusion: Lower dose CT of L-spine reconstructed with IMR demonstrates better tissue differentiation than iDose{sup 4} and standard dose CT with FBP.

  5. Knowledge-based iterative model reconstruction technique in computed tomography of lumbar spine lowers radiation dose and improves tissue differentiation for patients with lower back pain

    International Nuclear Information System (INIS)

    Yang, Cheng Hui; Wu, Tung-Hsin; Lin, Chung-Jung; Chiou, Yi-You; Chen, Ying-Chou; Sheu, Ming-Huei; Guo, Wan-Yuo; Chiu, Chen Fen

    2016-01-01

    Highlights: • Knowledge-based IMR improves tissue differentiation in CT of L-spine better than hybrid IR (iDose 4 ). • Higher strength IMR improves image qualities of the IVD and IVF in spinal stenosis. • IMR provides diagnostic lower dose CT of L-spine. - Abstract: Purpose: To evaluate the image quality and diagnostic confidence of reduced-dose computed tomography (CT) of the lumbar spine (L-spine) reconstructed with knowledge-based iterative model reconstruction (IMR). Materials and methods: Prospectively, group A consisted of 55 patients imaged with standard acquisition reconstructed with filtered back-projection. Group B consisted of 58 patients imaged with half tube current, reconstructed with hybrid iterative reconstruction (iDose 4 ) in Group B1 and knowledge-based IMR in Group B2. Signal-to-noise ratio (SNR) of different regions, the contrast-to-noise ratio between the intervetebral disc (IVD) and dural sac (D-D CNR), and subjective image quality of different regions were compared. Higher strength IMR was also compared in spinal stenosis cases. Results: The SNR of the psoas muscle and D-D CNR were significantly higher in the IMR group. Except for the facet joint, subjective image quality of other regions including IVD, intervertebral foramen (IVF), dural sac, peridural fat, ligmentum flavum, and overall diagnostic acceptability were best for the IMR group. Diagnostic confidence of narrowing IVF and IVD was good (kappa = 0.58–0.85). Higher strength IMR delineated IVD better in spinal stenosis cases. Conclusion: Lower dose CT of L-spine reconstructed with IMR demonstrates better tissue differentiation than iDose 4 and standard dose CT with FBP.

  6. Lumbar Spine CT scan

    Science.gov (United States)

    ... M. Computed tomography. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic ... MRI and ultrasound. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic ...

  7. Minimally Invasive Transforaminal Lumbar Interbody Fusion with Percutaneous Bilateral Pedicle Screw Fixation for Lumbosacral Spine Degenerative Diseases. A retrospective database of 40 consecutive treated cases and literature review.

    Science.gov (United States)

    Millimaggi, Daniele Francesco; DI Norcia, Valerio; Luzzi, Sabino; Alfiero, Tommaso; Galzio, Renato Juan; Ricci, Alessandro

    2017-04-12

    To report our results about minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with bilateral pedicle screw fixation, in patients with degenerative lumbosacral spine disease. To describe the indications, surgical technique and results of a consecutive series of 40 patients undergone MI-TLIF. Despite the limited number of clinical studies, published data suggest tremendous potential advantages of this technique. Forty patients with radiological findings of degenerative lumbosacral spine disease were undergone MI-TLIF between July 2012 and January 2015. Clinical outcomes were assessed by means of Oswestry Disability Index (ODI) and Health Survey Scoring (SF36) before surgery and at first year follow-up. Furthermore, the following parameters were retrospectively reviewed: age, sex, working activity, body mass index (BMI), type of degenerative disease, number of levels of fusion, operative time, blood loss, length of hospital stay. Average operative time was of 230 minutes, mean estimated blood loss 170 mL, average length of hospital stay 5 days. The ODI improved from a score of 59, preoperatively, to post-operative score of 20 at first year follow-up. Average SF36 score increased from 36 to 54 (Physical Health) and from 29 to 50 (Mental Health) at first year outcome evaluation. MI-TLIF with bilateral pedicle screw fixation is an excellent choice for selected patients suffering from symptomatic degenerative lumbosacral spine disease, especially secondary to recurrent disk herniations.

