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Sample records for degenerative lumbar stenosis

  1. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging.

    PubMed

    Sirvanci, Mustafa; Bhatia, Mona; Ganiyusufoglu, Kursat Ali; Duran, Cihan; Tezer, Mehmet; Ozturk, Cagatay; Aydogan, Mehmet; Hamzaoglu, Azmi

    2008-05-01

    Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation of patient's disability level and radiographic constriction of the lumbar spinal canal is of interest. The aim of this study was to establish a relationship between the degree of radiologically established anatomical stenosis and the severity of self-assessed Oswestry Disability Index in patients undergoing surgery for degenerative lumbar spinal stenosis. Sixty-three consecutive patients with degenerative lumbar spinal stenosis who were scheduled for elective surgery were enrolled in the study. All patients underwent preoperative magnetic resonance imaging and completed a self-assessment Oswestry Disability Index questionnaire. Quantitative image evaluation for lumbar spinal stenosis included the dural sac cross-sectional area, and qualitative evaluation of the lateral recess and foraminal stenosis were also performed. Every patient subsequently answered the national translation of the Oswestry Disability Index questionnaire and the percentage disability was calculated. Statistical analysis of the data was performed to seek a relationship between radiological stenosis and percentage disability recorded by the Oswestry Disability Index. Upon radiological assessment, 27 of the 63 patients evaluated had severe and 33 patients had moderate central dural sac stenosis; 11 had grade 3 and 27 had grade 2 nerve root compromise in the lateral recess; 22 had grade 3 and 37 had grade 2 foraminal stenosis. On the basis of the percentage disability score, of the 63 patients, 10 patients demonstrated mild disability, 13 patients moderate disability, 25 patients severe disability, 12 patients were crippled and three patients were bedridden. Radiologically, eight patients with severe central stenosis and nine patients with moderate lateral stenosis demonstrated only minimal disability on percentage Oswestry Disability Index scores. Statistical evaluation of central and lateral radiological stenosis versus Oswestry Disability Index percentage scores showed no significant correlation. In conclusion, lumbar spinal stenosis remains a clinico-radiological syndrome, and both the clinical picture and the magnetic resonance imaging findings are important when evaluating and discussing surgery with patients having this diagnosis. MR imaging has to be used to determine the levels to be decompressed. PMID:18324426

  2. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR Imaging

    PubMed Central

    Bhatia, Mona; Ganiyusufoglu, Kursat Ali; Duran, Cihan; Tezer, Mehmet; Ozturk, Cagatay; Aydogan, Mehmet; Hamzaoglu, Azmi

    2008-01-01

    Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation of patient’s disability level and radiographic constriction of the lumbar spinal canal is of interest. The aim of this study was to establish a relationship between the degree of radiologically established anatomical stenosis and the severity of self-assessed Oswestry Disability Index in patients undergoing surgery for degenerative lumbar spinal stenosis. Sixty-three consecutive patients with degenerative lumbar spinal stenosis who were scheduled for elective surgery were enrolled in the study. All patients underwent preoperative magnetic resonance imaging and completed a self-assessment Oswestry Disability Index questionnaire. Quantitative image evaluation for lumbar spinal stenosis included the dural sac cross-sectional area, and qualitative evaluation of the lateral recess and foraminal stenosis were also performed. Every patient subsequently answered the national translation of the Oswestry Disability Index questionnaire and the percentage disability was calculated. Statistical analysis of the data was performed to seek a relationship between radiological stenosis and percentage disability recorded by the Oswestry Disability Index. Upon radiological assessment, 27 of the 63 patients evaluated had severe and 33 patients had moderate central dural sac stenosis; 11 had grade 3 and 27 had grade 2 nerve root compromise in the lateral recess; 22 had grade 3 and 37 had grade 2 foraminal stenosis. On the basis of the percentage disability score, of the 63 patients, 10 patients demonstrated mild disability, 13 patients moderate disability, 25 patients severe disability, 12 patients were crippled and three patients were bedridden. Radiologically, eight patients with severe central stenosis and nine patients with moderate lateral stenosis demonstrated only minimal disability on percentage Oswestry Disability Index scores. Statistical evaluation of central and lateral radiological stenosis versus Oswestry Disability Index percentage scores showed no significant correlation. In conclusion, lumbar spinal stenosis remains a clinico-radiological syndrome, and both the clinical picture and the magnetic resonance imaging findings are important when evaluating and discussing surgery with patients having this diagnosis. MR imaging has to be used to determine the levels to be decompressed. PMID:18324426

  3. Fitts's Law using lower extremity movement: Performance driven outcomes for degenerative lumbar spinal stenosis.

    PubMed

    Passmore, Steven R; Johnson, Michael G; Kriellaars, Dean J; Pelleck, Valerie; Enright, Austin; Glazebrook, Cheryl M

    2015-12-01

    A paucity of objective outcome measures exists for assessing movement disorders, including degenerative lumbar spinal stenosis (LSS). Fitts's Law provides a novel approach to clinical outcome measurement since performance is resistant to learning, and task difficulty can be altered. The objective of the present study was to compare, using a Fitts's task, movement performance of individuals with and without LSS to determine if motor difficulties that arise with LSS impede the planning, initiation, or execution of deliberate lower limb movements. Twelve pre-surgical LSS patients and twelve control participants from the community performed a Fitts's Law (foot reaching) task, while LSS participants also completed pain and disability questionnaires. Fitts's Law was evident for both groups, however the LSS group's movements were more adversely impacted as task difficulty increased. Specifically, the LSS group's movement time and time to peak velocity (ttPV) increased as task index of difficulty increased, while peak velocity decreased. Correlations between ttPV and leg pain, and with stenosis impairment severity respectively, provided evidence that less support leg pain and less stenosis impairment severity yield faster ttPV in the moving leg at the highest index of difficulty. Therefore a lower extremity Fitts's Law task captured differences in the planning and execution of leg movements between healthy and LSS populations. PMID:26433923

  4. Physical Therapy Interventions for Degenerative Lumbar Spinal Stenosis: A Systematic Review

    PubMed Central

    Macedo, Luciana Gazzi; Hum, Abraham; Kuleba, Laura; Mo, Joey; Truong, Linda; Yeung, Mankeen

    2013-01-01

    Background Physical therapy is commonly prescribed for patients with lumbar spinal stenosis (LSS); however, little is known about its effectiveness. Purpose The purpose of this study was to systematically review randomized controlled trials (RCTs), controlled trials, and cohort studies evaluating the effectiveness of physical therapy for LSS. Data Sources Studies were searched on electronic databases to January 2012. Study Selection Inclusion criteria were: clinical diagnosis of LSS with confirmatory imaging, evaluation of physical therapy treatment, presence of a comparison group, and outcomes of pain, disability, function, or quality of life. Data Extraction Outcomes were extracted and, when possible, pooled using RevMan 5, a freely available review program from the Cochrane Library. Data Synthesis Ten studies were included: 5 RCTs, 2 controlled trials, 2 mixed-design studies, and 1 longitudinal cohort study. Pooled effects of 2 studies revealed that the addition of a physical therapy modality to exercise had no statistically significant effect on outcome. Pooled effects results of RCTs evaluating surgery versus physical therapy demonstrated that surgery was better than physical therapy for pain and disability at long term (2 years) only. Other results suggested that exercise is significantly better than no exercise, that cycling and body-weight–supported treadmill walking have similar effects, and that corsets are better than no corsets. Limitations The limitations of this review include the low quality and small number of studies, as well as the heterogeneity in outcomes and treatments. Conclusions No conclusions could be drawn from the review regarding which physical therapy treatment is superior for LSS. There was low-quality evidence suggesting that modalities have no additional effect to exercise and that surgery leads to better long-term (2 years) outcomes for pain and disability, but not walking distance, than physical therapy in patients with LSS. PMID:23886845

  5. Lumbar Spinal Stenosis

    PubMed Central

    Genevay, Stephane

    2009-01-01

    Lumbar spinal stenosis (LSS) is most commonly due to degenerative changes in older individuals. LSS is being more commonly diagnosed and may relate to better access to advanced imaging and to an aging population. This review focuses on radicular symptoms related to degenerative central and lateral stenosis and updates knowledge of LSS pathophysiology, diagnosis and management. Since patients with anatomic LSS can range from asymptomatic to severely disabled, the clinical diagnosis focuses on symptoms and examination findings associated with LSS. Imaging findings are helpful for patients with persistent, bothersome symptoms in whom invasive treatments are being considered. There is limited information from high quality studies about the relative benefits and harms of commonly used treatments. Interpreting and comparing results of available research is limited by a lack of consensus about the definition of LSS. Nevertheless, evidence supports decompressive laminectomy for patients with persistent and bothersome symptoms. Recommendations favor a shared decision making approach due to important trade-offs between alternative therapies and differences among patients in their preferences and values. PMID:20227646

  6. Superion® InterSpinous Spacer for treatment of moderate degenerative lumbar spinal stenosis: durable three-year results of a randomized controlled trial

    PubMed Central

    Patel, Vikas V; Nunley, Pierce D; Whang, Peter G; Haley, Thomas R; Bradley, W Daniel; Davis, Raphael P; Block, Jon E; Geisler, Fred H

    2015-01-01

    Purpose This report provides the 3-year clinical outcomes from the randomized, controlled US Food and Drug Administration Investigational Device Exemption trial of the Superion® for the treatment of moderate degenerative lumbar spinal stenosis. Patients and methods The Superion® was evaluated in the treatment of subjects aged 45 years or older suffering from symptoms of intermittent neurogenic claudication, secondary to a confirmed diagnosis of moderate degenerative lumbar spinal stenosis at one or two contiguous levels from L1 to L5. Patients were treated between June 2008 and December 2011 at 31 investigational sites. Three hundred ninety-one subjects were included in the randomized study group consisting of 190 Superion® and 201 X-STOP® control subjects. The primary composite endpoint was individual patient success based on four components: improvement in two of three domains of the Zurich Claudication Questionnaire, no reoperations at the index level, no major implant/procedure-related complications, and no clinically significant confounding treatments. Results At 3 years, the proportion of subjects achieving the primary composite endpoint was greater for Superion® (63/120, 52.5%) than for X-STOP® (49/129, 38.0%) (P=0.023) and the corresponding success rates exceeded 80% for each of the individual components of the primary endpoint in the Superion® group (range: 81%–91%). Improvements in back and leg pain severity as well as back- and disease-specific functional outcomes were also maintained through 36 months. Conclusion The 3-year outcomes from this randomized controlled trial demonstrate durable clinical improvement consistently across all clinical outcomes for the Superion® in the treatment of patients with moderate degenerative lumbar spinal stenosis. PMID:26491369

  7. Semi-Circumferential Decompression: Microsurgical Total en-bloc Ligamentum Flavectomy to Treat Lumbar Spinal Stenosis with Grade I Degenerative Spondylolisthesis

    PubMed Central

    Choi, Jun Cheol; Oh, Sang Hun; Park, Sub Ri; Park, Sang Jun; Cho, Nam Ik

    2015-01-01

    Background To describe and assess clinical outcomes of the semi-circumferential decompression technique for microsurgical en-bloc total ligamentum flavectomy with preservation of the facet joint to treat the patients who have a lumbar spinal stenosis with degenerative spondylolisthesis. Methods We retrospectively analyzed the clinical and radiologic outcomes of 19 patients who have a spinal stenosis with Meyerding grade I degenerative spondylolisthesis. They were treated using the "semi-circumferential decompression" method. We evaluated improvements in back and radiating pain using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). We also evaluated occurrence of spinal instability on radiological exam using percentage slip and slip angle. Results The mean VAS score for back pain decreased significantly from 6.3 to 4.3, although some patients had residual back pain. The mean VAS for radiating pain decreased significantly from 8.3 to 2.5. The ODI score improved significantly from 25.3 preoperatively to 10.8 postoperatively. No significant change in percentage slip was observed (10% preoperatively vs. 12.2% at the last follow-up). The dynamic percentage slip (gap in percentage slip between flexion and extension X-ray exams) did not change significantly (5.2% vs. 5.8%). Slip angle and dynamic slip angle did not change (3.2° and 8.2° vs. 3.6° and 9.2°, respectively). Conclusions The results suggested that semi-circumferential decompression is a clinically recommendable procedure that can improve pain. This procedure does not cause spinal instability when treating patients who have a spinal stenosis with degenerative spondylolisthesis.

  8. The effects of aquatic walking and jogging program on physical function and fall efficacy in patients with degenerative lumbar spinal stenosis

    PubMed Central

    Lee, Jae-Hyun; Sung, Eunsook

    2015-01-01

    The purpose of this study was to evaluate the effects of 12-week aqua walking and jogging program on muscle function, ankle range of motion (ROM), balance and fell efficacy in degenerative lumbar spinal stenosis (DLSS) patients. Six patients (2 males, 4 females) with DLSS participated in aquatic exercise program 3 times per week with each session of 60 min (warming-up, aqua walking, aqua jogging and cool down) at 1 m 20 cm–1 m 30 cm deep pool. Janda’s muscle function test, ankle ROM, Berg balance scale (BBS) and fall efficacy scale (FES) were analyzed before and after the training intervention. We found significant increases in balance, muscle function, ankle ROM and fall efficacy after training intervention. In conclusion, aquatic exercise seems to affect physical function and fall efficacy positively in elderly DLSS patients. PMID:26535218

  9. Lumbar spinal stenosis.

    PubMed

    Chad, David A

    2007-05-01

    Lumbar spinal stenosis may be congenital or acquired. A classic clinical presentation is described as neurogenic claudication. Physical signs of sensory loss, weakness, and attenuation of reflexes often are mild and limited in distribution. Neuroimaging of the lumbosacral spine with MRI and electrodiagnostic (electromyographic [EMG]) tests are the most informative diagnostic modalities. Conservative management often is successful, but surgical decompression may be indicated in refractory cases. PMID:17445736

  10. Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT)

    PubMed Central

    Rihn, Jeffrey A.; Radcliff, Kristen; Hilibrand, Alan S.; Anderson, David T.; Zhao, Wenyan; Lurie, Jon; Vaccaro, Alexander R.; Freedman, Mitch K.; Albert, Todd J.; Weinstein, James N.

    2013-01-01

    Study Design Retrospective subgroup analysis of prospectively collected data according to treatment received. Objective The purpose of this study is to determine if obesity affects treatment outcomes for lumbar stenosis (SpS) and degenerative spondylolisthesis (DS). Summary of Background Data Obesity is thought to be associated with increased complications and potentially less favorable outcomes following the treatment of degenerative conditions of the lumbar spine. This, however, remains a matter of debate in the existing literature. Methods An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of SpS or DS. A comparison was made between patients with a body mass index (BMI) <30 (“non-obese”, n=373 SpS, 376 DS) and those with a BMI ? 30 (“obese”, n=261 SpS, 225 DS). Baseline patient characteristics, intraoperative data, and complications were documented. Primary and secondary outcomes were measured at baseline and regular follow-up time intervals up to 4 years. The difference in improvement over baseline between surgical and nonsurgical treatment (i.e. treatment effect) was determined at each follow-up interval for the obese and nonobese groups. Results At 4-years follow-up, operative and nonoperative treatment provided improvement in all primary outcome measures over baseline in patients with BMI of < 30 and ? 30. For SpS patients, there were no differences in the surgical complication or reoperation rates between groups. DS patients with BMI ? 30 had a higher postoperative infection rate (5% vs. 1%, p=0.05) and twice the reoperation rate at 4-years follow-up (20% vs. 11%, p=0.01) than those with BMI < 30. At 4-years, surgical treatment of SpS and DS was equally effective in both BMI groups in terms of the primary outcome measures, with the exception that obese DS patients had less improvement from baseline in the SF36 physical function score compared to nonobese patients (22.6 vs. 27.9, p=0.022). With nonoperative treatment, SpS patients with BMI ? 30 did worse in regards to all three primary outcome measures, and DS patients with BMI ? 30 had similar SF-36 bodily pain scores but less improvement over baseline in the SF-36 physical function and ODI scores. Treatment effects for SpS and DS were significant within each BMI group for all primary outcome measures, in favor of surgery. Obese patients had a significantly greater treatment effect compared to nonobese patients with SpS (ODI, p=0.037) and DS (SF36 PF, p=0.004), largely due to the relatively poor outcome of nonoperative treatment in obese patients. Conclusion Obesity does not affect the clinical outcome of operative treatment for SpS. There are higher rates of infection and reoperation and less improvement from baseline in the SF-36 physical function score in obese patients following surgery for DS. Nonoperative treatment may not be as effective in obese patients with SpS or DS. PMID:22614793

  11. Efficacy of a Human Amniotic Tissue-derived Allograft, NuCel, in Patients Undergoing Posteriolateral Lumbar Fusions for Degenerative Disc Disease

    ClinicalTrials.gov

    2015-10-08

    Lumbar Degenerative Disc Disease; Spinal Stenosis; Spondylolisthesis; Spondylosis; Intervertebral Disk Displacement; Intervertebral Disk Degeneration; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases; Spondylolysis

  12. Management of lumbar spinal stenosis.

    PubMed

    Lurie, Jon; Tomkins-Lane, Christy

    2016-01-01

    Lumbar spinal stenosis (LSS) affects more than 200?000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality. PMID:26727925

  13. Effect of fusion following decompression for lumbar spinal stenosis: a meta-analysis and systematic review

    PubMed Central

    Liang, Lin; Jiang, Wei-Min; Li, Xue-Feng; Wang, Heng

    2015-01-01

    Purpose: The surgical methods of degenerative lumbar spinal stenosis include spinal decompression with or without instrumented or non-instrumented spinal fusion. Previous meta-analysis and systematic reviews have reported the contrast between surgical management and nonsurgical management for degenerative lumbar spinal stenosis, while no literature did among surgical managements. And it is evidenced that whether fusion should be added to spinal decompression in patients of lumbar spinal stenosis is still divisive. So our purpose is to identify whether spinal fusion with or without decompression has a better effect than decompression alone for patients with degenerative lumbar spinal stenosis. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) for reports before November 2014 and PubMed, EMBASE, GOOGLE SCHOLAR for those before December 2014. We also searched the reference lists included in studies and previous reviews. Randomized Controlled Trials and prospective or retrospective cohort studies of patients with degenerative lumbar spinal stenosis after spinal decompression with or without fusion were eligible. Abstracted outcomes from retrieved articles included clinical outcome and reoperation rate of two aspects. Both random-effects and fixed-effects models were used to calculate the end-points. Results: We identified 23 studies with data collected from 61576 patients. The combined relative risk (RR) of clinical outcome for the spinal fusion compared with the spinal decompression was 0.91 (95% confidence interval [CI]: 0.85 to 0.98), and little evidence of heterogeneity was observed. Namely, a satisfactory clinical outcome was significantly more likely with fusion than with decompression alone. But there was a trend toward a higher reoperation rate with fusion compared with decompression alone (RR: 0.93; 95% CI: 0.88 to 0.97). Conclusion: This meta-analysis provides robust evidence of a better clinical outcome but a higher reoperation rate for spinal fusion compared with decompression alone.

  14. Effects of interspinous spacers on lumbar degenerative disease

    PubMed Central

    ZHOU, DONG; NONG, LU-MING; DU, RUI; GAO, GONG-MING; JIANG, YU-QING; XU, NAN-WEI

    2013-01-01

    The present study aimed to evaluate the early effects of interspinous spacers on lumbar degenerative disease. The clinical outcomes of 23 patients with lumbar degenerative disease, treated using interspinous spacer implantation alone or combined with posterior lumbar fusion, were retrospectively studied and assessed with a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Pre-operative and post-operative interspinous distance, disc space height, foraminal width and height and segmental lordosis were determined. The early effects and complications associated with the interspinous spacers were recorded. The surgical procedures performed with the in-space treatment were easy and minimally invasive. The VAS scores and ODI were improved post-operatively compared with pre-operatively. Significant changes in the interspinous distance, disc space height, foraminal width and height and segmental lordosis were noted. In-space treatment for degenerative lumbar disease is easy and safe, with good early effects. The in-space system provides an alternative treatment for lumbar degenerative disease. PMID:23407682

  15. Controversies about Interspinous Process Devices in the Treatment of Degenerative Lumbar Spine Diseases: Past, Present, and Future

    PubMed Central

    Galarza, Marcelo

    2014-01-01

    A large number of interspinous process devices (IPD) have been recently introduced to the lumbar spine market as an alternative to conventional decompressive surgery in managing symptomatic lumbar spinal pathology, especially in the older population. Despite the fact that they are composed of a wide range of different materials including titanium, polyetheretherketone, and elastomeric compounds, the aim of these devices is to unload spine, restoring foraminal height, and stabilize the spine by distracting the spinous processes. Although the initial reports represented the IPD as a safe, effective, and minimally invasive surgical alternative for relief of neurological symptoms in patients with low back degenerative diseases, recent studies have demonstrated less impressive clinical results and higher rate of failure than initially reported. The purpose of this paper is to provide a comprehensive overview on interspinous implants, their mechanisms of action, safety, cost, and effectiveness in the treatment of lumbar stenosis and degenerative disc diseases. PMID:24822224

  16. Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study

    PubMed Central

    Kaya, Ramazan Alper; Türkmenoglu, Osman Nuri; Tuncer, Cengiz; Çolak, ?brahim; Ayd?n, Yunus

    2007-01-01

    The aim of our study is to evaluate the results and effectiveness of bilateral decompression via a unilateral approach in the treatment of degenerative lumbar spinal stenosis. We have conducted a prospective study to compare the midterm outcome of unilateral laminotomy with unilateral laminectomy. One hundred patients with 269 levels of lumbar stenosis without instability were randomized to two treatment groups: unilateral laminectomy (Group 1), and laminotomy (Group 2). Clinical outcomes were assessed with the Oswestry Disability Index (ODI) and Short Form–36 Health Survey (SF-36). Spinal canal size was measured pre- and postoperatively. The spinal canal was increased to 4–6.1-fold (mean 5.1 ± SD 0.8-fold) the preoperative size in Group 1, and 3.3–5.9-fold (mean 4.7 ± SD 1.1-fold) the preoperative size in Group 2. The mean follow-up time was 5.4 years (range 4–7 years). The ODI scores decreased significantly in both early and late follow-up evaluations and the SF-36 scores demonstrated significant improvement in late follow-up results in our series. Analysis of clinical outcome showed no statistical differences between two groups. For degenerative lumbar spinal stenosis unilateral approaches allowed sufficient and safe decompression of the neural structures and adequate preservation of vertebral stability, resulted in a highly significant reduction of symptoms and disability, and improved health-related quality of life. PMID:17712577

  17. Lumbar Stenosis: A Recent Update by Review of Literature

    PubMed Central

    Lee, Seung Yeop; Kim, Tae-Hwan; Oh, Jae Keun; Lee, Seung Jin

    2015-01-01

    Degeneration of the intervertebral disc results in initial relative instability, hypermobility, and hypertrophy of the facet joints, particularly at the superior articular process. This finally leads to a reduction of the spinal canal dimensions and compression of the neural elements, which can result in neurogenic intermittent claudication caused by venous congestion and arterial hypertension around nerve roots. Most patients with symptomatic lumbar stenosis had neurogenic intermittent claudication with the risk of a fall. However, although the physical findings and clinical symptoms in lumbar stenosis are not acute, the radiographic findings are comparatively severe. Magnetic resonance imaging is a noninvasive and good method for evaluation of lumbar stenosis. Though there are very few studies pertaining to the natural progression of lumbar spinal stenosis, symptoms of spinal stenosis usually respond favorably to non-operative management. In patients who fail to respond to non-operative management, surgical treatments such as decompression or decompression with spinal fusion are required. Restoration of a normal pelvic tilt after lumbar fusion correlates to a good clinical outcome. PMID:26435805

  18. Lumbar Stenosis: A Recent Update by Review of Literature.

    PubMed

    Lee, Seung Yeop; Kim, Tae-Hwan; Oh, Jae Keun; Lee, Seung Jin; Park, Moon Soo

    2015-10-01

    Degeneration of the intervertebral disc results in initial relative instability, hypermobility, and hypertrophy of the facet joints, particularly at the superior articular process. This finally leads to a reduction of the spinal canal dimensions and compression of the neural elements, which can result in neurogenic intermittent claudication caused by venous congestion and arterial hypertension around nerve roots. Most patients with symptomatic lumbar stenosis had neurogenic intermittent claudication with the risk of a fall. However, although the physical findings and clinical symptoms in lumbar stenosis are not acute, the radiographic findings are comparatively severe. Magnetic resonance imaging is a noninvasive and good method for evaluation of lumbar stenosis. Though there are very few studies pertaining to the natural progression of lumbar spinal stenosis, symptoms of spinal stenosis usually respond favorably to non-operative management. In patients who fail to respond to non-operative management, surgical treatments such as decompression or decompression with spinal fusion are required. Restoration of a normal pelvic tilt after lumbar fusion correlates to a good clinical outcome. PMID:26435805

  19. Total Disc Replacement in Lumbar Degenerative Disc Diseases

    PubMed Central

    2015-01-01

    More than 10 years have passed since lumbar total disc replacement (LTDR) was introduced for the first time to the world market for the surgical management of lumbar degenerative disc disease (DDD). It seems like the right time to sum up the relevant results in order to understand where LTDR stands on now, and is heading forward to. The pathogenesis of DDD has been currently settled, but diagnosis and managements are still controversial. Fusion is recognized as golden standard of surgical managements but has various kinds of shortcomings. Lately, LTDR has been expected to replace fusion surgery. A great deal of LTDR reports has come out. Among them, more than 5-year follow-up prospective randomized controlled studies including USA IDE trials were expected to elucidate whether for LTDR to have therapeutic benefit compared to fusion. The results of these studies revealed that LTDR was not inferior to fusion. Most of clinical studies dealing with LTDR revealed that there was no strong evidence for preventive effect of LTDR against symptomatic degenerative changes of adjacent segment disease. LTDR does not have shortcomings associated with fusion. However, it has a potentiality of the new complications to occur, which surgeons have never experienced in fusion surgeries. Consequently, longer follow-up should be necessary as yet to confirm the maintenance of improved surgical outcome and to observe any very late complications. LTDR still may get a chance to establish itself as a substitute of fusion both nominally and virtually if it eases the concerns listed above. PMID:26713139

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

    PubMed Central

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

    2015-01-01

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

  1. Surgical versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis

    PubMed Central

    Weinstein, James N.; Lurie, Jon D.; Tosteson, Tor D.; Hanscom, Brett; Tosteson, Anna N.A.; Blood, Emily A.; Birkmeyer, Nancy J.O.; Hilibrand, Alan S.; Herkowitz, Harry; Cammisa, Frank P.; Albert, Todd J.; Emery, Sanford E.; Lenke, Lawrence G.; Abdu, William A.; Longley, Michael; Errico, Thomas J.; Hu, Serena S.

    2008-01-01

    BACKGROUND Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials. METHODS Surgical candidates from 13 centers in 11 U.S. states who had at least 12 weeks of symptoms and image-confirmed degenerative spondylolisthesis were offered enrollment in a randomized cohort or an observational cohort. Treatment was standard decompressive laminectomy (with or without fusion) or usual nonsurgical care. The primary outcome measures were the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) bodily pain and physical function scores (100-point scales, with higher scores indicating less severe symptoms) and the modified Oswestry Disability Index (100-point scale, with lower scores indicating less severe symptoms) at 6 weeks, 3 months, 6 months, 1 year, and 2 years. RESULTS We enrolled 304 patients in the randomized cohort and 303 in the observational cohort. The baseline characteristics of the two cohorts were similar. The one-year crossover rates were high in the randomized cohort (approximately 40% in each direction) but moderate in the observational cohort (17% crossover to surgery and 3% crossover to nonsurgical care). The intention-to-treat analysis for the randomized cohort showed no statistically significant effects for the primary outcomes. The as-treated analysis for both cohorts combined showed a significant advantage for surgery at 3 months that increased at 1 year and diminished only slightly at 2 years. The treatment effects at 2 years were 18.1 for bodily pain (95% confidence interval [CI], 14.5 to 21.7), 18.3 for physical function (95% CI, 14.6 to 21.9), and ?16.7 for the Oswestry Disability Index (95% CI, ?19.5 to ?13.9). There was little evidence of harm from either treatment. CONCLUSIONS In nonrandomized as-treated comparisons with careful control for potentially confounding baseline factors, patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically. (ClinicalTrials.gov number, NCT00000409.) PMID:17538085

  2. Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disorders: Mini-open TLIF and Corrective TLIF

    PubMed Central

    HARA, Masahito; NISHIMURA, Yusuke; NAKAJIMA, Yasuhiro; UMEBAYASHI, Daisuke; TAKEMOTO, Masaya; YAMAMOTO, Yuu; HAIMOTO, Shoichi

    Minimally invasive transforaminal lumbar interbody fusion (TLIF) as a short fusion is widely accepted among the spine surgeons. However in the long fusion for degenerative kyphoscoliosis, corrective spinal fixation by an open method is thought to be frequently selected. Our objective is to study whether the mini-open TLIF and corrective TLIF contribute to the improvement of the spinal segmental and global alignment. We divided the patients who performed lumbar fixation surgery into three groups. Group 1 (G1) consisted of mini-open TLIF procedures without complication. Group 2 (G2) consisted of corrective TLIF without complication. Group 3 (G3) consisted of corrective TLIF with instrumentation-related complication postoperatively. In all groups, the lumbar lordosis (LL) highly correlated with developing surgical complications. LL significantly changed postoperatively in all groups, but was not corrected in the normal range in G3. There were statistically significant differences in preoperative and postoperative LL and mean difference between the pelvic incidence (PI) and LL between G3 and other groups. The most important thing not to cause the instrumentation-related failure is proper correction of the sagittal balance. In the cases with minimal sagittal imbalance with or without coronal imbalance, short fusion by mini-open TLIF or long fusion by corrective TLIF contributes to good clinical results if the lesion is short or easily correctable. However, if the patients have apparent sagittal imbalance with or without coronal imbalance, we should perform proper correction of the sagittal spinal alignment introducing various technologies. PMID:26119895

  3. Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years

    PubMed Central

    Tosteson, Anna N.A.; Lurie, Jon D.; Tosteson, Tor D.; Skinner, Jonathan S.; Herkowitz, Harry; Albert, Todd; Boden, Scott D.; Bridwell, Keith; Longley, Michael; Andersson, Gunnar B.; Blood, Emily A.; Grove, Margaret R.; Weinstein, James N.

    2009-01-01

    Background The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain. Objective To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis. Design Prospective cohort study. Data Sources Resource utilization, productivity, and EuroQol EQ-5D score measured at 6 weeks and at 3, 6, 12, and 24 months after treatment among SPORT participants. Target Population Patients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis. Time Horizon 2 years. Perspective Societal. Intervention Nonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis). Outcome Measures Cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis Among 634 patients with stenosis, 394 (62%) had surgery, most often decompressive laminectomy (320 of 394 [81%]). Stenosis surgeries improved health to a greater extent than nonoperative care (QALY gain, 0.17 [95% CI, 0.12 to 0.22]) at a cost of $77 600 (CI, $49 600 to $120 000) per QALY gained. Among 601 patients with degenerative spondylolisthesis, 368 (61%) had surgery, most including fusion (344 of 368 [93%]) and most with instrumentation (269 of 344 [78%]). Degenerative spondylolisthesis surgeries significantly improved health versus non-operative care (QALY gain, 0.23 [CI, 0.19 to 0.27]), at a cost of $115 600 (CI, $90 800 to $144 900) per QALY gained. Result of Sensitivity Analysis Surgery cost markedly affected the value of surgery. Limitation The study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment non-adherence among randomly assigned participants. Conclusion The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon. PMID:19075203

  4. Characteristics of Back Muscle Strength in Patients with Scheduled for Lumbar Fusion Surgery due to Symptomatic Lumbar Degenerative Diseases

    PubMed Central

    Park, Won Hah; Lee, Chong Suh; Kang, Kyung Chung

    2014-01-01

    Study Design Cross sectional study. Purpose To evaluate characteristics of back muscle strength in patients scheduled for lumbar fusion surgery. Overview of Literature Little is known regarding muscle strength in patients with symptomatic lumbar degenerative diseases who require fusion surgery. Methods Consecutive 354 patients scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases were approached for participation. 316 patients were enrolled. Before surgery, muscle strength was assessed by measuring maximal isometric extension strength at seven angular positions (0°, 12°, 24°, 36°, 48°, 60°, and 72°) and mean isometric strength was calculated. The Oswestry Disability Index (0-100) and visual analogue scale (0-100) for back pain were recorded. Muscle strength was compared according to gender, age (<60, 60-70, and ?70 years) and scheduled fusion level (short, <3; long, ?3). Results Isometric strength was significantly decreased compared with previously reported results of healthy individuals, particularly at extension positions (0°-48°, p<0.05). Mean isometric strength was significantly lower in females (p<0.001) and older patients (p<0.05). Differences of isometric strength between short and long level fusion were not significantly different (p>0.05). Isometric strengths showed significant, but weak, inverse correlations with age and Oswestry Disability Index (r<0.4, p<0.05). Conclusions In patients with symptomatic lumbar degenerative diseases, back muscle strength significantly decreased, particularly at lumbar extension positions, and in females and older patients. PMID:25346820

  5. Prognostic Factors of Surgical Outcome after Spinous Process-Splitting Laminectomy for Lumbar Spinal Stenosis

    PubMed Central

    Tachibana, Toshiya; Inoue, Shinichi; Arizumi, Fumihiro; Yoshiya, Shinichi

    2015-01-01

    Study Design A retrospective case review. Purpose To assess the clinical and radiographic outcomes and identify the predictive factors associated with poor clinical outcomes after lumbar spinous process-splitting laminectomy (LSPSL) for lumbar spinal stenosis (LSS). Overview of Literature LSPSL is an effective surgical treatment for LSS. Special care should be taken in patients with degenerative lumbar scoliosis (DLS). Methods A consecutive retrospective case review of patients undergoing LSPSL for LSS with a minimum 2-year follow-up was performed. Mild DLS and mild degenerative spondylolisthesis (DS) were included in the study. The Japanese Orthopedic Association (JOA) score and recovery rate were reviewed. Poor clinical outcome was defined as a recovery rate <50% using Hirabayashi's method. Results A total of 52 patients (mean age, 72 years) met the inclusion criteria and had a mean follow-up of 2.6 years (range, 2-4.5 years). The preoperative diagnosis was LSS in 19, DS in 19, and DLS in 14 cases. The mean JOA score significantly increased from 14.6 to 23.2 at the final follow-up. The overall mean recovery rate was 60.1%. Thirteen patients (25%) were assigned to the poor outcome group. A higher rate of pre-existing DLS was observed in the poor outcome (poor) group (good, 15%; poor, 62%; p=0.003) than in the good outcome (good) group. None of the patient factors examined were associated with a poor outcome. A progression of slippage ?5 mm was found in 8 of 24 patients (33%) in the DS group. A progression of curvature ?5° was found in 5 of 14 patients (36%) in the DLS group. The progression of scoliosis and slippage did not influence the clinical outcome. Conclusions The clinical and radiographic outcomes of LSPSL for LSS were favorable. Pre-existing DLS was significantly associated with poor clinical outcome. PMID:26435788

  6. Outcomes and Complications of Diabetes Mellitus on Patients Undergoing Degenerative Lumbar Spine Surgery

    PubMed Central

    Guzman, Javier Z.; Iatridis, James C.; Skovrlj, Branko; Cutler, Holt; Hecht, Andrew C.; Qureshi, Sheeraz A.; Cho, Samuel K.

    2014-01-01

    Study Design Retrospective database analysis. Objective To assess the effect glycemic control has on perioperative morbidity and mortality in patients undergoing elective degenerative lumbar spine surgery. Summary of background data Diabetes Mellitus (DM) is a prevalent disease of glucose dysregulation that has been demonstrated to increase morbidity and mortality following spine surgery. However, there is limited understanding of whether glycemic control influences surgical outcomes in DM patients undergoing lumbar spine procedures for degenerative conditions. Methods The Nationwide Inpatient Sample was analyzed from 2002 to 2011. Hospitalizations were isolated based on International Classification of Diseases Ninth Revision, Clinical Modification procedural codes for lumbar spine surgery and diagnoses codes for degenerative conditions of the lumbar spine. Patients were then classified into three cohorts: controlled diabetics, uncontrolled diabetics and non-diabetics. Patient demographic data, acute complications and hospitalization outcomes were determined for each cohort. Results A total of 403,629 (15.7%) controlled diabetics and 19,421(0.75%) uncontrolled diabetics underwent degenerative lumbar spine surgery from 2002-2011. Relative to non-diabetics, uncontrolled diabetics had significantly increased odds of cardiac complications, deep venous thrombosis and post-operative shock; additionally, uncontrolled diabetics also had an increased mean length of stay (approximately 2.5 days), greater costs (1.3-fold) and a greater risk of inpatient mortality (odds ratio=2.6, 95% confidence interval=1.5-4.8, p < .0009). Controlled diabetics also had increased risk of acute complications and inpatient mortality when compared to non-diabetics, but not nearly to the same magnitude as uncontrolled diabetics. Conclusion Suboptimal glycemic control in diabetic patients undergoing degenerative lumbar spine surgery leads to increased risk of acute complications and poor outcomes. Patients with uncontrolled DM, or poor glucose control, may benefit from improving glycemic control prior to surgery. PMID:24983935

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

    PubMed Central

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

    2015-01-01

    Abstract 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. PMID:26200620

  8. Percutaneous Decompression of Lumbar Spinal Stenosis with a New Interspinous Device

    SciTech Connect

    Masala, Salvatore; Fiori, Roberto; Bartolucci, Dario Alberto Volpi, Tommaso; Calabria, Eros; Novegno, Federica; Simonetti, Giovanni

    2012-04-15

    Objective: This study was designed to evaluate the feasibility of the implantation of a new interspinous device (Falena) in patients with lumbar spinal stenosis. The clinical outcomes and imaging results were assessed by orthostatic MR during an up to 6-month follow-up period. Methods: Between October 2008 and February 2010, the Falena was implanted at a single level in 26 patients (17 men; mean age, 69 (range, 54-82) years) who were affected by degenerative lumbar spinal stenosis. All of the patients were clinically evaluated before the procedure and at 1 and 3 months. Furthermore, 20 patients have completed a 6-month follow-up. Pain was assessed before and after the intervention using the Visual Analogue Scale score and the Oswestry Disability Index questionnaire. Orthostatic MR imaging was performed before the implantation and at 3 months to assess the correlation with the clinical outcome. Results: The mean ODI score decreased from 48.9 before the device implantation to 31.2 at 1 month (p < 0.0001). The mean VAS score decreased from 7.6 before to 3.9 (p < 0.0001) at 1 month and 3.6 at 3 months after the procedure (p = 0.0115). These values were stable at 6 months evaluation. No postimplantation major complications were recorded. MRI evaluation documented in most cases an increased size of the spinal canal area. Similarly a bilateral foraminal area improvement was found. The variation of the intervertebral space height measured on the posterior wall was not significant. Conclusions: In our preliminary experience with the Falena in a small cohort of patients, we obtained clinical and imaging results aligned to those reported with similar interspinous devices.

  9. Computer aided diagnosis of degenerative intervertebral disc diseases from lumbar MR images.

    PubMed

    Oktay, Ayse Betul; Albayrak, Nur Banu; Akgul, Yusuf Sinan

    2014-10-01

    This paper presents a novel method for the automated diagnosis of the degenerative intervertebral disc disease in midsagittal MR images. The approach is based on combining distinct disc features under a machine learning framework. The discs in the lumbar MR images are first localized and segmented. Then, intensity, shape, context, and texture features of the discs are extracted with various techniques. A Support Vector Machine classifier is applied to classify the discs as normal or degenerated. The method is tested and validated on a clinical lumbar spine dataset containing 102 subjects and the results are comparable to the state of the art. PMID:24972858

  10. Lumbar spinal stenosis is a highly genetic condition partly mediated by disc degeneration

    PubMed Central

    Battié, Michele C.; Ortega-Alonso, Alfredo; Niemelainen, Riikka; Gill, Kevin; Levalahti, Esko; Videman, Tapio; Kaprio, Jaakko

    2014-01-01

    Objectives Lumbar spinal stenosis is one of the most commonly diagnosed spinal disorders in older adults. Although the pathophysiology of the clinical syndrome is not well understood, a narrow central canal or intervertebral foramen is an essential or defining feature. The aim of the present study was to estimate the magnitude of genetic versus environmental influences on central lumbar spinal stenosis, and investigate disc degeneration and stature or bone development as possible genetic pathways. Methods A classic twin study with multivariate analyses considering lumbar level and other covariates was conducted. The study sample comprised 598 male twins (147 monozygotic and 152 dizygotic pairs), 35-70 years of age, from the population-based Finnish Twin Cohort. Primary phenotypes were central lumbar stenosis assessed qualitatively on MRI and quantitatively measured dural sac cross-sectional area. Additional phenotypes to examine possible genetic pathways included disc bulging and standing height, as an indicator of overall skeletal size or development. Results The heritability estimate (h2) for qualitatively assessed central lumbar spinal stenosis on MRI was 67% (95%CI: 56.8-74.5). The broad sense heritability estimate for dural sac cross-sectional area was 81.2% (95%CI: 74.5 – 86.1%), with a similar magnitude of genetic influences across lumbar levels (h2=72.4-75.6). The additive genetic correlation of quantitatively assessed stenosis and disc bulging was extremely high. There was no indication of shared genetic influences between stenosis and stature. Conclusion Central lumbar spinal stenosis and associated dural sac dimensions are highly genetic, and disc degeneration (bulging) appears to be one pathway through which genes influence spinal stenosis. PMID:25155712

  11. Factors Affecting Clinical Results after Corrective Osteotomy for Lumbar Degenerative Kyphosis

    PubMed Central

    Kim, Whoan Jeang; Kang, Sung Il; Sung, Hwan Il; Park, Kun Young; Park, Jae Guk; Kwon, Won Cho; Choy, Won Sik

    2010-01-01

    Study Design This study is a prospective, clinical study for lumbar degenerative kyphosis. Purpose To determine the factors affecting postoperative clinical outcomes in patients who undergo corrective osteotomy for lumbar degenerative kyphosis. Overview of Literature Only a small number of studies have reported clinical results for surgery for lumbar degenerative kyphosis. There are almost no studies about prognostic factors that predict postoperative clinical results. Methods This study involved 25 patients who were diagnosed with lumbar degenerative kyphosis and who underwent corrective osteotomy following gait analysis. A pedicle subtraction osteotomy was done at the third lumbar vertebra (L 3). Regarding the fusion level, surgery was done within a range from T10 proximally to S1 distally. Of these, for rigid fixation of a distal part, an iliac screw was used. Pain was evaluated using a 10-point pain scale and a questionnaire about activities. We also evaluated cosmesis and subjective satisfaction using a modified version of the Scoliosis Research Society Outcome-22 (SRS-22) instrument. This assessment was done using a 5-point scale which was designed by us. We assigned patients to group A (good clinical outcomes) if their postoperative pain score was lower than 4 (of 10 points) and if scores indicating activity, cosmesis and subjective satisfaction were higher than 11 (of 15 points). All other patients were assigned to group B (poor clinical outcomes). Results Clinical outcomes were good in 64% of patients (16/25) and poor in 36% (9/25). Regarding cosmesis and subjective satisfaction, there were significant differences between the two groups. There were also significant differences in physical factors of individual patients such as body mass index (BMI): 23.78 ± 2.79 in group A and 26.44 ± 2.75 in group B. On gait analysis, there was a significant difference in the dynamic pelvic tilt: 7.5 ± 3.3° in group A and 11.72 ± 1.89° in group B. Conclusions There is no correlation between preoperative degree of kyphotic deformity and clinical outcomes. The degree of anterior rotation of pelvic tilt does not change significantly; rather, compensatory mechanisms of the pelvis and BMI were found to have more influence. Because neither the degree of satisfaction with clinical outcomes nor the increased activity was relatively higher, a more sincere decision should be made before recommending corrective osteotomy for degenerative lumbar kyphosis. PMID:20622949

  12. Surgery for lumbar degenerative spondylolisthesis in SPORT: Does incidental durotomy affect outcome?

    PubMed Central

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

    2011-01-01

    Study Design Retrospective review of a prospectively collected multi-institutional database. Objective In the present analysis we investigate the impact of incidental durotomy on outcome in patients undergoing surgery for lumbar degenerative spondylolisthesis. Summary of Background Data Surgery for lumbar degenerative spondylolisthesis has several potential complications, one of the most common of which is incidental durotomy. The effect of incidental durotomy on outcome, however, remains uncertain. Methods Spine Patient Outcomes Research Trial cohort participants with a confirmed diagnosis of lumbar degenerative spondylolisthesis (DS) undergoing standard first-time open decompressive laminectomy, with or without fusion, were followed from baseline at 6 weeks, and 3, 6, 12 months and yearly thereafter, at 13 spine clinics in 11 US states. Patient data from this prospectively gathered database was reviewed. As of May 2009, the mean (Standard Deviation) follow-up among all analyzed DS patients was 46.6 (13.1) months (No durotomy: 46.7 vs. Had durotomy: 45.2, p-value=0.49). The median (range) follow-up time among all analyzed DS patients was 47.6 (2.5, 84) months. Results A 10.5% incidence of durotomy was detected among the 389 patients undergoing surgery. No significant differences were observed with or without durotomy in age, race, the prevalence of smoking, diabetes and hypertension, decompression level, number of levels, or whether a fusion was performed. There were no differences in incidence of nerve root injury, post-op mortality, additional surgeries, SF-36 scores of body pain or physical function, or Oswestry disability index at 1, 2, 3 and 4 years. Conclusions Incidental durotomy during first time surgery for lumbar degenerative spondylolisthesis does not appear to impact outcome in affected patients. PMID:21971123

  13. Expression and significance of telomerase in the nucleus pulposus tissues of degenerative lumbar discs

    PubMed Central

    ZHANG, XU; YANG, MING-KUN; LI, ZHOU; LIU, CHUAN; WU, JI-SHENG; WANG, JIE

    2015-01-01

    The pathogenesis of lumbar disc degeneration is extremely complex, and the expression and role of telomerase in degenerative lumbar disc tissues remains unclear. The aim of the present study was to detect telomerase expression in nucleus pulposus tissues of degenerative lumbar discs and to explore the correlation between telomerase expression and other factors typical of disc degeneration. A total of 8 patients with degenerative nucleus pulposus were included as the experimental group and compared with 8 control patients without evident lumbar disc degeneration. The expression of telomerase in nucleus pulposus tissues was detected by immunohistochemical staining. ELISA was performed to determine the differential expression of telomerase, type II collagen and chondroitin sulfate between the two groups. In addition, a correlation analysis was performed to form associations between these factors. Finally, 5 cases in the experimental group and 5 in the control group were involved in the analysis. Immunohistochemistry results showed that telomerase expression in the experimental group was significantly lower compared to the control group and the percentage in the unit field of view showed significant differences between the two groups (P<0.05). Similarly, the ELISA test results showed lower expression levels of telomerase, type II collagen and chondroitin sulfate in the experimental group when compared with the control group (P<0.05). The correlation analysis revealed that telomerase was positively correlated with type II collagen and chondroitin sulfate (correlation coefficients, 0.673 and 0.528, respectively; P<0.01). In conclusion, telomerase is involved in the degeneration process of nucleus pulposus tissue in lumbar discs and has a positive correlation with other factors typically associated with degeneration.

  14. Incidental Dural Tears During Lumbar Spine Surgery: A Retrospective Case Study of 84 Degenerative Lumbar Spine Patients

    PubMed Central

    Anekstein, Yoram; Mirovsky, Yigal

    2014-01-01

    Study Design A retrospective case study. Purpose To retrospectively review all incidental dural tears (DTs) that occurred at a single institution, classify them anatomically and evaluate the clinical significance of each subgroup. Overview of Literature Dural tears are considered the most commonly encountered complication during lumbar spine surgery. In contrast to the high frequency of DTs, reports on the characteristic location and mechanism are sparse. Methods We retrospectively retrieved all cases of degenerative lumbar spine surgery performed over a 9-year period and classified all identified DTs according to two independent planes. The coronal plane was divided into lower, middle and upper surgical fields, and the sagittal plane into posterior, lateral and ventral occurring tears. Demographic and clinical variables were retrieved and analyzed to search for significant associations. Results From 2003 to 2011, 1,235 cases of degenerative lumbar spine conditions were treated surgically at our institution. In 84 operations (6.8%), an incidental DT was either identified intraoperatively or suspected retrospectively. The most commonly involved location was the lower surgical field (n=39, 46.4%; p=0.002), followed equally by the middle and upper fields (n=16, 19%). In the sagittal plane, the most commonly involved locations were those in close proximity to the nerve root (n=35, 41.6%), followed by the dorsal aspect of the dural sac (n=24, 28.6%). None of the variables recorded was found to be associated with a particular location. Conclusions In our series, incidental DTs were found to occur most commonly in the lower surgical field. We hypothesize that local anatomic feature, such as the lordotic and broadening lumbar dura, may play a role in the observed DT tendency to occur in the lower surgical field. In light of the high frequency and potentially substantial resulting morbidity of incidental DTs, a better characterization of its location and mechanism may optimize both prevention and management. PMID:25346817

  15. Outcome of posterior lumbar interbody fusion for L4-L5 degenerative spondylolisthesis

    PubMed Central

    Hayashi, Hiroyuki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Kawahara, Norio; Tsuchiya, Hiroyuki

    2015-01-01

    Background: Posterior lumbar interbody fusion (PLIF) has become the standard in the treatment for degenerative spondylolisthesis since improvement of spinal instrumentation However, few published studies have reported long term outcomes of PLIF using a same surgical procedure. The purpose of this study is to evaluate a long term outcome of PLIF using a same surgical procedure for L4-L5 degenerative spondylolisthesis. Materials and Methods: Out of 45 patients who underwent L4-L5 PLIF for degenerative spondylolisthesis between 1995 and 2003, 37 patients (16 males and 21 females) were evaluated in this study. Mean age was 61.8 years. The average followup period was 121 months. We evaluated % slip, lordosis at L4/L5, lumbar lordosis, Japanese Orthopedic Association's (JOA) score and adjacent segment degeneration. Results: The % slip significantly improved from an average of 17.0% before surgery to 9.7% at the last followup. Lordosis at L4/L5 averaged 3.6° before surgery, 8.2° after surgery and 6.9° at the last followup. Although patients experienced some loss of correction at last followup, their lordosis at L4/L5 at last followup still was significantly different from their lordosis at L4/L5 before surgery. Lumbar lordosis did not significantly change. Mean JOA score was 13.4 before surgery and 24.5 at the last followup; mean recovery ratio was 71.2%. Adjacent segment degeneration occurred in 40.5% of patients, almost all of which occurred in the cranial adjacent segment. Three patients (8.1%) required reoperation due to adjacent segment degeneration, at an average of 76 months after their initial surgery. Conclusions: With more than 10-year followup after L4-L5 PLIF for degenerative spondylolisthesis, the adjacent segment degeneration occurred in 40.5% and reoperation was required in 8.1%. PMID:26015627

  16. Neuropathic Pain Components in Patients with Lumbar Spinal Stenosis

    PubMed Central

    An, Howard S; Moon, Seong Hwan; Lee, Hwan Mo; Suh, Seung Woo; Chen, Ding; Jeon, Jin Ho

    2015-01-01

    Purpose To determine the prevalence and characteristics of neuropathic pain (NP) in patients with lumbar spinal stenosis (LSS) according to subgroup analysis of symptoms. Materials and Methods We prospectively enrolled subjects with LSS (n=86) who were scheduled to undergo spinal surgery. The patients were divided into two groups according to a chief complaint of radicular pain or neurogenic claudication. We measured patient's pain score using the visual analog scale (VAS), Oswestry Disability Index (ODI) and Leads Assessment of Neuropathic Symptoms and Signs (LANSS). According to LANSS value, the prevalence of NP component pain in patients with LSS was assessed. Statistical analysis was performed to find the relationship between LANSS scores and the other scores. Results From our sample of 86 patients, 31 (36.0%) had a NP component, with 24 (63.4%) in the radicular pain group having NP. However, only seven patients (15.6%) in the neurogenic claudication group had NP. The LANSS pain score was not significantly correlated with VAS scores for back pain, but did correlate with VAS scores for leg pain (R=0.73, p<0.001) and with ODI back pain scores (R=0.54, p<0.01). Conclusion One-third of the patients with LSS had a NP component. The presence of radicular pain correlated strongly with NP. The severity of leg pain and ODI score were also closely related to a NP component. This data may prove useful to understanding the pain characteristics of LSS and in better designing clinical trials for NP treatment in patients with LSS. PMID:26069129

  17. Surgical Outcome of Reduction and Instrumented Fusion in Lumbar Degenerative Spondylolisthesis

    PubMed Central

    Omidi-Kashani, Farzad; Hassankhani, Ebrahim Ghayem; Shiravani, Reza; Mirkazemi, Masoud

    2016-01-01

    Background: Lumbar degenerative spondylolisthesis (LDS) is a degenerative slippage of the lumbar vertebrae. We aimed to evaluate the surgical outcome of degenerative spondylolisthesis with neural decompression, pedicular screw fixation, reduction, and posterolateral fusion. Methods: This before-after study was carried out on 45 patients (37 female and 8 male) with LDS operated from August 2008 to January 2011. The patients’ pain and disability were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) questionnaire. In surgery, we applied distraction force to facilitate slip reduction. All the intra- and postoperative complications were recorded. The paired t-test and Pearson correlation coefficient were used for statistical analysis. Results: The mean age of patients and mean follow-up period were 58.3±3.5 years and 31.2±4.8 months, respectively. The mean slip correction rate was 52.2% with a mean correction loss of 4.8%. Preoperative VAS and ODI improved from 8.8 and 71.6 to postoperative 2.1 and 28.7, respectively. Clinical improvement was more prominent in more reduced patients, but Pearson coefficient could not find a significant correlation. Conclusion: Although spinal decompression with fusion and posterior instrumentation in surgical treatment of the patients with LDS result in satisfactory outcome, vertebral reduction cannot significantly enhance the clinical improvement. PMID:26722140

  18. Impact of changes in extracellular matrix in the lumbar degenerative disc

    PubMed Central

    Ciurea, AV; Mitrica, M; Mohan, A

    2011-01-01

    The complexity of the clinical, biochemical, hystochemical and immunologic aspects of the intervertebral disk, along with its molecular biology, justifies the object of our study on the extracellular matrix modifications in lumbar disk hernias and their impact on patient quality of life. Material and method: the research lot was composed of 50 patients, aged between 18 and 73, who have undergone lumbar disk hernia surgery. MMP–9 (metalloproteinase–9) and TIMP–1 (tissue inhibitor of matrix metalloprotease 1) have been dosed in order to study the modifications on extracellular disk matrix, and quality of life assessment was carried out both in pre–operatory and post–operatory periods. Conclusions: patients may prevent the appearance of degenerative processes of the intervertebral disk with care and responsibility by controlling their weight, avoiding intense physical activities and ceasing to smoke. PMID:22567050

  19. Comparison of the Oswestry Disability Index and Magnetic Resonance Imaging Findings in Lumbar Canal Stenosis: An Observational Study

    PubMed Central

    Goni, Vijay G; Hampannavar, Aravind; Singh, Paramjeet; Sudesh, Pebam; Logithasan, Rajesh Kumar; Sharma, Anurag; BK, Shashidhar; Sament, Radheshyam

    2014-01-01

    Study Design Cross-sectional study. Purpose The aim of the study was to determine relationship between the degrees of radiologically demonstrated anatomical lumbar canal stenosis using magnetic resonance imaging (MRI) and its correlation with the patient's disability level, using the Oswestry Disability Index (ODI). Overview of Literature The relationship between the imaging studies and clinical symptoms has been uncertain in patients suffering from symptomatic lumbar canal stenosis. There is a limited number of studies which correlates the degree of stenosis with simple reproducible scoring methods. Methods Fifty patients were selected from 350 patients who fulfilled the inclusion criteria. The patients answered the national-language translated form of ODI. The ratio of disability was interpreted, and the patients were grouped accordingly. They were subjected to MRI; and the anteroposterior diameters of the lumbar intervertebral disc spaces and the thecal sac cross sectional area were measured. Comparison was performed between the subdivisions of the degree of lumbar canal stenosis, based on the following: anteroposterior diameter (three groups: normal, relative stenosis and absolute stenosis); subdivisions of the degree of central canal stenosis, based on the thecal sac cross-sectional area, measured on axial views (three groups: normal, moderately stenotic and severely stenotic); and the ODI outcome, which was also presented in 20 percentiles. Results No significant correlation was established between the radiologically depicted anatomical lumbar stenosis and the Oswestry Disability scores. Conclusions Magnetic resonance imaging alone should not be considered in isolation when assessing and treating patients diagnosed with lumbar canal stenosis. PMID:24596604

  20. Evaluation of Degenerative Lumbar Scoliosis After Short Segment Decompression and Fusion.

    PubMed

    Wang, Naiguo; Wang, Dachuan; Wang, Feng; Tan, Bingyi; Yuan, Zenong

    2015-11-01

    The objective of this study was to investigate short segment decompression of degenerative lumbar scoliosis (DLS) and the efficiency of fusion treatment.After DLS surgery, the patients were retrospectively reviewed using the VAS (visual analog scale) and ODI (Oswestry Disability Index) to assess clinical outcomes. All patients underwent posterior lumbar decompressive laminectomy, pedicle screw internal fixation, and posterolateral bone graft fusion surgery. Radiographic measurements included the scoliotic Cobb angle, the fused Cobb angle, the anterior intervertebral angle (AIA), the sagittal intervertebral angle (SIA), and lumbar lordosis angle. The relationships between these parameters were examined by bivariate Pearson analysis and linear regression analysis.Preoperatively, the Cobb angle at the scoliotic segment was 15.4°, which decreased to 10.2° immediately following surgery (P?

  1. A Randomized Controlled Trial Comparing Transforaminal Lumbar Interbody Fusion and Uninstrumented Posterolateral Fusion in the Degenerative Lumbar Spine

    PubMed Central

    Jalalpour, Kourosh; Neumann, Pavel; Johansson, Christer; Hedlund, Rune

    2015-01-01

    Study Design?Randomized controlled trial. Objective?Despite a large number of publications of outcomes after spinal fusion surgery, there is still no consensus on the efficacy of the several different fusion methods. The aim of this study was to determine whether transforaminal lumbar interbody fusion (TLIF) results in an improved clinical outcome compared with uninstrumented posterolateral fusion (PLF) in the surgical treatment for chronic low back pain. Methods?This study included 135 patients with degenerative disk disease (n?=?96) or postdiskectomy syndrome (n?=?39). Inclusion criteria were at least 1?year of back pain with or without leg pain in patients aged 20 to 65 with one- or two-level disease. Exclusion criteria were sequestration of disk hernia, psychosocial instability, isthmic spondylolisthesis, drug abuse, and previous spine surgery other than diskectomy. Pain was assessed by visual analog scale (pain index). Functional disability was quantified by the disability rating index and Oswestry Disability Index. The global outcome was assessed by the patient and classified as much better, better, unchanged, or worse. The patients were randomized to conventional uninstrumented PLF (n?=?67) or TLIF (n?=?68). PLF was performed in a standardized fashion using autograft. TLIF was performed with pedicle titanium screw fixation and a porous tantalum interbody spacer with interbody and posterolateral autograft. The clinical outcome measurements were obtained preoperatively and at 12 and 24 months postoperatively. The 2-year follow-up rate was 98%. Results?The two treatment groups improved significantly from preoperatively to 2 years' follow-up. At final follow-up, the results in the TLIF group were significantly superior to those in the PLF group in pain index (2.0 versus 3.9, p?=?0.007) and in disability rating index (22 versus 36, p?=?0.003). The Oswestry Disability Index was better in the TLIF group (20 versus 28, p?=?0.110, not significant). The global assessment was clearly superior in the TLIF group: 63% of patients scored “much better” in the TLIF group as compared with 48% in the PLF group (p?=?0.017). Conclusions?The results of the current study support the use of TLIF rather than uninstrumented PLF in the surgical treatment of the degenerative lumbar spine. The less optimal outcome after uninstrumented PLF may be explained by the much higher reoperation rate. PMID:26225282

  2. Outcome and Complications in Surgical Treatment of Lumbar Stenosis or Spondylolisthesis in Geriatric Patients

    PubMed Central

    Lee, Jin-Young; Moon, Seong-Hwan; Suh, Bo-Kyung; Yang, Myung Ho

    2015-01-01

    Development of anesthesiology and improvement of surgical instruments enabled aggressive surgical treatment even in elderly patients, who require more active physical activities than they were in the past. However, there are controversies about the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. The purpose of this study is to review the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. MEDLINE search on English-language articles was performed. There were 39685 articles from 1967 to 2013 regarding spinal disease, among which 70 dealt with geriatric lumbar surgery. Eighteen out of 70 articles dealt with geriatric lumbar surgery under the diagnosis of spinal stenosis or spondylolisthesis. One was non-randomized prospective, and other seventeen reports were retrospective. One non-randomized prospective and twelve out of seventeen retrospective studies showed that old ages did not affect the clinical outcomes. One non-randomized prospective and ten of seventeen retrospective studies elucidated postoperative complications: some reports showed that postoperative complications increased in elderly patients, whereas the other reports showed that they did not increase. Nevertheless, most complications were minor. There were two retrospective studies regarding the mortality. Mortality which was unrelated to surgical procedure increased, but surgical procedure-related mortality did not increase. Surgery as a treatment option in the elderly patients with the spinal stenosis or spondylolisthesis may be reasonable. However, there is insufficient evidence to make strong recommendations regarding spinal surgery for geriatric patients with spinal stenosis and spondylolisthesis. PMID:26256960

  3. Motion-preserving technologies for degenerative lumbar spine: The past, present, and future horizons

    PubMed Central

    Serhan, Hassan; Mhatre, Devdatt; Defossez, Henri; Bono, Christopher M.

    2011-01-01

    Over the past few decades, remarkable advancements in the understanding of the origin of low-back pain and lumbar spinal disorders have been achieved. Spinal fusion is generally considered the “gold standard” in the treatment of low-back pain; however, fusion is also associated with accelerated degeneration of adjacent levels. Spinal arthroplasty and dynamic stabilization technologies, as well as the continuous improvement in diagnosis and surgical interventions, have opened a new era of treatment options. Recent advancements in nonfusion technologies such as motion-preservation devices and posterior dynamic stabilization may change the gold standard. These devices are designed with the intent to provide stabilization and eliminate pain while preserving motion of the functional spinal unit. The adaption of nonfusion technologies by the surgical community and payers for the treatment of degenerative spinal conditions will depend on the long-term clinical outcome of controlled randomized clinical studies. Although the development of nonfusion technology has just started and the adoption is very slow, it may be considered a viable option for motion preservation in coming years. This review article provides technical and surgical views from the past and from the present, as well as a glance at the future endeavors and challenges in instrumentation development for lumbar spinal disorders. © 2011 SAS - The International Society for the Advancement of Spine Surgery. Published by Elsevier Inc. All rights reserved. PMID:25802672

  4. Minimally invasive anterior lumbar interbody fusion for adult degenerative scoliosis with 1 or 2 dislocated levels.

    PubMed

    Flouzat-Lachaniette, Charles-Henri; Ratte, Louis; Poignard, Alexandre; Auregan, Jean-Charles; Queinnec, Steffen; Hernigou, Philippe; Allain, Jérôme

    2015-12-01

    OBJECT Frequent complications of posterolateral instrumented fusion have been reported after treatment of degenerative scoliosis in elderly patients. Considering that in some cases, most of the symptomatology of adult degenerative scoliosis (ADS) is a consequence of the segmental instability at the dislocated level, the use of minimally invasive anterior lumbar interbody fusion (ALIF) to manage symptoms can be advocated to reduce surgical morbidity. The purpose of this study was to evaluate the midterm outcomes of 1- or 2-level minimally invasive ALIFs in ADS patients with 1- or 2-level dislocations. METHODS A total of 47 patients (average age 64 years; range 43-80 years) with 1- or 2-level ALIF performed for ADS (64 levels) in a single institution were included in the study. An independent spine surgeon retrospectively reviewed all the patients' medical records and radiographs to assess operative data and surgery-related complications. Clinical outcome was reported using the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for lumbar and leg pain. Intraoperative data and complications were collected. Fusion and risk for adjacent-level degeneration were assessed. RESULTS The mean follow-up duration was 3 years (range 1-10 years). ODI, and back and leg pain VAS scores were significantly improved at last follow-up. A majority of patients (74%) had a statistically significant improvement in their ODI score of more than 20 points at latest follow-up and 1 had a worsening of his disability. The mean operating time was 166 minutes (range 70-355 minutes). The mean estimated blood loss was 410 ml (range 50-1700 ml). Six (5 major and 1 minor) surgical complications (12.7% of patients) and 13 (2 major and 11 minor) medical complications (27.7% of patients) occurred without death or wound infection. Fusion was achieved in 46 of 47 patients. Surgery resulted in a slight but significant decrease of the Cobb angle, and improved the pelvic parameters and lumbar lordosis, but had no effect on the global sagittal balance. At latest follow-up, 9 patients (19.1%) developed adjacent-segment disease at a mean of 2 years' delay from the index surgery; 4 were symptomatic but treated medically, and none required iterative surgery. CONCLUSIONS Single- or 2-level minimally invasive fusion through a minimally invasive anterior approach in some selected cases of ADS produced a good functional outcome with a high fusion rate. They were associated with a significantly lower rate of complications in this study than the historical control. PMID:26315959

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

    SciTech Connect

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

    2013-06-15

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

  6. Therapeutic sustainability and durability of coflex interlaminar stabilization after decompression for lumbar spinal stenosis: a four year assessment

    PubMed Central

    Bae, Hyun W.; Lauryssen, Carl; Maislin, Greg; Leary, Scott

    2015-01-01

    Background Approved treatment modalities for the surgical management of lumbar spinal stenosis encompass a variety of direct and indirect methods of decompression, though all have varying degrees of limitations and morbidity which potentially limit the efficacy and durability of the treatment. The coflex® interlaminar stabilization implant (Paradigm Spine, New York, NY), examined under a United States Food and Drug Administration (US FDA) Investigational Device Exemption (IDE) clinical trial, is shown to have durable outcomes when compared to posterolateral fusion in the setting of post-decompression stabilization for stenotic patients. Other clinical and radiographic parameters, more indicative of durability, were also evaluated. The data collected from these parameters were used to expand the FDA composite clinical success (CCS) endpoint; thus, creating a more stringent Therapeutic Sustainability Endpoint (TSE). The TSE allows more precise calculation of the durability of interlaminar stabilization (ILS) when compared to the fusion control group. Methods A retrospective analysis of data generated from a prospective, randomized, level-1 trial that was conducted at 21 US sites was carried out. Three hundred forty-four per-protocol subjects were enrolled and randomized to ILS or fusion after decompression for lumbar stenosis with up to grade 1 degenerative spondylolisthesis. Clinical, safety, and radiographic data were collected and analyzed in both groups. Four-year outcomes were assessed, and the TSE was calculated for both cohorts. The clinical and radiographic factors thought to be associated with therapeutic sustainability were added to the CCS endpoints which were used for premarket approval (PMA). Results Success rate, comprised of no second intervention and an ODI improvement of ? 15 points, was 57.6% of ILS and 46.7% of fusion patients (p = 0.095). Adding lack of fusion in the ILS cohort and successful fusion in the fusion cohort showed a CCS of 42.7% and 33.3%, respectively. Finally, adding adjacent level success to both cohorts and maintenance of foraminal height in the coflex cohort showed a CCS of 36.6% and 25.6%, respectively. With additional follow-up to five years in the U.S. PMA study, these trends are expected to continue to show the superior therapeutic sustainability of ILS compared to posterolateral fusion after decompression for spinal stenosis. Conclusion There are clear differences in both therapeutic sustainability and intended clinical effect of ILS compared to posterolateral fusion with pedicle screw fixation after decompression for spinal stenosis. There are CCS differences between coflex and fusion cohorts noted at four years post-op similar to the trends revealed in the two year data used for PMA approval. When therapeutic sustainability outcomes are added to the CCS, ILS is proven to be a sustainable treatment for stabilization of the vertebral motion segment after decompression for lumbar spinal stenosis. PMID:26056630

  7. Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis

    PubMed Central

    Weinstein, James N.; Tosteson, Tor D.; Lurie, Jon D.; Tosteson, Anna N.A.; Blood, Emily; Hanscom, Brett; Herkowitz, Harry; Cammisa, Frank; Albert, Todd; Boden, Scott D.; Hilibrand, Alan; Goldberg, Harley; Berven, Sigurd; An, Howard

    2008-01-01

    BACKGROUND Surgery for spinal stenosis is widely performed, but its effectiveness as compared with nonsurgical treatment has not been shown in controlled trials. METHODS Surgical candidates with a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis (as confirmed on imaging) were enrolled in either a randomized cohort or an observational cohort at 13 U.S. spine clinics. Treatment was decompressive surgery or usual nonsurgical care. The primary outcomes were measures of bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, and 1 and 2 years. RESULTS A total of 289 patients were enrolled in the randomized cohort, and 365 patients were enrolled in the observational cohort. At 2 years, 67% of patients who were randomly assigned to surgery had undergone surgery, whereas 43% of those who were randomly assigned to receive nonsurgical care had also undergone surgery. Despite the high level of nonadherence, the intention-to-treat analysis of the randomized cohort showed a significant treatment effect favoring surgery on the SF-36 scale for bodily pain, with a mean difference in change from baseline of 7.8 (95% confidence interval, 1.5 to 14.1); however, there was no significant difference in scores on physical function or on the Oswestry Disability Index. The as-treated analysis, which combined both cohorts and was adjusted for potential confounders, showed a significant advantage for surgery by 3 months for all primary outcomes; these changes remained significant at 2 years. CONCLUSIONS In the combined as-treated analysis, patients who underwent surgery showed significantly more improvement in all primary outcomes than did patients who were treated nonsurgically. (ClinicalTrials.gov number, NCT00000411.) PMID:18287602

  8. Minimum 3-Year Outcomes in Patients with Lumbar Spinal Stenosis after Bilateral Microdecompression by Unilateral or Bilateral Laminotomy

    PubMed Central

    Yang, Sang-Mi; Chang, Jae-chil; Kim, Ra-Sun; Park, Sukh-Que; Cho, Sung-Jin

    2013-01-01

    Objective Lumbar spine stenosis (LSS) can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Minimally invasive surgery has come to be more commonly used for the treatment of LSS. The current study describes outcomes of bilateral microdecompression by unilateral or bilateral laminotomy (BML) for degenerative LSS after a minimum follow-up period of 3 years and investigates factors that result in a poor outcome. Methods Twenty-one patients who were followed-up for at least 3 years were included in this study. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, and disc height. Results Twenty-one patients (10 men, 11 women) aged 53-82 years (64.1±8.9 years) were followed-up for a minimum of 3 years (36-69 months). During follow-up, two patients underwent reoperation. Average preoperative JOA score and clinical symptoms, except persistent low back pain, improved significantly at the latest follow-up. There were no significant differences in radiological findings preoperatively and postoperatively. Thirteen patients (61.9%) had excellent to fair outcomes. Conclusion BML resulted in a favorable and persistent outcome for patients with degenerative LSS without radiological instability over a mid-term follow-up period. Persistent low back pain unrelated to postoperative instability adversely affects mid-term outcomes. PMID:24278647

  9. Spinal stenosis

    MedlinePLUS

    ... claudication; Central spinal stenosis; Foraminal spinal stenosis; Degenerative spine disease; Back pain - spinal stenosis ... to bulge. The bones and ligaments of the spine thicken or grow larger. This is caused by ...

