Sample records for degenerative lumbar stenosis

  1. Degenerative lumbar spinal stenosis: evaluation and management.

    PubMed

    Issack, Paul S; Cunningham, Matthew E; Pumberger, Matthias; Hughes, Alexander P; Cammisa, Frank P

    2012-08-01

    Degenerative lumbar spinal stenosis is caused by mechanical factors and/or biochemical alterations within the intervertebral disk that lead to disk space collapse, facet joint hypertrophy, soft-tissue infolding, and osteophyte formation, which narrows the space available for the thecal sac and exiting nerve roots. The clinical consequence of this compression is neurogenic claudication and varying degrees of leg and back pain. Degenerative lumbar spinal stenosis is a major cause of pain and impaired quality of life in the elderly. The natural history of this condition varies; however, it has not been shown to worsen progressively. Nonsurgical management consists of nonsteroidal anti-inflammatory drugs, physical therapy, and epidural steroid injections. If nonsurgical management is unsuccessful and neurologic decline persists or progresses, surgical treatment, most commonly laminectomy, is indicated. Recent prospective randomized studies have demonstrated that surgery is superior to nonsurgical management in terms of controlling pain and improving function in patients with lumbar spinal stenosis. PMID:22855855

  2. Comparison of Sagittal Spinopelvic Alignment between Lumbar Degenerative Spondylolisthesis and Degenerative Spinal Stenosis

    PubMed Central

    Lim, Jae Kwan

    2014-01-01

    Objective The purpose of this study was to evaluate the differences in sagittal spinopelvic alignment between lumbar degenerative spondylolisthesis (DSPL) and degenerative spinal stenosis (DSS). Methods Seventy patients with DSPL and 72 patients with DSS who were treated with lumbar interbody fusion surgery were included in this study. The following spinopelvic parameters were measured on whole spine lateral radiographs in a standing position : pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LL), L4-S1 segmental lumbar angle (SLL), thoracic kyphosis (TK), and sagittal vertical axis from the C7 plumb line (SVA). Two groups were subdivided by SVA value, respectively. Normal SVA subgroup and positive SVA subgroup were divided as SVA value (<50 mm and ?50 mm). Spinopelvic parameters/PI ratios were assessed and compared between the groups. Results The PI of DSPL was significantly greater than that of DSS (p=0.000). The SVA of DSPL was significantly greater than that of DSS (p=0.001). In sub-group analysis between the positive (34.3%) and normal SVA (65.7%), there were significant differences in LL/PI and SLL/PI (p<0.05) in the DSPL group. In sub-group analysis between the positive (12.5%) and normal SVA (87.5%), there were significant differences in PT/PI, SS/PI, LL/PI and SLL/PI ratios (p<0.05) in the DSS group. Conclusion Patients with lumbar degenerative spondylolisthesis have the propensity for sagittal imbalance and higher pelvic incidence compared with those with degenerative spinal stenosis. Sagittal imbalance in patients with DSPL is significantly correlated with the loss of lumbar lordosis, especially loss of segmental lumbar lordosis. PMID:25237428

  3. 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

  4. Clinical outcomes of degenerative lumbar spinal stenosis treated with lumbar decompression and the Cosmic “semi-rigid” posterior system

    PubMed Central

    Kaner, Tuncay; Sasani, Mehdi; Oktenoglu, Tunc; Aydin, Ahmet Levent; Ozer, Ali Fahir

    2010-01-01

    Background Although some investigators believe that the rate of postoperative instability is low after lumbar spinal stenosis surgery, the majority believe that postoperative instability usually develops. Decompression alone and decompression with fusion have been widely used for years in the surgical treatment of lumbar spinal stenosis. Nevertheless, in recent years several biomechanical studies have shown that posterior dynamic transpedicular stabilization provides stabilization that is like the rigid stabilization systems of the spine. Recently, posterior transpedicular dynamic stabilization has been more commonly used as an alternative treatment option (rather than rigid stabilization with fusion) for the treatment of degenerative spines with chronic instability and for the prevention of possible instability after decompression in lumbar spinal stenosis surgery. Methods A total of 30 patients with degenerative lumbar spinal stenosis (19 women and 11 men) were included in the study group. The mean age was 67.3 years (range, 40–85 years). Along with lumbar decompression, a posterior dynamic transpedicular stabilization (dynamic transpedicular screw–rigid rod system) without fusion was performed in all patients. Clinical and radiologic results for patients were evaluated during follow-up visits at 3, 12, and 24 months postoperatively. Results The mean follow-up period was 42.93 months (range, 24–66 months). A clinical evaluation of patients showed that, compared with preoperative assessments, statistically significant improvements were observed in the Oswestry and visual analog scale scores in the last follow-up control. Compared with preoperative values, there were no statistically significant differences in radiologic evaluations, such as segmental lordosis angle (?) scores (P = .125) and intervertebral distance scores (P = .249). There were statistically significant differences between follow-up lumbar lordosis scores (P = .048). There were minor complications, including a subcutaneous wound infection in 2 cases, a dural tear in 2 cases, cerebrospinal fluid fistulas in 1 case, a urinary tract infection in 1 case, and urinary retention in 1 case. We observed L5 screw loosening in 1 of the 3-level decompression cases. No screw breakage was observed and no revision surgery was performed in any of these cases. Conclusions Posterior dynamic stabilization without fusion applied to lumbar decompression leads to better clinical and radiologic results in degenerative lumbar spinal stenosis. To avoid postoperative instability, especially in elderly patients who undergo degenerative lumbar spinal stenosis surgery with chronic instability, the application of decompression with posterior dynamic transpedicular stabilization is likely an important alternative surgical option to fusion, because it does not have fusion-related side effects, is easier to perform than fusion, requires a shorter operation time, and has low morbidity and complication rates.

  5. Lumbar spinal stenosis.

    PubMed Central

    Ciricillo, S F; Weinstein, P R

    1993-01-01

    Lumbar spinal stenosis, the results of congenital and degenerative constriction of the neural canal and foramina leading to lumbosacral nerve root or cauda equina compression, is a common cause of disability in middle-aged and elderly patients. Advanced neuroradiologic imaging techniques have improved our ability to localize the site of nerve root entrapment in patients presenting with neurogenic claudication or painful radiculopathy. Although conservative medical management may be successful initially, surgical decompression by wide laminectomy or an intralaminar approach should be done in patients with serious or progressive pain or neurologic dysfunction. Because the early diagnosis and treatment of lumbar spinal stenosis may prevent intractable pain and the permanent neurologic sequelae of chronic nerve root entrapment, all physicians should be aware of the different neurologic presentations and the treatment options for patients with spinal stenosis. Images PMID:8434469

  6. Interspinous spacer decompression (X-STOP) for lumbar spinal stenosis and degenerative disk disease: a multicenter study with a minimum 3-year follow-up.

    PubMed

    Puzzilli, Fabrizio; Gazzeri, Roberto; Galarza, Marcelo; Neroni, Massimiliano; Panagiotopoulos, Konstantinos; Bolognini, Andrea; Callovini, Giorgio; Agrillo, Umberto; Alfieri, Alex

    2014-09-01

    Interspinous distraction devices provide an effective treatment for patients suffering from lumbar spinal stenosis and/or degenerative disk disease. The aim of this multicenter study was the prospective evaluation of patients treated for symptomatic lumbar spinal stenosis with interspinous process decompression (IPD) implants compared with a population of patients managed with conservative treatment. 542 patients affected by symptomatic lumbar spine degenerative disease were enrolled in a controlled trial. 422 patients underwent surgical treatment consisting of X-STOP device implantation, whereas 120 control cases were managed conservatively. Both patient groups underwent follow-up evaluations at 6, 12, 24, and 36 months using the Zurich Claudication Questionnaire, the Visual Analog Scale score and spinal lumbar X-rays, CT scans and MR imaging. One-year follow-up evaluation revealed positive good results in the 83.5% of patients treated with IPD with respect to 50% of the nonoperative group cases. During the first three years, in 38 out of the 120 control cases, a posterior decompression and/or spinal fixation was performed because of unsatisfactory results of the conservative therapy. In 24 of 422 patients, the IPD device had to be removed, and a decompression and/or pedicle screw fixation was performed because of the worsening of neurological symptoms. Our results support the effectiveness of surgery in patients with stenosis. IPD may offer an effective and less invasive alternative to classical microsurgical posterior decompression in selected patients with spinal stenosis and lumbar degenerative disk diseases. PMID:25064150

  7. 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

  8. Lumbar Spinal Canal Stenosis

    MedlinePLUS

    ... pain caused by a ruptured disk in the lumbar spine is usually easy to diagnose and is known ... the pressure off the nerves in your lower spine. This surgery works well for many people. Questions to Ask Your Doctor My father had lumbar spinal canal stenosis. Am I at risk of ...

  9. Lumbar degenerative disk disease.

    PubMed

    Modic, Michael T; Ross, Jeffrey S

    2007-10-01

    The sequelae of disk degeneration are among the leading causes of functional incapacity in both sexes and are a common source of chronic disability in the working years. Disk degeneration involves structural disruption and cell-mediated changes in composition. Mechanical, traumatic, nutritional, and genetic factors all may play a role in the cascade of disk degeneration, albeit to variable degree in different individuals. The presence of degenerative change is by no means an indicator of symptoms, and there is a very high prevalence in asymptomatic individuals. The etiology of pain as the symptom of degenerative disease is complex and appears to be a combination of mechanical deformation and the presence of inflammatory mediators. The role of imaging is to provide accurate morphologic information and influence therapeutic decision making. A necessary component, which connects these two purposes, is accurate natural history data. Understanding the relationship of etiologic factors, the morphologic alterations, which can be characterized with imaging, and the mechanisms of pain production and their interactions in the production of symptoms will require more accurate and reproducible stratification of patient cohorts. PMID:17885180

  10. The pathophysiology and nonsurgical treatment of lumbar spinal stenosis.

    PubMed

    Daffner, Scott D; Wang, Jeffrey C

    2009-01-01

    Lumbar spinal stenosis, which affects an ever-increasing number of patients, is best defined as a collection of clinical symptoms that includes low back pain, bilateral lower extremity pain, paresthesias, and other neurologic deficits that occur concomitantly with anatomic narrowing of the neural pathway through the spine. The narrowing may be centrally located in the spinal canal or more laterally in the lateral recesses or neuroforamina. Lumbar spinal stenosis can have a congenital or acquired etiology, and the origin of acquired lumbar stenosis is classified as degenerative, posttraumatic, or iatrogenic. In degenerative lumbar stenosis, the anatomic changes result from a cascade of events that includes intervertebral disk degeneration, facet joint arthrosis, and hypertrophy of the ligamentum flavum. The altered biomechanical characteristics of the spinal segment perpetuate a cycle of degenerative changes, and the resulting stenosis produces radicular pain through a combination of direct mechanical compression of nerve roots, restriction of microvascular circulation and axoplasmic flow, and inflammatory mediators. The initial treatment of lumbar spinal stenosis is nonsurgical. The most effective nonsurgical treatment is a comprehensive combination of oral anti-inflammatory drugs, physical therapy and conditioning, and epidural steroid injections. A significant number of patients improve after nonsurgical treatment, although most studies have found that patients treated surgically have better clinical results. Delaying surgical treatment until after a trial of nonsurgical treatment does not affect the outcome. Surgical intervention should be considered only if a comprehensive program of nonsurgical measures fails to improve the patient's quality of life. PMID:19385575

  11. Stabilising effect of dynamic interspinous spacers in degenerative low-grade lumbar instability

    Microsoft Academic Search

    Johannes Holinka; Petra Krepler; Michael Matzner; Josef G. Grohs

    2011-01-01

    The aim of the study was to investigate the stabilising effect of dynamic interspinous spacers (IS) in combination with interlaminar\\u000a decompression in degenerative low-grade lumbar instability with lumbar spinal stenosis and to compare its clinical effect\\u000a to patients with lumbar spinal stenosis in stable segments treated by interlaminar decompression only. Fifty consecutive patients\\u000a with a minimum age of 60 years were

  12. Percutaneous endoscopic decompression for lumbar spinal stenosis.

    PubMed

    Ahn, Yong

    2014-11-01

    Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation. Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis. Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: central stenosis, lateral recess stenosis and foraminal stenosis. Moreover, percutaneous endoscopic decompression (PED) techniques may vary according to the type of lumbar stenosis, including interlaminar PED, transforaminal PED and endoscopic lumbar foraminotomy. However, these techniques are continuously evolving. In the near future, PED for lumbar stenosis may be an efficient alternative to conventional open lumbar decompression surgery. PMID:25033889

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

    ClinicalTrials.gov

    2015-03-24

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

  14. A case report of 3-level degenerative spondylolisthesis with spinal canal stenosis

    PubMed Central

    Moo, Ing How; Tan, See Wei; Kasat, Niraj; Thng, Leong Keng

    2014-01-01

    Introduction Lumbar degenerative spondylolisthesis is a major cause of impaired quality of life and diminished functional capacity in the elderly. Degenerative spondylolisthesis often involves only one or two level and tend to present with one or two level spinal canal stenosis. Case report The authors describe an unusual case of degenerative spondylolisthesis involving 3 levels of the lumbar spine from L2 to L5. The patient was a 58-year-old woman who suffered chronic back pain and neurogenic claudication. Plain radiography revealed grade I degenerative spondylolisthesis at L2–L3, L3–L4 and L4–L5. Elevated pedicle-facet joint angles and W-type facet joints at the lumbar spine was observed. Magnetic resonance imaging showed L2–S1 spinal cord compression at the lumbar spine. Patient underwent L2–S1 decompression laminectomy and posterior lateral fusion of L2–S1 with posterior instrumentation and bone grafting. Symptoms improved significantly at 4 months follow-up. Conclusion Thorough evaluation for multilevel segmental involvement in degenerative spondylolisthesis is important because of the frequency of severe symptomatic spinal stenosis or foraminal encroachment. Good surgical outcome can be expected from decompression and stabilisation. The pathogenesis of multi-level lumbar degenerative spondylolisthesis can be complex and heterogeneous. PMID:25666306

  15. Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

    PubMed Central

    Hasankhani, Ebrahim Ghayem; Ashjazadeh, Amir

    2014-01-01

    Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome. PMID:25187873

  16. Diagnosis and Treatment of Lumbar Spinal Canal Stenosis

    Microsoft Academic Search

    Masabumi Miyamoto; Yoshikazu Genbum; Hiromoto Ito

    2002-01-01

    Lumbar spinal canal stenosis(LSCS)was first described in 1954 by Verbiest followed by the currently accepted international classification of LSCS in 1976 by Arnoldi. Briefly LSCS is a nervous system syndrome that is characterized by neural symptoms in the lower extremities due to tightened cauda equina and spinal nerve root involvement. LSCS international classification consists of:(1)degenerative, (2)congenital developmental, (3) combined, (4)

  17. Lumbar spinal stenosis in the elderly: an overview.

    PubMed

    Szpalski, Marek; Gunzburg, Robert

    2003-10-01

    Lumbar spinal stenosis is a common condition in elderly patients and also one of the most common reasons to perform spinal surgery at an advanced age. Disc degeneration, facet degeneration and hypertrophy, and ligamentum flavum hypertrophy and calcification usually participate in the genesis of a stenotic condition in the elderly. These changes can lead to symptoms by themselves or decompensate a preexisting narrow canal. Although some lesions are more central or more lateral, this classic dichotomy is less present in the elderly patient, in whom the degenerative process usually encroaches both central and lateral pathways. Some less common causes of lumbar spinal stenosis are found in the aging subject, such as Paget's disease. However, it must be stressed that so-called stenotic images (sometimes severe) are present on imaging studies in a great number of symptom-free individuals, and that the relationship between degenerative lesions, importance of abnormal images, and complaints is still unclear. Lumbar stenosis is a very common reason for decompressive surgery and/or fusion. Various conditions can lead to a narrowing of the neural pathways and differential diagnosis with vascular troubles, also common in the elderly, can be challenging. The investigation of stenotic symptoms should be extremely careful and thorough and include a choice of technical examinations including vascular investigations. This is of utmost importance, especially if a surgical sanction is considered to avoid disappointing results. PMID:13680315

  18. [Microsurgical decompression of lumbar spinal stenosis].

    PubMed

    Drumm, J; Branea, I; Pitzen, T

    2010-06-01

    Lumbar spinal stenosis in most cases is due to progressive degeneration of the spine, resulting in thickening of facet joints and flaval ligament. Thus the diameter of the lumbar spinal canal is reduced to less than 12 mm in the AP direction. Typically complaints consist in neurogenic claudication. Patients usually experience improvement of pain when bending their back or walking up a hill. Diagnosis of lumbar spinal stenosis is confirmed by MRI. CT myelography may help detect where compression is most pronounced. Surgical treatment should be based on the clinical symptoms of the mostly elderly people and should be performed as microsurgical decompression or in cases of clinical instability as TLIF. PMID:20480133

  19. Lumbar Disc Degenerative Disease: Disc Degeneration Symptoms and Magnetic Resonance Image Findings

    PubMed Central

    Saleem, Shafaq; Rehmani, Muhammad Asim Khan; Raees, Aisha; Alvi, Arsalan Ahmad; Ashraf, Junaid

    2013-01-01

    Study Design Cross sectional and observational. Purpose To evaluate the different aspects of lumbar disc degenerative disc disease and relate them with magnetic resonance image (MRI) findings and symptoms. Overview of Literature Lumbar disc degenerative disease has now been proven as the most common cause of low back pain throughout the world. It may present as disc herniation, lumbar spinal stenosis, facet joint arthropathy or any combination. Presenting symptoms of lumbar disc degeneration are lower back pain and sciatica which may be aggravated by standing, walking, bending, straining and coughing. Methods This study was conducted from January 2012 to June 2012. Study was conducted on the diagnosed patients of lumbar disc degeneration. Diagnostic criteria were based upon abnormal findings in MRI. Patients with prior back surgery, spine fractures, sacroiliac arthritis, metabolic bone disease, spinal infection, rheumatoid arthritis, active malignancy, and pregnancy were excluded. Results During the targeted months, 163 patients of lumbar disc degeneration with mean age of 43.92±11.76 years, came into Neurosurgery department. Disc degeneration was most commonly present at the level of L4/L5 105 (64.4%).Commonest types of disc degeneration were disc herniation 109 (66.9%) and lumbar spinal stenosis 37 (22.7%). Spondylolisthesis was commonly present at L5/S1 10 (6.1%) and associated mostly with lumbar spinal stenosis 7 (18.9%). Conclusions Results reported the frequent occurrence of lumbar disc degenerative disease in advance age. Research efforts should endeavor to reduce risk factors and improve the quality of life. PMID:24353850

  20. Spectrum of magnetic resonance imaging findings in congenital lumbar spinal stenosis

    PubMed Central

    Soldatos, Theodoros; Chalian, Majid; Thawait, Shrey; Belzberg, Alan J; Eng, John; Carrino, John A; Chhabra, Avneesh