  8. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain

    Energy Technology Data Exchange (ETDEWEB)

    Brooks, Benjamin K.; Southam, Samuel L.; Mlady, Gary W.; Logan, Jeremy; Rosett, Matthew [University of New Mexico School of Medicine, Department of Radiology, Albuquerque, NM (United States)

    2010-07-15

    To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain. The records of 2,555 patients who had undergone abdominal and pelvic CT in 2008 were reviewed electronically. In order to determine a true representation of the general population, we reviewed all indications for CT, excluding patients with a primary complaint of low back pain as the primary indication for imaging. Equal numbers of patients were separated into age groups by decade to ensure an even distribution of ages for statistical analysis. Patients older than 70 years were grouped together to provide case numbers comparable to those of the other decades. Logistic regression analysis was performed to evaluate the significance of the results. Three board-certified radiologists, including two musculoskeletal fellows and a radiology resident, retrospectively evaluated CT scans for lumbar spondylolysis, including unilateral and bilateral defects. Of the 2,555 cases evaluated, there were 203 positive cases of defects of the lumbar pars interarticularis. This corresponded to an overall prevalence of 8.0%. Prevalence per decade was fairly evenly distributed and ranged from 7.0%(ages 30-39 years) to 9.2% (ages 70 years and above). Prevalence of ages 20-49 years was 7.9%, and that of ages 50 years and older was 8.0%. Male to female ratio was 1.5:1. Logistic regression showed no significant increase in spondylolysis based on age. No significant increase in the prevalence of lumbar spondylolysis was demonstrated in patients older than 20 years. This suggests that the development of symptomatic lumbar pars defects do not occur in this population and should not be considered as a rare but potentially treatable cause of new onset low back pain in adults. This study demonstrated an overall prevalence of pars defects of 8

  9. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain.

    Science.gov (United States)

    Brooks, Benjamin K; Southam, Samuel L; Mlady, Gary W; Logan, Jeremy; Rosett, Matthew

    2010-07-01

    To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain. The records of 2,555 patients who had undergone abdominal and pelvic CT in 2008 were reviewed electronically. In order to determine a true representation of the general population, we reviewed all indications for CT, excluding patients with a primary complaint of low back pain as the primary indication for imaging. Equal numbers of patients were separated into age groups by decade to ensure an even distribution of ages for statistical analysis. Patients older than 70 years were grouped together to provide case numbers comparable to those of the other decades. Logistic regression analysis was performed to evaluate the significance of the results. Three board-certified radiologists, including two musculoskeletal fellows and a radiology resident, retrospectively evaluated CT scans for lumbar spondylolysis, including unilateral and bilateral defects. Of the 2,555 cases evaluated, there were 203 positive cases of defects of the lumbar pars interarticularis. This corresponded to an overall prevalence of 8.0%. Prevalence per decade was fairly evenly distributed and ranged from 7.0%( ages 30-39 years) to 9.2% (ages 70 years and above). Prevalence of ages 20-49 years was 7.9%, and that of ages 50 years and older was 8.0%. Male to female ratio was 1.5:1. Logistic regression showed no significant increase in spondylolysis based on age. No significant increase in the prevalence of lumbar spondylolysis was demonstrated in patients older than 20 years. This suggests that the development of symptomatic lumbar pars defects do not occur in this population and should not be considered as a rare but potentially treatable cause of new onset low back pain in adults. This study demonstrated an overall prevalence of pars defects of 8

  10. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain

    International Nuclear Information System (INIS)

    Brooks, Benjamin K.; Southam, Samuel L.; Mlady, Gary W.; Logan, Jeremy; Rosett, Matthew

    2010-01-01

    To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain. The records of 2,555 patients who had undergone abdominal and pelvic CT in 2008 were reviewed electronically. In order to determine a true representation of the general population, we reviewed all indications for CT, excluding patients with a primary complaint of low back pain as the primary indication for imaging. Equal numbers of patients were separated into age groups by decade to ensure an even distribution of ages for statistical analysis. Patients older than 70 years were grouped together to provide case numbers comparable to those of the other decades. Logistic regression analysis was performed to evaluate the significance of the results. Three board-certified radiologists, including two musculoskeletal fellows and a radiology resident, retrospectively evaluated CT scans for lumbar spondylolysis, including unilateral and bilateral defects. Of the 2,555 cases evaluated, there were 203 positive cases of defects of the lumbar pars interarticularis. This corresponded to an overall prevalence of 8.0%. Prevalence per decade was fairly evenly distributed and ranged from 7.0%(ages 30-39 years) to 9.2% (ages 70 years and above). Prevalence of ages 20-49 years was 7.9%, and that of ages 50 years and older was 8.0%. Male to female ratio was 1.5:1. Logistic regression showed no significant increase in spondylolysis based on age. No significant increase in the prevalence of lumbar spondylolysis was demonstrated in patients older than 20 years. This suggests that the development of symptomatic lumbar pars defects do not occur in this population and should not be considered as a rare but potentially treatable cause of new onset low back pain in adults. This study demonstrated an overall prevalence of pars defects of 8