  10. Design of the Verbiest trial: cost-effectiveness of surgery versus prolonged conservative treatment in patients with lumbar stenosis

    PubMed Central

    2011-01-01

    Background Degenerative changes of lumbar spine anatomy resulting in the encroachment of neural structures are often regarded progressive, ultimately necessitating decompressive surgery. However the natural course is not necessarily progressive and the efficacy of a variety of nonsurgical interventions has also been described. At present there is insufficient data to compare surgical and nonsurgical interventions in terms of their relative benefit and safety. Previous attempts failed to provide clear clinical recommendations or to distinguish subgroups that substantially benefit from a certain treatment strategy. We present the design of a randomized controlled trial on (cost-) effectiveness of surgical decompression versus prolonged conservative treatment in patients with neurogenic intermittent claudication caused by lumbar stenosis. Methods/Design The aim of the Verbiest trial is to evaluate the effectiveness of prolonged conservative treatment compared to decompressive surgery. The study is a multi-center randomized controlled trial with two parallel groups design. Patients (age over 50) presenting to the neurologist or neurosurgeon with at least 3 months complaints of neurogenic intermittent claudication and considering surgical treatment are eligible for inclusion. Participants are randomly allocated to either prolonged conservative treatment, receiving further treatment from their general practitioner and physical therapist, or allocated to surgery and operated within 4 weeks. Primary outcome measure is the functional assessment of the patient as measured by the Zurich Claudication Questionnaire at 24 months of follow-up. Data is analyzed according to the intention to treat principle. Discussion With a cost-effectiveness analysis the trade off between the costs of prolonged conservative treatment and delayed surgery in a smaller number of patients are compared with the current policy of surgical management. As surgery is expected to be inevitable in certain subgroups of patients, the distinction of and classification by predictive patient characteristics is most relevant to clinical practice. Trial registration Netherlands Trial Register (NTR): NTR2216 PMID:21371314

  11. Risk for Adjacent Segment and Same Segment Reoperation After Surgery for Lumbar Stenosis: A subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT)

    PubMed Central

    Radcliff, Kris; Curry, Patrick; Hilibrand, Alan; Kepler, Chris; Lurie, Jon; Zhao, Wenyan; Albert, Todd; Weinstein, James

    2013-01-01

    Study Design Subgroup analysis of prospective, randomized database. Objective The purpose of this study was to compare surgical or patient characteristics, such as fusion, instrumentation, or obesity, to identify whether these factors were associated with increased risk of reoperation for spinal stenosis. This prognostic information would be valuable to patients, healthcare professionals, and society as strategies to reduce reoperation, such as motion preservation, are developed. Summary of Background Data Reoperation due to recurrence of index level pathology or adjacent segment disease is a common clinical problem. Despite multiple studies on the incidence of reoperation, there have been few comparative studies establishing risk factors of reoperation after spinal stenosis surgery. The hypothesis of this subgroup analysis was that lumbar fusion or particular patient characteristics, such as obesity, would render patients with lumbar stenosis more susceptible to reoperation at the index or adjacent levels. Methods The study population combined the randomized and observational cohorts enrolled in SPORT for treatment of spinal stenosis. The surgically treated patients were stratified according to those who had reoperation (n=54) or no-reoperation (n= 359). Outcome measures were assessed at baseline, 1 year, 2 years, 3 years, and 4 years. The difference in improvement between those who had reoperation and those who did not was determined at each follow-period. Results Of the 413 patients who underwent surgical treatment for spinal stenosis, 54 patients had a reoperation within four years. At baseline, there were no significant differences in demographic characteristics or clinical outcome scores between reoperation and non-reoperation groups. Furthermore, between groups there were no differences in the severity of symptoms, obesity, physical examination signs, levels of stenosis, location of stenosis, stenosis severity, levels of fusion, levels of laminectomy, levels decompressed, operation time, intraoperative or postoperative complications. There was an increased percentage of patients with duration of symptoms greater than 12 months in the reoperation group (56% reoperation vs 36% no-reoperation, p<0.008). At final follow-up, there was significantly less improvement in the outcome of the reoperation group in SF36 PF (14.4 vs 22.6, p < 0.05), ODI (?12.4 vs. ?21.1, p < 0.01), and Sciatica Bothersomeness Index (?5 vs ?8.1, p < 0.006). Conclusion Lumbar fusion and instrumentation were not associated with increased rate of reoperation at index or adjacent levels compared to nonfusion techniques. The only specific risk factor for reoperation after treatment of spinal stenosis was duration of pretreatment symptoms > 12 months. The overall incidence of reoperations for spinal stenosis surgery was 13% and reoperations were equally distributed between index and adjacent lumbar levels. Reoperation may be related to the natural history of spinal degenerative disease. PMID:23154835

  12. Effect of body mass index on early outcomes of minimally invasive degenerative lumbar surgery.

    PubMed

    Goldin, Amanda N; Alander, Dirk H

    2015-01-01

    This retrospective study examined the early outcomes of healthy weight and severely obese subjects who underwent minimally invasive (MI) fusion and decompression surgery for degenerative lumbar disease at one to two spinal levels. A single surgeon (D.A.) operated on all subjects. Subjects were categorized based on body mass index [normal (18.5-24.9 kg/m(2)) or severely obese (over 35 kg/m(2))]. Surgical data included blood loss, hospital length of stay, narcotic use, discharge disposition, and postoperative infection. Data were compared using Levene's test for equality of variances, t test for equality of means, Pearson chi-square test, and Cramer's V correlation test (? ? .05 for all). SPSS software was utilized for all tests. Significant differences between the groups included blood loss, hospital length of stay, and early narcotic use. In the early postoperative setting, healthy weight subjects went home sooner and lost less blood, but needed more narcotic prescriptions filled than their obese counterparts. The use of MI spinal surgery in the severely obese population provides manageable issues for the patient and no significant complications when compared with the healthy weight population, indicating that it is a good alternative for obese patients. PMID:25830257

  13. Single transverse-orientation cage via MIS-TLIF approach for the treatment of degenerative lumbar disease: a technical note

    PubMed Central

    Wang, Shan-Jin; Han, Ying-Chao; Pan, Fu-Min; Ma, Bin; Tan, Jun

    2015-01-01

    Background: Single transverse cage placed in the anterior vertebral column can better maintain lumbar lordosis and sagittal alignment and is frequently used via the lateral transpsoas approach. However, there is no clear description in the literature of the steps required to place the single transverse cage during the instrumented transforaminal lumbar interbody fusion (TLIF) procedure for the treatment of degenerative lumbar disease. The objective of this study is to describe the technique using single transverse-orientation cage when performing TLIF procedures. Materials and methods: We present 18 illustrative cases in which single transverse-orientation cage was placed according to a step-by-step technique that can be used during the TLIF procedure. Information acquired included procedure time, intraoperative blood loss and postoperative complications. The preoperative and postoperative Oswestry Disability Index (ODI) and the visual analogue scale (VAS) scores were recorded. Changes in disc height and segmental lordosis were measured at radiographs. Results: The single transverse-orientation cage was successfully placed in 18 patients in a stepwise technique to achieve lumbar fusion. Using this technique, the patients significantly improved clinically and radiographically at postoperative visits. Conclusions: This is the first report demonstrating the safety and efficacy of instrumented TLIF with single transverse-orientation cage for the treatment of degenerative lumbar disease. Single transverse-orientation cage via MIS-TLIF approach can maintain greater lumbar lordosis and avoid the unique complications of lateral transpsoas approach. Understanding the options for cage placement is important for surgeons considering the use of this technique. PMID:26550387

  14. The timed up and go test for lumbar degenerative disc disease.

    PubMed

    Gautschi, Oliver P; Corniola, Marco V; Joswig, Holger; Smoll, Nicolas R; Chau, Ivan; Jucker, Dario; Stienen, Martin N

    2015-12-01

    We report on the use and performance of an objective measure of functional impairment, the timed up and go (TUG) test, in clinical practice for patients with lumbar degenerative disc disease (DDD). We illustrate nine representative patients with lumbar DDD, who were selected from an ongoing prospective study, to report our clinical experience with the TUG test. In addition, a preliminary sample of 30 non-selected consecutive patients is presented. The following parameters were assessed preoperatively, and 3days and 6weeks postoperatively: back and leg pain using the visual analogue scale (VAS); functional impairment using the Oswestry disability index (ODI) and Roland-Morris disability index (RMDI); health-related quality of life using the EuroQol 5D (EQ5D) and Short-Form 12 (SF-12). The TUG test results improved by 2.6 and 5.4s after 3days and 6weeks compared to the baseline assessment. The mean VAS for back and leg pain decreased by 2.3 and 5.3, respectively, after 3days, and by 2.7 and 4.6 after 6weeks. The mean RMDI and ODI decreased by 3.4 and 23.3, respectively, after 3days, and by 7.0 and 28.0 after 6weeks. The mean EQ5D increased by 0.38 after 3days and 0.358 after 6weeks. The mean SF-12 mental component scale decreased by 0.2 after 3days and increased by 5.6 after 6weeks, whereas the mean SF-12 physical component scale increased by 6.4 after 3days and by 9.8 after 6weeks. The TUG test proved to be a useful, easy to use tool that could add a new, objective dimension to the armamentarium of clinical tests for the diagnosis and management of DDD. From our preliminary experience, we conclude that the TUG test accurately reflects a patient's objective functional impairment before and after surgery. PMID:26260113

  15. Gait Analysis Using a Support Vector Machine for Lumbar Spinal Stenosis.

    PubMed

    Hayashi, Hiroyuki; Toribatake, Yasumitsu; Murakami, Hideki; Yoneyama, Takeshi; Watanabe, Tetsuyou; Tsuchiya, Hiroyuki

    2015-11-01

    Lumbar spinal canal stenosis (LSS) is diagnosed based on physical examination and radiological documentation of lumbar spinal canal narrowing. Differential diagnosis of the level of lumbar radiculopathy is difficult in multilevel spinal stenosis. Therefore, the authors focused on gait analysis as a classification method to improve diagnostic accuracy. The goal of this study was to identify gait characteristics of L4 and L5 radiculopathy in patients with LSS and to classify L4 and L5 radiculopathy using a support vector machine (SVM). The study group comprised 13 healthy volunteers (control group), 11 patients with L4 radiculopathy (L4 group), and 22 patients with L5 radiculopathy (L5 group). Light-emitting diode markers were attached at 5 sites on the affected side, and walking motion was analyzed using video recordings and the authors' development program. Potential gait characteristics of each group were identified to use as SVM parameters. In the knee joint of the L4 group, the waveform was similar to that of normal gait, but knee extension at initial contact was slightly greater than that of the other groups. In the ankle joint of the L5 group, the one-peak waveform pattern with disappearance of the second peak was present in 10 (45.5%) of 22 cases. The total classification accuracy was 80.4% using the SVM. The highest and lowest classification accuracies were obtained in the control group (84.6%) and the L4 group (72.7%), respectively. The authors' walking motion analysis system identified several useful factors for differentiating between healthy individuals and patients with L4 and L5 radiculopathy, with a high accuracy rate. [Orthopedics. 2015; 38(11):e959-e964.]. PMID:26558674

  16. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases

    PubMed Central

    Jund, Jérôme; Noseda, Olivier; Roussouly, Pierre

    2007-01-01

    Retrospective analysis of the spino-pelvic alignment in a population of 85 patients with a lumbar degenerative disease. Several previous publications reported the analysis of spino-pelvic alignment in the normal and low back pain population. Data suggested that patients with lumbar diseases have variations of sagittal alignment such as less distal lordosis, more proximal lumbar lordosis and a more vertical sacrum. Nevertheless most of these variations have been reported without reference to the pelvis shape which is well-known to strongly influence spino-pelvic alignment. The objective of this study was to analyse spino-pelvic parameters, including pelvis shape, in a population of 85 patients with a lumbar degenerative disease and compare these patients with a control group of normal volunteers. We analysed three different lumbar degenerative diseases: disc herniation (DH), n = 25; degenerative disc disease (DDD), n = 32; degenerative spondylolisthesis (DSPL), n = 28. Spino-pelvic alignment was analysed pre-operatively on full spine radiographs. Spino-pelvic parameters were measured as following: pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, thoracic kyphosis, spino-sacral angle and positioning of C7 plumb line. For each group of patients the sagittal profile was compared with a control population of 154 asymptomatic adults that was the subject of a previous study. In order to understand variations of spino-pelvic parameters in the patients’ population a stratification (matching) according to the pelvic incidence was done between the control group and each group of patients. Concerning first the pelvis shape, patients with DH and those with DDD demonstrated to have a mean pelvic incidence equal to 49.8° and 51.6°, respectively, versus 52° for the control group (no significant difference). Only young patients, less than 45 years old, with a disc disease (DH or DDD) demonstrated to have a pelvic incidence significantly lower (48.3°) than the control group, P < 0.05. On the contrary, in the DSPL group the pelvic incidence was significantly greater (60°) than the control group (52°), P < 0.0005. Secondly the three groups of patients were characterized by significant variations in spino-pelvic alignment: anterior translation of the C7 plumb line (P < 0.005 for DH, P < 0.05 for DDD and P < 0.05 for DSPL); loss of lumbar lordosis after matching according to pelvic incidence (P < 0.0005 for DH, DDD and DSPL); decrease of sacral slope after matching according to pelvic incidence (P = 0.001 for DH, P < 0.0005 for DDD and P < 0.0005 for DSPL). Measurement of the pelvic incidence and matching according to this parameter between each group of patients and the control group permitted to understand variations of spino-pelvic parameters in a population of patients. PMID:17211522

  17. Low back pain associated with lumbar disc herniation: role of moderately degenerative disc and annulus fibrous tears.

    PubMed

    Yang, Hao; Liu, Hui; Li, Zemin; Zhang, Kuibo; Wang, Jianru; Wang, Hua; Zheng, Zhaomin

    2015-01-01

    Lumbar disc herniation is one of the most common spinal degenerative disorders which may lead to low back pain (LBP) and radicular leg pain. However, it remains difficult to diagnose a degenerative herniated disc as the LBP generator in clinical practice. The purpose of this study is to explore the characteristic changes of a herniated disc causing LBP on MRI and to clarify the underlying role of inflammatory mediators and annulus fibrous (AF) tears in LBP generation associated with disc herniation. We prospectively collected intervertebral disc specimens and MRI from 57 single-segment disc herniation patients with radiculopathy. All subjects were grouped according to LBP occurrence or disc degeneration severity for the comparison of inflammatory mediators' expression and AF tears occurrence (High Intensity Zone, HIZ, on MRI). LBP incidence under circumstances of different degeneration severity with or without HIZ was further analyzed. Both LBP incidence and Inflammatory mediators expression in moderately degenerated group was higher than mildly and severely degenerative groups. HIZ incidence was higher in moderately and severely degenerated groups. LBP incidence in the patients with both moderately degenerated discs and HIZ was 86.7%, much higher than the rest of the patient population. In conclusion, the high expression of inflammatory mediators with AF tears causes LBP associated with disc herniation. Moderately degenerative disc with HIZ is MRI morphological change of herniated disc causing LBP, which can be applied to diagnose LBP. PMID:25932092

  18. Magnetic resonance imaging-based interpretation of degenerative changes in the lower lumbar segments and therapeutic consequences

    PubMed Central

    Maataoui, Adel; Vogl, Thomas J; Khan, M Fawad

    2015-01-01

    Intervertebral disc degeneration and facet joint osteoarthritis of the lumbar spine are, among others, well known as a cause of low back and lower extremity pain. Together with their secondary disorders they set a big burden on health care systems and economics worldwide. Despite modern imaging modalities, such as magnetic resonance imaging, for a large proportion of patients with low back pain (LBP) it remains difficult to provide a specific diagnosis. The fact that nearly all the lumbar structures are possible sources of LBP, may serve as a possible explanation. Furthermore, our clinical experience confirms, that imaging alone is not a sufficient approach explaining LBP. Here, the Oswestry Disability Index, as the most commonly used measure to quantify disability for LBP, may serve as an easy-to-apply questionnaire to evaluate the patient’s ability to cope with everyday life. For therapeutic purposes, among the different options, the lumbar facet joint intra-articular injection of corticosteroids in combination with an anaesthetic solution is one of the most frequently performed interventional procedures. Although widely used the clinical benefit of intra-articular steroid injections remains controversial. Therefore, prior to therapy, standardized diagnostic algorithms for an accurate assessment, classification and correlation of degenerative changes of the lumbar spine are needed. PMID:26339462

  19. Pedicle-Screw-Based Dynamic Systems and Degenerative Lumbar Diseases: Biomechanical and Clinical Experiences of Dynamic Fusion with Isobar TTL

    PubMed Central

    Barrey, Cédric; Perrin, Gilles; Champain, Sabina

    2013-01-01

    Dynamic systems in the lumbar spine are believed to reduce main fusion drawbacks such as pseudarthrosis, bone rarefaction, and mechanical failure. Compared to fusion achieved with rigid constructs, biomechanical studies underlined some advantages of dynamic instrumentation including increased load sharing between the instrumentation and interbody bone graft and stresses reduction at bone-to-screw interface. These advantages may result in increased fusion rates, limitation of bone rarefaction, and reduction of mechanical complications with the ultimate objective to reduce reoperations rates. However published clinical evidence for dynamic systems remains limited. In addition to providing biomechanical evaluation of a pedicle-screw-based dynamic system, the present study offers a long-term (average 10.2 years) insight view of the clinical outcomes of 18 patients treated by fusion with dynamic systems for degenerative lumbar spine diseases. The findings outline significant and stable symptoms relief, absence of implant-related complications, no revision surgery, and few adjacent segment degenerative changes. In spite of sample limitations, this is the first long-term report of outcomes of dynamic fusion that opens an interesting perspective for clinical outcomes of dynamic systems that need to be explored at larger scale. PMID:25031874

  20. Hospital and Surgeon Variation in Complications and Repeat Surgery Following Incident Lumbar Fusion for Common Degenerative Diagnoses

    PubMed Central

    Martin, Brook I; Mirza, Sohail K; Franklin, Gary M; Lurie, Jon D; MacKenzie, Todd A; Deyo, Richard A

    2013-01-01

    Objective To identify factors that account for variation in complication rates across hospitals and surgeons performing lumbar spinal fusion surgery. Data Sources Discharge registry including all nonfederal hospitals in Washington State from 2004 to 2007. Study Design We identified adults (n = 6,091) undergoing an initial inpatient lumbar fusion for degenerative conditions. We identified whether each patient had a subsequent complication within 90 days. Logistic regression models with hospital and surgeon random effects were used to examine complications, controlling for patient characteristics and comorbidity. Principal Findings Complications within 90 days of a fusion occurred in 4.8 percent of patients, and 2.2 percent had a reoperation. Hospital effects accounted for 8.8 percent of the total variability, and surgeon effects account for 14.4 percent. Surgeon factors account for 54.5 percent of the variation in hospital reoperation rates, and 47.2 percent of the variation in hospital complication rates. The discretionary use of operative features, such as the inclusion of bone morphogenetic proteins, accounted for 30 and 50 percent of the variation in surgeons' reoperation and complication rates, respectively. Conclusions To improve the safety of lumbar spinal fusion surgery, quality improvement efforts that focus on surgeons' discretionary use of operative techniques may be more effective than those that target hospitals. PMID:22716168

  1. Minimally Invasive Unilateral vs. Bilateral Pedicle Screw Fixation and Lumbar Interbody Fusion in Treatment of Multi-Segment Lumbar Degenerative Disorders

    PubMed Central

    Liu, Xiaoyang; Li, Guangrun; Wang, Jiefeng; Zhang, Heqing

    2015-01-01

    Background The choice for instrumentation with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in treatment of degenerative lumbar disorders (DLD) remains controversial. The goal of this study was to investigate clinical outcomes in consecutive patients with multi-segment DLD treated with unilateral pedicle screw (UPS) vs. bilateral pedicle screw (BPS) instrumented TLIF. Material/Methods Eighty-four consecutive patients who had multi-level MIS-TLIF were retrospectively reviewed. All data were collected to compare the clinical outcomes between the 2 groups. Results Both groups showed similar clinical function scores in VAS and ODI. The two groups differed significantly in operative time (P<0.001), blood loss (P<0.001), and fusion rate (P=0.043), respectively. Conclusions This study demonstrated similar clinical outcomes between UPS fixation and BPS procedure after MIS-TLIF for multi-level DLD. Moreover, UPS technique was superior in operative time and blood loss, but represented lower fusion rate than the BPS construct did. PMID:26603050

  2. Minimally Invasive Unilateral vs. Bilateral Pedicle Screw Fixation and Lumbar Interbody Fusion in Treatment of Multi-Segment Lumbar Degenerative Disorders.

    PubMed

    Liu, Xiaoyang; Li, Guangrun; Wang, Jiefeng; Zhang, Heqing

    2015-01-01

    BACKGROUND The choice for instrumentation with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in treatment of degenerative lumbar disorders (DLD) remains controversial. The goal of this study was to investigate clinical outcomes in consecutive patients with multi-segment DLD treated with unilateral pedicle screw (UPS) vs. bilateral pedicle screw (BPS) instrumented TLIF. MATERIAL AND METHODS Eighty-four consecutive patients who had multi-level MIS-TLIF were retrospectively reviewed. All data were collected to compare the clinical outcomes between the 2 groups. RESULTS Both groups showed similar clinical function scores in VAS and ODI. The two groups differed significantly in operative time (P<0.001), blood loss (P<0.001), and fusion rate (P=0.043), respectively. CONCLUSIONS This study demonstrated similar clinical outcomes between UPS fixation and BPS procedure after MIS-TLIF for multi-level DLD. Moreover, UPS technique was superior in operative time and blood loss, but represented lower fusion rate than the BPS construct did. PMID:26603050

  3. Case Report: A case report highlighting bilateral EDB wasting as a clinical marker for lumbar canal stenosis

    PubMed Central

    Kumar, Bijoy Mohan; Munakomi, Sunil

    2015-01-01

    Herein we discuss a case of a 55 year old male presenting with history suggestive of sciatica on the left leg. Straight leg raising (SLR) test was positive at 45 degrees on the left side. His ankle reflex was absent and the power of extensor hallusus longus (EHL) was 4/5 on the same side. MRI lumbosacral spine revealed left paramedian disc prolapsed on L4/L5 level with spinal canal diameter of 9mm.However since his bilateral extensor digitorm brevis (EDB) were wasted, we suspected associated lumbar canal stenosis and thereby opted for laminectomy and discectomy in this case. Intraoperatively dural wasting, hypertrophied facets and narrow canal were confirmed. Laminectomy, medial facectectomy and discectomy were carried out. The patient recovered uneventfully with resolution of his sciatica-like pain. Bilateral EDB wasting thereby provides a clinical clue to the underlying lumbar canal stenosis and can help in making correct therapeutic decisions. PMID:26535113

  4. Effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis

    PubMed Central

    Choi, Jioun; Lee, Sangyong; Jeon, Chunbae

    2015-01-01

    [Purpose] This study examined the effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis. [Subjects] Thirty patients with lumbar spinal stenosis were divided into two groups: a conservative treatment group (n=15) and a flexion-distraction manipulation group (n=15). [Methods] The conservative treatment group received conservative physical therapy, and the flexion-distraction group received both conservative physical therapy and flexion-distraction manipulation therapy. Both groups received treatment 3 times a week for 6 weeks. The Visual Analog Scale was used to measure pain intensity, and the Oswestry Disability Index was used to evaluate the level of disability caused by the pain. [Results] The Visual Analog Scale scores for pain were significantly decreased in both groups. In the between-group comparison, the decrease in pain was more significant in the flexion-distraction group. According to the Oswestry Disability Index, the level of disability was significantly decreased in both groups, but the decrease was more significant in the flexion-distraction group. [Conclusion] Flexion-distraction manipulation appears to be an effective intervention for pain and disability among patients with lumbar spinal stenosis. PMID:26180352

  5. Risk of progression in de novo low-magnitude degenerative lumbar curves: natural history and literature review.

    PubMed

    Chin, Kingsley R; Furey, Christopher; Bohlman, Henry H

    2009-08-01

    Natural history studies have focused on risk for progression in lumbar curves of more than 30 degrees, while smaller curves have little data for guiding treatment. We studied curve progression in de novo degenerative scoliotic curves of no more than 30 degrees. Radiographs of 24 patients (17 women, 7 men; mean age, 68.2 years) followed for up to 14.3 years (mean, 4.85 years) were reviewed. Risk factors studied for curve progression included lumbar lordosis, lateral listhesis of more than 5 mm, sex, age, convexity direction, and position of intercrestal line. Curves averaged 14 degrees at presentation and 22 degrees at latest follow-up and progressed a mean of 2 degrees (SD, 1 degrees) per year. Mean progression was 2.5 degrees per year for patients older than 69 years and 1.5 degrees per year for younger patients. Levoscoliosis progressed 3 degrees per year and dextroscoliosis 1 degrees per year (P<.05). Forty-six percent of patients had lateral listhesis of more than 5 mm at L3 and L4. Curve progression was not linear and might occur rapidly, particularly in women older than 69 with lateral listhesis of more than 5 mm and levoscoliosis. Small curves can progress and therefore should be individualized in the context of other risk factors. PMID:19809605

  6. The Associations Between Physical Therapy and Long-Term Outcomes for Individuals with Lumbar Spinal Stenosis in the SPORT study

    PubMed Central

    Fritz, Julie M.; Lurie, Jon D.; Zhao, Wenyan; Whitman, Julie M.; Delitto, Anthony; Brennan, Gerard P.; Weinstein, James N.

    2013-01-01

    Background/Context A period of non-surgical management is advocated prior to surgical treatment for most patients with lumbar spinal stenosis. Currently, little evidence is available to define optimal non-surgical management. Physical therapy is often used, however its use and effectiveness relative to other non-surgical strategies has not been adequately explored. Purpose Describe the utilization of physical therapy and other non-surgical interventions by patients with lumbar spinal stenosis and examine the relationship between physical therapy and long-term prognosis. Study Design Secondary analysis of the Spine Patient Outcomes Research Trial (SPORT) combining data from randomized and observational studies. Setting 13 spine clinics in 11 states in the United States. Patient Sample Patients with lumbar spinal stenosis receiving non-surgical management including those who did or did not receive physical therapy within 6 weeks of enrollment. Outcome Measures Primary outcome measures included cross-over to surgery, the bodily pain and physical function scales changes from the Survey Short Form 36 (SF-36), and the modified Oswestry Disability Index. Secondary outcome measures were patient satisfaction and the Sciatica Bothersomeness Index. Methods Baseline characteristics and rates of cross-over to surgery were compared between patients who did or did not receive physical therapy. Baseline factors predictive of receiving physical therapy were examined with logistic regression. Mixed effects models were used to compare outcomes between groups at 3 and 6 months, and 1 year after enrollment adjusted for baseline severity and patient characteristics. Results Physical therapy was used in the first 6 weeks by 90 of 244 patients (37%) and was predicted by the absence of radiating pain and being single instead of married. Physical therapy was associated with a reduced likelihood of cross-over to surgery after 1 year (21% vs 33%, p=0.045), and greater reductions on the SF-36 physical functioning scale after 6 months (mean difference =6.0, 95% CI: 0.2, 11.7) and 1 year (mean difference =6.5, 95% CI: 0.6, 12.4). There were no differences in bodily pain or Oswestry scores across time. Conclusion Many patients with lumbar spinal stenosis pursuing conservative management receive physical therapy. Using physical therapy was associated with reduced likelihood of patients receiving surgery within 1 year. Results for other outcomes were mixed with no differences in several measures. Further research is needed to examine the effectiveness of physical therapy relative to other non-surgical management strategies for patients with lumbar spinal stenosis. PMID:24373681

  7. Nonoperative Korean Medicine Combination Therapy for Lumbar Spinal Stenosis: A Retrospective Case-Series Study

    PubMed Central

    Kim, Kiok; Jeong, Yongjae; Youn, Yousuk; Choi, Jeongcheol; Kim, Jaehong; Chung, Wonseok; Kim, Tae-Hun

    2015-01-01

    This is a retrospective case series exploring the therapeutic benefits and harm of nonoperative Korean medicine combination therapy for lumbar spinal stenosis (LSS). The medical records of a total of 33 LSS patients, who were treated as inpatients at Mokhuri Neck and Back Hospital, Republic of Korea, from November 2010 to January 2012, were reviewed first and telephone survey on these patients was conducted after one year. Body acupuncture, pharmacoacupuncture, Chuna, and oral administration of herbal medicines were offered to all patients. A Visual analogue scale (VAS) of pain and the walking duration without pain were used to assess the patients during the approximately 1-month treatment period. The average VAS score of pain and the walking duration improved significantly; the VAS score decreased from 9 (SD, 1.15) to 2.75 (2.22) (p < 0.01), and the walking duration increased from 5.5 (6.66) to 16.75 (13.00) minutes (p < 0.01). No adverse event was reported during the treatment. In addition, the decreased pain level and improved function continued for over one year. Although we did not find definitive evidence, the study results suggest that KM combination therapy may be beneficial for decreasing pain and improving function in LSS patients and may produce comparatively few adverse events. PMID:26543486

  8. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis

    PubMed Central

    Kobayashi, Shigeru

    2014-01-01

    Spinal nerve roots have a peculiar structure, different from the arrangements in the peripheral nerve. The nerve roots are devoid of lymphatic vessels but are immersed in the cerebrospinal fluid (CSF) within the subarachnoid space. The blood supply of nerve roots depends on the blood flow from both peripheral direction (ascending) and the spinal cord direction (descending). There is no hypovascular region in the nerve root, although there exists a so-called water-shed of the bloodstream in the radicular artery itself. Increased mechanical compression promotes the disturbance of CSF flow, circulatory disturbance starting from the venous congestion and intraradicular edema formation resulting from the breakdown of the blood-nerve barrier. Although this edema may diffuse into CSF when the subarachnoid space is preserved, the endoneurial fluid pressure may increase when the area is closed by increased compression. On the other hand, the nerve root tissue has already degenerated under the compression and the numerous macrophages releasing various chemical mediators, aggravating radicular symptoms that appear in the area of Wallerian degeneration. Prostaglandin E1 (PGE1) is a potent vasodilator as well as an inhibitor of platelet aggregation and has therefore attracted interest as a therapeutic drug for lumbar canal stenosis. However, investigations in the clinical setting have shown that PGE1 is effective in some patients but not in others, although the reason for this is unclear. PMID:24829876

  9. Clinical and Radiological Results of Microsurgical Posterior Lumbar Interbody Fusion and Decompression without Posterior Instrumentation for Lateral Recess Stenosis

    PubMed Central

    ?i?man, Lokman; Türkmen, Faik; Efe, Duran; Pekince, O?uzhan; Göncü, Recep Gani; Sever, Cem

    2015-01-01

    Study Design A single-center, retrospective patient review of clinical and radiological outcomes of microsurgical posterior lumbar interbody fusion and decompression, without posterior instrumentation, for the treatment of lateral recess stenosis. Purpose This study documented the clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression of the lateral recess using interbody cages without posterior instrumentation for the treatment of lateral recess stenosis. Overview of Literature Although microsurgery has some advantages, various complications have been reported following microsurgical decompression, including cage migration, pseudoarthrosis, neurologic deficits, and persistent pain. Methods A total of 34 patients (13 men, 21 women), with a mean age of 56.65±9.1 years (range, 40-77 years) confirmed spinal stability, and preoperative radiological findings of lateral recess stenosis, were included in the study. Interbody polyetheretherketone cages and auto grafts were used in all patients. Posterior instrumentation was not used because of limited resection of the posterior lumbar structures. Preoperative and postoperative radiographs, computed tomography scans, and magnetic resonance imaging were assessed and compared to images taken at the final follow-up. Functional recovery was also evaluated according to the Macnab criteria at the final follow-up. Results The average follow-up time was 35.05±8.65 months (range, 24-46 months). The clinical results, operative time, intraoperative blood loss, and duration of hospital stay were similar to previously published results; the fusion rate (85.2%) was decreased and the migration rate (5.8%) was increased, compared with prior reports. Conclusions Although microsurgery has some advantages, migration and pseudoarthrosis remain challenges to achieving adequate lumbar interbody fusion. PMID:26435789

  10. One-Year Follow-Up of a Series of 100 Patients Treated for Lumbar Spinal Canal Stenosis by Means of HeliFix Interspinous Process Decompression Device

    PubMed Central

    Alexandre, Alberto; Alexandre, Andrea Maria; De Pretto, Mario; Corò, Luca; Saggini, Raul

    2014-01-01

    Purpose. New interspinous process decompression devices (IPDs) provide an alternative to conservative treatment and decompressive surgery for patients with neurogenic intermittent claudication (NIC) due to degenerative lumbar spinal stenosis (DLSS). HeliFix is a minimally invasive IPD that can be implanted percutaneously. This is a preliminary evaluation of safety and effectiveness of this IPD up to 12 months after implantation. Methods. After percutaneous implantation in 100 patients with NIC due to DLSS, data on symptoms, quality of life, pain, and use of pain medication were obtained for up to 12 months. Results. Early symptoms and physical function improvements were maintained for up to 12 months. Leg, buttock/groin, and back pain were eased throughout, and the use and strength of related pain medication were reduced. Devices were removed from 2% of patients due to lack of effectiveness. Conclusions. Overall, in a period of up to 12-month follow-up, the safety and effectiveness of the HeliFix offered a minimally invasive option for the relief of NIC complaints in a high proportion of patients. Further studies are undertaken in order to provide insight on outcomes and effectiveness compared to other decompression methods and to develop guidance on optimal patient selection. PMID:24822181

  11. Comparative Analysis of Inpatient and Outpatient Interspinous Process Device Placement for Lumbar Spinal Stenosis.

    PubMed

    Ortega, Alicia; Sarmiento, J Manuel; Patil, Chirag; Mukherjee, Debraj; Ugiliweneza, Beatrice; Nuño, Miriam; Lad, Shivanand; Boakye, Maxwell

    2015-11-01

    Purpose?To compare reoperations, health care utilization, and costs in lumbar spinal stenosis (LSS) patients undergoing interspinous process (ISP) device placement in an inpatient versus outpatient setting. Methods?The MarketScan database (2007-2009) was queried for adults with LSS undergoing ISP device placement as a primary procedure. Reoperations, health care utilization, and costs in patients with at least 18 months of follow-up were analyzed. Chi-square and Student t tests were used to assess the differences in characteristics and outcomes between patients treated in the inpatient and outpatient setting. Results?A total of 411 patients who underwent ISP device placement were identified; the mean age was 72 years, 51% were female, and most patients were insured by Medicare (73.7%). The average postoperative follow-up was 24.9 months. A subset of 182 patients (44.3%) had inpatient procedures; 229 (55.7%) underwent outpatient ISP device placements. The overall reoperation rate was 20.4%. ISP reoperation rates between inpatient and outpatient cohorts were comparable (23.1% versus 18.3%; p?=?0.24). Inpatients accrued significantly higher index procedural costs compared with outpatients ($17,432 versus $8854; p?=?0.0001), however, the outpatient cohort utilized more postoperative outpatient services (143 versus 112; p?=?0.09) and higher outpatient service costs ($25,376 versus $15,481; p?=?0.01). Consequently, cumulative overall cost was similar among the two cohorts ($51,059 versus $51,778; p?=?0.94). Conclusions?Long-term reoperation rates following ISP device placement are comparable in the inpatient and outpatient setting. Upfront cost savings may be achieved with outpatient ISP device placement, but this benefit is lost by 18 months following initial surgery. PMID:25915499

  12. Kambin's Triangle Approach of Lumbar Transforaminal Epidural Injection with Spinal Stenosis

    PubMed Central

    Park, Ji Woong; Nam, Hee Seung; Cho, Soo Kyoung; Jung, Hee Jin; Lee, Byeong Ju

    2011-01-01

    Objective To compare the short-term effect and advantage of transforaminal epidural steroid injection (TFESI) performed using the Kambin's triangle and subpedicular approaches. Method Forty-two patients with radicular pain from lumbar spinal stenosis were enrolled. Subjects were randomly assigned to one of two groups. All procedures were performed using C-arm KMC 950. The frequency of complications during the procedure and the effect of TFESI at 2 and 4 weeks after the procedure between the two groups were compared. Short-term outcomes were measured using a visual numeric scale (VNS) and a five-grade scale. Multiple logistic regression analyses were performed to evaluate the relationship between possible outcome predictors (Kambin's triangle or subpedicular approach, age, duration of symptoms and sex) and the therapeutic effect. Results VNS was improved 2 weeks after the injection and continued to improve until 4 weeks in both groups. There were no statistical differences in changes of VNS, effectiveness and contrast spread pattern between these two groups. No correlation was found between the other variables tested and therapeutic effect. Spinal nerve pricking occurred in five cases of the subpedicular and in none of the cases of the Kambin's triangle approach (p<0.05). Conclusion The Kambin's triangle approach is as efficacious as the subpedicular approach for short-term effect and offers considerable advantages (i.e., less spinal nerve pricking during procedure). The Kambin's triangle approach maybe an alternative method for transforaminal epidural steroid injection in cases where needle tip positioning in the anterior epidural space is difficult. PMID:22506212

  13. Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer

    PubMed Central

    Anderson, Louise H.; Nelson, Teresa; Patel, Vikas V.

    2015-01-01

    Background Lumbar spinal stenosis is a painful and debilitating condition resulting in healthcare costs totaling tens of billions of dollars annually. Initial treatment consists of conservative care modalities such as physical therapy, NSAIDs, opioids, and steroid injections. Patients refractory to these therapies can undergo decompressive surgery, which has good long-term efficacy but is more traumatic and can be associated with high post-operative adverse event (AE) rates. Interspinous spacers have been developed to offer a less-invasive alternative. The objective of this study was to compare the costs and quality adjusted life years (QALYs) gained of conservative care (CC) and decompressive surgery (DS) to a new minimally-invasive interspinous spacer. Methods A Markov model was developed evaluating 3 strategies of care for lumbar spinal stenosis. If initial therapies failed, the model moved patients to more invasive therapies. Data from the Superion FDA clinical trial, a prospective spinal registry, and the literature were used to populate the model. Direct medical care costs were modeled from 2014 Medicare reimbursements for healthcare services. QALYs came from the SF-12 PCS and MCS components. The analysis used a 2-year time horizon with a 3% discount rate. Results CC had the lowest cost at $10,540, while Spacers and DS were nearly identical at about $13,950. CC also had the lowest QALY increase (0.06), while Spacers and DS were again nearly identical (.28). The incremental cost-effectiveness ratios (ICER) for Spacers compared to CC was $16,300 and for DS was $15,200. Conclusions Both the Spacer and DS strategies are far below the commonly cited $50,000/QALY threshold and produced several times the QALY increase versus CC, suggesting that surgical care provides superior value (cost / effectiveness) versus sustained conservative care in the treatment of lumbar spinal stenosis. PMID:26273546

  14. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A.; McManus, Carla D.; Pampati, Vidyasagar

    2013-01-01

    Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied. Study Design: A prospective evaluation. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis. Methods: Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter. Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12, 18 and 24 months post treatment. The primary outcome measure was 50% or more improvement in pain scores and ODI scores. Results: Overall, a primary outcome or significant pain relief and functional status improvement of 50% or more was seen in 71% of patients at the end of 2 years. The overall number of procedures over a period of 2 years were 5.7 ± 2.73. Limitations: The lack of a control group and a prospective design. Conclusions: Significant relief and functional status improvement as seen in 71% of the 70 patients with percutaneous adhesiolysis utilizing local anesthetic steroids and hypertonic sodium chloride solution may be an effective management strategy in patients with chronic function limiting low back and lower extremity pain with central spinal stenosis after failure of conservatie management and fluoroscopically directed epidural injections. PMID:23289005

  15. Limited Unilateral Decompression and Pedicle Screw Fixation with Fusion for Lumbar Spinal Stenosis with Unilateral Radiculopathy: A Retrospective Analysis of 25 Cases

    PubMed Central

    Zhang, Li; Miao, Hai-xiong; Wang, Yong; Chen, An-fu; Zhang, Tao

    2015-01-01

    Objective Lumbar spinal stenosis is conventionally treated with surgical decompression. However, bilateral decompression and laminectomy is more invasive and may not be necessary for lumbar stenosis patients with unilateral radiculopathy. We aimed to report the outcomes of unilateral laminectomy and bilateral pedicle screw fixation with fusion for patients with lumbar spinal stenosis and unilateral radiculopathy. Methods Patients with lumbar spinal stenosis with unilateral lower extremity radiculopathy who received limited unilateral decompression and bilateral pedicle screw fixation were included and evaluated using visual analog scale (VAS) pain and the Oswestry Disability Index (ODI) scores preoperatively and at follow-up visits. Ligamentum flavum thickness of the involved segments was measured on axial magnetic resonance images. Results Twenty-five patients were included. The mean preoperative VAS score was 6.6±1.6 and 4.6±3.1 for leg and back pain, respectively. Ligamentum flavum thickness was comparable between the symptomatic and asymptomatic side (p=0.554). The mean follow-up duration was 29.2 months. The pain in the symptomatic side lower extremity (VAS score, 1.32±1.2) and the back (VAS score, 1.75±1.73) significantly improved (p=0.000 vs. baseline for both). The ODI improved significantly postoperatively (6.60±6.5; p=0.000 vs. baseline). Significant improvement in VAS pain and ODI scores were observed in patients receiving single or multi-segment decompression fusion with fixation (p<0.01). Conclusion Limited laminectomy and unilateral spinal decompression followed by bilateral pedicle screw fixation with fusion achieves satisfactory outcomes in patients with spinal stenosis and unilateral radiculopathy. This procedure is less damaging to structures that are important for maintaining posterior stability of the spine. PMID:26279816

  16. Does the duration of symptoms in patients with spinal stenosis and degenerative spondylolisthesis affect outcomes? Analysis of the Spine Outcomes Research Trial

    PubMed Central

    Radcliff, Kristen; Rihn, Jeff; Hilibrand, Alan; DiIorio, Timothy; Tosteson, Tor; Lurie, Jon; Zhao, Wenyan; Vaccaro, Alex; Albert, Todd; Weinstein, James N.

    2011-01-01

    Study Design Retrospective subgroup analysis of prospectively collected data according to treatment received. Objective The purpose of this study is to determine if the duration of symptoms affects outcomes following the treatment of spinal stenosis (SS) or degenerative spondylolisthesis (DS). Summary of Background Data The Spine Outcomes Research Trial (SPORT) study was designed to provide scientific evidence on the effectiveness of spinal surgery versus a variety of non-operative treatments. Methods An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of SS or DS. A comparison was made between patients with SS with ?12 months (n=405) and those with >12 months (n=227) duration of symptoms. A comparison was also made between patients with DS with ?12 months (n=397) and those with >12 months (n=204) duration of symptoms. Baseline patient characteristics were documented. Primary and secondary outcomes were measured at baseline and at regular follow-up time intervals up to 4 years. The difference in improvement among patients whose surgical or nonsurgical treatment began less than or greater than 12 months after the onset of symptoms was measured. In addition, the difference in improvement with surgical versus nonsurgical treatment (treatment effect) was determined at each follow-period for each group. Results At final followup, there was significantly less improvement in primary outcome measures in SS patients with >12 months symptom duration. Primary and secondary outcome measures within the DS group did not differ according to symptom duration. There were no statistically significant differences in treatment effect of surgery in SS or DS patients. Conclusions Patients with spinal stenosis with fewer than twelve months of symptoms experienced significantly better outcomes with surgical and nonsurgical treatment relative to those with symptom duration greater than twelve months. There was no difference in outcome of patients with degenerative spondylolisthesis according to symptom duration. PMID:21912308

  17. Predominant Leg Pain Is Associated With Better Surgical Outcomes in Degenerative Spondylolisthesis and Spinal Stenosis: Results from the Spine Patient Outcomes Research Trial (SPORT)

    PubMed Central

    Pearson, Adam; Blood, Emily; Lurie, Jon; Abdu, William; Sengupta, Dilip; Frymoyer, John W.; Weinstein, James

    2010-01-01

    Study Design As-treated analysis of the Spine Patient Outcomes Research Trial (SPORT). Objective To compare baseline characteristics and surgical and nonoperative outcomes in degenerative spondylolisthesis (DS) and spinal stenosis (SpS) patients stratified by predominant pain location (i.e. leg vs. back). Summary of Background Data Evidence suggests that degenerative spondylolisthesis (DS) and spinal stenosis (SpS) patients with predominant leg pain may have better surgical outcomes than patients with predominant low back pain (LBP). Methods The DS cohort included 591 patients (62% underwent surgery), and the SpS cohort included 615 patients (62% underwent surgery). Patients were classified as leg pain predominant, LBP predominant or having equal pain according to baseline pain scores. Baseline characteristics were compared between the three predominant pain location groups within each diagnostic category, and changes in surgical and nonoperative outcome scores were compared through two years. Longitudinal regression models including baseline covariates were used to control for confounders. Results Among DS patients at baseline, 34% had predominant leg pain, 26% had predominant LBP, and 40% had equal pain. Similarly, 32% of SpS patients had predominant leg pain, 26% had predominant LBP, and 42% had equal pain. DS and SpS patients with predominant leg pain had baseline scores indicative of less severe symptoms. Leg pain predominant DS and SpS patients treated surgically improved significantly more than LBP predominant patients on all primary outcome measures at one and two years. Surgical outcomes for the equal pain groups were intermediate to those of the predominant leg pain and LBP groups. The differences in nonoperative outcomes were less consistent. Conclusions Predominant leg pain patients improved significantly more with surgery than predominant LBP patients. However, predominant LBP patients still improved significantly more with surgery than with nonoperative treatment. PMID:21124260

  18. Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance.

    PubMed

    Hikata, Tomohiro; Watanabe, Kota; Fujita, Nobuyuki; Iwanami, Akio; Hosogane, Naobumi; Ishii, Ken; Nakamura, Masaya; Toyama, Yoshiaki; Matsumoto, Morio

    2015-10-01

    OBJECT The object of this study was to investigate correlations between sagittal spinopelvic alignment and improvements in clinical and quality-of-life (QOL) outcomes after lumbar decompression surgery for lumbar spinal canal stenosis (LCS) without coronal imbalance. METHODS The authors retrospectively reviewed data from consecutive patients treated for LCS with decompression surgery in the period from 2009 through 2011. They examined correlations between preoperative or postoperative sagittal vertical axis (SVA) and radiological parameters, clinical outcomes, and health-related (HR)QOL scores in patients divided according to SVA. Clinical outcomes were assessed according to Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores. Health-related QOL was evaluated using the Roland-Morris Disability Questionnaire (RMDQ) and the JOA Back Pain Evaluation Questionnaire (JOABPEQ). RESULTS One hundred nine patients were eligible for inclusion in the study. Compared to patients with normal sagittal alignment prior to surgery (Group A: SVA < 50 mm), those with preoperative sagittal imbalance (Group B: SVA ? 50 mm) had significantly smaller lumbar lordosis and thoracic kyphosis angles and larger pelvic tilt. In Group B, there was a significant decrease in postoperative SVA compared with the preoperative SVA (76.3 ± 29.7 mm vs 54.3 ± 39.8 mm, p = 0.004). The patients in Group B with severe preoperative sagittal imbalance (SVA > 80 mm) had residual sagittal imbalance after surgery (82.8 ± 41.6 mm). There were no significant differences in clinical and HRQOL outcomes between Groups A and B. Compared to patients with normal postoperative SVA (Group C: SVA < 50 mm), patients with a postoperative SVA ? 50 mm (Group D) had significantly lower JOABPEQ scores, both preoperative and postoperative, for walking ability (preop: 36.6 ± 26.3 vs 22.7 ± 26.0, p = 0.038, respectively; postop: 71.1 ± 30.4 vs 42.5 ± 29.6, p < 0.001) and social functioning (preop: 38.7 ± 18.5 vs 30.2 ± 16.7, p = 0.045; postop: 67.0 ± 25.8 vs 49.6 ± 20.0, p = 0.001), as well as significantly higher postoperative RMDQ (4.9 ± 5.2 vs 7.9 ± 5.7, p = 0.015) and VAS scores for low-back pain (2.68 ± 2.69 vs 3.94 ± 2.59, p = 0.039). CONCLUSIONS Preoperative sagittal balance was not significantly correlated with clinical or HRQOL outcomes after decompression surgery in LCS patients without coronal imbalance. Decompression surgery improved the SVA value in patients with preoperative sagittal imbalance; however, the patients with severe preoperative sagittal imbalance (SVA > 80 mm) had residual imbalance after decompression surgery. Both clinical and HRQOL outcomes were negatively affected by postoperative residual sagittal imbalance. PMID:26140404

  19. Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study

    PubMed Central

    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, (p<0.001). The increase was most marked in the oldest age groups with a 1.9 and 2.33-fold increase in admissions for patients aged 60–74 and ?75?years, respectively, and a 2.8-fold increase in procedures for those aged ?60?years. Trends in hospital admissions were characterised by a widening gender gap, increasing mean patient age, and decreasing mean hospital stay (p<0.001). Trends in procedures were characterised by a narrowing gender gap, increasing mean patient age (p=0.014) and decreasing mean hospital stay (p<0.001). Linear regression models estimate that each hospital admission translates to 0.27 procedures, per 100?000 (95% CI 0.25 to 0.30, r 0.99, p<0.001; r, Pearson's correlation coefficient). Hospital admissions are increasing at 3.5 times the rate of surgical procedures (regression gradient 7.63 vs 2.18 per 100?000/year). Conclusions LBP represents a significant and increasing workload for hospitals in England. These trends demonstrate an increasing demand for specialists involved in the surgical and non-surgical management of this disease, and highlight the need for services capable of dealing with the increased comorbidity burden associated with an ageing patient group. PMID:26671956

  20. Effect of complications within 90 days on patient-reported outcomes 3 months and 12 months following elective surgery for lumbar degenerative disease.

    PubMed

    Chotai, Silky; Parker, Scott L; Sivaganesan, Ahilan; Sielatycki, J Alex; Asher, Anthony L; McGirt, Matthew J; Devin, Clinton J

    2015-12-01

    OBJECT There is a paradigm shift toward rewarding providers for quality rather than volume. Complications appear to occur at a fairly consistent frequency in large aggregate data sets. Understanding how complications affect long-term patient-reported outcomes (PROs) following degenerative lumbar surgery is vital. The authors hypothesized that 90-day complications would adversely affect long-term PROs. METHODS Nine hundred six consecutive patients undergoing elective surgery for degenerative lumbar disease over a period of 4 years were enrolled into a prospective longitudinal registry. The following PROs were recorded at baseline and 12-month follow-up: Oswestry Disability Index (ODI) score, numeric rating scales for back and leg pain, quality of life (EQ-5D scores), general physical and mental health (SF-12 Physical Component Summary [PCS] and Mental Component Summary [MCS] scores) and responses to the North American Spine Society (NASS) satisfaction questionnaire. Previously published minimum clinically important difference (MCID) threshold were used to define meaningful improvement. Complications were divided into major (surgicalsite infection, hardware failure, new neurological deficit, pulmonary embolism, hematoma and myocardial infarction) and minor (urinary tract infection, pneumonia, and deep venous thrombosis). RESULTS Complications developed within 90 days of surgery in 13% (118) of the patients (major in 12% [108] and minor in 8% [68]). The mean improvement in ODI scores, EQ-5D scores, SF-12 PCS scores, and satisfaction at 3 months after surgery was significantly less in the patients with complications than in those who did not have major complications (ODI: 13.5 ± 21.2 vs 21.7 ± 19, < 0.0001; EQ-5D: 0.17 ± 0.25 vs 0.23 ± 0.23, p = 0.04; SF-12 PCS: 8.6 ± 13.3 vs 13.0 ± 11.9, 0.001; and satisfaction: 76% vs 90%, p = 0.002). At 12 months after surgery, the patients with major complications had higher ODI scores than those without complications (29.1 ± 17.7 vs 25.3 ± 18.3, p = 0.02). However, there was no difference in the change scores in ODI and absolute scores across all other PROs between the 2 groups. In multivariable linear regression analysis, after controlling for an array of preoperative variables, the occurrence of a major complication was not associated with worsening ODI scores 12 months after surgery. There was no difference in the percentage of patients achieving the MCID for disability (66% vs 64%), back pain (55% vs 56%), leg pain (62% vs 59%), or quality of life (19% vs 14%) or in patient satisfaction rates (82% vs 80%) between those without and with major complications. CONCLUSIONS Major complications within 90 days following lumbar spine surgery have significant impact on the short-term PROs. Patients with complications, however, do eventually achieve clinically meaningful outcomes and report satisfaction equivalent to those without major complications. This information allows a physician to counsel patients on the fact that a complication creates frustration, cost, and inconvenience; however, it does not appear to adversely affect clinically meaningful long-term outcomes and satisfaction. PMID:26621422

  1. Epidural Steroid Injections Are Associated with Less Improvement in the Treatment of Lumbar Spinal Stenosis: A subgroup analysis of the SPORT

    PubMed Central

    Radcliff, Kris; Kepler, Christopher; Hilibrand, Alan; Rihn, Jeffrey; Zhao, Wenyan; Lurie, Jon; Tosteson, Tor; Vaccaro, Alexander; Albert, Todd; Weinstein, James

    2013-01-01

    Summary of Background Data Lumbar spinal stenosis is a common incidental finding among adults over the age of 60, The use of ESI in these patients is common, although there is little evidence in the literature to demonstrate the long-term benefit of ESI in the treatment of lumbar stenosis. Objective The hypothesis of this study was that patients who received epidural steroid injections (ESI) during initial treatment as part of the Spine Patient Outcomes Research Trial (SPORT) would have improved clinical outcomes and a lower rate of crossover to surgery compared to patients who did not receive ESI. Methods Patients with lumbar spinal stenosis who received epidural steroid injections within the first three months of enrollment in SPORT (ESI) were compared to patients who did not receive epidural injections during the first three months of the study (No ESI). Results There were 69 ESI patients and 207 No-ESI patients. There were no significant differences in demographic factors, baseline clinical outcome scores, or operative details although there was a significant increase in baseline preference for nonsurgical treatment among ESI patients (62% vs. 33%, p <0.001). There was an average 26 minute increase in operative time and an increased length of stay by 0.9 days among the ESI patients who ultimately underwent surgical treatment. Averaged over four years, there was significantly less improvement in SF36 PF among surgically treated ESI patients (ESI 14.8 vs. No-ESI 22.5, p=0.025). In addition, there was also significantly less improvement among the nonsurgically treated patients in SF36 BP (ESI 7.3 vs. No-ESI 16.7, p=0.007) and SF36 PF (ESI 5.5 vs. No-ESI 15.2, p=0.009). Of the patients assigned to surgical treatment, there was a significantly increased crossover to nonsurgical treatment among patients who received an ESI (ESI 33% vs. No ESI 11%, p=0.012). Of the patients assigned to non-operative treatment, there was a significantly increased crossover to surgical treatment in the ESI patients (ESI 58% vs. No ESI 32%, p=0.003). Conclusion Despite equivalent baseline status, ESI were associated with significantly less improvement at four years among all patients with spinal stenosis in SPORT. Furthermore, ESI were associated with longer duration of surgery and longer hospital stay. There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically. PMID:23238485

  2. Adult's Degenerative Scoliosis: Midterm Results of Dynamic Stabilization without Fusion in Elderly Patients—Is It Effective?

    PubMed Central

    Di Silvestre, Mario; Lolli, Francesco; Greggi, Tiziana; Vommaro, Francesco; Baioni, Andrea

    2013-01-01

    Study Design. A retrospective study. Purpose. Posterolateral fusion with pedicle screw instrumentation used for degenerative lumbar scoliosis can lead to several complications. In elderly patients without sagittal imbalance, dynamic stabilization could represent an option to avoid these adverse events. Methods. 57 patients treated by dynamic stabilization without fusion were included. All patients had degenerative lumbar de novo scoliosis (average Cobb angle 17.2°), without sagittal imbalance, associated in 52 cases (91%) with vertebral canal stenosis and in 24 (42%) with degenerative spondylolisthesis. Nineteen patients (33%) had previously undergone lumbar spinal surgery. Results. At an average followup of 77 months, clinical results improved with statistical significance. Scoliosis Cobb angle was 17.2° (range, 12° to 38°) before surgery and 11.3° (range, 4° to 26°) at last follow-up. In the patients with associated spondylolisthesis, anterior vertebral translation was 19.5% (range, 12% to 27%) before surgery, 16.7% (range, 0% to 25%) after surgery, and 17.5% (range, 0% to 27%) at followup. Complications incidence was low (14%), and few patients required revision surgery (4%). Conclusions. In elderly patients with mild degenerative lumbar scoliosis without sagittal imbalance, pedicle screw-based dynamic stabilization is an effective option, with low complications incidence, granting curve stabilization during time and satisfying clinical results. PMID:23781342

  3. Adult's Degenerative Scoliosis: Midterm Results of Dynamic Stabilization without Fusion in Elderly Patients-Is It Effective?

    PubMed

    Di Silvestre, Mario; Lolli, Francesco; Greggi, Tiziana; Vommaro, Francesco; Baioni, Andrea

    2013-01-01

    Study Design. A retrospective study. Purpose. Posterolateral fusion with pedicle screw instrumentation used for degenerative lumbar scoliosis can lead to several complications. In elderly patients without sagittal imbalance, dynamic stabilization could represent an option to avoid these adverse events. Methods. 57 patients treated by dynamic stabilization without fusion were included. All patients had degenerative lumbar de novo scoliosis (average Cobb angle 17.2°), without sagittal imbalance, associated in 52 cases (91%) with vertebral canal stenosis and in 24 (42%) with degenerative spondylolisthesis. Nineteen patients (33%) had previously undergone lumbar spinal surgery. Results. At an average followup of 77 months, clinical results improved with statistical significance. Scoliosis Cobb angle was 17.2° (range, 12° to 38°) before surgery and 11.3° (range, 4° to 26°) at last follow-up. In the patients with associated spondylolisthesis, anterior vertebral translation was 19.5% (range, 12% to 27%) before surgery, 16.7% (range, 0% to 25%) after surgery, and 17.5% (range, 0% to 27%) at followup. Complications incidence was low (14%), and few patients required revision surgery (4%). Conclusions. In elderly patients with mild degenerative lumbar scoliosis without sagittal imbalance, pedicle screw-based dynamic stabilization is an effective option, with low complications incidence, granting curve stabilization during time and satisfying clinical results. PMID:23781342

  4. Transforaminal Endoscopic Lumbar Decompression & Foraminoplasty: A 10 Year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery

    PubMed Central

    Knight, Martin TN; Jago, Ingrid; Norris, Christopher; Midwinter, Lynne; Boynes, Christopher

    2014-01-01

    Background Conventional diagnosis between axial and foraminal stenosis is suboptimal and long-term outcomes limited to posterior decompression. Aware state Transforaminal Endoscopic Lumbar Decompression and Foraminoplasty (TELDF) offers a direct aware state means of localizing and treating neuro-claudicant back pain, referred pain and weakness associated with stenosis failing to respond to conventional rehabilitation, pain management or surgery. This prospective survivability study examines the outcomes 10 years after TELDF in patients with foraminal stenosis arising from degeneration or failed back surgery. Methods For 10 years prospective data were collected on 114 consecutive patients with multilevel spondylosis and neuro-claudicant back pain, referred pain and weakness with or without failed back surgery whose symptoms had failed to respond to conventional rehabilitation and pain management and who underwent TELDF. The level responsible for the predominant presenting symptoms of foraminal stenosis, determined on clinical grounds, MRI and or CT scans, was confirmed by transforaminal probing and discography. Patients underwent TELDF at the spinal segment at which the predominant presenting symptoms were reproduced. Those that required treatment at an additional segment were excluded. Outcomes were assessed by postal questionnaire with failures being examined by the independent authors using the Visual Analogue Pain Scale (VAPS), the Oswestry Disability Index (ODI) and the Prolo Activity Score. Results Cohort integrity was 69%. 79 patients were available for evaluation after removal of the deceased (12), untraceable (17) and decliners (6) from the cohort. VAP scores improved from a pre-operative mean of 7.3 to 2.4 at year 10. The ODI improved from a mean of 58.5 at baseline to 17.5 at year 10. 72% of reviewed patients fulfilled the definition of an “Excellent” or “Good Clinical Impact” at review using the Spinal Foundation Outcome Score. Based on the Prolo scale, 61 patients (77%) were able to return and continue in full or part-time work or retirement activity post-TELDF. Complications of TELDF were limited to transient nerve irritation, which affected 19% of the cohort for 2 – 4 weeks. TELDF was equally beneficial in those with failed back surgery. Conclusions TELDF is a beneficial intervention for the long-term treatment of severely disabled patients with neuro-claudicant symptoms arising from spinal or foraminal stenosis with a dural diameter of more than 3mm, who have failed to respond to conventional rehabilitation or chronic pain management. It results in considerable improvements in symptoms and function sustained 10 years later despite co-morbidity, ageing or the presence of failed back surgery. Clinical Relevance The long term outcome of TELDF in severely disabled patients with neuro-claudicant symptoms arising from foraminal stenosis which had failed to respond to conventional rehabilitation, surgery or chronic pain management suggests that foraminal pathology is a major cause of lumbar axial and referred pain and that TELDF should be offered as primary treatment for these conditions even in the elderly and infirm. The application of TELDF at multiple levels may further widen the benefits of this technique. PMID:25694924

  5. Adult Degenerative Scoliosis with Spinal Stenosis Treated with Stand-Alone Cage via an Extreme Lateral Transpsoas Approach; a Case Report and Literature Review

    PubMed Central

    von Keudell, Arvind; Alimi, Marjan; Gebhard, Harry; Härtl, Roger

    2015-01-01

    We report the case of a 73-year-old female with severe degenerative scoliosis and back and leg pain that was successfully treated with stand- alone cages via an extreme lateral transpsoas approach. This patient had declined open surgery and instrumentation due to her advanced age concerns about potential side effects. PMID:26110180

  6. Angiopoietin-like protein 2 induced by mechanical stress accelerates degeneration and hypertrophy of the ligamentum flavum in lumbar spinal canal stenosis.

    PubMed

    Nakamura, Takayuki; Okada, Tatsuya; Endo, Motoyoshi; Kadomatsu, Tsuyoshi; Taniwaki, Takuya; Sei, Akira; Odagiri, Haruki; Masuda, Tetsuro; Fujimoto, Toru; Nakamura, Takafumi; Oike, Yuichi; Mizuta, Hiroshi

    2014-01-01

    Chronic inflammation and subsequent fibrosis induced by mechanical stress play an important role in ligamentum flavum (LF) hypertrophy and degeneration in patients with lumbar spinal canal stenosis (LSCS). Angiopoietin-like protein 2 (Angptl2) is a chronic inflammatory mediator induced under various pathological conditions and increases the expression of TGF-?1, which is a well-characterized mediator in LF hypertrophy. We investigated whether Angptl2 is induced by mechanical stress, and whether it contributes to LF hypertrophy and degeneration by activating the TGF-?1 signaling cascade. In this study, we investigated human LF tissue and LF fibroblasts isolated from patients who underwent lumbar surgery. We found that Angptl2 was abundantly expressed in fibroblasts of hypertrophied LF tissues at both the mRNA and protein levels. This expression was not only positively correlated with LF thickness and degeneration but also positively correlated with lumbar segmental motion. Our in vitro experiments with fibroblasts from hypertrophied LF tissue revealed that mechanical stretching stress increases the expression and secretion of Angptl2 via activation of calcineurin/NFAT pathways. In hypertrophied LF tissue, expression of TGF-?1 mRNA was also increased and TGF-?1/Smad signaling was activated. Angptl2 expression in LF tissue was positively correlated with the expression of TGF-?1 mRNA, suggesting cooperation between Angptl2 and TGF-?1 in the pathogenesis of LF hypertrophy. In vitro experiments revealed that Angptl2 increased levels of TGF-?1 and its receptors, and also activated TGF-?1/Smad signaling. Mechanical stretching stress increased TGF-?1 mRNA expression, which was partially attenuated by treatment with a calcineurin/NFAT inhibitor or Angptl2 siRNA, indicating that induction of TGF-?1 expression by mechanical stretching stress is partially mediated by Angptl2. We conclude that expression of Angptl2 induced by mechanical stress in LF fibroblasts promotes LF tissue degeneration by activation of TGF-?1/Smad signaling, which results in LF hypertrophy in patients with LSCS. PMID:24465594

  7. Role of the Self-Administered, Self-Reported History Questionnaire to Identify Types of Lumbar Spinal Stenosis: A Sensitivity Analysis

    PubMed Central

    Nayeb Aghaei, Hossein; Shahzadi, Sohrab; Azhari, Shirzad; Mohammadi, Hassan Reza

    2015-01-01

    Study Design Case-control design. Purpose To evaluate the role of the self-administered, self-reported history questionnaire (SSHQ) in identifying types of lumbar spinal stenosis (LSS). Overview of Literature Diagnosis of types of LSS is controversial. Methods A total of 235 patients with LSS were asked to respond to the SSHQ. All of these patients recovered following surgical treatment. The classification of LSS patients was based on history, physical examinations, and imaging studies. It is considered to be the gold standard. Radicular and neurogenic claudication types of LSS were based on the SSHQ developed by Konno et al. Two categories of LSS were determined based on the SSHQ tool and gold standard. Finally, a sensitivity analysis was carried out to evaluate the diagnostic value of the SSHQ. Results The mean age of patients was 59.4 years. According to the criteria for gold standard, patients were diagnosed with the radicular type (n=103), and neurogenic claudication type (n=132). The questionnaire had desirable sensitivity, specificity, and accuracy in categorizing the two types of LSS: 97.8%, 66.6%, and 96.8% for the radicular type, and 97.0%, 80.0%, and 95.7% for the neurogenic claudication type. Conclusions Our findings indicate that the SSHQ is a reliable and a valid measure and it may be a clinical diagnosis support tool for identifying patients with two types of LSS. PMID:26435785

  8. Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study

    PubMed Central

    2010-01-01

    Background To assess safety, risk factors and clinical outcomes in elderly patients with spinal stenosis after decompressive laminectomy. Methods A prospective cohort of patients 70 years and older with spinal stenosis undergoing conventional laminectomy without fusion (n = 101) were consecutively enrolled from regular clinical practice and reassessed at 3 and 12 months. Primary outcome was change in health related quality of life measured (HRQL) with EuroQol-5 D (EQ-5D). Secondary outcomes were safety assessment, changes in Oswestry disability index (ODI), Visual Analogue Scale (EQ-VAS) score for self reported health, VAS score for leg and back pain and patient satisfaction. We used regression analyses to evaluate risk factors for less improvement. Results The mean EQ-5 D total score were 0.32, 0.63 and 0.60 at baseline, 3 months and 12 months respectively, and represents a statistically significant (P < 0.001) improvement. Effect size was > 0.8. Mean ODI score at baseline was 44.2, at 3 months 25.6 and at 27.9. This represents an improvement for all post-operative scores. A total of 18 (18.0%) complications were registered with 6 (6.0%) classified as major, including one perioperative death. Patients stating that the surgery had been beneficial at 3 months was 82 (89.1%) and at 12 months 73 (86.9%). The only predictor found was patients with longer duration of leg pain had less improvement in ODI (P < 0.001). Increased age or having complications did not predict a worse outcome in any of the outcome variables. Conclusions Properly selected patients of 70 years and older can expect a clinical meaningful improvement of HRQL, functional status and pain after open laminectomy without fusion. The treatment seems to be safe. However, patients with longstanding leg-pain prior to operation are less likely to improve one year after surgery. PMID:21092227

  9. Effectiveness of Preemptive Analgesia Using a Frequency Rhythmic Electrical Modulation System in Patients Having Instrumented Fusion for Lumbar Stenosis

    PubMed Central

    Aydo?an, Serhat; Özlü, Onur

    2014-01-01

    Study Design A randomized prospective study. Purpose To assess postoperative analgesic requirements after Phyback therapy preemptively in patients undergoing lumbar stabilization. Overview of Literature Frequency Rhythmic Electrical Modulation System is the latest method of preemptive analgesia. Methods Forty patients were divided into two groups. Patients who were to receive tramadol were allocated to "group A" and those who were to receive Phyback therapy were allocated to "group B." In patients with a visual analog scale score of >4 or a verbal rating scale score of >2, 75 mg of diclofenac IM was administered. The amount of analgesic consumption, the bolus demand dosage, and the number of bolus doses administered were recorded. Patient satisfaction was evaluated using the visual analog patient satisfaction scale. Results There were statistically significant differences in the visual analog scale and verbal rating scale scores in the fourth, sixth, 12th, and 24th hours. The number of bolus infusions was significantly lower in group B. The amount of analgesic consumption was higher in group A. There was a significant difference between the two groups in the number of bolus infusions and the total amount of analgesic consumption, and this comparison showed better results for group B. Conclusions Application of Phyback therapy reduced postoperative opioid consumption and analgesic demand, and it contributed to reducing patients' level of pain and increased patient satisfaction. Moreover, the application of preemptive Phyback therapy contributed to reducing preoperative pain which may have reduced patient anxiety. PMID:24761202

  10. Degenerative Changes of Spine in Helicopter Pilots

    PubMed Central

    Byeon, Joo Hyeon; Kim, Jung Won; Jeong, Ho Joong; Sim, Young Joo; Kim, Dong Kyu; Choi, Jong Kyoung; Im, Hyoung June

    2013-01-01

    Objective To determine the relationship between whole body vibration (WBV) induced helicopter flights and degenerative changes of the cervical and lumbar spine. Methods We examined 186 helicopter pilots who were exposed to WBV and 94 military clerical workers at a military hospital. Questionnaires and interviews were completed for 164 of the 186 pilots (response rate, 88.2%) and 88 of the 94 clerical workers (response rate, 93.6%). Radiographic examinations of the cervical and the lumbar spines were performed after obtaining informed consent in both groups. Degenerative changes of the cervical and lumbar spines were determined using four radiographs per subject, and diagnosed by two independent, blinded radiologists. Results There was no significant difference in general and work-related characteristics except for flight hours and frequency between helicopter pilots and clerical workers. Degenerative changes in the cervical spine were significantly more prevalent in the helicopter pilots compared with control group. In the cervical spine multivariate model, accumulated flight hours (per 100 hours) was associated with degenerative changes. And in the lumbar spine multivariate model, accumulated flight hours (per 100 hours) and age were associated with degenerative changes. Conclusion Accumulated flight hours were associated with degenerative changes of the cervical and lumbar spines in helicopter pilots. PMID:24236259

  11. Cell-Based Therapies Used to Treat Lumbar Degenerative Disc Disease: A Systematic Review of Animal Studies and Human Clinical Trials

    PubMed Central

    Oehme, David; Goldschlager, Tony; Ghosh, Peter; Rosenfeld, Jeffrey V.; Jenkin, Graham

    2015-01-01

    Low back pain and degenerative disc disease are a significant cause of pain and disability worldwide. Advances in regenerative medicine and cell-based therapies, particularly the transplantation of mesenchymal stem cells and intervertebral disc chondrocytes, have led to the publication of numerous studies and clinical trials utilising these biological therapies to treat degenerative spinal conditions, often reporting favourable outcomes. Stem cell mediated disc regeneration may bridge the gap between the two current alternatives for patients with low back pain, often inadequate pain management at one end and invasive surgery at the other. Through cartilage formation and disc regeneration or via modification of pain pathways stem cells are well suited to enhance spinal surgery practice. This paper will systematically review the current status of basic science studies, preclinical and clinical trials utilising cell-based therapies to repair the degenerate intervertebral disc. The mechanism of action of transplanted cells, as well as the limitations of published studies, will be discussed. PMID:26074979

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

    PubMed Central

    Cher, Daniel Joseph; Reckling, W Carlton

    2015-01-01

    Background Pain from the sacroiliac joint (SIJ) is an under-recognized cause of low back pain. The degree to which SIJ pain decreases quality of life has not been directly compared to other more familiar conditions of the lumbar spine. Methods Multivariate regression analysis of individual patient data from two prospective multicenter clinical trials of SIJ fusion and three prospective multicenter clinical trials of surgical treatments for degenerative lumbar spine conditions. Results Controlling for baseline demographic parameters as well as a validated disability score, quality of life scores (EuroQOL 5-D and SF-36) were, in most cases, lower in the SIJ cohorts compared to the three other spine surgery cohorts. Conclusion Patients with SIJ dysfunction considering surgery have decrements in quality of life as or more severe compared to patients with degenerative spondylolisthesis, spinal stenosis, and intervertebral disc herniation. PMID:26396547

  13. Iatrogenic neurologic deficit after lumbar spine surgery: A review.

    PubMed

    Ghobrial, George M; Williams, Kim A; Arnold, Paul; Fehlings, Michael; Harrop, James S

    2015-12-01

    Iatrogenic neurologic deficits after lumbar spine surgery are rare complications, but important to recognize and manage. Complications such as radiculopathy, spinal cord compression, motor deficits (i.e. foot drop with L5 radiculopathy), and new onset radiculitis, while uncommon do occur. Attempts at mitigating these complications with the use of neuromonitoring have been successful. Guidance in the literature as to the true rate of iatrogenic neurologic deficit is limited to several case studies and retrospective designed studies describing the management, prevention and treatment of these deficits. The authors review the lumbar spinal surgery literature to examine the incidence of iatrogenic neurologic deficit in the lumbar spinal surgery literature. An advanced MEDLINE search conducted on May 14th, 2015 from January 1, 2004 through May 14, 2015, using the following MeSH search terms "postoperative complications," then subterms "lumbar vertebrae," treatment outcome," "spinal fusion," and "radiculopathy" were included together with "postoperative complications" in a single search. Postoperative complications including radiculopathy, weakness, and spinal cord compression were included. The definition of iatrogenic neurologic complication was limited to post-operative radiculopathy, motor weakness or new onset pain/radiculitis. An advanced MEDLINE search conducted on May 14th, 2015 using all of the above terms together yielded 21 results. After careful evaluation, 11 manuscripts were excluded and 10 were carefully reviewed. The most common indications for surgery were degenerative spondylolisthesis, spondylosis, scoliosis, and lumbar stenosis. In 2783 patients in 12 total studies, there were 56 patients who had reported a postoperative neurologic deficit for a rate of 5.7. The rates of deficits ranged from 0.46% to 17% in the studies used. The average rate of reported neurologic complications within these papers was 9% (range 0.46-24%). Thirty patients of a total of 731 (4.1%) had a new onset neurologic injury after anterior lumber interbody fusion or lateral lumber interbody fusion. Thirty-seven out of 2052 (1.9%) patients had a neurologic injury after posterior decompression and fusion. Screw malposition was responsible for 11 deficits. Spinal surgery for lumbar degenerative disease carries a low but definite rate of neurologic deficits. Despite the introduction of neuromonitoring, these complications still occur. Interpretation of neurologic injury rates for lumbar surgery is limited by the few prospective and cohort-matched controlled studies. Likewise, most injuries were associated with the placement of instrumentation despite the type of approach. PMID:26386902

  14. Degenerative Spondylolisthesis.

    PubMed

    Koreckij, Theodore D; Fischgrund, Jeffrey S

    2015-08-01

    Degenerative spondylolisthesis (DS) is one of the more commonly encountered spine conditions. The diagnosis of DS has changed little in the last 30 years. However, there has been an evolution in the treatment of this disease entity. There have been several landmark papers that helped govern our treatment. These helped serve as the basis for the treatment arms of the Spine Patient Outcomes Research Trial (SPORT), which offers the highest quality evidence to date. Although few would argue that the fusion of the diseased segment appears to offer the best and most durable results, treatment of this disease is best tailored to the individual. Fusion may offer the best results in the young active patient, but the same results may never become evident in the medically infirm patient. Laminectomy or unilateral laminoforaminotomy still plays a role in disease treatment. This review will focus on the diagnosis and the treatment of DS as well as discuss the author's preferred treatment of this disease. PMID:26172828

  15. Surgical versus Non-Operative Treatment for Lumbar Spinal Stenosis Four-Year Results of the Spine Patient Outcomes Research Trial (SPORT)

    PubMed Central

    Weinstein, James N.; Tosteson, Tor D.; Lurie, Jon D.; Tosteson, Anna; Blood, Emily; Herkowitz, Harry; Cammisa, Frank; Albert, Todd; Boden, Scott D.; Hilibrand, Alan; Goldberg, Harley; Berven, Sigurd; An, Howard

    2012-01-01

    Study Design Randomized trial and concurrent observational cohort study Objective To compare 4 year outcomes of surgery to non-operative care for spinal stenosis. Summary of Background Data Surgery for spinal stenosis has been shown to be more effective compared to non-operative treatment over two years, but longer-term data have not been analyzed. Methods Surgical candidates from 13 centers in 11 U.S. states with at least 12 weeks of symptoms and confirmatory imaging were enrolled in a randomized cohort (RC) or observational cohort (OC). Treatment was standard decompressive laminectomy or standard non-operative care. Primary outcomes were SF-36 bodily pain (BP) and physical function (PF) scales and the modified Oswestry Disability index (ODI) assessed at 6 weeks, 3 months, 6 months and yearly up to 4 years. Results 289 patients enrolled in the RC and 365 patients enrolled in the OC. An as-treated analysis combining the RC and OC and adjusting for potential confounders found that the clinically significant advantages for surgery previously reported were maintained through 4 years, with treatment effects (defined as mean change in surgery group minus mean change in non-op group) for BP 12.6 (95% CI, 8.5 to 16.7); PF 8.6 (95% CI, 4.6 to 12.6); and ODI ?9.4 (95% CI, ?12.6, to ?6.2). Early advantages for surgical treatment for secondary measures such as bothersomeness, satisfaction with symptoms and self-rated progress also were maintained. Conclusions Patients with symptomatic spinal stenosis treated surgically compared to those treated non-operatively maintain substantially greater improvement in pain and function through four years. PMID:20453723

  16. Meatal Stenosis

    MedlinePLUS

    ... Stenosis Meatal Stenosis Sometimes the opening of the penis where urine passes can become blocked and can ... of the opening at the tip of the penis. This condition is usually acquired but can exist ...