    2014-01-01

    AIM: To investigate whether congenital lumbar spinal stenosis (CLSS) is associated with a specific degenerative changes of the lumbar spine. METHODS: The lumbar spine magnetic resonance imaging studies of 52 subjects with CLSS and 48 control subjects were retrospectively evaluated. In each examination, the five lumbar levels were assessed for the presence or absence of circumferential or shallow annular bulges, annular tears, anterior or posterior disc herniations, epidural lipomatosis, Schmorl’s nodes, spondylolisthesis, pars defects, and stress reactions of the posterior vertebral elements. RESULTS: Compared to control individuals, subjects with CLSS exhibited increased incidence of circumferential and shallow annular bulges, annular tears, disc herniations and spondylolisthesis (P < 0.05). CONCLUSION: CLSS is associated with increased incidence of degenerative changes in specific osseous and soft-tissue elements of the lumbar spine. PMID:25516864

  1. Outcomes of Fluoroscopically Guided Lumbar Transforaminal Epidural Steroid Injections in Degenerative Lumbar Spondylolisthesis Patients

    PubMed Central

    Wechmongkolgorn, Supaporn; Chatriyanuyok, Bangon; Woratanarat, Patarawan; Udomsubpayakul, Umaporn; Chanplakorn, Pongsathorn; Keorochana, Gun; Wajanavisit, Wiwat

    2014-01-01

    Study Design A prospective cohort. Purpose To report the short and long term outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injection (TFESI) in degenerative lumbar spondylolisthesis (DLS) patients. Overview of Literature TFESI has been widely used for the treatment of lumbosacral radicular pains. However, to our knowledge, there has been no study which has evaluated the outcomes of TFESI in patients with DLS. Methods The DLS patients received fluoroscopically guided lumbar TFESI with 80 mg of methylprednisolone and 2 mL of 1% lidocaine hydrochloride. Patients were evaluated by an independent observer before the initial injection, at 2 weeks, at 6 weeks, at 3 months, and at 12 months after the injections. Visual analog scale (VAS), Roland 5-point pain scale, standing tolerance, walking tolerance, and patient satisfaction scale were evaluated for outcomes. Results Thirty three DLS patients treated with TFESI, who were completely followed up, were included in this study. The average number of injections per patient was 1.9 (range from 1 to 3 injections per patient). Significant improvements in VAS and Roland 5-point pain scale were observed over the follow up period from 2 weeks to 12 months. However, the standing and walking tolerance were not significantly improved after 2 weeks. At 2 weeks, the patient satisfaction scale was highest, although, these outcomes declined with time. The DLS patients with one level of spinal stenosis showed significantly better outcome than the DLS patients with two levels of spinal stenosis. Five patients (13%) underwent surgical treatment during the 3 to 12 months follow up. Conclusions TFESI provides short term improvements in VAS and Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale in DLS patients. In the long term, it improves VAS but limits the improvements in Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale. PMID:24761192

  2. The Clinical Syndrome Associated with Lumbar Spinal Stenosis

    Microsoft Academic Search

    Khean Jin Goh; Waël Khalifa; Philip Anslow; Tom Cadoux-Hudson; Michael Donaghy

    2004-01-01

    Lumbar spinal stenosis is well defined in patho-anatomical terms but its clinical features are heterogeneous. We carried out a comprehensive retrospective review of the clinical features, radiological changes and outcome of 75 patients with radiologically diagnosed lumbar spinal stenosis in order to define its clinical spectrum. The presenting complaints were of weakness, numbness\\/tingling, radicular pain and neurogenic claudication in almost

  3. Degenerative disease in lumbar spine of military parachuting instructors.

    PubMed

    Bar-Dayan, Y; Weisbort, M; Bar-Dayan, Y; Velan, G J; Ravid, M; Hendel, D; Shemer, J

    2003-12-01

    Parachuting, be it static line or skydiving, places enormous stresses on the human spine. It is, therefore, important to determine the prevalence and severity of degenerative changes in the lumbar spine of subjects who practice this sport activity. Seventy four parachuting instructors, mean age 33 years and with an average of 410 static line and skydiving jumps, were included in the study. Past radiographs were examined and compared to current anterolateral and lateral views of the lumbar spine, in order to determine the prevalence of degenerative changes and document possible progression. Doubtful radiographic changes in the lumbar spine were identified in 47.4 percent of the parachuting instructors, mild degeneration in 9.6 percent, moderate degenerative disease in 10.9 percent and severe radiographic changes in 5.5 percent. Schmorll nodes were found in 8.1 percent of the subjects. Traction spurs--osteophytes were identified in 6.8 percent. The degenerative changes correlated with age and the number of jumps. Spondylolysis of L5-S1 and L3-L4 segments were observed in 12.2 and 1.4 percent respectively. Progressive spondylolisthesis was found in 2 subjects. No correlation was found between the severity of radiographic changes and either the prevalence and the severity of low back pain. The present findings provide a rational for considering repeated sheer stress as an etiology of degenerative changes in the spinal cord, and as a possible contributing factor to the pathogenesis of spondylolysis. Further study has to be done comparing parachuting instructors to a non-parachuting group, or equivalent physically active individuals, in order to assess the effect of sport-background on the development of degenerative changes. PMID:15015796

  4. [Diagnosis and treatment of lumbar spinal canal stenosis].

    PubMed

    Miyamoto, Masabumi; Genbum, Yoshikazu; Ito, Hiromoto

    2002-12-01

    Lumbar spinal canal stenosis (LSCS) was first described in 1954 by Verbiest, followed by the currently accepted international classification of LSCS in 1976 by Arnoldi. Briefly, LSCS is a nervous system syndrome that is characterized by neural symptoms in the lower extremities due to tightened cauda equina and spinal nerve root involvement. LSCS international classification consists of: (1) degenerative, (2) congenital developmental, (3) combined, (4) spondylolytic spondylolisthesis, (5) iatrogenic and (6) post traumatic stenosis. Degenerative stenosis-the most common type of LSCS-is caused by disc degeneration, osteoarthritis of the facet joint and hypertrophy of the ligamentum flavum. LSCS may also be the result of intervertebral disc degeneration, protruded intervertebral disc and/or bony spur compress cauda equina and spinal nerve root anteriorally, while degenerated facet joint and hypertrophied the ligamentum flavum compress cauda equina and spinal nerve root posteriorally? Most often, spondylolytic spondylolisthesis occurs at the fourth lumbar vertebrae in middle-aged women. As a result of a slipping forward of the vertebra, cauda equina and spinal nerve roots can be tightened between the edge behind the top of lower vertebra and frontal edge of the lower part of upper lamina. Typical clinical symptoms of LSCS are low back pain, leg pain and intermittent claudication. Low back pain is chronic with secondary radiating pain in the buttock. The leg pain is called "sciatica", which tends to appear on the back of thigh, in the lateral aspect of lower leg and calf muscles, and which intensifies when the patient is fatigued. Intermittent claudication is a symptom associated with this syndrome. Often, patients with LSCS find it impossible to walk because of increased numbness and pain in their leg. Many patients report that after squatting for a few minutes they are able to resume walking. LSCS patients may also report dysaesthesia in the perineum area, and may also report urinary dysfunction ranging from extreme urgency to urinary delay. Patients who present with symptoms of LSCS should be seen by an orthopedic surgeon. Correct diagnosis by imaging and clinical examination, with appropriate conservative or operative treatment in a timely fashion should be encouraged in order to prevent irreversible nerve damage. PMID:12646992

  5. Total Disc Arthroplasty for Treating Lumbar Degenerative Disc Disease

    PubMed Central

    2015-01-01

    Study Design Lumber disc arthroplasty is a technological advancement that has occurred in the last decade to treat lumbar degenerative disk diseases. Purpose The aim of this retrospective study was to establish the impact and outcomes of managing patients with lumbar degenerative disk disease who have been treated with lumbar total disc arthroplasty (TDA). Overview of Literature Several studies have shown promising results following this surgery. Methods We reviewed the files of 104 patients at the Department of Neurosurgery in Colmar (France) who had been operated on by lumbar spine arthroplasty (Prodisc) between April 2002 and October 2008. Results Among the 104 patients, 67 were female and 37 were male with an average age of 33.1 years. We followed the cases for a mean of 20 months. The most frequent level of discopathy was L4-L5 with 62 patients (59.6%) followed by L5-S1 level with 52 patients (50%). Eighty-three patients suffered from low back pain, 21 of which were associated with radiculopathy. The status of 82 patients improved after surgery according to the Oswestry Disability Index score, and 92 patients returned to work. Conclusions The results indicate that TDA is a good alternative treatment for lumbar spine disk disease, particularly for patients with disabling and chronic low back pain. This technique contributes to improve living conditions with correct patient selection for surgery. PMID:25705336

  6. Retrolisthesis as a Compensatory Mechanism in Degenerative Lumbar Spine

    PubMed Central

    Jeon, Ikchan

    2015-01-01

    Objective Posterior vertebral translation as a type of spondylolisthesis, retrolisthesis is observed commonly in patients with degenerative spinal problems. Nevertheless, there is insufficient literature on retrolisthesis compared to anterolisthesis. The purpose of this study is to clarify the clinical features of retrolisthesis, and its developmental mechanism associated with a compensatory role in sagittal imbalance of the lumbar spine. Methods From 2003 to 2012, 230 Korean patients who underwent spinal surgery in our department under the impression of degenerative lumbar spinal disease were enrolled. All participants were divided into four groups : 35 patients with retrolisthesis (group R), 32 patients with simultaneous retrolisthesis and anterolisthesis (group R+A), 76 patients with anterolisthesis (group A), and 87 patients with non-translation (group N). The clinical features and the sagittal parameters related to retrolisthesis were retrospectively analyzed based on the patients' medical records. Results There were different clinical features and developmental mechanisms between retrolisthesis and anterolisthesis. The location of retrolisthesis was affected by the presence of simultaneous anterolisthesis, even though it predominantly manifest in L3. The relative lower pelvic incidence, pelvic tilt, and lumbar lordosis compared to anterolisthesis were related to the generation of retrolisthesis, with the opposite observations of patients with anterolisthesis. Conclusion Retrolisthesis acts as a compensatory mechanism for moving the gravity axis posteriorly for sagittal imbalance in the lumbar spine under low pelvic incidence and insufficient intra-spinal compensation. PMID:25810857

  7. Controversies about interspinous process devices in the treatment of degenerative lumbar spine diseases: past, present, and future.

    PubMed

    Gazzeri, Roberto; Galarza, Marcelo; Alfieri, Alex

    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

  8. Electrodiagnostic challenges in the evaluation of lumbar spinal stenosis.

    PubMed

    Plastaras, Christopher T

    2003-02-01

    Taken together, the most common electromyographic finding in lumbar spinal stenosis is bilateral multilevel radiculopathy. The sensitivity of electrodiagnostic testing for radiculopathy is difficult to quantify because there is no criterion standard. Differentiating peripheral neuropathy and lumbar spinal stenosis on electromyography and routine nerve-conduction studies can be clinically challenging, especially when the two entities may be present simultaneously in older patients. PMID:12622482

  9. Cervical and lumbar MRI in asymptomatic older male lifelong athletes: Frequency of degenerative findings

    SciTech Connect

    Healy, J.F.; Healy, B.B.; Wong, W.H.M.; Olson, E.M. [Univ. of California, San Diego, CA (United States)] [Univ. of California, San Diego, CA (United States)

    1996-01-01

    The athletic activity of the adult U.S. population has increased markedly in the last 20 years. To evaluate the possible long-term effects of such activity on the cervical and lumbar spine, we studied a group of asymptomatic currently very active lifelong male athletes over age 40 (41-69 years old, av. age 53). Nineteen active, lifelong male athletes were studied with MRI and the results compared with previous imaging studies of other populations. An athletic history and a spine history were also taken. Evidence of asymptomatic degenerative spine disease was similar to that seen in published series of other populations. Degenerative changes including disk protrusion and herniation, spondylosis, and spinal stenosis were present and increased in incidence with increasing patient age. In this group, all MRI findings proved to be asymptomatic and did not limit athletic activity. The incidence of lumbar degenerative changes in our study population of older male athletes was similar to those seen in other populations. 14 refs., 8 figs., 1 tab.

  10. Predicting Lumbar Central Canal Stenosis – A Magnetic Resonance Imaging Study

    PubMed Central

    Premchandran, Divya; Mahale, Ajith

    2014-01-01

    Background: Low back pain is a common complaint among adults, worldwide. Lumbar canal stenosis is frequently diagnosed as a cause for low back pain. In this study we evaluate morphometric measures using MRI sections to predict the occurrence of lumbar central canal stenosis. Settings and Design: One hundred and fifty four lumbar spinal MRI sagital and axial section images, 77 males and females each were evaluated from the Department of Radiology, Kasturba Medical College, Mangalore, Manipal University. The study design was a prospective study. Materials and Methods: Various measurements were taken and two constant ratios were calculated. The Canal Body Ratio and the Ratio between the area of the dural sac and the vertebral body was evaluated. Statistical analysis: Unpaired t-test analysis was conducted using SPSS software. Results: A canal body ratio less than 0.6 from L1 to L3 levels and less than 0.5 at L4 and L5 levels were found. The ratio between area of dural sac and vertebral body was found to be a constant at 0.2 at all levels. It was found that maximum central canal stenosis occurred at the L5 lumbar vertebral level in 15.6% males and 13% females. This was followed by stenosis at the L4 and L3 lumbar vertebral levels with 5.1% males having stenosis at both levels and 3.9% and 5.1% females in L4 and L3 lumbar levels respectively. Conclusion: These morphometrical findings of the lumbar vertebrae could be of use in evaluating the possible cases of lumbar canal stenosis. PMID:25584282

  11. Basic aspects in MR imaging of degenerative lumbar disk disease.

    PubMed

    Heuck, Andreas; Glaser, Christian

    2014-07-01

    Degenerative disease may lead to spinal canal stenosis and long-lasting pain. It is among the leading cause of disability that may affect the ability to work. It has become more common in an increasingly aging population. MRI is the most comprehensive imaging modality and provides detailed morphologic information. A standardized terminology facilitates communication with referring physicians. Yet imaging findings need careful interpretation in conjunction with the results of clinical tests and symptoms to truly help guide therapeutic decision making. This review summarizes aspects of normal anatomy of the intervertebral disk, pathologic mechanisms, terminology, and examples of the imaging spectrum of disk degeneration and herniation. PMID:24896740

  12. Lumbar vertebral hemangioma mimicking lateral spinal canal stenosis: case report and review of literature.

    PubMed

    Syrimpeis, Vasileios; Vitsas, Vasileios; Korovessis, Panagiotis

    2014-03-01

    Context Hemangiomas are the commonest benign tumors of the spine. Most occur in the thoracolumbar spine and the majority are asymptomatic. Rarely, hemangiomas cause symptoms through epidural expansion of the involved vertebra, resulting in spinal canal stenosis, spontaneous epidural hemorrhage, and pathological burst fracture. Findings We report a rare case of a 73-year-old woman, who had been treated for two months for degenerative neurogenic claudication. On admission, magnetic resonance imaging and computed tomographic scans revealed a hemangioma of the third lumbar vertebra protruding to the epidural space producing lateral spinal stenosis and ipsilateral nerve root compression. The patient underwent successful right hemilaminectomy for decompression of the nerve root, balloon kyphoplasty with poly-methyl methacrylate (PMMA) and pedicle screw segmental stabilization. Postoperative course was uneventful. Conclusion In the elderly, this rare presentation of spinal stenosis due to hemangiomas may be encountered. Decompression and vertebral augmentation by means balloon kyphoplasty with PMMA plus segmental pedicle screw fixation is recommended. PMID:24090267

  13. Lumbar vertebral hemangioma mimicking lateral spinal canal stenosis: Case report and review of literature

    PubMed Central

    Syrimpeis, Vasileios; Vitsas, Vasileios; Korovessis, Panagiotis

    2014-01-01

    Context Hemangiomas are the commonest benign tumors of the spine. Most occur in the thoracolumbar spine and the majority are asymptomatic. Rarely, hemangiomas cause symptoms through epidural expansion of the involved vertebra, resulting in spinal canal stenosis, spontaneous epidural hemorrhage, and pathological burst fracture. Findings We report a rare case of a 73-year-old woman, who had been treated for two months for degenerative neurogenic claudication. On admission, magnetic resonance imaging and computed tomographic scans revealed a hemangioma of the third lumbar vertebra protruding to the epidural space producing lateral spinal stenosis and ipsilateral nerve root compression. The patient underwent successful right hemilaminectomy for decompression of the nerve root, balloon kyphoplasty with poly-methyl methacrylate (PMMA) and pedicle screw segmental stabilization. Postoperative course was uneventful. Conclusion In the elderly, this rare presentation of spinal stenosis due to hemangiomas may be encountered. Decompression and vertebral augmentation by means balloon kyphoplasty with PMMA plus segmental pedicle screw fixation is recommended. PMID:24090267

  14. Surgical results of dynamic nonfusion stabilization with the Segmental Spinal Correction System for degenerative lumbar spinal diseases with instability: Minimum 2-year follow-up

    PubMed Central

    Ohta, Hideki; Matsumoto, Yoshiyuki; Morishita, Yuichirou; Sakai, Tsubasa; Huang, George; Kida, Hirotaka; Takemitsu, Yoshiharu

    2011-01-01

    Background When spinal fusion is applied to degenerative lumbar spinal disease with instability, adjacent segment disorder will be an issue in the future. However, decompression alone could cause recurrence of spinal canal stenosis because of increased instability on operated segments and lead to revision surgery. Covering the disadvantages of both procedures, we applied nonfusion stabilization with the Segmental Spinal Correction System (Ulrich Medical, Ulm, Germany) and decompression. Methods The surgical results of 52 patients (35 men and 17 women) with a minimum 2-year follow-up were analyzed: 10 patients with lumbar spinal canal stenosis, 15 with lumbar canal stenosis with disc herniation, 20 with degenerative spondylolisthesis, 6 with disc herniation, and 1 with lumbar discopathy. Results The Japanese Orthopaedic Association score was improved, from 14.4 ± 5.3 to 25.5 ± 2.8. The improvement rate was 76%. Range of motion of the operated segments was significantly decreased, from 9.6° ± 4.2° to 2.0° ± 1.8°. Only 1 patient had adjacent segment disease that required revision surgery. There was only 1 screw breakage, but the patient was asymptomatic. Conclusions Over a minimum 2-year follow-up, the results of nonfusion stabilization with the Segmental Spinal Correction System for unstable degenerative lumbar disease were good. It is necessary to follow up the cases with a focus on adjacent segment disorders in the future.