  11. Psoas muscle architectural design, in vivo sarcomere length range, and passive tensile properties support its role as a lumbar spine stabilizer.

    Science.gov (United States)

    Regev, Gilad J; Kim, Choll W; Tomiya, Akihito; Lee, Yu Po; Ghofrani, Hossein; Garfin, Steven R; Lieber, Richard L; Ward, Samuel R

    2011-12-15

    Controlled laboratory and cross-sectional study designs. To determine psoas major (PM) muscle architectural properties, in vivo sarcomere-length operating range, and passive mechanical properties. PM is an important hip flexor but its role in lumbar spine function is not fully understood. Several investigators have detailed the gross anatomy of PM, but comprehensive architectural data and in vivo length-tension and passive mechanical behaviors have not been documented. PM was isolated in 13 cadaver specimens, permitting architectural measurements of physiological cross-sectional area (PCSA), normalized fiber length (Lf), and Lf:muscle length (Lm) ratio. Sarcomere lengths were measured in vivo from intraoperative biopsies taken with the hip joint in flexed and extended positions. Single-fiber and fiber bundle tensile properties and titin molecular weight were then measured from separate biopsies. Architecturally, average PCSA was 18.45 ± 1.32 cm2, average Lf was 12.70 ± 2 cm, and average Lf: Lm was 0.48 ± 0.06. Intraoperative sarcomere length measurements revealed that the muscle operates from 3.18 ± 0.20 μm with hip flexed at 10.7° ± 13.9° to 3.03 ± 0.22 μm with hip flexed at 55.9° ± 21.4°. Passive mechanical data demonstrated that the elastic modulus of the PM muscle fibers was 37.44 ± 9.11 kPa and of fiber bundles was 55.3 ± 11.8 kPa. Analysis of PM architecture demonstrates that its average Lf and passive biomechanical properties resemble those of the lumbar erector spinae muscles. In addition, PM sarcomere lengths were confined to the descending portion of the length-tension curve allowing the muscle to become stronger as the hip is flexed and the spine assumes a forward leaning posture. These findings suggest that the human PM has architectural and physiologic features that support its role as both a flexor of the hip and a dynamic stabilizer of the lumbar spine.

  12. Effects of nonlinearity in the materials used for the semi-rigid pedicle screw systems on biomechanical behaviors of the lumbar spine after surgery

    International Nuclear Information System (INIS)

    Kim, Hyun; Lee, Sung-Jae; Lim, Do-Hyung; Oh, Hyun-Ju; Lee, Kwon-Yong

    2011-01-01

    Recently, various types of semi-rigid pedicle screw fixation systems have been developed for the surgical treatment of the lumbar spine. They were introduced to address the adverse issues commonly found in traditional rigid spinal fusion--abnormally large motion at the adjacent level and subsequent degeneration. The semi-rigid system uses more compliant materials (nitinol or polymers) and/or changes in rod design (coiled or twisted rods) as compared to the conventional rigid straight rods made of Ti alloys (E = 114 GPa, υ = 0.32). However, biomechanical studies on the semi-rigid pedicle screw systems were usually limited to linear modeling of the implant and anatomic elements, which may not be capable of reflecting realistic post-operative motions of the spine. In this study, we evaluated the effects of nonlinearity in materials used for semi-rigid pedicle screw fixation systems to evaluate the changes in biomechanical behaviors using finite element analysis. Changes in range of motion (ROM) and center of rotation (COR) were assessed at the operated and adjacent levels. Actual load-displacement results of the semi-rigid rod from mechanical test were carried out to reflect the nonlinearity of the implant. In addition, nonlinear material properties of various spinal ligaments studies were used for the finite element modeling. The post-operative models were constructed by modifying the previously validated intact model of the L1-S1 spine. Eight different post-operative models were made to address the effects of nonlinearity-with a traditional stiffness modulus rod (with linear ligaments, case 1; with nonlinear ligaments, case 5), with a rigid rod (with linear ligaments, case 2; with nonlinear ligaments, case 6), with a soft rod (with linear ligaments, case 3; with nonlinear ligaments, case 7), and with a nonlinear rod (with linear ligaments, case 4; with nonlinear ligaments, case 8). To simulate the load on the lumbar spine in a neutral posture, follower load (400 N