  17. Lateral Lumbar Interbody Fusion

    PubMed Central

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

    2015-01-01

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

  18. Aortic stenosis

    MedlinePLUS

    ... made when the health care provider heard a heart murmur and performed tests. Symptoms of aortic stenosis include: ... A heart murmur, click, or other abnormal sound is almost always heard through a stethoscope. The health care provider may ...

  19. Minimally invasive procedures on the lumbar spine

    PubMed Central

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

    2015-01-01

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

  20. Pulmonary valve stenosis

    MedlinePLUS

    ... valve pulmonary stenosis; Pulmonary stenosis; Stenosis - pulmonary valve; Balloon valvuloplasty - pulmonary ... water pills) Treat abnormal heartbeats and rhythms Percutaneous balloon pulmonary dilation (valvuloplasty) may be performed when no ...

  1. Mimickers of lumbar radiculopathy.

    PubMed

    Grimm, Bennett Douglas; Blessinger, Brian Joseph; Darden, Bruce Vaiden; Brigham, Craig D; Kneisl, Jeffrey S; Laxer, Eric B

    2015-01-01

    Orthopaedic surgeons frequently treat patients who report pain that radiates from the back into the lower extremity. Although the most common etiology is either a herniated disk or spinal stenosis, a myriad of pathologies can mimic the symptoms of radiculopathy, resulting in differences in the clinical presentation and the workup. Therefore, the clinician must be able to distinguish the signs and symptoms of lumbar radiculopathy from pathologies that may have a similar presentation. Being cognizant of these other possible conditions enables the physician to consider a breadth of alternative diagnoses when a patient presents with radiating lower extremity pain. PMID:25538126

  2. Degenerative Nerve Diseases

    MedlinePLUS

    Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many of these diseases are genetic. Sometimes the cause is a medical ...

  3. Spinal Stenosis

    MedlinePLUS

    ... column provides the main support for the upper body, allowing humans to stand upright or bend and twist, and ... of nerve roots that continues from the lumbar region, where the spinal cord ends, ... part of the body. It resembles a “horse’s tail” ( cauda equina in ...

  4. Research strategies for pain in lumbar radiculopathy focusing on acid-sensing ion channels and their toxins.

    PubMed

    Lin, Jiann-Her; Chiang, Yung-Hsiao; Chen, Chih-Cheng

    2015-01-01

    In lumbar radiculopathy, the dorsal root or dorsal root ganglia (DRG) are compressed or affected by herniated discs or degenerative spinal canal stenosis. The disease is multi-factorial and involves almost all types of pain, such as ischemic, inflammatory, mechanical, and neuropathic pain. Acid-sensing ion channels (ASICs) activated by extracellular acidosis play an important role in pain generation, and the effects of ASICs are widespread in lumbar radiculopathy. ASICs may be involved in the disc degeneration process, which results in disc herniation and, therefore, the compression of the dorsal roots or DRG. ASIC3 is involved in inflammatory pain and ischemic pain, and, likely, mechanical pain. ASIC1a and ASIC3 may have an important effect on control of the vascular tone of the radicular artery. In the central nervous system, ASIC1a modulates the central sensitization of the spinal dorsal horn. Thus, toxins targeting ASICs, because of their specificity, may help elucidate the roles of ASICs in lumbar radiculopathy and could be developed as novel analgesic agents. PMID:25686734

  5. The Effect of Iliac Crest Autograft on the Outcome of Fusion in the Setting of Degenerative Spondylolisthesis

    PubMed Central

    Radcliff, Kristen; Hwang, Raymond; Hilibrand, Alan; Smith, Harvey E.; Gruskay, Jordan; Lurie, Jon D.; Zhao, Wenyan; Albert, Todd; Weinstein, James

    2012-01-01

    Background: There is considerable controversy about the long-term morbidity associated with the use of posterior autologous iliac crest bone graft for lumbar spine fusion procedures compared with the use of bone-graft substitutes. The hypothesis of this study was that there is no long-term difference in outcome for patients who had posterior lumbar fusion with or without iliac crest autograft. Methods: The study population includes patients enrolled in the degenerative spondylolisthesis cohort of the Spine Patient Outcomes Research Trial who underwent lumbar spinal fusion. Patients were divided according to whether they had or had not received posterior autologous iliac crest bone graft. Results: There were 108 patients who had fusion with iliac crest autograft and 246 who had fusion without iliac crest autograft. There were no baseline differences between groups in demographic characteristics, comorbidities, or baseline clinical scores. At baseline, the group that received iliac crest bone graft had an increased percentage of patients who had multilevel fusions (32% versus 21%; p = 0.033) and L5-S1 surgery (37% versus 26%; p = 0.031) compared with the group without iliac crest autograft. Operative time was higher in the iliac crest bone-graft group (233.4 versus 200.9 minutes; p < 0.001), and there was a trend toward increased blood loss (686.9 versus 582.3; p = 0.057). There were no significant differences in postoperative complications, including infection or reoperation rates, between the groups. On the basis of the numbers available, no significant differences were detected between the groups treated with or without iliac crest bone graft with regard to the scores on Short Form-36, Oswestry Disability Index, Stenosis Bothersomeness Index, and Low Back Pain Bothersomeness Scale or the percent of patient satisfaction with symptoms averaged over the study period. Conclusions: The outcome scores associated with the use of posterior iliac crest bone graft for lumbar spinal fusion were not significantly lower than those after fusion without iliac crest autograft. Conversely, iliac crest bone-grafting was not associated with an increase in the complication rates or rates of reoperation. On the basis of these results, surgeons may choose to use iliac crest bone graft on a case-by-case basis for lumbar spinal fusion. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:22878599

  6. Percutaneous endoscopic lumbar discectomy - early clinical experience.

    PubMed

    Hirano, Yoshitaka; Mizuno, Junichi; Takeda, Masaaki; Itoh, Yasunobu; Matsuoka, Hidenori; Watanabe, Kazuo

    2012-01-01

    We report our early clinical experience with percutaneous endoscopic lumbar discectomy (PELD) for herniated nucleus pulposus (HNP) in the lumbar spine. We introduced PELD to our clinical practice in June 2009. A total of 311 patients with degenerative lumbar spine disease were treated in our hospital up to August 2011. Thirty-seven patients with lumbar HNP were treated by PELD. PELD was carried out under local anesthesia, and the endoscope was continuously irrigated with saline. Twenty-eight patients were treated through the transforaminal approach, 5 were treated through the interlaminar approach, and 4 were treated through the extraforaminal approach. Surgery was discontinued due to uncontrollable intraoperative pain or anatomical inaccessibility in one case of the interlaminar approach and 2 cases of the extraforaminal approach. In the other 34 patients, the elapsed time of surgery was 34 to 103 minutes (mean 62.4 minutes). Extracorporeal blood loss was insignificant. Immediate symptom relief was achieved in all patients, and postoperative magnetic resonance imaging revealed sufficient removal of the HNP. The length of the postoperative hospital stay was 1 or 2 days in all patients. The surgical method of PELD is completely different from percutaneous nucleotomy, and the aim is to directly remove the HNP with minimum damage to the musculoskeletal structure. Although this study is based on our early clinical outcomes, PELD seemed to be a promising minimally invasive surgery for HNP in the lumbar spine. PMID:23006872

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

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

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

  8. Post intubation tracheal stenosis

    PubMed Central

    De, Sajal; De, Sarmishtha

    2008-01-01

    Tracheal stenosis following prolonged intubation is a relatively rare but a serious problem. However, some degree of airway injury is common following intubation, no matter whether it is prolonged or of short duration. Here, we are reporting a fifty six year old male patient who developed multiple web like tracheal stenosis following intubation with high volume low pressure cuff endotracheal tube. Subsequently, the stenosis was successfully dilated by balloon bronchoplasty. PMID:19742266

  9. [Epidural long-term local pharmacotherapy in patients with degenerative dystrophic spinal diseases during combined rehabilitation therapy].

    PubMed

    Likhachev, M Iu; Razumov, A N; Sidorov, V D

    2002-01-01

    Epidural long-term local pharmacotherapy in degenerative-dystrophic diseases of the lumbar spine proved most effective in combination with rehabilitation procedures. Such combined treatment can be used in cases with long-standing disease resistant to conservative treatment. PMID:12532592

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

    PubMed

    Hiratzka, Jayme; Rastegar, Farbod; Contag, Alec G; Norvell, Daniel C; Anderson, Paul A; Hart, Robert A

    2015-12-01

    Study Design?Systematic review. Objectives?(1) To compare the quality of adverse event (AE) methodology and reporting among randomized trials comparing lumbar fusion with lumbar total disk replacement (TDR) using established AE reporting systems; (2) to compare the AEs and reoperations of lumbar spinal fusion with those from lumbar TDR; (3) to make recommendations on how to report AEs in randomized controlled trials (RCTs) so that surgeons and patients have more-detailed and comprehensive information when making treatment decisions. Methods?A systematic search of PubMed, the Cochrane collaboration database, and the National Guideline Clearinghouse through May 2015 was conducted. Randomized controlled trials with at least 2 years of follow-up comparing lumbar artificial disk replacement with lumbar fusion were included. Patients were required to have axial or mechanical low back pain of ?3 months' duration due to degenerative joint disease defined as degenerative disk disease, facet joint disease, or spondylosis. Outcomes included the quality of AE acquisition methodology and results reporting, and AEs were defined as those secondary to the procedure and reoperations. Individual and pooled relative risks and their 95% confidence intervals comparing lumbar TDR with fusion were calculated. Results?RCTs demonstrated a generally poor description of methods for assessing AEs. There was a consistent lack of clear definition or grading for these events. Furthermore, there was a high degree of variation in reporting of surgery-related AEs. Most studies lacked adequate reporting of the timing of AEs, and there were no clear distinctions between acute or chronic AEs. Meta-analysis of the pooled data demonstrated a twofold increased risk of AEs in patients having lumbar fusion compared with patients having lumbar TDR at 2-year follow-up, and this relative risk was maintained at 5 years. Furthermore, the pooled data demonstrated a 1.7 times greater relative risk of reoperation in the fusion group compared with lumbar TDR, although this risk decreased to 1.1 at 5-year follow-up. However, given the lack of quality and consistency in the methods of recording and reporting of AEs, we are unable to make a clear recommendation of one treatment over the other. Conclusions?Based on the currently available literature, lumbar TDR appears to be comparable in safety to lumbar fusion. However, due to lack of consistency in reporting of AEs, it is difficult to make conclusions regarding the true safety profile of lumbar TDR. Standardization in AE reporting will significantly improve the reliability of the current literature. PMID:26682099

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

    PubMed Central

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

    2015-01-01

    Study Design?Systematic review. Objectives?(1) To compare the quality of adverse event (AE) methodology and reporting among randomized trials comparing lumbar fusion with lumbar total disk replacement (TDR) using established AE reporting systems; (2) to compare the AEs and reoperations of lumbar spinal fusion with those from lumbar TDR; (3) to make recommendations on how to report AEs in randomized controlled trials (RCTs) so that surgeons and patients have more-detailed and comprehensive information when making treatment decisions. Methods?A systematic search of PubMed, the Cochrane collaboration database, and the National Guideline Clearinghouse through May 2015 was conducted. Randomized controlled trials with at least 2 years of follow-up comparing lumbar artificial disk replacement with lumbar fusion were included. Patients were required to have axial or mechanical low back pain of ?3 months' duration due to degenerative joint disease defined as degenerative disk disease, facet joint disease, or spondylosis. Outcomes included the quality of AE acquisition methodology and results reporting, and AEs were defined as those secondary to the procedure and reoperations. Individual and pooled relative risks and their 95% confidence intervals comparing lumbar TDR with fusion were calculated. Results?RCTs demonstrated a generally poor description of methods for assessing AEs. There was a consistent lack of clear definition or grading for these events. Furthermore, there was a high degree of variation in reporting of surgery-related AEs. Most studies lacked adequate reporting of the timing of AEs, and there were no clear distinctions between acute or chronic AEs. Meta-analysis of the pooled data demonstrated a twofold increased risk of AEs in patients having lumbar fusion compared with patients having lumbar TDR at 2-year follow-up, and this relative risk was maintained at 5 years. Furthermore, the pooled data demonstrated a 1.7 times greater relative risk of reoperation in the fusion group compared with lumbar TDR, although this risk decreased to 1.1 at 5-year follow-up. However, given the lack of quality and consistency in the methods of recording and reporting of AEs, we are unable to make a clear recommendation of one treatment over the other. Conclusions?Based on the currently available literature, lumbar TDR appears to be comparable in safety to lumbar fusion. However, due to lack of consistency in reporting of AEs, it is difficult to make conclusions regarding the true safety profile of lumbar TDR. Standardization in AE reporting will significantly improve the reliability of the current literature. PMID:26682099

  12. Paraplegia with lumbar artery compression by the diaphragmatic crus.

    PubMed

    Batt, Michel; Rogopoulos, André; Benchimol, Daniel; Chapot, René; Jean-Baptiste, Elixène; Baque, Patrick

    2008-10-01

    The authors report three cases of transient and recurrent paraplegia due to compression of the second right lumbar artery by the diaphragmatic crus. Circumstances of appearance are suggestive when paraplegia occurs in dorsolumbar hyperlordosis and low cardiac output is an associated hemodynamic risk factor. Selective medullary arteriography is indispensable for diagnosis and can demonstrate three signs: an anterior spinal dorsolumbar artery (artery of Adamkiewicz) that does not descend to the conus medullaris; posterior spinal arteries arising from the second lumbar arteries that vascularize the conus medullaris; existence of a tight stenosis on the second right lumbar artery that is aggravated during dynamic maneuvers. Section of the right diaphragmatic crus and release of the second right lumbar artery from the aorta to the fibrous arcade of the psoas permits definitive cure of symptoms. PMID:18586436

  13. Complications associated with posterior and transforaminal lumbar interbody fusion.

    PubMed

    Chrastil, Jesse; Patel, Alpesh A

    2012-05-01

    Posterior lumbar interbody fusion and transforaminal lumbar interbody fusion are commonly performed to obtain a 360° arthrodesis through a posterior-only approach. These techniques are currently used in the management of spondylolisthesis, degenerative scoliosis, pseudarthrosis, recurrent disk herniation, and chronic low back pain with associated degenerative disk disease. Several adverse events have been described, including intraoperative neurologic injury, implant migration or subsidence, dural tears, infection, heterotopic ossification, BMP-related radiculitis, and osteolysis. Although the use of newer materials (eg, bone morphogenetic proteins) and procedures (eg, minimally invasive surgery) is on the rise, they are associated with unique concerns. Understanding the potential adverse events and steps that can be taken to prevent, detect, and manage complications is critical in patient counseling and perioperative decision making. PMID:22553100

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

    NASA Astrophysics Data System (ADS)

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

    2015-05-01

    Indian Hedgehog (HH) has been shown to be involved in osteoarthritis (OA) in articular joints, where there is evidence that Indian HH blockade could ameliorate OA. It seems to play a prominent role in development of the intervertebral disc (IVD) and in postnatal maintenance. There is little work on IHH in the IVD. Hence the aim of the current study was to investigate the role of Indian Hedgehog in the pathology of facet joint (FJ) OA. 24 patients diagnosed with lumbar intervertebral disk herniation or degenerative spinal stenosis were included. Preoperative magnetic resonance imaging (MRI) and Osteoarthritis Research Society International (OARSI) histopathology grading system was correlated to the mRNA levels of GLI1, PTCH1, and HHIP in the FJs. The Weishaupt grading and OARSI scores showed high positive correlation (r?=?0.894) (P?

  15. What Is Spinal Stenosis?

    MedlinePLUS

    ... To order the Sports Injuries Handout on Health full-text version, please contact NIAMS using the contact information ... publication. To order the Spinal Stenosis Q&A full-text version, please contact NIAMS using the contact information ...

  16. Echocardiographic volume flow and stenosis severity measures with changing flow rate in aortic stenosis.

    PubMed

    Burwash, I G; Forbes, A D; Sadahiro, M; Verrier, E D; Pearlman, A S; Thomas, R; Kraft, C; Otto, C M

    1993-11-01

    The anatomy of degenerative valvular aortic stenosis has been poorly represented in animal models, limiting the evaluation of noninvasive echo-Doppler measures of transvalvular volume flow rate and stenosis severity during progressive disease evolution or under conditions of changing volume flow rates. To study these issues, chronic valvular aortic stenosis, characterized by stiff leaflets without commissural fusion, was created in nine adult mongrel dogs by suturing pericardial covered Teflon-felt pads into the sinuses of Valsalva below the coronary ostia during hypothermic cardiac arrest. In the eight surviving dogs, echo-Doppler examinations were performed weekly for up to 8 wk postoperatively. Simultaneous invasive micromanometer pressure data were collected at 2-wk intervals in all subjects, with simultaneous ascending aortic transit time-volume flow measurement in four subjects. Volume flow rates were altered with saline and dobutamine infusions during invasive studies for comparison of echo-Doppler and invasive pressure gradients, volume flow, and valve areas. Serial echo-Doppler follow-up (39 +/- 11 days) demonstrated that, from baseline to final study, mean transvalvular pressure gradient increased (4 +/- 1 to 38 +/- 7 mmHg, P = 0.001), continuity equation aortic valve area decreased (2.06 +/- 0.18 to 0.54 +/- 0.04 cm2, P < 0.0001), and progressive left ventricular hypertrophy developed (62 +/- 6 to 114 +/- 9 g, P = 0.0003). Echo-Doppler and invasive data correlated well for measures of transvalvular pressure gradients (n = 98, maximum instantaneous gradient r = 0.95, mean gradient r = 0.91), volume flow (n = 75, stroke volume r = 0.86, cardiac output r = 0.86), and valve area (n = 73, r = 0.73) despite acute alterations in volume flow and progressive disease evolution. This chronic canine model, with anatomy and hemodynamics similar to clinical degenerative valvular aortic stenosis, should provide a valuable tool for investigating clinically relevant new measures of stenosis severity with use of invasive or noninvasive techniques. PMID:8238587

  17. Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience.

    PubMed

    Nakajima, Hideaki; Uchida, Kenzo; Honjoh, Kazuya; Sakamoto, Takumi; Kitade, Makoto; Baba, Hisatoshi

    2016-01-01

    OBJECT Low lumbar osteoporotic vertebral collapse (OVC) has not been well documented compared with OVC of the thoracolumbar spine. The differences between low lumbar and thoracolumbar lesions should be studied to provide better treatment. The aim of this study was to clarify the clinical and imaging features as well as outcomes of low lumbar OVC and to discuss the appropriate surgical treatment. METHODS Thirty patients (10 men; 20 women; mean age 79.3 ± 4.7 years [range 70-88 years]) with low lumbar OVC affecting levels below L-3 underwent surgical treatment. The clinical symptoms, morphological features of affected vertebra, sagittal spinopelvic alignment, neurological status before and after surgery, and surgical procedures were reviewed at a mean follow-up period of 2.4 years. RESULTS The main clinical symptom was radicular leg pain. Most patients had old compression fractures at the thoracolumbar level. The affected vertebra was flat-type and concave or H-shaped type, not wedge type as often found in thoracolumbar OVC. There were mismatches between pelvic incidence and lumbar lordosis on plain radiographs. On CT and MR images, foraminal stenosis was seen in 18 patients (60%) and canal stenosis in 24 patients (80%). Decompression with short fusion using a posterior approach was performed. Augmentations of vertebroplasty, posterolateral fusion, and posterior lumbar interbody fusion were performed based on the presence/absence of local kyphosis of lumbar spine, cleft formation, and/or intervertebral instability. Although the neurological and visual analog scale scores improved postoperatively, 8 patients (26.7%) developed postoperative complications mainly related to instrumentation failure. In patients with postoperative complications, lumbar spine bone mineral density was significantly low, but the spinopelvic alignment showed no correlation when compared with those without complications. CONCLUSIONS The main types of low lumbar OVC were flat-type and concave type, which resulted in neurological symptoms by retropulsed bony fragments generating foraminal stenosis and/or canal stenosis. For patients with low lumbar OVC, decompression of the foraminal and canal stenosis with short fusion surgery via posterior approach can improve neurological symptoms. Since these patients are elderly with poor bone quality and other complications, treatments for both OVC and osteoporosis should be provided to achieve good clinical outcome. PMID:26384132

  18. Screening for Carotid Artery Stenosis

    MedlinePLUS

    Understanding Task Force Recommendations Screening for Carotid Artery Stenosis The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Carotid Artery Stenosis. This final ...

  19. The Effect of Extreme Obesity on Outcomes of Treatment for Lumbar Spinal Conditions: Subgroup Analysis of the Spine Patient Outcomes Research Trial (SPORT)

    PubMed Central

    McGuire, Kevin J; Khaleel, Mohammed A; Rihn, Jeffrey A; Lurie, Jon D; Zhao, Wenyan; Weinstein, James N

    2015-01-01

    Study Design/Setting SPORT subgroup analysis Objective To evaluate the effect of extreme obesity on management of lumbar spinal stenosis (SpS), degenerative spondylolisthesis (DS), and intervertebral disc herniation (IDH) Summary of Background Data Prior SPORT analyses compared nonobese and obese. This study compares nonobese to class I obesity and class II/III extreme obesity. Methods For SpS, 250/634 nonobese, 104/167 obese, and 59/94 extremely obese patients underwent surgery. For DS, 233/376 nonobese, 90/129 obese, and 66/96 extremely obese patients had surgery. For IDH, 542/854 nonobese, 151/207 obese, 94/129 extremely obese patients had surgery. Outcomes included SF-36, Oswestry Disability Index, Stenosis/Sciatica Bothersomeness Index, Low Back Pain Bothersomeness Index, operative events, complications, and reoperations. Results Extremely obese patients had increased comorbidities. Baseline SF-36 physical function scores were lower for obese; lowest for extremely obese. For SpS, surgical treatment effect and operative events among groups were not significantly different. For DS, 4-year SF-36 physical function scores had greatest treatment effect in extremely obese. This observation was found in most primary outcome measures, and is attributable to the significantly poorer nonoperative outcomes. Operative times and wound infection rates were greatest for the extremely obese. Additional surgery at 3 and 4 years was higher in both obese cohorts. For IDH, extremely obese experienced less improvement post-op than obese and nonobese; however, nonoperative treatment for extremely obese patients was worse, resulting in treatment effect still greater in almost all measures. Operative time was greatest for extremely obese. Blood loss and length of stay was greater for both obese cohorts compared to non-obese. Conclusions Extremely obese with DS experienced longer operative times and increased infection. Operative time was greatest for extremely obese with IDH. DS and IDH saw greater surgical treatment effect for extremely obese due to poor outcomes of nonsurgical management. PMID:25365713

  20. Diagnostic Lumbar Puncture

    PubMed Central

    Doherty, Carolynne M; Forbes, Raeburn B

    2014-01-01

    Diagnostic Lumbar Puncture is one of the most commonly performed invasive tests in clinical medicine. Evaluation of an acute headache and investigation of inflammatory or infectious disease of the nervous system are the most common indications. Serious complications are rare, and correct technique will minimise diagnostic error and maximise patient comfort. We review the technique of diagnostic Lumbar Puncture including anatomy, needle selection, needle insertion, measurement of opening pressure, Cerebrospinal Fluid (CSF) specimen handling and after care. We also make some quality improvement suggestions for those designing services incorporating diagnostic Lumbar Puncture. PMID:25075138

  1. Paraplegia after epidural-general anesthesia in a Morquio patient with moderate thoracic spinal stenosis

    PubMed Central

    Krane, Elliot J.; Tomatsu, Shunji; Theroux, Mary C.; Lee, Roland R.

    2014-01-01

    Purpose We describe an instance in which complete paraplegia was evident immediately postoperatively after apparently uneventful lumbar epidural-general anesthesia in a patient with Morquio Type A syndrome (Morquio A) with moderate thoracic spinal stenosis. Clinical features A 16-yr-old male with Morquio A received lumbar epidural-general anesthesia for bilateral distal femoral osteotomies. Preoperative imaging had revealed a stable cervical spine and moderate thoracic spinal stenosis with a mild degree of spinal cord compression. Systolic blood pressure (BP) was maintained within 20% of the pre-anesthetic baseline value. The patient sustained a severe thoracic spinal cord infarction. The epidural anesthetic contributed to considerable delay in the recognition of the diagnosis of paraplegia. Conclusion This experience leads us to suggest that, in patients with Morquio A, it may be prudent to avoid the use of epidural anesthesia without very firm indication, to support BP at or near baseline levels in the presence of even moderate spinal stenosis, and to avoid flexion or extension of the spinal column in intraoperative positioning. If the spinal cord/column status is unknown or if the patient is known to have any degree of spinal stenosis, we suggest that the same rigorous BP support practices that are typically applied in other patients with severe spinal stenosis, especially stenosis with myelomalacia, should apply to patients with Morquio A and that spinal cord neurophysiological monitoring should be employed. In the event that cord imaging is not available, e.g., emergency procedures, it would be prudent to assume the presence of spinal stenosis. PMID:25323122

  2. [Atherosclerotic renal artery stenosis].

    PubMed

    Sauguet, A; Honton, B

    2014-12-01

    Atherosclerotic renal artery stenosis can cause ischaemic nephropathy and arterial hypertension. Renal artery stenosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Many patients with RAS may be managed effectively with medical therapy for several years without endovascular stenting, as demonstrated by randomized, prospective trials including the cardiovascular outcomes in Renal Atherosclerotic Lesions (CORAL) trial, the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial. These trials share the limitation of excluding subsets of patients with high-risk clinical presentations, including episodic pulmonary edema and rapidly progressing renal failure and hypertension. Blood pressure control and medication adjustment may become more difficult with declining renal function and may prevent the use of angiotensin receptor blocker and angiotensin-converting enzyme inhibitors. The objective of this review is to evaluate the current management of RAS for cardiologists in the context of recent randomized clinical trials. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary edema, rapidly declining renal function and severe resistant hypertension. PMID:25450992

  3. Chordoma of the Lumbar Spine Presenting as Sciatica and Treated with Vertebroplasty

    SciTech Connect

    Chatterjee, Somenath; Bodhey, Narendra Kuber Gupta, Arun Kumar; Periakaruppan, Alagappan

    2010-12-15

    The lumbar spine is a less common location for chordoma. Here we describe a 44-year-old woman presenting with pain due to a L4 vertebral expansile lesion that caused significant canal stenosis and neural foraminal compromise. Vertebroplasty was performed and resulted in immediate pain relief. For patients with painful lumbar chordoma who are unwilling to undergo surgery, vertebroplasty can play a palliative role as in patients with other vertebral lesions. Treating pain and stabilizing vertebra by way of vertebroplasty in a case of chordoma has not yet been reported.

  4. Retrolisthesis and Lumbar Disc Herniation: A Pre-operative Assessment of Patient Function

    PubMed Central

    Shen, Michael; Razi, Afshin; Lurie, Jon D.; Hanscom, Brett; Weinstein, Jim

    2008-01-01

    BACKGROUND CONTEXT Retrolisthesis is relatively rare but when present has been associated with increased back pain and impaired back function. Neither the prevalence of this condition in individuals with lumbar disc herniations nor its possible relation to pre-operative back pain and dysfunction has been well studied. PURPOSE The purposes of this study were as follows: 1) to determine the prevalence of retrolisthesis (alone or in combination with other degenerative conditions) in individuals with confirmed L5 – S1 disc herniation who later underwent lumbar discectomy; 2) to determine if there is any association between retrolisthesis and degenerative changes within the same vertebral motion segment; and 3) to determine the relation between retrolisthesis (alone or in combination with other degenerative conditions) and pre-operative low back pain, physical function, and quality of life. STUDY DESIGN/SETTING Cross-sectional study. PATIENT SAMPLE A total of 125 individuals were identified for incorporation into this study. All patients had confirmed L5-S1 disc herniation on MRI and later underwent L5-S1 discectomy. All patients were enrolled in the SPORT (Spine Patient Outcomes Research Trial) study; data was obtained from the multi-institutional database comprised of SPORT patients from across the United States. OUTCOME MEASURES Retrolisthesis, Degenerative change on MRI, Modic Changes. METHODS MRI scans of the lumbar spine were assessed at spinal level L5–S1 for all 125 patients. Retrolisthesis was defined as posterior subluxation of 8% or more. Disc degeneration was defined as any loss of disc signal on T2 imaging. Modic changes were graded 1 – 3 and collectively classified as vertebral endplate degenerative changes. The presence of facet arthropathy and ligamentum flavum hypertrophy were classified jointly as posterior degenerative changes. RESULTS The overall incidence of retrolisthesis at L5-S1 in our study was 23.2%. Retrolisthesis combined with posterior degenerative changes, degenerative disc disease, or vertebral endplate changes had incidences of 4.8%, 16%, and 4.8% respectively. The prevalence of retrolisthesis did not vary by sex, age, race, smoking status, or education level when compared to individuals with normal sagittal alignment. However, individuals with retrolisthesis were more likely to be receiving worker compensation than those without retrolisthesis. Increased age was found to be associated with individuals having vertebral endplate degenerative changes (both alone and in conjunction with retrolisthesis) and degenerative disc disease. Individuals who had retrolisthesis with concomitant vertebral endplate degenerative changes were more often smokers and had no insurance. The presence of retrolisthesis was not associated with an increased incidence of having degenerative disc disease, posterior degenerative changes, or vertebral endplate changes. No statistical significance was found between the presence of retrolisthesis on the degree of patient pre-operative low back pain and physical function. Patients with degenerative disc disease were found to have increased leg pain compared to those patients without degenerative disc changes. CONCLUSIONS We found no significant relationship between retrolisthesis in patients with L5-S1 disc herniation and worse baseline pain or function. It is possible that the contribution of pain or dysfunction related to retrolisthesis was far overshadowed by the presence of symptoms due to the concomitant disc herniation. It remains to be seen whether retrolisthesis will affect outcome following discectomy in these patients. PMID:17630138

  5. Retinal prostheses in degenerative retinal diseases.

    PubMed

    Lin, Tai-Chi; Chang, Hua-Ming; Hsu, Chih-Chien; Hung, Kuo-Hsuan; Chen, Yan-Ting; Chen, Szu-Yu; Chen, Shih-Jen

    2015-09-01

    Degenerative retinal diseases may lead to significant loss of vision. Age-related macular degeneration (AMD) and retinitis pigmentosa (RP), which eventually affect the photoreceptors, are the two most common retinal degenerative diseases. Once the photoreceptorcells are lost, there are no known effective therapies for AMD or RP. The concept of retinal prosthesis is to elicit neural activity in the remaining retinal neurons by detecting light and converting it into electrical stimuli using artificial devices. Subretinal, epiretinal, and other retinal prostheses implants are currently designed to restore functional vision in retinal degenerative diseases. In this review, we have summarized different types of retinal prostheses, implant locations, and visual outcomes. Our discussions will further elucidate the results from clinical trials, and the challenges that will need to be overcome to more efficaciously assist patients with AMD and RP in the future. PMID:26142056

  6. Cervical Stenosis, Myelopathy and Radiculopathy

    MedlinePLUS

    ... between the vertebrae results in narrowing of the space for the spinal cord and its branches, known ... and cervical stenosis refers to narrowing of the space for the spinal cord or nerve branches in ...

  7. The effect of age on sagittal plane profile of the lumbar spine according to standing, supine, and various sitting positions

    PubMed Central

    2014-01-01

    Background The sagittal alignment of the spine changes depending on body posture and degenerative changes. This study aimed to observe changes in sagittal alignment of the lumbar spine with different positions (standing, supine, and various sitting postures) and to verify the effect of aging on lumbar sagittal alignment. Methods Whole-spine lateral radiographs were obtained for young volunteers (25.4?±?2.3 years) and elderly volunteers (66.7?±?1.7 years). Radiographs were obtained in standing, supine, and sitting (30°, 60°, and 90°) positions respectively. We compared the radiological changes in the lordotic and segmental angles in different body positions and at different ages. Upper and lower lumbar lordosis were defined according to differences in anatomical sagittal mobility and kinematic behavior. Results Lumbar lordosis was greater in a standing position (52.79° and 53.90° in young and old groups, respectively) and tended to decrease as position changed from supine to sitting. Compared with the younger group, the older group showed significantly more lumbar lordosis in supine and 60° and 90° sitting positions (P?=?0.043, 0.002, 0.011). Upper lumbar lordosis in the younger group changed dynamically in all changed positions compared with the old group (P?=?0.019). Lower lumbar lordosis showed a decreasing pattern in both age groups, significantly changing as position changed from 30° to 60° (P?=?0.007, 0.007). Conclusions Lumbar lordosis decreases as position changes from standing to 90°sitting. The upper lumbar spine is more flexible in individuals in their twenties compared to those in their sixties. Changes in lumbar lordosis were concentrated in the lower lumbar region in the older group in sitting positions. PMID:24571953

  8. Discrete subaortic stenosis.

    PubMed Central

    Khan, M M; Varma, M P; Cleland, J; O'Kane, H O; Webb, S W; Mulholland, H C; Adgey, A A

    1981-01-01

    Data concerning 17 consecutive patients with discrete subaortic stenosis are recorded. Twelve patients underwent operative resection of the obstructing lesion. Of these all except one were symptomatic and all had electrocardiographic evidence of left ventricular hypertrophy or left ventricular hypertrophy with strain. They had a peak resting systolic left ventricular outflow tract gradient of greater than 50 mmHg as predicted from the combined cuff measurement of systolic blood pressure and the echocardiographically estimated left ventricular systolic pressure and/or as determined by cardiac catheterisation. The outflow tract gradient as predicted from M-mode echocardiography and peak systolic pressure showed close correlation with that measured at cardiac catheterisation or operation. During the postoperative follow-up from one month to 11 years, of 11 patients, one patient required a further operation for recurrence of the obstruction four years after the initial operation. All patients are now asymptomatic. Five patients have not had an operation. The left ventricular outflow tract gradient as assessed at the time of cardiac catheterisation was greater than 50 mmHg. One patient has been lost to follow-up. The remaining four have been followed from four to eight years and have remained asymptomatic and the electrocardiograms have remained unchanged. Careful follow-up of all patients is essential with continuing clinical assessment, electrocardiograms, M-mode and two-dimensional echocardiograms, and if necessary cardiac catheterisation. Prophylaxis against bacterial endocarditis is also essential. Images PMID:6457617

  9. D-penicillamine Induced Degenerative Dermopathy

    PubMed Central

    Khandpur, Sujay; Jain, Naresh; Singla, Shweta; Chatterjee, Priti; Behari, Madhuri

    2015-01-01

    D-penicillamine interferes with elastin and collagen metabolism and produces several cutaneous and multi-systemic side-effects. We present two cases of Wilson's disease who on long-term penicillamine therapy developed drug-induced degenerative dermopathy manifesting as skin fragility over pressure sites and cutis laxa-like changes. PMID:26288416

  10. Clinical and surgical outcomes after lumbar laminectomy: An analysis of 500 patients

    PubMed Central

    Bydon, Mohamad; Macki, Mohamed; Abt, Nicholas B.; Sciubba, Daniel M.; Wolinsky, Jean-Paul; Witham, Timothy F.; Gokaslan, Ziya L.; Bydon, Ali

    2015-01-01

    Background: The objective of this study is to determine the clinical and surgical outcomes following lumbar laminectomy. Methods: We retrospectively reviewed medical records of neurosurgical patients who underwent first-time, bilateral, 1-3 level laminectomies for degenerative lumbar disease. Patients with discectomy, complete facetectomy, and fusion were excluded. Results: Five hundred patients were followed for an average of 46.79 months. Following lumbar laminectomy, patients experienced statistically significant improvement in back pain, neurogenic claudication, radiculopathy, weakness, and sensory deficits. The rate of intraoperative durotomy was 10.00%; however, 1.60% experienced a postoperative cerebrospinal fluid leak. The risk of experiencing at least one postoperative complication with a lumbar laminectomy was 5.60%. Seventy-two patients (14.40%) required reoperations for progression of degenerative disease over a mean of 3.40 years. The most common symptoms prior to reoperation included back pain (54.17%), radiculopathy (47.22%), weakness (18.06%), sensory deficit (15.28%), and neurogenic claudication (19.44%). The relative risk of reoperation for patients with postoperative back pain was 6.14 times higher than those without postoperative back pain (P < 0.001). Of the 72 patients undergoing reoperations, 55.56% underwent decompression alone, while 44.44% underwent decompression and posterolateral fusions. When considering all-time reoperations, the lifetime risk of requiring a fusion after a lumbar laminectomy based on this study (average follow-up of 46.79 months) was 8.0%. Conclusion: Patients experienced statistically significant improvements in back pain, neurogenic claudication, radiculopathy, motor weakness, and sensory deficit following lumbar laminectomy. Incidental durotomy rate was 10.00%. Following a first-time laminectomy, the reoperation rate was 14.4% over a mean of 3.40 years. PMID:26005583

  11. Thoracic spinal stenosis and myelopathy: report of two rare cases and review of the literature.

    PubMed

    Amato, V; Giannachi, L; Irace, C; Corona, C

    2012-12-01

    The authors report two cases of thoracic spinal canal stenosis (SCS) and myelopathy. One is extremely unusual because of degenerative changes occurred in the upper thoracic spine. The other because of its multiple etiology among which calcification and ossification of the ligamentum flavum (OLF) in a Caucasian man. Both patients presented with an history of slowly progressive spastic paraparesis. In the first case computed tomography (CT) scans and magnetic resonance (MR) images revealed hypertrophy of the legamentum flavum and laminae causing compression of the spinal cord at T2-T3. In the second case diagnostic imaging showed three levels of stenosis in the lower thoracic spine due to degenerative changes, calcification and OLF with cord damage at T9-T10. A decompressive laminectomy and medial facetectomy was performed in both patients. The ligamentum flavum, hypertrophied and infolded in the first case and calcified and ossified in the second, was removed with careful dissection of the dural adhesions. Both patients showed a rapid post-operative recovery and regained autonomous walking within 1 month of surgery. Thoracic spinal cord stenosis is a rare and complex disorder because of differential diagnosis, neuroimaging features and treatment options. Regardless of its cause, prompt surgical decompression plays a key role in improving the functional outcome of myelopathy. PMID:23111299

  12. Two-level total lumbar disc replacement

    PubMed Central

    Bakaloudis, Georgios; Lolli, Francesco; Vommaro, Francesco; Parisini, Patrizio

    2009-01-01

    Total lumbar disc replacement (TDR) has been widely used as a treatment option for 2-level symptomatic degenerative disc disease. However, recent studies have presented conflicting results and some authors concluded that outcome deteriorated when disc replacement was performed bisegmentally, with an increase of complications for bisegmental replacements in comparison with monosegmental disc arthroplasty. The goal of the present retrospective study is to investigate results in a group of patients who have received bisegmental TDR with SB Charitè III artificial disc for degenerative disc disease with a minimum follow-up of 3 years, and to compare the results of 2-level disc replacement versus 1-level patients treated with the same prosthesis. A total of 32 patients had at least 3-years follow-up and were reviewed. The average age of the patients was 38.5 years. There were 11 males and 21 females. About 16 patients received 2-level TDR (SB Charitè III) and 16 received 1-level TDR (SB Charitè III). Both radiographic and functional outcome analysis, including patient’s satisfaction, was performed. There were no signs of degenerative changes of the adjacent segments in any case of the 2- or 1-level TDR. There was no statistically significant difference between 2- and 1-level TDR both at 12 months and at 3-years follow-up on functional outcome scores. There was a statistically insignificant difference concerning the patients satisfaction between 1- and 2-level surgeries at the last follow-up (P = 0.46). In the 2-level TDR patients, there were 5 minor complications (31.25%), whereas major complications occurred in 4 more patients (25%) and required a new surgery in 2 cases (12.5%). In the 1-level cases there were 2 minor complications (12.5%) and 2 major complications (12.5%) and a new revision surgery was required in 1 patient (6.25%). In conclusion, the use of 2-level disc replacement at last follow-up presented a higher incidence of complications than in cases with 1-level replacement. At the same time it was impossible to delineate a clear difference in evaluating the questionnaires between the follow-up results of patients receiving 2- and 1-level TDR: the 2-level group presented slightly lower scores at follow-up, but none was statistically significant. PMID:19399536

  13. Particle transport near arterial stenosis

    NASA Astrophysics Data System (ADS)

    Hendabadi, Sahar; Shadden, Shawn

    2010-11-01

    We will present work towards understanding particle transport near arterial stenoses. Prior studies have shown increased platelet aggregation downstream of stenosis, or analogous geometrical models that induce flow separation and recirculation via abrupt expansion. Stenosis leads to changes in fluid mechanical quantities such as shear stress, flow separation, recirculation and reattachment and there exists several hypotheses on how these conditions influence platelet activation and aggregation. In particular, it is thought that high shear at the stenotic throat "activates" platelets that subsequently aggregate in the low shear separation zone perpetuating thrombotic events. We aim to understand particle (e.g. platelet) transport downstream of a stenosis in close detail. Towards this objective, we have developed numerical models of pulsatile flow near arterial stenoses and methods for particle tracking, including quantification of mechanical stimuli thought to initiate platelet activation. We will discuss results of this effort, comparison with previous studies, and plans for continued numerical and experimental work.

  14. Consensus Paper: Management of Degenerative Cerebellar Disorders

    PubMed Central

    Ilg, W.; Bastian, A. J.; Boesch, S.; Burciu, R. G.; Celnik, P.; Claaßen, J.; Feil, K.; Kalla, R.; Miyai, I.; Nachbauer, W.; Schöls, L.; Strupp, M.; Synofzik, M.; Teufel, J.

    2015-01-01

    Treatment of motor symptoms of degenerative cerebellar ataxia remains difficult. Yet there are recent developments that are likely to lead to significant improvements in the future. Most desirable would be a causative treatment of the underlying cerebellar disease. This is currently available only for a very small subset of cerebellar ataxias with known metabolic dysfunction. However, increasing knowledge of the pathophysiology of hereditary ataxia should lead to an increasing number of medically sensible drug trials. In this paper, data from recent drug trials in patients with recessive and dominant cerebellar ataxias will be summarized. There is consensus that up to date, no medication has been proven effective. Aminopyridines and acetazolamide are the only exception, which are beneficial in patients with episodic ataxia type 2. Aminopyridines are also effective in a subset of patients presenting with downbeat nystagmus. As such, all authors agreed that the mainstays of treatment of degenerative cerebellar ataxia are currently physiotherapy, occupational therapy, and speech therapy. For many years, well-controlled rehabilitation studies in patients with cerebellar ataxia were lacking. Data of recently published studies show that coordinative training improves motor function in both adult and juvenile patients with cerebellar degeneration. Given the well-known contribution of the cerebellum to motor learning, possible mechanisms underlying improvement will be outlined. There is consensus that evidence-based guidelines for the physiotherapy of degenerative cerebellar ataxia need to be developed. Future developments in physiotherapeutical interventions will be discussed including application of non-invasive brain stimulation. PMID:24222635

  15. Cervical degenerative intraspinal cyst: a case report and literature review involving 132 cases

    PubMed Central

    Machino, Masaaki; Yukawa, Yasutsugu; Ito, Keigo; Kato, Fumihiko

    2012-01-01

    Intraspinal and extradural cysts in the cervical spine are rare disorders that may cause myelopathy or radiculopathy. A synovial cyst or ganglion derived from the facet joint and that from a ligamentum flavum have been reported. We report a surgical case of degenerative intraspinal cyst, causing cervical myelopathy. MRI of a case revealed cystic lesion at C4–5. Spinal cord was compressed by cyst and symptoms of myelopathy were also observed. The patient with cervical spinal canal stenosis underwent laminoplasty and excision of the cyst. The patient recovered well immediately after the surgery. Literature review showed that 133 patients have been reported, including the present case. Previous reports indicated that most cysts occurred in old patients and at the atlanto–axial or C7–T1 junction, and laminectomy or laminoplasty with excision of the cyst gave good results in most cases. PMID:23195823

  16. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Lumbar spine. 572.187 Section 572.187... Test Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in drawing 175-5500. For purposes of this test, the lumbar spine is mounted within...

  17. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Lumbar spine. 572.187 Section 572.187... Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in drawing 175-5500. For purposes of this test, the lumbar spine is mounted within...

  18. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Lumbar spine. 572.187 Section 572.187... Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in drawing 175-5500. For purposes of this test, the lumbar spine is mounted within...

  19. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Lumbar spine. 572.187 Section 572.187... Test Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in drawing 175-5500. For purposes of this test, the lumbar spine is mounted within...

  20. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine. 572.187 Section 572.187... Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in drawing 175-5500. For purposes of this test, the lumbar spine is mounted within...

  1. Quality and Quantity of Published Studies Evaluating Lumbar Fusion during the Past 10 Years: A Systematic Review

    PubMed Central

    Hart, Robert; Hermsmeyer, Jeffrey T.; Sethi, Rajiv K.; Norvell, Daniel C.

    2015-01-01

    Study Design?Systematic review. Clinical Questions?(1) Has the proportion and number of randomized controlled trials (RCTs) as an indicator of quality of evidence regarding lumbar fusion increased over the past 10 years? (2) Is there a difference in the proportion of RCTs among the four primary fusion diagnoses (degenerative disk disease, spondylolisthesis, deformity, and adjacent segment disease) over the past 10 years? (3) Is there a difference in the type and quality of clinical outcomes measures reported among RCTs over time? (4) Is there a difference in the type and quality of adverse events measures reported among RCTs over time? (5) Are there changes in fusion surgical approach and techniques over time by diagnosis over the past 10 years? Methods?Electronic databases and reference lists of key articles were searched from January 1, 2004, through December 31, 2013, to identify lumbar fusion RCTs. Fusion studies designed specifically to evaluate recombinant human bone morphogenetic protein-2 or other bone substitutes, revision surgery studies, nonrandomized comparison studies, case reports, case series, and cost-effectiveness studies were excluded. Results?Forty-two RCTs between January 1, 2004, and December 31, 2013, met the inclusion criteria and form the basis for this report. There were 35 RCTs identified evaluating patients diagnosed with degenerative disk disease, 4 RCTs evaluating patients diagnosed with degenerative spondylolisthesis, and 3 RCTs evaluating patients with a combination of degenerative disk disease and degenerative spondylolisthesis. No RCTs were identified evaluating patients with deformity or adjacent segment disease. Conclusions?This structured review demonstrates that there has been an increase in the available clinical database of RCTs using patient-reported outcomes evaluating the benefit of lumbar spinal fusion for the diagnoses of degenerative disk disease and degenerative spondylolisthesis. Gaps remain in the standardization of reportage of adverse events in such trials, as well as uniformity of surgical approaches used. Finally, continued efforts to develop higher-quality data for other surgical indications for lumbar fusion, most notably in the presence of adult spinal deformity and revision of prior surgical fusions, appear warranted. PMID:26131387

  2. Chiropractic management of a patient with lumbar spine pain due to synovial cyst: a case report

    PubMed Central

    Cox, James M.

    2012-01-01

    Introduction The purpose of this study is to report the findings resulting from chiropractic care using flexion distraction spinal manipulation for a patient with low back and radicular pain due to spinal stenosis caused by a synovial cyst. Case Report A 75-year-old man presented with low back pain radiating to the right anterior thigh and down the left posterior leg of 3 years' duration. Physical and imaging examinations showed a synovial cyst–induced spinal stenosis at the right L3-L4 level and bilateral L4-L5 spinal stenosis. Intervention and Outcomes Flexion distraction spinal manipulation and physiological therapeutics were applied at the levels of stenosis. After 4 visits, the patient noted total absence of the right and left lower extremity pain and no adverse reaction to treatment. After 3 months of treatment and 16 visits, his low back and buttock pain were minimal; and he had no leg pain. Conclusion Lumbar synovial cyst and stenosis–generated low back and radicular pain was 80% relieved in a 75-year-old man following Cox flexion distraction spinal manipulation. PMID:22942836

  3. The Outcome of Using Closed Suction Wound Drains in Patients Undergoing Lumbar Spine Surgery: A Systematic Review

    PubMed Central

    Waly, Feras; Alzahrani, Mohammad M.; Abduljabbar, Fahad H.; Landry, Tara; Ouellet, Jean; Moran, Kathryn; Dettori, Joseph R.

    2015-01-01

    Study Design?Systematic review. Objective?Determine whether closed suction wound drains decrease the incidence of postoperative complications compared with no drain use in patients undergoing spine surgery for lumbar degenerative conditions. Methods?Electronic databases and reference lists of key articles were searched up through January 22, 2015, to identify studies comparing the use of closed suction wound drains with no drains in spine surgery for lumbar degenerative conditions. Outcomes assessed included the cumulative incidence of epidural hematoma, superficial and deep wound infection, and postoperative blood transfusion. The overall strength of evidence across studies was based on precepts outlined by the Grades of Recommendation Assessment, Development and Evaluation Working Group. Results?Five heterogeneous studies, three randomized controlled trials, and two cohort studies form the evidence basis for this report. There was no difference in the incidence of hematoma, superficial wound infection, or deep infection in patients with compared with patients without closed suction wound drains after lumbar surgery. The upper bounds of the 95% confidence interval for hematoma ranged from 1.1 to 16.7%; for superficial infection, 1.0 to 7.3%; and for deep infection, 1.0 to 7.1%. One observational study reported a 3.5-fold increase in the risk of blood transfusion in patients with a drain. The overall strength of evidence for these findings is considered low or insufficient. Conclusions?Conclusions from this systematic review are limited by the quality of included studies that assessed the use of closed suction wound drains in lumbar spine surgeries for degenerative conditions. We believe that spine surgeons should not routinely rely on closed suction wound drains in lumbar spine surgery until a higher level of evidence becomes available to support its use. PMID:26682098

  4. Developing Cellular Therapies for Retinal Degenerative Diseases

    PubMed Central

    Bharti, Kapil; Rao, Mahendra; Hull, Sara Chandros; Stroncek, David; Brooks, Brian P.; Feigal, Ellen; van Meurs, Jan C.; Huang, Christene A.; Miller, Sheldon S.

    2014-01-01

    Biomedical advances in vision research have been greatly facilitated by the clinical accessibility of the visual system, its ease of experimental manipulation, and its ability to be functionally monitored in real time with noninvasive imaging techniques at the level of single cells and with quantitative end-point measures. A recent example is the development of stem cell–based therapies for degenerative eye diseases including AMD. Two phase I clinical trials using embryonic stem cell–derived RPE are already underway and several others using both pluripotent and multipotent adult stem cells are in earlier stages of development. These clinical trials will use a variety of cell types, including embryonic or induced pluripotent stem cell–derived RPE, bone marrow– or umbilical cord–derived mesenchymal stem cells, fetal neural or retinal progenitor cells, and adult RPE stem cells–derived RPE. Although quite distinct, these approaches, share common principles, concerns and issues across the clinical development pipeline. These considerations were a central part of the discussions at a recent National Eye Institute meeting on the development of cellular therapies for retinal degenerative disease. At this meeting, emphasis was placed on the general value of identifying and sharing information in the so-called “precompetitive space.” The utility of this behavior was described in terms of how it could allow us to remove road blocks in the clinical development pipeline, and more efficiently and economically move stem cell–based therapies for retinal degenerative diseases toward the clinic. Many of the ocular stem cell approaches we discuss are also being used more broadly, for nonocular conditions and therefore the model we develop here, using the precompetitive space, should benefit the entire scientific community. PMID:24573369

  5. [Degenerative lesions of the peripheral retina].

    PubMed

    Conart, J-B; Baron, D; Berrod, J-P

    2014-01-01

    Degenerative lesions of the peripheral retina are present from teenage years onwards and increase with age. These abnormabilities are frequent, some of them being benign while others predispose to retinal tears and detachment. In the latter case, the lesions are rhegmatogenous and may justify prophylactic treatment by laser photocoagulation. We distinguish congenital lesions of the peripheral retina and intraretinal, chorioretinal and vitreoretinal degenerations. The holes and tears observed in 2% of the population consist of round atrophic holes, "horseshoe" tears, oral dialyses and giant tears. PMID:24239217

  6. Postoperative Flat Back: Contribution of Posterior Accessed Lumbar Interbody Fusion and Spinopelvic Parameters

    PubMed Central

    Kim, Jin Kwon; Kim, Deok Ryeng; Kim, Joo Seung

    2014-01-01

    Objective Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance (R2=0.286, p=0.0005). Conclusion Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back. PMID:25371781

  7. Pars Stress Fracture (Lumbar Spondylolysis)

    MedlinePLUS

    ... his or her sport. Studies Show: 30% of adolescents involved in sports will have an episode of low back pain Pars stress fracture, also called lumbar spondylolysis, is one of the causes of low back pain in this age group ...

  8. Stem cell treatment of degenerative eye disease?

    PubMed Central

    Mead, Ben; Berry, Martin; Logan, Ann; Scott, Robert A.H.; Leadbeater, Wendy; Scheven, Ben A.

    2015-01-01

    Stem cell therapies are being explored extensively as treatments for degenerative eye disease, either for replacing lost neurons, restoring neural circuits or, based on more recent evidence, as paracrine-mediated therapies in which stem cell-derived trophic factors protect compromised endogenous retinal neurons from death and induce the growth of new connections. Retinal progenitor phenotypes induced from embryonic stem cells/induced pluripotent stem cells (ESCs/iPSCs) and endogenous retinal stem cells may replace lost photoreceptors and retinal pigment epithelial (RPE) cells and restore vision in the diseased eye, whereas treatment of injured retinal ganglion cells (RGCs) has so far been reliant on mesenchymal stem cells (MSC). Here, we review the properties of non-retinal-derived adult stem cells, in particular neural stem cells (NSCs), MSC derived from bone marrow (BMSC), adipose tissues (ADSC) and dental pulp (DPSC), together with ESC/iPSC and discuss and compare their potential advantages as therapies designed to provide trophic support, repair and replacement of retinal neurons, RPE and glia in degenerative retinal diseases. We conclude that ESCs/iPSCs have the potential to replace lost retinal cells, whereas MSC may be a useful source of paracrine factors that protect RGC and stimulate regeneration of their axons in the optic nerve in degenerate eye disease. NSC may have potential as both a source of replacement cells and also as mediators of paracrine treatment. PMID:25752437

  9. Stenosis of pulmonary veins in Down syndrome.

    PubMed

    Stewart, A D; Calder, A L; Neutze, J M; James, A H; Brandt, P W

    1992-04-01

    Two patients with Down syndrome, intracardiac communications and elevated pulmonary arteriolar resistance presented early in life. Both patients had significant stenosis of pulmonary veins. The progressive nature of the stenosis is illustrated in one patient. Pulmonary venous stenosis in Down syndrome has been recorded only twice before in the literature, and may play a part in the early onset of pulmonary vascular occlusive disease in some patients. PMID:1532897

  10. [Magnetic resonance imaging for lumbar disk pathology. incidence of false negatives].

    PubMed

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

    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 discrography and/or pathology examination of the discs can go unrecognized. Likewise sensitivity for the detection of protruding discal 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. PMID:7494842

  11. Lumbar spinal fusion using the Diapason system.

    PubMed

    Musha, Y; Okajima, Y; Motegi, M

    1995-01-01

    Lumbar spinal fusion with the Diapason system was performed on 58 patients at Toho University Ohmori Hospital from November 1991 to November 1994. The first 44 consecutive patients were followed for more than 1 year, including 34 cases with degenerative diseases. Those 34 cases consisted of 22 men and 12 women, ages 19-78 years (average 47.4), with 49 vertebral levels; these patients were followed for an average of 26.3 months. The clinical improvement and rate of bony union after 1 year of surgery were examined and the intervertebral angulatory motion degree of fused vertebrae was measured using a radiographic functional photo image during 1 year. We also performed an experimental study to evaluate the rigidity of this system. There were no severe complications. Although there was no instrument breakage or screw migration, two cases of rod migration were observed in L5-S1 arthrodesis. A mean improvement rate of 84.3% in the Japanese Orthopaedics Association (JOA) score was revealed. Thirty-three of 34 (97.1%) patients demonstrated successful arthrodesis after their initial procedure. In 10 segments (20.4%) 3-5 degrees of angulatory mobility were still retained, and no angulatory motion was observed in 27 segments (55.1%) 3 months after the surgery; however, no angulatory motion was observed in 44 segments (89.8%) 1 year after the surgery. In our biomechanical study, we observed that the anterior intervertebral space became narrow and mobile with loading, but when the loading was removed, the space reverted to the initial site. This movement was thought to be due to a certain elasticity in the rod and screw, and not loosening at the connection level. This system was evaluated based on the results of both clinical and biomechanical study. Notwithstanding the fact that this method has been evaluated as semirigid fusion, it does provide satisfactory bony union in posterolateral fusion, with excellent clinical results. PMID:7787346

  12. Magnetic Resonance Imaging (MRI): Lumbar Spine

    MedlinePLUS

    ... Kids Deal With Bullies Pregnant? What to Expect Magnetic Resonance Imaging (MRI): Lumbar Spine KidsHealth > Parents > Doctors & Hospitals > Medical Tests & Exams > Magnetic Resonance Imaging (MRI): Lumbar Spine Print A A ...

  13. Investigation of biomechanical behavior of lumbar vertebral segments with dynamic stabilization device using finite element approach

    NASA Astrophysics Data System (ADS)

    Deoghare, Ashish B.; Kashyap, Siddharth; Padole, Pramod M.

    2013-03-01

    Degenerative disc disease is a major source of lower back pain and significantly alters the biomechanics of the lumbar spine. Dynamic stabilization device is a remedial technique which uses flexible materials to stabilize the affected lumbar region while preserving the natural anatomy of the spine. The main objective of this research work is to investigate the stiffness variation of dynamic stabilization device under various loading conditions under compression, axial rotation and flexion. Three dimensional model of the two segment lumbar spine is developed using computed tomography (CT) scan images. The lumbar structure developed is analyzed in ANSYS workbench. Two types of dynamic stabilization are considered: one with stabilizing device as pedicle instrumentation and second with stabilization device inserted around the inter-vertebral disc. Analysis suggests that proper positioning of the dynamic stabilization device is of paramount significance prior to the surgery. Inserting the device in the posterior region indicates the adverse effects as it shows increase in the deformation of the inter-vertebral disc. Analysis executed by positioning stabilizing device around the inter-vertebral disc yields better result for various stiffness values under compression and other loadings. [Figure not available: see fulltext.

  14. Newer lumbar interbody fusion techniques.

    PubMed

    Nasca, Richard J

    2013-01-01

    The purpose of this review is to update the reader on more recent, less invasive lumbar interbody fusion procedures. The article contains a brief history on the development of lumbar interbody fusion methods, as well as the indications and descriptions of the various open and minimally invasive procedures, their complications, and outcomes. In contrast to the more traditional open methods of performing anterior and posterior interbody fusions, surgeons doing the less invasive techniques of transforaminal lumbar interbody fusion, extreme lateral and direct lateral interbody fusion, and the presacral axial approach are reporting less morbidity, shorter hospital stays, high rates of fusion, and improved patient outcomes. Although each technique has a different anatomical plane of approach, the goal is to achieve a solid interbody fusion of the pain generating segment(s) without complications. PMID:23628562

  15. Measuring lumbar motion in industry, utilizing the lumbar motion monitor 

    E-print Network

    Bryan, Rex Wade

    1999-01-01

    measure and document the E3-dimensional trunk motions of high frequency MMH jobs in industry using the Lumbar Motion Monitor (LMM) from Chattanooga Group, loc. Five jobs were analyzed with five different workers in each job. The range of motion observed...

  16. Lumbar discography: an update.

    PubMed

    Anderson, Mark W

    2004-01-01

    Discogenic pain most commonly affects the low back, buttocks, and hips and is thought to be a byproduct of internal disk degeneration. It is postulated that progressive annular breakdown and tearing results in biomechanical and/or biochemical stimulation of the pain fibers that reside in the outer one third of the annulus. Although multiple imaging modalities, most notably MRI, can show morphologic abnormalities of the spine, discography remains the only test that provides physiologic information regarding what role a given intervertebral disk plays in a patient's symptom complex. The controversy surrounding discography is here to stay until more definitive, well-designed studies are performed. In the meantime, there are certain things that can help the discographer maximize the accuracy of the test: 1. Always try to inject one "normal" disk as a "control level." 2. Be alert for factors that are associated with an increased false-positive rate (abnormal non-anatomic pain maps, a history of chronic pain of spinal or nonspinal origin, abnormal psychometric testing, and prior surgery at the injected disk level). In these cases, special attention should be directed to both the patient's verbal and nonverbal cues during disk injection. 3. Do not give any audible clues as to what level is being injected or when the injection is starting or finishing. In this regard, we find it very helpful to have one of our personnel talk with the patient during this portion of the procedure while closely observing the patient for any nonverbal cues regarding their pain response. This distraction is preferable to a silent room where the patient is intensely focused on what is going on with the injections. We also find that music playing during the procedure helps to relax and often distract the patient as well. 4. If the results are equivocal at a level (i.e., you are unable to determine whether or not the patient's pain response was truly concordant), go on to inject another disk level and then come back to reinject more contrast into the disk in question. As radiologists, we tend to focus on the technical aspects of a procedure and the anatomic/morphologic information it provides. However, it cannot be emphasized enough that when performing lumbar discography, the assessment of the patient's pain response during the injection is the most important component of the procedure, and requires not only technical skills, but an understanding of how best to avoid some of the pitfalls that can lead to inaccurate results. PMID:14976837

  17. Difference of Sagittal Spinopelvic Alignments between Degenerative Spondylolisthesis and Isthmic Spondylolisthesis

    PubMed Central

    Lim, Jae Kwan

    2013-01-01

    Objective The purpose of this study was to analyze the differences of spinopelvic parameters between degenerative spondylolisthesis (DSPL) and isthmic spondylolisthesis (ISPL) patients. Methods Thirty-four patients with DSPL and 19 patients with ISPL were included in this study. Spinopelvic parameters were evaluated on whole spine X-rays in a standing position. The following spinopelvic parameters were measured : pelvic incidence (PI), sacral slope, pelvic tilt (PT), lumbar lordosis (LL), and sagittal vertical axis from C7 plumb line (SVA). The population of patients was compared with a control population of 30 normal and asymptomatic adults. Results There were statistically significant differences in LL (p=0.004) and SVA (p=0.005) between the DSPL and ISPL group. The LL of DSPL (42±13°) was significantly lower than that of the control group (48±11°; p=0.029), but that of ISPL (55±6°) was significantly greater than a control group (p=0.004). The SVA of DSPL (55±49 mm) was greater than that of a control group (<40 mm), but that of ISPL (21±22 mm) was within 40 mm as that of a control group. The PT of DSPL (24±7°) and ISPL (21±7°) was significantly greater than that of a control group (11±6°; p=0.000). Conclusion Both symptomatic DSPL and ISPL patients had a greater PI than that of the asymptomatic control group. In conclusion, DSPL populations are likely to have global sagittal imbalance (high SVA) compared with ISPL populations because of the difference of lumbar lordosis between two groups. PMID:23560173

  18. Contribution of Microglia-Mediated Neuroinflammation to Retinal Degenerative Diseases

    PubMed Central

    Madeira, Maria H.; Boia, Raquel; Santos, Paulo F.; Ambrósio, António F.; Santiago, Ana R.

    2015-01-01

    Retinal degenerative diseases are major causes of vision loss and blindness worldwide and are characterized by chronic and progressive neuronal loss. One common feature of retinal degenerative diseases and brain neurodegenerative diseases is chronic neuroinflammation. There is growing evidence that retinal microglia, as in the brain, become activated in the course of retinal degenerative diseases, having a pivotal role in the initiation and propagation of the neurodegenerative process. A better understanding of the events elicited and mediated by retinal microglia will contribute to the clarification of disease etiology and might open new avenues for potential therapeutic interventions. This review aims at giving an overview of the roles of microglia-mediated neuroinflammation in major retinal degenerative diseases like glaucoma, age-related macular degeneration, and diabetic retinopathy. PMID:25873768

  19. Hybrid Surgery Combined with Dynamic Stabilization System and Fusion for the Multilevel Degenerative Disease of the Lumbosacral Spine

    PubMed Central

    Lee, Soo Eon; Kim, Hyun Jib

    2015-01-01

    Background As motion-preserving technique has been developed, the concept of hybrid surgery involves simultaneous application of two different kinds of devices, dynamic stabilization system and fusion technique. In the present study, the application of hybrid surgery for lumbosacral degenerative disease involving two-segments and its long-term outcome were investigated. Methods Fifteen patients with hybrid surgery (Hybrid group) and 10 patients with two-segment fusion (Fusion group) were retrospectively compared. Results Preoperative grade for disc degeneration was not different between the two groups, and the most common operated segment had the most degenerated disc grade in both groups; L4-5 and L5-S1 in the Hybrid group, and L3-4 and L4-5 in Fusion group. Over 48 months of follow-up, lumbar lordosis and range of motion (ROM) at the T12-S1 global segment were preserved in the Hybrid group, and the segmental ROM at the dynamic stabilized segment maintained at final follow-up. The Fusion group had a significantly decreased global ROM and a decreased segmental ROM with larger angles compared to the Hybrid group. Defining a 2-mm decrease in posterior disc height (PDH) as radiologic adjacent segment pathology (ASP), these changes were observed in 6 and 7 patients in the Hybrid and Fusion group, respectively. However, the last PDH at the above adjacent segment had statistically higher value in Hybrid group. Pain score for back and legs was much reduced in both groups. Functional outcome measured by Oswestry disability index (ODI), however, had better improvement in Hybrid group. Conclusion Hybrid surgery, combined dynamic stabilization system and fusion, can be effective surgical treatment for multilevel degenerative lumbosacral spinal disease, maintaining lumbar motion and delaying disc degeneration. PMID:26484008

  20. Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis.

    PubMed

    Akinduro, Oluwaseun O; Miller, Brandon A; Haussen, Diogo C; Pradilla, Gustavo; Ahmad, Faiz U

    2015-10-01

    OBJECT The authors' aim in this paper was to review the intraoperative use of epidural steroids in lumbar discectomy surgery with a focus on surgical complications. METHODS A comprehensive literature search was done using PubMed, MEDLINE, and the Cochrane Central Registry of Controlled Trials. Relevant papers were retrieved and analyzed. The authors performed a meta-analysis of all available data. Search terms included epidural, steroids, discectomy, lumbar disc surgery, herniated lumbar disc, methylprednisolone, and perioperative.The primary outcome was surgical complications such as wound infection or need for reoperation. Secondary outcomes were pain and postoperative narcotic usage. RESULTS Sixteen trials and 1 retrospective study (a total of 1933 patients) were eligible for inclusion in this study. In all studies, steroids were added epidurally over the nerve root before closure in cases, and control patients underwent discectomy alone. The mean age (42.7 years vs 42.4 years; RR 0.30 [95% CI -0.30 to 0.90], p = 0.32), overall complication rates (2.69% vs 1.18%; RR 1.94 [95% CI 0.72-5.26], p = 0.19), and infectious complication rates (0.94% vs 0.08%; RR 4.58 [95% CI 0.75-27.95], p = 0.10) were similar between the steroid group and control group, respectively. CONCLUSIONS There is good evidence that epidural steroids can decrease pain in the short term and decrease the usage of postoperative narcotics after lumbar spinal surgery for degenerative spinal disease. The authors' results demonstrate a trend toward increased infection with epidural steroid use, but there was not a statistically significant difference. More studies are needed to validate the long-term risk/benefit ratio of epidural steroids in lumbar discectomy. PMID:26424336

  1. Patterns of chronic adhesive arachnoiditis following Myodil myelography: the significance of spinal canal stenosis and previous surgery.