  15. Clinical Study of Lumbar Spine Stenosis Treated by Using Acupotomy Combined with Oriental Medical Treatments

    PubMed Central

    Yuk, Dong-il; Sung, In-su; Song, Da-hyung; Kim, Min-jung; Hong, Kown-eui

    2013-01-01

    Objectives: The aim of this study is to evaluate the effect of acupotomy in patients with degenerative lumbar spine stenosis. Methods: A total of 437 patients who had been diagnosed as having lumbar spine stenosis and who had been admitted to Daejeon Oriental hospital from June 1, 2008, to September 31, 2012, were included in this study. The patients underwent acupotomy once, twice or three times on the lumbar spine, according to their symptoms. Then, the patients were asked to complete the verbal numeric rating scale (VNRS) and the oswestry disability index (ODI) before and after acupotomy and underwent a global assessment. The resulting data were analyzed. Results: The gender ratio of the participants was 1:1.54, and the mean age was 65 ± 10.0 yr. The number of patients over the age of 65 yr was less than that of the patients under the age of 65 yr in the ratio of 1:1.3. The average disease period was 30.17 ± 56.63 months. The verbal numeric rating scale (VNRS) significantly decreased from 10 to an average of 7.10 ± 2.50 after one acupotomy, 6.30 ± 2.60 after two acupotomies, and 5.50 ± 2.50 after three acupotomies. The ODI was significantly decrease from 20.60 ± 8.70 to 17.80 ± 8.60 after once acupotomy, 17.10 ± 8.50 after two acupotomies, and 16.70 ± 8.60 after three acupotomies. High scores were also observed on the global assessment. Conclusion: These results provide evidence that acupotomy is effective to relieve pain and to improve quality of life in patients with degenerative lumbar spinal stenosis.

  16. Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women

    Microsoft Academic Search

    Shigeyuki Muraki; Seizo Yamamoto; Hideaki Ishibashi; Toshiyuki Horiuchi; Takayuki Hosoi; Hajime Orimo; Kozo Nakamura

    2004-01-01

    Degenerative diseases of lumbar spine commonly noted in elderly people may affect their lumbar spine bone mineral density (BMD). The aim of this study is to determine whether the degree of degenerative spinal diseases is correlated with lumbar spine and femoral neck BMD. This study included 630 women age 60 years or over (mean age 73.3 ± 6.9 years) visiting the Osteoporosis Outpatient

  17. Minimally invasive lumbar decompression for lumbar stenosis: review of clinical outcomes and cost effectiveness.

    PubMed

    Johans, S J; Amin, B Y; Mummaneni, P V

    2015-03-01

    Lumbar stenosis patients typically present with neurogenic claudication or radiculopathy. Studies have shown the benefit of surgical management of lumbar stenosis for patients who fail medical management. Surgical management traditionally involved an open laminectomy and foramenotomies. The emergence of minimally invasive spinal surgery has allowed for comparable clinical outcomes to open laminectomies, with the potential additional benefits of decreased blood loss, shorter hospital stay, decreased postoperative narcotic requirement, decreased rate of infection, and the potential benefit of decreasing the risk of postoperative instability. A shorter length of stay and faster return to work after minimally invasive lumbar decompression may result in the minimally invasive approach being more cost effective than an open approach. A literature review was performed to evaluate the clinical outcomes and cost effectiveness associated with minimally invasive decompression of lumbar stenosis. PMID:25370820

  18. Artificial Discs for Lumbar and Cervical Degenerative Disc Disease –Update

    PubMed Central

    2006-01-01

    Executive Summary Objective To assess the safety and efficacy of artificial disc replacement (ADR) technology for degenerative disc disease (DDD). Clinical Need Degenerative disc disease is the term used to describe the deterioration of 1 or more intervertebral discs of the spine. The prevalence of DDD is roughly described in proportion to age such that 40% of people aged 40 years have DDD, increasing to 80% among those aged 80 years or older. Low back pain is a common symptom of lumbar DDD; neck and arm pain are common symptoms of cervical DDD. Nonsurgical treatments can be used to relieve pain and minimize disability associated with DDD. However, it is estimated that about 10% to 20% of people with lumbar DDD and up to 30% with cervical DDD will be unresponsive to nonsurgical treatments. In these cases, surgical treatment is considered. Spinal fusion (arthrodesis) is the process of fusing or joining 2 bones and is considered the surgical gold standard for DDD. Artificial disc replacement is the replacement of the degenerated intervertebral disc with an artificial disc in people with DDD of the lumbar or cervical spine that has been unresponsive to nonsurgical treatments for at least 6 months. Unlike spinal fusion, ADR preserves movement of the spine, which is thought to reduce or prevent the development of adjacent segment degeneration. Additionally, a bone graft is not required for ADR, and this alleviates complications, including bone graft donor site pain and pseudoarthrosis. It is estimated that about 5% of patients who require surgery for DDD will be candidates for ADR. Review Strategy The Medical Advisory Secretariat conducted a computerized search of the literature published between 2003 and September 2005 to answer the following questions: What is the effectiveness of ADR in people with DDD of the lumbar or cervical regions of the spine compared with spinal fusion surgery? Does an artificial disc reduce the incidence of adjacent segment degeneration (ASD) compared with spinal fusion? What is the rate of major complications (device failure, reoperation) with artificial discs compared with surgical spinal fusion? One reviewer evaluated the internal validity of the primary studies using the criteria outlined in the Cochrane Musculoskeletal Injuries Group Quality Assessment Tool. The quality of concealment allocation was rated as: A, clearly yes; B, unclear; or C, clearly no. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the overall quality of the body of evidence (defined as 1 or more studies) supporting the research questions explored in this systematic review. A random effects model meta-analysis was conducted when data were available from 2 or more randomized controlled trials (RCTs) and when there was no statistical and or clinical heterogeneity among studies. Bayesian analyses were undertaken to do the following: Examine the influence of missing data on clinical success rates; Compute the probability that artificial discs were superior to spinal fusion (on the basis of clinical success rates); Examine whether the results were sensitive to the choice of noninferiority margin. Summary of Findings The literature search yielded 140 citations. Of these, 1 Cochrane systematic review, 1 RCT, and 10 case series were included in this review. Unpublished data from an RCT reported in the grey literature were obtained from the manufacturer of the device. The search also yielded 8 health technology assessments evaluating ADR that are also included in this review. Six of the 8 health technology assessments concluded that there is insufficient evidence to support the use of either lumbar or cervical ADR. The results of the remaining 2 assessments (one each for lumbar and cervical ADR) led to a National Institute for Clinical Excellence guidance document supporting the safety and effectiveness of lumbar and cervical ADR with the proviso that an ongoing audit of all clinical outcomes be undertaken owing to a lack of long-term outcome data from clinical trials. Regard

  19. Bilateral decompression of multilevel lumbar spinal stenosis through a unilateral approach.

    PubMed

    Haba, Katsuhiko; Ikeda, Masato; Soma, Mariko; Yamashima, Tetsumori

    2005-02-01

    Lumbar canal stenosis due to hypertrophy and calcification of the facet joints and/or ligamentum flavum is a common condition in the elderly. Although a large number of individuals are symptom-free, the degenerative process, usually encroaching on both central and lateral pathways, may lead to symptoms of itself or decompensate a preexisting narrow canal. Even at an advanced age, decompression surgery is effective for symptomatic stenosis. Less invasive procedures preserving maximal bony and ligamentous structures have recently been recommended to reduce associated morbidity. This paper introduces a unilateral surgical approach for bilateral decompression by ligamentectomy, partial facetectomy and foraminal unroofing. Using a specially designed, one-side retractor, after the ipsilateral nerve root decompression the contralateral dural sac and nerve roots were approached through an 8 x 15 mm window in the interspinous ligament. The contralateral ligamentum flavum, facet joints and foraminal roof were resected, preserving the supraspinous ligament complex and much of the contralateral musculature. This technique, preserving anatomy and biomechanical function of the lumbar spine, is useful for surgery on multilevel lumbar canal stenoses. PMID:15749421

  20. Central Decompressive Laminoplasty for Treatment of Lumbar Spinal Stenosis : Technique and Early Surgical Results

    PubMed Central

    2014-01-01

    Objective Lumbar spinal stenosis is a common degenerative spine disease that requires surgical intervention. Currently, there is interest in minimally invasive surgery and various technical modifications of decompressive lumbar laminectomy without fusion. The purpose of this study was to present the author's surgical technique and results for decompression of spinal stenosis. Methods The author performed surgery in 57 patients with lumbar spinal stenosis between 2006 and 2010. Data were gathered retrospectively via outpatient interviews and telephone questionnaires. The operation used in this study was named central decompressive laminoplasty (CDL), which allows thorough decompression of the lumbar spinal canal and proximal two foraminal nerve roots by undercutting the lamina and facet joint. Kyphotic prone positioning on elevated curvature of the frame or occasional use of an interlaminar spreader enables sufficient interlaminar working space. Pain was measured with a visual analogue scale (VAS). Surgical outcome was analyzed with the Oswestry Disability Index (ODI). Data were analyzed preoperatively and six months postoperatively. Results The interlaminar window provided by this technique allowed for unhindered access to the central canal, lateral recess, and upper/lower foraminal zone, with near-total sparing of the facet joint. The VAS scores and ODI were significantly improved at six-month follow-up compared to preoperative levels (p<0.001, respectively). Excellent pain relief (>75% of initial VAS score) of back/buttock and leg was observed in 75.0% and 76.2% of patients, respectively. Conclusion CDL is easily applied, allows good field visualization and decompression, maintains stability by sparing ligament and bony structures, and shows excellent early surgical results. PMID:25368762

  1. Surgical Procedures and Clinical Results of Endoscopic Decompression for Lumbar Canal Stenosis

    Microsoft Academic Search

    Munehito Yoshida; Akitaka Ueyoshi; Kazuhiro Maio; Masaki Kawai; Yukihiro Nakagawa

    The purpose of this study was to evaluate the surgical indication and clinical outcomes of endoscopic decompression for lumbar spinal canal stenosis. From September 1998 to March 2002, 250 consecutive patients underwent posterior endoscopic surgery for lumbar radiculopathy. Among these patients, 27 were treated by posterior endoscopic decompression for lumbar canal stenosis. There were 19 men and 8 women, and

  2. Diagnostic value of the lumbar extension-loading test in patients with lumbar spinal stenosis: a cross-sectional study

    PubMed Central

    2014-01-01

    Background The gait-loading test is a well known, important test with which to assess the involved spinal level in patients with lumbar spinal stenosis. The lumbar extension-loading test also functions as a diagnostic loading test in patients with lumbar spinal stenosis; however, its efficacy remains uncertain. The purpose of this study was to compare the diagnostic value of the lumbar extension-loading test with that of the gait-loading test in patients with lumbar spinal stenosis. Methods A total of 116 consecutive patients (62 men and 54 women) diagnosed with lumbar spinal stenosis were included in this cross-sectional study of the lumbar extension-loading test. Subjective symptoms and objective neurological findings (motor, sensory, and reflex) were examined before and after the lumbar extension-loading and gait-loading tests. The efficacy of the lumbar extension-loading test for establishment of a correct diagnosis of the involved spinal level was assessed and compared with that of the gait-loading test. Results There were no significant differences between the lumbar extension-loading test and the gait-loading test in terms of subjective symptoms, objective neurological findings, or changes in the involved spinal level before and after each loading test. Conclusions The lumbar extension-loading test is useful for assessment of lumbar spinal stenosis pathology and is capable of accurately determining the involved spinal level. PMID:25080292

  3. Does Transforaminal Lumbar Interbody Fusion Have Advantages over Posterolateral Lumbar Fusion for Degenerative Spondylolisthesis?

    PubMed Central

    Fujimori, Takahito; Le, Hai; Schairer, William W.; Berven, Sigurd H.; Qamirani, Erion; Hu, Serena S.

    2014-01-01

    Study Design?Retrospective cohort study. Objective?To compare the clinical and radiographic outcomes of transforaminal lumbar interbody fusion (TLIF) and posterolateral lumbar fusion (PLF) in the treatment of degenerative spondylolisthesis. Methods?This study compared 24 patients undergoing TLIF and 32 patients undergoing PLF with instrumentation. The clinical outcomes were assessed by visual analog scale (VAS) for low back pain and leg pain, physical component summary (PCS) of the 12-item Short-Form Health Survey, and the Oswestry Disability Index (ODI). Radiographic parameters included slippage of the vertebra, local disk lordosis, the anterior and posterior disk height, lumbar lordosis, and pelvic parameters. Results?The improvement of VAS of leg pain was significantly greater in TLIF than in PLF unilaterally (3.4 versus 1.0; p?=?0.02). The improvement of VAS of low back pain was significantly greater in TLIF than in PLF (3.8 versus 2.2; p?=?0.02). However, there was no significant difference in improvement of ODI or PCS between TLIF and PLF. Reduction of slippage and the postoperative disk height was significantly greater in TLIF than in PLF. There was no significant difference in local disk lordosis, lumbar lordosis, or pelvic parameters. The fusion rate was 96% in TLIF and 84% in PLF (p?=?0.3). There was no significant difference in fusion rate, estimated blood loss, adjacent segmental degeneration, or complication rate. Conclusions?TLIF was superior to PLF in reduction of slippage and restoring disk height and might provide better improvement of leg pain. However, the health-related outcomes were not significantly different between the two procedures. PMID:25844282

  4. Computer-aided diagnosis of lumbar stenosis conditions

    NASA Astrophysics Data System (ADS)

    Koompairojn, Soontharee; Hua, Kathleen; Hua, Kien A.; Srisomboon, Jintavaree

    2010-03-01

    Computer-aided diagnosis (CAD) systems are indispensable tools for patients' healthcare in modern medicine. Nevertheless, the only fully automatic CAD system available for lumbar stenosis today is for X-ray images. Its performance is limited due to the limitations intrinsic to X-ray images. In this paper, we present a system for magnetic resonance images. It employs a machine learning classification technique to automatically recognize lumbar spine components. Features can then be extracted from these spinal components. Finally, diagnosis is done by applying a Multilayer Perceptron. This classification framework can learn the features of different spinal conditions from the training images. The trained Perceptron can then be applied to diagnose new cases for various spinal conditions. Our experimental studies based on 62 subjects indicate that the proposed system is reliable and significantly better than our older system for X-ray images.

  5. 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

  6. Posterior lumbar interbody fusion (PLIF) with cages and local bone graft in the treatment of spinal stenosis.

    PubMed

    Trouillier, Hans; Birkenmaier, Christof; Rauch, Alexander; Weiler, Christoph; Kauschke, Thomas; Refior, Hans Jürgen

    2006-08-01

    Posterior lumbar interbody fusion (PLIF) implants are increasingly being used for 360 degrees fusion after decompression of lumbar spinal stenosis combined with degenerative instability. Both titanium and PEEK (PolyEtherEtherKetone) implants are commonly used. Assessing the clinical and radiological results as well as typical complications, such as migration of the cages, is important. In addition, questions such as which radiological parameters can be used to assess successful fusion, and whether the exclusive use of local bone graft is sufficient, are frequently debated. We prospectively evaluated 30 patients after PLIF instrumentation for degenerative lumbar spinal canal stenosis, over a course of 42 months. In all cases, titanium cages and local bone graft were used for spondylodesis. The follow-up protocol of these 30 cases included standardised clinical and radiological evaluation at 3, 6, 12 and 42 months after surgery. Overall satisfactory results were achieved. With one exception, a stable result was achieved with restoration of the intervertebral space in the anterior column. After 42 months of follow-up in most cases, a radiologically visible loss of disc space height can be demonstrated. Clinically relevant migration of the cage in the dorsal direction was detected in one case. Based on our experience, posterior lumbar interbody fusion (PLIF) can be recommended for the treatment of monosegmental and bisegmental spinal stenosis, with or without segmental instability. Postoperative evaluation is mainly based on clinical parameters since the titanium implant affects the diagnostic value of imaging studies and is responsible for artefacts. The results observed in our group of patients suggest that local autologous bone graft procured from the posterior elements after decompression is an adequate material for bone grafting in this procedure. PMID:17009828

  7. Presence of NGF and its receptor TrkA in degenerative lumbar facet joint specimens

    Microsoft Academic Search

    M. F. Surace; D. Prestamburgo; M. Campagnolo; A. Fagetti; L. Murena

    2009-01-01

    In a preliminary study, the recurrent presence of nervous terminations was demonstrated with optical microscopy in several\\u000a slides of degenerative lumbar facet joints and surrounding soft tissues. The purpose of this study was to prove the presence\\u000a of NGF (nerve growth factor) and its receptor TrkA (tyrosine kinase receptor) with immunofluorescence. The peri\\/articular\\u000a tissues were harvested from the lumbar facet

  8. Lumbar degenerative disc disease and tibiotalar joint arthritis: a 710-specimen postmortem study.

    PubMed

    Boiwka, Alex V; Bajwa, Navkirat S; Toy, Jason O; Eubanks, Jason; Ahn, Nicholas U

    2015-04-01

    Research has associated lumbar spinal disease with lower extremity arthrosis. These studies focused solely on the lumbar spine's connection with hip or knee pathology, failing to investigate potential ankle relationships. We specifically explored the interplay between lumbar disc degeneration and tibiotalar joint arthritis. Lumbar disc degeneration and tibiotalar joint arthritis was graded 0 to 4, according to osteophytosis of the vertebral rim and talar surface in 710 randomly selected cadaveric specimens. We corrected for confounding factors of age, sex, race, and height. A significant association was found between lumbar disc degeneration and tibiotalar joint arthritis (P < .01). Lumbar disc degeneration encompassing 3 intervetebral discs demonstrated the highest odds for development of severe tibiotalar joint arthritis. Severe lumbar degenerative disc disease was more prevalent than severe tibiotalar joint arthritis in individuals age 20 years and older. Furthermore, the presence of severe lumbar degeneration significantly predisposes individuals to the development of severe ankle arthritis (P < .05). Gait changes resulting from disc degeneration or neural compression in the lumbar spine may play a role in ankle osteoarthritis development. This association must be considered when treating patients with lumbar disc degeneration and leg pain. PMID:25844591

  9. Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine

    PubMed Central

    Lykissas, Marios G; Aichmair, Alexander

    2013-01-01

    Back pain is a common chronic disorder that represents a large burden for the health care system. There is a broad spectrum of available treatment options for patients suffering from chronic lower back pain in the setting of degenerative disorders of the lumbar spine, including both conservative and operative approaches. Lumbar arthrodesis techniques can be divided into sub-categories based on the part of the vertebral column that is addressed (anterior vs posterior). Furthermore, one has to differentiate between approaches aiming at a solid fusion in contrast to motion-sparing techniques with the proposed advantage of a reduced risk of developing adjacent disc disease. However, the field of application and long-term outcomes of these novel motion-preserving surgical techniques, including facet arthroplasty, nucleus replacement, and lumbar disc arthroplasty, need to be more precisely evaluated in long-term prospective studies. Innovative surgical treatment strategies involving minimally invasive techniques, such as lateral lumbar interbody fusion or transforaminal lumbar interbody fusion, as well as percutaneous implantation of transpedicular or transfacet screws, have been established with the reported advantages of reduced tissue invasiveness, decreased collateral damage, reduced blood loss, and decreased risk of infection. The aim of this study was to review well-established procedures for lumbar spinal fusion with the main focus on current concepts on spinal arthrodesis and motion-sparing techniques in degenerative disorders of the lumbar spine. PMID:24303453

  10. Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments: the Wallis system

    Microsoft Academic Search

    J. Sénégas

    2002-01-01

    A first-generation implant for non-rigid stabilization of lumbar segments was developed in 1986. It included a titanium interspinous blocker and an artificial ligament made of dacron. Following an initial observational study in 1988 and a prospective controlled study from 1988 to 1993, more than 300 patients have been treated for degenerative lesions with this type of implant with clinical and

  11. Combined anterior interbody fusion and posterior pedicle screw fixation in patients with degenerative lumbar disc disease

    Microsoft Academic Search

    M. A. El Masry; W. S. Badawy; P. Rajendran; D Chan

    2004-01-01

    We reviewed 47 consecutive patients with degenerative lumbar disc disease. All patients were treated by anterior interbody fusion using an autogenous iliac bone graft in combination with posterior pedicle fixation but without a posterior fusion. There were 32 men and 15 women with a mean age of 44 (range 23–56) years. One third ( n=15) of the patients had previous

  12. Polyetheretherketone (PEEK) rods: short-term results in lumbar spine degenerative disease.

    PubMed

    Colangeli, S; Barbanti Brodàno, G; Gasbarrini, A; Bandiera, S; Mesfin, A; Griffoni, C; Boriani, S

    2015-06-01

    Pedicle screw and rod instrumentation has become the preferred technique for performing stabilization and fusion in the surgical treatment of lumbar spine degenerative disease. Rigid fixation leads to high fusion rates but may also contribute to stress shielding and adjacent segment degeneration. Thus, the use of semirigid rods made of polyetheretherketone (PEEK) has been proposed. Although the PEEK rods biomechanical properties, such as anterior load sharing properties, have been shown, there are few clinical studies evaluating their application in the lumbar spine surgical treatment. This study examined a retrospective cohort of patients who underwent posterior lumbar fusion for degenerative disease using PEEK rods, in order to evaluate the clinical and radiological outcomes and the incidence of complications. PMID:25751575

  13. [Lumbar spinal stenosis : From diagnosis to correct therapy].