  13. Biomechanical study of percutaneous lumbar diskectomy

    International Nuclear Information System (INIS)

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

    2003-01-01

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

  14. The Clinical Correlations between Diabetes, Cigarette Smoking and Obesity on Intervertebral Degenerative Disc Disease of the Lumbar Spine.

    Science.gov (United States)

    Jakoi, Ande M; Pannu, Gurpal; D'Oro, Anthony; Buser, Zorica; Pham, Martin H; Patel, Neil N; Hsieh, Patrick C; Liu, John C; Acosta, Frank L; Hah, Raymond; Wang, Jeffrey C

    2017-06-01

    Retrospective analysis of a nationwide private insurance database. Chi-square analysis and linear regression models were utilized for outcome measures. The purpose of this study was to investigate any relationship between lumbar degenerative disc disease, diabetes, obesity and smoking tobacco. Diabetes, obesity, and smoking tobacco are comorbid conditions known to individually have effect on degenerative disc disease. Most studies have only been on a small populous scale. No study has yet to investigate the combination of these conditions within a large patient cohort nor have they reviewed the combination of these conditions on degenerative disc disease. A retrospective analysis of insurance billing codes within the nationwide Humana insurance database was performed, using PearlDiver software (PearlDiver, Inc., Fort Wayne, IN, USA), to identify trends among patients diagnosed with lumbar disc degenerative disease with and without the associated comorbidities of obesity, diabetes, and/or smoking tobacco. Patients billed for a comorbidity diagnosis on the same patient record as the lumbar disc degenerative disease diagnosis were compared over time to patients billed for lumbar disc degenerative disease without a comorbidity. There were no sources of funding for this manuscript and no conflicts of interest. The total number and prevalence of patients (per 10,000) within the database diagnosed with lumbar disc degenerative disease increased by 241.4% and 130.3%, respectively. The subsets of patients within this population who were concurrently diagnosed with either obesity, diabetes, tobacco use, or a combination thereof, was significantly higher than patients diagnosed with lumbar disc degenerative disease alone ( p degenerative disease and smoking rose significantly more than patients diagnosed with lumbar disc degenerative disease and either diabetes or obesity ( p degenerative disease, smoking and obesity rose significantly more than the number of patients

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-10-01

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

  16. Comparison of Model Predictions of Image Quality with Results of Clinical Trials in Chest and Lumbar Spine Screen-film Imaging

    International Nuclear Information System (INIS)

    Sandborg, M.; McVey, G.; Dance, D.R.; Carlsson, G.A.

    2000-01-01

    The ability to predict image quality from known physical and technical parameters is a prerequisite for making successful dose optimisation. In this study, imaging systems have been simulated using a Monte Carlo model of the imaging systems. The model includes a voxelised human anatomy and quantifies image quality in terms of contrast and signal-to-noise ratio for 5-6 anatomical details included in the anatomy. The imaging systems used in clinical trials were simulated and the ranking of the systems by the model and radiologists compared. The model and the results of the trial for chest PA both show that using a high maximum optical density was significantly better than using a low one. The model predicts that a good system is characterised by a large dynamic range and a high contrast of the blood vessels in the retrocardiac area. The ranking by the radiologists and the model agreed for the lumbar spine AP. (author)

  17. A milk and cereal dietary pattern is associated with a reduced likelihood of having a low bone mineral density of the lumbar spine in Korean adolescents.