    PubMed

    Laitt, R; Jackson, A; Isherwood, I

    1996-08-01

    109 patients who had undergone Myodil myelography on at least one occasion were identified. The patterns of lumbar nerve root distribution in this group were examined using magnetic resonance imaging. The relationship between these patterns and the presence of spinal stenosis or previous surgery was investigated. Chronic adhesive arachnoiditic nerve root patterns were seen in 68 patients and were classified into three groups according to Delemarter et al. Central clumping of nerve roots (type 1) and complete opacification of the thecal sac (type 3), extending over at least one vertebral level, were significantly related to spinal stenosis at an adjacent level (p < 0.0001). Peripheral adhesion of nerve roots to the theca (type 2) was significantly related to previous surgery at the level of abnormality (p < 0.00005). Only a single case of arachnoiditic nerve root patterns was seen in the absence of stenosis or previous surgery. We conclude that chronic adhesive arachnoiditis is significantly related to previous Myodil myelography in the presence of spinal stenosis or previous surgery but that Myodil alone rarely produces these changes. PMID:8949669

  2. Effect of Lumbar Stabilization and Dynamic Lumbar Strengthening Exercises in Patients With Chronic Low Back Pain

    PubMed Central

    Moon, Hye Jin; Kim, Dae Ha; Kim, Ha Jeong; Cho, Young Ki; Lee, Kwang Hee; Kim, Jung Hoo; Choi, Yoo Jung

    2013-01-01

    Objective To compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric strength of the lumbar extensors, pain severity and functional disability in patients with chronic low back pain (LBP). Methods Patients suffering nonspecific LBP for more than 3 months were included prospectively and randomized into lumbar stabilization exercise group (n=11) or lumbar dynamic strengthening exercise group (n=10). Exercises were performed for 1 hour, twice weekly, for 8 weeks. The strength of the lumbar extensors was measured at various angles ranging from 0° to 72° at intervals of 12°, using a MedX. The visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ) were used to measure the severity of LBP and functional disability before and after the exercise. Results Compared with the baseline, lumbar extension strength at all angles improved significantly in both groups after 8 weeks. The improvements were significantly greater in the lumbar stabilization exercise group at 0° and 12° of lumbar flexion. VAS decreased significantly after treatment; however, the changes were not significantly different between the groups. ODQ scores improved significantly in the stabilization exercise group only. Conclusion Both lumbar stabilization and dynamic strengthening exercise strengthened the lumbar extensors and reduced LBP. However, the lumbar stabilization exercise was more effective in lumbar extensor strengthening and functional improvement in patients with nonspecific chronic LBP. PMID:23525973

  3. Congenital esophageal stenosis owing to tracheobronchial remnants

    PubMed Central

    Rebelo, Priscila Guyt; Ormonde, João Victor C.; Ormonde, João Baptista C.

    2013-01-01

    OBJECTIVE To emphasize the need of an accurate diagnosis of congenital esophageal stenosis due to tracheobronchial remnants, since its treatment differs from other types of congenital narrowing. CASE DESCRIPTION Four cases of lower congenital esophageal stenosis due to tracheobronchial remnants, whose definitive diagnosis was made by histopathology. Except for the last case, in which a concomitant anti-reflux surgery was not performed, all had a favorable outcome after resection and anastomosis of the esophagus. COMMENTS The congenital esophageal stenosis is an intrinsic narrowing of the organâ€(tm)s wall associated with its structural malformation. The condition can be caused by tracheobronchial remnants, fibromuscular stenosis or membranous diaphragm and the first symptom is dysphagia after the introduction of solid food in the diet. The first-choice treatment to tracheobronchial remnants cases is the surgical resection and end-to-end anastomosis of the esophagus. PMID:24142326

  4. Laryngotracheal stenosis: a 5-year review.

    PubMed

    Smith, R J; Catlin, F I

    1991-01-01

    Twenty-seven children with varying degrees of laryngotracheal stenosis were treated at Texas Children's Hospital (TCH) from January 1984 to January 1989. Nineteen children had a residual airway demonstrable preoperatively, and following laryngotracheoplasty, 18 (95%) were successfully decannulated; all but 1 had a normal voice. Eight children had complete stenosis. Of these children, 6 could be decannulated, but 3 required a second laryngotracheoplasty. Four children now have voice abnormalities. PMID:2022479

  5. Hemodynamics of Curved Vessels with Stenosis

    NASA Astrophysics Data System (ADS)

    Boghosian, Michael E.; Cassel, Kevin W.

    2007-11-01

    In hemodialysis access, the brachiocephalic or upper-arm fistula has less than optimal functional rates. The cause of this reduced patency is stenosis due to intimal hyperplasia in the cephalic vein. Stenosis typically leads to thrombosis and ultimately failure of the fistula. To increase our understanding of this process, numerical simulations of the unsteady, two-dimensional, incompressible Navier-Stokes equations are solved for the flow in an infinite channel having curvature and stenosis. Physiologically relevant Reynolds numbers ranging from 300 to 1500 and stenosis percentages of 0, 25, 50, and 75 are modeled. The post-stenotic flow is characterized by strong shear layers and recirculation regions. The largest shear stresses are found just upstream of the stenosis apex. The maximum shear stress increases with increasing Reynolds number and percent stenosis. The results indicate that hemodynamic conditions in the vein after fistula creation combined with curvature of the cephalic arch lead to shear stresses that exceed normal physiological values (both minimum and maximum). In some cases, the shear stresses are sufficiently large to cause damage to the endothelium and possibly denudation.

  6. Who should have surgery for degenerative spondylolisthesis?

    PubMed Central

    Pearson, Adam M.; Lurie, Jon D.; Tosteson, Tor D.; Zhao, Wenyan; Abdu, William A.; Weinstein, James N.

    2013-01-01

    Study Design Combined prospective randomized controlled trial and observational cohort study of degenerative spondylolisthesis (DS) with an as-treated analysis. Objective To determine modifiers of the treatment effect (TE) of surgery (the difference between surgical and nonoperative outcomes) for DS using subgroup analysis. Summary of Background Data SPORT demonstrated a positive surgical TE for DS at the group level. However, individual characteristics may affect TE. Methods DS patients were treated with either surgery (n=395) or nonoperative care (n=206) and were analyzed according to treatment received. Fifty-five baseline variables were used to define subgroups for calculating the time-weighted average TE for the Oswestry Disability Index (ODI) over 4 years (TE=?ODIsurgery-?ODInonoperative). Variables with significant subgroup-by-treatment interactions (p<0.05) were simultaneously entered into a multivariate model to select independent TE predictors. Results All analyzed subgroups that included at least 50 patients improved significantly more with surgery than with nonoperative treatment (p<0.05). Multivariate analyses demonstrated that age ? 67 (TE ?15.7 vs. ?11.8 for age>67, p=0.014); female gender (TE ?15.6 vs. ?11.2 for males, p=0.01); the absence of stomach problems (TE ?15.2 vs. ?11.3 for those with stomach problems, p=0.035); neurogenic claudication (TE ?15.3 vs. ?9.0 for those without claudication, p=0.004); reflex asymmetry (TE ?17.3 vs. ?13.0 for those without asymmetry, p=0.016); opioid use (TE ?18.4 vs. ?11.7 for those not using opioids, p<0.001); not taking antidepressants (TE ?14.5 vs. ?5.4 for those on antidepressants, p=0.014); dissatisfaction with symptoms (TE ?14.5 vs. ?8.3 for those satisfied or neutral, p=0.039); and anticipating a high likelihood of improvement with surgery (TE ?14.8 vs. ?5.1 for anticipating a low likelihood of improvement with surgery, p=0.019) were independently associated with greater TE. Conclusions Patients who met strict inclusion criteria improved more with surgery than with nonoperative treatment, regardless of other specific characteristics. However, TE varied significantly across certain subgroups. PMID:23846502

  7. Retrolisthesis and lumbar disc herniation: a postoperative assessment of patient function

    PubMed Central

    Kang, Kevin K.; Shen, Michael S.; Zhao, Wenyan; Lurie, Jon D.; Razi, Afshin E.

    2013-01-01

    BACKGROUND CONTEXT The presence of retrolisthesis has been associated with the degenerative changes of the lumbar spine. However, retrolisthesis in patients with L5–S1 disc herniation has not been shown to have a significant relationship with worse baseline pain or function. Whether it can affect the outcomes after discectomy, is yet to be established. PURPOSE The purpose of this study was to determine the relationship between retrolisthesis (alone or in combination with other degenerative conditions) and postoperative low back pain, physical function, and quality of life. This study was intended to be a follow-up to a previous investigation that looked at the preoperative assessment of patient function in those with retrolisthesis and lumbar disc herniation. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE Patients enrolled in SPORT (Spine Patient Outcomes Research Trial) who had undergone L5–S1 discectomy and had a complete magnetic resonance imaging scan available for review (n=125). Individuals with anterolisthesis were excluded. OUTCOME MEASURES Time-weighted averages over 4 years for the Short Form (SF)-36 bodily pain scale, SF-36 physical function scale, Oswestry Disability Index (ODI), and Sciatica Bothersomeness Index (SBI). METHODS Retrolisthesis was defined as a posterior subluxation of 8% or more. Disc degeneration was defined as any loss of disc signal on T2 imaging. Modic changes were graded 1 to 3 and collectively classified as vertebral end plate degenerative changes. The presence of facet arthropathy and ligamentum flavum hypertrophy was classified jointly as posterior degenerative changes. Longitudinal regression models were used to compare the time-weighted outcomes over 4 years. RESULTS Patients with retrolisthesis did significantly worse with regard to bodily pain and physical function over 4 years. However, there were no significant differences in terms of ODI or SBI. Similarly, retrolisthesis was not a significant factor in the operative time, blood loss, lengths of stay, complications, rate of additional spine surgeries, or recurrent disc herniations. Disc degeneration, modic changes, and posterior degenerative changes did not affect the outcomes. CONCLUSIONS Although retrolisthesis in patients with L5–S1 disc herniation did not affect the baseline pain or function, postoperative outcomes appeared to be somewhat worse. It is possible that the contribution of pain or dysfunction related to retrolisthesis became more evident after removal of the disc herniation. PMID:23201024

  8. New treatments and imaging strategies in degenerative disease of the intervertebral disks.

    PubMed

    Lotz, Jeffrey C; Haughton, Victor; Boden, Scott D; An, Howard S; Kang, James D; Masuda, Koichi; Freemont, Anthony; Berven, Sigurd; Sengupta, Dilip K; Tanenbaum, Lawrence; Maurer, Philip; Ranganathan, Arun; Alavi, Abass; Marinelli, Nicholas L

    2012-07-01

    Magnetic resonance (MR) imaging in patients with persistent low back pain and sciatica effectively demonstrates spine anatomy and the relationship of nerve roots and intervertebral disks. Except in cases with nerve root compression, disk extrusion, or central stenosis, conventional anatomic MR images do not help distinguish effectively between painful and nonpainful degenerating disks. Hypoxia, inflammation, innervation, accelerated catabolism, and reduced water and glycosaminoglycan content characterize degenerated disks, the extent of which may distinguish nonpainful from painful ones. Applied to the spine, "functional" imaging techniques such as MR spectroscopy, T1? calculation, T2 relaxation time measurement, diffusion quantitative imaging, and radio nucleotide imaging provide measurements of some of these degenerative features. Novel minimally invasive therapies, with injected growth factors or genetic materials, target these processes in the disk and effectively reverse degeneration in controlled laboratory conditions. Functional imaging has applications in clinical trials to evaluate the efficacy of these therapies and eventually to select patients for treatment. This report summarizes the biochemical processes in disk degeneration, the application of advanced disk imaging techniques, and the novel biologic therapies that presently have the most clinical promise. PMID:22723559

  9. The human lumbar dorsal rami.

    PubMed Central

    Bogduk, N; Wilson, A S; Tynan, W

    1982-01-01

    The L 1-4 dorsal rami tend to form three branches, medial, lateral, and intermediate, which are distributed, respectively, to multifidus, iliocostalis, and longissimus. The intertransversarii mediales are innervated by a branch of the dorsal ramus near the origin of the medial branch. The L 4 dorsal ramus regularly forms three branches while the L 1-3 levels the lateral and intermediate branches may, alternatively, arise from a short common stem. The L 5 dorsal ramus is much longer than the others and forms only a medial and an intermediate branch. Each lumbar medial branch innervates two adjacent zygapophysial joints and ramifies in multifidus, supplying only those fascicles which arise from the spinous process with the same segmental number as the nerve. The comparative anatomy of the lumbar dorsal rami is discussed and the applied anatomy with respect to 'rhizolysis', 'facet denervation' and diagnostic paraspinal electromyography is described. PMID:7076562

  10. Clinical and Statistical Correlation of Various Lumbar Pathological Conditions

    PubMed Central

    Johnson, J. Michael; Mahfouz, Mohamed; Battaglia, Nicholas V.; Sharma, Adrija; Cheng, Joseph S.; Komistek, Richard D.

    2013-01-01

    Current clinical evaluations often rely on static anatomic imaging modalities for diagnosis of mechanical low back pain, which provide anatomic snapshots and a surrogate analysis of a functional disease. Three dimensional in vivo motion is available with the use of digital fluoroscopy, which was used to capture kinematic data of the lumbar spine in order to identify coefficients of motion that may assist the physician in differentiating patient pathology. 40 patients distributed among 4 classes of lumbar degeneration, from healthy to degenerative, underwent CT, MRI, and digital x-ray fluoroscopy. Each patient underwent diagnosis by a neurosurgeon. Fluoroscopy was taken as the patient performed lateral bending (LB), axial rotation (AR) and flexion-extension (FE). Patient specific models were registered with the fluoroscopy images to obtain in vivo kinematic data. Motion coefficients, CLB, CAR, CFE, were calculated as the ratio of in-plane motion to total out-of-plane motion. Range of motion (ROM) was calculated about the axis of motion for each exercise. Inter- and Intra- group statistics were examined for each coefficient and a flexible Bayesian classifier was used to differentiate patients with degeneration. The motion coefficients CLB and CFE were significantly different (p < 0.05) in 4 of 6 group comparisons. In plane motion, ROMLB, was significantly different in only 1 of 6 group comparisons. The classifier achieved 95% sensitivity and specificity using (CFE, CLB, ROMLB) as input features, and 40% specificity and 80% sensitivity using ROM variables. The new coefficients were better correlated with patient pathology than ROM measures. The coefficients suggest a relationship between pathology and measured motion which has not been reported previously. PMID:23270717

  11. Hemorrhagic lumbar synovial cyst: case report and literature review

    PubMed Central

    Cannarsa, Gregory; Clark, Shannon W.; Chalouhi, Norah; Zanaty, Mario; Heller, Joshua

    2015-01-01

    ABSTRACT Intraspinal synovial cysts are infrequent causes of back and radicular leg pain. Commonly associated with degenerative spinal disease, the majority of synovial cysts appear in the lumbar spine. Rarely, intracystic hemorrhage can occur through an unclear mechanism. Similarly rare, cysts may also become migratory. The pathogenesis of hemorrhagic synovial cysts remains uncertain and their potential for migration also remains unclear. A 36 year-old male presented to the clinic with 5 months of back pain and leg pain that began after a work-related injury. An initial MRI obtained by another surgeon 3 month prior demonstrated an epidural cystic mass with T1 hypointensity and T2 hyperintensity at L2-L3. With worsening pain, the patient came to our clinic for a second opinion. A second MRI demonstrated resolution of the L2-L3 epidural cystic mass and formation of a new epidural cystic mass at L3-L4 causing compression of the thecal sac. The patient subsequently underwent decompressive hemilaminectomy with cyst removal. We present a case of two lumbar synovial cysts, separated over time and a vertebral level and giving the appearance of a single, migratory cyst. This is the first case of an "occult migratory" synovial cyst with repeat MR imaging capturing spontaneous resolution of the initial cyst and formation of a hemorrhagic cyst one level below. We also present a summary of the 44 cases of hemorrhagic synovial cysts reported in the literature and propose a mechanism that may account for the hemorrhagic and migratory progression in some patients. PMID:26412895

  12. The Felix-trial. Double-blind randomization of interspinous implant or bony decompression for treatment of spinal stenosis related intermittent neurogenic claudication

    PubMed Central

    2010-01-01

    Background Decompressive laminotomy is the standard surgical procedure in the treatment of patients with canal stenosis related intermittent neurogenic claudication. New techniques, such as interspinous process implants, claim a shorter hospital stay, less post-operative pain and equal long-term functional outcome. A comparative (cost-) effectiveness study has not been performed yet. This protocol describes the design of a randomized controlled trial (RCT) on (cost-) effectiveness of the use of interspinous process implants versus conventional decompression surgery in patients with lumbar spinal stenosis. Methods/Design Patients (age 40-85) presenting with intermittent neurogenic claudication due to lumbar spinal stenosis lasting more than 3 months refractory to conservative treatment, are included. Randomization into interspinous implant surgery versus bony decompression surgery will take place in the operating room after induction of anesthesia. The primary outcome measure is the functional assessment of the patient measured by the Zurich Claudication Questionnaire (ZCQ), at 8 weeks and 1 year after surgery. Other outcome parameters include perceived recovery, leg and back pain, incidence of re-operations, complications, quality of life, medical consumption, absenteeism and costs. The study is a randomized multi-institutional trial, in which two surgical techniques are compared in a parallel group design. Patients and research nurses are kept blinded of the allocated treatment during the follow-up period of 1 year. Discussion Currently decompressive laminotomy is the golden standard in the surgical treatment of lumbar spinal stenosis. Whether surgery with interspinous implants is a reasonable alternative can be determined by this trial. Trial register Dutch Trial register number: NTR1307 PMID:20507568

  13. Radicular interdural lumbar disc herniation.

    PubMed

    Akhaddar, Ali; Boulahroud, Omar; Elasri, Abad; Elmostarchid, Brahim; Boucetta, Mohammed

    2010-07-01

    Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between the two radicular dura layers. The patient, a 34-year-old soldier, was admitted with a 12-month history of low back pain and episodic left sciatica. Neurologic examination showed a positive straight leg raising test on the left side without sensory, motor or sphincter disturbances. Spinal CT scan and MRI exploration revealed a left posterolateral osteophyte formation at the L5-S1 level with an irregular large disc herniation, which migrated superiorly. An intradural extension was suspected. A left L5 hemilaminectomy and S1 foraminotomy were performed. The exploration revealed a large fragment of disc material located between the inner and outer layers of the left S1 radicular dura. The mass was extirpated without cerebrospinal fluid outflow. The postoperative course was uneventful. Radicular interdural lumbar disc herniation should be suspected when a swollen, hard and immobile nerve root is present intraoperatively. PMID:19888608

  14. Lumbar lordosis of extinct hominins.

    PubMed

    Been, Ella; Gómez-Olivencia, Asier; Kramer, Patricia A

    2012-01-01

    The lordotic curvature of the lumbar spine (lumbar lordosis) in humans is a critical component in the ability to achieve upright posture and bipedal gait. Only general estimates of the lordotic angle (LA) of extinct hominins are currently available, most of which are based on the wedging of the vertebral bodies. Recently, a new method for calculating the LA in skeletal material has become available. This method is based on the relationship between the lordotic curvature and the orientation of the inferior articular processes relative to vertebral bodies in the lumbar spines of living primates. Using this relationship, we developed new regression models in order to calculate the LAs in hominins. The new models are based on primate group-means and were used to calculate the LAs in the spines of eight extinct hominins. The results were also compared with the LAs of modern humans and modern nonhuman apes. The lordotic angles of australopithecines (41° ± 4), H. erectus (45°) and fossil H. sapiens (54° ± 14) are similar to those of modern humans (51° ± 11). This analysis confirms the assumption that human-like lordotic curvature was a morphological change that took place during the acquisition of erect posture and bipedalism as the habitual form of locomotion. Neandertals have smaller lordotic angles (LA = 29° ± 4) than modern humans, but higher angles than nonhuman apes (22° ± 3). This suggests possible subtle differences in Neandertal posture and locomotion from that of modern humans. PMID:22052243

  15. Predisposing factors for dural tear in patients undergoing lumbar spine surgery.

    PubMed

    Smorgick, Yossi; Baker, Kevin C; Herkowitz, Harry; Montgomery, David; Badve, Siddharth A; Bachison, Casey; Ericksen, Steven; Fischgrund, Jeffrey S

    2015-05-01

    OBJECT The purpose of this prospective cohort study was to identify risk factors for incidental durotomies in lumbar spine surgery. The authors hypothesized that the incidence of durotomy would be higher in cases involving multiple operations. METHODS The authors prospectively evaluated 523 patients who underwent lumbar and thoracolumbar spine surgery. They compared data on patients in whom a dural tear occurred and those in whom a dural tear did not occur. Data from patients in whom a dural tear occurred were compared with data from patients who did not experience durotomy. The data included basic demographic information, intraoperative data, and clinical information from a medical record review. RESULTS One hundred thirty-one patients underwent discectomy and 392 patients underwent laminectomy. Among the 131 patients who underwent discectomy 6 patients had a dural tear. Among the 392 patients who underwent discectomy 49 patients had dural tear. Patients with incidental durotomy were older (mean 65 ± 13 vs 60 ± 14 years of age; p = 0.044, t-test), and had longer surgery (146 ± 59 vs 110 ± 54 minutes; p = 0.025, t-test), compared with the patients without dural tear. The incidence of dural tear was more common in patients with a history of previous spine surgery (p < 0.001). CONCLUSIONS In patients who underwent lumbar and thoracolumbar spine surgery for degenerative problems, previous surgery and older age were found to be predisposing factors for dural tear. PMID:25700240

  16. Acute Contralateral Radiculopathy after Unilateral Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Jang, Kyoung-Min; Kim, Young-Baeg; Park, Yong-Sook; Nam, Taek-Kyun; Lee, Young-Seok

    2015-01-01

    Objective Cases of contralateral radiculopathy after a transforaminal lumbar interbody fusion with a single cage (unilateral TLIF) had been reported, but the phenomenon has not been explained satisfactorily. The purpose of this study was to determine its incidence, causes, and risk factors. Methods We did retrospective study with 546 patients who underwent a unilateral TLIF, and used CT and MRI to study the causes of contralateral radicular symptoms that appeared within a week postoperatively. Clinical and radiological results were compared by dividing the patients into the symptomatic group and asymptomatic group. Results Contralateral symptoms occurred in 32 (5.9%) of the patients underwent unilateral TLIF. The most common cause of contralateral symptoms was a contralateral foraminal stenosis in 22 (68.8%), screw malposition in 4 (12.5%), newly developed herniated nucleus pulposus in 3 (9.3%), hematoma in 1 (3.1%), and unknown origin in 2 patients (6.3%). 16 (50.0%) of the 32 patients received revision surgery. There was no difference in visual analogue scale and Oswestry disability index between the two groups at discharge. Both preoperative and postoperative contralateral foraminal areas were significantly smaller, and postoperative segmental angle was significantly greater in the symptomatic group comparing to those of the asymptomatic group (p<0.05). Conclusion The incidence rate is not likely to be small (5.9%). If unilateral TLIF is performed for cases when preoperative contralateral foraminal stenosis already exists or when a large restoration of segmental lordosis is required, the probability of developing contralateral radiculopathy is increased and caution from the surgeon is needed. PMID:26587189

  17. A study on difference and importance of sacral slope and pelvic sacral angle that affect lumbar curvature.

    PubMed

    Choi, Seyoung; Lee, Minsun; Kwon, Byongan

    2014-01-01

    Individual pelvic sacral angle was measured, compared and analyzed for the 6 male and female adults who were diagnosed with lumbar spinal stenosis, foraminal stenosis and mild spondylolisthesis in accordance with spinal parameters, pelvic parameters and occlusion state of sacroiliac joint presented by the author of this thesis based on the fact that the degree of lumbar excessive lordosis that was one of the causes for lumbar pain was determined by sacral slope. The measured values were compared with the standard values of the average normal range from 20 s to 40 s of normal Koreans stated in the study on the change in lumbar lordosis angle, lumbosacral angle and sacral slope in accordance with the age by Oh et al. [5] and sacral slope and pelvic sacral slope of each individual of the subjects for measurement were compared. Comparing the difference between the two tilt angles possessed by an individual is a comparison to determine how much the sacroiliac joint connecting pelvis and sacral vertebrae compensated and corrected the sacral vertebrae slope by pelvic tilt under the condition of synarthrodial joint.Under the condition that the location conforming to the line in which the sagittal line of gravity connects with pelvic ASIS and pubic pubic tuberele is the neutral location of pelvic tilt, sacral slope being greater than pelvic sacral slope means pelvic anterior tilting, whereas sacral slope being smaller than pelvic sacral slope means pelvic posterior tilting. On that account, male B, female A and female C had a pelvic posterior tilting of 16 degrees, 1 degree and 5 degrees respectively, whereas male A, male C and female B had a pelvic anterior tilting of 3 degrees, 9 degrees and 4 degrees respectively. In addition, the 6 patients the values of lumbar lordosis angle, lumbosacral angle and sacral slope that were almost twice as much as the normal standard values of Koreans. It is believed that this is because the pelvic sacral slope maintaining an angle that is slightly greater than the normal range by being located in the lowest end of spine considering that the compensation for pelvic tilt, in other words, pelvic limb is not much causes an excess of lumbar lordosis angle. The meaning of this study based on these results is to prove that PSA is one of the important factors that fundamentally determine lumbar curvature. And this is because it is definitely required to have a study on the guideline for appropriate posture and life habit to the maintenance and management of ideal PSA before the end of growth phase and also the exercise therapy and adjustment for the control of PSA. PMID:24704656

  18. Efficacy of glucosamine, chondroitin, and methylsulfonylmethane for spinal degenerative joint disease and degenerative disc disease: a systematic review

    PubMed Central

    Stuber, Kent; Sajko, Sandy; Kristmanson, Kevyn

    2011-01-01

    Background: Nutritional supplements are commonly used for a variety of musculoskeletal conditions, including knee and hip degenerative joint disease. Although these supplements are occasionally recommended for patients with degenerative disc disease and spinal degenerative joint disease, the evidence supporting this use is unknown. Objective: To systematically search and assess the quality of the literature on the use of glucosamine, chondroitin sulfate, and methylsulfonylmethane for the treatment of spinal osteoarthritis / degenerative joint disease, and degenerative disc disease. Data Sources: The Index of Chiropractic Literature, AMED, Medline, and CINAHL were searched for randomized controlled trials in English from 1984 to July 2009. Data Extraction and Synthesis: Data from studies meeting the inclusion criteria was extracted and reviewed by three reviewers. The Jadad scale was used to assess study quality. No attempts were made at meta-analysis due to variation in study design. Results: Two articles met the inclusion criteria. One study was found to have good quality but reported negative results for the supplemented group compared with placebo, the other study had low quality but reported significant positive results for the supplemented group when compared with a no intervention control group. Conclusion: There was little literature found to support the use of common nutritional supplements for spinal degeneration, making it difficult to determine whether clinicians should recommend them. PMID:21403782

  19. Evidence for Management of Carotid Artery Stenosis

    PubMed Central

    YOSHIDA, Kazumichi; MIYAMOTO, Susumu

    2015-01-01

    In this review, we presented the evidence concerning carotid artery stenosis treatment in symptomatic stenosis and asymptomatic stenosis separately, and discussed the future challenges. The validity of carotid endarterectomy (CEA) to treat moderate or greater degree of symptomatic carotid artery stenosis appears to be established. Due to the additional option of carotid artery stenting (CAS), it is necessary to comprehensively determine whether CEA or CAS is more appropriate for each individual patient. Moreover, since there are rapid advancements in devices for CAS and improvements in treatment outcomes, continual learning of the latest treatment method is essential. For asymptomatic stenosis, due to improvements in the outcomes with best medical treatment (BMT), it is essential to re-evaluate the use of invasive CEA/CAS. Continual verification of the latest randomized clinical trial that compares CEA, CAS, and BMT, and establishment of a diagnostic method that can accurately extract the group of patients who have the highest future risk of developing ischemia, are desired. PMID:25739437

  20. Anterior Cervical Spine Surgery for Degenerative Disease: A Review

    PubMed Central

    SUGAWARA, Taku

    Anterior cervical spine surgery is an established surgical intervention for cervical degenerative disease and high success rate with excellent long-term outcomes have been reported. However, indications of surgical procedures for certain conditions are still controversial and severe complications to cause neurological dysfunction or deaths may occur. This review is focused mainly on five widely performed procedures by anterior approach for cervical degenerative disease; anterior cervical discectomy, anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical foraminotomy, and arthroplasty. Indications, procedures, outcomes, and complications of these surgeries are discussed. PMID:26119899

  1. Peripheral pulmonary artery stenosis in three cats.

    PubMed

    Aoki, Takuma; Sunahara, Hiroshi; Sugimoto, Keisuke; Ito, Tetsuro; Kanai, Eiichi; Fujii, Yoko

    2015-04-01

    Case 1 involved a 4-month-old intact male Somali cat in which peripheral pulmonary artery stenosis (PPS) was recognized after a cardiac murmur remained following patent ductus arteriosus ligation. Case 2, which involved a 1-year-old neutered male Norwegian Forest cat, and Case 3, which involved a 6-month-old intact female American Curl cat, were referred, because of cardiac murmurs. Grades III to IV/VI systolic heart murmurs were auscultated at the left heart base in all 3 cats. All cases showed bilateral pulmonary artery stenosis, although there were no associated clinical signs. In Cases 1 and 2, the pressure gradient through the stenosis decreased after treatment with atenolol. PMID:25650057

  2. Nanobacteria-associated calcific aortic valve stenosis.

    PubMed

    Jelic, Tomislav M; Chang, Ho-Huang; Roque, Rod; Malas, Amer M; Warren, Stafford G; Sommer, Andrei P

    2007-01-01

    Calcific aortic valve stenosis is the most common valvular disease in developed countries, and the major reason for operative valve replacement. In the US, the current annual cost of this surgery is approximately 1 billion dollars. Despite increasing morbidity and mortality, little is known of the cellular basis of the calcifications, which occur in high-perfusion zones of the heart. The case is presented of a patient with calcific aortic valve stenosis and colonies of progressively mineralized nanobacteria in the fibrocalcific nodules of the aortic cusps, as revealed by transmission electron microscopy. Consistent with their outstanding bioadhesivity, nanobacteria might serve as causative agents in the development of calcific aortic valve stenosis. PMID:17315391

  3. Tracheal reconstruction for comlex acute tracheal stenosis.

    PubMed

    Fatimi, Saulat H; Qasim Raza, M; Ghani, Alina; Shah, Nilay; Ashfaq, Awais

    2013-01-01

    Tracheal stenosis refers to a reduction in the size of the tracheal lumen and can be due to a myriad of reasons, but the most common remains trauma. In iatrogenic situations, internal trauma is the most likely culprit, resulting from prolonged intubation. Our case reviews a patient who developed severe tracheal stenosis (90% reduction in lumen size) within a month of a threeday- long intubation, and presented to the emergency room with dyspnea, orthopnea, and stridor. Tracheal reconstruction with resection of the stenosed segment and end-to-end anastomosis was done. The patient returned a month later with re-stenosis, and underwent tracheal dilatation. Subsequently, he was discharged with a tracheostomy with no problems thereafter. PMID:25628886

  4. Questions and Answers about Treating Arterial Stenosis and Preventing Stroke

    MedlinePLUS

    ... context of stroke, “stenosis” is usually caused by atherosclerosis, a condition where a blood vessel supplying blood ... high cholesterol. How does stenosis contribute to stroke? Atherosclerosis can activate cells involved in blood clotting. As ...

  5. Augmentation Improves Human Cadaveric Vertebral Body Compression Mechanics For Lumbar Total Disc Replacement

    PubMed Central

    Yoder, Jonathon H.; Auerbach, Joshua D.; Maurer, Philip M.; Erbe, Erik M.; Entrekin, Dean; Balderston, Richard A.; Bertagnoli, Rudolf; Elliott, Dawn M.

    2012-01-01

    Study Design Cadaveric biomechanical study. Objectives Quantify the effects of vertebral body augmentation on biomechanics under axial compression by a total disc replacement (TDR) implant. Summary of Background Data TDR is a surgical alternative to lumbar spinal fusion to treat degenerative disc disease. Osteoporosis in the adjacent vertebrae to the interposed TDR may lead to implant subsidence or vertebral body fracture. Vertebral augmentation is used to treat osteoporotic compression fracture. The study sought to evaluate whether vertebral augmentation improves biomechanics under TDR axial loading. Methods Forty-five L1-L5 lumbar vertebral body segments with intact posterior elements were used. Peripheral quantitative computed tomography scans were performed to determine bone density, block randomizing specimens by bone density into augmentation and control groups. A semi-constrained keeled lumbar disc replacement device was implanted providing 50% endplate coverage. Vertebral augmentation of 17.6 ± 0.9% vertebral volume fill with Cortoss was performed on augmentation group. All segments underwent axial compression at a rate of 0.2 mm/s to 6mm. Results The load-displacement response for all specimens was non-linear. Subfailure mechanical properties with augmentation were significantly different from control; in all cases the augmented group was 2× higher than control. At failure, the maximum load and stiffness with augmentation was not significantly different from control. The maximum apparent stress and modulus with augmentation were 2× and 1.3× greater than control, respectively. The subfailure stress and apparent modulus with augmentation was moderately correlated with bone density while the control subfailure properties were not. The augmented maximum stress was not correlated with bone density, while the control was weakly correlated. The maximum apparent modulus was moderately correlated with bone density for both the augmented and control groups. Conclusion Augmentation improved the mechanical properties of the lumbar vertebral body for compression by a TDR implant. PMID:20375770

  6. Prevalence and Distribution of Thoracic and Lumbar Compressive Lesions in Cervical Spondylotic Myelopathy

    PubMed Central

    Kodera, Ryuzo; Yoshiiwa, Toyomi; Kawano, Masanori; Kaku, Nobuhiro; Tsumura, Hiroshi

    2015-01-01

    Study Design Retrospective cross-sectional study. Purpose This study analyzed the prevalence and distribution of horacic and lumbar compressive lesions in cervical spondylotic myelopathy as well as their relationships with cervical developmental spinal canal stenosis (DCS) by using whole-spine postmyelographic computed tomography. Overview of Literature There are few studies on missed compressive lesions of the spinal cord or cauda equina at the thoracolumbar level in cervical spondylotic myelopathy. Furthermore, the relationships between DCS, and the prevalence and distribution of thoracic and lumbar compressive lesions are unknown. Methods Eighty patients with symptomatic cervical spondylotic myelopathy were evaluated. Preoperative image data were obtained. Patients were classified as DCS or non-DCS (n=40 each) if their spinal canal longitudinal diameter was <12 mm at any level or ?12 mm at all levels, respectively. Compressive lesions in the anterior and anteroposterior parts, ligamentum flavum ossification, posterior longitudinal ligament ossification, and spinal cord tumors at the thoracolumbar levels were analyzed. Results Compressive lesions in the anterior and anteroposterior parts were observed in 13 (16.3%) and 45 (56.3%) patients, respectively. Ligamentum flavum and posterior longitudinal ligament ossification were observed in 19 (23.8%) and 3 (3.8%) patients, respectively. No spinal cord tumors were observed. Thoracic and lumbar compressive lesions of various causes tended to be more common in DCS patients than non-DCS patients, although the difference was statistically insignificant. Conclusions Surveying compressive lesions and considering the thoracic and lumbar level in cervical spondylotic myelopathy in DCS patients are important for preventing unexpected neurological deterioration and predicting accurate neurological condition after cervical surgery. PMID:25901233

  7. Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysis

    PubMed Central

    Liu, Kuan; Liu, Pengcheng; Liu, Run; Wu, Xing; Cai, Ming

    2015-01-01

    Purpose To investigate the effectiveness and safety of epidural steroid injections in patients with lumbar spinal stenosis (LSS). Methods We performed a search on the CENTRAL, Pubmed, Embase and Cochrane databases up to September 2014. We recovered 17 original articles, of which only 10 were in full compliance with the randomized controlled trial (RCT) criteria. These articles were reviewed in an independent and blinded way by two reviewers who were previously trained to extract data and score their quality by the criteria of the Cochrane Handbook (5.1.0). Results We accepted ten studies with 1,010 participants. There is minimal evidence that shows that epidural steroid injections are better than lidocaine alone, regardless of the mode of epidural injection. There is a fair short-term and long-term benefit for treating spinal stenosis with local anesthetic and steroids. Conclusions This meta-analysis suggests that epidural steroid injections provide limited improvement in short-term and long-term benefits in LSS patients. PMID:25678775

  8. Symptomatic Triple-Region Spinal Stenosis Treated with Simultaneous Surgery: Case Report and Review of the Literature

    PubMed Central

    Schaffer, Joseph C.; Raudenbush, Brandon L.; Molinari, Christine; Molinari, Robert W.

    2015-01-01

    Study Design?Case report. Objectives?Symptomatic triple-region spinal stenosis (TRSS), defined as spinal stenosis in three different regions of the spine, is extremely rare. To our knowledge, treatment with simultaneous decompressive surgery is not described in the literature. We report a case of a patient with TRSS who was treated successfully with simultaneous decompressive surgery in three separate regions of the spine. Methods?A 50-year-old man presented with combined progressive cervical and thoracic myelopathy along with severe lumbar spinal claudication and radiculopathy. He underwent simultaneous decompressive surgery in all three regions of his spine and concomitant instrumented fusion in the cervical and thoracic regions. Results?Estimated blood loss for the procedure was 600 mL total (250 mL cervical, 250 mL thoracic, 100 mL lumbar) and operative time was ?3.5 hours. No changes were noted on intraoperative monitoring. The postoperative course was uncomplicated. The patient was discharged to inpatient rehabilitation on postoperative day (POD) 7 and discharged home on POD 11. At 6-month follow-up, his gait and motor function was improved and returned to normal in all extremities. He remains partially disabled due to chronic back pain. Conclusions?This report is the first of symptomatic TRSS treated with simultaneous surgery in three different regions of the spine. Simultaneous triple region stenosis surgery appears to be an effective treatment option for this rare condition, but may be associated with prolonged hospital stay after surgery. PMID:26682102

  9. Playing Contact Sports in Youth May Raise Risk for Degenerative Brain Disease

    MedlinePLUS

    ... Sports in Youth May Raise Risk for Degenerative Brain Disease Study suggests that vulnerability to CTE not ... the only ones who can develop a degenerative brain disease linked to repeated concussions during decades of ...

  10. ISASS Policy Statement – Lumbar Artificial Disc

    PubMed Central

    Garcia, Rolando

    2015-01-01

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

  11. Management of carotid stenosis. History and today

    PubMed Central

    Jargie??o, Tomasz; Drelich-Zbroja, Anna

    2013-01-01

    Internal carotid stenosis constitutes a significant clinical challenge, since it is the cause of 20–25% of ischemic brain strokes. The management of the internal carotid stenosis for many years has been raising controversies amongst neurologists, vascular surgeons and interventional radiologists mainly due to the introduction of endovascular stenting as an alternative to surgical treatment. Its application, however, requires knowledge of specific selection criteria for this kind of treatment as well as of the methods of monitoring patients after stent implantation into the internal carotid artery. Duplex Doppler ultrasound examination is currently a basis for the diagnosis of the arterial stenosis of precranial segments of the carotid arteries. It allows a reliable assessment of not only the course and morphology of the walls, but also of the hemodynamics of blood flow. Interventional treatment is applicable in patients with internal carotid stenosis of ?70%, which is accompanied by an increase of the systolic flow velocity above 200 cm/s and the end-diastolic velocity above 50–60 cm/s in the stenotic lumen. In most cases, such a diagnosis in duplex Doppler ultrasound examination does not require any confirmation by additional diagnostic methods and if neurological symptoms are also present, it constitutes a single indication for interventional treatment. When deciding about choice of surgical or endovascular method of treatment, the following factors are of crucial importance: morphology of atherosclerotic plaque, its size, echogenicity, homogeneity of its structure, its surface and outlines. By means of ultrasound examinations, patients can be monitored after endovascular stent implantation. They enable evaluation of the degree of stent patency and allow for an early detection of symptoms indicating stenosis recurrence or presence of in-stent thrombosis. When interpreting the findings of the US checkup, it is essential to refer to the initial examination performed in the first days after the procedure and the next ones conducted during the monitoring period.

  12. Fractures of the Thoracic and Lumbar Spine

    MedlinePLUS

    .org Fractures of the Thoracic and Lumbar Spine Page ( 1 ) Spinal fractures can vary widely in severity. While some fractures are very serious injuries that require emergency treatment, other fractures can ...

  13. Lumbar disc injury in the athlete.

    PubMed

    Watkins, Robert G

    2002-01-01

    The lumbar spine is a highly vulnerable area for injury in a number of different sports. And while the incidence is significant and the time lost may be significant, probably the most important problems are related to the fear of spinal injuries and the need for a therapeutic plan. Lumbar pain is significant in many sports, but an organized diagnostic and therapeutic plan can prevent permanent injury, allowing full function and maximum performance. PMID:11877868

  14. Epidural cerebrospinal fluid collection after lumbar puncture.

    PubMed

    Aronson, Paul L; Zonfrillo, Mark R

    2009-07-01

    Lumbar puncture is a common procedure in the emergency department. Cerebrospinal fluid (CSF) leak through a dural tear can cause transient side effects including headache and backache, although more severe symptoms may occur. These CSF collections can be managed nonoperatively without any neurologic sequelae. We report a patient with a symptomatic epidural CSF collection after diagnostic lumbar puncture, followed by a brief review of the literature including discussion of techniques that can reduce CSF leak. PMID:19606006

  15. Degenerative Spondylolisthesis: Does Fusion Method Influence Outcome? Four-Year Results of the Spine Patient Outcomes Research Trial (SPORT)

    PubMed Central

    Abdu, William A.; Lurie, Jon D.; Spratt, Kevin F.; Tosteson, Anna N.A.; Zhao, Wenyan; Tosteson, Tor D.; Herkowitz, Harry; Longely, Michael; Boden, Scott D.; Emery, Sanford; Weinstein, James N.

    2013-01-01

    Study Design Clinical trial sub-group analysis Objective To compare outcomes of different fusion techniques treating degenerative spondylolisthesis (DS). Summary of Background Data Surgery has been shown to be more effective than non-operative treatment out to four years.1,2 Questions remain regarding the differential effect of fusion technique. METHODS Surgical candidates from 13 centers in 11 states with at least 12 weeks of symptoms and confirmatory imaging showing stenosis and DS were studied. In addition to standard decompressive laminectomy, one of three fusion techniques was employed at the surgeon’s discretion: posterolateral in situ fusion (PLF); posterolateral instrumented fusion with pedicle screws (PPS); or PPS plus interbody fusion (360°). Main outcome measures were the SF-36 Bodily Pain (BP) and Physical Function (PF) scales and the modified Oswestry Disability Index (ODI) assessed at 6 weeks, 3 months, 6 months, and yearly to 4 years. The as-treated analysis combined the randomized and observational cohorts using mixed longitudinal models adjusting for potential confounders. RESULTS Of 380 surgical patients, 21% (N= 80) received a PLF; 56% (N=213) received a PPS; 17% (N=63) received a 360°; and 6% (N=23) had decompression only without fusion. Early outcomes varied, favoring PLF compared to PPS at 6 weeks (PF: 12.73 vs. 6.22, p<0.020) and 3 months (PF: 25.24 vs.18.95, p<0.025) and PPS compared to 360° at 6 weeks (ODI: ?14.46 vs. ?9.30, p<0.03) and 3 months (ODI: ?22.30 vs. ?16.78, p<0.02). At two years, 360° had better outcomes: BP: 39.08 vs. 29.17 PLF, p<0.011; and vs. 29.13 PPS, p<0.002; PF; 31.93 vs. 23.27 PLF, p<0.021; and vs. 25.29 PPS, p<0.036. However, these differences were not maintained at 3- and 4-year follow-up, when there were no statistically significant differences between the three fusion groups. CONCLUSIONS In patients with degenerative spondylolisthesis and associated spinal stenosis, no consistent differences in clinical outcomes were seen among fusion groups over four years. PMID:19755935

  16. Acquired degenerative changes of the intervertebral segments at and suprajacent to the lumbosacral junction. A radioanatomic analysis of the nondiskal structures of the spinal column and perispinal soft tissues.

    PubMed

    Jinkins, J R

    2001-01-01

    In earlier evolutionary times, mammals were primarily quadrupeds. However, other bipeds have also been represented during the course of the Earth's several billion year history. In many cases, either the bipedal stance yielded a large tail and hypoplastic upper extremities (e.g., Tyrannosaurus rex and the kangaroo), or it culminated in hypoplasia of the tail and further development and specialization of the upper extremities (e.g., nonhuman primates and human beings). In the human species this relatively recently acquired posture resulted in a more or less pronounced lumbosacral kyphosis. In turn, certain compensatory anatomic features have since occurred. These include the normal characteristic posteriorly directed wedge-shape of the L5 vertebral body and the L5-S1 intervertebral disk; the L4 vertebral body and the L4-L5 disk may be similarly visibly affected. These compensatory mechanisms, however, have proved to be functionally inadequate over the long term of the human life span. Upright posture also leads to increased weight bearing in humans that progressively causes excess stresses at and suprajacent to the lumbosacral junction. These combined factors result in accelerated aging and degenerative changes and a predisposition to frank biomechanical failure of the subcomponents of the spinal column in these spinal segments. One other specific problem that occurs at the lumbosacral junction that predisposes toward premature degeneration is the singular relationship that exists between a normally mobile segment of spine (i.e., the lumbar spine) and a normally immobile one (i.e., the sacrum). It is well known that mobile spinal segments adjacent to congenitally or acquired fused segments have a predilection toward accelerated degenerative changes. The only segment of the spine in which this is invariably normally true is at the lumbosacral junction (i.e., the unfused lumbar spine adjoining the fused sacrum). Nevertheless, biomechanical failures of the human spine are not lethal traits; in most cases today, mankind reaches sexual maturity before spinal biomechanical failure precludes sexual reproduction. For this gene-preserving reason, degenerative spinal disorders will likely be a part of modern societies for the foreseeable eternity of the race. The detailed alterations accruing from the interrelated consequences of and phenomena contributing to acquired degenerative changes of the lumbosacral intervertebral segments as detailed in this discussion highlight the extraordinary problems that are associated with degenerative disease in this region of the spine. Further clinicoradiologic research in this area will progressively determine the clinical applications and clinical efficacy of the various traditional and newer methods of therapy in patients presenting with symptomatic acquired collapse of the intervertebral disks at and suprajacent to the lumbosacral junction and the interrelated degenerative alterations of the nondiskal structures of the spine. PMID:11221507

  17. Shock absorption in lumbar disc prosthesis: a preliminary mechanical study.

    PubMed

    LeHuec, J C; Kiaer, T; Friesem, T; Mathews, H; Liu, M; Eisermann, L

    2003-08-01

    Lumbar disc prostheses have been used in treating symptomatic degenerative disc diseases. A few prostheses of the ball-socket design are currently available for clinical use, the joint mechanism being materialized either with a hard polymer core or a metal-to-metal couple. Other prostheses of "shock absorber" design were not available at the time of the study. The objective of this work was to establish whether there was a difference in the shock absorption capacity between a device having an ultra-high-molecular-weight polyethylene center core and a device having a metal-on-metal bearing. Vibration and shock loading were applied to two lumbar total disc prostheses: PRODISC, manufactured by Spine Solutions, and MAVERICK Total Disc Replacement, manufactured by Medtronic Sofamor Danek. The shock absorption capacity of the device was evaluated by comparing the input and the output force measurements. The disc prosthesis was mounted onto a test apparatus. Each side of the device was equipped with a force sensor. The input shock load and the output resulting forces were simultaneously measured and recorded. The loading force pattern included 1). a static preload of 350 N plus an oscillating vibration of 100 N with frequency sweeping from 0 to 100 Hz and 2). a sudden shock load of 250 N applied over a 0.1-second interval. Both input and output signal data were processed and were transformed into their frequency spectrums. The vibration and shock transmissibility of the device, defined as the ratio of the output spectrum over the input spectrum, were calculated in sweeping the frequency from 0 to 100 Hz. The phase deviation was calculated to characterize the shock absorber effects. For both tested devices under vibration and shock loading, the phase angle displacement between the input and the output signals was 10 degrees. Under oscillating vibration loading, both tested devices had a transmission ratio higher than 99.8%. Over the frequency interval 1-100 Hz, the difference in transmission ratio between the two devices was <0.3%. Under sudden shock loading, both tested devices had a transmission ratio higher than 98%. The difference between the two devices was <0.8%. Both tested devices have identical vibration and shock transmissibility. PMID:12902950

  18. Analysis of adjacent segment reoperation after lumbar total disc replacement

    PubMed Central

    Rainey, Scott; Blumenthal, Scott L.; Zigler, Jack E.; Guyer, Richard D.; Ohnmeiss, Donna D.

    2012-01-01

    Background Fusion has long been used for treating chronic back pain unresponsive to nonoperative care. However, potential development of adjacent segment degeneration resulting in reoperation is a concern. Total disc replacement (TDR) has been proposed as a method for addressing back pain and preventing or reducing adjacent segment degeneration. The purpose of the study was to determine the reoperation rate at the segment adjacent to a level implanted with a lumbar TDR and to analyze the pre-TDR condition of the adjacent segment. Methods This study was based on a retrospective review of charts and radiographs from a consecutive series of 1000 TDR patients to identify those who underwent reoperation because of adjacent segment degeneration. Some of the patients were part of randomized studies comparing TDR with fusion. Adjacent segment reoperation data were also collected from 67 patients who were randomized to fusion in those studies. The condition of the adjacent segment before the index surgery was compared with its condition before reoperation based on radiographs, magnetic resonance imaging (MRI), and computed tomography. Results Of the 1000 TDR patients, 20 (2.0%) underwent reoperation. The mean length of time from arthroplasty to reoperation was 28.3 months (range, 0.5–85 months). Of the adjacent segments evaluated on preoperative MRI, 38.8% were normal, 38.8% were moderately diseased, and 22.2% were classified as having severe degeneration. None of these levels had a different grading at the time of reoperation compared with the pre-TDR MRI study. Reoperation for adjacent segment degeneration was performed in 4.5% of the fusion patients. Conclusions The 2.0% rate of adjacent segment degeneration resulting in reoperation in this study is similar to the 2.0% to 2.8% range in other studies and lower than the published rates of 7% to 18% after lumbar fusion. By carefully assessing the presence of pre-existing degenerative changes before performing arthroplasty, this rate may be reduced even more. PMID:25694883

  19. Endovascular treatment of extracranial vertebral artery stenosis

    PubMed Central

    Kocak, Burak; Korkmazer, Bora; Islak, Civan; Kocer, Naci; Kizilkilic, Osman

    2012-01-01

    Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery (VA) stenosis seems a safe, effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation, with a low complication rate and good long-term results. In patients with severe tortuosity of the vessel, stent placement is a real challenge. The new coronary balloon-expandable stents may be preferred. A large variability of restenosis rates has been reported. Drug-eluting stents may be the solution. After a comprehensive review of the literature, it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible, but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management. PMID:23024840

  20. Potential of Bone Marrow Stromal Cells in Applications for Neuro-Degenerative, Neuro-Traumatic and Muscle Degenerative Diseases

    PubMed Central

    Dezawa, Mari; Ishikawa, Hiroto; Hoshino, Mikio; Itokazu, Yutaka; Nabeshima, Yo-ichi

    2005-01-01

    Cell transplantation is a promising strategy for the treatment of neurodegenerative and muscle degenerative diseases. Many kinds of cells, including embryonic stem cells and tissue stem cells, have been considered as candidates for transplantation therapy. Bone marrow stromal cells (MSCs) have great potential as therapeutic agents since they are easy to isolate and can be expanded from patients without serious ethical or technical problems. We discovered a new method for the highly efficient and specific induction of functional Schwann cells, neurons and skeletal muscle lineage cells from both rat and human MSCs. These induced cells were transplanted into animal models of neurotraumatic injuries, Parkinson’s disease, stroke and muscle dystrophies, resulting in the successful integration of transplanted cells and an improvement in behavior of the transplanted animals. Here we focus on the respective potentials of MSC-derived cells and discuss the possibility of clinical application in degenerative diseases. PMID:18369401

  1. [Iatrogenic urethral stenosis. Apropos of 100 cases].

    PubMed

    Boujnah, H; Abid, I; Trabelsi, N; Zmerli, S

    1989-03-01

    Iatrogenic causes of stenosis of urethra appear to be increasing in frequency. 100 cases out of a total of 582 patients being of iatrogenic origin. The principal cause is the use of a urethral catheter. Various therapeutic methods are used, preference being given quite clearly to internal urethrotomy. Prevention is of fundamental importance and is based on the less untimely routine use of urethral catheters, particularly after general surgical operations and in intensive care. PMID:2659605

  2. Anterior lumbar interbody surgery for spondylosis results from a classically-trained neurosurgeon.

    PubMed

    Chatha, Gurkirat; Foo, Stacy W L; Lind, Christopher R P; Budgeon, Charley; Bannan, Paul E

    2014-09-01

    Anterior lumbar surgery for degenerative disc disease (DDD) is a relatively novel technique that can prevent damage to posterior osseous, muscular and ligamentous spinal elements. This study reports the outcomes and complications in 286 patients who underwent fusion - with artificial disc implants or combined fusion and artificial disc implants - by a single-operator neurosurgeon, with up to 24 months of follow-up. The visual analogue scale (VAS), Oswestry Disability Index (ODI), Short Form 36 (SF36) and prospective log of adverse events were used to assess the clinical outcome. Radiographic assessments of implant position and bony fusion were analysed. Intraoperative and postoperative complications were also recorded. Irrespective of pre-surgical symptoms (back pain alone or back and leg pain combined), workers' compensation status and type of surgical implant, clinically significant improvements in VAS, ODI and SF36 were primarily observed at 3 and/or 6 month follow-up, and improvements were maintained at 24 months after surgery. A 94% fusion rate was obtained; the overall complication was 9.8% which included 3.5% with vascular complications. The anterior lumbar approach can be used for treating DDD for both back pain and back and leg pain with low complication rates. With appropriate training, single-operator neurosurgeons can safely perform these surgeries. PMID:24786717

  3. Changes in the Flow-Volume Curve According to the Degree of Stenosis in Patients With Unilateral Main Bronchial Stenosis

    PubMed Central

    Yoo, Jung-Geun; Yi, Chin A; Lee, Kyung Soo; Jeon, Kyeongman; Um, Sang-Won; Koh, Won-Jung; Suh, Gee Young; Chung, Man Pyo; Kwon, O Jung

    2015-01-01

    Objectives The shape of the flow-volume (F-V) curve is known to change to showing a prominent plateau as stenosis progresses in patients with tracheal stenosis. However, no study has evaluated changes in the F-V curve according to the degree of bronchial stenosis in patients with unilateral main bronchial stenosis. Methods We performed an analysis of F-V curves in 29 patients with unilateral bronchial stenosis with the aid of a graphic digitizer between January 2005 and December 2011. Results The primary diseases causing unilateral main bronchial stenosis were endobronchial tuberculosis (86%), followed by benign bronchial tumor (10%), and carcinoid (3%). All unilateral main bronchial stenoses were classified into one of five grades (I, ?25%; II, 26%-50%; III, 51%-75%; IV, 76%-90%; V, >90% to near-complete obstruction without ipsilateral lung collapse). A monophasic F-V curve was observed in patients with grade I stenosis and biphasic curves were observed for grade II-IV stenosis. Both monophasic (81%) and biphasic shapes (18%) were observed in grade V stenosis. After standardization of the biphasic shape of the F-V curve, the breakpoints of the biphasic curve moved in the direction of high volume (x-axis) and low flow (y-axis) according to the progression of stenosis. Conclusion In unilateral bronchial stenosis, a biphasic F-V curve appeared when bronchial stenosis was >25% and disappeared when obstruction was near complete. In addition, the breakpoint moved in the direction of high volume and low flow with the progression of stenosis. PMID:26045916

  4. The implications of constraint in lumbar total disc replacement.

    PubMed

    Huang, Russel C; Girardi, Federico P; Cammisa, Frank P; Wright, Timothy M

    2003-08-01

    Lumbar total disc replacement (TDR) is an evolving technique that has the potential to replace arthrodesis as the gold standard surgical treatment of degenerative disc disease. The interaction between host anatomy and physiology and the biomechanical properties of TDR implants will determine the quality of long-term clinical results. However, there is scant literature addressing this subject. The purpose of this article is to discuss the implications of biomechanical constraint in TDR. Based upon available data for normal motion segments and the design of two TDRs currently in clinical trials, unconstrained designs appear to have a kinematic advantage. They are more likely to provide a physiologic mobile instantaneous axis of rotation (IAR), which may explain why they display greater range of motion in vivo. Their lack of constraint may prevent excessive facet joint or capsuloligamentous loads in the extremes of flexion and extension. Furthermore, since the IAR is mobile, they may be less sensitive to small errors in implant placement. On the other hand, constrained devices appear to have an advantage in protection of the posterior elements from shear loading. Spinal shear loads of considerable magnitude occur during activities of daily living. Whether the transference of stresses to the implant and implant-bone interface is clinically significant is unknown. Although this article focuses on two specific TDR designs, future designs will need to account for the same kinematic and loading concerns regarding constraint. We hope this discussion will assist clinicians and researchers in the design, selection, and clinical comparison of present and future TDR implants. PMID:12902958

  5. Pancreaticoduodenal artery aneurysm formation with superior mesenteric artery stenosis.

    PubMed

    Kitaoka, Tadashi; Deguchi, Juno; Kamiya, Chiaki; Suzuki, Jun; Sato, Osamu

    2014-01-01

    Celiac stenosis or occlusion is attributed partly to increase blood flow at pancreatic arcade from the superior mesenteric artery (SMA) system and may play a causal role in true aneurysm of pancreaticoduodenal artery (PDAA) formation. However, despite possible increased blood flow in the pancreatic arcades like celiac stenosis, PDAAs with a stenotic SMA are extremely rare, with only three cases have been reported in the literature. We report a case of PDAA with SMA stenosis and review the literature. PMID:25298835

  6. Pancreaticoduodenal Artery Aneurysm Formation with Superior Mesenteric Artery Stenosis

    PubMed Central

    Kitaoka, Tadashi; Kamiya, Chiaki; Suzuki, Jun; Sato, Osamu

    2014-01-01

    Celiac stenosis or occlusion is attributed partly to increase blood flow at pancreatic arcade from the superior mesenteric artery (SMA) system and may play a causal role in true aneurysm of pancreaticoduodenal artery (PDAA) formation. However, despite possible increased blood flow in the pancreatic arcades like celiac stenosis, PDAAs with a stenotic SMA are extremely rare, with only three cases have been reported in the literature. We report a case of PDAA with SMA stenosis and review the literature. PMID:25298835

  7. Pulmonary Vein Stenosis in a Newborn: A Commonly Overlooked Diagnosis

    PubMed Central

    Bravo-valenzuela, Nathalie Jeanne Magioli; Silva, Guilherme Ricardo Nunes; Varella, Marcela Pinto

    2015-01-01

    The diagnosis of primary pulmonary vein stenosis is often overlooked because its symptoms overlap lung diseases and pulmonary arterial hypertension. Its diagnosis may be difficult because the condition is progressive and associated with other defects. We present a case of pulmonary vein stenosis in a newborn with stenosis of the left-sided common pulmonary vein, diffuse hypoplasia of the superior right pulmonary vein, and atresia of the inferior right pulmonary vein. PMID:26457207

  8. Notalgia paresthetica associated with cervical spinal stenosis and cervicothoracic disk disease at C4 through C7.

    PubMed

    Alai, Nili N; Skinner, Harry B; Nabili, Siamak T; Jeffes, Edward; Shahrokni, Seyed; Saemi, Arash M

    2010-02-01

    Notalgia paresthetica (NP) is a common refractory, sensory, neuropathic syndrome with the hallmark symptom of localized pruritus of the unilateral infrascapular back. It generally is a chronic noncurable condition with periodic remissions and exacerbations. While the dermatologic syndrome may be multifactorial in etiology, a possible association with underlying cervical spine disease should be evaluated for proper treatment. Collaborative multispecialty evaluation by dermatology, radiology, orthopedic surgery, and neurology may be indicated for primary management of this condition. First-line therapy for NP with associated cervical disease may include nondermatologic noninvasive treatments such as spinal manipulation, physical therapy, massage, cervical traction, cervical muscle strengthening, and oral nonsteroidal anti-inflammatory drugs and muscle relaxants. Notalgia paresthetica may in fact be a cutaneous sign of an underlying degenerative cervical spine disease. We report a case of a patient with cervical spinal stenosis that corresponded directly with the clinical findings of NP. PMID:20349681

  9. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) ANTHROPOMORPHIC TEST DEVICES Side Impact Hybrid Dummy 50th Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar...

  10. Low-Grade Carotid Stenosis: Implications of MR Imaging.

    PubMed

    Mossa-Basha, Mahmud; Wasserman, Bruce A

    2016-02-01

    Although treatment guidelines are well established for symptomatic patients with greater than 69% carotid stenosis on catheter angiography, optimal management of lower degrees of stenosis remain unclear. Vessel wall MR imaging of the carotid arteries has proved helpful in the evaluation of plaque burden and vulnerable plaque characteristics, and in stratifying risk in low-grade carotid stenosis. This article discusses the pathophysiology and imaging of atherosclerotic plaques resulting in low-grade carotid stenosis, and the corresponding stroke risk and association with plaque elsewhere in the cardiovascular system. PMID:26610665

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

    PubMed

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

    2015-11-01

    This study aims to assess the results of extended transforaminal lumbar interbody fusion (TLIF) for a two surgeon, single institution series. In total, extended TLIF with bilateral decompression was performed in 57 patients. Pain, American Spinal Injury Association scores, patient demographics, body mass index (BMI), perioperative indices and radiographic measurements were recorded and analysed. The surgeries were performed between February 2011 and January 2014 on 38 women and 19 men. The mean patient age was 62.86years, and the mean BMI was 30.31kg/m(2). In 49 patients, spondylolisthesis was the primary indication. The mean intraoperative time was 284.65min, and this decreased as the series progressed. The median length of stay was 5days (range: 2-9). The surgical complication rate was 19.3%. Two patients died from cardiopulmonary complications. Single level TLIF was performed in 78.9% of the cohort, with L4/5 the most commonly fused level. Significant pain reduction was achieved from a mean (±standard deviation) preoperative visual analogue scale (VAS) of 8.28±1.39 to 1.50±1.05 at 12months postoperatively. No patients deteriorated neurologically. Spondylolisthesis was significantly corrected from a preoperative mean of 6.82mm to 2.80mm postoperatively. Although there is a learning curve associated with the procedure, extended TLIF with bilateral facet joint removal and decompression appeared to be a safe and effective alternative to other fusion techniques, and our results were comparable to other published case series. The stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life. PMID:26358199

  12. Economic impact of minimally invasive lumbar surgery

    PubMed Central

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

    2015-01-01

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

  13. Supervised methods for detection and segmentation of tissues in clinical lumbar MRI.

    PubMed

    Ghosh, Subarna; Chaudhary, Vipin

    2014-10-01

    Lower back pain (LBP) is widely prevalent all over the world and more than 80% of the people suffer from LBP at some point of their lives. Moreover, a shortage of radiologists is the most pressing cause for the need of CAD (computer-aided diagnosis) systems. Automatic localization and labeling of intervertebral discs from lumbar MRI is the first step towards computer-aided diagnosis of lower back ailments. Subsequently, for diagnosis and characterization (quantification and localization) of abnormalities like disc herniation and stenosis, a completely automatic segmentation of intervertebral discs and the dural sac is extremely important. Contribution of this paper towards clinical CAD systems is two-fold. First, we propose a method to automatically detect all visible intervertebral discs in clinical sagittal MRI using heuristics and machine learning techniques. We provide a novel end-to-end framework that outputs a tight bounding box for each disc, instead of simply marking the centroid of discs, as has been the trend in the recent past. Second, we propose a method to simultaneously segment all the tissues (vertebrae, intervertebral disc, dural sac and background) in a lumbar sagittal MRI, using an auto-context approach instead of any explicit shape features or models. Past work tackles the lumbar segmentation problem on a tissue/organ basis, and which tend to perform poorly in clinical scans due to high variability in appearance. We, on the other hand, train a series of robust classifiers (random forests) using image features and sparsely sampled context features, which implicitly represent the shape and configuration of the image. Both these methods have been tested on a huge clinical dataset comprising of 212 cases and show very promising results for both disc detection (98% disc localization accuracy and 2.08mm mean deviation) and sagittal MRI segmentation (dice similarity indices of 0.87 and 0.84 for the dural sac and the inter-vertebral disc, respectively). PMID:24746606

  14. Management of a 59-year-old female patient with adult degenerative scoliosis using manipulation under anesthesia

    PubMed Central

    Morningstar, Mark W.; Strauchman, Megan N.

    2010-01-01

    Objective Manipulation under anesthesia (MUA) is an outpatient procedure that is performed to restore normal joint kinematics and musculoskeletal function. This article presents a case of a patient with idiopathic lumbar degenerative scoliosis who developed intractable pain as an adult and reports on the outcomes following a trial of MUA. Clinical Features A 59-year-old female patient presented to a chiropractic office with primary subjective symptoms of lower back and bilateral hip pain. Numerical pain rating scores were reported at 8 of 10 for the lower back and 9 of 10 for the sacroiliac joint/gluteal region. A disability score using a functional rating index demonstrated a score of 26 of 40 (or 64% disability). Over the preceding 5 years, the patient had tried a number of conservative therapies to relieve her pain without success. Intervention and Outcome The patient was evaluated for MUA. The patient was scheduled for a serial MUA over 3 days. Numerical pain rating scores 8 weeks after the MUA were 1 of 10 for the lower back and 3 of 10 for the sacroiliac joint. Her disability rating decreased to 11 of 40 (28%). Radiological improvements were also observed. These outcomes were maintained at 6-month follow-up. Conclusion Pain, functional, and radiographic outcomes demonstrated improvements immediately following treatment for this patient. PMID:21629554

  15. Activations of Deep Lumbar Stabilizing Muscles by Transcutaneous Neuromuscular Electrical Stimulation of Lumbar Paraspinal Regions

    PubMed Central

    Baek, Seung Ok; Ahn, Sang Ho; Jones, Rodney; Cho, Hee Kyung; Jung, Gil Su; Cho, Yun Woo

    2014-01-01

    Objective To investigate changes in lumbar multifidus (LM) and deep lumbar stabilizing abdominal muscles (transverse abdominis [TrA] and obliquus internus [OI]) during transcutaneous neuromuscular electrical stimulation (NMES) of lumbar paraspinal L4-L5 regions using real-time ultrasound imaging (RUSI). Methods Lumbar paraspinal regions of 20 healthy physically active male volunteers were stimulated at 20, 50, and 80 Hz. Ultrasound images of the LM, TrA, OI, and obliquus externus (OE) were captured during stimulation at each frequency. Results The thicknesses of superficial LM and deep LM as measured by RUSI were greater during NMES than at rest for all three frequencies (p<0.05). The thicknesses in TrA, OI, and OE were also significantly greater during NMES of lumbar paraspinal regions than at rest (p<0.05). Conclusion The studied transcutaneous NMES of the lumbar paraspinal region significantly activated deep spinal stabilizing muscle (LM) and the abdominal lumbar stabilizing muscles TrA and OI as evidenced by RUSI. The findings of this study suggested that transcutaneous NMES might be useful for improving spinal stability and strength in patients having difficulty initiating contraction of these muscles. PMID:25229029

  16. A mitochondrial paradigm for degenerative diseases and ageing.

    PubMed

    Wallace, D C

    2001-01-01

    A variety of degenerative diseases have now been shown to be caused by mutations in mitochondrial genes encoded by the mitochondrial DNA (mtDNA) or the nuclear DNA (nDNA). The mitochondria generate most of the cellular energy by oxidative phosphorylation (OXPHOS), and produce most of the toxic reactive oxygen species (ROS) as a by-product. Genetic defects that inhibit OXPHOS also cause the redirection of OXPHOS electrons into ROS production, thus increasing oxidative stress. A decline in mitochondrial energy production and an increase in oxidative stress can impinge on the mitochondrial permeability transition pore (mtPTP) to initiate programmed cell death (apoptosis). The interaction of these three factors appear to play a major role on the pathophysiology of degenerative diseases. Inherited diseases can result from mtDNA base substitution and rearrangement mutations and can affect the CNS, heart and skeletal muscle, and renal, endocrine and haematological systems. In addition, somatic mtDNA mutations accumulate with age in post-mitotic tissues in association with the age-related decline in mitochondrial function and are thought to be an important factor in ageing and senescence. The importance of mitochondrial defects in degenerative diseases and ageing has been demonstrated using mouse models of mitochondrial disease. An mtDNA mutation imparting chloramphenical resistance (CAPR) to mitochondrial protein synthesis has been transferred into mice and resulted in growth retardation and cardiomyopathy. A nDNA mutation which inactivates the heart-muscle isoform of the adenine nucleotide translocator (Ant1) results in mitochondrial myopathy and cardiomyopathy; induction of ROS production; the compensatory up-regulation of energy, antioxidant, and apoptosis gene expression; and an increase in the mtDNA somatic mutation rate. Finally, a nDNA mutation which inactivates the mitochondrial Mn superoxide dismutase (MnSOD) results in death in about 8 days due to dilated cardiomyopathy, which can be ameliorated by treatment with catalytic anti-oxidants. A partial MnSOD deficiency chronically increases oxidative stress, decreases OXPHOS function, and stimulates apoptosis. Thus, the decline of mitochondrial energy production resulting in increased oxidative stress and apoptosis does play a significant role in degenerative diseases and ageing. PMID:11280029

  17. Health assessment of environmental pollutants; Proliferative and degenerative diseases

    SciTech Connect

    Stuart, B.O. )

    1987-01-01

    The health assessments of environmental air contaminants are at present frequently based upon probability of cancer, if this has been identified as a potential result of prolonged exposure to the particular inhalation hazard. However, for many airborne hazards chronic inhalation exposure may result in morbidity or mortality risks due to chronic degenerative diseases such as emphysema, fibrosis, or chronic obstructive pulmonary disease that may be nearly as great or greater than those of more widely recognized neoplastic or proliferative disease. The relative hazards of environmentally released radioactive and chemical air contaminants, i.e., radon daughters and diesel engine exhaust, are discussed as examples.

  18. Health program effectiveness measurement: a case of degenerative disease.

    PubMed

    Klementiev, A A

    1992-11-01

    An administrator of a Health Program aiming at the control of a specified disease has a need for a quantitative evaluation of the consequences of the Program's realization. On the population level, Lifetime Lost (LTL) figures calculated for both target and reference populations might be used for this purpose. The LTL methodology provides a user with a new procedure for medical data processing. It allows to estimate the LTL values from mortality data only, without the laborious procedure of registration of the morbidity episodes in target and reference populations. This approach is valid for a special case of degenerative diseases. PMID:1470041

  19. Plantar fasciitis: a degenerative process (fasciosis) without inflammation.

    PubMed

    Lemont, Harvey; Ammirati, Krista M; Usen, Nsima

    2003-01-01

    The authors review histologic findings from 50 cases of heel spur surgery for chronic plantar fasciitis. Findings include myxoid degeneration with fragmentation and degeneration of the plantar fascia and bone marrow vascular ectasia. Histologic findings are presented to support the thesis that "plantar fasciitis" is a degenerative fasciosis without inflammation, not a fasciitis. These findings suggest that treatment regimens such as serial corticosteroid injections into the plantar fascia should be reevaluated in the absence of inflammation and in light of their potential to induce plantar fascial rupture. PMID:12756315

  20. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY...-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and...