    PubMed

    Benditz, A; Grifka, J; Matussek, J

    2015-04-01

    The number of patients with a diagnosis of lumbar spinal stenosis (LSS) is steadily increasing and the expectations of patients are high; however, valid data for an appropriate therapy are lacking. Treatment is mostly the result of the surgeon's experience and the clinical focus. The findings in magnetic resonance imaging (MRI) often do not correlate with the patient's symptoms. It is proposed that treatment should start with a conservative multimodal approach. Increased pain with neurogenic claudication symptoms under conservative treatment should be treated surgically. Absolute indications for surgery, such as a conus cauda syndrome are rare. The goal of all surgical procedures is to decompress the spinal canal without compromising the stability of the motion segment. This can also make an additional fusion necessary. PMID:25854156

  14. Priapism associated with lumbar stenosis in a dog.

    PubMed

    Payan-Carreira, R; Colaço, B; Rocha, C; Albuquerque, C; Luis, M; Abreu, H; Pires, M A

    2013-08-01

    Priapism, a persistent long-lasting involuntary erection of the penis, is uncommon in dogs. In this report, the case of a 13-year-old male Pointer, referred to our services due to persistent exposition of the penis, is described. This condition was consecutive to an intermittent priapism situation lasting for several days, which has been initially attributed to the inflammation and haematoma associated with a perianal bite. The owners became unable to retract the penis into the prepuce. At presentation, the dog was anorectic for 48 h, intolerant to manipulation, and showed poor body condition and unsteady locomotion. During physical evaluation, a marked engorgement of the local vessels in the prepuce and penis was found. An abdominal X-ray was asked under the suspicion of a neurogenic origin for the clinical situation, which showed evidences of spondylosis. After discussion of the clinical condition, the owners asked for euthanasia. The necropsy confirmed the engorgement of the regional vessels deriving from the pudendal arteries and blood accumulation within all the cavernous spaces, accompanied by congestion and thrombosis within the erectile structures of the penis. No significant changes were observed in the pelvic organs that could be at the origin of priapism. The lumbar-sacral spinal regions were carefully inspected and evidenced signs of L7-S1 stenosis due to spondylosis. The case presented herein is a rare situation of priapism of neurogenic origin in a dog. Necropsy findings suggest that it was consecutive to cauda equina compression due to lumbar spinal stenosis. PMID:23551292

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

    SciTech Connect

    Masala, Salvatore; Fiori, Roberto; Bartolucci, Dario Alberto, E-mail: bartolucci.md@gmail.com; Volpi, Tommaso; Calabria, Eros [University of Rome 'Tor Vergata', Department of Diagnostic and Molecular Imaging, Interventional Radiology, Nuclear Medicine and Radiation Therapy (Italy); Novegno, Federica [University of Rome 'Tor Vergata', Department of Neurosurgery (Italy); Simonetti, Giovanni [University of Rome 'Tor Vergata', Department of Diagnostic and Molecular Imaging, Interventional Radiology, Nuclear Medicine and Radiation Therapy (Italy)

    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.

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

    PubMed

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

    2014-12-01

    Objective. 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 to 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. The primary phenotypes were central lumbar stenosis as assessed qualitatively on magnetic resonance imaging (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 66.9% (95% confidence interval [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

  17. Efficacy of Epidural Injections in the Treatment of Lumbar Central Spinal Stenosis: A Systematic Review

    PubMed Central

    Manchikanti, Laxmaiah; Kaye, Alan David; Manchikanti, Kavita; Boswell, Mark; Pampati, Vidyasagar; Hirsch, Joshua

    2015-01-01

    Context: Lumbar central spinal stenosis is common and often results in chronic persistent pain and disability, which can lead to multiple interventions. After the failure of conservative treatment, either surgical or nonsurgical modalities such as epidural injections are contemplated in the management of lumbar spinal stenosis. Evidence Acquisition: Recent randomized trials, systematic reviews and guidelines have reached varying conclusions about the efficacy of epidural injections in the management of central lumbar spinal stenosis. The aim of this systematic review was to determine the efficacy of all three anatomical epidural injection approaches (caudal, interlaminar, and transforaminal) in the treatment of lumbar central spinal stenosis. A systematic review was performed on randomized trials published from 1966 to July 2014 of all types of epidural injections used in the management of lumbar central spinal stenosis. Methodological quality assessment and grading of the evidence was performed. Results: The evidence in managing lumbar spinal stenosis is Level II for long-term improvement for caudal and lumbar interlaminar epidural injections. For transforaminal epidural injections, the evidence is Level III for short-term improvement only. The interlaminar approach appears to be superior to the caudal approach and the caudal approach appears to be superior to the transforaminal one. Conclusions: The available evidence suggests that epidural injections with local anesthetic alone or with local anesthetic with steroids offer short- and long-term relief of low back and lower extremity pain for patients with lumbar central spinal stenosis. However, the evidence is Level II for the long-term efficacy of caudal and interlaminar epidural injections, whereas it is Level III for short-term improvement only with transforaminal epidural injections. PMID:25789241

  18. Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature

    Microsoft Academic Search

    Karin D. van den Eerenbeemt; Raymond W. Ostelo; Barend J. van Royen; Wilco C. Peul; Maurits W. van Tulder

    2010-01-01

    The objective of this study is to evaluate the effectiveness and safety of total disc replacement surgery compared with spinal\\u000a fusion in patients with symptomatic lumbar disc degeneration. Low back pain (LBP), a major health problem in Western countries,\\u000a can be caused by a variety of pathologies, one of which is degenerative disc disease (DDD). When conservative treatment fails,\\u000a surgery

  19. A minimally invasive posterior lumbar interbody fusion using percutaneous long arm pedicle screw system for degenerative lumbar disease

    PubMed Central

    He, Er-Xing; Cui, Ji-Hao; Yin, Zhi-Xun; Li, Chuang; Tang, Cheng; He, Yi-Qian; Liu, Cheng-Wei

    2014-01-01

    The aim of this study is to evaluate the therapeutic efficacy of patients with lumbar degeneration and instability treated with percutaneous pedicle screw fixation and minimally invasive lumbar interbody fusion. Twenty-one patients were selected in our hospital from November, 2012 to March, 2013. The patients with an average age 55.62 years, including 8 vertebral spondylolisthesis, 4 lumbar intervertebral disc herniation, and 9 lumbar spinal canal stenosis cases. All the patients were managed to take the lumbar MRI and radiographs. The comparison of preoperative and postoperative (3 days, 2 weeks, 3 months) VAS and ODI score were analyzed. The results indicated that VAS scores were 7.14 ± 0.79 before operation, and 5.19 ± 0.81 in 3 days after operation, 4 ± 0.84 after 2 weeks, and 2.67 ± 0.66 after 3 months. The pain was relieved, and the postoperative VAS score was lower than that before treatment (P < 0.05). ODI score was 55.8 ± 11.4 before operation, 47.38 ± 9.38 after 3 days, 41.38 ± 8.09 after 2 weeks, 35.76 ± 4.50 after 3 months. ODI score was obviously decreased (P < 0.05). In conclusion, percutaneous pedicle screw fixation combined with minimally invasive interbody fusion is a safe, effective, feasible minimally invasive spine operation, with worthy for spreading. PMID:25550904

  20. Prosthetic lumbar disc replacement for degenerative disc disease.

    PubMed

    Kulkarni, Arvind G; Diwan, Ashish D

    2005-12-01

    Mechanical articulated device to replace intervertebral disc as a treatment for low back pain secondary to disc degeneration has emerged as a promising tool for selected patients. The potential advantages are prevention of adjacent segment degeneration, maintenance of mobility as well as avoidance of all the complications associated with fusion. The short-term results have been comparable to that of fusion, a few mid-term results have shown mixed outcome, but information on long-term results and performance are not available at present. The rationale for lumbar disc arthroplasty, indications, contraindications, the various artificial devices in the market and the concepts intrinsic to each of them, basic technique of insertion, complications are discussed and a brief summary of our experience with one of the devices is presented. PMID:16565543

  1. Minimally invasive surgical treatment of lumbar spinal stenosis: Two-year follow-up in 54 patients

    PubMed Central

    Palmer, Sylvain; Davison, Lisa

    2012-01-01

    Objective: Minimally invasive surgery has seen increasing application in the treatment of spinal disorders. Treatment of degenerative spinal stenosis, with or without spondylolisthesis, with minimally invasive technique preserves stabilizing ligaments, bone, and muscle. Satisfactory results can be achieved without the need for fusion in most cases. Methods: Fifty-four consecutive patients underwent bilateral decompressions from a unilateral approach for spinal stenosis using METRx instrumentation. Visual Analog Scale (VAS) pain scores were recorded preoperatively and patients were interviewed, in person or by phone, by our office nurse practitioner (LD) to assess postoperative VAS scores, and patient satisfaction with the clinical results 21-39 months postoperatively (median 27 months). Results: Fifty-four patients underwent decompression at 77 levels (L4/5 = 43, L3/4 = 22, L5/S1 = 8, L1/2 = 4, L2/3 = 4), (single = 35, double = 16, triple = 2, quadruple = 1). There were 39 females and 15 males. The average age was 67 years. The average operative time was 78 minutes and the average blood loss was 37 ml per level. Twenty-seven patients had preoperative degenerative spondylolisthesis (Grade 1 = 26, Grade 2 = 1). Eight patients had discectomies and four had synovial cysts. Patient satisfaction was high. Use of pain medication for leg and back pain was low, and VAS scores improved by more than half. There were three dural tears. There were no deaths or infections. One patient with an unrecognized dural tear required re-exploration for repair of a pseudomeningocele and one patient required a lumbar fusion for pain associated with progression of her spondylolisthesis. Conclusions: Minimally invasive bilateral decompression of acquired spinal stenosis from a unilateral approach can be successfully accomplished with reasonable operative times, minimal blood loss, and acceptable morbidity. Two-year outcomes in this series revealed high patient satisfaction and only one patient progressed to lumbar fusion. PMID:22530175

  2. Evaluation of circulatory compromise in the leg in lumbar spinal canal stenosis.

    PubMed

    Chosa, Etsuo; Sekimoto, Tomohisa; Kubo, Shinichiro; Tajima, Naoya

    2005-02-01

    To evaluate whether hemoglobin oxygen saturation and hemoglobin concentration of the leg are useful indicators for circulatory compromise in patients with lumbar spinal canal stenosis, we investigated the changes in the indices during level gait using reflectance spectrophotometry. Thirty-three patients with lumbar spinal stenosis were studied. Preoperatively, the hemoglobin oxygen saturation was greater in the 33 patients than in the control subjects. The indices increased in the control subjects more than those in the patients. Postoperatively, the increases in hemoglobin oxygen saturation were greater in the patients with lumbar spinal canal stenosis than before decompression and the hemoglobin concentration tended to approximate that in the control subjects. The results suggest these indices might be useful for monitoring disease severity in patients with lumber spinal canal stenosis. In addition to stenotic ischemia in the spinal canal, it is thought that the neurogenic intermittent claudication is secondarily caused by circulatory failure in the lower extremities attributable to the autonomic nervous dysfunction. PMID:15685065

  3. Lumbar spine stenosis: a common cause of back and leg pain.

    PubMed

    Alvarez, J A; Hardy, R H

    1998-04-15

    Lumbar spine stenosis most commonly affects the middle-aged and elderly population. Entrapment of the cauda equina roots by hypertrophy of the osseous and soft tissue structures surrounding the lumbar spinal canal is often associated with incapacitating pain in the back and lower extremities, difficulty ambulating, leg paresthesias and weakness and, in severe cases, bowel or bladder disturbances. The characteristic syndrome associated with lumbar stenosis is termed neurogenic intermittent claudication. This condition must be differentiated from true claudication, which is caused by atherosclerosis of the pelvofemoral vessels. Although many conditions may be associated with lumbar canal stenosis, most cases are idiopathic. Imaging of the lumbar spine performed with computed tomography or magnetic resonance imaging often demonstrates narrowing of the lumbar canal with compression of the cauda equina nerve roots by thickened posterior vertebral elements, facet joints, marginal osteophytes or soft tissue structures such as the ligamentum flavum or herniated discs. Treatment for symptomatic lumbar stenosis is usually surgical decompression. Medical treatment alternatives, such as bed rest, pain management and physical therapy, should be reserved for use in debilitated patients or patients whose surgical risk is prohibitive as a result of concomitant medical conditions. PMID:9575322

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

    NASA Astrophysics Data System (ADS)

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

    2011-03-01

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

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

    PubMed Central

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

    2014-01-01

    Background: Transforaminal lumbar interbody fusion (TLIF) has been used in lumbar degenerative diseases. Some researchers have applied unilateral fixation in TLIF to reduce operational trauma without compromising the clinical outcome, but it is always suspected biomechanically unstable. The supplementary contralateral translaminar facet screw (cTLFS) seemed to be able to overcome the inherent drawbacks of unilateral pedicle screw (uPS) fixation theoretically. This study evaluates the safety, feasibility and efficacy of TLIF using uPS with cTLFS fixation in the treatment of lumbar degenerative diseases (LDD). Materials and Methods: 50 patients (29 male) underwent the aforementioned surgical technique for their LDD between December 2009 and April 2012. The results were evaluated based on visual analogue scale (VAS) of the leg and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were recorded. The radiographic examinations in form of X-ray, computed tomography (CT) or magnetic resonance imaging was done preoperatively and 1 week, 3 months, 6 months, 12 months and 24 months postoperatively. The student t-test was used for comparison between the preoperative values and postoperative counterparts. P < 0.05 was considered to be statistically significant. Results: Among 50 patients, 22 received one level fusion and 28 two level's, with corresponding operation time and estimated blood loss being approximately 90 min, 150 ml and 120 min, 200 ml, respectively. No severe complications happened perioperatively. The mean VAS (back, leg) scores dropped from (7.6, 7.5) preoperatively to (2.1, 0.6) at 12 months’ followup, ODI from 49.1 preoperatively to 5.6 and JOA score raised from 10.6 preoperatively to 28.5, all P < 0.001, suggesting of good clinical outcome. From the three-dimensional reconstructed CT, 62 out of 70 segments displayed solid fusion with fusion rate of 88.6% at 12 months postoperatively. Conclusions: TLIF using uPS fixation plus cTLFS fixation is a safe, feasible and effective technique in the treatment of one or two level lumbar degenerative diseases short termly. PMID:25143640

  6. Surgical outcomes of modified lumbar spinous process-splitting laminectomy for lumbar spinal stenosis.

    PubMed

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

    2015-04-01

    The lumbar spinous process-splitting laminectomy (LSPSL) procedure was developed as an alternative to lumbar laminectomy. In the LSPSL procedure, the spinous process is evenly split longitudinally and then divided at its base from the posterior arch, leaving the bilateral paravertebral muscle attached to the lateral aspects. This procedure allows for better exposure of intraspinal nerve tissues, comparable to that achieved by conventional laminectomy while minimizing damage to posterior supporting structures. In this study, the authors make some modifications to the original LSPSL procedure (modified LSPSL), in which laminoplasty is performed instead of laminectomy. The purpose of this study was to compare postoperative outcomes in modified LSPSL with those in conventional laminectomy (CL) and to evaluate bone unions between the split spinous process and residual laminae following modified LSPSL. Forty-seven patients with lumbar spinal stenosis were enrolled in this study. Twenty-six patients underwent modified LSPSL and 21 patients underwent CL. Intraoperative blood loss and surgical duration were evaluated. The Japanese Orthopaedic Association (JOA) scale scores were used to assess parameters before surgery and 12 months after surgery. The recovery rates were also evaluated. Postoperative paravertebral muscle atrophy was assessed using MRI. Bone union rates between the split spinous process and residual laminae were also examined. The mean surgical time and intraoperative blood loss were 25.7 minutes and 42.4 ml per 1 level in modified LSPSL, respectively, and 22.7 minutes and 29.5 ml in CL, respectively. The recovery rate of the JOA score was 64.2% in modified LSPSL and 68.7% in CL. The degree of paravertebral muscle atrophy was 7.8% in modified LSPSL and 22.2% in CL at 12 months after surgery (p < 0.05). The fusion rates of the spinous process with the arcus vertebrae at 6 and 12 months in modified LSPSL were 56.3% and 81.3%, respectively. The modified LSPSL procedure was less invasive to the paravertebral muscles and could be a laminoplasty; therefore, the modified LSPSL procedure presents an effective alternative to lumbar laminectomy. PMID:25594729

  7. Variation in the PTH2R gene is associated with age-related degenerative changes in the lumbar spine.

    PubMed

    Åkesson, Kristina; Tenne, Max; Gerdhem, Paul; Luthman, Holger; McGuigan, Fiona E

    2015-01-01

    In the elderly, degenerative changes in the lumbar spine are common, contributing to falsely elevated bone mineral density (BMD) values. The parathyroid hormone (PTH) system plays an important role in the regulation of bone turnover and we explore the hypothesis that polymorphisms (SNPs) within genes in this pathway (PTH, PTHLH, PTH1R and PTH2R) contribute to degenerative manifestations of the spine in elderly women. The study included 1,004 Swedish women aged 75 years from the population-based OPRA cohort who attended follow-up at 5 and 10 years. Lumbar spine BMD was assessed by dual energy X-ray absorptiometry (DXA) and each individual vertebra was evaluated visually on the DXA image for apparent degenerative manifestations. Six SNPs in PTH and 3 SNPs each in PTH1R, PTH2R and PTHLH were analysed. Among women with degenerative manifestations at the lumbar spine, there was an over-representation at baseline of those carrying the PTH2R SNP rs897083 A-allele (p = 0.0021; odds ratio 1.5 95 % CI 1.2-2.0) and across the duration of follow-up (p = 0.0008). No association was observed between degenerative manifestations and variation in the other genes. None of the PTH hormone system genes were associated with vertebral fracture. Variation in the PTH2R gene (Chr2q34, rs897083) may contribute to the age-associated degenerative manifestations that develop at the lumbar spine. PMID:24378925

  8. Dynamic Stabilization for Challenging Lumbar Degenerative Diseases of the Spine: A Review of the Literature

    PubMed Central

    Kaner, Tuncay; Ozer, Ali Fahir

    2013-01-01

    Fusion and rigid instrumentation have been currently the mainstay for the surgical treatment of degenerative diseases of the spine over the last 4 decades. In all over the world the common experience was formed about fusion surgery. Satisfactory results of lumbar spinal fusion appeared completely incompatible and unfavorable within years. Rigid spinal implants along with fusion cause increased stresses of the adjacent segments and have some important disadvantages such as donor site morbidity including pain, wound problems, infections because of longer operating time, pseudarthrosis, and fatigue failure of implants. Alternative spinal implants were developed with time on unsatisfactory outcomes of rigid internal fixation along with fusion. Motion preservation devices which include both anterior and posterior dynamic stabilization are designed and used especially in the last two decades. This paper evaluates the dynamic stabilization of the lumbar spine and talks about chronologically some novel dynamic stabilization devices and thier efficacies. PMID:23662211

  9. Arteriovenous fistula of the filum terminale misdiagnosed and previously operated as lower lumbar degenerative disease.