    Science.gov (United States)

    Shin, Sangah; Hong, Kyungeui; Kang, Seung Wan; Joung, Hyojee

    2013-01-01

    The traditional rice-based Korean diet has been changing toward a Western-style diet. This change has been especially rapid among adolescents. The purpose of this study was to investigate the association between dietary patterns and bone health among Korean adolescents. This cross-sectional study was conducted on 196 adolescents aged 12 to 15 years. Information on the general characteristics of the subjects was obtained through a questionnaire, and dietary intake was assessed with 6-day food records. Bone mineral densities (BMDs) of the lumbar spine and femur were measured by dual-energy x-ray absorptiometry. Dietary patterns were derived from 24 food groups using factor analysis. Four distinct dietary patterns-traditional Korean, fast food, milk and cereal, and snacks-were identified and accounted for 28.4% of the total variance. After adjusting for sex, age, body mass index percentiles, weight loss attempts, pubertal status, and regular exercise, the adolescents in the highest tertile of the "milk and cereal" dietary pattern score had significantly a reduced likelihood of having low BMD compared with those in the lowest tertile of this diet at the lumbar spine (odds ratio, 0.36; 95% confidence interval, 0.14-0.93; P = .0461). The other dietary patterns were not associated with the BMD of Korean adolescents. These results indicate that the intake of milk and cereal is important for the bone health of Korean adolescents, whose diets are composed mainly of grains and vegetables. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension: technical note.

    Science.gov (United States)

    Mendel, Ehud; Nathoo, Narendra; Scharschmidt, Thomas; Schmidt, Carl; Boehmler, James; Mayerson, Joel L

    2014-03-01

    En bloc resection with negative tumor margins remains the principal treatment option for control or cure of primary pelvic chondrosarcomas, as current adjuvant therapies remain ineffective. Iliosacral chondrosarcomas with involvement of the sciatic notch are sufficiently challenging tumors. However, when there is concomitant lumbar extension requiring resection of the pedicles to maintain negative surgical margins, transpedicular screw fixation is not possible, making reconstruction of the lumbopelvic junction extremely challenging. A patient with an iliosacral chondrosarcoma with lumbar spine extension is presented in this report to illustrate a novel lumbopelvic spinal construct. Following combined external pelvectomy and hemisacrectomy with contralateral L3-5 hemilaminectomy and ipsilateral pediculotomy, bicortical transvertebral body screws were substituted for the missing pedicles, resulting in the creation of "false pedicles," which were further supplemented with an autologous vascularized fibular strut graft from the amputated lower limb and applied to the lateral aspect of the vertebral bodies. The creation of false pedicles allowed for a robust reconstruction of the lumbopelvic junction, including maintaining pelvic ring integrity with a "neo-pelvis", creating a functional load-bearing construct adequate for early mobilization and ambulation. The biomechanical dynamics of this unique construct are also discussed.

  19. A biomechanical comparison in the lower limb and lumbar spine between a hit and drag flick in field hockey.

    Science.gov (United States)

    Ng, Leo; Rosalie, Simon M; Sherry, Dorianne; Loh, Wei Bing; Sjurseth, Andreas M; Iyengar, Shrikant; Wild, Catherine Y

    2018-03-01

    Research has revealed that field hockey drag flickers have greater odds of hip and lumbar injuries compared to non-drag flickers (DF). This study aimed to compare the biomechanics of a field hockey hit and a specialised field hockey drag flick. Eighteen male and seven female specialised hockey DF performed a hit and a drag flick in a motion analysis laboratory with an 18-camera three-dimensional motion analysis system and a calibrated multichannel force platform to examine differences in lower limb and lumbar kinematics and kinetics. Results revealed that drag flicks were performed with more of a forward lunge on the left lower limb resulting in significantly greater left ankle dorsiflexion, knee, hip and lumbar flexion (Pshit. Drag flicks were also performed with significantly greater lateral flexion (P hit. Differences in kinematics lead to greater shear, compression and tensile forces in multiple left lower limb and lumbar joints in the drag flick compared to the hit (P hit may have ramifications with respect to injury in field hockey drag flickers.

  20. The standardized creation of a lumbar spine vertebral compression fracture in a sheep osteoporosis model induced by ovariectomy, corticosteroid therapy and calcium/phosphorus/vitamin D-deficient diet.