  1. 49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  2. 49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Lumbar spine, abdomen, and pelvis. 572.9 Section... Percentile Male § 572.9 Lumbar spine, abdomen, and pelvis. (a) The lumbar spine, abdomen, and pelvis consist... minutes after the release. (d) When the abdomen is subjected to continuously applied force in...

  3. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  4. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Lumbar spine and pelvis. 572.115 Section 572.115... 50th Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to those for the SID dummy as set forth in § 572.42 except that...

  5. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Lumbar spine and pelvis. 572.115 Section 572.115... 50th Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to those for the SID dummy as set forth in § 572.42 except that...

  6. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Lumbar spine and pelvis. 572.115 Section 572.115... 50th Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to those for the SID dummy as set forth in § 572.42 except that...

  7. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Lumbar spine and pelvis. 572.115 Section 572.115... 50th Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to those for the SID dummy as set forth in § 572.42 except that...

  8. Fellowship and Practice Composition Affect Surgical Decision Making in Patients with Adult Degenerative Scoliosis: Spinal Deformity versus Degenerative Spinal Surgeons

    PubMed Central

    Protopsaltis, Themistocles; Patel, Ashish; Yoo, Andrew; Lonner, Baron

    2015-01-01

    Background For the Adult Degenerative Scoliosis (ADS) patient with radiculopathy, there is no clear data in the literature to guide the spine surgeon's decision making in choosing between limited decompression alone, short segment fusion, or longer arthrodesis of the deformity. This study investigates the differences in operative planning, for patients with ADS and radiculopathy, between two groups of spine surgeons based on fellowship experience and practice composition. Methods Six Degenerative Spine surgeons (Group 1) and 6 Spinal Deformity surgeons (Group 2) were shown 7 cases of patients with ADS and radiculopathy. Surgeons completed a questionnaire detailing their planned operative intervention including the number of fusion levels, if any, approach, choice of bone graft, and interbody device. Pearson Correlation was used to investigate the association between fellowship training, practice composition, number of levels fused, and other variables. Intraclass correlation (ICC) analysis was used to investigate the internal consistency among the groups. Results There was a direct correlation between fellowship deformity experience and practice composition (r=0.75, p<0.01), and between deformity practice composition and the number of planned fusion levels (r=0.90, p<0.001). Group 1 surgeons fused a mean 3.7 vertebral levels (range 0-6.7), while Group 2 surgeons fused a mean 10.8 levels (range 4-16.5). Group 2 surgeons fused a significantly greater number of levels for each case than degenerative surgeons on paired student t-test (p=0.002). Group 1 surgeons chose decompression alone more commonly than deformity surgeons (p<0.05). Group 2 surgeons had significantly higher group consistency by ICC analysis (p=0.004). Conclusions Fellowship and practice composition influence the physician's surgical planning in ADS. There is a lack of standardized treatment paradigms for the management of radiculopathy in patients with ADS. PMID:26114090

  9. Postoperative Epidural Hematomas in the Lumbar Spine.

    PubMed

    Schroeder, Gregory D; Kurd, Mark F; Kepler, Christopher K; Arnold, Paul M; Vaccaro, Alexander R

    2015-11-01

    Postoperative epidural hematomas are rare complications following lumbar spine surgery, but if they are not quickly identified and treated they can lead to permanent neurological deficits. Epidural hematomas occur in approximately 0.10%-0.24% of all spine surgeries, and despite the fact that multiple large studies have been performed attempting to identify risk factors for this complication, there is still significant debate about the effect of subfascial drains, postoperative anticoagulation, and antiplatelet medication on the incidence of postoperative hematoma. The purpose of this manuscript is to review the epidemiology, etiology, diagnosis, and treatment of patients who develop a postoperative lumbar epidural hematoma. PMID:26484502

  10. Lumbar vertebral pedicles: radiologic anatomy and pathology

    SciTech Connect

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

    1988-01-01

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

  11. Viscoelastic Disc Arthroplasty Provides Superior Back and Leg Pain Relief in Patients with Lumbar Disc Degeneration Compared to Anterior Lumbar Interbody Fusion

    PubMed Central

    Rischke, Burkhard; Smith, Eric

    2015-01-01

    Background Lumbar disc degeneration (LDD) is one of the most frequently diagnosed spinal diseases. The symptoms these disorders cause are anticipated to increase as the population in Western countries ages. Purpose Compare back and leg pain alleviation in patients with LDD and a viscoelastic disc prosthesis documented in the SWISSspine registry versus patients with anterior lumbar interbody fusion documented in the Spine Tango registry. Study Design Prospectively collected clinical and outcome data in two independent spine registries. Outcome Measures were back and leg pain relief on 0 to 10 numerical rating scales. Materials and Methods The analysis included a single surgeon series of 48 patients with viscoelastic total disc replacement (VTDR) from the SWISSspine registry which were compared to 131 patients with anterior lumbar interbody fusion (ALIF) from the Spine Tango registry. Two linear multivariate regression models were built to assess the associations of patient characteristics with back and leg pain relief. The following covariates were included in the models: patient age and sex, disc herniation as additional diagnosis, number of treated segments, level of treated segment, treatment type (VTDR, ALIF), preoperative back and leg pain levels and follow-up interval. Results Both models showed VTDR to be associated with significantly higher back (2.76 points; 95% confidence interval (CI) 1.78 - 3.73; p < 0.001) and leg pain (2.12 points; 95% CI 1.12 to 3.13; p < 0.001) relief than ALIF. Other influential factors for higher back pain relief were female sex compared with male sex (1.03 additional points; 95% CI 0.27 to 1.78; p = 0.008), monosegmental surgery compared with bisegmental surgery (1.02 additional points; 95% CI 0.21 to 1.83; p = 0.014), and higher back pain at baseline (0.87 points additional pain relief per level of preoperative back pain; 95% CI 0.70 to 1.03; p < 0.001). Other influential factors for leg pain relief were monosegmental surgery (0.93 additional points; 95% CI 0.10 to 1.77; p = 0.029) and higher leg pain at baseline (0.83 points additional pain relief per level of preoperative leg pain; 95% CI 0.70 to 0.96). In both models the L3/4 segment showed 2.36 points (95% CI -4.27 to -0.45; p = 0.016) and 3.69 points (95% CI -5.66 to -1.71; p < 0.001) less pain relief than L5/S1. Discussion Significantly higher back and leg pain relief were observed after viscoelastic total disc replacement in comparison with anterior lumbar interbody fusion. The new less rigid materials used in the second generation total disc replacements (TDRs) may make artificial disc replacement an increasingly attractive option for patients with degenerative lumbar disc disease. Further controlled and long-term follow-up studies are required for more detailed comparisons of the outcomes of these types of disc implants. The Freedom Lumbar Disc is limited by U.S. federal law to investigational use only. PMID:26196033

  12. Atherosclerotic renal artery stenosis: current status.

    PubMed

    Kwon, Soon Hyo; Lerman, Lilach O

    2015-05-01

    Atherosclerotic renal artery stenosis (ARAS) remains a major cause of secondary hypertension and kidney failure. Randomized prospective trials show that medical treatment should constitute the main therapeutic approach in ARAS. Regardless of intensive treatment and adequate blood pressure control, however, renal and extrarenal complications are not uncommon. Yet, the precise mechanisms, accurate detection, and optimal treatment in ARAS remain elusive. Strategies oriented to early detection and targeting these pathogenic pathways might prevent development of clinical end points. Here, we review the results of recent clinical trials, current understanding of the pathogenic mechanisms, novel imaging techniques to assess kidney damage in ARAS, and treatment options. PMID:25908472

  13. Role of Oxidative RNA Damage in Chronic-Degenerative Diseases

    PubMed Central

    2015-01-01

    Normal cellular metabolism and exposure to ionizing and ultraviolet radiations and exogenous agents produce reactive oxygen species (ROS). Due to their reactivity, they can interact with many critical biomolecules and induce cell damage. The reaction of ROS with free nucleobases, nucleosides, nucleotides, or oligonucleotides can generate numerous distinct modifications in nucleic acids. Oxidative damage to DNA has been widely investigated and is strongly implicated in the development of many chronic-degenerative diseases. In contrast, RNA damage is a poorly examined field in biomedical research. In this review, I discuss the importance of RNA as a target of oxidative damage and the role of oxidative damage to RNA in the pathogenesis of some chronic-degenerative diseases, such as neurological disorders, atherosclerosis, and cancer. Furthermore, I review recent evidence suggesting that RNA may be the target for toxic agents and indicating RNA degradation as a powerful tool to treat any pathology in which there is an aberrant expression of mRNA and/or its gene products. PMID:26078805

  14. [Progressive degenerative myoclonic epilepsy. Systematized olivo-cerebellar lesions].

    PubMed

    Habib, M; Roger, J; Khalil, R; Pellissier, J F; Bureau, M; Boudouresques, G; Delpuech, F

    1985-01-01

    A 15 year-old North-African female showed typical symptoms and evolution of Progressive Myoclonus Epilepsy of the Unverricht type. Pathological examination failed to show either inclusion bodies or any other storage material. The only relevant findings included degenerative changes in the inferior olives and, to a lesser extent, in the cerebellar cortex. The site of lesions was remarkable: in the inferior olives, lesions were bilaterally and symmetrically restricted to the external angles (lateral lamellae); in the cerebellum, loss of Purkinje cells and ascending fibres of the molecular layer was prominent in the lateralmost part of the hemispheres (semilunar lobules). Such a topography implies a system disorder involving the olivo-cerebellar pathway, particularly in that part which projects to the neocerebellum. Twelve other clinico-pathological cases of progressive myoclonus epilepsy of the degenerative group are reviewed. It is suggested that, here again, lesions--although more diffuse--may be related to a primarily olivo-cerebellar involvement. PMID:3925524

  15. How frequent is chronic lumbar arachnoiditis following intrathecal Myodil?

    PubMed

    Hughes, D G; Isherwood, I

    1992-09-01

    Chronic lumbar arachnoiditis has numerous causes, including the introduction of contrast media into the lumbar subarachnoid space. The oily contrast medium Myodil (iophendylate) is often cited but the true incidence of symptomatic lumbar arachnoiditis due solely to the presence of Myodil is unknown. A retrospective review of 98 patients in whom Myodil was introduced by ventriculography or cisternography, i.e. remote from the lumbar spine, revealed no cases of chronic lumbar arachnoiditis. All patients were monitored closely for periods ranging from 1 to 28 years. We conclude that, in these circumstances, it is rare for Myodil to produce symptomatic arachnoiditis. PMID:1393409

  16. Current status of surgical treatment for aortic valve stenosis.

    PubMed

    Wollersheim, Laurens W; Li, Wilson W; de Mol, Bas A

    2014-09-01

    In this review, we discuss the current surgical treatment for aortic valve stenosis. Surgical strategy for treatment of aortic valve stenosis is based on the risk profile of the patient. We reviewed the existing literature and present the current state of the art of these various approaches, taking into account clinical outcomes, quality of life, costs, and learning curve. PMID:24980691

  17. Development of an Experimental Animal Model for Lower Back Pain by Percutaneous Injury-Induced Lumbar Facet Joint Osteoarthritis.

    PubMed

    Kim, Jae-Sung; Ahmadinia, Kasra; Li, Xin; Hamilton, John L; Andrews, Steven; Haralampus, Chris A; Xiao, Guozhi; Sohn, Hong-Moon; You, Jae-Won; Seo, Yo-Seob; Stein, Gary S; Van Wijnen, Andre J; Kim, Su-Gwan; Im, Hee-Jeong

    2015-11-01

    We report generation and characterization of pain-related behavior in a minimally invasive facet joint degeneration (FJD) animal model in rats. FJD was produced by a non-open percutaneous puncture-induced injury on the right lumbar FJs at three consecutive levels. Pressure hyperalgesia in the lower back was assessed by measuring the vocalization response to pressure from a force transducer. After hyperalgesia was established, pathological changes in lumbar FJs and alterations of intervertebral foramen size were assessed by histological and imaging analyses. To investigate treatment options for lumber FJ osteoarthritis-induced pain, animals with established hyperalgesia were administered with analgesic drugs, such as morphine, a selective COX-2 inhibitor, a non-steroidal anti-inflammatory drug (NSAID) (ketorolac), or pregabalin. Effects were assessed by behavioral pain responses. One week after percutaneous puncture-induced injury of the lumbar FJs, ipsilateral primary pressure hyperalgesia developed and was maintained for at least 12 weeks without foraminal stenosis. Animals showed decreased spontaneous activity, but no secondary hyperalgesia in the hind paws. Histopathological and microfocus X-ray computed tomography analyses demonstrated that the percutaneous puncture injury resulted in osteoarthritis-like structural changes in the FJs cartilage and subchondral bone. Pressure hyperalgesia was completely reversed by morphine. The administration of celecoxib produced moderate pain reduction with no statistical significance while the administration of ketorolac and pregabalin produced no analgesic effect on FJ osteoarthritis-induced back pain. Our animal model of non-open percutanous puncture-induced injury of the lumbar FJs in rats shows similar characteristics of low back pain produced by human facet arthropathy. PMID:25858171

  18. The Change of Sagittal Alignment of the Lumbar Spine after Dynesys Stabilization and Proposal of a Refinement

    PubMed Central

    Park, Won Man; Kim, Chi Heon; Kim, Yoon Hyuk; Jahng, Tae-Ahn

    2015-01-01

    Objective Dynesys® is one of the pedicle-based dynamic lumbar stabilization systems and good clinical outcome has been reported. However, the cylindrical spacer between the heads of the screws undergoes deformation during assembly of the system. The pre-strain probably change the angle of instrumented spine with time and oblique-shaped spacer may reduce the pre-strain. We analyzed patients with single-level stabilization with Dynesys® and simulated oblique-shaped spacer with finite element (FE) model analysis. Methods Consecutive 14 patients, who underwent surgery for single-level lumbar spinal stenosis and were followed-up more than 24 months (M : F=6 : 8; age, 58.7±8.0 years), were analyzed. Lumbar lordosis and segmental angle at the index level were compared between preoperation and postoperative month 24. The von Mises stresses on the obliquely-cut spacer (5°, 10°, 15°, 20°, 25°, and 30°) were calculated under the compressive force of 400 N and 10 Nm of moment with validated FE model of the L4-5 spinal motion segment with segmental angle of 16°. Results Lumbar lordosis was not changed, while segmental angle was changed significantly from -8.1±7.2° to -5.9±6.7° (p<0.01) at postoperative month 24. The maximum von Mises stresses were markedly decreased with increased angle of the spacer up to 20°. The stress on the spacer was uneven with cylindrical spacer but it became even with the 15° oblique spacer. Conclusion The decreased segmental lordosis may be partially related to the pre-strain of Dynesys. Further clinical and biomechanical studies are required for relevant use of the system. PMID:26279812

  19. Usefulness of Acceleration Time for Internal Carotid Artery Origin Stenosis

    PubMed Central

    2013-01-01

    Calcification of the internal carotid artery (ICA) hinders accurate evaluation of the stenosis by conventional ultrasonography due to acoustic shadow. We examined the relationship between acceleration time (AcT) and ICA origin stenosis. One hundred thrity seven samples (266 vessels) that enforced duplex ultrasonography in our hospital were targeted. The results have shown that there is a significant relationship between AcT and stenosis. AcT of more than 110 msec suggests that the stenosis is more than 60% by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. AcT is thought to be useful for the diagnosis of ICA stenosis with calcification. (*English Translation of J Jpn Coll Angiol 2011; 51: 365-371) PMID:24130614

  20. Experimental study of effect of stenosis geometry on flow parameters

    NASA Astrophysics Data System (ADS)

    Veselý, Ond?ej; Nováková, Ludmila; Adamec, Josef

    2015-05-01

    A stenosis is a narrowing in a tubular organ or structure. In medicine, vessel stenosis poses health risks for people. In this work, experimental investigations of pressure loss coefficient for varying stenosis eccentricity and shape were performed. Five models of different geometry were studied; all models were stenosis of 75 % area reduction. The flow conditions approximate physiological flow. The measuring range of Reynolds number was from 130 to 2730, measured values of pressure loss coefficient were from 12 to 20. The steady experimental results indicated that static pressure loss coefficient is affected by the shape of stenosis, but it was affected more significantly by the eccentricity. Visualization experiments have been performed in Polycarbonate models.

  1. SPORT: Radiographic Predictors of Clinical Outcomes Following Operative or Non-operative Treatment of Degenerative Spondylolisthesis

    PubMed Central

    Pearson, Adam M.; Lurie, Jon D.; Blood, Emily A.; Frymoyer, John W.; Braeutigam, Heike; An, Howard; Girardi, Federico P.; Weinstein, James N.

    2009-01-01

    STUDY DESIGN Subgroup analyses according to treatment received. OBJECTIVES To evaluate whether baseline radiographic findings predicted outcomes in patients with degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA The SPORT combined randomized and observational DS cohorts. METHODS The Meyerding listhesis grade was determined on the neutral radiograph (n=222). Patients were classified as having low disk height if disk height was less than 5 mm. Flexion-extension radiographs (n=185) were evaluated for mobility. Those with greater than 10° rotation or 4mm translation were considered Hypermobile. Changes in outcome measures were compared between listhesis (Grade 1 vs. Grade 2), disk height (Low vs. Normal) and mobility (Stable vs. Hypermobile) groups using longitudinal regression models adjusted for potential confounders. Outcome measures included SF-36 bodily pain (BP) and physical function (PF) scales, Oswestry disability index (ODI), stenosis bothersomeness index (SBI), and low back pain bothersomeness scale. RESULTS Overall, 86% had a Grade 1 listhesis, 78% had Normal disk height, and 73% were Stable. Baseline symptom severity was similar between groups. Overall, surgery patients improved more than patients treated non-operatively. At one year, outcomes were similar in surgery patients across listhesis, disk height, and mobility groups (ODI: Grade 1 -23.7 vs. Grade 2 -23.3, p=0.90; Normal disk height-23.5 vs. Low disk height -21.9, p=0.66; Stable -21.6 vs. Hypermobile -25.2, p=0.30). Among those treated nonoperatively, Grade 1 patients improved more than Grade 2 patients (BP +13.1 vs. -4.9, p=0.019; ODI -8.0 vs. +4.8, p=0.010 at 1 year), and Hypermobile patients improved more than Stable patients (ODI -15.2 vs -6.6, p=0.041; SBI -7.8 vs -2.7, p=0.002 at 1 year). DISCUSSION Regardless of listhesis grade, disk height or mobility, patients who had surgery improved more than those treated non-operatively. These differences were due, in part, to differences in non-operative outcomes, which were better in patients classified as Grade 1 or Hypermobile. PMID:19050582

  2. Fetomaternal outcome of pregnancy with Mitral stenosis

    PubMed Central

    Ahmed, Nazia; Kausar, Hafeeza; Ali, Lubna; Rakhshinda

    2015-01-01

    Objective: To evaluate the frequency of fetomaternal outcome of pregnancy with Mitral stenosis admitted in Civil Hospital Karachi. Methods: It was a two years descriptive study done in the Department of Obstetrics and Gynaecology Civil Hospital Karachi. All pregnant women with a known or newly diagnosed Mitral stenosis on echocardiography were included in the study. History was taken regarding age, parity, gestational age (calculated by ultrasound) and complaints. Mode of delivery and Maternal mortality noted. Foetal outcome was analyzed by birth weight and Apgar score. Results: A total of 101 patients meeting the inclusion criteria were enrolled in the study. The ages of the women ranged between 20-29 years (69%) and 81% were multigravidas. Vaginal delivery occurred in 67 (66.3%) women and 78.3% were term pregnancies. Preterm deliveries were 21.8% and 27.7% newborns were low birth weight. APGAR score <7 was found in 14.9% of neonates and 9 babies had intrauterine death. Low ejection fraction<55% was diagnosed in 20(13.9%) women and Maternal mortality was found in two cases. Conclusion: Heart disease in pregnancy is associated with significant morbidity, it should be carefully managed in a tertiary care hospital to obtain optimum maternal and foetal outcome. PMID:26150860

  3. Aqueduct stenosis. Case review and discussion.

    PubMed Central

    McMillan, J J; Williams, B

    1977-01-01

    Twenty-seven cases of hydrocephalus associated with aqueduct stenosis are reviewed, and a further nine cases discussed in which hydrocephalus was present and the aqueduct was stenosed but some additional feature was present. This was either a meningocoele or an encephalocoele, or else the aqueduct was not completely obstructed radiologically at the initial examination. The ratio of the peripheral measurement from the inion to the nasion to the distance between the inion and the posterior lip of the foramen magnum is presented for each case with an outline of the ventricles. The cases behave as would be expected if the aqueduct was being blocked by the lateral compression of the mid-brain between the enlarged lateral ventricles. On reviewing these cases and other evidence it is suggested that non-tumourous aqueduct stenosis is more likely to be the result of hydrocephalus than the initial cause. The response to treatment is reviewed and a high relapse rate noted. It is suggested that assessment of the extracerebral pathways may be advisable before undertaking third ventriculostomy or ventriculo-cisternostomy. PMID:302852

  4. Radiographic Parameters in Adult Degenerative Scoliosis and Different Parameters Between Sagittal Balanced and Imbalanced ADS Patients

    PubMed Central

    Yang, Changwei; Yang, Mingyuan; Chen, Yuanyuan; Wei, Xianzhao; Ni, Haijian; Chen, Ziqiang; Li, Jingfeng; Bai, Yushu; Zhu, Xiaodong; Li, Ming

    2015-01-01

    Abstract A retrospective study. To summarize and describe the radiographic parameters of adult degenerative scoliosis (ADS) and explore the radiological parameters which are significantly different in sagittal balanced and imbalanced ADS patients. ADS is the most common type of adult spinal deformity. However, no comprehensive description of radiographic parameters in ADS patients has been made, and few studies have been performed to explore which radiological parameters are significantly different between sagittal balanced and imbalanced ADS patients. Medical records of ADS patients in our outpatient clinic from January 2012 to January 2014 were reviewed. Demographic data including age and sex, and radiographic data including the coronal Cobb angle, location of apical vertebra/disc, convexity of the curve, degree of apical vertebra rotation, curve segments, thoracic kyphosis (TK), lumbar lordosis (LL), thoracolumbar kyphosis (TL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), and PI minus LL (PI???LL) were reviewed to make comprehensive description of radiographic parameters of ADS. Furthermore, patients were divided into 2 groups according to whether the patients’ sagittal plane was balanced: Group A (imbalanced, SVA?>?5?cm) and Group B (balanced, SVA???5?cm). Demographic and radiological parameters were compared between these 2 groups. A total of 99 patients were included in this study (Group A?=?33 and Group B?=?66; female?=?83 and male?=?16; sex ratio?=?5:1). The median of age were 67 years (range: 41–92 years). The median of coronal Cobb angle and length of curve was 23 (range: 10–75°) and 5 segments (range: 3–7), respectively. The most common location of apical vertebra was at L2 to L3 (81%) and the median of degree of apical vertebra rotation was 2° (range: 1–3). Our study also showed significant correlations between coronal Cobb angle and curve segments (r?=?0.23, P?

  5. Efficacy and follow-up of transcatheter aortic valve implantation in patients with radiation-induced aortic stenosis

    PubMed Central

    Dijos, Marina; Reynaud, Amélie; Leroux, Lionel; Réant, Patricia; Cornolle, Claire; Roudaut, Raymond; Dos Santos, Pierre; Lafitte, Stéphane

    2015-01-01

    Objective To investigate transcatheter aortic valve implantation (TAVI) feasibility, effectiveness and safety in radiation-induced aortic valve stenosis cases. Methods 198 consecutive patients referred for TAVI were prospectively enrolled. They were divided into two groups: patients with a history of chest radiation therapy with suspected radiation-induced valvular disease (RXT) and others with suspected degenerative aortic valve stenosis (NRXT). Procedural, early and mid-term clinical outcomes were compared. Results Of the 198 patients enrolled in our study, 9.6% qualified for inclusion in the RXT group. A comparison of baseline characteristics revealed that patients with RXT were younger than patients with NRXT (68.3 vs 82.5?years; p<0.05) and exhibited a lower surgical risk score (Euroscore: 7.1% vs 21.8%; p<0.05) and a higher frequency of hostile thorax and porcelain aorta (52.6% vs 28.5%; p<0.05; 63.2% vs 10.6%; p<0.05, respectively). In both groups, the implantation success rate was high and the 30-day safety end point acceptable (RXT: 94.7% and 83.3%; NRXT: 93.9% and 75.6%, respectively). At 6?months, overall mortality was significantly lower in the RXT group (0% vs 18%; p=0.048). Conclusions In patients suffering from radiation-induced aortic valve stenosis and contraindicated for surgery, TAVI is a promising approach, with high feasibility, acceptable risk, low mortality and high clinical effectiveness at mid-term follow-up. PMID:26339494

  6. Lumbar spinal atypical teratoid rhabdoid tumor.

    PubMed

    Dhir, Aditi; Tekautz, Tanya; Recinos, Violette; Murphy, Erin; Prayson, Richard A; Ruggieri, Paul; Wolff, Johannes

    2015-12-01

    We describe a pediatric patient with an atypical teratoid rhabdoid tumor (AT/RT) exclusively of the lumbar spine, with a different presentation from the two previously reported pediatric lumbar AT/RT. AT/RT are rare pediatric tumors of the central nervous system, with a dismal prognosis. Although there is sufficient literature on brain AT/RT, spinal AT/RT continues to be a rare entity, with a lumbar location even less frequently reported. A 30-month-old African American boy with multiple comorbidities presented with the inability to ambulate, encopresis and urinary dribbling. The MRI showed an intradural extramedullary mass extending downwards from the L3-4 level. He underwent an L3-S2 laminoplasty. The surgically resected mass was marked by sheets of cells with large nuclei and prominent nucleoli. The tumor cells stained with antibodies to synaptophysin and CAM5.2, and showed no immunoreactivity to INI-1 antibody. He was diagnosed with a World Health Organization Grade IV AT/RT. There was no mutation detected in the SMARCB1 gene on a comprehensive analysis of his blood. The boy is currently being treated according to the Medical University of Vienna AT/RT protocol, with no evidence of tumor recurrence 8months after surgery. To our knowledge, this is the only report of a lumbar AT/RT in an African American child. PMID:26234633

  7. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...it to fall freely to achieve an impact velocity of 6.05 ±0.1 m/s measured at...with its decelerating mechanism. The velocity-time history of the pendulum falls...ES-2re Lumbar Spine Certification Pendulum Velocity Corridor Upper boundary...

  8. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...it to fall freely to achieve an impact velocity of 6.05 ±0.1 m/s measured at...with its decelerating mechanism. The velocity-time history of the pendulum falls...ES-2re Lumbar Spine Certification Pendulum Velocity Corridor Upper boundary...

  9. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...it to fall freely to achieve an impact velocity of 6.05 ±0.1 m/s measured at...with its decelerating mechanism. The velocity-time history of the pendulum falls...ES-2re Lumbar Spine Certification Pendulum Velocity Corridor Upper boundary...

  10. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...it to fall freely to achieve an impact velocity of 6.05 ±0.1 m/s measured at...with its decelerating mechanism. The velocity-time history of the pendulum falls...ES-2re Lumbar Spine Certification Pendulum Velocity Corridor Upper boundary...

  11. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...it to fall freely to achieve an impact velocity of 6.05 ±0.1 m/s measured at...with its decelerating mechanism. The velocity-time history of the pendulum falls...ES-2re Lumbar Spine Certification Pendulum Velocity Corridor Upper boundary...

  12. Lumbar discitis caused by Clostridium perfringens.

    PubMed

    Lotte, Romain; Popoff, M R; Degand, Nicolas; Lotte, Laurene; Bouvet, Philippe; Baudin, Guillaume; Cua, Eric; Roger, Pierre-Marie; Ruimy, Raymond

    2014-10-01

    We report here a rare case of chronic lumbar discitis caused by Clostridium perfringens in an elderly patient that was treated with a combination of ?-lactams and clindamycin. Molecular analysis performed on the strain revealed an unusual toxin gene pattern. PMID:25056327

  13. Cost minimization in treatment of adult degenerative scoliosis.

    PubMed

    Uddin, Omar M; Haque, Raqeeb; Sugrue, Patrick A; Ahmed, Yousef M; El Ahmadieh, Tarek Y; Press, Joel M; Koski, Tyler; Fessler, Richard G

    2015-12-01

    OBJECT Back pain is an increasing concern for the aging population. This study aims to evaluate if minimally invasive surgery presents cost-minimization benefits compared with open surgery in treating adult degenerative scoliosis. METHODS Seventy-one patients with adult degenerative scoliosis received 2-stage, multilevel surgical correction through either a minimally invasive spine surgery (MIS) approach with posterior instrumentation (n = 38) or an open midline (Open) approach (n = 33). Costs were derived from hospital and rehabilitation charges. Length of stay, blood loss, and radiographic outcomes were obtained from electronic medical records. Functional outcomes were measured with Oswestry Disability Index (ODI) and visual analog scale (VAS) surveys. RESULTS Patients in both cohorts were similar in age (AgeMIS = 65.68 yrs, AgeOpen = 63.58 yrs, p = 0.28). The mean follow-up was 18.16 months and 21.82 months for the MIS and Open cohorts, respectively (p = 0.34). MIS and Open cohorts had an average of 4.37 and 7.61 levels of fusion, respectively (p < 0.01). Total inpatient charges were lower for the MIS cohort ($269,807 vs $391,889, p < 0.01), and outpatient rehabilitation charges were similar ($41,072 vs $49,272, p = 0.48). MIS patients experienced reduced length of hospital stay (7.03 days vs 14.88 days, p < 0.01) and estimated blood loss (EBL) (EBLMIS = 470.26 ml, EBLOpen= 2872.73 ml, p < 0.01). Baseline ODI scores were lower in the MIS cohort (40.03 vs 48.04, p = 0.03), and the cohorts experienced similar 1-year improvement (?ODIMIS = -15.98, ?ODIOpen = -21.96, p = 0.25). Baseline VAS scores were similar (VASMIS = 6.56, VASOpen= 7.10, p = 0.32), but MIS patients experienced less reduction after 1 year (?VASMIS = -3.36, ?VASOpen = -4.73, p = 0.04). Preoperative sagittal vertical axis (SVA) were comparable (preoperative SVAMIS = 63.47 mm, preoperative SVAOpen = 71.3 mm, p = 0.60), but MIS patients had larger postoperative SVA (postoperative SVAMIS = 51.17 mm, postoperative SVAOpen = 28.17 mm, p = 0.03). CONCLUSIONS Minimally invasive surgery demonstrated reduced costs, blood loss, and hospital stays, whereas open surgery exhibited greater improvement in VAS scores, deformity correction, and sagittal balance. Additional studies with more patients and longer follow-up will determine if MIS provides cost-minimization opportunities for treatment of adult degenerative scoliosis. PMID:26315955

  14. Mitochondrial anomalies: driver to age associated degenerative human ailments.

    PubMed

    Bunkar, Neha; Bhargava, Arpit; Khare, Naveen Kumar; Mishra, Pradyumna Kumar

    2016-01-01

    Mitochondria play a fundamental role in regulating a variety of complex metabolic processes to maintain adequate energy balance for cellular existence. To orchestrate these functions, an undisturbed mitochondrial dynamics is imperative through a set of tightly guided mechanisms. Interference in key signature processes by several genetic, epigenetic and age-linked factors triggers mitochondrial dysfunction through decrease in mitochondrial biogenesis, reduced mitochondrial content, aberrant mtDNA mutations, increased oxidative stress, deficient mitophagy, energy dysfunction, decrease in anti oxidant defense and impaired calcium homeostasis. Mitochondrial dysfunction is widely implicated in origin and development of various age associated degenerative human ailments including metabolic syndromes, cardiovascular diseases, cancer, diabetes and neurodegenerative disorders. The present review revisits the mitochondrial anomalies involved in aetiology of different human diseases and also highlights the translational significance of nano-vectors aimed for selective mitochondrial engineering which might pave way for development of novel therapeutics. PMID:26709805

  15. Regenerative nanomedicine and the treatment of degenerative retinal diseases.

    PubMed

    Zarbin, Marco A; Montemagno, Carlo; Leary, James F; Ritch, Robert

    2012-01-01

    Regenerative medicine deals with the repair or the replacement of tissues and organs using advanced materials and methodologies. Regenerative nanomedicine uses nanoparticles containing gene transcription factors and other modulating molecules that allow reprogramming of cells in vivo as well as nanomaterials to induce selective differentiation of neural progenitor cells and to create neural-mechanical interfaces. In this article, we consider some applications of nanotechnology that may be useful for the treatment of degenerative retinal diseases, for example, use of nanoparticles for drug and gene therapy, use of nanomaterials for neural interfaces and extracellular matrix construction for cell-based therapy and neural prosthetics, and the use of bionanotechnology to re-engineer proteins and cell behavior for regenerative medicine. PMID:22170869

  16. Oxidants, antioxidants, and the degenerative diseases of aging.

    PubMed Central

    Ames, B N; Shigenaga, M K; Hagen, T M

    1993-01-01

    Metabolism, like other aspects of life, involves tradeoffs. Oxidant by-products of normal metabolism cause extensive damage to DNA, protein, and lipid. We argue that this damage (the same as that produced by radiation) is a major contributor to aging and to degenerative diseases of aging such as cancer, cardiovascular disease, immune-system decline, brain dysfunction, and cataracts. Antioxidant defenses against this damage include ascorbate, tocopherol, and carotenoids. Dietary fruits and vegetables are the principal source of ascorbate and carotenoids and are one source of tocopherol. Low dietary intake of fruits and vegetables doubles the risk of most types of cancer as compared to high intake and also markedly increases the risk of heart disease and cataracts. Since only 9% of Americans eat the recommended five servings of fruits and vegetables per day, the opportunity for improving health by improving diet is great. Images Fig. 1 PMID:8367443

  17. Who should have surgery for spinal stenosis?

    PubMed Central

    Pearson, Adam; Lurie, Jon; Tosteson, Tor; Zhao, Wenyan; Abdu, William; Weinstein, James

    2013-01-01

    Study Design Combined prospective randomized controlled trial and observational cohort study of spinal stenosis (SpS) with an as-treated analysis. Objective To determine modifiers of the treatment effect (TE) of surgery (the difference between surgical and nonoperative outcomes) for SpS using subgroup analysis. Summary of Background Data SPORT demonstrated a positive surgical TE for SpS at the group level. However, individual characteristics may affect TE. No prior studies have evaluated TE modifiers in SpS. Methods SpS patients were treated with either surgery (n=419) or nonoperative care (n=235) and were analyzed according to treatment received. Fifty-three baseline variables were used to define subgroups for calculating the time-weighted average TE for the Oswestry Disability Index (ODI) over 4 years (TE=?ODIsurgery-?ODInonoperative). Variables with significant subgroup by* treatment interactions (p<0.05) were simultaneously entered into a multivariate model to select independent TE predictors. Results Other than smokers, all analyzed subgroups including at least 50 patients improved significantly more with surgery than with nonoperative treatment (p<0.05). Multivariate analysis demonstrated: baseline ODI ? 56 (TE ?15.0 vs. ?4.4 ODI > 56, p<0.001), not smoking (TE ?11.7 vs. ?1.6 smokers, p<0.001), neuroforaminal stenosis (TE ?14.2 vs. ?8.7 no neuroforaminal stenosis, p=0.002), predominant leg pain (TE ?11.5 vs. ?7.3 predominant back pain, p=0.035), not lifting at work (TE ?12.5 vs. ?8.5 lifting at work, p=0.017), and the presence of a neurological deficit (TE ?13.3 vs. ?7.2 no neurological deficit, p<0.001) were associated with greater TE. Conclusions With the exception of smokers, patients who met strict inclusion criteria improved more with surgery than with nonoperative treatment, regardless of other specific characteristics. However, TE varied significantly across certain subgroups, and these data can be used to individualize shared decision making discussions about likely outcomes. Smoking cessation should be considered prior to surgery for SpS. PMID:23018805

  18. Iliac Crest Bone Graft in Lumbar Fusion: The Effectiveness and Safety Compared with Local Bone Graft, and Graft Site Morbidity Comparing a Single-Incision Midline Approach with a Two-Incision Traditional Approach

    PubMed Central

    France, John C.; Schuster, James M.; Moran, Katherine; Dettori, Joseph R.

    2015-01-01

    Study Design?Systematic review. Clinical Questions?(1) Is autologous local bone (LB) graft as safe and effective as iliac crest bone graft (ICBG) in lumbar spine fusion? (2) In lumbar fusion using ICBG, does a single-incision midline approach reduce postoperative iliac crest pain compared with a two-incision traditional approach? Methods?Electronic databases and reference lists of key articles were searched up to October 2014 to identify studies reporting the comparative efficacy and safety of ICBG versus LB graft or comparing ICBG harvest site for use in lumbar spine surgery. Studies including allograft, synthetic bone, or growth factors in addition to ICBG and those with less than 80% of patients with degenerative disease in the lumbar spine were excluded. Two independent reviewers assessed the level of the evidence quality using the Grades of Recommendation Assessment, Development and Evaluation criteria, and disagreements were resolved by consensus. Results?Seven studies were identified as using ICBG fusion for degenerative disease in the lumbar spine. There were no differences in the fusion, leg pain, low back pain, or functional outcomes between patients receiving LB versus ICBG. There was a higher incidence of donor site pain and sensory loss in patients receiving ICBG, with no donor site complications attributed to LB. Compared with patients with the graft harvested through the two-incision traditional approach, patients with the graft harvested through the single-incision midline approach had lower mean pain scores over the iliac crest, with a higher proportion reporting no iliac crest tenderness. In patients with ICBG harvested through the single-incision midline approach on either the right or the left side of the ilium, only 36% of the patients were able to correctly identify the side when asked whether they knew which iliac crest was harvested. Only 19% of the patients with ICBG harvested through the single-incision midline approach on either the right or the left side of the ilium reported pain that was concordant with the side that was actually harvested. Conclusions?LB is as safe and efficacious as ICBG for instrumented fusion in the lumbar spine to treat degenerative disease. When ICBG is used, graft harvest through the single-incision midline approach reduces postoperative iliac crest pain compared with a two-incision approach. PMID:26131386

  19. Fatigue evaluation of lumbar muscles during repeated dynamic trunk exercise.

    PubMed

    Lee, C; Minamitani, H; Ju, K; Wakano, K; Onishi, S; Yamazaki, H

    1996-06-01

    Muscle fatigue in the lumbar muscles for five normal subjects was investigated during repeated dynamic trunk exercise using a lumbar extension machine which is designed to isolated lumbar extension functions. The electromyogram (EMG) signal from erector spinae muscles at lumbar 1 (L1), lumbar 3 (L3) and lumbar 5 (L5) spinal level was detected by bipolar Ag-AgCl surface electrodes. Subjects were required to perform one set of variable resistance lumbar extensions through a 72 degrees range of motion (ROM) with a weight load (50% maximal voluntary contraction) that allowed 13 repetitions of fatigue contraction. Median frequency (MF) of EMG power spectrum was analyzed to compare the difference of fatigability between each lumbar muscle. The experimental results indicated: 1) each lumbar muscle has characteristic MF, especially at the beginning of the trunk exercise (i.e., L1 = 86 Hz, L3 = 96 Hz and L5 = 106 Hz); 2) Significant differences (P < 0.001) in MF between the beginning and the end of trunk exercise for all lumbar muscle sites; 3) Significant differences in the decreasing ratios of MF between L1, L3 and L5. Based on the theory that the decreasing ratio of MF is proportional to fatigability, L5 was more fatiguable than L1 and L3. PMID:8803496

  20. Perioperative care of infants with pyloric stenosis.

    PubMed

    Kamata, Mineto; Cartabuke, Richard S; Tobias, Joseph D

    2015-12-01

    Pyloric stenosis (PS) is one of the most common surgical conditions affecting neonates and young infants. The definitive treatment for PS is surgical pyloromyotomy, either open or laparoscopic. However, surgical intervention should never be considered urgent or emergent. More importantly, emergent medical intervention may be required to correct intravascular volume depletion and electrolyte disturbances. Given advancements in surgical and perioperative care, morbidity and mortality from PS should be limited. However, either may occur related to poor preoperative resuscitation, anesthetic management difficulties, or postoperative complications. The following manuscript reviews the current evidence-based medicine regarding the perioperative care of infants with PS with focus on the preoperative assessment and correction of metabolic abnormalities, intraoperative care including airway management (particularly debate related to rapid sequence intubation), maintenance anesthetic techniques, and techniques for postoperative pain management. Additionally, reports of applications of regional anesthesia for either postoperative pain control or as an alternative to general anesthesia are discussed. Management recommendations are provided whenever possible. PMID:26490352

  1. Infantile hypertrophic pyloric stenosis: an infectious cause?

    PubMed

    Sherwood, W; Choudhry, M; Lakhoo, K

    2007-01-01

    The aetiology of infantile hypertrophic pyloric stenosis (IHPS) remains unclear. The aim of this study was to test the hypothesis that a common bacterium, Helicobacter pylori (HP) may be implicated in the pathogenesis of IHPS. Thirty-nine consecutive infants with confirmed IHPS had their stool analysed with an enzyme immunoassay for the presence of HP. An age/sex-matched group of infants with unrelated surgical conditions were also tested. No positive results for the presence of HP stool antigen were obtained in the study nor the control group. The results of this study demonstrate no causative link between HP and IHPS. A genetic basis has been implicated for IHPS. However, evidence does exist that IHPS is a condition acquired after birth and that an infective agent may be involved in the pathogenesis. Further studies are required to elucidate perinatal factors that may induce the expression of this condition in a genetically sensitive individual. PMID:17031712

  2. Does spinal stenosis correlate with MRI findings and pain, psychologic factor and quality of life?

    PubMed Central

    Lee, Mi Young; Jung, Sung Won; Lee, Su Yong

    2015-01-01

    Background To investigate and analyze MRI findings in relation to visual analogue scale (VAS), Oswestry Disability Index (ODI), psychological-factor, sleep-quality, and Short-Form Health Survey (SF-36) scores among patients with central lumbar spinal stenosis (LSS) for the purpose of elucidating a correlation. Methods From July 2013 to May 2014, 117 consecutive patients with central LSS were included in this study. All of the MRIs were evaluated by one of the authors, and the evaluated items were the dural sac cross-sectional area (DSCSA), the number of stenotic levels, and the presence and levels of spondylolisthesis. The ODI, VAS, 36-item SF-36, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI) questionnaires were used to evaluate the participants. Results There are no correlations between the ODI, VAS, BDI, BAI, PSQI, and SF-36 scores and the minimum DSCSA; however, a significant correlation was found between the ODI scores and multilevel LSS. The BDI, BAI, and PSQI scores are higher for multilevel LSS compared with single-level LSS, but the difference of this mean value is not statistically significant. Conclusions A significant correlation was shown between those patients with multilevel LSS and the ODI scores; however, significant correlations were not found between the MRI findings and the psychological factors pertaining to sleep and life qualities. PMID:26495059

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

    PubMed Central

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

    2015-01-01

    [Purpose] This study examined the effects of lumbar stabilization exercises on the functional disability and lumbar lordosis angles in patients with chronic low back pain. [Subjects] The subjects were 30 patients with chronic low back pain divided into a lumbar stabilization exercise group (n = 15) and a conservative treatment group (n = 15). [Methods] The lumbar stabilization exercise and conservative treatment groups performed an exercise program and conservative physical treatment, respectively. Both programs were performed 3 times a week for 6 weeks. The degree of functional disability was assessed by the Oswestry disability index, and lumbar lordosis angles were measured by plain radiography. [Results] The Oswestry disability index decreased significantly in the both groups; however, it was significantly lower in the lumbar stabilization exercise group. The lumbar lordosis angle increased significantly in the lumbar stabilization exercise group after treatment and was also significantly greater than that in the conservative treatment group. [Conclusion] Lumbar stabilization exercise is more effective than conservative treatment for improving functional disability and lumbar lordosis angles. PMID:26180363

  4. Lumbar Cryptococcal Osteomyelitis Mimicking Metastatic Tumor

    PubMed Central

    Joo, Hyun Seok; Ha, Jung-Ki; Hwang, Chang Ju; Lee, Dong-Ho; Lee, Choon Sung

    2015-01-01

    Cryptococcus is an encapsulated, yeast-like fungus that rarely causes infection in immunocompetent patients. We present the case report of a 66-year-old female patient with a history of rectal cancer with an isolated lumbar vertebral cryptococcosis proven by biopsy performed during operation. The patient was not an immunocompromised host and did not have any other risk factors except the history of cured rectal cancer. The presumptive diagnosis based on imaging studies was metastatic spine cancer, so operation was performed. However, cryptococcal osteomyelitis was diagnosed in the pathologic examination. This case report emphasizes that we should be aware that lumbar cryptococcosis can be a rare cause of mimicking lesions with metastatic cancer. PMID:26435802

  5. [Repeated operations for recurrent lumbar disc herniations].

    PubMed

    Kloc, W; Imieli?ski, B L; Wasilewski, W; Jende, P; Puzyrewski, R

    1999-01-01

    A study of 73 patients who underwent reoperation for persistent or new complaints following initial lumbar discectomy is presented. 32 patients showed true recurrence of disc herniation (6 on the contralateral side) and 41 at a different level. 14 patients needed 3rd operation. Final results were evaluated using the Functional Economic Rating Scale elaborated by Prolo. Mean score for group operated on twice was 8.1 according to Prolo and 7.1 for group operated on 3 times. PMID:10791038

  6. Determination of the intervertebral disc space from CT images of the lumbar spine

    NASA Astrophysics Data System (ADS)

    Korez, Robert; Å tern, Darko; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž

    2014-03-01

    Degenerative changes of the intervertebral disc are among the most common causes of low back pain, where for individuals with significant symptoms surgery may be needed. One of the interventions is the total disc replacement surgery, where the degenerated disc is replaced by 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 the determination of the intervertebral disc space from three-dimensional (3D) computed tomography (CT) images of the lumbar spine. The first step of the proposed method is the construction of a model of vertebral bodies in the lumbar spine. For this purpose, a chain of five elliptical cylinders is initialized in the 3D image and then deformed to resemble vertebral bodies by introducing 25 shape parameters. The parameters are obtained by aligning the chain to the vertebral bodies in the CT image according to image intensity and appearance information. The determination of the intervertebral disc space is finally achieved by finding the planes that fit the endplates of the obtained parametric 3D models, and placing points in the space between the planes of adjacent vertebrae that enable surface reconstruction of the intervertebral disc space. The morphometric analysis of images from 20 subjects yielded 11:3 +/- 2:6, 12:1 +/- 2:4, 12:8 +/- 2:0 and 12:9 +/- 2:7 cm3 in terms of L1-L2, L2-L3, L3-L4 and L4-L5 intervertebral disc space volume, respectively.

  7. Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity.

    PubMed

    Phan, Kevin; Rao, Prashanth J; Scherman, Daniel B; Dandie, Gordon; Mobbs, Ralph J

    2015-11-01

    We conducted a systematic review to assess the safety and clinical and radiological outcomes of the recently introduced, direct or extreme lateral lumbar interbody fusion (XLIF) approach for degenerative spinal deformity disorders. Open fusion and instrumentation has traditionally been the mainstay treatment. However, in recent years, there has been an increasing emphasis on minimally invasive fusion and instrumentation techniques, with the aim of minimizing surgical trauma and blood loss and reducing hospitalization. From six electronic databases, 21 eligible studies were included for review. The pooled weighted average mean of preoperative visual analogue scale (VAS) pain scores was 6.8, compared to a postoperative VAS score of 2.9 (p<0.0001). The weighted average preoperative and postoperative coronal segmental Cobb angles were 3.6 and 1.1°, respectively. The weighted average preoperative and postoperative coronal regional Cobb angles were 19.1 and 10.0°, respectively. Regional lumbar lordosis also significantly improved from 35.8 to 43.3°. Sagittal alignment was comparable pre- and postoperatively (34mm versus 35.1mm). The weighted average operative duration was 125.6minutes, whilst the mean estimated blood loss was 155mL. The weighted average hospitalization length was 3.6days. Whilst the available data is limited, minimally invasive XLIF procedures appear to be a promising alternative for the treatment of scoliosis, with improved functional VAS and Oswestry disability index outcomes and restored coronal deformity. Future comparative studies are warranted to assess the long term benefits and risks of XLIF compared to anterior and posterior procedures. PMID:26190218

  8. Lumbar Diskography and Failed Back Syndrome in Patients Receiving Workers' Compensation.

    PubMed

    Anderson, Joshua T; Haas, Arnold R; Percy, Rick; Woods, Stephen T; Ahn, Uri M; Ahn, Nicholas U

    2015-11-01

    Lumbar diskography (LD) is frequently used in the evaluation of patients with degenerative disk disease and diskogenic low back pain. Its safety and diagnostic accuracy are a topic of debate. No study has evaluated the efficacy of LD within the clinically distinct workers' compensation population. Within this setting, the authors wished to determine the effect of undergoing LD before diskogenic fusion on rates of postoperative failed back surgery syndrome (FBSS). Also, the authors compared opioid analgesic use between patients undergoing LD and patients not undergoing LD. ICD-9 diagnoses and CPT procedural codes were used to identify 1591 patients from the Ohio Bureau of Workers' Compensation who underwent diskogenic fusion between 1993 and 2013. A total of 682 patients underwent LD before fusion, which formed the LD group, with the remaining 909 patients as controls. The authors used a multivariate logistic regression analysis while correcting for relevant covariates. Diskography before fusion was a positive predictor of postoperative FBSS (P=.04; odds ratio, 1.44). The rate of FBSS was 13.9% of the LD group and 8.8% in the control group. Postoperatively, the LD group was supplied with a significantly higher daily opioid analgesic load (P=.04) for an average of 130 additional days (P<.01). Additional predictors of FBSS included the ability to remain at work within 1 week of index fusion (P=.02; odds ratio, 0.54), male sex (P=.03; odds ratio, 1.51), preoperative narcotic use for more than 1 year (P=.02; odds ratio, 1.53), and fusion technique (P=.03). Diskography should ideally help identify good candidates for lumbar fusion. However, the authors' study raises significant concerns regarding LD's current role within the workers' compensation population. [Orthopedics. 2015; 38(11):e951-e958.]. PMID:26558673

  9. Evaluation framework for carotid bifurcation lumen segmentation and stenosis grading

    E-print Network

    Chung, Albert C. S.

    (Abegunde et al., 2005). Atherosclerosis, a disease of the vessel wall, is the major cause of cardiovascular diseases such as stroke (Frostegård, 2005). Atherosclerosis may lead to stenosis (luminal narrowing

  10. Epidermolysis Bullosa with Hypertrophic Pyloric Stenosis in a Newborn

    PubMed Central

    Ben Dhaou, Mahdi; Ammar, Saloua; Louati, Hamdi; Zitouni, Hayet; Jallouli, Mohamed; Mhiri, Riadh

    2015-01-01

    Epidermolysis bullosa (EB) is an inherited blistering disorder characterized by the fragility of the skin and mucous membranes. Extracutaneous manifestations can be associated. We report a unique concomitant occurrence of EB and hypertrophic pyloric stenosis in a newborn. PMID:26500857

  11. Semilobar Holoprosencephaly with Congenital Oropharyngeal Stenosis in a Term Neonate

    PubMed Central

    Hishikawa, Kenji; Fujinaga, Hideshi; Nagata, Chie; Higuchi, Masataka; Ito, Yushi

    2015-01-01

    Background?Holoprosencephaly (HPE) is often accompanied by a deficit in midline facial development; however, congenital oropharyngeal stenosis in neonates with HPE has not been reported before. We describe a case of a neonate with prenatally diagnosed semilobar HPE accompanied by congenital oropharyngeal stenosis. Case Report?The patient was born at 39 weeks of gestation and developed dyspnea shortly after. Laryngoscopic test revealed oropharyngeal stenosis. Nasal continuous positive airway pressure, high-flow nasal cannula, and nasopharyngeal airway did not resolve her dyspnea; tracheostomy was required. Conclusion?Neonates with HPE might be at higher risk of pharyngeal stenosis because of the functional and/or anatomical abnormalities. In the case of dyspnea in neonates with HPE, laryngoscopic evaluation should be considered. PMID:26495165

  12. Vascular stenosis with retroperitoneal rhabdomyosarcoma in a child: Case report

    SciTech Connect

    Bakody, P.J.; Stanley, P.

    1983-08-01

    Discovery on angiography of arterial stenosis in an 11-month-old girl with a retroperitoneal mass led to a preoperative diagnosis of neuroblastoma. Surgery revealed a rhabdomyosarcoma. The arteriographic appearance in both tumors may be identical.

  13. Linear Lumbar Localized Lysis of Elastic Fibers

    PubMed Central

    Tschen, Jaime A.

    2013-01-01

    Background: The absence or loss of elastic fibers in the skin is referred to as dermal elastolysis. Purpose: This paper describes a woman with a distinctive clinical presentation of mid-dermal elastolysis characterized morphologically by multiple horizontal raised bands on the lower back. Methods: A 20-year-old Filipino woman presented with multiple asymptomatic, flesh-colored, raised, firm, linear, cord-like bands on the lumbar area of her back. There were neither similar lesions elsewhere nor a family member with this condition. Results: Microscopic examination of the raised band showed nearly complete absence of elastic fibers in the mid dermis. In contrast, a biopsy of symmetrically located normal-appearing skin showed a uniform distribution of elastic fibers throughout the dermis. Linear lumbar localized elastolysis is a descriptive designation that accurately reflects a correlation of the clinical and pathological changes of this condition. Conclusion: The clinical differential of raised horizontal cord-like bands on the lower back (without a family history of an inherited elastic fiber disorder, a prior history of trauma, or a significant change in weight or exercise habit) includes linear focal elastosis and linear lumbar localized elastolysis. Microscopic evaluation of a Verhoeff-van Gieson stained lesion specimen (which may be accompanied by a biopsy of normal-appearing skin for comparison) will readily differentiate these conditions. The former is usually characterized by increased elastic fibers, whereas the latter, as in this patient, shows a paucity or absence of elastic fibers in the mid dermis. PMID:23882313

  14. The relationship between dizziness and cervical artery stenosis.

    PubMed

    Chen, Hongxi; Shi, Ziyan; Feng, Huiru; Wang, Renhua; Zhang, Yan; Xie, Jinglu; Yao, Shaoli; Zhou, Hongyu

    2015-12-16

    Dizziness is a common complaint in neurology departments. We sought to identify the relationship between dizziness and cervical artery stenosis, as assessed using cervical computed tomographic angiography. From 1 January 2012 to 20 April 2014, we prospectively and continuously collected the demographic characteristics, clinical data, and chief complaints of all hospitalized patients aged between 20 and 80 years who underwent computed tomographic angiography at our medical center. Altogether, 5796 hospitalized patients were enrolled in this study. After propensity-score matching, a matched cohort of 1139 patients in a dizziness group and 1139 patients in a nondizziness group was created. The proportion of patients with vertebrobasilar artery stenosis was larger in the dizziness group than in the nondizziness group (13.3 vs. 7.6% in the matched cohort) and was especially larger among patients with stroke histories (19.4 vs. 11.2% in the matched cohort). In the logistic regression, dizziness did not significantly predict carotid artery stenosis (P>0.01). Age, male sex, and hypertension, diabetes, myocardial infarction, cerebral infarction, or demyelinating diseases were the predictors of carotid artery stenosis that remained after adjustment (P<0.01). Patients with dizziness faced nearly twice the risk for vertebrobasilar artery stenosis than did those without dizziness (P<0.01). The other independent predictors of vertebrobasilar artery stenosis were age, male sex, hypertension, coronary artery disease, cerebral infarction, and hemorrhage (P<0.01). Patients with dizziness faced nearly twice the risk for vertebrobasilar artery stenosis than did those without dizziness, whereas dizziness did not significantly predict carotid artery stenosis. PMID:26512935

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

    PubMed Central

    Yang, Hae-sun; Yoo, Won-gyu

    2014-01-01

    [Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4–5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4–5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4–5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale scores for stretching with lumbar traction in lumbar 4–5 HIVD patients, from 18±1.29 to 2.1±1.35. The Oswestry scale scores also decreased significantly, from 20.35±2.01 to 3.5±2.84, after stretching with lumbar traction. [Conclusion] Thus, we suggest stretching with lumbar traction for lumbar 4–5 HIVD patients. PMID:25140094

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

    PubMed

    Yang, Hae-Sun; Yoo, Won-Gyu

    2014-07-01

    [Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4-5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4-5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4-5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale scores for stretching with lumbar traction in lumbar 4-5 HIVD patients, from 18±1.29 to 2.1±1.35. The Oswestry scale scores also decreased significantly, from 20.35±2.01 to 3.5±2.84, after stretching with lumbar traction. [Conclusion] Thus, we suggest stretching with lumbar traction for lumbar 4-5 HIVD patients. PMID:25140094

  17. Aortic stenosis: the spectrum of practice.

    PubMed

    Khalid, O; Luxenberg, D M; Sable, C; Benavidez, O; Geva, T; Hanna, B; Abdulla, R

    2006-01-01

    There is significant variation in practice patterns in managing congenital aortic valve stenosis. Review of medical literature reveals no significant information regarding the current practice methods in the treatment of a simple lesion such as aortic stenosis (AS). Therefore, this survey-based study was conducted in an attempt to better understand the uniformity or heterogeneity of practice in treating AS. A questionnaire was prepared to evaluate the style of management of AS. This survey was designed to assess the practice of follow-up visitations, type and frequency of investigative studies, pharmacological therapy, and exercise recommendations. Questions about therapeutic intervention included those of timing and type of intervention. Questionnaires were sent to all academic pediatric cardiology programs in the United States (48 program) and selected international programs from Europe, Asia, and Australasia (19 program). The total number of surveys sent out was 67, and the total number of respondents was 25 (37%), 15 (31%) from the United States and 9 (53%) from outside the United States. The definition of moderate AS varied among respondents. The range provided for mild AS was identified as that with a peak-to-peak pressure gradient of < 25-30 mmHg, peak instantaneous Doppler gradient of < 36-50 mmHg, or mean Doppler gradient of < 25-40 mmHg. On the other hand, severe AS was defined as that with a peak-to-peak gradient of > 50-60 mmHg, peak instantaneous Doppler gradient of > 64-80 mmHg, or mean Doppler gradient of > 45-64 mmHg. In assessing follow-up patterns, 84% of respondents recommended seeing patients with mild AS annually, the longest time of follow-up listed in the questionnaire, whereas 20% suggested follow-up every 6 months. There was no consensus among survey centers regarding follow-up of patients with moderate AS. For severe AS, 16% recommend immediate intervention, 16% arrange follow-up every 6 months, and 56 and 28% recommend follow-up in 3 and 1 month(s), respectively. In making the decision to proceed with biventricular versus univentricular repair in patients with AS in the neonatal period, many factors were considered. Ninety-two percent of respondents rely on mitral valve z score, 84% on aortic valve z score, 52% on left ventricle length, 48% on the presence of antegrade ascending aorta flow, and only 32% considered significant endocardial fibroelastosis as a factor. Rhodes score was used by 20% of respondents in decision making regarding the approach to management of this subset of AS. This study shows that there is consensus in the management of mild and severe forms of AS. As expected, disagreement is present in the definition, evaluation, and therapy of moderate aortic valve stenosis. There is a tendency for catheter intervention except in the presence of dysplastic aortic valve or moderate to severe aortic regurgitation. There is also disagreement regarding methods used to determine biventricular versus univentricular repair of a borderline hypoplastic left heart. PMID:17111288

  18. The Bcl-2 family in autoimmune and degenerative disorders.

    PubMed

    Mérino, Delphine; Bouillet, Philippe

    2009-04-01

    Members of the Bcl-2 family are essential regulators of programmed cell death and thus play a major role in the development and function of many tissues. The balance between pro-survival and pro-apoptotic members of the family decides whether a cell will live or die. This mechanism allows organisms to get rid of cells that are no longer needed or have become dangerous. Deregulation of apoptosis is a major contributing factor in the development of many diseases. A deeper understanding of how the Bcl-2 family proteins orchestrate death in normal and pathologic conditions is thus relevant not only for disease etiology, but also to try to prevent these various disorders. Experiments with transgenic and gene-ablated mice have helped elucidate the function of the different members of the Bcl-2 family and their physiological roles. The present review highlights the role of Bcl-2 family members in autoimmune and degenerative disorders, with a particular focus on the mouse models that have been used to study their function. PMID:19172396

  19. Unravelling the proteome of degenerative human mitral valves.

    PubMed

    Tan, Hwee Tong; Lim, Teck Kwang; Richards, Arthur Mark; Kofidis, Theodoros; Teoh, Kristine Leok-Kheng; Ling, Lieng H; Chung, Maxey C M

    2015-09-01

    Degenerative mitral valve disease (DMVD), which includes the syndromes of mitral valve prolapse (MVP) and flail leaflet, is a common valvular condition which can be complicated by mitral regurgitation and adverse cardiovascular outcomes. Although several genetic and other studies of MVP in dog models have provided some information regarding the underlying disease mechanisms, the proteins and molecular events mediating human MVP pathogenesis have not been unraveled. In this study, we report the first large-scale proteome profiling of mitral valve tissue resected from patients with MVP. A total of 1134 proteins were identified, some of which were validated using SWATH-MS and western blotting. GO annotation of these proteins confirmed the validity of this proteome database in various cardiovascular processes. Among the list of proteins, we found several structural and extracellular matrix proteins, such as asporin, biglycan, decorin, lumican, mimecan, prolargin, versican, and vinculin, that have putative roles in the pathophysiology of MVP. These proteins could also be involved in the cardiac remodeling associated with mitral regurgitation. All MS data have been deposited in the ProteomeXchange with identifier PXD000774 (http://proteomecentral.proteomexchange.org/dataset/PXD000774). PMID:25914152

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

    PubMed Central

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

    2015-01-01

    Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar surgery for patients with adjacent segment degeneration (ASD) and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients) or repeated open lumbar surgery (25 patients), due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and ?0.56 in the open lumbar surgery group (P < 0.0001). Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort. PMID:25861474

  1. 78 FR 36305 - Proposed Information Collection (Non-Degenerative Arthritis (Including Inflammatory, Autoimmune...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ... disability benefits related to a claimant's diagnosis of a non-degenerative arthritis or osteonecrosis... treating physician regarding the results of medical examinations and related to the claimant's diagnosis...

  2. Detection of degenerative change in lateral projection cervical spine x-ray images

    NASA Astrophysics Data System (ADS)

    Jebri, Beyrem; Phillips, Michael; Knapp, Karen; Appelboam, Andy; Reuben, Adam; Slabaugh, Greg

    2015-03-01

    Degenerative changes to the cervical spine can be accompanied by neck pain, which can result from narrowing of the intervertebral disc space and growth of osteophytes. In a lateral x-ray image of the cervical spine, degenerative changes are characterized by vertebral bodies that have indistinct boundaries and limited spacing between vertebrae. In this paper, we present a machine learning approach to detect and localize degenerative changes in lateral x-ray images of the cervical spine. Starting from a user-supplied set of points in the center of each vertebral body, we fit a central spline, from which a region of interest is extracted and image features are computed. A Random Forest classifier labels regions as degenerative change or normal. Leave-one-out cross-validation studies performed on a dataset of 103 patients demonstrates performance of above 95% accuracy.

  3. Comparative Review of the Treatment Methodologies of Carotid Stenosis.

    PubMed

    Bae, Coney; Szuchmacher, Mauricio; Chang, John B

    2015-09-01

    The treatment of carotid stenosis entails three methodologies, namely, medical management, carotid angioplasty and stenting (CAS), as well as carotid endarterectomy (CEA). The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) have shown that symptomatic carotid stenosis greater than 70% is best treated with CEA. In asymptomatic patients with carotid stenosis greater than 60%, CEA was more beneficial than treatment with aspirin alone according to the Asymptomatic Carotid Atherosclerosis (ACAS) and Asymptomatic Carotid Stenosis Trial (ACST) trials. When CAS is compared with CEA, the CREST resulted in similar rates of ipsilateral stroke and death rates regardless of symptoms. However, CAS not only increased adverse effects in women, it also amplified stroke rates and death in elderly patients compared with CEA. CAS can maximize its utility in treating focal restenosis after CEA and patients with overwhelming cardiac risk or prior neck irradiation. When performing CEA, using a patch was equated to a more durable result than primary closure, whereas eversion technique is a new methodology deserving a spotlight. Comparing the three major treatment strategies of carotid stenosis has intrinsic drawbacks, as most trials are outdated and they vary in their premises, definitions, and study designs. With the newly codified best medical management including antiplatelet therapies with aspirin and clopidogrel, statin, antihypertensive agents, strict diabetes control, smoking cessation, and life style change, the current trials may demonstrate that asymptomatic carotid stenosis is best treated with best medical therapy. The ongoing trials will illuminate and reshape the treatment paradigm for symptomatic and asymptomatic carotid stenosis. PMID:26417191

  4. 49 CFR 572.43 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a fully assembled dummy...

  5. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... rotate from its initial position in accordance with Figure No. 18 of § 572.21 (49 CFR part 572) by 40... 49 Transportation 7 2013-10-01 2013-10-01 false Lumbar spine flexure. 572.85 Section 572.85... Lumbar spine flexure. (a) When subjected to continuously applied force in accordance with paragraph...

  6. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... rotate from its initial position in accordance with Figure No. 18 of § 572.21 (49 CFR part 572) by 40... 49 Transportation 7 2014-10-01 2014-10-01 false Lumbar spine flexure. 572.85 Section 572.85... Lumbar spine flexure. (a) When subjected to continuously applied force in accordance with paragraph...

  7. 49 CFR 572.43 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a fully assembled dummy...

  8. 49 CFR 572.43 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a fully assembled dummy...

  9. 49 CFR 572.43 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a fully assembled dummy...

  10. The Robotic Lumbar Spine (RLS): Dynamics and Feedback Linearization Control

    E-print Network

    Williams II, Robert L.

    The Robotic Lumbar Spine (RLS): Dynamics and Feedback Linearization Control Ernur Karadogan. Karadogan and R.L. Williams II, 2013, "The Robotic Lumbar Spine (RLS): Dynamics and Feedback Linearization Spine (RLS): Dynamics and Feedback Linearization Control Ernur Karadogan 1 and Robert L. Williams II 2 1

  11. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... rotate from its initial position in accordance with Figure No. 18 of § 572.21 (49 CFR part 572) by 40... 49 Transportation 7 2012-10-01 2012-10-01 false Lumbar spine flexure. 572.85 Section 572.85... Lumbar spine flexure. (a) When subjected to continuously applied force in accordance with paragraph...

  12. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... rotate from its initial position in accordance with Figure No. 18 of § 572.21 (49 CFR part 572) by 40... 49 Transportation 7 2011-10-01 2011-10-01 false Lumbar spine flexure. 572.85 Section 572.85... Lumbar spine flexure. (a) When subjected to continuously applied force in accordance with paragraph...

  13. 49 CFR 572.43 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a fully assembled dummy...

  14. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... rotate from its initial position in accordance with Figure No. 18 of § 572.21 (49 CFR part 572) by 40... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine flexure. 572.85 Section 572.85... Lumbar spine flexure. (a) When subjected to continuously applied force in accordance with paragraph...

  15. The Robotic Lumbar Spine: Dynamics and Feedback Linearization Control

    PubMed Central

    Karadogan, Ernur; Williams, Robert L.