    PubMed

    Sharma, Pankaj; Ranjan, Alok; Lath, Rahul

    2014-06-01

    Filum terminale arteriovenous fistula (FTAVF) presenting as a cause of failed back surgery syndrome is a rare entity. We report a 48-year-old male patient who presented with clinical features of a conus medullaris/cauda equina lesion. He had upper and lower motor neuron signs in both the lower limbs with autonomic dysfunction. The patient was misdiagnosed and was operated twice earlier for lumbar canal stenosis and disc prolapse. After reviewing his clinical and radiological findings a diagnosis of FTAVF was made. He underwent surgery and there was a significant improvement in his neurological functions. We discuss the case and review the literature on FTAVF's. PMID:24967053

  10. Lumbosacral Fixation Using the Diagonal S2 Screw for Long Fusion in Degenerative Lumbar Deformity: Technical Note Involving 13 Cases

    PubMed Central

    Kim, Hong-Sik; Baek, Seung-Wook; Lee, Sang-Hyun

    2013-01-01

    Placing instrumentation into the ilium has been shown to increase the biomechanical stability and the fusion rates, but it has some disadvantages. The diagonal S2 screw technique is an attractive surgical procedure for degenerative lumbar deformity. Between 2008 and 2010, we carried out long fusion across the lumbosacral junction in 13 patients with a degenerative lumbar deformity using the diagonal S2 screws. In 12 of these 13 patients, the lumbosacral fusion was graded as solid fusion with obvious bridging bone (92%). One patient had a rod dislodge at one S2 screw and breakage of one S1 screw and underwent revision nine months postoperatively. So, we present alternative method of lumbopelvic fixation for long fusion in degenerative lumbar deformity using diagonal S2 screw instead of iliac screw. PMID:24009909

  11. 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

  12. Two-year clinical and radiographic success of minimally invasive lateral transpsoas approach for the treatment of degenerative lumbar conditions

    PubMed Central

    Ozgur, Burak M.; Agarwal, Vijay; Nail, Erin; Pimenta, Luiz

    2010-01-01

    Background The lateral transpsoas approach to interbody fusion is a less disruptive but direct-visualization approach for anterior/anterolateral fusion of the thoracolumbar spine. Several reports have detailed the technique, the safety of the approach, and the short term clinical benefits. However, no published studies to date have reported the long term clinical and radiographic success of the procedure. Materials and methods The current study is a retrospective chart review of prospectively collected clinical and radiographic outcomes in 62 patients having undergone the Anterolateral transpsoas procedure at a single institution for anterior column stabilization as treatment for degenerative conditions, including degenerative disk disease, spondylolisthesis, scoliosis, and stenosis. Only patients who were a minimum of 2 years postoperative were included in this evaluation. Clinical outcomes measured included visual analog pain scales (VAS) and Oswestry disability index (ODI). Radiographic outcomes included identification of successful arthrodesis. Results Sixty-two patients were treated with lateral interbody fusion between 2003 and December 2006. Twenty-six patients (42%) were single-level, 13 (21%) 2-level, and 23 (37%) 3- or more levels. Forty-five (73%) included supplemental posterior pedicle fixation, 4 (6%) lateral fixation, and 13 (21%) were stand-alone. Pain scores (VAS) decreased significantly from preoperative to 2 years follow-up by 37% (P < .0001). Functional scores (ODI) decreased significantly by 39% from preoperative to 2 years follow-up (P < .0001). Clinical success by ODI-change definition was achieved in 71% of patients. Radiographic success was achieved in 91% of patients, with 1 patient with pseudarthrosis requiring posterior revision. Conclusion The lateral transpsoas approach is similar to a traditional anterior lumbar interbody fusion, in that access is obtained through a retroperitoneal, direct-visualization exposure, and a large implant can be placed in the interspace to achieve disk height and alignment correction. The 2 years plus clinical and radiographic success rates are similar to or better than those reported for traditional anterior and posterior approach procedures, which, coupled with significant short-term benefits of minimal morbidity, make the lateral approach a safe and effective treatment option for anterior/anterolateral lumbar fusions.

  13. Association of COL2A1 Gene Polymorphism with Degenerative Lumbar Scoliosis

    PubMed Central

    Hwang, Dae Woo; Lee, Sang Hoon; Kim, Jung Youn; Kim, Dong Hwan

    2014-01-01

    Background Degenerative lumbar scoliosis (DLS) progresses with aging after 50-60 years, and the genetic association of DLS remains largely unclear. In this study, the genetic association between collagen type II alpha 1 (COL2A1) gene and DLS was investigated. Methods COL2A1 gene polymorphism was investigated in DLS subjects compared to healthy controls to investigate the possibility of its association with COL2A1 gene. Based on a single nucleotide polymorphism (SNP) database, SNP (rs2276454) in COL2A1 were selected and genotyped using direct sequencing in 51 patients with DLS and 235 healthy controls. The SNP effects were analyzed using three models of codominant, dominant, and recessive. Logistic regression models were calculated for odds ratios (ORs) with 95% confidence intervals (CIs) and corresponding p-values, controlling age and gender as co-variables. Results SNP (rs2276454) in COL2A1 was significantly associated with the degenerative lumbar scoliosis in the codominant (OR, 1.90; 95% CI, 1.17 to 3.10; p = 0.008) and dominant models (OR, 3.58; 95% CI, 1.59 to 9.29; p = 0.001). Conclusions The results suggest that COL2A1 is associated with the risk of DLS in Korean population. PMID:25436060

  14. Factors affecting disability and physical function in degenerative lumbar spondylolisthesis of L4–5: evaluation with axially loaded MRI

    Microsoft Academic Search

    Kuo-Yuan Huang; Ruey-Mo Lin; Yung-Ling Lee; Jenq-Daw Li

    2009-01-01

    Few studies have investigated the factors related to the disability and physical function in degenerative lumbar spondylolisthesis\\u000a using axially loaded magnetic resonance imaging (MRI). Therefore, we aimed to investigate the effect of axial loading on the\\u000a morphology of the spine and the spinal canal in patients with degenerative spondylolisthesis of L4–5 and to correlate morphologic\\u000a changes to their disability and

  15. Chronic inflammatory demyelinating polyneuropathy mimicking a lumbar spinal stenosis syndrome

    Microsoft Academic Search

    L Ginsberg; A D Platts; P K Thomas

    1995-01-01

    A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) established by biopsy developed cauda equina symptoms due to swelling of the nerve roots in the lumbar spinal canal. Magnetic resonance imaging of the lumbar spine showed profoundly thickened nerve roots from the level of the conus medullaris, filling the caudal thecal sac. Immunosuppressant treatment produced partial clinical and radiological resolution. This

  16. Correlation between disability and MRI findings in lumbar spinal stenosis

    PubMed Central

    2011-01-01

    Background and purpose MRI is the modality of choice when diagnosing spinal stenosis but it also shows that stenosis is prevalent in asymptomatic subjects over 60. The relationship between preoperative health-related quality of life, functional status, leg and back pain, and the objectively measured dural sac area in single and multilevel stenosis is unknown. We assessed this relationship in a prospective study. Patients and methods The cohort included 109 consecutive patients with central spinal stenosis operated on with decompressive laminectomy or laminotomy. Preoperatively, all patients completed the questionnaires for EQ-5D, SF-36, Oswestry disability index (ODI), estimated walking distance and leg and back pain (VAS). The cross-sectional area of the dural sac was measured at relevant disc levels in mm2, and spondylolisthesis was measured in mm. For comparison, the area of the most narrow level, the number of levels with dural sac area < 70 mm2, and spondylolisthesis were studied. Results Before surgery, patients with central spinal stenosis had low HRLQoL and functional status, and high pain levels. Patients with multilevel stenosis had better general health (p = 0.04) and less leg and back pain despite having smaller dural sac area than patients with single-level stenosis. There was a poor correlation between walking distance, ODI, the SF-36, EQ-5D, and leg and back pain levels on the one hand and dural sac area on the other. Women more often had multilevel spinal stenosis (p = 0.05) and spondylolisthesis (p < 0.001). Spondylolisthetic patients more often had small dural sac area (p = 0.04) and multilevel stenosis (p = 0.06). Interpretation Our findings indicate that HRQoL, function, and pain measured preoperatively correlate with morphological changes on MRI to a limited extent. PMID:21434811

  17. Measuring spinal canal size in lumbar spinal stenosis: description of method and preliminary results

    PubMed Central

    Makirov, Serik K.; Osadchiy, Valentin

    2015-01-01

    Background Lumbar spinal stenosis is a pathological condition of the spinal channel with its concentric narrowing with presence of specific clinical syndrome. Absence of the clear unified radiological signs is the one of the basic problems of the lumbar spinal stenosis. Purpose The authors seek to create method of assessment of the spinal canal narrowing degree, based on anatomical aspects of lumbar spinal stenosis. Study Design Development of diagnostic criteria based on analysis of a consecutive patients group and a control group. Methods Thirty seven patients (73 stenotic segments) with mean age 62,4 years old were involved in the study. Severity of clinical symptoms has been estimated by the measuring scales: Oswestry Disability Index (ODI) and Swiss Spinal Stenosis Questionnaire (SSQ). Mean number of the stenotic segments was 1.97. For all patients 8 radiological criteria have been measured. In the control group have been included 37 randomly selected patients (volunteers) in mean age of 53,4 years old without stenosis signs and narrowing of the spinal canal on the MRI imaging (73 segments total). Measurements were performed at the middle of intervertebral disc and facet joints level. Results For description of the state of spinal canal we offer the coefficient: ratio of the lateral canals total area to the cross-sectional area of the dural sac (“coefficient of stenosis”). Comparison of mean values of “coefficient of stenosis” for main and control groups showed statistically significant differences (t = -12,5; p < 0.0001). Strong statistically significant correlation with the ODI and SSS scales was revealed for the obtained coefficient (p <0.05). Conclusions In our study new method of assessment of the spinal canal narrowing degree has been applied. Promising results have been obtained in a small group of patients. It is necessary to check the data on a large sample of recommendations for its clinical application.

  18. Decreased sleep duration: a risk of progression of degenerative lumbar scoliosis.

    PubMed

    Li, Hao; Liang, Chengzhen; Shen, Chenchun; Li, Yan; Chen, Qixin

    2012-02-01

    Degenerative lumbar scoliosis (DLS) is a spinal deformity that develops after skeletal maturity with a Cobb angle of more than 10° in the coronal plane. As the life expectancy of our population increases, DLS becomes a prevalent health issue affecting the quality of life of the elderly. The degree of the scoliosis curvature affects not only the symptoms but also the choice of treatments. Osteoporosis and intervertebral disc degeneration (IDD) have been suggested as two important risks associated with the progression of DLS. Interestingly, recent data implicate interleukin-1 (IL-1) in the altered matrix biology that characterizes human IDD. Compelling evidence links decreased sleep duration to lower bone mineral density (BMD) and elevated expression of IL-1. Based on these evidences, we propose that decreased sleep duration might be a risk of the progression of DLS, and hypothesize that the underlying mechanisms might be the elevated excretion of glucocorticoids and elevated expression of IL-1. PMID:22118954

  19. Preoperative MRI Findings Predict Two-Year Postoperative Clinical Outcome in Lumbar Spinal Stenosis

    PubMed Central

    Kuittinen, Pekka; Sipola, Petri; Leinonen, Ville; Saari, Tapani; Sinikallio, Sanna; Savolainen, Sakari; Kröger, Heikki; Turunen, Veli; Airaksinen, Olavi; Aalto, Timo

    2014-01-01

    Purpose To study the predictive value of preoperative magnetic resonance imaging (MRI) findings for the two-year postoperative clinical outcome in lumbar spinal stenosis (LSS). Methods 84 patients (mean age 63±11 years, male 43%) with symptoms severe enough to indicate LSS surgery were included in this prospective observational single-center study. Preoperative MRI of the lumbar spine was performed with a 1.5-T unit. The imaging protocol conformed to the requirements of the American College of Radiology for the performance of MRI of the adult spine. Visual and quantitative assessment of MRI was performed by one experienced neuroradiologist. At the two-year postoperative follow-up, functional ability was assessed with the Oswestry Disability Index (ODI 0–100%) and treadmill test (0–1000 m), pain symptoms with the overall Visual Analogue Scale (VAS 0–100 mm), and specific low back pain (LBP) and specific leg pain (LP) separately with a numeric rating scale from 0–10 (NRS-11). Satisfaction with the surgical outcome was also assessed. Results Preoperative severe central stenosis predicted postoperatively lower LP, LBP, and VAS when compared in patients with moderate central stenosis (p<0.05). Moreover, severe stenosis predicted higher postoperative satisfaction (p?=?0.029). Preoperative scoliosis predicted an impaired outcome in the ODI (p?=?0.031) and lowered the walking distance in the treadmill test (p?=?0.001). The preoperative finding of only one stenotic level in visual assessment predicted less postoperative LBP when compared with patients having 2 or more stenotic levels (p?=?0.026). No significant differences were detected between quantitative measurements and the patient outcome. Conclusions Routine preoperative lumbar spine MRI can predict the patient outcome in a two-year follow up in patients with LSS surgery. Severe central stenosis and one-level central stenosis are predictors of good outcome. Preoperative finding of scoliosis may indicate worse functional ability. PMID:25229343

  20. 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.

  1. Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review.

    PubMed

    Bonaldi, G; Brembilla, C; Cianfoni, A

    2015-05-01

    The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered "standard of care", are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists' interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications. PMID:24906245

  2. Successful operative management of an upper lumbar spinal canal stenosis resulting in multilevel lower nerve root radiculopathy

    PubMed Central

    McClelland, Shearwood; Kim, Stefan S.

    2015-01-01

    Lumbar stenosis is a common disorder, usually characterized clinically by neurogenic claudication with or without lumbar/sacral radiculopathy corresponding to the level of stenosis. We present a case of lumbar stenosis manifesting as a multilevel radiculopathy inferior to the nerve roots at the level of the stenosis. A 55-year-old gentleman presented with bilateral lower extremity pain with neurogenic claudication in an L5/S1 distribution (posterior thigh, calf, into the foot) concomitant with dorsiflexion and plantarflexion weakness. Imaging revealed grade I spondylolisthesis of L3 on L4 with severe spinal canal stenosis at L3-L4, mild left L4-L5 disc herniation, no stenosis at L5-S1, and no instability. EMG revealed active and chronic L5 and S1 radiculopathy. The patient underwent bilateral L3-L4 hemilaminotomy with left L4-L5 microdiscectomy for treatment of his L3-L4 stenosis. Postoperatively, he exhibited significant improvement in dorsiflexion and plantarflexion. The L5-S1 level was not involved in the operative decompression. Patients with radiculopathy and normal imaging at the level corresponding to the radiculopathy should not be ruled out for operative intervention should they have imaging evidence of lumbar stenosis superior to the expected affected level. PMID:25552866

  3. Loading is more effective than posture in lumbar spinal stenosis: a study with a treadmill equipment

    Microsoft Academic Search

    Hasan O?uz; Funda Levendo?lu; Tunç Cevat Ö?ün; Aysenur Tantu?

    2007-01-01

    The objective of this study was to assess the correlation between neurogenic intermittent claudication (NIC) in LSS and different\\u000a positions as well as loading status, using the treadmill device. The study was a prospective clinical trial on lumbar spinal\\u000a stenosis (LSS) using a treadmill equipment. The study population comprised of 80 LSS patients with a mean age of 61. The

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

    SciTech Connect

    Masala, Salvatore, E-mail: salva.masala@tiscali.it [Interventional Radiology and Radiotherapy, University of Rome 'Tor Vergata', Department of Diagnostic and Molecular Imaging (Italy); Tarantino, Umberto [University of Rome 'Tor Vergata', Department of Orthopaedics and Traumatology (Italy); Nano, Giovanni, E-mail: gionano@gmail.com [Interventional Radiology and Radiotherapy, University of Rome 'Tor Vergata', Department of Diagnostic and Molecular Imaging (Italy); Iundusi, Riccardo [University of Rome 'Tor Vergata', Department of Orthopaedics and Traumatology (Italy); Fiori, Roberto, E-mail: fiori.r@libero.it; Da Ros, Valerio, E-mail: valeriodaros@hotmail.com; Simonetti, Giovanni [Interventional Radiology and Radiotherapy, University of Rome 'Tor Vergata', Department of Diagnostic and Molecular Imaging (Italy)

    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.

  5. Posterior interbody fusion using a diagonal cage with unilateral transpedicular screw fixation for lumbar stenosis.

    PubMed

    Zhao, Jian; Zhang, Feng; Chen, Xiaoqing; Yao, Yu

    2011-03-01

    Few reports have described the combined use of unilateral pedicle screw fixation and interbody fusion for lumbar stenosis. We retrospectively reviewed 79 patients with lumbar stenosis. The rationale and effectiveness of unilateral pedicle screw fixation were studied from biomechanical and clinical perspectives, aiming to reduce stiffness of the implant. All patients were operated with posterior interbody fusion using a diagonal cage in combination with unilateral transpedicular screw fixation and had reached the 3-year follow-up interval after operation. The mean operating time was 115 minutes (range=95-150 min) and the mean estimated blood loss was 150 mL (range=100-200 mL). The mean duration of hospital stay was 10 days (range=7-15 days). Clinical outcomes were assessed prior to surgery and reassessed at intervals using Denis' pain and work scales. Fusion status was determined from X-rays and CT scans. At the final follow-up, the clinical results were satisfactory and patients showed significantly improved scores (p<0.01) either on the pain or the work scale. Successful fusion was achieved in all patients. There were no new postoperative radiculopathies, or instances of malpositioned or fractured hardware. Posterior interbody fusion using a diagonal cage with unilateral transpedicular fixation is an effective treatment for decompressive surgery for lumbar stenosis. PMID:21237659

  6. Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature

    PubMed Central

    van den Eerenbeemt, Karin D.; van Royen, Barend J.; Peul, Wilco C.; van Tulder, Maurits W.