    Science.gov (United States)

    Eschler, Anica; Röpenack, Paula; Herlyn, Philipp K E; Roesner, Jan; Pille, Kristin; Büsing, Kirsten; Vollmar, Brigitte; Mittlmeier, Thomas; Gradl, Georg

    2015-10-01

    Vertebral compression fractures (VCFs) are one of the most common injuries in the aging population presenting with an annual incidence of 1.4 million new cases in Europe. Current treatment strategies focus on cement-associated solutions (kyphoplasty/vertebroplasty techniques). Specific cement-associated problems as leakage, embolism and the adjacent fracture disease are reported adding to open questions like general fracture healing properties of the osteoporotic spine. In order to analyze those queries animal models are of great interest; however, both technical difficulties in the induction of experimental osteoporosis in animal as well as the lack of a standardized fracture model impede current and future in vivo studies. This study introduces a standardized animal model of an osteoporotic VCF type A3.1 that may enable further in-depth analysis of the afore mentioned topics. Twenty-four 5-year-old female Merino sheep (mean body weight: 67 kg; range 57-79) were ovariectomized (OP1) and underwent 5.5 months of weekly corticosteroid injections (dexamethasone and dexamethasone-sodium-phosphate), adding to a calcium/phosphorus/vitamin D-deficient diet. Osteoporosis induction was documented by pQCT and micro-CT BMD (bone mineral density) as well as 3D histomorphometric analysis postoperatively of the sheep distal radius and spine. Non osteoporotic sheep served as controls. Induction of a VCF of the second lumbar vertebra was performed via a mini-lumbotomy surgical approach with a standardized manual compression mode (OP2). PQCT analysis revealed osteoporosis of the distal radius with significantly reduced BMD values (0.19 g/cm(3), range 0.13-0.22 vs. 0.27 g/cm(3), range 0.23-0.32). Micro-CT documented significant lowering of BMD values for the second lumbar vertebrae (0.11 g/cm(3), range 0.10-0.12) in comparison to the control group (0.14 g/cm(3), range 0.12-0.17). An incomplete burst fracture type A3.1 was achieved in all cases and resulted in a significant decrease

  1. EFFECTS OF POSTEROANTERIOR LUMBAR SPINE MOBILIZATIONS ON PAIN, ROM AND FUNCTIONAL DISABILITY IN FEMALE SUBJECTS WITH CHRONIC NONSPECIFIC LOW BACK PAIN

    Directory of Open Access Journals (Sweden)

    C. Shanthi

    2014-12-01

    Full Text Available Background: Chronic nonspecific low back pain (CNSLBP i.e., low back pain of at least 12 weeks duration without a specific cause is a major cause of activity limitation, absenteeism , and high health care expenses. The prevalence of CNSLBP is estimated approximately 23% and activity limitation due to LBP have been found to be 11% to 12% of the population. Previous studies comparing the efficacy of postero-anterior mobilisation and prone-press ups were done and revealed statistically significant improvements in extension ranges but not clinical relevant improvements. This is possibly attributable to single session of interventions. So long term gains in pain reduction and lumbar extension cannot be assumed. Hence this study would be intending to prove the effect of postero-anterior mobilisation and prone press ups on chronic non-specific low back pain after 6 weeks and their clinical application. Method: 30 subjects who met the inclusion criteria were selected randomly from the department of physiotherapy, SVIMS and BIRRD, Tirupati. The study conducted for a period of 6 weeks.2 groups were formed with 15 in each group. PA lumbar glide and prone press up's was given to group I and only prone press up's was given to group II. Subjects were evaluated pre and post treatment for VAS, extension ROM of lumbar spine and functional disability. Result: Results showed that there exists a statistical significance between the groups in all the 3 parameters. Present randomized clinical trial provided evidence to support the use of postero-anterior mobilisation and prone press-ups in relieving pain, improving ROM and reducing disability in subjects with non-specific low back pain. In addition, results supported that postero-anterior mobilisation was more effective than prone press-ups.

  2. Cross sectional CT morphology of the three lower lumbar vertebrae: with contributions to a more accurate interpretation of AP radiographs of the lumbar spine

    International Nuclear Information System (INIS)

    Schaik, J.P.J. van.