    2013-01-01

    The robotic lumbar spine (RLS) is a 15 degree-of-freedom, fully cable-actuated robotic lumbar spine which can mimic in vivo human lumbar spine movements to provide better hands-on training for medical students. The design incorporates five active lumbar vertebrae and the sacrum, with dimensions of an average adult human spine. It is actuated by 20 cables connected to electric motors. Every vertebra is connected to the neighboring vertebrae by spherical joints. Medical schools can benefit from a tool, system, or method that will help instructors train students and assess their tactile proficiency throughout their education. The robotic lumbar spine has the potential to satisfy these needs in palpatory diagnosis. Medical students will be given the opportunity to examine their own patient that can be programmed with many dysfunctions related to the lumbar spine before they start their professional lives as doctors. The robotic lumbar spine can be used to teach and test medical students in their capacity to be able to recognize normal and abnormal movement patterns of the human lumbar spine under flexion-extension, lateral bending, and axial torsion. This paper presents the dynamics and nonlinear control of the RLS. A new approach to solve for positive and nonzero cable tensions that are also continuous in time is introduced. PMID:24151527

  16. Instrumented transforaminal lumbar interbody fusion with bioabsorbable polymer implants and iliac crest autograft.

    PubMed

    Coe, Jeffrey D

    2004-03-15

    Object. The purpose of this study was to evaluate the clinical and radiographic results in 31 patients from one center who underwent instrumented transforaminal lumbar interbody fusion (TLIF) for primarily degenerative indications. Methods. Bioabsorbable polymer spacers manufactured with a copolymer of 70:30 poly(L-lactide-co-D,L-lactide) and filled with iliac crest autograft bone were used for the TLIF procedure. In this paper the details of this procedure, intermediate (1- to 2-year) clinical and radiographic outcomes, and the basic science and rationale for the use of bioabsorbable polymers are discussed. At a mean of 18.4 months of follow up, 30 patients (96.8%) were judged to have attained solid fusions and 25 patients (81%) had good to excellent results. Three patients (9.7%) experienced complications, none of which were directly or indirectly attributable to the use of the bioabsorbable polymer implant. Only one implant in one patient (3.2%) demonstrated mechanical failure on insertion, and that patient experienced no clinical sequelae. Conclusions. This is the first clinical series to be published in which the mean follow-up duration equals or exceeds the biological life expectancy of this material (12-18 months). Both the clinical and radiographic results of this study support the use of interbody devices manufactured from biodegradable polymers for structural interbody support in the TLIF procedure. PMID:15198499

  17. Bacterial meningitis associated with lumbar drains: a retrospective cohort study

    PubMed Central

    Coplin, W.; Avellino, A.; Kim, D; Winn, H; Grady, M

    1999-01-01

    OBJECTIVES—The infective potential of lumbar drainage is an important topic deserving particular study. The aetiology, incidence, and clinical findings associated with bacterial meningitis are described in patients having continuous lumbar CSF drainage to treat communicating hydrocephalus after subarachnoid haemorrhage or CSF leaks after traumatic dural rents.?METHODS—Retrospective review of the records of patients with a positive CSF bacterial culture who underwent lumbar drain placement over a 39 month period.?RESULTS—Thirteen cases of bacterial meningitis occurred subsequent to the use of 312 lumbar drain kits (4.2%). All meningitic patients had CSF pleocytosis, but not all had peripheral leukocytosis. Fever, peripheral leukocytosis, and CSF pleocytosis did not help to differentiate the presence of bacterial meningitis from other infections. Eight patients had prior CSF drainage procedures, including ventriculostomy (n=5) or lumbar drain (n=5) placements; two patients received both procedures. Six of 13 patients developed their CSF infection within 24 hours of lumbar drain insertion. Six of 13 patients developed meningitis while receiving antibiotics for other reasons.?CONCLUSIONS—External lumbar drainage seems to carry a low risk of infectious meningitis and offers a safe alternative to ventriculostomy or serial lumbar punctures. Antibiotics do not seem to protect completely against developing the infection. The infection happens most often with skin organisms. The meningitis often appears within 24 hours after lumbar drain placement. Daily CSF samples should include bacterial cultures but cell counts may not offer any additional useful information in diagnosing the complication. Lumbar drain insertion and management need not be confined to the intensive care unit.?? PMID:10486393

  18. Establishment of a new animal model for ischemic lumbar vertebrae

    PubMed Central

    Hou, Changlong; Tan, Guosheng; Zhuang, Wenquan; Yang, Jianyong

    2015-01-01

    Degeneration and ischemia of lumbar intervertebral disc has become a more and more important issue for elder people. However the mechanism for this is still known, largely due to a lack of a suitable animal model. In this study, we constructed a new animal model for the study of ischemic lumbar vertebrae. 42 New Zealand white rabbits were chosen for the study. For each rabbit, two vertebrae were used. L5 was set as the experimental group and L4 was set as the control group. Percutaneous lumbar puncture needles were applied in vertebrae adjacent to endplate for L5 and L4. For L4 1 ml saline was injected and for L5 1 ml pingyangmycin (2 mg/mL) was used. 1, 2, 3, 4, 5 weeks; 2 and 3 months after surgery, 6 rabbits at each time point were randomly chosen and underwent MRI, pathological test. The results in L5 and L4 were compared. Another 6 rabbits were used for DSA (Digital Subtraction Angiography) and vascular cast to study the length and diameters of the branches of lumbar artery. It was identified that since the third week, slightly hyperintense signal on T2-weighted image (T2WI) and fat-suppression T2-weighted image (FS T2WI) were detected. Lumbar vertebrae damage could be identified since the fourth week. Results of MRI and the size of pathological area were positively related (r=0.965, P<0.05). DSA and vascular cast could both clearly show the third level branches of lumbar artery. Our study suggested that injection of pingyangmycin via percutaneous lumbar needle could successfully induce ischemia in lumbar endplate. This method had little trauma, required a simple operation process and is highly repetitive. Besides, by vascular cast, the most important source of blood supply is the media branch of the lumbar artery. This branch could be a new therapy pathway for the degeneration of lumbar vertebrae. PMID:26379856

  19. The spinal stenosis pedometer and nutrition lifestyle intervention (SSPANLI) randomized controlled trial protocol

    PubMed Central

    2013-01-01

    Background Because of symptoms, people with lumbar spinal stenosis (LSS) are often inactive, and this sedentary behaviour implies risk for diseases including obesity. Research has identified body mass index as the most powerful predictor of function in LSS. This suggests that function may be improved by targeting weight as a modifiable factor. An e-health lifestyle intervention was developed aimed at reducing fat mass and increasing physical activity in people with LSS. The main components of this intervention include pedometer-based physical activity promotion and nutrition education. Methods/Design The Spinal Stenosis Pedometer and Nutrition Lifestyle Intervention (SSPANLI) was developed and piloted with 10 individuals. The protocol for a randomized controlled trail comparing the SSPANLI intervention to usual non-surgical care follows. One hundred six (106) overweight or obese individuals with LSS will be recruited. Baseline and follow-up testing includes dual energy x-ray absorptiometry, blood draw, 3-day food record, 7-day accelerometry, questionnaire, maximal oxygen consumption, neurological exam, balance testing and a Self-Paced Walking Test. Intervention: During Week 1, the intervention group will receive a pedometer, and a personalized consultation with both a Dietitian and an exercise specialist. For 12 weeks participants will log on to the e-health website to access personal step goals, walking maps, nutrition videos, and motivational quotes. Participants will also have access to in-person Coffee Talk meetings every 3 weeks, and meet with the Dietitian and exercise specialist at week 6. The control group will proceed with usual care for the 12-week period. Follow-up testing will occur at Weeks 13 and 24. Discussion This lifestyle intervention has the potential to provide a unique, non-surgical management option for people with LSS. Through decreased fat mass and increased function, we may reduce risk for obesity, chronic diseases of inactivity, and pain. The use of e-health interventions provides an opportunity for patients to become more involved in managing their own health. Behaviour changes including increased physical activity, and improved dietary habits promote overall health and quality of life, and may decrease future health care needs in this population. Trial registration Clinicaltrials.gov, NCT01902979 PMID:24228747

  20. Management of acquired punctal stenosis with perforated punctal plugs

    PubMed Central

    Ozgur, Ozlen Rodop; Akcay, Levent; Tutas, Nesrin; Karadag, Onur

    2015-01-01

    Purpose To evaluate the efficiency of perforated punctal plug in acquired punctal stenosis. Materials and methods Forty-five eyes of 33 patients who had epiphora due to punctal stenosis were included in this study. After biomicroscopic examination and lacrimal dilatation punctal stenosis was managed with the perforated punctal plugs in all patients. In the following period epiphora, plug tolerance, lacrimal drainage were evaluated and graded. Lacrimal drainage was evaluated with fluorescein dye disappearing test. Results The age of the patients ranged between 31 and 80 (mean 55.78 ± 13.11). Preoperatively punctal dilatation and lacrimal system irrigations were performed on all patients. Lacrimal system irrigation was positive in all patients. Perforated punctal plugs were placed in the inferior puncti in all patients. The plugs were explanted 6 months after operation. The follow-up period ranged between 6 and 24 months. Plug tolerance was good in 97.8% of the eyes in the 1st month visit. Epiphora decreased remarkably in 88.9% of the patients 1 month after plug implantation, except one whose plug dropped off spontaneously in 2 weeks. Fluorescein disappearing times were found under 3 min in 97.8% of the eyes after plug explanations. Conclusion Punctum stenosis is one of the several disorders that cause lacrimal drainage obstruction. Perforated punctal plugs are found convenient and effective in managing punctal stenosis. PMID:26155080

  1. Restenosis following balloon dilation of benign esophageal stenosis

    PubMed Central

    Cheng, Ying-Sheng; Li, Ming-Hua; Yang, Ren-Jie; Zhang, Hui-Zhen; Ding, Zai-Xian; Zhuang, Qi-Xin; Jiang, Zhi-Ming; Shang, Ke-Zhong

    2003-01-01

    AIM: To elucidate the mechanism of restenosis following balloon dilation of benign esophageal stenosis. METHODS: A total of 49 rats with esophageal stenosis were induced in 70 rats using 5 mL of 50% sodium hydroxide solution and the double-balloon method, and an esophageal restenosis (RS) model was developed by esophageal stenosis using dilation of a percutaneous transluminal coronary angioplasty (PTCA) balloon catheter. These 49 rats were divided into two groups: rats with benign esophageal stricture caused by chemical burn only (control group, n = 21) and rats with their esophageal stricture treated with balloon catheter dilation (experimental group, n = 28). Imaging analysis and immunohistochemistry were used for both quantitative and qualitative analyses of esophageal stenosis and RS formation in the rats, respectively. RESULTS: Cross-sectional areas and perimeters of the esophageal mucosa layer, muscle layer, and the entire esophageal layers increased significantly in the experimental group compared with the control group. Proliferating cell nuclear antigen (PCNA) was expressed on the 5th day after dilation, and was still present at 1 mo. Fibronectin (FN) was expressed on the 1st day after dilation, and was still present at 1 month. CONCLUSION: Expression of PCNA and FN plays an important role in RS after balloon dilation of benign esophageal stenosis. PMID:14606107

  2. 49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  3. 49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Lumbar spine, abdomen, and pelvis assembly and...) ANTHROPOMORPHIC TEST DEVICES 6-Year-Old Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The lumbar spine, abdomen, and pelvis consist...

  4. Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546

    PubMed Central

    Arts, Mark P; Peul, Wilco C; Brand, Ronald; Koes, Bart W; Thomeer, Ralph TWM

    2006-01-01

    Background Open discectomy is the standard surgical procedure in the treatment of patients with long-lasting sciatica caused by lumbar disc herniation. Minimally invasive approaches such as microendoscopic discectomy have gained attention in recent years. Reduced tissue trauma allows early ambulation, short hospital stay and quick resumption of daily activities. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in patients with lumbar disc herniation. Methods/Design Patients (age 18–70 years) presenting with sciatica due to lumbar disc herniation lasting more than 6–8 weeks are included. Patients with disc herniation larger than 1/3 of the spinal canal diameter, or disc herniation less than 1/3 of the spinal canal diameter with concomitant lateral recess stenosis or sequestration, are eliglible for participation. Randomisation into microendoscopic discectomy or conventional unilateral transflaval discectomy will take place in the operating room after induction of anesthesia. The length of skin incision is equal in both groups. The primary outcome measure is the functional assessment of the patient, measured by the Roland Disability Questionnaire for Sciatica, at 8 weeks and 1 year after surgery. We will also evaluate several other outcome parameters, including perceived recovery, leg and back pain, incidence of re-operations, complications, serum creatine kinase, quality of life, medical consumption, absenteeism and costs. The study is a randomised prospective multi-institutional trial, in which two surgical techniques are compared in a parallel group design. Patients and research nurses are kept blinded of the allocated treatment during the follow-up period of 2 years. Discussion Currently, open discectomy is the golden standard in the surgical treatment of lumbar disc herniation. Whether microendoscopic discectomy is more cost-effective than unilateral transflaval discectomy has to be determined by this trial. PMID:16696861

  5. [Lumbar spondylodiscitis caused by Salmonella enteritidis].

    PubMed

    Schüler, A; Schaumann, D; Manns, M P; Koch, K M

    1994-10-14

    A 19-year-old boy developed paravertebral muscular pain in the lumbar region after an episode of extremely arduous sporting activity, with fever followed by meningism. The cerebrospinal fluid showed a reactive pleocytosis. Initially, no acute inflammatory changes were present on serum and blood analysis, although the erythrocyte sedimentation rate was moderately increased to 25/60 mm. Pyrexia of up to 38.5 degrees C developed 6 days after admission. Because Borrelia IgM and IgG titres were positive, the diagnosis was at first thought to be atypical borreliosis and the patient was treated with antibiotics. However, after a further episode of fever. Salmonella antibody titres, which had initially been normal, rose to 1: 3200 (Salmonella typhi O and H antigens) and 1: 12800 (Salmonella enteritidis, H antigen). At this stage, the erythrocyte sedimentation rate rose to 86/120 mm and the C-reactive protein to 77 mg/dl. The white cell count remained normal throughout. Blood cultures grew Salmonella enteritidis. Abnormalities on bone scintigraphy were confirmed by CT and MRI scans, showing spondylodiscitis of lumbar vertebrae 1 and 2 with limited osteolysis. The lesion resolved completely on 6 week's treatment with ciprofloxacin (200 mg twice a day intravenously) and conservative supportive treatment. Spondylodiscitis is an uncommon complication of salmonellosis and may occur long after the diarrhoea. Cross reactions with Borrelia flagellin antigens may lead to the wrong diagnosis being made. PMID:7924947

  6. Physiology-based diagnosis algorithm for arteriovenous fistula stenosis detection.

    PubMed

    Yeih, Dong-Feng; Wang, Yuh-Shyang; Huang, Yi-Chun; Chen, Ming-Fong; Lu, Shey-Shi

    2014-01-01

    In this paper, a diagnosis algorithm for arteriovenous fistula (AVF) stenosis is developed based on auscultatory features, signal processing, and machine learning. The AVF sound signals are recorded by electronic stethoscopes at pre-defined positions before and after percutaneous transluminal angioplasty (PTA) treatment. Several new signal features of stenosis are identified and quantified, and the physiological explanations for these features are provided. Utilizing support vector machine method, an average of 90% two-fold cross-validation hit-rate can be obtained, with angiography as the gold standard. This offers a non-invasive easy-to-use diagnostic method for medical staff or even patients themselves for early detection of AVF stenosis. PMID:25571021

  7. [Post-denervation renal artery stenosis - a matter of concern?].

    PubMed

    Cordeanu, M; Gaertner, S; Prinz, É; Bronner, F; Jahn, C; Hannedouche, T; Stephan, D

    2015-06-01

    Renal denervation, an invasive technique indicated in resistant hypertension patients insufficiently controlled by antihypertensive drugs, has a good safety profile. However, an increasing number of post-denervation renal artery stenosis cases has recently been reported. We describe the case of a 49-year-old woman with resistant hypertension who was referred to our university hypertension center for renal sympathetic denervation. Her daily treatment included six antihypertensive drugs. CT angiography prior to denervation showed no renal artery stenosis or vessel wall lesions. A standard renal denervation procedure using the St Jude protocol was performed. After an initial improvement in blood pressure profile, she presented with a blood pressure impairment at 3 months after renal denervation leading to the diagnosis of a severe right renal artery stenosis. PMID:26047879

  8. Antithrombotic therapy in carotid artery stenosis: an update.

    PubMed

    Paciaroni, Maurizio; Bogousslavsky, Julien

    2015-01-01

    Carotid stenosis is generally associated with high risks of stroke and vascular events. In asymptomatic and symptomatic patients, with or without revascularization, optimal managements of carotid artery stenosis require the use of medications or lifestyle modifications (stopping smoking and monitoring hypertension, hyperlipidemia, and diabetes) to control the processes associated with atheroma to reduce the risk of embolic events. Moreover, antiplatelet therapy should be considered. There is little evidence that antiplatelet therapy is beneficial in preventing stroke or the progression of stenosis in asymptomatic patients, whereas, evidence of a benefit from antiplatelet therapy for secondary prevention of recurrent stroke in symptomatic patients with carotid atherosclerosis is more robust. Also, in patients undergoing carotid endarterectomy, perioperative antithrombotic therapy should include aspirin, while the addition of clopidogrel should be decided case-by-case. Furthermore, perioperative antithrombotic therapy in patients undergoing carotid stenting should consist a combination of aspirin plus clopidogrel. PMID:25402664

  9. Waves in fluid-filled elastic tubes with a stenosis

    NASA Astrophysics Data System (ADS)

    Demiray, Hilmi

    2007-05-01

    In the present work, by treating the arteries as thin-walled prestressed elastic tubes with a stenosis and the blood as an inviscid fluid we have studied the propagation of weakly nonlinear waves in such a medium, in the longwave approximation, by employing the reductive perturbation method. The variable coefficients KdV and modified KdV equations are obtained depending on the balance between the nonlinearity and the dispersion. By seeking a localized progressive wave type of solution to these evolution equations, we observed that the wave speeds takes their maximum values at the center of stenosis and gets smaller and smaller as one goes away from the stenosis. Such a result seems to reasonable from the physical point of view.

  10. Endovascular Approach to Transplant Renal Artery Stenosis.

    PubMed

    Braga, André Felipe Farias; Catto, Rafel Cespedes; Dalio, Marcelo Bellini; Tenório, Emanuel Junio Ramos; Ribeiro, Maurício Serra; Piccinato, Carlos Eli; Joviliano, Edwaldo Edner

    2015-01-01

    BACKGROUND The endovascular approach has shown high initial technical success rates, good patency rates, and minimal complications in treating transplant renal artery stenosis (TRAS). The objective of this study was to describe our experience with an endovascular approach to TRAS. MATERIAL AND METHODS We performed a retrospective single-institutional review of all kidney transplant procedures performed at our institution from September 2009 to September 2014. All consecutive cases of TRAS were included. RESULTS From a total of 183 kidney transplantations, 16 patients had TRAS. Mean time from transplantation to TRAS diagnosis was 201.8 days. Stenoses or hemodynamic significant kinkings were located at the anastomosis (7), proximal (5) and middle (4) portions of the transplant artery. All patients were treated with angioplasty and primary balloon-expanding stenting. Early technical success was 93.75% and local complication rate was 12.5%. No deaths occurred. Mean serum creatinine level dropped from 3.87 mg/dL to 2.91 mg/dL after 24 hours; 1.85 mg/dL after one month; and 1.67 mg/dL after three months (P<0.05). Mean estimated glomerular filtration rate increased from 31.60 mL/min to 39.53 mL/min after 24 hours; 50.92 mL/min after one month; and 55.05 mL/min after three months (P<0.05). Doppler ultrasound criteria normalized after the procedure. Number of classes of antihypertensive drugs was not different before and after the procedure (P=0.38). Mean follow-up time was 9.75 months. One patient had a restenosis and required surgical intervention to restore graft function. CONCLUSIONS The endovascular approach to TRAS with primary balloon-expanding stenting was safe and had a high rate of technical success. It was effective for restore and maintain the renal function in transplant kidney grafts with a low rate of restenosis. PMID:26596354

  11. Anesthetic manipulation in extreme airway stenosis: a case report

    PubMed Central

    2014-01-01

    Introduction Anesthetic management with airway stenosis is challenging. Techniques for maintaining spontaneous respiration are required under sedative and analgesic conditions. Case presentation A 35-year-old Chinese woman presented to our hospital with difficulty breathing. Computerized tomography showed a tumor in the frontal area of her neck, which was causing extreme narrowing of her trachea. She was immediately scheduled for emergency surgery to remove the tumor. Fiberscopic intubation was carefully performed with dexmedetomidine sedation and remifentanil analgesia. Spontaneous respiration was successfully maintained. Conclusion In cases of extreme airway stenosis, intubation can be safely achieved with dexmedetomidine sedation and remifentanil analgesia. PMID:25186092

  12. Transjugular Portal Venous Stenting in Inflammatory Extrahepatic Portal Vein Stenosis

    SciTech Connect

    Schaible, Rolf; Textor, Jochen; Decker, Pan; Strunk, Holger; Schild, Hans

    2002-12-15

    We report the case of a 37-year-old man with necrotizing pancreatitis associated with inflammatory extrahepatic portal vein stenosis and progressive ascites. Four months after the acute onset, when no signs of infection were present, portal decompression was performed to treat refractory ascites. Transjugulartranshepatic venoplasty failed to dilate the stenosis in the extrahepatic portion of the portal vein sufficiently. Therefore a Wallstent was implanted, resulting in almost normal diameter of the vessel. In follow-up imaging studies the stent and the portal vein were still patent 12 months after the intervention and total resolution of the ascites was observed.

  13. [Ultrasound diagnosis of pyloric stenosis in young children].

    PubMed

    Krivchenia, D Iu; Babko, S A; Chekanova, L R

    1992-01-01

    The results of observation of 12 children ranging in age from 1 to 4 mos with tentative diagnosis of pyloric stenosis are presented. The study was performed by special method, using "Aloka" SSD-280 (Japan) ultrasound apparatus. The characteristic symptoms of the disease were revealed in 9 children, diagnosis of pyloric stenosis was confirmed by means of endoscopy, palpation, and intraoperatively. The use of US is practically harmless, and can completely substitute for a roentgenologic method in detecting the given congenital pathology. PMID:1453618

  14. Aortic Stenosis and Noncardiac Surgery: Managing the Risk.

    PubMed

    Pislaru, Sorin V; Abel, Martin D; Schaff, Hartzell V; Pellikka, Patricia A

    2015-11-01

    Managing the risk of noncardiac surgery in patients with aortic stenosis is a problem that is frequently confronted in clinical practice. Traditionally, patients with severe aortic stenosis were considered to be at substantial risk during noncardiac surgery, and as such, elective procedures were avoided before intervention on the aortic valve in most patients other than those who were ineligible or refused aortic valve replacement. Recent data suggest that with contemporary anesthesia and surgical techniques, the risk of noncardiac surgery is substantially lower than previously believed. We review the existent literature in the field, and propose a practical approach to complex patients. PMID:26471206

  15. Cervical branching of lumbar vestibulospinal axons

    PubMed Central

    Abzug, C.; Maeda, M.; Peterson, B. W.; Wilson, V. J.; Bean, C. P.

    1974-01-01

    1. We have investigated the possibility that individual lateral vestibulospinal tract (LVST) axons branch so as to innervate more than one spinal cord level. 2. LVST cells in Deiters' nucleus were activated antidromically by means of electrical stimulation applied through fine metal electrodes inserted into the spinal cord. Both by directly measuring the spread of effect of stimulus current, and from theoretical considerations (Appendix), we determined that in most cases an estimate of spread of effect of stimulus current was 10 ?m/?A. From the magnitude of the threshold stimulus and from the location of the stimulus point we could often exclude the possibility that the stimulus was spreading to the LVST instead of activating local branches. 3. Movable stimulating electrodes, or multi-electrode arrays placed in fixed position, were used to activate 115 LVST neurones antidromically by stimulation of local branches in the lower cervical or upper thoracic cord. Of these cells, 50% were also fired antidromically by stimulation of the LVST at levels ranging from L1 to L4 (Lc cells). The remaining cells were not activated by the lumbar stimulus (C cells). An additional group of cells was only fired by the lumbar tract stimulus (L cells). 4. The distribution of locations of Lc cells within Deiters' nucleus more closely resembles that of L cells than that of C cells. In addition the median conduction velocity of Lc cells is similar to that of L cells, but higher than that of C cells. 5. Much of the information reaching the lower cervical level from neurones of the LVST is information that is also simultaneously being passed downward to the lumbar region. Such integration makes it possible for a single neurone to be used to co-ordinate widespread motor activity. 6. A theory is presented in a separate section (Appendix) to account for the spread of effect of stimulus current upon a myelinated axon submerged in an isotropic medium. The threshold for stimulation of a node by a nearby monopolar electrode is predicted to be proportional to the electrode-node spacing. The constant of proportionality is given in a closed form that depends on the electrical properties of both the neurone and the surrounding medium. The predictions of the theory are shown to be in good accord with the experimental results. PMID:4449072

  16. Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease

    PubMed Central

    2015-01-01

    Degenerative diseases of the mitral valve (MV) are the most common cause of mitral regurgitation in the Western world and the most suitable pathology for MV repair. Several studies have shown excellent long-term durability of MV repair for degenerative diseases. The best follow-up results are obtained with isolated prolapse of the posterior leaflet, however even with isolated prolapse of the anterior leaflet or prolapse of both leaflets the results are gratifying, particularly in young patients. The freedom from reoperation on the MV at 15 years exceeds 90% for isolated prolapse of the posterior leaflet and it is around 70-85% for prolapse of the anterior leaflet or both leaflets. The degree of degenerative change in the MV also plays a role in durability of MV repair. Most studies have used freedom from reoperation to assess durability of the repair but some studies that examined valve function late after surgery suggest that recurrent mitral regurgitation is higher than estimated by freedom from reoperation. We can conclude that MV repair for degenerative mitral regurgitation is associated with low probability of reoperation for up to two decades after surgery. However, almost one-third of the patients develop recurrent moderate or severe mitral regurgitation suggesting that surgery does not arrest the degenerative process. PMID:26539345

  17. Gene Expression Profiling Identifies Interferon Signalling Molecules and IGFBP3 in Human Degenerative Annulus Fibrosus

    PubMed Central

    Kazezian, Zepur; Gawri, Rahul; Haglund, Lisbet; Ouellet, Jean; Mwale, Fackson; Tarrant, Finbarr; O’Gaora, Peadar; Pandit, Abhay; Alini, Mauro; Grad, Sibylle

    2015-01-01

    Low back pain is a major cause of disability especially for people between 20 and 50 years of age. As a costly healthcare problem, it imposes a serious socio-economic burden. Current surgical therapies fail to replace the normal disc in facilitating spinal movements and absorbing load. The focus of regenerative medicine is on identifying biomarkers and signalling pathways to improve our understanding about cascades of disc degeneration and allow for the design of specific therapies. We hypothesized that comparing microarray profiles from degenerative and non-degenerative discs will lead to the identification of dysregulated signalling and pathophysiological targets. Microarray data sets were generated from human annulus fibrosus cells and analysed using IPA ingenuity pathway analysis. Gene expression values were validated by qRT-PCR, and respective proteins were identified by immunohistochemistry. Microarray analysis revealed 238 differentially expressed genes in the degenerative annulus fibrosus. Seventeen of the dysregulated molecular markers showed log2-fold changes greater than ±1.5. Various dysregulated cellular functions, including cell proliferation and inflammatory response, were identified. The most significant canonical pathway induced in degenerative annulus fibrosus was found to be the interferon pathway. This study indicates interferon-alpha signalling pathway activation with IFIT3 and IGFBP3 up-regulation, which may affect cellular function in human degenerative disc. PMID:26489762

  18. Bovine Progressive Degenerative Myeloencephalopathy (Weaver Syndrome) in Brown Swiss Cattle in Canada: A Literature Review and Case Report

    PubMed Central

    Baird, John D.; Sarmiento, Ulla M.; Basrur, Parvathi K.

    1988-01-01

    A 15-month-old purebred Brown Swiss heifer was presented because of posterior paresis and ataxia. Histopathological examination of the brain and spinal cord showed evidence of a mild diffuse degenerative myeloencephalopathy. The most severe degenerative lesions were located in the white matter of the thoracic spinal cord. We believe this to be the first documented case of bovine progressive degenerative myeloencephalopathy (“weaver syndrome”) in Canada. ImagesFigure 1.Figure 2., Figure 3., Figure 4.Figure 5. PMID:17423028

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

    PubMed

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

    2015-09-01

    A 64-year-old man was referred to the authors with low-back pain (LBP) and right leg pain with a history of previously diagnosed lumbar disc herniation (LDH) at L4-5. He had undergone 2 percutaneous endoscopic lumbar discectomies (PELDs) for the herniation at another institution, and according to the surgical record of the second surgery, a dural tear occurred intraoperatively but was not repaired. Postoperative conservative treatments such as an epidural block and blood patch had not relieved his persistent LBP or right leg pain. Upon referral to the authors, MRI and myelography revealed an intradural LDH. The herniated mass was removed by durotomy, and posterior lumbar interbody fusion was performed. His symptoms were partially improved after surgery. Primary suture is technically difficult when a dural tear occurs during PELD. Therefore, close attention should be paid to avoiding such tears, and surgeons should increase their awareness of intradural LDH as a possible postoperative complication of PELD. PMID:26068274

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

    PubMed

    Eun, Jong-Pil; Oh, Young-Min

    2015-10-01

    Recently, we observed a case of lumbar artery injury after trauma, which was treated by endovascular embolization. A 67-year-old woman who was injured in a traffic accident was brought to the emergency room. She was conscious and her hemodynamic condition was stable, but she had paraplegia below L1 dermatome. Contrast-enhanced computed tomography scan of abdomen and pelvis revealed fracture dislocation of L3/4 along with retroperitoneal hematomas. However, there was no evidence of traumatic injury in both thoracic and abdominal cavity. At that time, her blood pressure suddenly decreased to 60/40 mmHg and her mental status deteriorated. Also, her hemoglobin level was 5.4 g/dl. While her hemodynamic condition stabilized with massive fluid resuscitation including blood transfusion, an angiography was immediately performed to look for and embolize site of retroperitoneal hemorrhage. On the angiographic images, there was an active extravasation from ruptured left 3rd lumbar artery, and we performed complete embolization with GELFOAM and coil. Lumbar artery injury after trauma is rare and endovascular treatment is useful in case of hemodynamic instability. PMID:25958959

  1. Adjacent Segment Pathology after Lumbar Spinal Fusion

    PubMed Central

    Lee, Jae Chul

    2015-01-01

    One of the major clinical issues encountered after lumbar spinal fusion is the development of adjacent segment pathology (ASP) caused by increased mechanical stress at adjacent segments, and resulting in various radiographic changes and clinical symptoms. This condition may require surgical intervention. The incidence of ASP varies with both the definition and methodology adopted in individual studies; various risk factors for this condition have been identified, although a significant controversy still exists regarding their significance. Motion-preserving devices have been developed, and some studies have shown their efficacy of preventing ASP. Surgeons should be aware of the risk factors of ASP when planning a surgery, and accordingly counsel their patients preoperatively. PMID:26435804

  2. [Fractures of the thoracic and lumbar spine].

    PubMed

    Gonschorek, O; Hauck, S; Weiß, T; Bühren, V

    2015-09-01

    Fractures of the thoracic and lumbar spine result from high velocity trauma, assuming bone density is normal. The main location of fractures is the thoracolumbar junction. Most injuries can be treated conservatively; however, patients transferred to hospitals and spine centers represent a preselection with more severe trauma and a higher incidence of operative treatment. There is a large variety of operative techniques that can be used, which can be principally differentiated by the approach: posterior or anterior. Dorsal approaches are differentiated by the instrumentation for spondylodesis as open or percutaneous techniques. Minimally invasive options are favored more and more. For osteoporotic bone, cement augmented solutions may be used. Correct reduction of mainly kyphotic malalignment is crucial for the long-term outcome. Biomechanically stable reconstruction of the anterior spinal column is important mainly for the thoracolumbar junction. PMID:26307631

  3. Transesophageal echocardiography assessment of severe ostial left main coronary stenosis

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Greenberg, N. L.; Lin, S. S.; Garcia, M. J.; Alexander, L. A.; Thomas, J. D.

    2000-01-01

    Doppler echocardiography is commonly used in the assessment of stenotic valvular orifices. We describe the application of transesophageal echocardiography for the detection of a critical ostial left main coronary stenosis. Because preoperative coronary angiography often is not routinely performed in young patients undergoing valve surgery, application of Doppler echocardiography can potentially prevent catastrophic complications, particularly in atypical cases.

  4. Factors influencing the functional significance in intermediate coronary stenosis

    PubMed Central

    Sun, Li-Jie; Wang, Gui-Song; Cui, Ming; Guo, Li-Jun; Zhang, Yong-Zhen; Zhang, Fu-Chun; Niu, Jie; Han, Jiang-Li; Xu, Wei-Xian; Zhu, Dan; Gao, Wei

    2015-01-01

    Objective To analyze the influencing factors of the functional significance determined by fractional flow reserve (FFR) in intermediate coronary artery stenosis. Methods The study enrolled 143 patients with 203 intermediate coronary lesions. Pressure-derived FFR of these lesions was gained at maximal hyperemia induced by intravenous adenosine infusion. An FFR < 0.80 was considered as abnormal functional significance. Anatomic parameters at the lesion sites were obtained by off-line quantitative coronary angiography analysis (QCA). The predictive value of the demographic characteristics and anatomic parameters for FFR in these intermediate lesions was assessed using multiple linear and binary logistic regression analysis. Results Overall, FFR < 0.8 was found in 70 (34%) of the total 203 intermediate coronary lesions. FFR values were positively correlated with QCA-measured minimum lumen diameters (MLD, r = 0.372, P = 0.000) and the reference vessel diameters (RVD, r = 0.217, P = 0.002) were negatively correlated with percent area stenosis (AS, r = ?0.251, P = 0.000) and percent diameter stenosis (DS, r = ?0.210, P = 0.000). Age, MLD and the lesion location in different coronary arteries were the independent determinants of FFR < 0.8. Conclusions MLD can predict the functional significance of intermediate coronary stenosis, while age and the lesion location in different coronary arteries should be taken into account as important influencing factors of FFR values. PMID:25870612

  5. The evolution of the treatment of isolated pulmonary valve stenosis.

    PubMed Central

    Glenn, W. W.

    1987-01-01

    In the course of studies covering 40 years, 1913 to 1953, leading to the development of cardiopulmonary bypass, many ingenious blind instrumental or digital intrusions were made into the heart chambers to treat lesions therein. Limits were defined for the arrest of circulation through part or all of the heart to permit a brief glimpse of the lesion and effect at least a partial correction. The often remarkably good results of operations performed under less than ideal operating conditions for lesions such as isolated pulmonary stenosis encouraged the interventional cardiologist and radiologist, working together, to adapt the cardiac catheter, used previously for exploration of the vascular system and diagnosing intravascular lesions, to therapeutic purposes. They positioned a catheter with uninflated balloon attached in the pulmonary artery, then either by inflating the balloon beyond the constricted orifice and pulling it through or by rapidly and precisely inflating the balloon lying across the orifice were able to disrupt the stricture and relieve the stenosis. Results matched those of early non-visual operations. Recently the cardiologist has expanded the approach to relieve other constricted orifices in the heart and great vessels and to close abnormal openings. In isolated pulmonary stenosis, the nearly complete relief of obstruction and the tolerance of the circulation to blunt disruption of valvular stenosis bodies well for the long-term success of balloon valvuloplasty in this congenital malformation of the heart. Images FIG. 1 FIG. 2 FIG. 5 FIG. 7 FIG. 9 PMID:2962371

  6. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability.

    PubMed

    Brinjikji, Waleed; Huston, John; Rabinstein, Alejandro A; Kim, Gyeong-Moon; Lerman, Amir; Lanzino, Giuseppe

    2016-01-01

    Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify patients with low- and high-grade carotid artery stenosis. For example, identification of IPH on MRI in patients with low-grade carotid artery stenosis is a risk factor for failure of medical therapy, and studies have shown that such patients may fair better with carotid endarterectomy (CEA). MR plaque imaging has also been found to be useful in identifying revascularization candidates who would be better candidates for CEA than carotid artery stenting (CAS), as high intraplaque signal on time of flight imaging is associated with vulnerable plaque and increased rates of adverse events in patients undergoing CAS but not CEA. PMID:26230478

  7. PREDICTING HEALTH CARE NEEDS FOLLOWING LUMBAR SPINE SURGERY

    E-print Network

    Kanaan, Saddam

    2013-08-31

    Low back pain is one of the most common health problems globally, having significant impact on individuals, community, and health care system. Lumbar Spine Surgery (LSS) is usually considered a treatment of low back pain ...

  8. Does myodil introduced for ventriculography lead to symptomatic lumbar arachnoiditis?

    PubMed

    Hill, C A; Hunter, J V; Moseley, I F; Kendall, B E

    1992-12-01

    Although there is a substantial body of evidence implicating Myodil or Pantopaque as a cause of lumbar arachnoiditis, assessment of the clinically based evidence is complicated by the additional potentially causative factors present in a high proportion of cases. These include pre-existing spinal pathology, traumatic lumbar puncture and surgery. The aim of this retrospective study was to attempt to ascertain whether Myodil introduced via ventricular catheter was associated with subsequent development of symptomatic lumbar arachnoiditis. In 222 patients in whom clinical records were reviewed there was no excess of back pain following ventriculography compared to the general population. Myodil ventriculography does not appear to be a major cause of symptomatic lumbar arachnoiditis. Several unavoidable problems with the methodology of this study are discussed. PMID:1286419

  9. Sense in the lumbar spine Is diminished with flexion

    E-print Network

    Gade, Venkata; Wilson, Sara E.

    2007-01-01

    Proprioception plays an important role in appropriate sensation of spine position, movement and stability. Previous research has demonstrated that position sense error in the lumbar spine is increased in flexed postures. This study investigated...

  10. Bowman lecture on the role of inflammation in degenerative disease of the eye

    PubMed Central

    Forrester, J V

    2013-01-01

    Inflammation, in the pathogenesis of many diseases previously thought to be strictly genetic, degenerative, metabolic, or endocrinologic in aetiology, has gradually entered the framework of a general mechanism of disease. This is exemplified by conditions such as Parkinson's disease, Alzheimer's disease, atherosclerosis, diabetes, and the more recently described Metabolic Syndrome. Chronic inflammatory processes have a significant, if not primary role, in ophthalmic diseases, particularly in retinal degenerative diseases. However, inflammation itself is not easy to define, and some aspects of inflammation may be beneficial, in a process described as ‘para-inflammation' by Medhzitov. In contrast, the damaging effects of inflammation, mediated by pro-inflammatory macrophages through activation of the intracellular protein-signalling complexes, termed inflammasomes, are well recognised and are important therapeutic targets. In this review, the range of inflammatory processes in the eye is evaluated in the context of how these processes impact upon retinal degenerative disease, particularly diabetic retinopathy and age-related macular degeneration. PMID:23288138

  11. Histone Deacetylases Inhibitors in the Treatment of Retinal Degenerative Diseases: Overview and Perspectives

    PubMed Central

    Dai, Xufeng; Du, Wei; Pang, Ji-jing

    2015-01-01

    Retinal degenerative diseases are one of the important refractory ophthalmic diseases, featured with apoptosis of photoreceptor cells. Histone acetylation and deacetylation can regulate chromosome assembly, gene transcription, and posttranslational modification, which are regulated by histone acetyltransferases (HATs) and histone deacetylases (HDACs), respectively. The histone deacetylase inhibitors (HDACis) have the ability to cause hyperacetylation of histone and nonhistone proteins, resulting in a variety of effects on cell proliferation, differentiation, anti-inflammation, and anti-apoptosis. Several HDACis have been approved for clinical trials to treat cancer. Studies have shown that HDACis have neuroprotective effects in nervous system damage. In this paper, we will summarize the neuroprotective effects of common HDACis in retinal degenerative diseases and make a prospect to the applications of HDACis in the treatment of retinal degenerative diseases in the future. PMID:26137316

  12. Moderate Aortic Stenosis and Coronary Artery Bypass Grafting: Clinical Update for the Perioperative Echocardiographer.

    PubMed

    Maldonado, Yasdet; Singh, Saket; Augoustides, John G; MacKnight, Brenda; Zhou, Elizabeth; Gutsche, Jacob T; Ramakrishna, Harish

    2015-10-01

    Incidental aortic stenosis in the setting of coronary artery bypass surgery may be a perioperative challenge. The accurate assessment of the degree of aortic stenosis remains an important determinant. Although severe aortic stenosis is an indication for valve replacement, current guidelines advise a balanced approach to the management of moderate aortic stenosis in this setting. Multiple factors should be considered in a team discussion to balance risks versus benefits for the various management options in the given patient. The rapid progress in aortic valve technologies also offer alternatives for definitive management of moderate aortic stenosis in this setting that will likely become even safer in the near future. PMID:26275517

  13. Laparoscopic Repair of Left Lumbar Hernia After Laparoscopic Left Nephrectomy

    PubMed Central

    Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair. PMID:21333197

  14. Correlation of intracranial atherosclerosis with carotid stenosis in ischemic stroke patients

    PubMed Central

    Ghosh, Manas; Ghosh, Kaushik; Chatterjee, Atri; Bhattacharya, Ambarish; Acharya, Amitava; Chakraborty, Sisir; Ghosh, Bhaskor

    2015-01-01

    Introduction: Carotid stenosis is a major risk factor for ischemic stroke. However, the effect of carotid stenosis on the site of stroke is still under investigation. Aims: This study aimed to elucidate how the presence of carotid stenosis influenced the pattern of stroke and also how it interacted with other risk factors for stroke. Materials and Methods: Thirty-eight patients with ischemic stroke were included in this study and were investigated with carotid artery Doppler and magnetic resonance angiography for carotid stenosis and intracranial stenosis in the circle of Willis, respectively. Other known risk factors of stroke were also studied in and compared between the subgroups with and without carotid stenosis. Results: In patients without carotid stenosis, anterior cerebral artery was the commonest site of stenosis. In patients with carotid stenosis, middle cerebral artery was the commonest site of stenosis. Overall, middle cerebral artery was the commonest territory of stroke. Patients with hypertension, diabetes and history of smoking had preferential stenosis of the anterior cerebral artery. PMID:26713012

  15. Regional cerebral blood flow in dialysis encephalopathy and primary degenerative dementia

    SciTech Connect

    Mathew, R.J.; Rabin, P.; Stone, W.J.; Wilson, W.H.

    1985-07-01

    Regional cerebral blood flow (CBF) was measured in patients with dialysis encephalopathy, primary degenerative dementia, dialysis patients with no central nervous system (CNS) complications, and normal controls. Both groups of dialysis patients (with and without CNS complications) demonstrated higher CBF values, and the dementia patients, lower CBF values than the controls. The dialysis patients had lower hematocrit, which correlated inversely with the cerebral blood flow. No such correlations were present in normals and patients with primary degenerative dementia. The dialysis patients and controls obtained similar CBF when the flow values were adjusted for the differences in hematocrit.

  16. Midline Lumbar Fusion with Cortical Bone Trajectory Screw

    PubMed Central

    MIZUNO, Masaki; KURAISHI, Keita; UMEDA, Yasuyuki; SANO, Takanori; TSUJI, Masanori; SUZUKI, Hidenori

    2014-01-01

    A novel cortical bone trajectory (CBT) screw technique provides an alternative fixation technique for lumbar spine. Trajectory of CBT screw creates a caudo-cephalad path in sagittal plane and a medio-lateral path in axial plane, and engages cortical bone in the pedicle. The theoretical advantage is that it provides enhanced screw grip and interface strength. Midline lumbar fusion (MIDLF) is composed of posterior mid-line approach, microsurgical laminectomy, and CBT screw fixation. We adopted the MIDLF technique for lumbar spondylolisthesis. Advantages of this technique include that decompression and fusion are available in the same field, and it minimizes approach-related damages. To determine whether MIDLF with CBT screw is as effective as traditional approach and it is minimum invasive technique, we studied the clinical and radiological outcomes of MIDLF. Our results indicate that MIDLF is effective and minimum invasive technique. Evidence of effectiveness of MIDLF is that patients had good recovery score, and that CBT screw technique was safety in clinical and stable in radiological. MIDLF with CBT screw provides the surgeon with additional options for fixation. This technique is most likely to be useful for treating lumbar spondylolisthesis in combination with midline decompression and insertion of an interbody graft, such as the transforaminal lumbar interbody fusion or posterior lumbar interbody fusion techniques. PMID:25169139

  17. Comparison of trunk and hip muscle activity during different degrees of lumbar and hip extension.

    PubMed

    Kim, Sang-Min; Yoo, Won-Gyu

    2015-09-01

    [Purpose] This study compared the activity of trunk and hip muscles during different degrees of lumbar and hip extension. [Subjects] The study enrolled 18 participants. [Methods] Two exercises (hip and lumbar extension) and two ranges (180° and <180°) were studied. [Results] Differences in degree of extension affected the percentage maximal voluntary isometric contraction of the lumbar erector spinae and biceps femoris muscles, with significantly higher average values at >180° than at 180° lumbar extension. No significant differences were found in gluteus maximus activity according to exercise type or range. [Conclusion] Hip extension may be more effective and safer for lumbar rehabilitation than lumbar extension. PMID:26504276

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

    PubMed Central

    GUO, SHUGUANG; SUN, JUNYING; TANG, GENLIN

    2013-01-01

    The aim of this study was to observe the clinical effects of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability. The 48 patients comprised 27 males and 21 females, aged 47–72 years. Three cases had first and second degree lumbar spondylolisthesis and all received bilateral vertebral lamina fenestration for posterior lumbar interbody fusion (PLIF) using a threaded fusion cage (TFC), which maintains the three-column spinal stability. Attention was given to ensure the correct pre-operative fenestration, complete decompression and the prevention of adhesions. After an average follow-up of 26.4 months, the one year post-operative X-ray radiographs suggested that the successful fusion rate was 88.1%, and this was 100% in the two-year post-operative radiographs. Moreover, the functional recovery rate was 97.9%. Bilateral vertebral lamina fenestration for lumbar interbody fusion is an ideal surgical method for the treatment of lower lumbar instability. The surgical method retains the spinal posterior column and middle column and results in full decompression and reliable fusion by a limited yet effective surgical approach. PMID:23407794

  19. The ubiquitinproteasome system in spongiform degenerative disorders Brandi R. Whatley, Lian Li , Lih-Shen Chin

    E-print Network

    Li, Lian

    Review The ubiquitin­proteasome system in spongiform degenerative disorders Brandi R. Whatley, Lian underlie the processes of spongiform change and neurodegeneration in the central nervous system that exhibit vacuolar change accom- panied by neural and/or glial cell death in the central nervous system

  20. Retinitis pigmentosa (RP) is a degenerative eye disease characterized by progressive loss of photoreceptors in the

    E-print Network

    Smith, Andrew D.

    Retinitis pigmentosa (RP) is a degenerative eye disease characterized by progressive loss Molecular Vision 1612 A profile of transcriptomic changes in the rd10 mouse model of retinitis pigmentosa determinants of RP [1]. However, we hope our study comparing the retinal tran- scriptomes of diseased and wild

  1. Teaching Early Braille Literacy Skills within a Stimulus Equivalence Paradigm to Children with Degenerative Visual Impairments

    ERIC Educational Resources Information Center

    Toussaint, Karen A.; Tiger, Jeffrey H.

    2010-01-01

    Despite the need for braille literacy, there has been little attempt to systematically evaluate braille-instruction programs. The current study evaluated an instructive procedure for teaching early braille-reading skills with 4 school-aged children with degenerative visual impairments. Following a series of pretests, braille instruction involved…

  2. Motor Training in Degenerative Spinocerebellar Disease: Ataxia-Specific Improvements by Intensive Physiotherapy and Exergames

    PubMed Central

    2014-01-01

    The cerebellum is essentially involved in movement control and plays a critical role in motor learning. It has remained controversial whether patients with degenerative cerebellar disease benefit from high-intensity coordinative training. Moreover, it remains unclear by which training methods and mechanisms these patients might improve their motor performance. Here, we review evidence from different high-intensity training studies in patients with degenerative spinocerebellar disease. These studies demonstrate that high-intensity coordinative training might lead to a significant benefit in patients with degenerative ataxia. This training might be based either on physiotherapy or on whole-body controlled videogames (“exergames”). The benefit shown in these studies is equal to regaining one or more years of natural disease progression. In addition, first case studies indicate that even subjects with advanced neurodegeneration might benefit from such training programs. For both types of training, the observed clinical improvements are paralleled by recoveries in ataxia-specific dysfunctions (e.g., multijoint coordination and dynamic stability). Importantly, for both types of training, the retention of the effects seems to depend on the frequency and continuity of training. Based on these studies, we here present preliminary recommendations for clinical practice, and articulate open questions that might guide future studies on neurorehabilitation in degenerative spinocerebellar disease. PMID:24877117

  3. Injectable electronics holds promise for basic neuroscience, treatment of neuro-degenerative diseases

    E-print Network

    Xie, Xiaoliang Sunney

    , an international team of researchers developed a method for fabricating nano-scale electronic scaffolds that canInjectable electronics holds promise for basic neuroscience, treatment of neuro- degenerative electronics through a metal needle into aqueous solution. Although the electronics appears to be a film

  4. Understanding Physiological and Degenerative Natural Vision Mechanisms to Define Contrast and Contour

    E-print Network

    Fouquet, Yannick

    Understanding Physiological and Degenerative Natural Vision Mechanisms to Define Contrast systems like neural networks based on lateral inhibition have a large field of applications in image processing, robotics and morphogenesis modeling. In this paper, we will propose some examples of dynamical

  5. [Extracorporeal shock wave therapy in athletes with degenerative and dystrophic disorders of locomotory system].

    PubMed

    Korchazhkina, N B; Mikha?lova, A A; Petrova, M S; Shchukin, A I; Ruzova, T K; Danilova, D P

    2013-01-01

    Degenerative and dystrophic changes of joints and ligaments are among the most prevalent disorders in professional athletes. Specification of a complex system for these diseases is an important task in sports medicine. Extracorporeal shock wave therapy is a modern and highly effective method of rehabilitation. PMID:24340767

  6. Positive outcomes of oil palm phenolics on degenerative diseases in animal models

    E-print Network

    Sinskey, Anthony J.

    Positive outcomes of oil palm phenolics on degenerative diseases in animal models Ravigadevi , Syed Fairus1 and Mohd Basri Wahid1 1 Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, 43000 Kajang, Selangor, Malaysia 2 Malaysian Palm Oil Council, 2nd Floor, Wisma Sawit, Lot 6, SS6

  7. Hepatocellular Carcinoma Supplied by the Right Lumbar Artery

    SciTech Connect

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

    2010-02-15

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

  8. Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery.

    PubMed

    Shamji, Mohammed F; Westwick, Harrison J; Heary, Robert F

    2015-10-01

    OBJECT Structural spinal surgery yields improvement in pain and disability for selected patients with spinal stenosis, spondylolisthesis, or a herniated intervertebral disc. A significant fraction of patients exhibit persistent postoperative neuropathic pain (PPNP) despite technically appropriate intervention, and such patients can benefit from spinal cord stimulation (SCS) to alleviate suffering. The complication profile of this therapy has not been systematically assessed and, thus, was the goal of this review. METHODS A comprehensive literature search was performed to identify prospective cohorts of patients who had PPNP following structurally corrective lumbar spinal surgery and who underwent SCS device implantation. Data about study design, technique of SCS lead introduction, and complications encountered were collected and analyzed. Comparisons of complication incidence were performed between percutaneously and surgically implanted systems, with the level of significance set at 0.05. RESULTS Review of 11 studies involving 542 patients formed the basis of this work: 2 randomized controlled trials and 9 prospective cohorts. Percutaneous implants were used in 4 studies and surgical implants were used in 4 studies; in the remainder, the types were undefined. Lead migration occurred in 12% of cases, pain at the site of the implantable pulse generator occurred in 9% of cases, and wound-related complications occurred in 5% of cases; the latter 2 occurred more frequently among surgically implanted devices. CONCLUSIONS Spinal cord stimulation can provide for improved pain and suffering and for decreased narcotic medication use among patients with PPNP after lumbar spinal surgery. This study reviewed the prospective studies forming the evidence base for this therapy, to summarize the complications encountered and, thus, best inform patients and clinicians considering its use. There is a significant rate of minor complications, many of which require further surgical intervention to manage, including lead migration or implant infection, although such complications do not directly threaten patient life or function. PMID:26424339

  9. Bilateral Renal Dysplasia, Nephroblastomatosis, and Bronchial Stenosis. A New Syndrome?

    PubMed Central

    Rodriguez, Maria Matilde; Correa-Medina, Mayrin; Whittington, Elizabeth E.

    2015-01-01

    Bilateral nephroblastomatosis (NB) is an uncommon renal anomaly characterized by multiple confluent nephrogenic rests scattered through both kidneys, with only a limited number of cases reported in the medical literature. Some of these children may have associated either Perlman or Beckwith–Wiedemann syndrome and others do not demonstrate syndromic features. We report a full-term boy with anteverted nose, bilateral bronchial stenosis due to lack of cartilage, bilateral obstructive renal dysplasia and NB with glomeruloid features. The infant had visceromegaly, but neither gigantism nor hemihypertrophy. Immunohistochemistry for PAX2 (Paired box gene-2) and WT-1 (Wilms Tumor 1) were strongly positive in the areas of NB. GLEPP-1 (Glomerular Epithelial Protein) did not stain the areas of NB with a glomeruloid appearance, but was positive in the renal glomeruli as expected. We found neither associated bronchial stenosis nor the histology of NB resembling giant glomeruli in any of the reported cases of NB. PMID:25871299

  10. Bilateral renal dysplasia, nephroblastomatosis, and bronchial stenosis. A new syndrome?

    PubMed

    Rodriguez, Maria Matilde; Correa-Medina, Mayrin; Whittington, Elizabeth E

    2015-06-01

    Bilateral nephroblastomatosis (NB) is an uncommon renal anomaly characterized by multiple confluent nephrogenic rests scattered through both kidneys, with only a limited number of cases reported in the medical literature. Some of these children may have associated either Perlman or Beckwith-Wiedemann syndrome and others do not demonstrate syndromic features. We report a full-term boy with anteverted nose, bilateral bronchial stenosis due to lack of cartilage, bilateral obstructive renal dysplasia and NB with glomeruloid features. The infant had visceromegaly, but neither gigantism nor hemihypertrophy. Immunohistochemistry for PAX2 (Paired box gene-2) and WT-1 (Wilms Tumor 1) were strongly positive in the areas of NB. GLEPP-1 (Glomerular Epithelial Protein) did not stain the areas of NB with a glomeruloid appearance, but was positive in the renal glomeruli as expected. We found neither associated bronchial stenosis nor the histology of NB resembling giant glomeruli in any of the reported cases of NB. PMID:25871299

  11. Computer-aided auscultation to diagnose Renal Artery Stenosis.

    PubMed

    Lund, Morten Enemark; Buur, Tom; Schmidt, Samuel Emil; Struijk, Johannes Jan

    2010-01-01

    Renal Artery Stenosis (RAS) is the most common cause of secondary hypertension, and early diagnosis is important since correct and timely treatment may cure hypertension and prevent loss of renal function. This study investigates a new approach to diagnosing renal artery stenosis by computer analysis of the phonogram recorded with an electronic stethoscope. Phonograms recorded from five positions over the renal arteries were obtained, three from patients with confirmed RAS and 15 from healthy subjects. Two features describing the power ratios between the systolic and diastolic periods in two different frequency bands were extracted. It was possible to discriminate all three RAS subjects from the healthy subjects in the frequency band 0.4-1.1 kHz. However, the number of subjects is insufficient to draw statistically significant conclusions about the performance of the system. PMID:21095799

  12. Compressive pancreaticoduodenal artery aneurysm associated with celiac artery stenosis.

    PubMed

    Wattez, Hélène; Lancelevée, Julien; Perot, Céline; Massouille, David; Chambon, Jean-Pierre

    2013-11-01

    Peripancreatic artery aneurysms are a rare condition, representing <2% of all splanchnic artery aneurysms, and have been significantly related to celiac axis stenosis. While they are most often asymptomatic, those aneurysms have a strong tendency to rupture (52% rupture rate at the initial presentation) and, in this case, the outcome is often dramatic. Given that reports of this disease are rare, appropriate guidelines are difficult to formulate and different treatment strategies have been proposed. Endovascular management seems to be efficient in the large majority of most recent reports, but open surgery still remains necessary for complex cases, especially when associated with celiac axis stenosis. We report a new occurrence of a symptomatic compressive aneurysm related to common bile duct compression that we treated using a hybrid procedure. PMID:23988551

  13. MODEL VALIDATION FOR A NONINVASIVE ARTERIAL STENOSIS DETECTION PROBLEM

    PubMed Central

    BANKS, H. THOMAS; HU, SHUHUA; KENZ, ZACKARY R.; KRUSE, CAROLA; SHAW, SIMON; WHITEMAN, JOHN; BREWIN, MARK P.; GREENWALD, STEPHEN E.; BIRCH, MALCOLM J.

    2014-01-01

    A current thrust in medical research is the development of a non-invasive method for detection, localization, and characterization of an arterial stenosis (a blockage or partial blockage in an artery). A method has been proposed to detect shear waves in the chest cavity which have been generated by disturbances in the blood flow resulting from a stenosis. In order to develop this methodology further, we use one-dimensional shear wave experimental data from novel acoustic phantoms to validate a corresponding viscoelastic mathematical model. We estimate model parameters which give a good fit (in a sense to be precisely defined) to the experimental data, and use asymptotic error theory to provide confidence intervals for parameter estimates. Finally, since a robust error model is necessary for accurate parameter estimates and confidence analysis, we include a comparison of absolute and relative models for measurement error. PMID:24506547

  14. Schizophrenic psychosis associated with aqueduct stenosis in adults.

    PubMed Central

    Roberts, J K; Trimble, M R; Robertson, M

    1983-01-01

    The case histories of five adult patients with hydrocephalus and aqueduct stenosis are presented. All the cases were associated with prominent psychotic symptoms (delusions, hallucinations or thought disorder). In the three cases where operative intervention was carried out the diagnosis was made in adult life. Using the Present State Examination all five cases were classified as having schizophrenic psychosis. The possible reasons for this association are discussed. PMID:6644313

  15. Urinary kallidinogenase for the treatment of cerebral arterial stenosis

    PubMed Central

    Zhao, Liandong; Zhao, Ying; Wan, Qi; Zhang, Haijun

    2015-01-01

    Aim Urinary kallidinogenase (UK) has shown promise in improving cerebral perfusion. This study aimed to examine how UK affects cognitive status and serum levels of amyloid betas (A?s) 1-40 and 1-42 in patients with cerebral arterial stenosis. Methods Ninety patients with cerebral arterial stenosis were enrolled, of whom 45 patients received UK + conventional treatment (UK group), and 45 patients received conventional treatment alone as control group. Cognitive status and A?1-40 and A?1-42 serum levels were determined before treatment and at 4 weeks and 8 weeks after treatment. Results At 4 weeks after treatment, cognitive status in patients treated with UK clearly improved accompanied by A?1-40 serum levels decreasing while there was no change of A?1-42. Cognitive status in patients receiving UK continued to improve, A?1-40 serum levels declined further as well as A?1-42 serum levels began to decrease dramatically at 8 weeks after treatment. Conclusion UK could improve cognitive status and decrease both A?1-40 and A?1-42 serum levels to prevent ischemic cerebral injury, which represents a good option for patients with cerebral arterial stenosis. PMID:26508834

  16. The role of carotid stenosis in vascular cognitive impairment.

    PubMed

    Rao, R

    2002-11-15

    As the contribution of carotid stenosis to cognitive impairment still remains unclear, neuropsychological function and soft neurological signs were examined in patients aged 65 and over. Twenty-five patients with symptomatic carotid stenosis (CS) of 75% or more were compared with 25 patients with first anterior circulation stroke, 25 with peripheral vascular disease and 25 healthy controls. All patients were assessed using CAMCOG (Cambridge Cognitive Examination), tests examining frontal lobe function (Behavioural Dyscontrol Scale [BDYS], Trail-Making Tests A and B, Controlled Word Association Test) and a scale for primitive reflexes (Frontal Release Signs Scale). Patients with symptomatic CS showed greater global impairment on CAMCOG and more severe impairment in frontal lobe function than controls. Those patients scoring less than 15 on the BDYS were more likely to have experienced transient ischemic attacks (TIA) for 5 or more years. Frontal lobe dysfunction, suicidal thinking and age were all independent predictors of global cognitive impairment. Mean number of frontal release signs was higher in patients with CS than in controls, with a higher proportion of patients showing all release signs except glabellar, paratonia and snout reflexes. The study is limited by small numbers and the absence of brain imaging, but provides some evidence for an association between severe carotid stenosis and neuropsychological impairment. The presence of clinically 'silent' cerebrovascular disease affecting frontal lobe function may be missed in routine clinical practice. PMID:12417366

  17. Finite Element Analysis of a New Pedicle Screw-Plate System for Minimally Invasive Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Zhou, Yue; Li, Changqing; Liu, Huan

    2015-01-01

    Purpose Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is increasingly popular for the surgical treatment of degenerative lumbar disc diseases. The constructs intended for segmental stability are varied in MI-TLIF. We adopted finite element (FE) analysis to compare the stability after different construct fixations using interbody cage with posterior pedicle screw-rod or pedicle screw-plate instrumentation system. Methods A L3–S1 FE model was modified to simulate decompression and fusion at L4–L5 segment. Fixation modes included unilateral plate (UP), unilateral rod (UR), bilateral plate (BP), bilateral rod (BR) and UP+UR fixation. The inferior surface of the S1 vertebra remained immobilized throughout the load simulation, and a bending moment of 7.5 Nm with 400N pre-load was applied on the L3 vertebra to recreate flexion, extension, lateral bending, and axial rotation. Range of motion (ROM) and Von Mises stress were evaluated for intact and instrumentation models in all loading planes. Results All reconstructive conditions displayed decreased motion at L4–L5. The pedicle screw-plate system offered equal ROM to pedicle screw-rod system in unilateral or bilateral fixation modes respectively. Pedicle screw stresses for plate system were 2.2 times greater than those for rod system in left lateral bending under unilateral fixation. Stresses for plate were 3.1 times greater than those for rod in right axial rotation under bilateral fixation. Stresses on intervertebral graft for plate system were similar to rod system in unilateral and bilateral fixation modes respectively. Increased ROM and posterior instrumentation stresses were observed in all loading modes with unilateral fixation compared with bilateral fixation in both systems. Conclusions Transforaminal lumbar interbody fusion augmentation with pedicle screw-plate system fixation increases fusion construct stability equally to the pedicle screw-rod system. Increased posterior instrumentation stresses are observed in all loading modes with plate fixation, and bilateral fixation could reduce stress concentration. PMID:26649749

  18. [Topography, relations and transformation of lumbar lymphatic sacs].

    PubMed

    Sharkus, Ye A

    2015-01-01

    The peculiarities of the structure, skeletotopy, and syntopy of the lumbar lymphatic collector were studied on 20 5-8 week-old embryos and on 80 9-36 week-old fetuses using a complex macro-microscopic method. It is found that the lumbar lymphatic collector in fetuses at 9-10 weeks was represented by retroperitoneal and retroaortic lymphatic sacs that had a fusion mode of formation and were interconnected. Retroperitoneal sac was located in the projection of L(I)-L(IV) and was in contact with the anterior surface of the abdominal aorta and inferior vena cava, aortic lumbar paraganglia, abdominal aortic plexus and ganglia of sympathetic trunk. Retroaortic sack at L(I)-L(II) was adjacent to posterior surface of the aorta, the lumbar vertebrae and the medial crus of the diaphragm. These topical relations were preserved throughout the whole fetal period. However, in fetuses of 11-13 weeks lymphatic sacs formed the lymphatic plexuses, while in fetuses of 14-36 weeks they formed lumbar lymph nodes and their interconnecting vessels. PMID:25958724

  19. Embolization of Isolated Lumbar Artery Injuries in Trauma Patients

    SciTech Connect

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

    2005-12-15

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

  20. Open and Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Intermediate Results and Complications

    PubMed Central

    Hee, Hwan Tak

    2015-01-01

    Study Design Prospective study. Purpose To compare clinical and radiological outcomes of open vs. minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Overview of Literature MI-TLIF promises smaller incisions and less soft tissue dissection resulting in lower morbidity and faster recovery; however, it is technically challenging. Methods Twenty-five patients with MI-TLIF were compared with 25 matched open TLIF controls. A minimum 2 year follow-up and a statistical analysis of perioperative and long-term outcomes were performed. Potential complications were recorded. Results The mean ages for the open and MI-TLIF cases were 44.4 years (range, 19-69 years) and 43.6 years (range, 20-69 years), respectively. The male:female ratio was 13:12 for both groups. Average follow-up was 26.9 months for the MI-TLIF group and 29.3 months for the open group. Operative duration was significantly longer in the MI-TLIF group than that in the open group (p<0.05). No differences in estimated blood loss, duration to ambulation, or length of stay were found. Significant improvements in the Oswestry disability index and EQ-5D functional scores were observed at 6-, 12-, and 24-months in both groups, but no significant difference was detected between the groups. Fusion rates were comparable. Cage sizes were significantly smaller in the MI-TLIF group at the L5/S1 level (p<0.05). One patient had residual spinal stenosis at the MI-TLIF level, and one patient who underwent two-level MI-TLIF developed a deep vein thrombosis resulting in a pulmonary embolism. Conclusions MI-TLIF and open TLIF had comparable long-term benefits. Due to technical constraints, patients should be advised on the longer operative time and potential undersizing of cages at the L5S1 level. PMID:25901228

  1. Low back pain and lumbar angles in Turkish coal miners

    SciTech Connect

    Sarikaya, S.; Ozdolap, S.; Gumustas, S.; Koc, U.

    2007-02-15

    This study was designed to assess the incidence of low back pain among Turkish coal miners and to investigate the relationship between angles of the lumbar spine and low back pain in coal miners. Fifty underground workers (Group I) and 38 age-matched surface workers (Group II) were included in the study. All the subjects were asked about low back pain in the past 5 years. The prevalence of low back pain was higher in Group I than in Group II (78.0%, 32.4%, respectively, P {lt} 0.001). The results of the study showed that low back pain occurred in 78.0% of Turkish coal miners. Although the nature of the occupation may have influenced coal miners' lumbar spinal curvature, lumbar angles are not a determinant for low back pain in this population. Further extensive studies involving ergonomic measurements are needed to validate our results for Turkish coal mining industry.

  2. Sex determination by discriminant function analysis of lumbar vertebrae.

    PubMed

    Ostrofsky, Kelly R; Churchill, Steven E

    2015-01-01

    Sex determination is critical for developing the biological profile of unidentified skeletal remains. When more commonly used elements (os coxa, cranium) for sexing are not available, methods utilizing other skeletal elements are needed. This study aims to assess the degree of sexual dimorphism of the lumbar vertebrae and develop discriminant functions for sex determination from them, using a sample of South African blacks from the Raymond A. Dart Collection (47 males, 51 females). Eleven variables at each lumbar level were subjected to univariate and multivariate discriminant function analyses. Univariate equations produced classification rates ranging from 57.7% to 83.5%, with the highest accuracies associated with dimensions of the vertebral body. Multivariate stepwise analysis generated classification rates ranging from 75.9% to 88.7%. These results are comparable to other methods for sexing the skeleton and indicate that measures of the lumbar vertebrae can be used as an effective tool for sex determination. PMID:25382679

  3. Posterior lumbar interbody fusion and posterolateral fusion: Analogous procedures in decreasing the index of disability in patients with spondylolisthesis

    PubMed Central

    Alijani, Babak; Emamhadi, Mohamahreza; Behzadnia, Hamid; Aramnia, Ali; Chabok, Shahrokh Yousefzadeh; Ramtinfar, Sara; Leili, Ehsan Kazemnejad; Golmohamadi, Shabnam

    2015-01-01

    Objective: The purpose of this study was to evaluate the disability in patients with spondylolisthesis who assigned either to posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF) and to compare it between two groups. Methods: In a prospective observational study, 102 surgical candidates with low-grade degenerative and isthmic spondylolisthesis enrolled from 2012 to 2014, and randomly assigned into two groups: PLF and PLIF. Evaluation of disability has been done by a questionnaire using Oswestry Disability Index (ODI). The questionnaire was completed by all patients before the surgery, the day after surgery, after 6 months and after 1-year. Results: There were no statistically significant differences in terms of age and sex distribution and pre-operation ODI between groups (P > 0.05). Comparison of the mean ODI scores of two groups over the whole study period showed no significant statistical difference (P = 0.074). ODIs also showed no significant differences between two groups the day after surgery, 6th months and 1-year after surgery (P = 0.385, P = 0.093, P = 0.122 and P = 433) respectively. Analyzing the course of ODI over the study period, showed a significant descending pattern for either of groups (P < 0.0001). Conclusion: Both surgical fusion techniques (PLF and PLIF) were efficient to lessen the disability of patients with spondylolisthesis, and none of the fusion techniques were related to a better outcome in terms of disability. PMID:25767584

  4. Clinical outcomes after treatment with disc prostheses in three lumbar segments compared to one- or two segments

    PubMed Central

    Gillberg-Aronsson, Nina

    2015-01-01

    Background Fusion surgery in the rare patients suffering from symptomatic degenerative disc disease (DDD) at three segments has been reported to produce poor results and a high frequency of complications, why patients suffering from DDD at three segments are seldom offered surgical treatment. Purpose To compare clinical outcome after one- and two years, between patients that have undergone disc replacement surgery (TDR) at three segments and patients that have been treated at less segments. Methods The present study is based on data recorded in the Swedish Spine Registry (SweSpine). The study group consisted of 30 patients who underwent three-segment TDR, the comparative group of 700 patients treated in one or two segments. Analyses included comparisons of preoperative data, postoperative results and improvement from baseline. Results Our results showed no differences in outcome between groups at one- and two years postoperatively. Improvements achieved after surgery in both groups well exceeded established values for minimally clinically important difference (MCID). Conclusions The results of this study show that patients with a diagnosis of therapy-resistant chronic low back pain (CLBP) due to DDD in one, two or even three lumbar segments achieve similar and good results after TDR surgery. Clinical relevance The rare patients with severe and convincing DDD from three segments might in carefully selected cases be offered surgery, with a reasonable chance of a beneficial outcome. PMID:26512343

  5. Genetic Association Studies in Lumbar Disc Degeneration: A Systematic Review

    PubMed Central

    Eskola, Pasi J.; Lemmelä, Susanna; Kjaer, Per; Solovieva, Svetlana; Männikkö, Minna; Tommerup, Niels; Lind-Thomsen, Allan; Husgafvel-Pursiainen, Kirsti; Cheung, Kenneth M. C.; Chan, Danny

    2012-01-01

    Objective Low back pain is associated with lumbar disc degeneration, which is mainly due to genetic predisposition. The objective of this study was to perform a systematic review to evaluate genetic association studies in lumbar disc degeneration as defined on magnetic resonance imaging (MRI) in humans. Methods A systematic literature search was conducted in MEDLINE, MEDLINE In-Process, SCOPUS, ISI Web of Science, The Genetic Association Database and The Human Genome Epidemiology Network for information published between 1990–2011 addressing genes and lumbar disc degeneration. Two investigators independently identified studies to determine inclusion, after which they performed data extraction and analysis. The level of cumulative genetic association evidence was analyzed according to The HuGENet Working Group guidelines. Results Fifty-two studies were included for review. Forty-eight studies reported at least one positive association between a genetic marker and lumbar disc degeneration. The phenotype definition of lumbar disc degeneration was highly variable between the studies and replications were inconsistent. Most of the associations presented with a weak level of evidence. The level of evidence was moderate for ASPN (D-repeat), COL11A1 (rs1676486), GDF5 (rs143383), SKT (rs16924573), THBS2 (rs9406328) and MMP9 (rs17576). Conclusions Based on this first extensive systematic review on the topic, the credibility of reported genetic associations is mostly weak. Clear definition of lumbar disc degeneration phenotypes and large population-based cohorts are needed. An international consortium is needed to standardize genetic association studies in relation to disc degeneration. PMID:23185509

  6. Lumbopelvic parameters and the extent of lumbar fusion

    PubMed Central

    Nguyen, Ha Son; Yoganandan, Narayan; Maiman, Dennis

    2015-01-01

    Background: Following lumbar fusion, sacroiliac (SI) joint pain has been regarded as a form of adjacent segment disease. Prior studies suggest increased stress to the SI joint and pelvis with lumbar fusion. Limited studies have evaluated the relationship between the extent of lumbar fusion and its potential influence on lumbopelvic parameters, which may provide the insights to persistent back pain. Methods: Three hundred fifty-five patients underwent lumbar fusions at our institution between fall 2010 and winter 2012; 80 patients met criteria for the study. Inclusion criteria included appropriate imaging available (preoperative and postoperative lateral films), follow-up >1-year, fusion where the rostral extent was up to L1 and the caudal extent was at most S1. Exclusion criteria included prior lumbar fusion, history of SI joint syndrome, follow-up <1-year, fusion involving thoracic levels, and inadequate films (inability to visualize appropriate anatomy). The patients were divided into groups based on the extent of fusion. The patients were evaluated based on age, sex, diagnosis, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope. The preoperative values were compared among the groups, the postoperative values were compared among the groups, and the pre- and post-operative values were compared within each group. Results: There were no statistically significant differences between pre- and post-operative lumbopelvic parameters within each fusion group. Conclusion: The results imply that the extent of instrumentation, including the involvement of the sacrum, may not alter lumbopelvic parameters. This appears to argue against the idea that longer fusion constructs induce more stress on the pelvis and SI joint. PMID:26543673

  7. Repeated microendoscopic discectomy for recurrent lumbar disk herniation

    PubMed Central

    Hou, Tianyong; Zhou, Qiang; Dai, Fei; Luo, Fei; He, Qingyi; Zhang, Jinsong; Xu, Jianzhong

    2015-01-01

    OBJECTIVES: To explore the microendoscopic discectomy technique and inclusion criteria for the treatment of recurrent lumbar disc herniation and to supply feasible criteria and technical notes to avoid complications and to increase the therapeutic effect. METHODS: A consecutive series of 25 patients who underwent posterior microendoscopic discectomy for recurrent lumbar disc herniation were included. The inclusion criteria were as follows: no severe pain in the lumbar region, no lumbar instability observed by flexion-extension radiography and no intervertebral discitis or endplate damage observed by magnetic resonance imaging. All patients were diagnosed by clinical manifestations and imaging examinations. RESULTS: Follow-up visits were carried out in all cases. Complications, such as nerve injuries, were not observed. The follow-up outcomes were graded using the MacNab criteria. A grade of excellent was given to 12 patients, good to 12 patients and fair to 1 patient. A grade of excellent or good occurred in 96% of cases. One patient relapsed 3 months after surgery and then underwent lumbar interbody fusion and inner fixation. The numerical rating scale of preoperative leg pain was 7.4± 1.5, whereas it decreased to 2.1±0.8 at 7 days after surgery. The preoperative Oswestry disability index of lumbar function was 57.5±10.0, whereas it was 26.0±8.5 at 7 days after surgery. CONCLUSION: In these cases, microendoscopic discectomy was able to achieve satisfactory clinical results. Furthermore, it has advantages over other methods because of its smaller incision, reduced bleeding and more efficient recovery. PMID:25789521

  8. APOE gene polymorphism and risk of coronary stenosis in Pakistani population.

    PubMed

    Cheema, Asma Naseer; Bhatti, Attya; Wang, Xingbin; Ali, Jabar; Bamne, Mikhil N; Demirci, F Yesim; Kamboh, M Ilyas

    2015-01-01

    Genetic variation in lipid regulatory genes, particularly APOE, significantly influences the risk of coronary artery disease (CAD). This study aimed to assess the association between APOE polymorphism and angiographically assessed coronary stenosis in Pakistani population. A total of 695 subjects (22.3% female, mean age = 54 ± 11 years) presenting with chest pain were enrolled after obtaining written informed consent. CAD stenosis/extent was assessed by angiography. Patients were classified as having severe stenosis (? 70%), moderate stenosis (30-69%), and mild stenosis (<30%). CAD patients with ? 70% stenosis (n = 491) were further categorized based on possessing one, two, or three vessel diseases to assess the disease extent. Genomic DNA from leukocytes was isolated with DNA purification kit (Qiagen) and APOE polymorphisms (E2/E3/E4) were determined using TaqMan assays. Six hundred and seventy-two of 695 subjects were successfully genotyped. The frequency of APOE?4 carriers (3/4 and 4/4 genotypes) was significantly higher in severe stenosis group (? 70%) as compared to mild group (<30%) (22.8% versus 13.01%; P = 0.01). In multiple regression, the odds ratio for APOE?4 carriers to develop ? 70% stenosis was 2.16 (95% CI: 1.29-3.79; P < 0.005). In conclusion, the presence of APOE?4 allele is a significant risk factor to develop severe coronary stenosis (>70%) among Pakistanis. PMID:25883965

  9. Renal Transplant Ureteral Stenosis: Treatment by Self-Expanding Metallic Stent

    SciTech Connect

    Cantasdemir, Murat; Kantarci, Fatih; Numan, Furuzan; Mihmanli, Ismail; Kalender, Betul

    2003-02-15

    We report the use of a metallic stent in a transplant ureteral stenosis. A 28-year-old man with chronic renal failure due to chronic pyelonephritis, who received a living-donor renal transplant, presented with transplant ureteral stenosis. The stenosis was unresponsive to balloon dilation and was treated by antegrade placement of a self-expanding Memotherm stent. The stentedureter stayed patent for 3 years. It may be reasonable to treat post-transplant ureteral stenosis resistant to balloon dilation with self-expanding metallic stents. However, long-term follow-up is required to evaluate the efficacy of this treatment.