    2010-01-01

    The objective of this study is to evaluate the effectiveness and safety of total disc replacement surgery compared with spinal fusion in patients with symptomatic lumbar disc degeneration. Low back pain (LBP), a major health problem in Western countries, can be caused by a variety of pathologies, one of which is degenerative disc disease (DDD). When conservative treatment fails, surgery might be considered. For a long time, lumbar fusion has been the “gold standard” of surgical treatment for DDD. Total disc replacement (TDR) has increased in popularity as an alternative for lumbar fusion. A comprehensive systematic literature search was performed up to October 2008. Two reviewers independently checked all retrieved titles and abstracts, and relevant full text articles for inclusion. Two reviewers independently assessed the risk of bias of included studies and extracted relevant data and outcomes. Three randomized controlled trials and 16 prospective cohort studies were identified. In all three trials, the total disc replacement was compared with lumbar fusion techniques. The Charité trial (designed as a non-inferiority trail) was considered to have a low risk of bias for the 2-year follow up, but a high risk of bias for the 5-year follow up. The Charité artificial disc was non-inferior to the BAK® Interbody Fusion System on a composite outcome of “clinical success” (57.1 vs. 46.5%, for the 2-year follow up; 57.8 vs. 51.2% for the 5-year follow up). There were no statistically significant differences in mean pain and physical function scores. The Prodisc artificial disc (also designed as a non-inferiority trail) was found to be statistically significant more effective when compared with the lumbar circumferential fusion on the composite outcome of “clinical success” (53.4 vs. 40.8%), but the risk of bias of this study was high. Moreover, there were no statistically significant differences in mean pain and physical function scores. The Flexicore trial, with a high risk of bias, found no clinical relevant differences on pain and physical function when compared with circumferential spinal fusion at 2-year follow up. Because these are preliminary results, in addition to the high risk of bias, no conclusions can be drawn based on this study. In general, these results suggest that no clinical relevant differences between the total disc replacement and fusion techniques. The overall success rates in both treatment groups were small. Complications related to the surgical approach ranged from 2.1 to 18.7%, prosthesis related complications from 2.0 to 39.3%, treatment related complications from 1.9 to 62.0% and general complications from 1.0 to 14.0%. Reoperation at the index level was reported in 1.0 to 28.6% of the patients. In the three trials published, overall complication rates ranged from 7.3 to 29.1% in the TDR group and from 6.3 to 50.2% in the fusion group. The overall reoperation rate at index-level ranged from 3.7 to 11.4% in the TDR group and from 5.4 to 26.1% in the fusion group. In conclusion, there is low quality evidence that the Charité is non-inferior to the BAK cage at the 2-year follow up on the primary outcome measures. For the 5-year follow up, the same conclusion is supported only by very low quality evidence. For the ProDisc, there is very low quality evidence for contradictory results on the primary outcome measures when compared with anterior lumbar circumferential fusion. High quality randomized controlled trials with relevant control group and long-term follow-up is needed to evaluate the effectiveness and safety of TDR. PMID:20508954

  7. 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 ...

  8. Percutaneous posterior-lateral lumbar interbody fusion for degenerative disc disease using a B-Twin expandable spinal spacer

    Microsoft Academic Search

    Lizu Xiao; Donglin Xiong; Qiang Zhang; Jin Jian; Husan Zheng; Yuhui Luo; Juanli Dai; Deren Zhang

    2010-01-01

    Degenerative disc disease (DDD) causes gradual intervertebral space collapse, concurrent discogenic or facet-induced pain,\\u000a and possible compression radiculopathy. A new minimal invasion procedure of percutaneous posterior-lateral lumbar interbody\\u000a fusion (PPLIF) using a B-Twin stand-alone expandable spinal spacer (ESS) was designed to treat this disease and evaluated\\u000a by follow-up more than 1 year. 12 cases with chronic low back pain and compressive

  9. Three-dimensional trabecular bone architecture of the lumbar spine in bone metastasis from prostate cancer: comparison with degenerative sclerosis

    Microsoft Academic Search

    Tsutomu Tamada; Teruki Sone; Yoshimasa Jo; Shigeki Imai; Yasumasa Kajihara; Masao Fukunaga

    2005-01-01

    ObjectiveProstate cancer frequently metastasizes to bone, inducing osteosclerotic lesions. The objective of this study was to clarify the three-dimensional (3D) trabecular bone microstructure in bone metastasis from prostate cancer by comparison with normal and degenerative sclerotic bone lesions, using microcomputed tomography (micro-CT).Design and materialsA total of 32 cancellous bone samples were excised from the lumbar spine of six autopsy patients:

  10. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: assessment of functional outcome following lumbar fusion.

    PubMed

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

    2014-07-01

    Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome. PMID:24980579

  11. Calcific extension towards the mitral valve causes non-rheumatic mitral stenosis in degenerative aortic stenosis: real-time 3D transoesophageal echocardiography study

    PubMed Central

    Iwataki, Mai; Takeuchi, Masaaki; Otani, Kyoko; Kuwaki, Hiroshi; Yoshitani, Hidetoshi; Abe, Haruhiko; Lang, Roberto M; Levine, Robert A; Otsuji, Yutaka

    2014-01-01

    Objective Mitral annular/leaflet calcification (MALC) is frequently observed in patients with degenerative aortic stenosis (AS). However, the impact of MALC on mitral valve function has not been established. We aimed to investigate whether MALC reduces mitral annular area and restricts leaflet opening, resulting in non-rheumatic mitral stenosis. Methods Real-time three-dimensional transoesophageal images of the mitral valve were acquired in 101 patients with degenerative AS and 26 control participants. The outer and inner borders of the mitral annular area (MAA) and the maximal leaflet opening angle were measured at early diastole. The mitral valve area (MVA) was calculated as the left ventricular stroke volume divided by the velocity time integral of the transmitral flow velocity. Results Although the outer MAA was significantly larger in patients with AS compared to control participants (8.2±1.3 vs 7.3±0.9?cm2, p<0.001), the inner MAA was significantly smaller (4.5±1.1 vs 5.9±0.9?cm2, p<0.001), resulting in an average decrease of 45% in the effective MAA. The maximal anterior and posterior leaflet opening angle was also significantly smaller in patients with AS (64±10 vs 72±8°, p<0.001, 71±12 vs 87±7°, p<0.001). Thus, MVA was significantly smaller in patients with AS (2.5±1.0 vs 3.8±0.8?cm2, p<0.001). Twenty-four (24%) patients with AS showed MVA <1.5?cm2. Multivariate regression analysis including parameters for mitral valve geometry revealed that a decrease in effective MAA and a reduced posterior leaflet opening angle were independent predictors for MVA. Conclusions Calcific extension to the mitral valve in patients with AS reduced effective MAA and the leaflet opening, resulting in a significant non-rheumatic mitral stenosis in one-fourth of the patients. PMID:25332828

  12. Screening for Nuclear Replacement Candidates in Patients With Lumbar Degenerative Disc Disease

    PubMed Central

    Pappou, Ioannis; Cammisa, Frank; Papadopoulos, Elias; Frelinghuysen, Peter

    2008-01-01

    Background Nuclear replacement is an emerging surgical treatment for degenerative disc disease (DDD) and low back pain (LBP). While clinical experience is most extensive with the prosthetic disc nucleus PDN (Raymedica, Minneapolis, Minnesota), strict indications apply for the implantation of this device. The purpose of this study was to ascertain what percentage of patients treated surgically for degenerative disc disease with other surgical procedures would have been candidates for nuclear replacement implantation. Methods The charts and films of 85 consecutive patients with failed conservative management for LBP treated surgically with fusion, disc replacement, or annuloplasty were retrospectively reviewed. There were 53 patients with 1-level disease and 32 with 2-level disease, accounting for 117 treated levels. Patients with the following radiographic contraindications to nuclear replacement were serially eliminated: (1) Schmorl's nodes and > 50% collapse of the disc space, (2) irregular/convex endplates on the MRI, (3) complete tears and large annular defects (ie, both incomplete tears and complete tears were eliminated, but patients with local annular deficiency were deemed eligible for nuclear replacement), and (4) a BMI > 30. Results Fifty-nine levels (50.4%) had no radiographic contraindications to treatment with a nuclear replacement device. Twelve levels in 10 patients with a BMI > 30 were excluded. Overall, 47 out of 117 levels (40.2%) had no contraindications to a prosthetic nucleus device. The L5-S1 level was the most commonly treated level (55 out of 117, 47%), but only 25.5% had no radiographic contraindications, and overall only 21.8% of the levels were suitable for a nuclear replacement device. Upper lumbar levels (L3-4 and L4-5) had no radiographic contraindications in a higher percentage of cases (68.8% and 72.7%, respectively). The inclusion of the BMI criteria reduced these percentages to 50% and 59.1%, respectively. Conclusions The surgeon has to assess endplate integrity, disc height, endplate shape, annular integrity, and BMI when offering nuclear replacement as treatment for patients with DDD.

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

    PubMed

    Robaina-Padrón, F J

    2007-10-01

    Investigation and development of new techniques for intrumented surgery of the spine is not free of conflicts of interest. The influence of financial forces in the development of new technologies an its immediately application to spine surgery, shows the relationship between the published results and the industry support. Even authors who have defend eagerly fusion techniques, it have been demonstrated that them are very much involved in the revision of new articles to be published and in the approval process of new spinal technologies. When we analyze the published results of spine surgery, we must bear in mind what have been call in the "American Stock and Exchange" as "the bubble of spine surgery". The scientific literature doesn't show clear evidence in the cost-benefit studies of most instrumented surgical interventions of the spine compare with the conservative treatments. It has not been yet demonstrated that fusion surgery and disc replacement are better options than the conservative treatment. It's necessary to point out that at present "there are relationships between the industry and back pain, and there is also an industry of the back pain". Nonetheless, the "market of the spine surgery" is growing up because patients are demanding solutions for their back problems. The tide of scientific evidence seams to go against the spinal fusions in the degenerative disc disease, discogenic pain and inespecific back pain. After decades of advances in this field, the results of spinal fusions are mediocre. New epidemiological studies show that "spinal fusion must be accepted as a non proved or experimental method for the treatment of back pain". The surgical literature on spinal fusion published in the last 20 years following the Cochrane's method establish that: 1- this is at least incomplete, not reliable and careless; 2- the instrumentation seems to slightly increase the fusion rate; 3- the instrumentation doesn't improve the clinical results in general, lacking studies in subgroups of patients. We still are needing randomized studies to compare the surgical results with the natural history of the disease, the placebo effect, or the conservative treatment. The European Guidelines for lumbar chronic pain management show a "strong evidence" indicating that complex and demanding spine surgery where different instrumentation is used, is not more effective than a simple, safer and cheaper posterolateral fusion without instrumentation. Recently, the literature published in this field is sending a message to use "minimally invasive techniques", abandon transpedicular fusions and clearly indicating that we must apply the knowledge accumulated at least along the last 20 years based on the scientific evidence. In conclusion, based in recent information, we must recommend the "abandon of the instrumented pathway" in a great number of present indications for degenerative spine surgery, and look for new strategies in the field of rehabilitation and conservative treatments correctly apply, using before the decompressive and instrumented surgery all the interventional and minimally invasive techniques that are presently offer in the field of modem lumbar chronic pain treatment. PMID:18008014

  14. Effectiveness of Surgery for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

    PubMed Central

    Machado, Gustavo C.; Ferreira, Paulo H.; Harris, Ian A.; Pinheiro, Marina B.; Koes, Bart W.; van Tulder, Maurits; Rzewuska, Magdalena; Maher, Chris G.; Ferreira, Manuela L.

    2015-01-01

    Background The management of spinal stenosis by surgery has increased rapidly in the past two decades, however, there is still controversy regarding the efficacy of surgery for this condition. Our aim was to investigate the efficacy and comparative effectiveness of surgery in the management of patients with lumbar spinal stenosis. Methods Electronic searches were performed on MEDLINE, EMBASE, AMED, CINAHL, Web of Science, LILACS and Cochrane Library from inception to November 2014. Hand searches were conducted on included articles and relevant reviews. We included randomised controlled trials evaluating surgery compared to no treatment, placebo/sham, or to another surgical technique in patients with lumbar spinal stenosis. Primary outcome measures were pain, disability, recovery and quality of life. The PEDro scale was used for risk of bias assessment. Data were pooled with a random-effects model, and the GRADE approach was used to summarise conclusions. Results Nineteen published reports (17 trials) were included. No trials were identified comparing surgery to no treatment or placebo/sham. Pooling revealed that decompression plus fusion is not superior to decompression alone for pain (mean difference –3.7, 95% confidence interval –15.6 to 8.1), disability (mean difference 9.8, 95% confidence interval –9.4 to 28.9), or walking ability (risk ratio 0.9, 95% confidence interval 0.4 to 1.9). Interspinous process spacer devices are slightly more effective than decompression plus fusion for disability (mean difference 5.7, 95% confidence interval 1.3 to 10.0), but they resulted in significantly higher reoperation rates when compared to decompression alone (28% v 7%, P < 0.001). There are no differences in the effectiveness between other surgical techniques for our main outcomes. Conclusions The relative efficacy of various surgical options for treatment of spinal stenosis remains uncertain. Decompression plus fusion is not more effective than decompression alone. Interspinous process spacer devices result in higher reoperation rates than bony decompression. PMID:25822730

  15. Risk factors for postoperative complication after spinal fusion and instrumentation in degenerative lumbar scoliosis patients

    PubMed Central

    2014-01-01

    Background Relatively few studies have focused on the major medical complications that are more common in older adults. Furthermore, these studies have generally not reported how accurately a risk factor, or combination of risk factors, can distinguish between those who will have a complication and those who will not. Methods A total of 236 consecutive patients who had undergone surgical treatment for degenerative lumbar scoliosis between June 2008 and June 2012 were included retrospectively in this study. The demographic distribution, medical history, and clinical data were collected to investigate the predictive factors of postoperative complications by logistic regression. Results Among 236 eligible patients, major medical complications occurred in 7.2% of cases and wound complications occurred in 1.7% of cases. Ninety-day mortality rate was 0.4%. Postoperative complications were strongly associated with history of severe chronic obstructive pulmonary disease (COPD) (P = 0.031), dyspnea with minimal exertion (P = 0.041), being at least partially dependent (P = 0.041), smoking within the past year (P = 0.044), American Society of Anesthesiologists (ASA) class of more than 2 (P = 0.000), diabetes treated with insulin (P = 0.003), and steroid use for chronic condition (P = 0.003). In logistic regressions, operation time (odds ratio 2.45, 95% confidence interval 1.11–4.78), ASA class (class 3 or 4 vs. class 1 or 2: odds ratio 2.21, 95% confidence interval 1.22–3.45), insulin-dependent diabetes (odds ratio 1.72, 95% confidence interval 1.18–2.43), and steroid use for chronic condition (odds ratio 1.55, 95% confidence interval 1.06–2.32) may be reasonable predictors for an individual's likelihood of surgical complications. Conclusions The occurrence of postoperative complications is most likely multifactorial and is related to operation time, ASA class, insulin-dependent diabetes and steroid use for chronic condition. PMID:24606963

  16. Lumbar Spinal Stenosis CAD from Clinical MRM and MRI Based on Inter-and Intra-Context Features with a Two-Level Classifier

    E-print Network

    Chaudhary, Vipin

    taken the significant part of the clinical evaluation of the lumbar spine. This is mainly due, and myelography, MRI has been adopted as a primary diagnostic tool in the clinical evaluation of the lumbar spineLumbar Spinal Stenosis CAD from Clinical MRM and MRI Based on Inter- and Intra-Context Features

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

    PubMed Central

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

    2010-01-01

    In the treatment of multilevel degenerative disorders of the lumbar spine, spondylodesis plays a controversial role. Most patients can be treated conservatively with success. Multilevel lumbar fusion with instrumentation is associated with severe complications like failed back surgery syndrome, implant failure, and adjacent segment disease (ASD). This retrospective study examines the records of 70 elderly patients with degenerative changes or instability of the lumbar spine treated between 2002 and 2007 with spondylodesis of more than two segments. Sixty-four patients were included; 5 patients had died and one patient was lost to follow-up. We evaluated complications, clinical/radiological outcomes, and success of fusion. Flexion-extension and standing X-rays in two planes, MRI, and/or CT scans were obtained pre-operatively. Patients were assessed clinically using the Oswestry disability index (ODI) and a Visual Analogue Scale (VAS). Surgery performed was dorsolateral fusion (46.9%) or dorsal fusion with anterior lumbar interbody fusion (ALIF; 53.1%). Additional decompression was carried out in 37.5% of patients. Mean follow-up was 29.4±5.4 months. Average patient age was 64.7±4.3 years. Clinical outcomes were not satisfactory for all patients. VAS scores improved from 8.6±1.3 to 5.6±3.0 pre- to post-operatively, without statistical significance. ODI was also not significantly improved (56.1±22.3 pre- and 45.1±26.4 post-operatively). Successful fusion, defined as adequate bone mass with trabeculation at the facets and transverse processes or in the intervertebral segments, did not correlate with good clinical outcomes. Thirty-five of 64 patients (54%) showed signs of pedicle screw loosening, especially of the screws at S1. However, only 7 of these 35 (20%) complained of corresponding back pain. Revision surgery was required in 24 of 64 patients (38%). Of these, indications were adjacent segment disease (16 cases), pedicle screw loosening (7 cases), and infection (one case). At follow-up of 29.4 months, patients with radiographic ASD had worse ODI scores than patients without (54.7 vs. 36.6; P<0.001). Multilevel fusion for degenerative disease still has a high rate of complications, up to 50%. The problem of adjacent segment disease after fusion surgery has not yet been solved. This study underscores the need for strict indication guidelines to perform lumbar spine fusion of more than two levels. PMID:21808698

  18. 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

  19. Symmetry of paraspinal muscle denervation in clinical lumbar spinal stenosis: Support for a hypothesis of posterior primary ramus stretching?

    PubMed Central

    Haig, Andrew J.; London, Zachary; Sandella, Danielle E.; Yamakawa, Karen S.J.