    1984-01-01

    This thesis is concerned with a cross-sectional morphological analysis of certain structures contained in the bony portion of the motion segments between L3 and S1, the vertebral bodies included. Measurements of lengths and angles were based on the use of constant reference points, which permitted comparative studies. Reference points were selected which were sufficiently well defined as to avoid gross errors in measurements. The lateral borders of the vertebral body of L3 are well visualized in AP radiographs, as well as the entire circumference of the pedicles. The bony cortical margins of these structures are more or less orientated in a sagittal direction, and are therefore caught by the X ray beam tangentially over the major part of their length. This tangential projection results in a sharp definition of these margins. Radiographic analysis of wired specimens of lumbar vertebrae showed that the shadow cast by the spinous process in the AP projection corresponds with its posterior portion. (Auth.)

  3. Measurement of the cross-sectional area of the dural tube in the lumbar spine on magnetic resonance imaging. Comparison between normal, pre- and post-discectomy conditions

    International Nuclear Information System (INIS)

    Matsubayashi, Yasutomo

    1997-01-01

    This study evaluated the usefulness of pre- and postoperative magnetic resonance imaging (MRI) of lumbar disc hernia with special attention to measurement of the cross-sectional area of the dural tube. Twenty-five patients (20 men and 5 women; 25 discs) who underwent posterior lumbar discectomy and 73 normal individuals (44 men and 29 women; 219 discs) of a similar age distribution were studied. Axial MRI was mainly used for the measurement of the dural tube. In the patient group, MRI examination was performed 1, 3, 6, and 12 months postoperatively. Assessment of the clinical symptoms was also included and used for comparison with the MRI evaluation. The cross-sectional area was significantly reduced to about 50% of the normal preoperatively. One month postoperatively, there was no significant increase in the size of the area, but after three months, the area increased significantly and progressed to the normal size within a year. One-month postoperatively, MRI examination was not considered useful because of postoperative hematoma and/or edema at the surgical site. The increase in the size of the cross-sectional area of the dural tube correlated well with the improvement in clinical symptoms. Three-months postoperatively, MRI evaluation of the lumbar disc seemed useful and measurement of the cross-sectional area of the dural tube appeared to serve as an indicator of the effectiveness of the surgery. (author)

  4. Measurement of the cross-sectional area of the dural tube in the lumbar spine on magnetic resonance imaging. Comparison between normal, pre- and post-discectomy conditions

    Energy Technology Data Exchange (ETDEWEB)

    Matsubayashi, Yasutomo [Juntendo Univ., Tokyo (Japan). School of Medicine

    1997-07-01

    This study evaluated the usefulness of pre- and postoperative magnetic resonance imaging (MRI) of lumbar disc hernia with special attention to measurement of the cross-sectional area of the dural tube. Twenty-five patients (20 men and 5 women; 25 discs) who underwent posterior lumbar discectomy and 73 normal individuals (44 men and 29 women; 219 discs) of a similar age distribution were studied. Axial MRI was mainly used for the measurement of the dural tube. In the patient group, MRI examination was performed 1, 3, 6, and 12 months postoperatively. Assessment of the clinical symptoms was also included and used for comparison with the MRI evaluation. The cross-sectional area was significantly reduced to about 50% of the normal preoperatively. One month postoperatively, there was no significant increase in the size of the area, but after three months, the area increased significantly and progressed to the normal size within a year. One-month postoperatively, MRI examination was not considered useful because of postoperative hematoma and/or edema at the surgical site. The increase in the size of the cross-sectional area of the dural tube correlated well with the improvement in clinical symptoms. Three-months postoperatively, MRI evaluation of the lumbar disc seemed useful and measurement of the cross-sectional area of the dural tube appeared to serve as an indicator of the effectiveness of the surgery. (author)

  5. The Kinematics and Spondylosis of the Lumbar Spine Vary Depending on the Levels of Motion Segments in Individuals With Low Back Pain.

    Science.gov (United States)

    Basques, Bryce A; Espinoza Orías, Alejandro A; Shifflett, Grant D; Fice, Michael P; Andersson, Gunnar B; An, Howard S; Inoue, Nozomu

    2017-07-01

    A prospective cohort study. The aim of this study was to identify associations of spondylotic and kinematic changes with low back pain (LBP). The ability to characterize and differentiate the biomechanics of both the symptomatic and asymptomatic lumbar spine is crucial to alleviate the sparse literature on the association of