  10. Treatment of lumbar disc herniation: Evidence-based practice

    PubMed Central

    Schoenfeld, Andrew J; Weiner, Bradley K

    2010-01-01

    Clinical question: What is the best treatment for lumbar disc herniations? Results: For patients failing six weeks of conservative care, the current literature supports surgical intervention or prolonged conservative management as appropriate treatment options for lumbar radiculopathy in the setting of disc herniation. Surgical intervention may result in more rapid relief of symptoms and restoration of function. Implementation: While surgery appears to provide more rapid relief, many patients will gradually get better with continued nonoperative management; thus, patient education and active participation in decision-making is vital. PMID:20689695

  11. The “Reverse” Latissimus Dorsi Flap for Large Lower Lumbar Defect

    PubMed Central

    Kotti, Bouraoui; Jaidane, Olfa; Ben Hassouna, Jamel; Rahal, Khaled

    2012-01-01

    The latissimus dorsi (LD) flap is one of the most common flaps used in plastic surgery based on its dominant thoracodorsal pedicle as well as free tissue transfer. The “distally based” or “reverse” fashion design has been used to repair myelomeningoceles, congenital diaphragmatic agenesis, or thoracolumbar defects. We present a case of a large lumbar defect after cancer resection covered by a combined tegument solution starring the “reverse” LD flap in its muscular version with a cutaneous gluteal flap. This flap is a safe and reliable way to cover large distal lumbar defect. PMID:23082273

  12. Recent advances in lumbar mechanics with relevance to clinicians

    PubMed Central

    McGill, Stuart M

    1989-01-01

    Perhaps the singular, most important impediment to universal recognition of chiropractic as a legitimate and mature health care alternative is the absence of a developed mechanical knowledge of chiropractic techniques. The purpose of this review paper was to describe, and to some extent critique, some recent research pertaining to mechanics of the lumbar spine and to illustrate the relevance to clinical chiropractic. Specific contentious issues addressed include discussion of the mechanical relationship of intra-abdominal pressure, the lumbodorsal fascia, muscle-ligament interplay and the abdominal musculature with the lumbar spine. Directions or future research are proposed given the pressing need to provide a rationale for, and explanation of, specific chiropractic treatment.

  13. Lumbar periradicular abscess mimicking a fragmented lumbar disc herniation : an unusual case.

    PubMed

    Bakar, Bulent; Tekkok, Ismail Hakki

    2008-12-01

    We herein describe the case of a focal spontaneous spinal epidural abscess who was initially diagnosed to have a free fragment of a lumbar disc. A 71-year-old woman presented with history of low back and right leg pain. Magnetic resonance imaging suggested a peripherally enhancing free fragment extending down from S1 nerve root axilla. Preoperative laboratory investigation showed elevation of c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels. She was taken for surgery and a fluctuating mass at the axilla of S1 nerve was found. When the mass was probed with a dissector, a dark yellow, thick pus drained out. Pus cultures were negative. Patients who present with extreme low back plus leg pain and increased leucocyte count, ESR and CRP levels should raise the suspicion of an infection of a vertebral body or spinal epidural space. PMID:19137084

  14. Regeneration of the retina: toward stem cell therapy for degenerative retinal diseases

    PubMed Central

    Jeon, Sohee; Oh, Il-Hoan

    2015-01-01

    Degenerative retinal diseases affect millions of people worldwide, which can lead to the loss of vision. However, therapeutic approaches that can reverse this process are limited. Recent efforts have allowed the possibility of the stem cell-based regeneration of retinal cells and repair of injured retinal tissues. Although the direct differentiation of pluripotent stem cells into terminally differentiated photoreceptor cells comprises one approach, a series of studies revealed the intrinsic regenerative potential of the retina using endogenous retinal stem cells. Muller glial cells, ciliary pigment epithelial cells, and retinal pigment epithelial cells are candidates for such retinal stem cells that can differentiate into multiple types of retinal cells and be integrated into injured or developing retina. In this review, we explore our current understanding of the cellular identity of these candidate retinal stem cells and their therapeutic potential for cell therapy against degenerative retinal diseases. [BMB Reports 2015; 48(4): 193-199] PMID:25560700

  15. [Dissertations 25 years after date 28. Degenerative diseases of the temporomandibular joint].

    PubMed

    de Bont, L G M

    2011-09-01

    In 1985, the dissertation 'Temporomandibular joint. Articular cartilage structure and function' was published. Much was known at the time concerning the (clinical) pathogenesis of osteoarthrosis of the temporomandibuIar joint, the associated radiographical characteristics and the results of non-surgical treatment. Little was known, however, concerning the processes that lead to the loss of bone tissue and other degenerative changes. The current idea that osteoarthrosis was histopathologically characterized by defects in the joint surfaces did not seem to apply to temporomandibular joints. In temporomandibular joints, the phenomenon was recognized of degenerative changes in the deeper layers of the articular cartilage and the subchondral bone, while the articular surface could be microscopically intact. A dislocated articular disc was seen as part of the disease osteoarthrosis. Clear insight into the origins of osteoarthrosis was not achieved. PMID:21957640

  16. Neuroimaging and Genetic Risk for Alzheimer’s Disease and Addiction-Related Degenerative Brain Disorders

    PubMed Central

    Jahanshad, Neda; Leonardo, Cassandra D.; Thompson, Paul M.

    2014-01-01

    Neuroimaging offers a powerful means to assess the trajectory of brain degeneration in a variety of disorders, including Alzheimer’s disease (AD). Here we describe how multimodal imaging can be used to study the changing brain during the different stages of AD. We integrate findings from a range of studies using magnetic resonance imaging (MRI), positron emission tomography (PET), functional MRI (fMRI) and diffusion weighted imaging (DWI). Neuroimaging reveals how risk genes for degenerative disorders affect the brain, including several recently discovered genetic variants that may disrupt brain connectivity. We review some recent neuroimaging studies of genetic polymorphisms associated with increased risk for late-onset Alzheimer’s disease (LOAD). Some genetic variants that increase risk for drug addiction may overlap with those associated with degenerative brain disorders. These common associations offer new insight into mechanisms underlying neurodegeneration and addictive behaviors, and may offer new leads for treating them before severe and irreversible neurological symptoms appear. PMID:24142306

  17. Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Recurrent Disc Herniation

    PubMed Central

    Lee, Dong Yeob; Shim, Chan Shik; Ahn, Yong; Choi, Young-Geun; Kim, Ho Jin

    2009-01-01

    Objective The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation. Methods Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging. Results Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups. Conclusion Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation. PMID:20062565

  18. Endovascular Treatment of 2 True Degenerative Aneurysms of Superficial Femoral Arteries.

    PubMed

    Lyazidi, Youssef; Abissegue, Yves; Chtata, Hassan; Taberkant, Mustapha

    2016-01-01

    We report the rare observation of a 58-year-old patient presenting 2 degenerative aneurysms of the superficial femoral arteries, with a rupture of the right aneurysm, treated by covered stents, with a satisfying midterm follow-up. The endovascular approach is a minimally invasive procedure which should be proposed as the first-line treatment to all the patients presenting aneurysms of the superficial femoral arteries, both asymptomatic as complicated. PMID:26363428

  19. Breed Distribution of SOD1 Alleles Previously Associated with Canine Degenerative Myelopathy

    PubMed Central

    Zeng, R; Coates, JR; Johnson, GC; Hansen, L; Awano, T; Kolicheski, A; Ivansson, E; Perloski, M; Lindblad-Toh, K; O'Brien, DP; Guo, J; Katz, ML; Johnson, GS

    2014-01-01

    Background Previous reports associated 2 mutant SOD1 alleles (SOD1:c.118A and SOD1:c.52T) with degenerative myelopathy in 6 canine breeds. The distribution of these alleles in other breeds has not been reported. Objective To describe the distribution of SOD1:c.118A and SOD1:c.52T in 222 breeds. Animals DNA from 33,747 dogs was genotyped at SOD1:c.118, SOD1:c.52, or both. Spinal cord sections from 249 of these dogs were examined. Methods Retrospective analysis of 35,359 previously determined genotypes at SOD1:c.118G>A or SOD1:c.52A>T and prospective survey to update the clinical status of a subset of dogs from which samples were obtained with a relatively low ascertainment bias. Results The SOD1:c.118A allele was found in cross-bred dogs and in 124 different canine breeds whereas the SOD1:c.52T allele was only found in Bernese Mountain Dogs. Most of the dogs with histopathologically confirmed degenerative myelopathy were SOD1:c.118A homozygotes, but 8 dogs with histopathologically confirmed degenerative myelopathy were SOD1:c.118A/G heterozygotes and had no other sequence variants in their SOD1 amino acid coding regions. The updated clinical conditions of dogs from which samples were obtained with a relatively low ascertainment bias suggest that SOD1:c.118A homozygotes are at a much higher risk of developing degenerative myelopathy than are SOD1:c.118A/G heterozygotes. Conclusions and Clinical Importance We conclude that the SOD1:c.118A allele is widespread and common among privately owned dogs whereas the SOD1:c.52T allele is rare and appears to be limited to Bernese Mountain Dogs. We also conclude that breeding to avoid the production of SOD1:c.118A homozygotes is a rational strategy. PMID:24524809

  20. Evolution of a New Function by Degenerative Mutation in Cephalochordate Steroid Receptors

    PubMed Central

    Bridgham, Jamie T.; Brown, Justine E.; Rodríguez-Marí, Adriana; Catchen, Julian M.; Thornton, Joseph W.

    2008-01-01

    Gene duplication is the predominant mechanism for the evolution of new genes. Major existing models of this process assume that duplicate genes are redundant; degenerative mutations in one copy can therefore accumulate close to neutrally, usually leading to loss from the genome. When gene products dimerize or interact with other molecules for their functions, however, degenerative mutations in one copy may produce repressor alleles that inhibit the function of the other and are therefore exposed to selection. Here, we describe the evolution of a duplicate repressor by simple degenerative mutations in the steroid hormone receptors (SRs), a biologically crucial vertebrate gene family. We isolated and characterized the SRs of the cephalochordate Branchiostoma floridae, which diverged from other chordates just after duplication of the ancestral SR. The B. floridae genome contains two SRs: BfER, an ortholog of the vertebrate estrogen receptors, and BfSR, an ortholog of the vertebrate receptors for androgens, progestins, and corticosteroids. BfSR is specifically activated by estrogens and recognizes estrogen response elements (EREs) in DNA; BfER does not activate transcription in response to steroid hormones but binds EREs, where it competitively represses BfSR. The two genes are partially coexpressed, particularly in ovary and testis, suggesting an ancient role in germ cell development. These results corroborate previous findings that the ancestral steroid receptor was estrogen-sensitive and indicate that, after duplication, BfSR retained the ancestral function, while BfER evolved the capacity to negatively regulate BfSR. Either of two historical mutations that occurred during BfER evolution is sufficient to generate a competitive repressor. Our findings suggest that after duplication of genes whose functions depend on specific molecular interactions, high-probability degenerative mutations can yield novel functions, which are then exposed to positive or negative selection; in either case, the probability of neofunctionalization relative to gene loss is increased compared to existing models. PMID:18787702

  1. Study of metabolism and energetics in hypogravity: Degenerative effects of prolonged hypogravity

    NASA Technical Reports Server (NTRS)

    Siegel, S. M.

    1976-01-01

    The role of gravity in the formation of rigid, lignified plant cell walls hence to the development of the erect land plant body is examined. An experiment was proposed with a general hypothesis that a chosen plant, a dwarf marigold, would display degenerative changes in mechanical supportive systems under hypogravity because normal lignin-cellulose wall structure fails to develop. Observational and experimental results are given.

  2. A Perspective on the Role of the Extracellular Matrix in Progressive Retinal Degenerative Disorders

    PubMed Central

    Al-Ubaidi, Muayyad R.; Naash, Muna I.; Conley, Shannon M.

    2013-01-01

    Progressive inherited retinal degenerative disorders (PIRDDs) are the leading cause of blindness in developed countries, with AMD and RP constituting the majority of PIRDDs. Currently, over 8 million Americans have PIRDDs, and that number is estimated to drastically increase by the end of this decade. Although a mutant protein is expressed starting early during retinal development in patients with PIRDDs, symptoms of retinal degeneration do not manifest until much later. Historically, research has focused on understanding the role a mutation has in the function of a protein and what role the mutant protein has in the disease process. However, it remains unknown why the disease, irrespective of the mutation, manifests clinically much later in life, while cellular indicators of disease (e.g., accumulation of toxic protein products and cell death) occur throughout early and middle life. Herein, we propose that there exists a time point at which the degenerative process is accelerated, leading to the appearance of clinical symptoms. This point is defined by structural disruptions of the extracellular matrix (ECM). Death of a critical number of ECM-maintaining mutant protein–expressing retinal cells contributes to that break point in the degenerative process. Therefore, it is important to understand the changes occurring at the ECM during PIRDDs and to take that into account when therapeutic approaches are designed. PMID:24346621

  3. The morphology of lumbar sympathetic trunk in humans: a cadaveric study.

    PubMed

    Gandhi, K R; Verma, V K; Chavan, S K; Joshi, S D; Joshi, S S

    2013-08-01

    The vasospastic diseases and chronic pain related to lower limb have been successfully treated by surgical ablation of lumbar sympathetic trunk for last 80 years.Precise knowledge of anatomy of lumbar sympathetic trunk and its adjoining structures is mandatory for safe and uncomplicated lumbar and spinal surgeries.We aim to study the detailed anatomy of entry and exit of lumbar sympathetic trunk, the number, dimensions and location of lumbar ganglia in relation to lumbar vertebra. Thorough dissection was carried out in 30 formalin embalmed cadavers available in the Department of Anatomy, Pravara Institute of Medical Sciences (PIMS), Rural Medical College (RMC), Loni, Maharashtra. A total of 238 ganglia were observed in 60 lumbar sympathetic trunks. The sympathetic trunk traversed dorsal to the crus of diaphragm in 72.6% and in 13.3% it entered dorsal to the medial arcuate ligament. The most common site of the location of lumbar ganglia was in relation to the second lumbar vertebra, sometimes extending up to the L2-L3 vertebral disc. There was a medial shift of sympathetic trunk in lumbar region and it coursed over sacral promontory to reach the pelvic region in 96% of specimens. These variations should be kept in mind in order to prevent hazardous complications like accidental avulsion of first lumbar ganglia and genitofemoral neuritis. PMID:24068683

  4. Factors to consider in identifying critical points in lumbar spine flexion relaxation.

    PubMed

    Zwambag, Derek P; Brown, Stephen H M

    2015-12-01

    Flexion relaxation (FR), a myoelectric silence of extensor muscles near end range of lumbar flexion, is commonly reported as the lumbar flexion angle at the instant the extensor muscles become silent. However, lumbar flexion angle alone is insufficient to characterize mechanisms that modulate FR. As FR requires the moment generated by passive lumbar extensor tissues to equilibrate the moment due to gravity, the inter-relationships between lumbar moment, flexion angle, and myoelectrical silence will provide added information in the understanding of FR. The purpose of this study was to examine the relationship between lumbar moment and flexion angle throughout various flexion manoeuvres. It was hypothesized that lumbar moment and flexion angle would not be linearly related and would be affected by lower limb position, range of motion, and the addition of mass to the torso. Eleven participants performed four different lumbar flexion trials. Results showed that lumbar flexion was correlated with the lumbar moment (r=0.92); however an analysis of residuals found that these measures were not linearly related. The moment was, however, correlated (r=0.99) and linearly related to the sine of trunk inclination (T12 rigid body with respect to global horizontal). Future studies of FR could use trunk inclination as a simple kinematic measure to predict relative changes in lumbar moment with flexion. PMID:26559463

  5. Coexistence of Internal Carotid Artery Stenosis in Patients with Abdominal Aortic Aneurysm

    PubMed Central

    Davidovic, Lazer; Vasic, Dragan; Radmili, Oliver

    2013-01-01

    Background and Objectives Abdominal Aortic Aneurysm (AAA) and carotid disease have medical and social significance, considering their morbidity, disability, and economic consequences. The study objectives were to determine the prevalence of asymptomatic internal carotid artery (ICA) lesions ?70% in patients with AAA, the correlation of AAA diameter with the degree of ICA stenosis and symptoms, and the importance of preventive ultrasound checkups. Subjects and Methods A prospective non-randomized controlled study including 740 patients, aged from 18-85 years, who were suitable for the inclusion and exclusion criteria and reported at the vascular laboratory of the Institute for Vascular and Endovascular Surgery, Clinical Center of Serbia from 1st of December 2011 to the 1st of November 2012. Results The prevalence of asymptomatic ICA stenosis ?70% in patients with AAA is 10.8%. Male representatives have more symptomatic ICA stenosis ?70%. Patients with small aneurysms more often have asymptomatic ICA stenosis ?70%. The occurrence of symptoms of carotid disease was more prevalent among patients with ICA stenosis ?70% compared to the group with stenosis <70%. There was no correlation found between the grade of ICA stenosis with the size of AAA. Conclusion The prevalence of asymptomatic ICA stenosis ?70% in patients with AAA is found to be 10.8%. Male patients with ICA stenosis ?70% more often had symptoms of carotid disease. In the smaller aneurysms, ICA stenosis ?70% occurs frequently, but without the symptoms of carotid disease, and there was no correlation between the size of AAA and the grade of ICA stenosis. Clinical implications of ICA imaging in patients with previously diagnosed AAA is necessary. PMID:24044014

  6. Preclosure pressure gradients predict patent ductus arteriosus patients at risk for later left pulmonary artery stenosis.

    PubMed

    Gowda, Srinath T; Kutty, Shelby; Ebeid, Makram; Qureshi, Athar M; Worley, Sarah; Latson, Larry A

    2009-10-01

    The objective of this study was to evaluate the incidence of pre-existing catheterization left pulmonary artery (LPA) gradients and correlation of these gradients with later LPA stenosis after successful patent ductus arteriosus (PDA) occlusion. We performed a single-center review of 130 patients with PDA closure from October 1993 to February 2005. We analyzed the pre-PDA closure LPA pressure gradients at catheterization to determine if these were predictive of late LPA stenosis. On follow-up, a V (max) >2 m/s by echocardiogram (transthoracic echocardiography; TTE) was considered indicative of possible LPA stenosis. Left lung perfusion of <35% was considered diagnostic of significant LPA stenosis. Post PDA closure, possible LPA stenosis by TTE was seen in 8 of 128 patients (6.25%). Seven of these eight had precatheter LPA gradients >7 mm Hg. Five of these had perfusion scans, three of the five had significant LPA stenosis, and two underwent LPA angioplasty. Patients with LPA catheter gradients >7 mm Hg were more likely to have possible LPA stenosis by TTE, significant LPA stenosis by lung scan, and intervention with LPA angioplasty. In conclusion, a preclosure main pulmonary artery-to-LPA pressure gradient >7 mm Hg was found in all patients who developed significant LPA stenosis on follow-up after transcatheter PDA closure. It appears likely that these patients have LPA abnormality rather than stenosis caused by the PDA occlusion device. Patients with preclosure LPA gradients >7 mm Hg should undergo follow-up evaluations for detection of significant stenosis and may require treatment if an important flow abnormality is documented. PMID:19365650

  7. A simple technique for producing supravalvular aortic stenosis in animals.

    PubMed

    Chien, S F; Diana, J N; Brum, J M; Bove, A A

    1988-10-01

    A safe and reproducible technique to create supravalvular aortic stenosis was developed, which avoids many of the difficulties encountered in the production of aortic stenosis. Dogs were anaesthetised and artificially ventilated. The chest was opened and the venae cavae were encircled with umbilical tapes. The ascending aorta was then encircled by a 1.5-2 cm wide, 6-7 cm long dacron patch, venous return was stopped by tightening the tapes, and a J-shaped clamp applied to the ascending aorta at the dacron patch. Two layers of continuous mattress suture were placed adjacent to the clamp, plicating the aortic diameter by about 50%. After releasing the clamp and restoring normal venous return, left ventricular (LV) and aortic (AO) pressures were measured. Subsequently, one or two deep mattress sutures were placed below the running mattress sutures to increase the stenosis and to obtain the desired gradient. The LV-AO systolic pressure gradients obtained immediately after the operation ranged from 40 to 75 mm Hg. Two to 6 months after the operation the pressure gradients ranged from 50 to 200 mm Hg. Left ventricular to body weight ratios were 6.41 (SEM 0.26) v 4.24(0.20) for the controls. Heart weight to body weight ratios were 8.37(0.35) v 5.65(0.33). LV end diastolic pressures were normal. This technique can be used either in puppies or adult animals. The problem of aortic rupture is eliminated. The pressure gradient can be easily controlled during the operation and reproducible LV hypertrophy can be obtained in a shorter time than with aortic banding of puppies. PMID:2978465

  8. Carotid Artery Stenosis with Acute Ischemic Stroke: Stenting versus Angioplasty

    PubMed Central

    Villwock, Mark R.; Padalino, David J.; Deshaies, Eric M.

    2015-01-01

    Background When a patient with carotid artery stenosis presents emergently with acute ischemic stroke, the optimum treatment plan is not clearly defined. If intervention is warranted, and open surgery is prohibitive, endovascular revascularization may be performed. The use of stents places the patient at additional risk due to their thrombogenic potential. The intent of this study was to compare outcomes following endovascular approaches (angioplasty alone vs. stent) in the setting of acute stroke. Methods We extracted a population from the National Inpatient Sample (2012) and the Nationwide Inpatient Sample (2003–2011) composed of patients with carotid artery stenosis with infarction that were admitted nonelectively and received endovascular revascularization. Patients treated with mechanical thrombectomy or thrombolysis were excluded. Categorical variables were compared between treatment groups with Chi-squared tests. Binary logistic regression was performed to evaluate mortality and iatrogenic stroke while controlling for age, case severity, and comorbidity burden. Results About 6,333 admissions met our criteria. A majority were treated via stenting (89%, n = 5,608). The angioplasty-alone group had significantly higher mortality (9.0% vs. 3.8%, p < 0.001) and iatrogenic stroke rate (3.9% vs. 1.9%, p < 0.001) than the stent group. The adjusted odds ratios of mortality and iatrogenic stroke for patients treated with angioplasty alone were 1.953 (p < 0.001) and 1.451 (p = 0.105), respectively, in comparison to patients treated with carotid stenting. Conclusion Multivariate analysis found the risk of mortality to be elevated following angioplasty alone. This may represent selection bias, but it also may indicate that symptomatic patients with stroke suffer from severe stenosis and unstable plaques that would benefit from stent placement. These results would caution angioplasty alone as an arm of a future randomized trial involving this severely burdened patient population requiring urgent intervention. PMID:26600924

  9. [Is posterior lumbar epidural space partitioned?].

    PubMed

    Morisot, P

    1992-01-01

    The anatomy of the posterior lumbar epidural space (PLES) has been extensively studied. Besides the anatomists, surgeons, radiologists and anaesthetists have taken an interest in this. However, because each one has considered the PLES from his own specialist field, descriptions are not always concordant. In particular, the reality of a medial partition in the PLES has been suggested by epidurography and intraoperative observations. Lewit and Sereghy and Luyendijk opened the debate by reporting, on antero-posterior epidurographic films, a clear-cut, medial, vertical and narrow picture which partitioned the PLES. However, this was not constant. Savolaine et al. also recognized this partition on epidurographic CT scans. During laminectomies, Luyendijk has taken photographs of a medial fold of the dura mater which appeared to hold it to the posterior vertebral arch, being collapsed on either side of the midline. He named it "plica mediana dorsalis durae matris" (PMD). Several anaesthetists considered that this could explain why epidural analgesia sometimes acted on one side only. Husemeyer and White, and Harrison et al., have tried to confirm this experimentally by making casts with polymerizing resins in cadavers. They did not get very convincing results. Blomberg also tried to see this space by epiduroscopy in the cadaver. Unfortunately, for technical reasons, his photographs were of poor quality. He, however, reported having seen each time the PMD and a band of connective tissue fixing it to the vertebral arch in the midline. However, all these anatomical studies used methods which alter the natural structures. Their results are therefore questionable. The PLES is a virtual space. Histological studies have shown that it is filled with fatty tissue between the dura and the vertebral arch. It is therefore conceivable that any liquid injected into the PLES, such as contrast medium or local anaesthetic, must push back the dura, the only tissue which can move to give it any room. The fatty tissue could therefore be compressed and take any of the shapes which have been described on epidurography. On the other hand, should it be torn, it seems this fatty tissue could make up these haphazard fibrous tracts tensed between the dura and the vertebral arch, such as described in classical anatomy, as Bonica recalled. These can be clearly seen during surgical and anatomical dissections, and during endoscopies carried out on cadavers with sufficient optical means, as opposed to the medial fibrous band fixing the dura to the vertebral arch.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1443817

  10. Enhanced muscle activity during lumbar extension exercise with pelvic stabilization

    PubMed Central

    Lee, Ho-Seong

    2015-01-01

    The purpose of this study was to investigate whether pelvic stabilization affects multifidus (MF) and iliocostalis lumborum (IL) muscle activities during dynamic extension exercise. Nine males (age, 25.1±6.3 yr; height, 176.6±2.4 cm; body mass, 74.9±6.7 kg) performed an isometric lumbar extension strength test and dynamic exercise in an upright seated position with or without pelvic stabilization. The electromyography and muscle strength of the MF and IL muscles were measured when the subjects performed the isometric lumbar extension strength test at the trunk angle 110°, 146°, and 182°. In addition, the trunk extensor muscle activities were measured using 50% muscle strength of maximum isometric strength during a dynamic trunk extension exercise. The MF and IL muscle activities were significantly higher at 110°, 146°, and 182° with pelvic stabilization than that without pelvic stabilization during the isometric lumbar extension strength test (P<0.05) and the dynamic exercise (P<0.05). These results suggest that the lumbar extension exercise with pelvic stabilization may be more effective for MF and IL muscle activity compared to that without pelvic stabilization.

  11. Surface strain distribution in isolated single lumbar vertebrae.

    PubMed Central

    Shah, J S; Coggins, J; Rogers, R; Jayson, M I; Hampson, W G

    1976-01-01

    The surface strains of isolated single lumbar vertebrae under compressive load were examined by the techniques of brittlecoat and photoelastic analysis. Directions of principal strain components have been determined. Areas of stress concentration were found around the vertebral rims, near the pedicles, and around the foramina of the basivertebral veins. Images PMID:1275581

  12. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2) Attach the pelvis to the seating surface by a bolt C/328, modified as shown in Figure 18, and the upper legs at the knee axial rotation joints by the attachments shown in Figure 18. Tighten the mountings so that the pelvis-lumbar joining...

  13. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2) Attach the pelvis to the seating surface by a bolt C/328, modified as shown in Figure 18, and the upper legs at the knee axial rotation joints by the attachments shown in Figure 18. Tighten the mountings so that the pelvis-lumbar joining...

  14. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2) Attach the pelvis to the seating surface by a bolt C/328, modified as shown in Figure 18, and the upper legs at the knee axial rotation joints by the attachments shown in Figure 18. Tighten the mountings so that the pelvis-lumbar joining...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2) Attach the pelvis to the seating surface by a bolt C/328, modified as shown in Figure 18, and the upper legs at the knee axial rotation joints by the attachments shown in Figure 18. Tighten the mountings so that the pelvis-lumbar joining...

  16. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2) Attach the pelvis to the seating surface by a bolt C/328, modified as shown in Figure 18, and the upper legs at the knee axial rotation joints by the attachments shown in Figure 18. Tighten the mountings so that the pelvis-lumbar joining...

  17. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine and pelvis. 572.115 Section 572.115 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) ANTHROPOMORPHIC TEST DEVICES Side Impact Hybrid...

  18. CO2 laser posterior transverse cordotomy for isolated type IV posterior glottic stenosis.

    PubMed

    Gaboriau, H; Laccourreye, O; Laccourreye, H; Brasnu, D

    1995-01-01

    One case of isolated type IV posterior glottic stenosis successfully treated with CO2 laser posterior transverse cordotomy is presented. This report emphasized the value of the CO2 laser posterior transverse cordotomy in this situation. A review of the various therapeutic options advocated in the medical literature to treat isolated posterior glottic stenosis is also presented. PMID:7503381

  19. Influence of subglottic stenosis on the flow-induced vibration of a computational vocal fold model.

    PubMed

    Smith, Simeon L; Thomson, Scott L

    2013-04-01

    The effect of subglottic stenosis on vocal fold vibration is investigated. An idealized stenosis is defined, parameterized, and incorporated into a two-dimensional, fully-coupled finite element model of the vocal folds and laryngeal airway. Flow-induced responses of the vocal fold model to varying severities of stenosis are compared. The model vibration was not appreciably affected by stenosis severities of up to 60% occlusion. Model vibration was altered by stenosis severities of 90% or greater, evidenced by decreased superior model displacement, glottal width amplitude, and flow rate amplitude. Predictions of vibration frequency and maximum flow declination rate were also altered by high stenosis severities. The observed changes became more pronounced with increasing stenosis severity and inlet pressure, and the trends correlated well with flow resistance calculations. Flow visualization was used to characterize subglottal flow patterns in the space between the stenosis and the vocal folds. Underlying mechanisms for the observed changes, possible implications for human voice production, and suggestions for future work are discussed. PMID:23503699

  20. Massive hemoptysis due to pulmonary vein stenosis following catheter ablation for atrial fibrillation.

    PubMed

    Lee, Jung Yeon; Chon, Gyu Rak; Park, Jong Hoon; Kang, Byung Ju; Shim, Tae Sun; Jo, Kyung-Wook

    2015-03-01

    Pulmonary vein stenosis, which is one of the rare complications of radiofrequency catheter ablation for atrial fibrillation, has various symptoms. Here, we report a rare case of massive hemoptysis due to pulmonary vein stenosis following radiofrequency catheter ablation, which was successfully managed with pneumonectomy. PMID:25316885

  1. A historical prospective cohort study of carotid artery stenosis after radiotherapy for head and neck malignancies

    SciTech Connect

    Brown, Paul D. . E-mail: brown.paul@mayo.edu; Foote, Robert L.; McLaughlin, Mark P.; Halyard, Michele Y.; Ballman, Karla V.; Collie, A. Craig; Miller, Robert C.; Flemming, Kelly D.; Hallett, John W.

    2005-12-01

    Purpose: To determine carotid artery stenosis incidence after radiotherapy for head-and-neck neoplasms. Methods and Materials: This historical prospective cohort study comprised 44 head-and-neck cancer survivors who received unilateral neck radiotherapy between 1974 and 1999. They underwent bilateral carotid duplex ultrasonography to detect carotid artery stenosis. Results: The incidence of significant carotid stenosis (8 of 44 [18%]) in the irradiated neck was higher than that in the contralateral unirradiated neck (3 of 44 [7%]), although this difference was not statistically significant (p = 0.13). The rate of significant carotid stenosis events increased as the time after radiotherapy increased. The risk of ipsilateral carotid artery stenosis was higher in patients who had undergone a neck dissection vs. those who had not. Patients with significant ipsilateral stenosis also tended to be older than those without significant stenosis. No other patient or treatment variables correlated with risk of carotid artery stenosis. Conclusions: For long-term survivors after neck dissection and irradiation, especially those who are symptomatic, ultrasonographic carotid artery screening should be considered.

  2. The Effects of Higher-Order Approximations in a Fluid-Filled Elastic Tube with Stenosis

    NASA Astrophysics Data System (ADS)

    Demiray, Hilmi

    2006-12-01

    Treating arteries as thin-walled prestressed elastic tubes with a narrowing (stenosis) and blood as an inviscid fluid, we study the propagation of weakly nonlinear waves in such a fluid-filled elastic tube by employing the reductive perturbation method in the long wave approximation. It is shown that the evolution equation of the first-order term in the perturbation expansion may be described by the conventional Korteweg-de Vries (KdV) equation. The evolution equation for the second-order term is found to be the linearized KdV equation with a nonhomogeneous term, which contains the contribution of the stenosis. A progressive wave type solution is sought for the evolution equation, and it is observed that the wave speed is variable, which results from the stenosis. We study the variation of the wave speed with the distance parameter ? for various amplitude values of the stenosis. It is observed that near the center of the stenosis the wave speed decreases with increasing stenosis amplitude. However, sufficiently far from the center of the stenosis stenosis amplitude becomes negligibly small.

  3. Transcatheter aortic valve implantation in Jehovah's Witness patients with symptomatic severe aortic valve stenosis

    PubMed Central

    Buz, Semih; Pasic, Miralem; Unbehaun, Axel; Hetzer, Roland

    2012-01-01

    Transcatheter aortic valve implantation (TAVI) is currently reserved for high or prohibitive surgical-risk patients with aortic valve stenosis. We report on successful TAVI in two Jehovah's witness patients. It offers a simple and effective treatment of severe aortic valve stenosis in high-risk patients who refuse the use of allogeneic blood and blood products. PMID:22753437

  4. Effectiveness of balloon valvuloplasty for stenosis of a bioprosthesis in the tricuspid valve position.

    PubMed

    Falcone, Adam M; Varghese, Joji J; Stoler, Robert C; Choi, James W

    2015-10-01

    A 67-year-old man underwent percutaneous balloon valvuloplasty for bioprosthetic tricuspid stenosis. He had undergone two tricuspid valve replacements over a period of 39 years and became symptomatic. After the valvuloplasty, his symptoms were resolved. Stenosis of a bioprosthetic tricuspid valve can be successfully and safely treated with balloon valvuloplasty. PMID:26424955

  5. Effectiveness of balloon valvuloplasty for stenosis of a bioprosthesis in the tricuspid valve position

    PubMed Central

    Falcone, Adam M.; Varghese, Joji J.; Stoler, Robert C.

    2015-01-01

    A 67-year-old man underwent percutaneous balloon valvuloplasty for bioprosthetic tricuspid stenosis. He had undergone two tricuspid valve replacements over a period of 39 years and became symptomatic. After the valvuloplasty, his symptoms were resolved. Stenosis of a bioprosthetic tricuspid valve can be successfully and safely treated with balloon valvuloplasty. PMID:26424955

  6. The Lumbar Lordosis in Males and Females, Revisited

    PubMed Central

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

    2015-01-01

    Background Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females. Methods Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height. Principal Findings Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined). Conclusions Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis). The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing. PMID:26301782

  7. Retroperitoneoscopic Lumbar Sympathectomy for Buerger's Disease: A Novel Technique

    PubMed Central

    Singh, Lakhvinder; Lal, Pawan; Jain, Akhilesh; Lal, Pawanindra; Ramteke, V. K.

    2004-01-01

    Background: The conventional lumbar sympathectomy procedure through the extraperitoneal route requires a muscle cutting-splitting incision, which leads to significant postoperative pain and prolonged convalescence. With increasing experience in retroperitoneoscopic procedures, we did a pilot study to explore the role of retroperitoneoscopy in lumbar sympathectomy. We describe herein our technique used for the surgery. Methods: The patient was placed in a lateral position. A 15-mm incision was made just below the 12th rib, and retroperitoneal space was created using blunt finger dissection. A custom-made, large balloon was inserted and inflated with the equivalent of 750 mL to 1000 mL of saline. The second 10-mm port was placed in line with the first port above the iliac crest. The third and fourth 5-mm ports were placed anterior to the first 2 ports. Peritoneum was retracted anteriorly. The medial border of the psoas muscle was used as a landmark and a chain identified immediately medial to it. Lumbar vessels were ligated on the right side. The first to fourth lumbar sympathetic ganglia were removed with the intervening chain. The port sites were closed without a drain. Results: We attempted and successfully completed this procedure in 8 patients; 6 on the left side and 2 on the right side. The average operating time was 38 minutes. The mean hospital stay was 1.5 days. All patients had symptomatic pain relief and clinical improvement. Conclusions: Retroperitoneoscopic lumbar sympathectomy is a safe and effective procedure. It has a short convalescent time and minimal morbidity; hence, it is a viable alternative for the open procedure. PMID:15347122

  8. Endovascular Stent Placement for Hemodialysis Arteriovenous Access Stenosis

    PubMed Central

    Neuen, Brendon L.; Baer, Richard A.; Grainer, Frank; Mantha, Murty L.

    2015-01-01

    This study aims to report the outcomes of nitinol and polytetrafluoroethylene covered stent placement to treat hemodialysis arteriovenous access stenosis at a single center over a five-year period. Clinical and radiological information was reviewed retrospectively. Poststent primary and secondary patency rates were determined using Kaplan-Meier analysis. Ten clinical variables were subjected to multivariate Cox regression analysis to determine predictors of patency after stent placement. During the study period 60 stents were deployed in 45 patients, with a mean follow-up of 24.5 months. The clinical and anatomical success rate was 98.3% (59/60). Poststent primary patency rates at 6, 12, and 24 months were 64%, 46%, and 35%, respectively. Poststent secondary patency rates at 6, 12, and 24 months were 95%, 89%, and 85%, respectively. Stent placement for upper arm lesions and in access less than 12 months of age was associated with reduced primary patency (adjusted hazards ratio [HR] 5.1, p = 0.0084, and HR 3.5, p = 0.0029, resp.). Resistant or recurrent stenosis can be successfully treated by endovascular stent placement with durable long-term patency, although multiple procedures are often required. Stent placement for upper arm lesions and in arteriovenous access less than 12 months of age was associated with increased risk of patency loss. PMID:26649199

  9. Effect of the degenerative state of the intervertebral disk on the impact characteristics of human spine segments

    E-print Network

    Wilson, Sara E.; Alkalay, Ron; Myers, Elizabeth

    2013-12-01

    Models of the dynamic response of the lumbar spine have been used to examine vertebral fractures (VFx) during falls and whole body vibration transmission in the occupational setting. Although understanding the viscoelastic stiffness or damping...

  10. Effect of the Degenerative State of the Intervertebral Disk on the Impact Characteristics of Human Spine Segments

    E-print Network

    Wilson, Sara E.; Alkalay, Ron; Myers, Elizabeth

    2013-11-01

    Models of the dynamic response of the lumbar spine have been used to examine vertebral fractures (VFx) during falls and whole body vibration transmission in the occupational setting. Although understanding the viscoelastic stiffness or damping...

  11. Effect of the degenerative state of the intervertebral disk on the impact characteristics of human spine segments

    E-print Network

    Wilson, Sara E.

    2013-12-16

    Models of the dynamic response of the lumbar spine have been used to examine vertebral fractures (VFx) during falls and whole body vibration transmission in the occupational setting. Although understanding the viscoelastic stiffness or damping...

  12. Hemodynamic Significance of Internal Carotid or Middle Cerebral Artery Stenosis Detected on Magnetic Resonance Angiography

    PubMed Central

    Seo, Hyo Jung; Pagsisihan, Jefferson R.; Choi, Seung Hong; Cheon, Gi Jeong; Chung, June-Key; Lee, Dong Soo; Kang, Keon Wook

    2015-01-01

    Purpose We evaluated hemodynamic significance of stenosis on magnetic resonance angiography (MRA) using acetazolamide perfusion single photon emission computed tomography (SPECT). Materials and Methods Of 171 patients, stenosis in internal carotid artery (ICA) and middle cerebral artery (MCA) (ICA-MCA) on MRA and cerebrovascular reserve (CVR) of MCA territory on SPECT was measured using quantification and a 3-grade system. Stenosis and CVR grades were compared with each other, and their prognostic value for subsequent stroke was evaluated. Results Of 342 ICA-MCA, 151 (44%) presented stenosis on MRA; grade 1 in 69 (20%) and grade 2 in 82 (24%) cases. Decreased CVR was observed in 9% of grade 0 stenosis, 25% of grade 1, and 35% of grade 2. The average CVR of grade 0 was significantly different from grade 1 (p<0.001) and grade 2 stenosis (p=0.007). In quantitative analysis, average CVR index was -0.56±7.91 in grade 0, -1.81±6.66 in grade 1 and -1.18±5.88 in grade 2 stenosis. Agreement between stenosis and CVR grades was fair in patients with lateralizing and non-lateralizing symptoms (?=0.230 and 0.346). Of the factors tested, both MRA and CVR were not significant prognostic factors (p=0.104 and 0.988, respectively), whereas hypertension and renal disease were significant factors (p<0.05, respectively). Conclusion A considerable proportion of ICA-MCA stenosis detected on MRA does not cause CVR impairment despite a fair correlation between them. Thus, hemodynamic state needs to be assessed for evaluating significance of stenosis, particularly in asymptomatic patients. PMID:26446655

  13. Complications and Morbidities of Mini-open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lumbar Interbody Fusion in 179 Patients

    PubMed Central

    Mac-Thiong, Jean-Marc; Hilmi, Radwan; Roussouly, Pierre

    2012-01-01

    Study Design A retrospective study including 179 patients who underwent oblique lumbar interbody fusion (OLIF) at one institution. Purpose To report the complications associated with a minimally invasive technique of a retroperitoneal anterolateral approach to the lumbar spine. Overview of Literature Different approaches to the lumbar spine have been proposed, but they are associated with an increased risk of complications and a longer operation. Methods A total of 179 patients with previous posterior instrumented fusion undergoing OLIF were included. The technique is described in terms of: the number of levels fused, operative time and blood loss. Persurgical and postsurgical complications were noted. Results Patients were age 54.1 ± 10.6 with a BMI of 24.8 ± 4.1 kg/m2. The procedure was performed in the lumbar spine at L1-L2 in 4, L2-L3 in 54, L3-L4 in 120, L4-L5 in 134, and L5-S1 in 6 patients. It was done at 1 level in 56, 2 levels in 107, and 3 levels in 16 patients. Surgery time and blood loss were, respectively, 32.5 ± 13.2 minutes and 57 ± 131 ml per level fused. There were 19 patients with a single complication and one with two complications, including two patients with postoperative radiculopathy after L3-5 OLIF. There was no abdominal weakness or herniation. Conclusions Minimally invasive OLIF can be performed easily and safely in the lumbar spine from L2 to L5, and at L1-2 for selected cases. Up to 3 levels can be addressed through a 'sliding window'. It is associated with minimal blood loss and short operations, and with decreased risk of abdominal wall weakness or herniation. PMID:22708012

  14. Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Degenerated Lumbar Spinal Kyphoscoliosis

    PubMed Central

    Mannoji, Chikato; Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Ochiai, Nobuyasu; Kishida, Shunji; Kuniyoshi, Kazuki; Aoki, Yasuchika; Nakamura, Junichi; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Shiga, Yasuhiro; Abe, Koki; Fujimoto, Kazuki; Kanamoto, Hiroto; Toyone, Tomoaki; Inoue, Gen; Takahashi, Kazuhisa

    2015-01-01

    Study Design Prospective case series. Purpose To examine the clinical efficacy of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion (OLIF) for degenerated lumbar spinal kyphoscoliosis. Overview of Literature The existing surgical procedures for the treatment of spinal kyphotic deformity, including Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection procedures, are invasive in nature. Extreme lateral interbody fusion to provide less invasive treatment of the deformity has been reported, but complications including spinal nerve and psoas muscle injury have been noted. In the current study, we examined the clinical efficacy and complications of OLIF for degenerated lumbar spinal kyphoscoliosis. Methods Twelve patients with degenerated lumbar spinal kyphoscoliosis were examined. All patients underwent OLIF surgery (using a cage and bone graft from the iliac crest) with open pedicle screws or percutaneous pedicle screws, without real-time monitoring by electromyography. Visual analog scale score and Oswestry disability index were evaluated before and 12 months after surgery, and fusion rate at OLIF cage, correction of the deformity, total blood loss, and surgical complications were also evaluated. Results Pain scores significantly improved after surgery (p<0.05). Fusion rate was found to be 90%, balance parameters also improved after surgery (p<0.05), and average total blood loss was less than 350 mL. There was no spinal nerve, major vessel, peritoneal, or urinary injury, or breakage of instrumentation. Conclusions OLIF surgery for degenerated lumbar spinal kyphoscoliosis is less invasive than other procedures and good surgical results were produced without major complications. PMID:26240716

  15. Evidence Report: Risk of Cardiovascular Disease and Other Degenerative Tissue Effects from Radiation Exposure

    NASA Technical Reports Server (NTRS)

    Patel, Zarana; Huff, Janice; Saha, Janapriya; Wang, Minli; Blattnig, Steve; Wu, Honglu; Cucinotta, Francis

    2015-01-01

    Occupational radiation exposure from the space environment may result in non-cancer or non-CNS degenerative tissue diseases, such as cardiovascular disease, cataracts, and respiratory or digestive diseases. However, the magnitude of influence and mechanisms of action of radiation leading to these diseases are not well characterized. Radiation and synergistic effects of radiation cause DNA damage, persistent oxidative stress, chronic inflammation, and accelerated tissue aging and degeneration, which may lead to acute or chronic disease of susceptible organ tissues. In particular, cardiovascular pathologies such as atherosclerosis are of major concern following gamma-ray exposure. This provides evidence for possible degenerative tissue effects following exposures to ionizing radiation in the form of the GCR or SPEs expected during long-duration spaceflight. However, the existence of low dose thresholds and dose-rate and radiation quality effects, as well as mechanisms and major risk pathways, are not well-characterized. Degenerative disease risks are difficult to assess because multiple factors, including radiation, are believed to play a role in the etiology of the diseases. As additional evidence is pointing to lower, space-relevant thresholds for these degenerative effects, particularly for cardiovascular disease, additional research with cell and animal studies is required to quantify the magnitude of this risk, understand mechanisms, and determine if additional protection strategies are required.The NASA PEL (Permissive Exposure Limit)s for cataract and cardiovascular risks are based on existing human epidemiology data. Although animal and clinical astronaut data show a significant increase in cataracts following exposure and a reassessment of atomic bomb (A-bomb) data suggests an increase in cardiovascular disease from radiation exposure, additional research is required to fully understand and quantify these adverse outcomes at lower doses (less than 0.5 gray (SI unit for ionizing radiation dosage, i.e. one joule of radiation energy per one kilogram of matter)) to facilitate risk prediction. This risk has considerable uncertainty associated with it, and no acceptable model for projecting degenerative tissue risk is currently available. In particular, risk factors such as obesity, alcohol, and tobacco use can act as confounding factors that contribute to the large uncertainties. The PELs could be violated under certain scenarios, including following a large SPE (solar proton event) or long-term GCR (galactic cosmic ray) exposure. Specifically, for a Mars mission, the accumulated dose is sufficiently high that epidemiology data and preliminary risk estimates suggest a significant risk for cardiovascular disease. Ongoing research in this area is intended to provide the evidence base for accurate risk quantification to determine criticality for extended duration missions. Data specific to the space radiation environment must be compiled to quantify the magnitude of this risk to decrease the uncertainty in current PELs and to determine if additional protection strategies are required. New research results could lead to estimates of cumulative radiation risk from CNS and degenerative tissue diseases that, when combined with the cancer risk, may have major negative impacts on mission design, costs, schedule, and crew selection. The current report amends an earlier report (Human Research Program Requirements Document, HRP-47052, Rev. C, dated Jan 2009) in order to provide an update of evidence since 2009.

  16. Analysis of Cervical Sagittal Balance Parameters in MRIs of Patients with Disc-Degenerative Disease

    PubMed Central

    Wang, Zhao-Lin; Xiao, Jian-Lin; Mou, Jian-Hui; Qin, Ting-Zheng; Liu, Peng

    2015-01-01

    Background The aim of this study was to explore the correlations between the different parameters of the cervical sagittal balance in magnetic resonance images (MRI) and evaluate the criteria for their clinical application in disc-degenerative diseases. Material/Methods We conducted a retrospective review of the MRIs of 125 adult outpatients with disc-degenerative diseases of the cervical spine; the images were obtained between May and July 2014 at our institute. The control group comprised 50 volunteers whose MRIs were also obtained. The parameters measured in the MRIs were: neck tilt (NT), T1 slope (T1S), thoracic inlet angle (TIA), and Cobb’s angle (C2–7). The correlation between the various parameters was analyzed using the Pearson correlation coefficient. Results The outpatients group showed moderate correlation between TIA and T1S, a significant correlation between TIA and NT, a weak correlation between T1S and Cobb’s angle, and a weakly negative correlation between T1S and NT. Further, the TIA showed no significant difference between the outpatient group and the control group, as per the sample t test. Conclusions Our findings indicate that TIA, T1S, and NT could be used as indices for the evaluation of cervical sagittal balance and that the TIA could be used as a reference to assess the cervical compensation. Restoration of the NT and T1S should be considered as a goal of surgical treatment during the preoperative planning in patients with disc-degenerative diseases. PMID:26486162

  17. The Karachi intracranial stenosis study (KISS) Protocol: An urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan

    PubMed Central

    Kamal, Ayeesha Kamran; Taj, Fawad; Junaidi, Babar; Rasheed, Asif; Zaidi, Moazzam; Murtaza, Muhammed; Iqbal, Naved; Hashmat, Fahad; Alam, Syed Vaqas; Saleem, Uzma; Waheed, Shahan; Bansari, Lajpat; Shah, Nabi; Samuel, Maria; Yameen, Madiha; Naz, Sobia; Khan, Farrukh Shahab; Ahmed, Naveeduddin; Mahmood, Khalid; Sheikh, Niaz; Makki, Karim Ullah; Ahmed, Muhammad Masroor; Memon, Abdul Rauf; Wasay, Mohammad; Syed, Nadir Ali; Khealani, Bhojo; Frossard, Philippe M; Saleheen, Danish

    2009-01-01

    Background Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions. PMID:19604359

  18. A new model of tracheal stenosis and its repair with free periosteal grafts.

    PubMed

    Cohen, R C; Filler, R M; Konuma, K; Bahoric, A; Kent, G; Smith, C

    1986-08-01

    Stenosis of 50% to 80% of the cervical or thoracic tracheal lumen was created in 17 piglets by encircling the trachea with silicone rubber sheet for 3 to 19 days (median 14 days). In 13 animals thoracic tracheal stenosis was repaired by longitudinal incision and insertion of a free tibial periosteal graft into the defect. An omental pedicle graft was applied to the surface of the free periosteal graft to augment its blood supply in three of these animals. An endotracheal silicone rubber splint was left in place for 2 to 3 weeks after the operations. Four animals served as untreated controls. In 12 of 13 piglets respiratory obstruction was relieved. One repair failed because of graft necrosis. In two animals put to death 1 month and 2 months later, stenosis was absent and the grafts showed variable ossification. The luminal surface had epithelialized. In nine of 10 animals put to death 3 months after the operation, tracheal cross-sectional areas had doubled, stenosis and granulation tissue were absent, and all the grafts had ossified and epithelialized. A mild stenosis (24%) developed over a 2 mm length in one animal and the graft had not ossified. The omental pedicle graft did not improve vascularization of the free periosteal graft. These studies describe a model of tracheal stenosis that can be used to assess various methods of repair. The results indicate that tracheal stenosis can be successfully treated by incision and insertion of a free periosteal graft into the defect. PMID:3736086

  19. Early adolescent lumbar intervertebral disc injury: a case study

    PubMed Central

    2013-01-01

    This article describes and discusses the case of an adolescent male with lumbar intervertebral disc injury characterized by chronic low back pain (LBP) and antalgia. A 13-year-old boy presented for care with a complaint of chronic LBP and subsequent loss of quality of life. The patient was examined and diagnosed by means of history, clinical testing and use of imaging. He had showed failure in natural history and conservative management relief in both symptomatic and functional improvement, due to injury to the intervertebral joints of his lower lumbar spine. Discogenic LBP in the young adolescent population must be considered, particularly in cases involving even trivial minor trauma, and in those in which LBP becomes chronic. More research is needed regarding long-term implications of such disc injuries in young people, and how to best conservatively manage these patients. A discussion of discogenic LBP pertaining to adolescent disc injury is included. PMID:23621900

  20. Spondylodiscitis Occurring after Diagnostic Lumbar Puncture: A Case Report

    PubMed Central

    Berkman, Mehmet Zafer

    2013-01-01

    Spondylodiscitis is a rare disease which is generally seen after long-term epidural catheterization. However, spondylidiscitis developing after diagnostic lumbar puncture is very rare. Early diagnosis has a crucial role in the management of the disease and inclines the morbidity rates. However, the diagnosis is often delayed due to the rarity and insidious onset of the disease usually presenting with low back pain which has a high frequency in the society. If it is diagnosed early before development of an abscess requiring surgery or neurological deficit, it responds to antimicrobial therapy quite well. We report 66-year-old male case of spondylodiscitis developing after diagnostic lumbar puncture. The patient was treated with antimicrobial therapy. After antimicrobial therapy, findings of spondylodiscitis were completely resolved and no recurrence was seen in the period of 9-month followup. PMID:23476837

  1. Comparison of standard fusion with a "topping off" system in lumbar spine surgery: a protocol for a randomized controlled trial

    PubMed Central

    2011-01-01

    Background Fusion of lumbar spine segments is a well-established therapy for many pathologies. The procedure changes the biomechanics of the spine. Initial clinical benefits may be outweighed by ensuing damage to the adjacent segments. Various surgical devices and techniques have been developed to prevent this deterioration. "Topping off" systems combine rigid fusion with a flexible pedicle screw system to prevent adjacent segment disease (ASD). To date, there is no convincing evidence that these devices provide any patient benefits. Methods/Design The study is designed as a randomized, therapy-controlled trial in a clinical care setting at a university hospital. Patients presenting to the outpatient clinic with degenerative disc disease or spondylolisthesis will be assessed against study inclusion and exclusion criteria. After randomization, the control group will undergo conventional fusion. The intervention group will undergo fusion with a supplemental flexible pedicle screw system to protect the adjacent segment ("topping off"). Follow-up examination will take place immediately after treatment during hospital stay, after 6 weeks, and then after 6, 12, 24 and 36 months. Subsequently, ongoing assessments will be performed annually. Outcome measurements will include quality of life and pain assessments using questionnaires (SF-36™, ODI, COMI). In addition, clinical and radiologic ASD, work-related disability, and duration of work disability will be assessed. Inpatient and 6-month mortality, surgery-related data (e.g., intraoperative complications, blood loss, length of incision, surgical duration), postoperative complications, adverse events, and serious adverse events will be documented and monitored throughout the study. Cost-effectiveness analysis will also be provided. Discussion New hybrid systems might improve the outcome of lumbar spine fusion. To date, there is no convincing published data on effectiveness or safety of these topping off systems. High quality data is required to evaluate the benefits and drawbacks of topping off devices. If only because these devices are quite expensive compared to conventional fusion implants, nonessential use should be avoided. In fact, these high costs necessitate efforts by health care providers to evaluate the effects of these implants. Randomized clinical trials are highly recommended to evaluate the benefits or harm to the patient. Trial Registration ClinicalTrials.gov: NCT01224379 PMID:22008088

  2. Mesenchymal stem cells and chronic renal artery stenosis.

    PubMed

    Oliveira-Sales, Elizabeth B; Boim, Mirian A

    2016-01-01

    Renal artery stenosis is the main cause of renovascular hypertension and results in ischemic nephropathy characterized by inflammation, oxidative stress, microvascular loss, and fibrosis with consequent functional failure. Considering the limited number of strategies that effectively control renovascular hypertension and restore renal function, we propose that cell therapy may be a promising option based on the regenerative and immunosuppressive properties of stem cells. This review addresses the effects of mesenchymal stem cells (MSC) in an experimental animal model of renovascular hypertension known as 2 kidney-1 clip (2K-1C). Significant benefits of MSC treatment have been observed on blood pressure and renal structure of the stenotic kidney. The mechanisms involved are discussed. PMID:26538439

  3. A role for genetic predisposition in subglottic stenosis.

    PubMed

    Pizzuto, M; Donaldson, D; Brodsky, L

    1998-08-01

    We present the development of ASGS in two of three premature male triplets; the affected infants were monozygotic, while the unaffected triplet was dizygotic. All three shared remarkably similar risk factor profiles. There is suggested the existence of a genetic factor or factors which may predispose certain infants to the development of ASGS. The expression of such genetic influence may be expressed through the a priori presence of CSGS or other genetically based mechanisms including abnormal cartilage growth or development, specific patterns of chondral or mucosal injury, the action of specific growth factors, or the effects of autoimmune or inflammatory mediators. We propose that genetic predisposition be considered a possible risk factor in the development of subglottic stenosis. PMID:9780075

  4. [Discrete Subaortic Stenosis in an Adult; Report of a Case].

    PubMed

    Mitsube, Keijiro; Doi, Hirosato; Koshima, Ryuji; Sumino, Satoshi; Hashimoto, Makoto; Furugen, Azusa

    2015-11-01

    Discrete subaortic stenosis (DSS) is a well-described cause of isolated left ventricular outflow tract obstruction( LVOTO) in children. But prevalence, rate of progression and postoperative data in adults are limited. We report a case of a 30-year-old woman, who was referred to our institution because of chest pain and loss of consciousness. Echocardiography revealed DSS with LVOTO (peak gradient 81 mmHg) and mild aortic regurgitation. Increased age at the time of diagnosis, female sex and preoperative left ventricular outflow tract(LVOT) gradient ?80 mmHg were thought to be predictors for reoperation, therefore the obstructing membrane was circumferentially excised and concomitant localized myectomy of the ventricular septum was performed to achieve complete relief of the LVOT obstruction. Her postoperative course was uneventful, and she was discharged on the 5th postoperative day. PMID:26555918

  5. TAVR and SAVR: Current Treatment of Aortic Stenosis

    PubMed Central

    Hu, Patrick P.

    2012-01-01

    Transcatheter aortic valve replacement (TAVR) was approved in the United States in late 2011, providing a critically needed alternative therapy for patients with severe aortic stenosis previously refused surgical aortic valve replacement (SAVR). Over 20,000 TAVR have been performed in patients worldwide since 2002 when Alain Cribier performed the first-in-man TAVR. This paper reviews the data from balloon expandable and self-expanding aortic stent valves as well as data comparing them with traditional surgical aortic valve replacement (SAVR). Complications using criteria established by the Valve Academic Research Consortium (VARC) are reviewed. Future challenges and possibilities are discussed and will make optimizing TAVR an important goal in the years to come. PMID:22952419

  6. Zoster sine herpete, vertebral artery stenosis, and ischemic stroke.

    PubMed

    Chen, Wei-Hsi; Chui, Chi; Yin, Hsin-Ling

    2013-10-01

    Although a previous or recent history of varicella-zoster virus (VZV) infection is known to increase the risk of stroke in both children and adults, the influence of zoster sine herpetic remains unclear. We report an immunocompetent man with common cold symptoms and conjunctivitis, followed by an acute onset of bulbar weakness and hemihypesthesia without preceding skin rash. Acute medullary infarction and left vertebral artery stenosis were detected. VZV infection was finally identified. Zoster sine herpetic interferes with accurate diagnosis of infectious stroke, and vertebral artery involvement is unusual in ischemic stroke in this situation. An unexplained course of ischemic stroke event should be suspected in patients with VZV cerebrovasculopathy, especially in those without conventional stroke risk factors and those exhibiting concomitant infectious complications. PMID:22974704

  7. Contribution of endoscopy to early diagnosis of hypertrophic pyloric stenosis.

    PubMed

    De Backer, A; Bové, T; Vandenplas, Y; Peeters, S; Deconinck, P

    1994-01-01

    The diagnostic accuracy of ultrasonography and gastrointestinal endoscopy was compared in 63 infants who were operated on for infantile hypertrophic pyloric stenosis. Endoscopy was far more accurate than ultrasonography, the diagnosis being made in 97 and 81% of the cases, respectively. The difference between the techniques was even more obvious in the younger patients and in those with a short history of vomiting. The ability to detect coexistent or other causes of vomiting with endoscopy appeared advantageous. The endoscopic procedure is easily done without general anesthesia and was without complications in our series. We recommend endoscopy as an important tool in very young patients with few clinical signs other than vomiting, allowing for appropriate treatment without delay. PMID:8126622

  8. Esophageal Stenosis Associated With Tumor Regression in Radiotherapy for Esophageal Cancer: Frequency and Prediction

    SciTech Connect

    Atsumi, Kazushige; Shioyama, Yoshiyuki; Arimura, Hidetaka; Terashima, Kotaro; Matsuki, Takaomi; Ohga, Saiji; Yoshitake, Tadamasa; Nonoshita, Takeshi; Tsurumaru, Daisuke; Ohnishi, Kayoko; Asai, Kaori; Matsumoto, Keiji; Nakamura, Katsumasa; Honda, Hiroshi

    2012-04-01

    Purpose: To determine clinical factors for predicting the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer. Methods and Materials: The study group consisted of 109 patients with esophageal cancer of T1-4 and Stage I-III who were treated with definitive radiotherapy and achieved a complete response of their primary lesion at Kyushu University Hospital between January 1998 and December 2007. Esophageal stenosis was evaluated using esophagographic images within 3 months after completion of radiotherapy. We investigated the correlation between esophageal stenosis after radiotherapy and each of the clinical factors with regard to tumors and therapy. For validation of the correlative factors for esophageal stenosis, an artificial neural network was used to predict the esophageal stenotic ratio. Results: Esophageal stenosis tended to be more severe and more frequent in T3-4 cases than in T1-2 cases. Esophageal stenosis in cases with full circumference involvement tended to be more severe and more frequent than that in cases without full circumference involvement. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. In the multivariate analysis, T stage, extent of involved circumference, and wall thickness of the tumor region were significantly correlated to esophageal stenosis (p = 0.031, p < 0.0001, and p = 0.0011, respectively). The esophageal stenotic ratio predicted by the artificial neural network, which learned these three factors, was significantly correlated to the actual observed stenotic ratio, with a correlation coefficient of 0.864 (p < 0.001). Conclusion: Our study suggested that T stage, extent of involved circumference, and esophageal wall thickness of the tumor region were useful to predict the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer.

  9. Evaluation of coronary stenosis with the aid of quantitative image analysis in histological cross sections.

    PubMed

    Dulohery, Kate; Papavdi, Asteria; Michalodimitrakis, Manolis; Kranioti, Elena F

    2012-11-01

    Coronary artery atherosclerosis is a hugely prevalent condition in the Western World and is often encountered during autopsy. Atherosclerotic plaques can cause luminal stenosis: which, if over a significant level (75%), is said to contribute to cause of death. Estimation of stenosis can be macroscopically performed by the forensic pathologists at the time of autopsy or by microscopic examination. This study compares macroscopic estimation with quantitative microscopic image analysis with a particular focus on the assessment of significant stenosis (>75%). A total of 131 individuals were analysed. The sample consists of an atherosclerotic group (n=122) and a control group (n=9). The results of the two methods were significantly different from each other (p=0.001) and the macroscopic method gave a greater percentage stenosis by an average of 3.5%. Also, histological examination of coronary artery stenosis yielded a difference in significant stenosis in 11.5% of cases. The differences were attributed to either histological quantitative image analysis underestimation; gross examination overestimation; or, a combination of both. The underestimation may have come from tissue shrinkage during tissue processing for histological specimen. The overestimation from the macroscopic assessment can be attributed to the lumen shape, to the examiner observer error or to a possible bias to diagnose coronary disease when no other cause of death is apparent. The results indicate that the macroscopic estimation is open to more biases and that histological quantitative image analysis only gives a precise assessment of stenosis ex vivo. Once tissue shrinkage, if any, is accounted for then histological quantitative image analysis will yield a more accurate assessment of in vivo stenosis. It may then be considered a complementary tool for the examination of coronary stenosis. PMID:23084314

  10. Spontaneous Regression of a Large Lumbar Disc Extrusion

    PubMed Central

    Ryu, Sung-Joo

    2010-01-01

    Although the spontaneous disappearance or decrease in size of a herniated disc is well known, that of a large extruded disc has rarely been reported. This paper reports a case of a spontaneous regression of a large lumbar disc extrusion. The disc regressed spontaneously with clinical improvement and was documented on a follow up MRI study 6 months later. The literature is reviewed and the possible mechanisms of spontaneous disc regression are discussed. PMID:21082061

  11. Lumbar ultrasound: useful gadget or time-consuming gimmick?

    PubMed

    Gambling, D R

    2011-10-01

    Despite widespread enthusiasm for using lumbar ultrasound in obstetrics, there are some who believe it is expensive and time-consuming, with undetermined risks and uncertain benefits. For decades, anesthesiologists have striven to perfect the identification and cannulation of the epidural space using skills learned during training and early clinical practice. These skills include knowledge of the relevant anatomy and detection of subtle tactile clues that aid successful placement of an epidural catheter. Indeed, obstetric anesthesiologists have managed to do this with great success without using imaging techniques. There is a long learning curve associated with lumbar ultrasound and it is unclear from the literature if the success rates associated with its use are superior to clinical skill alone. Is it only a matter of time before regulators insist that lumbar ultrasound is used before inserting an epidural? Indeed, this has already happened for central vein catheters. The United States spent $2.2 trillion on health care in 2007, nearly twice the average of other developed nations. If rapid health cost growth persists, one out of every four dollars in the US national economy will be tied up in the health system by 2025. Do obstetric anesthesiologists want to add to these costs by using unnecessary and expensive equipment? Although many feel that diagnostic ultrasound in obstetrics is safe, some argue that we have yet to perform an appropriate risk analysis for lumbar ultrasound during pregnancy. The issue of ultrasound bio-safety needs to be considered before we all jump on the ultrasound bandwagon. PMID:21169011

  12. Interleukin-2 is upregulated in patients with a prolapsed lumbar intervertebral disc and modulates cell proliferation, apoptosis and extracellular matrix metabolism of human nucleus pulposus cells

    PubMed Central

    WANG, ZHIRONG; WANG, GENLIN; ZHU, XUESONG; GENG, DECHUN; YANG, HUILIN

    2015-01-01

    Previous studies have demonstrated that the expression levels of cytokines are increased in degenerated intervertebral disc tissues, and several cytokines are associated with the pathogenesis of intervertebral disc degeneration. However, the role of interleukin (IL)-2 in the cellular functions of intervertebral disc tissues remains unreported. The present study aimed to determine the expression levels of IL-2 in the nucleus pulposus (NP) tissues of patients with a prolapsed lumbar intervertebral disc; and to observe the changes in cell proliferation, apoptosis, extracellular matrix (ECM) metabolism and p38 mitogen-activated protein kinase (MAPK) signaling in human NP cells (HNPCs) following treatment with IL-2. The present study demonstrated that IL-2 expression levels were upregulated in the NP tissues of patients with a prolapsed lumbar intervertebral disc; and a subsequent MTT assay demonstrated that IL-2 inhibits the proliferation of HNPCs in a dose-dependent manner. Furthermore, as demonstrated by the increased protein expression levels of Fas cell surface death receptor and the induction of caspase-8 and caspase-3 activity, the death receptor pathway was activated by IL-2 in the HNPCs in order to promote cell apoptosis. In addition, IL-2 promoted ECM degradation in the HNPCs, as demonstrated by an increase in the expression levels of type I collagen, a disintegrin and metalloproteinase with thrombospondin motifs and matrix metalloproteinases, and decreased aggrecan and type II collagen expression levels. Furthermore, phosphorylated-p38 was significantly increased in the HNPCs following IL-2 treatment. In conclusion, the present study demonstrated that IL-2 inhibits cell proliferation, and induces cell apoptosis and ECM degradation, accompanied by the activation of p38 MAPK signaling in HNPCs. Therefore, IL-2 may be a potential therapeutic agent for the treatment of degenerative disc disease.

  13. Airway management in patients with subglottic stenosis: experience at an academic institution.

    PubMed

    Knights, Richard M; Clements, Stephan; Jewell, Elizabeth; Tremper, Kevin; Healy, David

    2013-12-01

    We describe a pilot study investigating the airway techniques used in the anesthetic management of subglottic stenosis. We searched the electronic clinical information database of the University of Michigan Health System for cases of subglottic stenosis in patients undergoing surgery. Demographics, airway techniques, incidence of hypoxemia, and technique failure were extracted from 159 records. A lower incidence of hypoxemia was found between the 4 most commonly used techniques and the less common techniques. We detected no difference in outcome between individual techniques. This study suggests a larger prospective multicenter study is required to further investigate these outcomes in patients with subglottic stenosis. PMID:24257385

  14. Acquired subglottic stenosis caused by methicillin resistant Staphylococcus aureus that produce epidermal cell differentiation inhibitor

    PubMed Central

    Yamada, Y; Sugai, M; Woo, M; Nishida, N; Sugimoto, T

    2001-01-01

    Local infection of the trachea in intubated neonates is one of the main risk factors for development of acquired subglottic stenosis, although its role in the pathogenesis is unclear. Methicillin resistant Staphylococcus aureus (MRSA) is often the cause of critical illness in neonatal patients. Two cases are reported of acquired subglottic stenosis following bacterial infection of the trachea, suggesting an association with the staphylococcal exotoxin, epidermal cell differentiation inhibitor (EDIN). EDIN-producing MRSA were isolated from purulent tracheal secretions from both infants. Acquired subglottic stenosis in both cases was probably caused by delayed wound healing as the result of EDIN inhibition of epithelial cell migration.?? PMID:11124922

  15. Sternohyoid myo-osseous flap for acquired subglottic stenosis in children.

    PubMed

    Close, L G; Lozano, A J; Schaefer, S D

    1983-04-01

    Endotracheal intubation can occasionally result in acquired subglottic stenosis (ASGS) in infants and children. Twenty-one consecutive patients, ages 3 months to 13 years, with ASGS secondary to endotracheal intubation and severe enough to require tracheotomy, are reviewed. Of this population, eight cases of ASGS were refractory to endoscopic excision and dilatation. These eight patients, five of whom had complete stenosis, underwent subglottic reconstruction using a sternohyoid myo-osseus flap. Six of the eight patients had been successfully decannulated with no evidence of recurrent stenosis at the time of this report. PMID:6834969

  16. Exertional abdominal pain as a symptom of secondary pulmonary hypertension in mitral stenosis.

    PubMed

    Najafian, J; Toghianifar, N; Khosravi, A

    2013-01-01

    We report a rare presentation of mitral stenosis (MS). MS is a common valvular disease, the first manifestation of which is usually easy fatigability and exertional dyspnea. As the disease progresses in severity, other signs and symptoms appear, such as orthopnea, hemoptysis, and peripheral edema. This is the first report of a case of mitral stenosis presenting with exertional abdominal pain as the first manifestation. This case report describes the clinical characteristics of a 55-year-old woman with mitral stenosis and severe pulmonary hypertension, whose first symptom was exertional abdominal pain. PMID:23377483

  17. [Reproducibility of lumbar spine kinematics in clinical gait analysis].