    2014-01-01

    Introduction Denervation of the paraspinal muscles in spinal disorders is frequently attributed to radiculopathy. Therefore, persons with lumbar spinal stenosis causing asymmetrical symptoms should have asymmetrical paraspinal denervation. Methods 73 persons with clinical lumbar spinal stenosis, aged 55 to 85, completed a pain drawing and underwent masked electrodiagnostic testing including bilateral paraspinal mapping and testing of 6 muscles on the most symptomatic (or randomly chosen) limb. Results With the exception of 10 subjects with unilateral thigh pain (p=0.043), there was no relationship between side of pain and paraspinal mapping score for any subgroups (symmetrical pain, pain into one calf only). Among those with positive limb EMG (tested on one side), no relationship between side of pain and paraspinal EMG score was found. Discussion The evidence suggests that paraspinal denervation in spinal stenosis may not be due to radiculopathy, but rather due to stretch or damage to the posterior primary ramus. PMID:23813584

  20. Trends, Major Medical Complications, and Charges Associated with Surgery for Lumbar Spinal Stenosis in Older Adults

    PubMed Central

    Deyo, Richard A.; Mirza, Sohail K.; Martin, Brook I.; Kreuter, William; Goodman, David C.; Jarvik, Jeffrey G.

    2010-01-01

    Context In recent decades, the fastest growth in lumbar surgery occurred in older patients with spinal stenosis. Trials indicate that for selected patients, decompressive surgery offers an advantage over non-operative treatment, but surgeons often recommend more invasive fusion procedures. Comorbidity is common in elderly patients, so benefits and risks must be carefully weighed in the choice of surgical procedure. Objective Examine trends in use of different types of stenosis operations and the association of complications and resource use with surgical complexity. Design, Setting, and Patients Retrospective cohort analysis of Medicare claims for 2002–2007, focusing on 2007 to assess complications and resource use in U.S. hospitals. Operations for Medicare recipients undergoing surgery for lumbar stenosis (n=32,152 in the first 11 months of 2007) were grouped into 3 gradations of invasiveness: decompression alone, simple fusion (one or two disc levels, single surgical approach) or complex fusion (more than 2 disc levels or combined anterior and posterior approach). Main Outcome Measures Rates of the 3 types of surgery, major complications, postoperative mortality, and resource use. Results Overall, surgical rates declined slightly from 2002–2007, but the rate of complex fusion procedures increased 15-fold, from 1.3 to 19.9 per 100,000 beneficiaries. Life-threatening complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex fusion compared to decompression alone was 2.95 (95% CI 2.50–3.49). A similar pattern was observed for rehospitalization within 30 days, which occurred for 7.8% of patients undergoing decompression and 13.0% having a complex fusion (adjusted OR 1.94; 95% CI 1.74–2.17). Adjusted mean hospital charges for complex fusion procedures were $80,888 compared to $23,724 for decompression alone. Conclusions Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased, while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use. PMID:20371784

  1. Change in onset times of the abdominal muscles following functional task in lumbar spinal stenosis

    PubMed Central

    Song, Hyun Seung; Park, Seong Doo

    2014-01-01

    The purpose of this study was to investigate the difference in the onset times of the abdominal muscle following a rapid arm task in lumbar spinal stenosis (LSS). In total, 32 patients with LSS were recruited from W oriental hospital. Muscle activity onset of the internal oblique (IO) and external oblique (EO) muscles was measured by electromyography (EMG) activity with a rapid arm movement and during the performance of a walking task. The LSS group demonstrated a significantly later onset of the IO, EO, and rectus abdominal (RA) muscles than the normal group. The deltoid reaction time of the normal group demonstrated significantly earlier activations of IO and EO, while the deltoid reaction time of the LSS group demonstrated significantly delayed activations of IO and RA. The EMG measurements of the IO, EO, and RA muscles while standing and walking were reliable and they offer empirical information about the trunk muscle activation of LSS patients. PMID:25426468

  2. Interspinous process device versus standard conventional surgical decompression for lumbar spinal stenosis: randomized controlled trial

    PubMed Central

    2013-01-01

    Objective To assess whether interspinous process device implantation is more effective in the short term than conventional surgical decompression for patients with intermittent neurogenic claudication due to lumbar spinal stenosis. Design Randomized controlled trial. Setting Five neurosurgical centers (including one academic and four secondary level care centers) in the Netherlands. Participants 203 participants were referred to the Leiden-The Hague Spine Prognostic Study Group between October 2008 and September 2011; 159 participants with intermittent neurogenic claudication due to lumbar spinal stenosis at one or two levels with an indication for surgery were randomized. Interventions 80 participants received an interspinous process device and 79 participants underwent spinal bony decompression. Main outcome measures The primary outcome at short term (eight weeks) and long term (one year) follow-up was the Zurich Claudication Questionnaire score. Repeated measurements were made to compare outcomes over time. Results At eight weeks, the success rate according to the Zurich Claudication Questionnaire for the interspinous process device group (63%, 95% confidence interval 51% to 73%) was not superior to that for standard bony decompression (72%, 60% to 81%). No differences in disability (Zurich Claudication Questionnaire; P=0.44) or other outcomes were observed between groups during the first year. The repeat surgery rate in the interspinous implant group was substantially higher (n=21; 29%) than that in the conventional group (n=6; 8%) in the early post-surgical period (P<0.001). Conclusions This double blinded study could not confirm the hypothesized short term advantage of interspinous process device over conventional “simple” decompression and even showed a fairly high reoperation rate after interspinous process device implantation. Trial registration Dutch Trial Register NTR1307. PMID:24231273

  3. Fluoroscopically guided transforaminal epidural dry needling for lumbar spinal stenosis using a specially designed needle

    PubMed Central

    2010-01-01

    Background This report describes the methodological approach and clinical application of a minimally invasive intervention to treat lumbar spinal stenosis (LSS). Methods Thirty-four patients with LSS underwent fluoroscopically guided transforaminal epidural dry needling using a specially designed flexed Round Needle. The needle was inserted 8-12 cm lateral to the midline at the level of the stenosis and advanced to a position between the anterior side of the facet joint and pedicle up to the outer-third of the pedicle. The needle was advanced medially and backed laterally within a few millimetres along the canal side of the inferior articular process between the facet joint and pedicle. The procedure was completed when a marked reduction in resistance was felt at the tip of the needle. The procedure was performed bilaterally at the level of the stenosis. Results The average follow-up period was 12.9 ± 1.1 months. The visual analogue scale (VAS) pain score was reduced from 7.3 ± 2.0 to 4.6 ± 2.5 points, the Oswestry Disability Index (ODI) score decreased from 41.4 ± 17.2 to 25.5 ± 12.6% and the average self-rated improvement was 52.6 ± 33.1%. The VAS scores indicated that 14 (41.2%) patients reported a "good" to "excellent" treatment response, while 11 (32.4%) had a "good" to "excellent" treatment response on the ODI and 22 (64.7%) had a "good" to "excellent" treatment response on the self-rated improvement scale. Conclusions These results suggest that fluoroscopically guided transforaminal epidural dry needling is effective for managing LSS. PMID:20698999

  4. Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease

    Microsoft Academic Search

    Malhar N. Kumar; Frederic Jacquot

    2001-01-01

    There are very few studies with more than 20 years' follow-up of lumbar spine fusions for disc degeneration. Currently, there is a lot of interest in the subject of degenerative changes above the level of fusion; this study is concerned with such changes in the very long term (30 years). Twenty-eight patients showing sound fusion on radiographs following posterior midline

  5. Unilateral versus Bilateral Pedicle Screw Fixation for Degenerative Lumbar Diseases: A Meta-Analysis of 10 Randomized Controlled Trials

    PubMed Central

    Li, Xianzhou; Lv, Chaoliang; Yan, Tingzhen

    2015-01-01

    Background The common and effective treatment for degenerative lumbar diseases is lumbar spinal fusion. Controversy still exists on the choice for instrumentation with spinal fusion procedures. Therefore, we conducted this meta-analysis exclusively of RCTs to compare the clinical outcomes of patients receiving bilateral versus unilateral pedicle screw fixation (PSF). Material/Methods After systematic review of published and unpublished literature, a meta-analysis was conducted to compare the 2 treatment strategies. The methodological quality of the literature was assessed using the PEDro critical appraisal tool. Results Data synthesis showed less blood loss (P<0.001) and shorter operative time (P<0.001) in patients receiving unilateral PSF compared to bilateral PSF. However, there was no significant difference in fusion rates and functional outcomes between the 2 groups. Conclusions The meta-analysis indicated no significant difference in fusion rates and functional outcomes between the 2 treatment procedures, but unilateral PS fixation reduced blood loss and operative time. PMID:25774950

  6. Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis. Methods/design This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome. Discussion Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms. Trial registration ClinicalTrials.gov identifier: NCT01943435 PMID:24872875

  7. Comparative effectiveness of microdecompression and laminectomy for central lumbar spinal stenosis: study protocol for an observational study

    PubMed Central

    Nerland, Ulf S; Jakola, Asgeir S; Solheim, Ole; Weber, Clemens; Rao, Vidar; Lønne, Greger; Solberg, Tore K; Salvesen, Øyvind; Carlsen, Sven M; Nygaard, Øystein P; Gulati, Sasha

    2014-01-01

    Introduction This observational study is designed to test the equivalence between the clinical effectiveness of microdecompression and laminectomy in the surgical treatment of central lumbar spinal stenosis. Lumbar spinal stenosis is the most frequent indication for spinal surgery in the elderly, and as the oldest segment of the population continues to grow its prevalence is likely to increase. However, data on surgical outcomes are limited. Open or wide decompressive laminectomy, often combined with medial facetectomy and foraminotomy, was formerly the standard treatment. In recent years a growing tendency towards less invasive decompressive procedures has emerged. At present, many spine surgeons perform microdecompression for central lumbar spinal stenosis. Methods and analysis Prospectively registered treatment and outcome data are obtained from the Norwegian Registry for Spine Surgery. The primary outcome measure is change in Oswestry disability index between baseline and 12-month follow-up. Secondary outcome measures are changes in health-related quality of life measured by the Euro-Qol-5D between baseline and 12-month follow-up, perioperative complications, and duration of surgical procedures and length of hospital stay. Ethics and dissemination The study has been evaluated and approved by the regional committee for medical research in central Norway and all participants provided written informed consent. The findings of this study will be disseminated through peer-reviewed publications. Trial registration number Clinicaltrials.gov (NCT02006901). PMID:24650809

  8. Allelic variation in the vitamin D receptor, lifestyle factors and lumbar spinal degenerative disease

    Microsoft Academic Search

    Graeme Jones; Christopher White; Philip Sambrook; John Eisman

    1998-01-01

    OBJECTIVETo describe the relation between spinal degenerative disease, allelic variation in the vitamin D receptor gene, and lifestyle factors in a population-based association study.METHODSRandom population-based sample of 110 men and 172 women over 60 years of age participating in the Dubbo Osteoporosis Epidemiology Study who had spinal radiographs (performed according to a standardised approach), assessment of lifestyle factors, bone densitometry

  9. Comparison of Spinous Process-Splitting Laminectomy versus Conventional Laminectomy for Lumbar Spinal Stenosis

    PubMed Central

    Uehara, Masashi; Hashidate, Hiroyuki; Mukaiyama, Keijiro; Kuraishi, Shugo; Shimizu, Masayuki; Ikegami, Shota; Futatsugi, Toshimasa; Ogihara, Nobuhide; Hirabayashi, Hiroki; Kato, Hiroyuki

    2014-01-01

    Study Design Seventy-five patients who had been treated for lumbar spinal stenosis (LSS) were reviewed retrospectively. Purpose Invasion into the paravertebral muscle can cause major problems after laminectomy for LSS. To address these problems, we performed spinous process-splitting laminectomy. We present a comparative study of decompression of LSS using 2 approaches. Overview of Literature There are no other study has investigated the lumbar spinal instability after spinous process-splitting laminectomy. Methods This study included 75 patients who underwent laminectomy for the treatment of LSS and who were observed through follow-ups for more than 2 years. Fifty-five patients underwent spinous process-splitting laminectomy (splitting group) and 20 patients underwent conventional laminectomy (conventional group). We evaluated the clinical and radiographic results of each surgical procedure. Results Japanese Orthopaedic Association score improved significantly in both groups two years postoperatively. The following values were all significantly lower, as shown with p-values, in the splitting group compared to the conventional group: average operating time (p=0.002), postoperative C-reactive protein level (p=0.006), the mean postoperative number of days until returning to normal body temperature (p=0.047), and the mean change in angulation 2 years postoperatively (p=0.007). The adjacent segment degeneration occurred in 6 patients (10.9%) in the splitting group and 11 patients (55.0%) in the conventional group. Conclusions In this study, the spinous process-splitting laminectomy was shown to be less invasive and more stable for patients with LSS, compared to the conventional laminectomy. PMID:25558319

  10. Combined spinal-epidural anesthesia for lumbar discectomy in a patient with asymptomatic severe aortic stenosis: a case report

    PubMed Central

    Kim, Young Sung; Park, Ji Hye; Lee, Shin Young; Kim, Heezoo; Lee, Il-ok; Kong, Myoung-Hoon

    2014-01-01

    The use of neuraxial anesthesia has traditionally been contraindicated in patients with severe aortic stenosis. However, general anesthesia can be riskier than neuraxial anesthesia for severe aortic stenosis patients undergoing spinal surgeries in the prone position as this can cause a major reduction in cardiac output secondary to diminished preload. In addition, general anesthesia, muscle relaxation, and positive-pressure ventilation can decrease venous return and reduce vascular tone, further compromising cardiac output. Combined spinal-epidural anesthesia with closely monitored, careful titration of the local anesthetic dose can be an efficient and safe anesthetic method for managing such patients. We describe the successful management of combined spinal-epidural anesthesia in an asymptomatic severe aortic stenosis patient scheduled for lumbar discectomy. PMID:25237450

  11. Early clinical effects of the Dynesys system plus transfacet decompression through the Wiltse approach for the treatment of lumbar degenerative diseases

    PubMed Central

    Liu, Chao; Wang, Lei; Tian, Ji-wei

    2014-01-01

    Background This study investigated early clinical effects of Dynesys system plus transfacet decompression through the Wiltse approach in treating lumbar degenerative diseases. Material/Methods 37 patients with lumbar degenerative disease were treated with the Dynesys system plus transfacet decompression through the Wiltse approach. Results Results showed that all patients healed from surgery without severe complications. The average follow-up time was 20 months (9–36 months). Visual Analogue Scale and Oswestry Disability Index scores decreased significantly after surgery and at the final follow-up. There was a significant difference in the height of the intervertebral space and intervertebral range of motion (ROM) at the stabilized segment, but no significant changes were seen at the adjacent segments. X-ray scans showed no instability, internal fixation loosening, breakage, or distortion in the follow-up. Conclusions The Dynesys system plus transfacet decompression through the Wiltse approach is a therapeutic option for mild lumbar degenerative disease. This method can retain the structure of the lumbar posterior complex and the motion of the fixed segment, reduce the incidence of low back pain, and decompress the nerve root. PMID:24859831

  12. Comparison of Functional Outcomes following Surgical Decompression and Posterolateral Instrumented Fusion in Single Level Low Grade Lumbar Degenerative versus Isthmic Spondylolisthesis

    PubMed Central

    Hasankhani, Ebrahim Ghayem; Rahimi, Mohammad Dawood; Khanzadeh, Reza

    2014-01-01

    Background The two most common types of surgically treated lumbar spondylolisthesis in adults include the degenerative and isthmic types. The aim of this study was to compare the functional outcomes of surgical decompression and posterolateral instrumented fusion in patients with lumbar degenerative and isthmic spondylolisthesis. Methods In this retrospective study, we reviewed the clinical outcomes in surgically treated patients with single level, low grade lumbar degenerative, and isthmic spondylolisthesis (groups A and B, respectively) from August 2007 to April 2011. We tried to compare paired settings with similar initial conditions. Group A included 52 patients with a mean age of 49.2 ± 6.1 years, and group B included 52 patients with a mean age of 47.3 ± 7.4 years. Minimum follow-up was 24 months. The surgical procedure comprised neural decompression and posterolateral instrumented fusion. Pain and disability were assessed by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively. The Wilcoxon and Mann-Whitney U-tests were used to compare indices. Results The most common sites for degenerative and isthmic spondylolisthesis were at the L4-L5 (88.5%) and L5-S1 (84.6%) levels, respectively. Surgery in both groups significantly improved VAS and ODI scores. The efficacy of surgery based on subjective satisfaction rate and pain and disability improvement was similar in the degenerative and isthmic groups. Notable complications were also comparable in both groups. Conclusions Neural decompression and posterolateral instrumented fusion significantly improved pain and disability in patients with degenerative and isthmic spondylolisthesis. The efficacy of surgery for overall subjective satisfaction rate and pain and disability improvement was similar in both groups. PMID:24900900

  13. Nocturnal Cramps in Patients with Lumbar Spinal Canal Stenosis Treated Conservatively: A Prospective Study

    PubMed Central

    Chhabra, Harvinder Singh; Kapoor, Kulwant Singh

    2014-01-01

    Study Design Prospective cohort study with questionnaire. Purpose To compare the treatment outcome of nocturnal leg cramps in lumbar spinal canal stenosis (LSCS) patients on conservative treatment with historical surgical cohorts and to determine the sensitivity and specificity as well as positive predictive value and negative predictive value of knee flexion test suggested for LSCS patient. Overview of Literature True prevalence of nocturnal leg cramps in LSCS patients as well as the clinical outcome of its surgical treatment have been reported. Methods A questionnaire suggested from previous study with minor modifications was used in this study. Clinical data was collected. Knee flexion test was performed in two groups. Results The prevalence of nocturnal leg cramp was higher in the LSCS group compared to the control group (second group). In LSCS patients, 38 (88%) had improved leg cramps after the conservative treatment, 3 (6.97%) remained unchanged, and 2 (4.6%) had worsened leg cramps. Of the 43 patients, 21 (48.8%) had no disturbance to their activities of daily living. In the LSCS group, the sensitivity and specificity of the knee flexion test was 53.5% and 33.3%, respectively. The knee flexion test in the LSCS group had a positive predictive value and a negative predictive value of 65.71% and 23.1%, respectively. Conclusions Our study demonstrated that nocturnal leg cramps were significantly more frequent in LSCS patients than in the control group. PMID:25346815

  14. The Efficacy of Intramuscular Calcitonin Injection in the Management of Lumbar Spinal Stenosis

    PubMed Central

    Ashraf, Alireza; Khodadadi, Mehdi; Sadraei, Amin; Nasseri, Ali

    2015-01-01

    Study Design A prospective, cross-sectional, non-randomized study. Purpose To assess the effectiveness of intramuscular calcitonin injection in the treatment of lumbar spinal stenosis (LSS). Overview of Literature LSS, manifesting as chronic low back pain and neurogenic claudication, is a chronic condition with an increasing incidence in the elderly population having inadequate effective conservative treatment options. Methods In this study, 36 patients with LSS who were diagnosed based on the clinical findings and magnetic resonance imaging were included. Patients received 100 IU of calcitonin per week for one month and were evaluated before and after treatment using the Oswestry disability index (ODI) questionnaire and visual analogue scale (VAS). Before treatment, the patients were divided into two subgroups based on their ODI results: patients with mild to moderate low back pain (disability, 0%-40%) and patients with severe or very severe low back pain (disability, 40%-100%). Results In patients with mild to moderate low back pain, there were no significant changes in the ODI and VAS after calcitonin injection. But in patients with severe or very severe low back pain, pain severity, personal functions, ability to lift and carry objects, time interval between standing and initiation of pain, social life, disability percentage, and VAS were significantly improved after treatment with calcitonin. Conclusions It seems that an intramuscular injection of low dose of calcitonin may have some beneficial effects on the pain due to LSS, especially in patients who suffer from severe or very severe low back pain. PMID:25705338