    PubMed

    Portscher, M; Vogt, L; Pfeifer, K; Banzer, W

    2000-06-01

    The objective measurement of functional lumbopelvical movements enables the evaluation of the quantity and quality of movements referring to functional disorders in dynamic test-situations. The goal of the present study is the determination of the reproducibility of time-continuous movement analysis of the pelvic region during walking and the determination of possible errors. The movements of the thoracic (Th12), lumbar and sacrum-region (S1) of 17 healthy subjects (age: 32.1 +/- 2.3 years) during walking on a treadmill (4.5 km/h) were investigated twice in an interval of 24 hours by means of a 3D ultrasonic movement analysis system. The ensemble averages of the low-pass filtered and time-normalized angle-time sequences of all anatomical planes and regions showed high test-retest correlations (r > or = 0.92, p < 0.01) except fo the lumbar movement in the sagittal plane (r = 0.79, p < 0.01). A paired t-test showed no significant differences for the amplitudes of test and retest measurements except for the thoracolumbar movement in the sagittal plane (p < .05). The results show that the evaluation of lumbar movement patterns can be regarded as admissible and desirable for clinical movement analysis. The data can be used as a diagnostic tool for the planning and control of therapeutic interventions. PMID:10939139

  18. Percutaneous treatment of cervical and lumbar herniated disc.

    PubMed

    Kelekis, A; Filippiadis, D K

    2015-05-01

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4-6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75-94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine. PMID:24673977

  19. [The efficiency of lumbar transperitoneal laparoscopic sympathectomy--100 cases revue].

    PubMed

    Bâtc?, V; Jitea, N; Albita, O; Bîtc?, T; M?nuc, D

    2011-01-01

    Lumbar sympathectomy, classical surgical technique applied in conventional arteriopathy treatment, has acquired new valence by the development of laparoscopic technique. In a period of ten years (2000-2009), a number of 100 patients with different cause of arteriopathy have been operated by transperitoneal lumbar sympathectomy. Mean age was 62 years. Indication establishment has been achieved by an investigation protocol taking into account clinical and Para clinical criteria and methods. Postop evolution has been simple with very low morbidity and mortality zero. Particularly good evolution had patients in stages II and III of the disease, with missing effort claudication and repaos pain. Unfavourably results were recorded in advanced stages of disease, at diabetic patients with plenty of associated disease, therefore 9 patients suffering amputations of limbs. Results immediate and late were coordinated with stage and age of patients. Lumbar laparoscopic transperitoneal sympathectomy represents a viable alternative in artheriopathy treatment because of reduced morbidity--representing a chance for these very delicate patients. PMID:22165057

  20. Magnetic resonance imaging (MRI) anatomy of the ovine lumbar spine.

    PubMed

    Nisolle, J F; Wang, X Q; Squélart, M; Hontoir, F; Kirschvink, N; Clegg, P; Vandeweerd, J M

    2014-06-01

    Although the ovine spine is a useful research model for intervertebral disc pathology and vertebral surgery, there is little peer-reviewed information regarding the MRI anatomy of the ovine spine. To describe the lumbar spine MRI anatomy, 10 lumbar segments of cadaver ewes were imaged by 1.5-Tesla MR. Sagittal and transverse sequences were performed in T1 and T2 weighting (T1W, T2W), and the images were compared to gross anatomic sagittal and transverse sections performed through frozen spines. MRI was able to define most anatomic structures of the ovine spine in a similar way as can be imaged in humans. In both T1W and T2W, the signals of ovine IVDs were similar to those observed in humans. Salient anatomic features were identified: (1) a 2- to 3-mm linear zone of hypersignal was noticed on both extremities of the vertebral body parallel to the vertebral plates in sagittal planes; (2) the tendon of the crura of the diaphragm appeared as a hypointense circular structure between hypaxial muscles and the aorta and caudal vena cava; (3) dorsal and ventral longitudinal ligaments and ligamentum flavum were poorly imaged; (4) no ilio-lumbar ligament was present; (5) the spinal cord ended between S1-S2 level, and the peripheral white matter and central grey matter were easily distinguished on T1W and T2W images. This study provides useful reference images to researchers working with ovine models. PMID:23668479

  1. Remote Cerebellar Hemorrhage Complicating Unintended Durotomy in Lumbar Spine Surgery

    PubMed Central

    Millgram, Michael A; Ashkenazi, Ely; Rand, Nahshon

    2015-01-01

    Study design Case reports and retrospective review of accidental durotomies in lumbar surgeries during 5 years. Objectives To draw attention to a potentially serious complication of incidental durotomy-remote cerebellar hemorrhage. Summary and background data Accidental durotomy is a frequent complication of spinal surgery. In most cases the outcome of incidental durotomy is favorable. A delayed potentially serious complication of CSF loss during and after lumbar surgery is remote cerebellar hemorrhage (RCH). Methods During 2008-2012, 1169 lumbar spine procedures were performed at our spine center. In 210 surgeries incidental or intentional durotomies occurred. All patients with durotomies were managed with suturing of the dural wound followed by deep wound drainage left for 5 days and tight wound closure. Results Of the 210 patients with CSF loss three patients were identified to suffer from RCH-an incidence of 0.26%. The three patients ages 56, 67 and 75 years developed RCH between 36-192 hours after surgery. All three were managed with supportive treatment and close clinical supervision. A gradual clinical and radiological improvement was noted in all three patients. Conclusions Severe headache after spinal surgery and or declining mental status should not be attributed only to low CSF pressure secondary to dural tearing. It can also be the result of remote cerebral or cerebellar hemorrhage. Once the diagnosis of RCH is made, close clinical supervision is mandatory. In most cases non-operative supportive treatment may lead to eventual full clinical recovery. PMID:26273547

  2. Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients with Lumbar Intervertebral Disc Herniation

    PubMed Central

    Lurie, Jon D.; Moses, Rachel A.; Tosteson, Anna N. A.; Tosteson, Tor D.; Carragee, Eugene J.; Carrino, John A.; Kaiser, Jay A.; Herzog, Richard J.

    2013-01-01

    Study Design A retrospective cohort design Objective To determine if baseline MRI findings including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression are associated with differential surgical treatment effect. Summary of Background Data Intervertebral Disc Herniation (IDH)remains the most common source of lumbar radiculopathy treated either with discectomy or non-operative intervention. Although MRI remains the reliable gold standard for diagnosis, uncertainty surrounds the relationship between MRI findings and treatment outcomes. Methods Three-hundred-and-seven “complete” images from patients enrolled in a previous trial were de-identified and evaluated by one of 4 independent readers. Findings were compared to outcome measures including the Oswestry Disability Index. Differences in surgery and non-operative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in ODI scores. Results The cohort was comprised of 40% females with an average age of 41.5 (±11.6), 61% of which underwent discectomy for IDH. Patients undergoing surgery with Modic type I endplate changes had worse outcomes (?26.4 versus ?39.7 for none and ?39.2 for type 2, p=0.002) and smaller treatment effect (?3.5 versus ?19.3 for none and ?15.7 for type 2, p=0.003). Those with compression >=1/3 showed the greatest improvement within the surgical group (?41.9 for >=1/3 versus ?31.6 for none and ?38.1 for <1/3,p=0.007), and the highest TE (?23 compared to ?11.7 for none and ?15.2 for <1/3, p=0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes(?26.5 versus ?41.1 for “displaced” and ?38.9 for “compressed”, p=0.016). Conclusion Among patients with IDH, those with thecal sac compression >=1/3 had greater surgical treatment effect than those with small disc herniations and Modic type I changes. Additionally, patients with nerve root “compression” and “displacement” benefit more from surgery than those with minimal nerve-root impingement. PMID:23429684

  3. Comparison of lumbar spinal angle between normal body mass index and overweight young adults

    PubMed Central

    Taweetanalarp, Soontharee; Purepong, Nithima

    2015-01-01

    [Purpose] This study compared the upper and lower lumbar angles of normal body mass index and overweight young adults, and examined the relationships among body mass index, waist circumferences, and lumbar angles. [Subjects and Methods] Sixty participants aged 18–25 years were recruited and allocated to 2 groups (n=30 per group): normal body mass index (18.5–24.9?kg/m2) and overweight group (body mass index, ? 25.0?kg/m2). During lumbar angle measurement, the participants stood in a relaxed position with bare feet. The upper and lower lumbar angles of each participant were measured using a flexible ruler, and the angle calculated by the tangent method. The waist circumference was also measured. [Results] The mean lower lumbar angle in the overweight group was significantly greater than that of the normal body weight group. Moreover, only the lower lumbar angle was associated with a significant increase in the body mass index (r=0.28). Waist circumference showed no association with the lumbar angles. [Conclusion] This is the first study to suggest that increased body weight could cause lower lumbar angle deviation in young adults. Further studies should investigate individuals with symptomatic back pain or back dysfunction and the impact of body weight on lumbar spinal angles. PMID:26311979

  4. Anatomical variations of lumbar arteries and their clinical implications: a cadaveric study.

    PubMed

    Karunanayake, Aranjan Lionel; Pathmeswaran, Arunasalam

    2013-01-01

    Lumbar arteries arise from the abdominal aorta. Some abdominal and spinal surgeries can damage these arteries, and that can lead to serious consequences. This study aimed at studying the types and frequencies of variations of lumbar vasculature. We dissected both sides of 109 adult human cadavers and studied the variations of lumbar vasculature. Age range was 43-90?years. Fifty-seven percent were males and 43% were females. The number of lumbar arteries arising from either side of the abdominal aorta varied between 3 and 5 pairs. The lumbar arteries arose from a common single stem in 12% of the cadavers. The third and fourth pairs of lumbar arteries arose from a common single stem in 3% and 11% of cadavers, respectively, and the first and second pairs of lumbar arteries arose from a common single stem in 1% and 2% of cadavers, respectively. The first and second lumbar arteries on the right side traveled anterior to the right crus of the diaphragm in 7% and 8% of cadavers, respectively. There were several variations with regard to the number, origin from the abdominal aorta, and pathway of lumbar arteries from what is described in the literature. PMID:25938093

  5. Treatment of lumbar disc herniation by percutaneous laser disc decompression (PLDD) and modified PLDD

    NASA Astrophysics Data System (ADS)

    Chi, Xiao fei; Li, Hong zhi; Wu, Ru zhou; Sui, Yun xian

    2005-07-01

    Objective: To study the micro-invasive operative method and to compare the effect of treatment of PLDD and modified PLDD for Lumbar Disc Herniation. Method: Vaporized part of the nucleus pulposus in single or multiple point after acupuncture into lumbar disc, to reach the purpose of the decompression of the lumbar disc. Result: Among the 19 cases of the regular PLDD group, the excellent and good rate was 63.2%, and among the 40 cases of the modified PLDD group, the excellent and good rate was 82.5%. Conclusion: The modified PLDD has good effect on the treatment for lumbar disc herniation.

  6. Neurobiology of retinal dopamine in relation to degenerative states of the tissue.

    PubMed

    Djamgoz, M B; Hankins, M W; Hirano, J; Archer, S N

    1997-12-01

    Neurobiology of retinal dopamine is reviewed and discussed in relation to degenerative states of the tissue. The Introduction deals with the basic physiological actions of dopamine on the different neurons in vertebrate retinae with an emphasis upon mammals. The intimate relationship between the dopamine and melatonin systems is also covered. Recent advances in the molecular biology of dopamine receptors is reviewed in some detail. As degenerative states of the retina, three examples are highlighted: Parkinson's disease; ageing; and retinal dystrophy (retinitis pigmentosa). As visual functions controlled, at least in part, by dopamine, absolute sensitivity, spatial contrast sensitivity, temporal (including flicker) sensitivity and colour vision are reviewed. Possible cellular and synaptic bases of the visual dysfunctions observed during retinal degenerations are discussed in relation to dopaminergic control. It is concluded that impairment of the dopamine system during retinal degenerations could give rise to many of the visual abnormalities observed. In particular, the involvement of dopamine in controlling the coupling of horizontal and amacrine cell lateral systems appears to be central to the visual defects seen. PMID:9425527

  7. The Impact of Obesity on Perioperative Resource Utilization after Elective Spine Surgery for Degenerative Disease

    PubMed Central

    Planchard, Ryan F.; Higgins, Dominique M.; Mallory, Grant W.; Puffer, Ross C.; Jacob, Jeffrey T.; Curry, Timothy B.; Kor, Daryl J.; Clarke, Michelle J.

    2015-01-01

    Study Design?Retrospective case series. Objective?To determine the effect of obesity on the resource utilization and cost in 3270 consecutive patients undergoing elective noninstrumented decompressive surgeries for degenerative spine disease at Mayo Clinic Rochester between 2005 and 2012. Methods?Groups were assessed for baseline differences (age, gender, and American Society of Anesthesiologists [ASA] classification, procedure type, and number of operative levels). Outcome variables included the transfusion requirements during surgery, the total anesthesia and surgical times, intensive care unit (ICU) admissions, standardized costs, as well as the ICU and hospital length of stay (LOS). Regression analysis was used to evaluate for strength of association between obesity and outcome variables. Results?Baseline differences between the groups (nonobese: n?=?1,853; obese: n?=?1,417) were found with respect to age, ASA class, gender, procedure type, and number of operative levels. After correcting for differences, we found significant associations between obesity and surgical (p?degenerative spine disease. PMID:26225277

  8. Nd:YAG laser in experimentally induced chronic degenerative osteoarthritis in broiler chickens: pilot study

    NASA Astrophysics Data System (ADS)

    Fortuna, Damiano; Rossi, Giacomo; Bilotta, Teresa W.; Zati, Allesandro; Cardillo, Ilaria; Venturini, Antonio; Pinna, Stefania; Serra, Christian; Masotti, Leonardo

    2002-10-01

    The Low Level Laser Therapy (LLLT) has been widely tested in arthritis disorders, but there is still some disagreement in the results, therefore in this study we have investigated High Intensity Laser Therapy (HILT). The degenerative arthritis was induced in 18 chickens by intra-articular inoculation of Freund's complete adjuvant. Clinical studies were carried out (weight increase and grades of lameness) as well as morphological (macroscopic and histological) tests and seroassay (C Reactive Protein). The Nd:YAG pulsed wave was employed. The serologic data revealed the anti-inflammatory effect on the laser, with a highly significant difference between those treated and the control group. No lesion on the skin, i.e. burn, or in depth has been observed in the Treated group. Heavyline of broiler chickens in growing age has been revealed a good animal model of O.A.. The Nd:YAG Pulsed Wave it is safe on these structures. The anti-inflammatory effect of the HILT it seems to contrast the destructive degenerative process.

  9. Redox Signaling as a Therapeutic Target to Inhibit Myofibroblast Activation in Degenerative Fibrotic Disease

    PubMed Central

    Berger, Peter; Zenzmaier, Christoph

    2014-01-01

    Degenerative fibrotic diseases encompass numerous systemic and organ-specific disorders. Despite their associated significant morbidity and mortality, there is currently no effective antifibrotic treatment. Fibrosis is characterized by the development and persistence of myofibroblasts, whose unregulated deposition of extracellular matrix components disrupts signaling cascades and normal tissue architecture leading to organ failure and death. The profibrotic cytokine transforming growth factor beta (TGF?) is considered the foremost inducer of fibrosis, driving myofibroblast differentiation in diverse tissues. This review summarizes recent in vitro and in vivo data demonstrating that TGF?-induced myofibroblast differentiation is driven by a prooxidant shift in redox homeostasis. Elevated NADPH oxidase 4 (NOX4)-derived hydrogen peroxide (H2O2) supported by concomitant decreases in nitric oxide (NO) signaling and reactive oxygen species scavengers are central factors in the molecular pathogenesis of fibrosis in numerous tissues and organs. Moreover, complex interplay between NOX4-derived H2O2 and NO signaling regulates myofibroblast differentiation. Restoring redox homeostasis via antioxidants or NOX4 inactivation as well as by enhancing NO signaling via activation of soluble guanylyl cyclases or inhibition of phosphodiesterases can inhibit and reverse myofibroblast differentiation. Thus, dysregulated redox signaling represents a potential therapeutic target for the treatment of wide variety of different degenerative fibrotic disorders. PMID:24701562

  10. Effects of the MWM Technique Accompanied by Trunk Stabilization Exercises on Pain and Physical Dysfunctions Caused by Degenerative Osteoarthritis

    PubMed Central

    Nam, Chan-Woo; Park, Sang-In; Yong, Min-Sik; Kim, Young-Min

    2013-01-01

    [Purpose] This study aimed to identify how treatment with the Mulligan technique of mobilization with movement (MWM) influences pain and physical function of patients with degenerative osteoarthritis. [Subjects] Thirty patients diagnosed with degenerative osteoarthritis were divided into an experimental group (n=15), and a control group (n=15). [Methods] The experimental group was treated with general physical therapy, trunk stabilization exercises, and performed the MWM using the Mulligan technique. The control group was treated with general physical therapy, and then performed trunk stabilization exercises. [Results] Statistically significant differences were found after the intervention in the experimental group in the visual analog scale and Western Ontario and McMaster Universities osteoarthritis index pain, stiffening, and physical function scores. [Conclusion] We consider the treatment of degenerative osteoarthritis patients using the MWM technique is effective for reducing pain and improving physical functions. PMID:24259931

  11. Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Lumbar Spinal Degeneration Disease

    PubMed Central

    Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Ochiai, Nobuyasu; Kishida, Shunji; Kuniyoshi, Kazuki; Aoki, Yasuchika; Nakamura, Junichi; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Fujimoto, Kazuki; Shiga, Yasuhiro; Abe, Koki; Toyone, Tomoaki; Inoue, Gen; Takahashi, Kazuhisa

    2015-01-01

    Purpose Surgery for lumbar spinal degeneration disease is widely performed. While posterior decompression and fusion are popular, anterior lumbar interbody fusion (ALIF) is also used for treatment. Extreme lateral interbody fusion (XLIF) is commonly used for noninvasive ALIF; however, several complications, such as spinal nerve and psoas muscle injury, have been reported. In the current study, we examined the clinical efficacy and complications of oblique lateral interbody fusion (OLIF) for lumbar spinal degeneration disease. Materials and Methods Thirty-five patients with degenerated spondylolisthesis, discogenic pain, and kyphoscoliosis were examined. All patients underwent OLIF surgery (using a cage and bone graft from the iliac crest) with or without posterior decompression, without real-time electromyography monitoring. Posterior screws were used in all patients. Visual analog scale (VAS) score and Oswestry Disability Index (ODI) were evaluated before and 6 months after surgery. Surgical complications were also evaluated. Results Pain scores significantly improved after surgery, compared to those before surgery (p<0.05). There was no patient who underwent revision surgery. There was no spinal nerve, major vessel, peritoneal, or urinary injury. Few patients showed symptoms from psoas invasion. Conclusion OLIF surgery produced good surgical results without any major complication. PMID:26069130

  12. Pig Lumbar Spine Anatomy and Imaging Guided Lateral Lumbar Puncture: A New Large Animal Model for Intrathecal Drug Delivery

    PubMed Central

    Pleticha, Josef; Maus, Timothy P.; Jeng-Singh, Christian; Marsh, Michael P.; Al-Saiegh, Fadi; Christner, Jodie A.; Lee, Kendall H.; Beutler, Andreas S.

    2014-01-01

    Intrathecal (IT) administration is an important route of drug delivery. Its modeling in a large animal species is a critical step. Although domestic swine is presently a preferred species in preclinical pharmacology, no proven minimally invasive method has been established to deliver agents into the pig IT space. While a “blind” lumbar puncture (LP) can sample cerebrospinal fluid (CSF), it is unreliable for drug delivery in pigs. Using computed tomography (CT) we determined the underlying anatomical reasons. The pig spinal cord was visualized terminating at the S2-S3 level. The lumbar region contained only small amounts of CSF visualized in the lateral recesses. Additional anatomical constraints identified were ossification of the midline ligaments; overlapping lamina with small interlaminar spaces; and a large bulk of epidural adipose tissue. Accommodating the pig CT anatomy, we developed an injection technique termed lateral LP (LLP) that employs advance planning of the needle path and monitoring of the IT injection progress. Key features of the LLP procedure were choosing a vertebral level without overlapping lamina or spinal ligament ossification; a needle trajectory crossing the midline; and entering the IT space in its lateral recess. Effective IT delivery was validated by injection of contrast media thereby obtaining a CT myelogram. LLP represents a safe and reliable method to deliver agents to the lumbar pig IT space, which can be implemented in a straightforward way by any laboratory with access to CT equipment and is therefore an attractive large animal model for preclinical studies of IT therapies. PMID:23518340

  13. Adjacent Segment Pathology Following Anterior Decompression and Fusion Using Cage and Plate for the Treatment of Degenerative Cervical Spinal Diseases

    PubMed Central

    Song, Kyung-Jin; Kim, Jong-Kil

    2014-01-01

    Study Design Retrospective study. Purpose To analyze the incidence and prevalence of clinical adjacent segment pathology (CASP) following anterior decompression and fusion with cage and plate augmentation for degenerative cervical diseases. Overview of Literature No long-term data on the use of cage and plate augmentation have been reported. Methods The study population consisted of 231 patients who underwent anterior cervical discectomy and fusion (ACDF) with cage and plate for degenerative cervical spinal disease. The incidence and prevalence of CASP was determined by using the Kaplan-Meier survival analysis. To analyze the factors that influence CASP, data on preoperative and postoperative sagittal alignment, spinal canal diameter, the distance between the plate and adjacent disc, extent of fusion level, and the presence or absence of adjacent segment degenerative changes by imaging studies were evaluated. Results CASP occurred in 15 of the cases, of which 9 required additional surgery. At 8-year follow-up, the average yearly incidence was 1.1%. The rate of disease-free survival based on Kaplan-Meier survival analysis was 93.6% at 5 years and 90.2% at 8 years. No statistically significant differences in CASP incidence based on radiological analysis were observed. Significantly high incidence of CASP was observed in the presence of increased adjacent segment degenerative changes (p<0.001). Conclusions ACDF with cage and plate for the treatment of degenerative cervical disease is associated with a lower incidence in CSAP by 1.1% per year, and the extent of preoperative adjacent segment degenerative changes has been shown as a risk factor for CASP. PMID:25558313

  14. Posterior lumbar interbody fusion with instrumented posterolateral fusion in adult spondylolisthesis: description and association of clinico-surgical variables with prognosis in a series of 36 cases

    PubMed Central

    Gomez-Moreta, Juan A.; Hernandez-Vicente, Javier

    2015-01-01

    Background We present our experience in the treatment of patients with isthmic or degenerative spondylolisthesis, by means of a posterior lumbar interbody fusion (PLIF) and instrumented posterolateral fusion (IPLF), and we compare them with those published in the literature. We analyse whether there exists any statistical association between the clinical characteristics of the patient, radiological characteristics of the disease and our surgical technique, with the complications and the clinical-radiological prognosis of the cases. Method We designed a prospective study. A total of 36 cases were operated. The patients included were 14 men and 22 women, with an average age of 57.17±27.32 years. Our technique consists of PLIF+IPLF, using local bone for the fusion. The clinical results were evaluated with the Visual Analogical Scale (VAS) and the Kirkaldy-Willis criteria. The radiological evaluation followed the Bratingan (PLIF) and Lenke (IPLF) methodology. A total of 42 variables were statistically analysed by means of SPSS18. We used the Paired Student's T-test, logistic regression and Pearson's Chi-square-test. Results The spondylolisthesis was isthmic in 15 cases and degenerative in 21 cases. The postoperative evaluations had excellent or good results in 94.5% (n = 34), with a statistically significant improvement in the back pain and sciatica (p < 0.01). The rate of circumferential fusion reached was approximately 92%. We had 13.88% of transitory morbility and 0% of mortality associated with our technique. A greater age, degree of listhesis or length of illness before the intervention, weakly correlated with worse clinical results (p< -0.2). In our series, the logistical regression showed that the clinical characteristics of the patient, radiological characteristics of the lesion and our surgical technique were not associated with greater postoperative complications. Conclusion Although a higher level of training is necessary, we believe that the described technique is a very effective decision in cases of spondylolisthesis, isthmic or degenerative, refractory to conservative treatment, for the obtaining the best clinical results and rates of fusion, with similar risks to those of the other published techniques. Our statistical analysis could contribute to improve outcomes after surgery. PMID:26196029

  15. Hour-glass deformity of the pulmonary valve: a third type of pulmonary valve stenosis.

    PubMed Central

    Milo, S; Fiegel, A; Shem-Tov, A; Neufeld, H N; Goor, D A

    1988-01-01

    In the 12 years from 1975 to 1987, 55 patients had open pulmonary valve surgery for isolated congenital stenosis of the pulmonary valve. Three types of pulmonary stenosis were seen: (a) dome-shaped pulmonary stenosis (34 patients); (b) dysplastic pulmonary valves with thick cauliflower-like cusps (12 patients), and (c) hour-glass deformity of the pulmonary valve, with "bottle-shaped" sinuses (nine patients). This third type has not been described before. Preoperative identification of the valve structure is important because the choice of treatment (balloon dilatation for some dome-shaped valves and excision for dysplastic and hour-glass valves) depends on the type of stenosis. Images Fig 2 Fig 3 Fig 4 PMID:3415872

  16. [Tracheal stenosis due to non-Hodgkin's lymphoma of the exceptionaly rare location].

    PubMed

    Kozakiewicz, Jacek; Wasowicz, Bozena; Gorczyca-Tarnowska, Jadwiga; Grochowski, Zbigniew; Olechnowicz, Henryk; Rusinowska, Zofia; Stockfisch, Jerzy

    2007-01-01

    A case of tracheobronchiale stenosis due to non-Hodgkin's lymphoma (mantle cell lymphoma) of the exceptionaly rare location, in 75 old woman is described. After the restoration of airways patency and stent implantation dyspnea was removed. PMID:18546947

  17. Carotid collar : a device for auscultory detection of carotid artery stenosis

    E-print Network

    Gift, Jason Ayres, 1981-

    2003-01-01

    The carotid collar is a hardware device designed to aid in detecting carotid artery stenosis, a disease that increases the risk of stroke. This device consists of three electronic stethoscopes that record heart and carotid ...

  18. Carotid Artery Stenosis at MSCT: Is there a Threshold in Millimeters that Determines Clinical Significance?

    SciTech Connect

    Saba, Luca; Sanfilippo, Roberto; Montisci, Roberto; Mallarini, Giorgio

    2012-02-15

    Purpose: The purpose of this work was to determine whether it is possible to identify a reliable carotid stenosis threshold-measured in millimeters (mm)-that is associated with cerebrovascular symptoms. Methods: Written, informed consent was obtained for each patient; 149 consecutive patients (98 men; median age, 68 years) were studied for suspected pathology of the carotid arteries by using MDCTA. In each patient, carotid artery stenosis was quantified using the mm-method. Continuous data were described as the mean value {+-} standard deviation (SD), and they were compared by using the Student's t test. A ROC curve was calculated to test the study hypothesis and identify a specific mm-stenosis threshold. Logistic regression analysis was performed to include other MDCTA findings, such as plaque type and ulcerations. A P value < 0.05 was considered to indicate statistical significance. Results: Twenty-six patients were excluded. Of those remaining, 75 patients suffered cerebrovascular symptoms (61%). There was a statistically significant difference (P = 0.0046) in the mm-carotid stenosis between patients with symptoms (1.31 {+-} 0.64 mm SD) and without symptoms (1.68 {+-} 0.79 mm SD). Multiple logistic regression analysis confirmed that symptoms were associated with increased luminal stenosis (P = 0.013) and with the presence of fatty plaques (P = 0.0491). Moreover, the ROC curve (Az = 0.669; {+-}0.051 SD; P = 0.0009) indicated that a threshold of 1.6 mm stenosis was associated with a sensitivity to symptoms of 76%. Conclusions: The results of our study suggest an association between luminal stenosis (measure in mm) and the presence of cerebrovascular symptoms. Luminal stenosis of 1.6 mm is associated, with a sensitivity of 76%, with cerebrovascular symptoms.

  19. Three-dimensional echocardiographic features of unicuspid aortic valve stenosis correlate with surgical findings.

    PubMed

    Brantley, Hutton P; Nekkanti, Rajasekhar; Anderson, Curtis A; Kypson, Alan P

    2012-09-01

    A unicuspid aortic valve (UAV) is a rare congenital defect that may manifest clinically as severe aortic stenosis or regurgitation in the third to fifth decade of life. This report describes two cases of UAV stenosis in adult patients diagnosed by transesophageal echocardiography (TEE). The utility of three-dimensional TEE in confirming valve morphology and its relevance to transcatheter valve replacement are discussed. PMID:22676160

  20. Left Apical Aneurysm in a Patient with Severe Aortic Valve Stenosis

    PubMed Central

    Drews, Thorsten; Pasic, Miralem; Hetzer, Roland

    2014-01-01

    We report on a very rare case of left ventricular aneurysm in a 77-year-old patient with aortic valve stenosis and without coronary artery disease. The patient underwent conventional aortic valve replacement and left ventricular aneurysmectomy with an uneventful postoperative course. The cause of the left ventricular aneurysm was suspected to be a long history of aortic valve stenosis that led to severe intraventricular hypertension, subsequently asymmetric septum hypertrophy, and finally apical aneurysm. PMID:25798350

  1. Stenosis enhances role of platelets in growth of regional thrombus and intimal wall thickening in rat carotid arteries.

    PubMed

    Igawa, T; Nagamura, Y; Ozeki, Y; Itoh, H; Unemi, F

    1995-08-01

    The authors present the results of a study in which stenosis was induced, resulting in either thrombus or intimal wall thickening, in rat carotid arteries. At > or = 75% stenosis in mildly denuded arteries, an acute and occlusive thrombus formation was induced, but the thrombus was significantly reduced in thrombocytopenia. Thrombus formation near the site of stenosis decreased with decreasing degree of stenosis, whereas the percent formation in the distal region (percent total thrombus) increased. Numerous mural platelet microthrombi were noted at the distal region of the stenosed arteries. After chronic 50% stenosis of the carotid artery for 2 weeks, significant intimal thickening was observed, without any occlusive thrombus formation. The combination with mild denudation was critical in eliciting the effect of stenosis. The magnitude of intimal growth in the stenosed artery was marked by day 6 and plateaued thereafter, whereas it was slight in nonstenosed arteries. The 5-bromodeoxyuridine index of the cells of the medial layer at day 3 was significantly increased by the stenosis, and the effect was reversed in thrombocytopenia. Complete reendothelialization of the intimal surface was observed by 7 to 10 days after surgery in the stenosed arteries. These findings suggest that the introduction of stenosis in these arteries enhances the interaction of platelets with the damaged arterial walls under abnormal fluid shear and that this enhancement leads to acute and occlusive thrombus formation associated with more marked stenosis as well as to sustained increase of intimal wall thickness in less marked stenosis. PMID:7614718

  2. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms

    PubMed Central

    Thorlund, J B; Juhl, C B; Roos, E M; Lohmander, LS

    2015-01-01

    Objective To determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease. Design Systematic review and meta-analysis. Main outcome measures Pain and physical function. Data sources Systematic searches for benefits and harms were carried out in Medline, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2014. Only studies published in 2000 or later were included for harms. Eligibility criteria for selecting studies Randomised controlled trials assessing benefit of arthroscopic surgery involving partial meniscectomy, debridement, or both for patients with or without radiographic signs of osteoarthritis were included. For harms, cohort studies, register based studies, and case series were also allowed. Results The search identified nine trials assessing the benefits of knee arthroscopic surgery in middle aged and older patients with knee pain and degenerative knee disease. The main analysis, combining the primary endpoints of the individual trials from three to 24 months postoperatively, showed a small difference in favour of interventions including arthroscopic surgery compared with control treatments for pain (effect size 0.14, 95% confidence interval 0.03 to 0.26). This difference corresponds to a benefit of 2.4 (95% confidence interval 0.4 to 4.3) mm on a 0–100?mm visual analogue scale. When analysed over time of follow-up, interventions including arthroscopy showed a small benefit of 3–5?mm for pain at three and six months but not later up to 24 months. No significant benefit on physical function was found (effect size 0.09, ?0.05 to 0.24). Nine studies reporting on harms were identified. Harms included symptomatic deep venous thrombosis (4.13 (95% confidence interval 1.78 to 9.60) events per 1000 procedures), pulmonary embolism, infection, and death. Conclusions The small inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time and absent at one to two years after surgery. Knee arthroscopy is associated with harms. Taken together, these findings do not support the practise of arthroscopic surgery for middle aged or older patients with knee pain with or without signs of osteoarthritis. Systematic review registration PROSPERO CRD42014009145. PMID:26383759

  3. A Protocol-Based Decision for Choosing a Proper Surgical Treatment Option for Carotid Artery Stenosis

    PubMed Central

    Jang, E-Wook; Chung, Joonho; Seo, Kwon-Duk; Suh, Sang Hyun; Kim, Yong Bae

    2015-01-01

    Objective There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. Materials and Methods A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. Results CEA or CAS is indicated when the patient has a symptomatic stenosis ? 50%, or when the patient has an asymptomatic stenosis ? 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. Conclusion We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis. PMID:26157689

  4. The use of 188Re to treat in-stent re-stenosis of coronary arteries.

    PubMed

    Fox, R A; Barker, P; Guy, D; Smart, G; Henson, P W; Mews, G C; Gibbons, F

    2001-09-01

    A pilot study has been conducted in which coronary arteries subject to re-stenosis after angioplasty and stenting have been irradiated following further angioplasty. The method of irradiation has been to use radioactive 188Re in an angioplasty balloon. This paper considers all aspects of the procedure including elution of the rhenium from a tungsten/rhenium generator, its concentration, dispensing and safe delivery to the patient using specially designed equipment to reduce staff doses and radioactive spills. In the pilot study of 28 lesions in 26 patients only 1 was recorded as having angiographic re-stenosis in the treated region at 6 months although 4 other patients had edge re-stenosis. This represents less than 18% re-stenosis in a population that would have been expected to exhibit at least 50% re-stenosis at 6 months. A total of 72 patients have been treated either in the pilot study or a subsequent trial. In only one case has a minor spill of radioactivity occurred and in no case has the balloon burst. Radiation doses to staff are approximately 20 microSv per procedure and are therefore not of serious consequence. It is concluded that this procedure is safe, feasible and effective in reducing in-stent re-stenosis. PMID:11764398

  5. Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis

    PubMed Central

    Lee, Jung Hee; Jeong, Dong Seop; Sung, Kiick; Kim, Wook Sung; Lee, Young Tak; Park, Pyo Won

    2015-01-01

    Background Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. Methods This retrospective study included 225 consecutive patients (mean age, 65±10 years; 123 males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary artery disease, an ejection fraction <50%, more than mild aortic regurgitation, or endocarditis. The patients were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia; group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution; and group C, treated with retrograde cold blood cardioplegia. Results Group A contained 70 patients (31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups showed significant differences with regard to the proportion of patients with a New York Heart Association functional classification ?III (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left ventricular dimensions (p<0.001), left ventricular mass index (p<0.001), and right ventricular systolic pressure (p<0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the three groups were not statistically significant. During postoperative recovery, no significant differences were found regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred. Similarly, no significant differences were found in long-term outcomes. Conclusion Although the three groups showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved with combined antegrade and retrograde cold blood cardioplegia. PMID:26078922

  6. Lumbar puncture and subdural hygroma and hematomas in hematopoietic cell transplant patients.

    PubMed

    Openshaw, H; Ressler, J A; Snyder, D S

    2008-05-01

    We reviewed records of hematopoietic cell transplantation (HCT) patients seen over the past 10 years who had head scan documentation of subdural fluid collections. A total of 17 patients were identified: 13 with allogeneic and 4 with autologous HCT (0.71% of allogeneic and 0.13% of autologous HCT patients seen in this time interval). Although less than 20% of HCT patients have lumbar puncture, 8 of the 17 subdural patients had lumbar puncture. The lumbar puncture was done 5-112 days (median 46 days) before subdural detection. Acute lymphocytic leukemia was the diagnosis in five of these eight; whereas, either acute myelogenous leukemia or myelodysplasia was the diagnosis in seven of the nine patients without lumbar puncture. In the patient group with lumbar puncture, subdurals were diagnosed earlier after HCT (median 25 days versus 5 months in the patient group without lumbar puncture) and were more often hygromas (37.5 versus 0%). These results support the suggestion of lumbar puncture or intrathecal therapy as a risk factor for subdurals. The presumptive mechanism involves lumbar cerebrospinal leak, low intracranial pressure, downward displacement of the brain, cerebrospinal fluid accumulation into the inner dural layers of the cerebral convexities (hygromas) and bleeding into these fluid collections (hematomas). PMID:18246118

  7. Comparison of chronic low-back pain patients hip range of motion with lumbar instability

    PubMed Central

    Lee, Sang wk; Kim, Suhn Yeop

    2015-01-01

    [Purpose] The purpose of this study was to compare differences in hip range of motion between a lumbar stability group and a lumbar instability group of patients with chronic low-back pain. [Subjects] Sixty-nine patients with chronic low-back pain were divided into two groups: a lumbar stability group (n=39) and a lumbar instability group (n=30). [Methods] The patients were assessed using a goniometer to evaluate the hip range of motion at pre-test. Data were analyzed using SPSS 18.0 software for Windows. The experimental data were analyzed using one-way ANOVA, repeated one-way ANOVA, and the t-test, and a significance level of 0.05. [Results] The limitation of hip range of motion of the lumbar instability group was significantly greater than that of the lumbar stability group. [Conclusion] The chronic low-back pain patients showed greater limitation of hip range of motion than healthy persons, and among them, those who had lumbar instability showed greater limitation than those with lumbar stability. PMID:25729165

  8. Neonatal Androgen-Dependent Sex Differences in Lumbar Spinal Cord Dopamine Concentrations and

    E-print Network

    Breedlove, Marc

    Neonatal Androgen-Dependent Sex Differences in Lumbar Spinal Cord Dopamine Concentrations to the spinal cord. DA in the dorsal and ventral horns modulates sensory, motor, nociceptive, and sexual in the lumbar spinal cord. The purpose of this study was to determine whether sex dif- ferences in spinal cord

  9. Androgen Regulates the Sexually Dimorphic Gastrin-Releasing Peptide System in the Lumbar Spinal Cord

    E-print Network

    Breedlove, Marc

    lumbar spinal cord of male rats projects to the lower lumbar spinal cord, releasing gastrin later, in a profound decrease in the expression of GRP in the spinal cord, as reflected feminization allele on expression of the receptor for GRP in the spinal cord, but castration did reduce

  10. Bipolar and Major Depressive Disorder: Neuroimaging the Developmental-Degenerative Divide

    PubMed Central

    Savitz, Jonathan; Drevets, Wayne C

    2010-01-01

    Both major depressive disorder and bipolar disorder are the subject of a voluminous imaging and genetics literature. Here, we attempt a comprehensive review of MRI and metabolic PET studies conducted to date on these two disorders, and interpret our findings from the perspective of developmental and degenerative models of illness. Elevated activity and volume loss of the hippocampus, orbital and ventral prefrontal cortex are recurrent themes in the literature. In contrast, dorsal aspects of the PFC tend to display hypometabolism. Ventriculomegaly and white matter hyperintensities are intimately associated with depression in elderly populations and likely have a vascular origin. Important confounding influences are medication, phenotypic and genetic heterogeneity, and technological limitations. We suggest that environmental stress and genetic risk variants interact with each other in a complex manner to alter neural circuitry and precipitate illness. Imaging genetic approaches hold out promise for advancing our understanding of affective illness. PMID:19428491

  11. Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis: long-term follow-up.

    PubMed

    Hug, U; Guggenheim, M; Kilgus, M; Giovanoli, P

    2012-04-01

    Radioscapholunate arthrodesis is the treatment of choice for symptomatic, degenerative radioscapholunate osteoarthritis. We report on three patients after radioscapholunate arthrodesis with a follow-up of 22-28 years. There were no short-term postoperative complications; range of motion and strength were stable. All three patients showed radiological evidence of progressive, but clinically asymptomatic midcarpal osteoarthritis. The conversion rate for radioscapholunate to panarthrodesis of the wrist is reported at 31% with follow-ups of more than five years, invariably due to either non-union, or progressive, symptomatic midcarpal osteoarthritis. Primary excision of the distal pole of the scaphoid during radioscapholunate arthrodesis probably plays an important role in avoiding these conditions in the long-term. This measure allows a residual range of motion more than previously believed; considering that the dart thrower's motion is the physiological axis of wrist motion. PMID:22484245

  12. Use of (/sup 99m/Tc)-HM-PAO in the diagnosis of primary degenerative dementia

    SciTech Connect

    Testa, H.J.; Snowden, J.S.; Neary, D.; Shields, R.A.; Burjan, A.W.; Prescott, M.C.; Northen, B.; Goulding, P.

    1988-12-01

    The clinical value of single photon emission computed tomography (SPECT) in the differential diagnosis of dementia due to cerebral atrophy was evaluated by comparing the pattern of distribution (/sup 99m/Tc)-HM-PAO in three dementing conditions. Imaging was carried out in 26 patients with suspected Alzheimer's disease, 14 with dementia of the frontal-lobe type, and 13 with progressive supranuclear palsy. Images were evaluated and reported without knowledge of clinical diagnosis with respect to regions of reduced uptake of tracer. Reduced uptake in the posterior cerebral hemispheres was characteristic of Alzheimer's disease, while selective anterior hemisphere abnormalities characterized both dementia of the frontal-lobe type and progressive supranuclear palsy. The latter conditions could be distinguished on the basis of the appearance of integrity of the rim of the frontal cortex. The technique has an important role in the differentiation of degenerative dementias.

  13. Radiological and Radionuclide Imaging of Degenerative Disease of the Facet Joints

    PubMed Central

    Shur, Natalie; Corrigan, Alexis; Agrawal, Kanhaiyalal; Desai, Amidevi; Gnanasegaran, Gopinath

    2015-01-01

    The facet joint has been increasingly implicated as a potential source of lower back pain. Diagnosis can be challenging as there is not a direct correlation between facet joint disease and clinical or radiological features. The purpose of this article is to review the diagnosis, treatment, and current imaging modality options in the context of degenerative facet joint disease. We describe each modality in turn with a pictorial review using current evidence. Newer hybrid imaging techniques such as single photon emission computed tomography/computed tomography (SPECT/CT) provide additional information relative to the historic gold standard magnetic resonance imaging. The diagnostic benefits of SPECT/CT include precise localization and characterization of spinal lesions and improved diagnosis for lower back pain. It may have a role in selecting patients for local therapeutic injections, as well as guiding their location with increased precision. PMID:26170560

  14. Prognosis of intervertebral disc loss from diagnosis of degenerative disc disease

    NASA Astrophysics Data System (ADS)

    Li, S.; Lin, A.; Tay, K.; Romano, W.; Osman, Said

    2015-03-01

    Degenerative Disc Disease (DDD) is one of the most common causes of low back pain, and is a major factor in limiting the quality of life of an individual usually as they enter older stages of life, the disc degeneration reduces the shock absorption available which in turn causes pain. Disc loss is one of the central processes in the pathogenesis of DDD. In this study, we investigated whether the image texture features quantified from magnetic resonance imaging (MRI) could be appropriate markers for diagnosis of DDD and prognosis of inter-vertebral disc loss. The main objective is to use simple image based biomarkers to perform prognosis of spinal diseases using non-invasive procedures. Our results from 65 subjects proved the higher success rates of the combination marker compared to the individual markers and in the future, we will extend the study to other spine regions to allow prognosis and diagnosis of DDD for a wider region.

  15. Zinc: an antioxidant and anti-inflammatory agent: role of zinc in degenerative disorders of aging.

    PubMed

    Prasad, Ananda S

    2014-10-01

    In the developed countries nearly 30% of the elderly are zinc deficient. Many chronic diseases seen in the elderly such as atherosclerosis, diabetes, neuro-degenerative disorders, Parkinson's disease and age related macular degeneration (AMD) may be due to chronic inflammation and increased oxidative stress. Zinc in human plays an important role in cell mediated immunity and is also an antioxidant and anti-inflammatory agent. Zinc supplementation studies in the elderly have shown decreased incidence of infections, decreased oxidative stress, and decreased generation of inflammatory cytokines. Decreased incidences of blindness in patients with AMD and increased atheroprotective effect have been observed in the zinc supplemented elderly. Zinc is a molecular signal for immune cells and many transcription factors involved in gene expression of inflammatory cytokines and adhesion molecules are regulated by zinc. PMID:25200490

  16. Autosomal dominant (Beukes) premature degenerative osteoarthropathy of the hip joint unlinked to COL2A1

    SciTech Connect

    Beighton, P.; Ramesar, R.; Cilliers, H.J.

    1994-12-01

    Molecular investigations have been undertaken in several separate large South African families with autosomal dominant skeletal dysplasias in which premature degenerative osteoarthropathy of the hip joint was the major manifestation. There are sometimes additional minor changes in the spine and these conditions fall into the general spondyloepiphyseal dysplasia (SED) nosological category. In some kindreds, linkage between phenotype and the type II collagen gene (COL2A1) has been established, while in others there is no linkage. We have now completed molecular linkage investigations in an Afrikaner family named Beukes, in which 47 members in 6 generations have premature osteoarthropathy of the hip joint. A LOD score of minus infinity indicates that this condition is not the result of a defect of the COL2A1 gene. 12 refs., 2 figs., 1 tab.

  17. Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion.

    PubMed

    Willems, Paul

    2013-02-01

    Chronic low back pain (CLBP) is one of the main causes of disability in the western world with a huge economic burden to society. As yet, no specific underlying anatomic cause has been identified for CLBP. Imaging often reveals degenerative findings of the disc or facet joints of one or more lumbar motion segments. These findings, however, can also be observed in asymptomatic people. It has been suggested that pain in degenerated discs may be caused by the ingrowth of nerve fibers into tears or clefts of the annulus fibrosus or nucleus pulposus, and by reported high levels of pro-inflammatory mediators. As this so-called discogenic pain is often exacerbated by mechanical loading, the concept of relieving pain by spinal fusion to stabilise a painful spinal segment, has been developed. For some patients lumbar spinal fusion indeed is beneficial, but its results are highly variable and hard to predict for the individual patient. To identify those CLBP patients who will benefit from fusion, many surgeons rely on tests that are assumed to predict the outcome of spinal fusion. The three most commonly used prognostic tests in daily practice are immobilization in a lumbosacral orthosis, provocative discography and trial immobilization by temporary external transpedicular fixation. Aiming for consensus on the indications for lumbar fusion and in order to improve its results by better patient selection, it is essential to know the role and value of these prognostic tests for CLBP patients in clinical practice. The overall aims of the present thesis were: 1) to evaluate whether there is consensus among spine surgeons regarding the use and appreciation of prognostic tests for lumbar spinal fusion; 2) to verify whether a thoracolumbosacral orthosisis (TLSO) truly minimises lumbosacral motion; 3) to verify whether a TLSO can predict the clinical outcome of fusion for CLBP; 4) to assess whether provocative discography of adjacent segments actually predicts the long-term clinical outcome fusion; 5) to determine the incidence of postdiscography discitis, and whether there is a need for routine antibiotic prophylaxis; 6) to assess whether temporary external transpedicular fixation (TETF) can help to predict the outcome of spinal fusion; 7) to determine the prognostic accuracy of the most commonly used tests in clinical practice to predict the outcome of fusion for CLBP. The results of a national survey among spine surgeons in the Netherlands were presented in Study I. The surgeons were questioned about their opinion on prognostic factors and about the use of predictive tests for lumbar fusion in CLBP patients. The comments were compared with findings from the prevailing literature. The survey revealed a considerable lack of uniformity in the use and appreciation of predictive tests. Prognostic factors known from the literature were not consistently incorporated in the surgeons' decision making process either. This heterogeneity in strategy is most probably caused by the lack of sound scientific evidence for current predictive tests and it was concluded that currently there is not enough consensus among spine surgeons in the Netherlands to create national guidelines for surgical decision making in CLBP. In Study II, the hypothesized working mechanism of a pantaloon cast (i.e., minimisation of lumbosacral joint mobility) was studied. In patients who were admitted for a temporary external transpedicular fixation test (TETF), infrared light markers were rigidly attached to the protruding ends of Steinman pins that were fixed in two spinal levels. In this way three-dimensional motion between these levels could be analysed opto-electronically. During dynamic test conditions such as walking, a plaster cast, either with or without unilateral hip fixation, did not significantly decrease lumbosacral joint motion. Although not substantiated by sound scientific support, lumbosacral orthoses or pantaloon casts are often used in everyday practice as a predictor for the outcome of fusion. A systematic review of the literature supplemented with a prospec

  18. Facet joint changes after application of lumbar nonfusion dynamic stabilization.

    PubMed

    Lee, Soo Eon; Jahng, Tae-Ahn; Kim, Hyun Jib

    2016-01-01

    OBJECTIVE The long-term effects on adjacent-segment pathology after nonfusion dynamic stabilization is unclear, and, in particular, changes at the adjacent facet joints have not been reported in a clinical study. This study aims to compare changes in the adjacent facet joints after lumbar spinal surgery. METHODS Patients who underwent monosegmental surgery at L4-5 with nonfusion dynamic stabilization using the Dynesys system (Dynesys group) or transforaminal lumbar interbody fusion with pedicle screw fixation (fusion group) were retrospectively compared. Facet joint degeneration was evaluated at each segment using the CT grading system. RESULTS The Dynesys group included 15 patients, while the fusion group included 22 patients. The preoperative facet joint degeneration CT grades were not different between the 2 groups. Compared with the preoperative CT grades, 1 side of the facet joints at L3-4 and L4-5 had significantly more degeneration in the Dynesys group. In the fusion group, significant facet joint degeneration developed on both sides at L2-3, L3-4, and L5-S1. The subjective back and leg pain scores were not different between the 2 groups during follow-up, but functional outcome based on the Oswestry Disability Index improved less in the fusion group than in the Dynesys group. CONCLUSIONS Nonfusion dynamic stabilization using the Dynesys system had a greater preventative effect on facet joint degeneration in comparison with that obtained using fusion surgery. The Dynesys system, however, resulted in facet joint degeneration at the instrumented segments and above. An improved physiological nonfusion dynamic stabilization system for lumbar spinal surgery should be developed. PMID:26721580

  19. Outcomes after incidental durotomy during first-time lumbar discectomy

    PubMed Central

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

    2015-01-01

    Introduction Incidental durotomy is an infrequent but well-recognized complication during lumbar disc surgery. The effect of a durotomy on long-term outcomes is however, controversial. We sought to examine whether the occurrence of durotomy during surgery impacts long-term clinical outcome. Methods Spine Patient Outcomes Research Trial (SPORT) cohort participants with a confirmed diagnosis of intervertebral disc herniation (IDH) undergoing standard first-time open discectomy were followed from baseline at 6 weeks, 3, 6, and 12 months, and yearly thereafter, at 13 spine clinics in 11 US states. Patient data from this prospectively gathered database was reviewed. As of May 2009, the mean (SD) follow-up among all analyzed IDH patients was 41.5 (14.5) months (No durotomy: 41.4 vs. Had durotomy: 40.2, p-value<0.68). The median (range) follow-up time among all analyzed IDH patients was 47 (1 to 95) months. Results 799 patients underwent first-time lumbar discectomy. There was an incidental durotomy in 25 (3.1%) of these patients. There were no significant differences with or without durotomy in age, sex, race, body mass index, the prevalence of smoking, diabetes, hypertension, or herniation level or type. When outcome differences between the groups were analyzed, the durotomy group was found to have significantly increased operative duration, operative blood loss and inpatient stay. However, there were no differences in incidence of nerve root injury, post-op mortality, additional surgeries or SF-36 scores of bodily pain or physical function, or Oswestry Disability Index at 1, 2, 3 or 4 years. Conclusions Incidental durotomy during first time lumbar discectomy does not appear to impact long-term outcome in affected patients. PMID:21375385

  20. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation

    PubMed Central

    Weinstein, James N.; Tosteson, Tor D.; Lurie, Jon D.; Tosteson, Anna N. A.; Hanscom, Brett; Skinner, Jonathan S.; Abdu, William A.; Hilibrand, Alan S.; Boden, Scott D.; Deyo, Richard A.

    2008-01-01

    Context Lumbar diskectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the efficacy of the procedure relative to nonoperative care remains controversial. Objective To assess the efficacy of surgery for lumbar intervertebral disk herniation. Design, Setting, and Patients The Spine Patient Outcomes Research Trial, a randomized clinical trial enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in 11 US states. Patients were 501 surgical candidates (mean age, 42 years; 42% women) with imaging-confirmed lumbar intervertebral disk herniation and persistent signs and symptoms of radiculopathy for at least 6 weeks. Interventions Standard open diskectomy vs nonoperative treatment individualized to the patient. Main Outcome Measures Primary outcomes were changes from baseline for the Medical Outcomes Study 36-item Short-Form Health Survey bodily pain and physical function scales and the modified Oswestry Disability Index (American Academy of Orthopaedic Surgeons MODEMS version) at 6 weeks, 3 months, 6 months, and 1 and 2 years from enrollment. Secondary outcomes included sciatica severity as measured by the Sciatica Bothersomeness Index, satisfaction with symptoms, self-reported improvement, and employment status. Results Adherence to assigned treatment was limited: 50% of patients assigned to surgery received surgery within 3 months of enrollment, while 30% of those assigned to nonoperative treatment received surgery in the same period. Intent-to-treat analyses demonstrated substantial improvements for all primary and secondary outcomes in both treatment groups. Between-group differences in improvements were consistently in favor of surgery for all periods but were small and not statistically significant for the primary outcomes. Conclusions Patients in both the surgery and the nonoperative treatment groups improved substantially over a 2-year period. Because of the large numbers of patients who crossed over in both directions, conclusions about the superiority or equivalence of the treatments are not warranted based on the intent-to-treat analysis. Trial Registration clinicaltrials.gov Identifier: NCT00000410 PMID:17119140

  1. Delayed Surgical Intervention in Central Cord Syndrome with Cervical Stenosis

    PubMed Central

    Park, Moon Soo; Moon, Seong-Hwan; Lee, Hwan-Mo; Kim, Tae-Hwan; Oh, Jae Keun; Suh, Bo-Kyung; Lee, Seung Jin; Riew, K. Daniel

    2014-01-01

    Study Design?Review of the literature. Objective?It is generally accepted that surgical treatment is necessary for central cord syndrome (CCS) with an underlying cervical stenosis. However, the surgical timing for decompression is controversial in spondylotic cervical CCS. The purpose of this study is to review the results of early and delayed surgery in patients with spondylotic cervical CCS. Methods?MEDLINE was searched for English-language articles on CCS. There were 1,653 articles from 1940 to 2012 regarding CCS, 5 of which dealt with the timing of surgery for spondylotic cervical CCS. Results?All five reports regarding the surgical timing of spondylotic cervical CCS were retrospective. Motor improvement, functional independence measures, and walking ability showed similar improvement in early and late surgery groups in the studies with follow-up longer than 1 year. However, greater improvement was seen in the early surgery group in the studies with follow-up shorter than 1 year. The complication rates did not show a difference between the early and late surgery groups. However, there are controversies regarding the length of intensive care unit stay or hospital stay for the two groups. Conclusions?There was no difference in motor improvement, functional independence, walking ability, and complication rates between early and late surgery for spondylotic cervical CCS. PMID:25649889

  2. Recommendations for Management of Patients with Carotid Stenosis

    PubMed Central

    Lovrencic-Huzjan, Arijana; Rundek, Tatjana; Katsnelson, Michael

    2012-01-01

    Stroke is a one of the leading causes of morbidity and mortality in the world. Carotid atherosclerosis is recognized as an important factor in stroke pathophysiology and represents a key target in stroke prevention; multiple treatment modalities have been developed to battle this disease. Multiple randomized trials have shown the efficacy of carotid endarterectomy in secondary stroke prevention. Carotid stenting, a newer treatment option, presents a less invasive alternative to the surgical intervention on carotid arteries. Advances in medical therapy have also enabled further risk reduction in the overall incidence of stroke. Despite numerous trials and decades of clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial. We will attempt to highlight some of the pivotal trials already completed, discuss the current controversies and complexities in the treatment decision-making, and postulate on what likely lies ahead. This paper will highlight the complexities of decision-making optimal treatment recommendations for patients with symptomatic and asymptomatic carotid stenosis. PMID:22645702

  3. [Treatment of esophagopericardial fistula following esophagogastroplasty for esophageal caustic stenosis].

    PubMed

    Michieletto, Silvia; Ruol, Alberto; Cagol, Matteo; Alfieri, Rita; Castoro, Carlo; Marano, Salvatore; Tosolini, Chiara; Ancona, Ermanno

    2007-01-01

    Esophagopericardial fistula is a rare and severe complication, involving several benign, malignant and traumatic pathologies of the esophagus. Only few cases of esophagopericardial fistula have been published so far, as compared to more frequently reported cases of gastropericardial fistula. We report on a 25-year-old female with an esophagopericardial fistula following retrosternal esophagogastroplasty for esophageal caustic stenosis. One month before admission to our hospital, the patient had fever and nonradiating substernal chest pain which was relieved by aspirin, unfortunately without adequate antacid therapy. After 3 weeks, for abdominal pain and worsening chest pain with shock, she was admitted to another hospital and underwent laparotomy: an haemoperitoneum was found, due to a rupture of an ovarian cyst which was removed. For persistent shock, the patient had an echocardiogram which revealed a cardiac tamponade, treated with placement of a pericardic drainage (300 cc of purulent liquid). She was then transferred to our unit: an esophageal swallow with a small amount of methilene blue revealed a fistula between the stomach of the esophagogatroplasty and the pericardium. She eventually underwent surgery. A pericardial window was created, the gastric tube was taken down because of the impossibility to suture the gastric ulcer, and an esophagocoloplasty was used for the reconstruction of the alimentary transit. The postoperative course was unevenqf&l. She is alive and well at 15 months after surgery. Esophagopericardial fistula is a rare complication, with a high mortality rate. A timely decision is mandatory and an aggressive treatment often necessary. PMID:17722501

  4. Infantile hypertrophic pyloric stenosis--genetics and syndromes.

    PubMed

    Peeters, Babette; Benninga, Marc A; Hennekam, Raoul C M

    2012-11-01

    Infantile hypertrophic pyloric stenosis (IHPS) is a common condition in neonates that is characterized by an acquired narrowing of the pylorus. The aetiology of isolated IHPS is still largely unknown. Classic genetic studies have demonstrated an increased risk in families of affected infants. Several genetic studies in groups of individuals with isolated IHPS have identified chromosomal regions linked to the condition; however, these associations could usually not be confirmed in subsequent cohorts, suggesting considerable genetic heterogeneity. IHPS is associated with many clinical syndromes that have known causative mutations. Patients with syndromes associated with IHPS can be considered as having an extreme phenotype of IHPS and studying these patients will be instrumental in finding causes of isolated IHPS. Possible pathways in syndromic IHPS include: (neuro)muscular disorders; connective tissue disorders; metabolic disorders; intracellular signalling pathway disturbances; intercellular communication disturbances; ciliopathies; DNA-repair disturbances; transcription regulation disorders; MAPK-pathway disturbances; lymphatic abnormalities; and environmental factors. Future research should focus on linkage analysis and next-generation molecular techniques in well-defined families with multiple affected members. Studies will have an increased chance of success if detailed phenotyping is applied and if knowledge about the various possible causative pathways is used in evaluating results. PMID:22777173

  5. Renal artery stenosis: Up-date on diagnosis and treatment.

    PubMed

    Zeller, Thomas; Macharzina, Roland; Rastan, Aljoscha; Beschorner, Ulrich; Noory, Elias

    2014-01-01

    Significant renal artery stenosis (RAS) can cause or result in deterioration of arterial hypertension and may promote the development of renal insufficiency. The activation of the renin-angiotensin-aldosterone system results in structural heart disease and may impact patient survival. Technical improvements of diagnostic and interventional endovascular tools have led to a more widespread use of endoluminal renal artery revascularization and extension of the indications for this type of therapy during the past two decades. Whereas balloon angioplasty is still the method of choice for the treatment of fibromuscular dysplasia, stent implantation is indicated in ostial atherosclerotic RAS. However, none of the so far published or presented randomized controlled trials could prove a beneficial outcome of RAS revascularization compared to medical management. As a result of these negative trials including the largest published trial to date, the ASTRAL trial, referrals to endovascular renal artery revascularization have declined and, moreover, reimbursement of these procedures has become a matter of debate. Crucial for a clinical benefit following revascularization of RAS is proper patient selection, revascularization being only indicated after proof of hemodynamic relevance of RAS. This article summarizes the appropriate diagnostic work-up of patients with suspected RAS, discusses the limitations of the results published so far and their impact on the indication for RAS revascularization. PMID:24429328

  6. Computational modeling of fluid structural interaction in arterial stenosis

    NASA Astrophysics Data System (ADS)

    Bali, Leila; Boukedjane, Mouloud; Bahi, Lakhdar

    2013-12-01

    Atherosclerosis affects the arterial blood vessels causing stenosis because of which the artery hardens resulting in loss of elasticity in the affected region. In this paper, we present: an approach to model the fluid-structure interaction through such an atherosclerosis affected region of the artery, The blood is assumed as an incompressible Newtonian viscous fluid, and the vessel wall was treated as a thick-walled, incompressible and isotropic material with uniform mechanical properties. The numerical simulation has been studied in the context of The Navier-Stokes equations for an interaction with an elastic solid. The study of fluid flow and wall motion was initially carried out separately, Discretized forms of the transformed wall and flow equations, which are coupled through the boundary conditions at their interface, are obtained by control volume method and simultaneously to study the effects of wall deformability, solutions are obtained for both rigid and elastic walls. The results indicate that deformability of the wall causes an increase in the time average of pressure drop, but a decrease in the maximum wall shear stress. Displacement and stress distributions in the wall are presented.

  7. Effect of Blood Shear Forces on Platelet Mediated Thrombosis Inside Arterial Stenosis.

    NASA Astrophysics Data System (ADS)

    Maalej, Nabil

    Shear induced activation of platelets plays a major role in the onset of thrombosis in atherosclerotic arteries. Blood hemodynamics and its effect on platelet kinetics has been studied mainly in in vitro and in ex vivo experiments. We designed new in vivo methods to study blood hemodynamic effects on platelet kinetics in canine stenosed carotid arteries. A carotid artery-jugular vein anastomotic shunt was produced. Intimal damage and controlled variations in the degree of stenosis were produced on the artery. An inflatable cuff was placed around the jugular vein to control vascular resistance. An electromagnetic flowmeter was used to measure blood flow. Doppler ultrasound crystals were used to measure the velocity profiles inside and distal to the stenosis. Stenosis geometry was obtained using digital subtraction angiography and quantitative arteriography. Using these measurements we calculated the wall shear stress using the finite difference solution of the Navier-Stokes equations. To study platelet kinetics, autologous platelets were labeled with Indium Oxine and injected IV. A collimated Nal gamma counter was placed over the stenosis to detect radio-labeled platelet accumulation as platelet mediated thrombi formed in the stenosis. The radioactive count rate increased in an inverse parallel fashion to the decline in flow rate during thrombus formation. The platelet accumulation increased with the increase of percent stenosis and was maximal at the narrow portion of the stenosis. Acute thrombus formation leading to arterial occlusion was only observed for stenosis higher than 70 +/- 5%. Platelet accumulation rate was not significant until the pressure gradient across the stenosis exceeded 40 +/- 10 mmHg. Totally occlusive thrombus formation was only observed for shear stresses greater than a critical value of 100 +/- 10 Pa. Beyond this critical value acute platelet thrombus formation increased exponentially with shear. Increased shear stresses were found to overcome the antithrombotic effect of aspirin. Critical levels of shear might be produced clinically at sites of arterial lesions by a sudden change in blood hemodynamics or flow geometry. This may put a patient with arterial stenosis at greater risk of acute thrombus formation leading to stroke or myocardial infarction.

  8. The effect of dynamic, semi-rigid implants on the range of motion of lumbar motion segments after decompression

    PubMed Central

    Hurschler, Christof; Haversath, Marcel; Liljenqvist, Ulf; Bullmann, Viola; Filler, Timm J.; Osada, Nani; Fallenberg, Eva-Maria; Hackenberg, Lars

    2008-01-01

    Undercutting decompression is a common surgical procedure for the therapy of lumbar spinal canal stenosis. Segmental instability, due to segmental degeneration or iatrogenic decompression is a typical problem that is clinically addressed by fusion, or more recently by semi-rigid stabilization devices. The objective of this experimental biomechanical study was to investigate the influence of spinal decompression alone, as well as in conjunction with two semi-rigid stabilizing implants (Wallis, Dynesys®) on the range of motion (ROM) of lumbar spine segments. A total of 21 fresh-frozen human lumbar spine motion segments were obtained. Range of motion and neutral zone (NZ) were measured in flexion-extension (FE), lateral bending (LAT) and axial rotation (ROT) for each motion segment under four conditions: (1) with all stabilizing structures intact (PHY), (2) after bilateral undercutting decompression (UDC), (3) after additional implantation of Wallis (UDC-W) and (4) after removal of Wallis and subsequent implantation of Dynesys® (UDC-D). Measurements were performed using a sensor-guided industrial robot in a pure-moment-loading mode. Range of motion was defined as the angle covered between loadings of ?5 and +5 Nm during the last of three applied motion cycles. Untreated physiologic segments showed the following mean ROM: FE 6.6°, LAT 7.4°, ROT 3.9°. After decompression, a significant increase of ROM was observed: 26% FE, 6% LAT, 12% ROT. After additional implantation of a semi-rigid device, a decrease in ROM compared to the situation after decompression alone was observed with a reduction of 66 and 75% in FE, 6 and 70% in LAT, and 5 and 22% in ROT being observed for the Wallis and Dynesys®, respectively. When the flexion and extension contribution to ROM was separated, the Wallis implant restricted extension by 69% and flexion by 62%, the Dynesys® by 73 and 75%, respectively. Compared to the intact status, instrumentation following decompression led to a ROM reduction of 58 and 68% in FE, 1 and 68% in LAT, ?6 and 13% in ROT, 61 and 65% in extension and 54 and 70% in flexion for Wallis and Dynesys®. The effect of the implants on NZ corresponded to that on ROM. In conclusion, implantation of the Wallis and Dynesys® devices following decompression leads to a restriction of ROM in all motion planes investigated. Flexion–extension is most affected by both implants. The Dynesys® implant leads to an additional strong restriction in lateral bending. Rotation is only mildly affected by both implants. Wallis and Dynesys® restrict not only isolated extension, but also flexion. These biomechanical results support the hypothesis that postoperatively, the semi-rigid implants provide a primary stabilizing function directly. Whether they can improve the clinical outcome must still be verified in prospective clinical investigations. PMID:18493802

  9. [Computerized tomography findings following successful lumbar intervertebral disk surgery].

    PubMed

    Hofmann, E; Reiniger, U; Ratzka, M

    1987-12-01

    Computed tomography findings were studied after successful lumbar disk surgery. All patients were asymptomatic after the operation thus presenting morphological changes that probably correspond to regular postoperative conditions. Small seromas in the area of surgery are well-known "normal" findings and have no pathological significance. Dorsal bulging at the level of the intervertebral disc operated upon has not yet been studied systematically. This protrusion that can even exceed the preoperative amount of bulging is due to swelling and folding of the posterior longitudinal ligament. In our patients it disappeared spontaneously within a few months and it should not be confused with real recurrent or residual disc herniation. PMID:3436123

  10. Intraspinal arachnoiditis and hydrocephalus after lumbar myelography using methylglucamine iocarmate.

    PubMed Central

    Jensen, T S; Hein, O

    1978-01-01

    A 35 year old woman developed a severe meningeal reaction after lumbar myelography using the water-soluble contrast medium methylglucamine iocarmate. Three months after myelography the findings were a transverse spinal cord syndrome corresponding to the middle thoracic segments resulting from well developed leptomeningeal adhesions. This was combined with a noncommunicating hydrocephalus, probably the result of leptomeningeal fibrosis in the posterior fossa. After treatment with a ventriculoatrial shunt the patient is almost free of symptoms. A possible pathogenetic relationship between the contrast medium, the chronic leptomeningeal changes, and the symptoms of our patient is discussed on the basis of the literature. Images PMID:305466

  11. Revision Surgical Treatment of a Second Lumbar Ewing Sarcoma

    PubMed Central

    Feng, Helin; Wang, Jin; Guo, Peng; Xu, Jianfa; Feng, Jiangang

    2015-01-01

    Abstract We report a case of a 58-year-old man who presented initially with lumbar pain. According to radiography, computed tomography, magnetic resonance imaging, and bone biopsy results, Ewing sarcoma (ES) was diagnosed. Tumor resection was performed, followed by chemotherapy and radiotherapy; pathology confirmed the diagnosis of ES. After surgery, the tumor recurred twice with progressive symptoms, meriting repeated excisional surgery. At the 4-year follow-up, the patient showed apparent improvement, with return of function and strength and resolution of pain. We discuss its clinical features and treatment in the light of the current knowledge. PMID:26222849

  12. Lumbar-pelvic range and coordination during lifting tasks

    E-print Network

    Maduri, Anupama; Pearson, Bethany L.; Wilson, Sara E.

    2008-01-01

    Page 1 of 22 Lumbar-Pelvic Range and Coordination During Lifting Tasks A. Maduri, M.S. 1 B.L. Pearson, B.S. 2 S.E. Wilson, Ph.D. 3 1 National Institute of Occupational Safety and Health, Morgantown, WV 2 Burns and Mc...]. In the United States, the total annual costs of back 4 pain are estimated to range from $20 - $50 billion [Nachemson, 1992, Pai and Sundaram, 5 2004]. Jobs involving flexion tasks and lifting heavy loads have been shown to be 6 associated with a higher...

  13. Lumbar spine surgery positioning complications: a systematic review.

    PubMed

    Shriver, Michael F; Zeer, Valerie; Alentado, Vincent J; Mroz, Thomas E; Benzel, Edward C; Steinmetz, Michael P

    2015-10-01

    OBJECT There are a variety of surgical positions that provide optimal exposure of the dorsal lumbar spine. These include the prone, kneeling, knee-chest, knee-elbow, and lateral decubitus positions. All are positions that facilitate exposure of the spine. Each position, however, is associated with an array of unique complications that result from excessive pressure applied to the torso or extremities. The authors reviewed clinical studies reporting complications that arose from positioning of the patient during dorsal exposures of the lumbar spine. METHODS MEDLINE, Scopus, and Web of Science database searches were performed to find clinical studies reporting complications associated with positioning during lumbar spine surgery. For articles meeting inclusion criteria, the following information was obtained: publication year, study design, sample size, age, operative time, type of surgery, surgical position, frame or table type, complications associated with positioning, time to first observed complication, long-term outcomes, and evidence-based recommendations for complication avoidance. RESULTS Of 3898 articles retrieved from MEDLINE, Scopus, and Web of Science, 34 met inclusion criteria. Twenty-four studies reported complications associated with use of the prone position, and 7 studies investigated complications after knee-chest positioning. Complications associated with the knee-elbow, lateral decubitus, and supine positions were each reported by a single study. Vision loss was the most commonly reported complication for both prone and knee-chest positioning. Several other complications were reported, including conjunctival swelling, Ischemic orbital compartment syndrome, nerve palsies, thromboembolic complications, pressure sores, lower extremity compartment syndrome, and shoulder dislocation, highlighting the assortment of possible complications following different surgical positions. For prone-position studies, there was a relationship between increased operation time and position complications. Only 3 prone-position studies reported complications following procedures of less than 120 minutes, 7 studies reported complications following mean operative times of 121-240 minutes, and 9 additional studies reported complications following mean operative times greater than 240 minutes. This relationship was not observed for knee-chest and other surgical positions. CONCLUSIONS This work presents a systematic review of positioning-related complications following prone, knee-chest, and other positions used for lumbar spine surgery. Numerous evidence-based recommendations for avoidance of these potentially severe complications associated with intraoperative positioning are discussed. This investigation may serve as a framework to educate the surgical team and decrease rates of intraoperative positioning complications. PMID:26424340

  14. Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess

    PubMed Central

    Bang, Jin Hyuk

    2015-01-01

    Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus. PMID:26512268

  15. Wonky worlds: Listeners revise world knowledge when utterances are odd Judith Degen, Michael Henry Tessler, Noah D. Goodman

    E-print Network

    Pratt, Vaughan

    Tessler, Noah D. Goodman {jdegen,mhtessler,ngoodman}@stanford.edu Department of Psychology, 450 Serra Mall world as a wonky world. The Rational Speech Acts framework (RSA) (Frank & Goodman, 2012; Goodman- cature (Degen, Franke, & J¨ager, 2013), markedness implica- ture (Bergen, Goodman, & Levy, 2012), scalar

  16. Three-Dimensional Electron Microscopy Reconstruction of Degenerative