  15. Loading is more effective than posture in lumbar spinal stenosis: a study with a treadmill equipment.

    PubMed

    O?uz, Hasan; Levendo?lu, Funda; O?ün, Tunç Cevat; Tantu?, Aysenur

    2007-07-01

    The objective of this study was to assess the correlation between neurogenic intermittent claudication (NIC) in LSS and different positions as well as loading status, using the treadmill device. The study was a prospective clinical trial on lumbar spinal stenosis (LSS) using a treadmill equipment. The study population comprised of 80 LSS patients with a mean age of 61. The equipment included a treadmill, unloading station and loading vests. The patients were instructed to walk in five different positions. The initiation time of symptoms and total walking time were recorded. The examination was stopped after 20 min or at the onset of severe symptoms. In order to obtain pretest demographic data on subjects, visual analog scale, Roland-Morris questionnaire, pain disability index, and Beck depression index were used. The initiation time of symptoms (ITS) and total walking time (TWT) were measured during the test. Unloading provided a longer and loading a shorter ITS and TWT. Decline or incline positions did not affect ITS or TWT. The changes in posture had no correlation with the appearance of symptoms in LSS patients with NIC on a treadmill in this study, rather ITS and TWT were determined by axial loading and unloading. PMID:17273837

  16. Loading is more effective than posture in lumbar spinal stenosis: a study with a treadmill equipment

    PubMed Central

    O?uz, Hasan; Ö?ün, Tunç Cevat; Tantu?, Aysenur

    2007-01-01

    The objective of this study was to assess the correlation between neurogenic intermittent claudication (NIC) in LSS and different positions as well as loading status, using the treadmill device. The study was a prospective clinical trial on lumbar spinal stenosis (LSS) using a treadmill equipment. The study population comprised of 80 LSS patients with a mean age of 61. The equipment included a treadmill, unloading station and loading vests. The patients were instructed to walk in five different positions. The initiation time of symptoms and total walking time were recorded. The examination was stopped after 20 min or at the onset of severe symptoms. In order to obtain pretest demographic data on subjects, visual analog scale, Roland–Morris questionnaire, pain disability index, and Beck depression index were used. The initiation time of symptoms (ITS) and total walking time (TWT) were measured during the test. Unloading provided a longer and loading a shorter ITS and TWT. Decline or incline positions did not affect ITS or TWT. The changes in posture had no correlation with the appearance of symptoms in LSS patients with NIC on a treadmill in this study, rather ITS and TWT were determined by axial loading and unloading. PMID:17273837

  17. Soft Stabilization With an Artificial Intervertebral Ligament in Grade I Degenerative Spondylolisthesis: Comparison With Instrumented Posterior Lumbar Interbody Fusion

    PubMed Central

    Lee, Sang-Ho; Park, Sun-Hee; Whang, Ji-Hee

    2007-01-01

    Background The purpose of this retrospective study was to evaluate the efficacy of soft stabilization with an artificial intervertebral ligament after microdecompression for the treatment of grade I degenerative spondylolisthesis. Methods From a total of 54 patients with degenerative spondylolisthesis who were treated surgically from May 2000 to April 2003, 36 patients who showed grade I spondylolisthesis without evidence of concomitant disc herniation necessitating discectomy were enrolled in the study. After decompression, the patients had undergone either soft stabilization with an artificial intervertebral ligament (n = 17) or instrumented posterior lumbar interbody fusion (PLIF; n = 19). Results The average follow-up period was 24 months for the PLIF group and 16 months for the soft stabilization group. In the PLIF group, preoperative mean scores of 60% on the Oswestry Disability Index, 8.8 on the visual analog scale (VAS) for low-back pain, and 9.3 on the VAS for leg pain improved to 28%, 4.1, and 2.6, respectively, after surgery. Corresponding scores in the soft stabilization group were 55%, 8.4, and 8.9, improving to 25%, 4.1, and 2.2 after surgery. There were no significant differences between the 2 groups in any of these clinical parameters. Patients’ subjective improvement rates and satisfaction with the surgical procedure were higher in the soft stabilization group, but the differences were not significant. Mean operation time and mean blood loss were significantly lower in the soft stabilization group than in the PLIF group. In the soft stabilization group, there were 3 cases of progression of slippage in patients who had had preoperative slippage of more than 20%; there was 1 dural tear in the PLIF group. Conclusions Patients with grade I degenerative spondylolisthesis who received soft stabilization with an artificial intervertebral ligament after microdecompression had clinical outcomes similar to those of patients who received PLIF. Since soft stabilization can be done in a much less invasive way than fusion, if slippage is 20% or less, soft stabilization with an artificial ligament is a viable alternative to fusion for patients who are elderly or who have significant comorbidities that make a prolonged operation inadvisable. Level of Evidence This study was a retrospective comparative study with a very limited population (level III evidence).

  18. Intraobserver and interobserver reproducibility of the novel transcription method for selection of potential nerve root compression in MRI study in degenerative disease of the lumbar spine

    PubMed Central

    Kubaszewski, ?ukasz; Nowakowski, Andrzej; Gasik, Robert; ?ab?dŸ, Wojciech

    2013-01-01

    Background Degenerative disease of the lumbar spine is characterized by symptoms related to the affected nerve root. A recently described method allows the classification of the roots in relation to the occurrence of compression on its course. This method can serve as a clinical selection tool and decision support for semi-invasive pain therapy in back pain patients. Material/Methods We examined 40 lumbar spine MRIs in 3 sessions of transcription each, according to the method being evaluated. Every MRI evaluation was performed by each of 3 different observers. Intra- and interobserver reproducibility was calculated using chance-corrected agreement using a weighted kappa (?) value with quadratic weights to assess reliability for each nerve root separately. Results We found high intraobserver agreement in indication of the root with most pronounced interference due to potential compression by degenerative changes, at the level mean ?=0.81 (with 95% CI, range 0.04). Less agreement was observed in the interobserver evaluation test with the mean ?=0.75 (95% CI within the range not exceeding 0.03), although it still reached the substantial agreement. Conclusions This zstudy provides evidence for substantial inter- and intraobserver agreement for the decision support method allowing selection of the most serious nerve structure compression in degenerative disease of the lumbar spine based on of the MRI description. PMID:23524527

  19. The efficacy of epiduroscopic neural decompression with Ho:YAG laser ablation in lumbar spinal stenosis.

    PubMed

    Lee, Gun Woo; Jang, Soo-Jin; Kim, Jae-Do

    2014-07-01

    Although epiduroscopy is one of the popular interventions for the management of lumbar spinal stenosis (LSS), only a part of these patients show improvement in pain and functional level. Consequently, the authors thought that holmium:YAG (Ho:YAG) laser can be a reasonable alternative as an adjunct of epiduroscopic procedure, but has not been thoroughly determined yet which influence is resulted by it. This study was conducted to evaluate and compare the efficacy of epiduroscopic neural decompression (END) and END with Ho:YAG laser (ELND) in patients with LSS. Forty-seven patients with LSS were enrolled, all of whom underwent END or ELND and were followed up for 2 years or more. Clinical outcomes were evaluated using the visual analog scale (VAS) for back and leg pain and the Roland Morris Disability Questionnaire (RMDQ). Procedure-related complications, especially including laser-related complications, were also evaluated. The only laser-related complication that occurred was transient mild motor paralysis in one case (3.1 %). In the END group, clinical score is exhibiting V-shaped upward trend that ended after procedure with the almost similar score obtained with preoperative status. However, in the ELND group, it is exhibiting relatively consistent improvement after procedure. There was a statistically significant improvement in the VAS and RMDQ score after 6 months after ELND procedure compared with END procedure (p = 0.01, 0.03, respectively). ELND could produce significant improvement of low back pain (LBP) at the last follow-up time (p = 0.01), but radiating pain of leg could not be improved significantly (p = 0.09). In conclusion, the current study suggests that performing Ho:YAG laser ablation concurrently with END could produce more decreased intensity of pain and prolonged effect of pain relief compared with END in LSS patients. LSS patients with LBP would be an ideal candidate for ELND, but radiating pain of LSS might not be managed effectively with ELND. PMID:24398702

  20. Role of Coflex as an Adjunct to Decompression for Symptomatic Lumbar Spinal Stenosis

    PubMed Central

    Shah, Siddarth M; Ng, Yau Hong; Pannierselvam, Vinodh Kumar; DasDe, Sudeep; Shen, Liang

    2014-01-01

    Study Design Prospective cohort study. Purpose To assess whether additional implantation of Coflex following spinal decompression provided better clinical outcomes compared to decompression alone for symptomatic lumbar spinal stenosis (LSS) and to determine whether improvement in clinical outcomes correlated with changes in the radiological indices studied. Overview of Literature Literature on benefits of additional Coflex implantation compared to decompression alone for symptomatic LSS is limited. Methods Patients with symptomatic LSS who met the study criteria were offered spinal decompression with Coflex implantation. Those patients who accepted Coflex implantation were placed in the Coflex group (n=22); while those opting for decompression alone, were placed in the comparison group (n=24). Clinical outcomes were assessed preoperatively, six-months, one-year and two-years postoperatively, using the Oswestry disability index, 100 mm visual analogue scale (VAS)-back pain and VAS-leg pain, and short form-36 (SF-36). Radiological indices (disc height, foraminal height and sagittal angle) were assessed preoperatively, six months, one year, and two years postoperatively. Results Both groups showed statistically significant (p<0.001) improvement in all the clinical outcome indicators at all points in time as compared to the preoperative status. However, improvement in the Coflex group was significantly greater (p<0.001) than the comparison group. Changes in the radiological indices did not correlate significantly with the improvement in clinical outcome indicators. Conclusions Additional Coflex implantation after spinal decompression in symptomatic LSS offers better clinical outcomes than decompression alone in the short-term. Changes in radiological indices do not correlate with the improvements in clinical outcomes after surgery for symptomatic LSS. PMID:24761198

  1. Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis

    Microsoft Academic Search

    Anthony M.-H. Ho; Manoj K. Karmakar

    2002-01-01

    Purpose  To report the use of a combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture\\u000a in an elderly patient with severe aortic stenosis.\\u000a \\u000a \\u000a \\u000a Clinical features  In an 87-yr-old lady with severe aortic stenosis and fracture of the right trochanter due to a fall, a combined rightsided\\u000a paravertebral lumbar plexus and parasacral sciatic nerve block was used

  2. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2

    PubMed Central

    Zhou, Yue; Zhang, Zheng Feng; Li, Chang Qing; Zheng, Wen Jie; Liu, Jie

    2010-01-01

    Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical reports published on the comparison of one-level transforaminal lumbar interbody fusion in low-grade spondylolisthesis performed with an independent blade retractor system or a traditional open approach. A prospective clinical study of 85 consecutive cases of degenerative and isthmic lower grade spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion (MiTLIF) or open transforaminal lumbar interbody fusion (OTLIF) was done. A total of 85 patients suffering from degenerative spondylolisthesis (n = 46) and isthmic spondylolisthesis (n = 39) underwent one-level MiTLIF (n = 42) and OTLIF (n = 43) by two experienced surgeons at one hospital, from June 2006 to March 2008 (minimum 13-month follow-up). The following data were compared between the two groups: the clinical and radiographic results, operative time, blood loss, transfusion needs, X-ray exposure time, postoperative back pain, length of hospital stay, and complications. Clinical outcome was assessed using the visual analog scale (VAS) and the Oswestry disability index. The operative time, clinical and radiographic results were basically identical in both groups. Comparing with the OTLIF group, the MiTLIF group had significantly lesser blood loss, lesser need for transfusion, lesser postoperative back pain, and shorter length of hospital stay. The radiation time was significantly longer in MiTLIF group. One case of nonunion was observed from each group. Minimally invasive TLIF has similar surgical efficacy with the traditional open TLIF in treating one-level lower grade degenerative or isthmic spondylolisthesis. The minimally invasive technique offers several potential advantages including smaller incisions, less tissue trauma and quicker recovery. However, this technique needs longer X-ray exposure time. PMID:20411281

  3. The Efficacy of Physical Therapy and Physical Therapy Plus Calcitonin in the Treatment of Lumbar Spinal Stenosis

    PubMed Central

    Yilmaz, Figen; Kotevoglu, Nurdan; Kuran, Banu

    2009-01-01

    Purpose The aim of our study was to compare the efficacy of physical therapy alone and in combination with calcitonin in patients with neurogenic claudication (NC). Materials and Methods In this single blind, and randomized study, patients with lumbar spinal canal stenosis who were diagnosed by clinical findings and MRI and having NC were included. Patients were observed for 8 weeks and evaluated before and after treatment. Patients were randomized between the salmon calcitonin 200 U/day + physical therapy (n = 23) (Group 1) and paracetamol 1,500 mg/day + physical therapy (n = 22) (Group 2) treatment groups. Both groups received the same physical therapy (interferential current + hot pack + short wave diathermy) and exercise protocol. The association of various clinical and functional parameters was assessed statistically by using paired and unpaired t test, chi square test and McNemar's test. p < 0.05 indicated statistical significant. Results Mean age of the patients in Group 1 was 57.6 ± 11.2 and in Group 2 54.5 ± 10.6 years. Before treatment, there were no significant differences between groups with respect to age, body mass index, spinal axial diameter, Visual Analogue Scale (VAS), spinal mobility, functional status and walking distance (p > 0.05). After 8 weeks of treatment, both groups benefited significantly with respect to VAS, functional status and walking distance (p < 0.001). There was no statistically significant difference between groups (p > 0.05). Conclusion In 45 patients with lumbar spinal stenosis who received 8 weeks of treatment, concomitant use of calcitonin with physical therapy and exercise did not have any benefical effect on the patient's pain, functional status, lumbar mobility and walking distance. PMID:19881973

  4. The SNAP trial: a double blind multi-center randomized controlled trial of a silicon nitride versus a PEEK cage in transforaminal lumbar interbody fusion in patients with symptomatic degenerative lumbar disc disorders: study protocol

    PubMed Central

    2014-01-01

    Background Polyetheretherketone (PEEK) cages have been widely used in the treatment of lumbar degenerative disc disorders, and show good clinical results. Still, complications such as subsidence and migration of the cage are frequently seen. A lack of osteointegration and fibrous tissues surrounding PEEK cages are held responsible. Ceramic implants made of silicon nitride show better biocompatible and osteoconductive qualities, and therefore are expected to lower complication rates and allow for better fusion. Purpose of this study is to show that fusion with the silicon nitride cage produces non-inferior results in outcome of the Roland Morris Disability Questionnaire at all follow-up time points as compared to the same procedure with PEEK cages. Methods/Design This study is designed as a double blind multi-center randomized controlled trial with repeated measures analysis. 100 patients (18–75 years) presenting with symptomatic lumbar degenerative disorders unresponsive to at least 6 months of conservative treatment are included. Patients will be randomly assigned to a PEEK cage or a silicon nitride cage, and will undergo a transforaminal lumbar interbody fusion with pedicle screw fixation. Primary outcome measure is the functional improvement measured by the Roland Morris Disability Questionnaire. Secondary outcome parameters are the VAS leg, VAS back, SF-36, Likert scale, neurological outcome and radiographic assessment of fusion. After 1 year the fusion rate will be measured by radiograms and CT. Follow-up will be continued for 2 years. Patients and clinical observers who will perform the follow-up visits will be blinded for type of cage used during follow-up. Analyses of radiograms and CT will be performed independently by two experienced radiologists. Discussion In this study a PEEK cage will be compared with a silicon nitride cage in the treatment of symptomatic degenerative lumbar disc disorders. To our knowledge, this is the first randomized controlled trial in which the silicon nitride cage is compared with the PEEK cage in patients with symptomatic degenerative lumbar disc disorders. Trial registration NCT01557829 PMID:24568365

  5. Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study

    PubMed Central

    Nerland, Ulf S; Jakola, Asgeir S; Solheim, Ole; Weber, Clemens; Rao, Vidar; Lønne, Greger; Solberg, Tore K; Salvesen, Øyvind; Carlsen, Sven M; Nygaard, Øystein P

    2015-01-01

    Objective To test the equivalence for clinical effectiveness between microdecompression and laminectomy in patients with central lumbar spinal stenosis. Design Multicentre observational study. Setting Prospective data from the Norwegian Registry for Spine Surgery. Participants 885 patients with central stenosis of the lumbar spine who underwent surgery at 34 Norwegian orthopaedic or neurosurgical departments. Patients were treated from October 2006 to December 2011. Interventions Laminectomy and microdecompression. Main outcome measures The primary outcome was change in Oswestry disability index score one year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), perioperative complications, and duration of surgical procedures and hospital stays. A blinded biostatistician performed predefined statistical analyses in unmatched and propensity matched cohorts. Results The study was powered to detect a difference between the groups of eight points on the Oswestry disability index at one year. 721 patients (81%) completed the one year follow-up. Equivalence between microdecompression and laminectomy was shown for the Oswestry disability index (difference 1.3 points, 95% confidence interval ?1.36 to 3.92, P<0.001 for equivalence). Equivalence was confirmed in the propensity matched cohort and full information regression analyses. No difference was found between groups in quality of life (EQ-5D) one year after surgery. The number of patients with complications was higher in the laminectomy group (15.0% v 9.8%, P=0.018), but after propensity matching for complications the groups did not differ (P=0.23). The duration of surgery for single level decompression was shorter in the microdecompression group (difference 11.2 minutes, 95% confidence interval 4.9 to 17.5, P<0.001), but after propensity matching the groups did not differ (P=0.15). Patients in the microdecompression group had shorter hospital stays, both for single level decompression (difference 1.5 days, 95% confidence interval 1.7 to 2.6, P<0.001) and two level decompression (0.8 days, 1.0 to 2.2, P=0.003). Conclusion At one year the effectiveness of microdecompression is equivalent to laminectomy in the surgical treatment of central stenosis of the lumbar spine. Favourable outcomes were observed at one year in both treatment groups. Trial registration ClinicalTrials.gov NCT02006901. PMID:25833966

  6. Hypertrophy of Ligamentum Flavum in Lumbar Spine Stenosis Is Associated with Increased miR-155 Level

    PubMed Central

    Chen, Jianwei; Liu, Zude; Zhong, Guibin; Qian, Lie; Li, Zhanchun; Qiao, Zhiguang; Chen, Bin; Wang, Hantao

    2014-01-01

    Hypertrophy of ligamentum flavum (LF) contributes to lumbar spinal stenosis (LSS) and is caused mainly by fibrosis. Recent data indicate that miR-155 plays a crucial role in the pathogenesis of different fibrotic diseases. This study aimed to test the hypothesis that miR-155 exerts effects on LF thickness by regulating collagen expression. We found that LF thickness and the expression of collagen I and, collagen III were higher in LF from LSS patients than in LF from lumbar disc herniation (LDH) patients (P < 0.01). The expression of miR-155 was significantly higher in LF from LSS group than in LF from LDH group (P < 0.01). miR-155 level was positively correlated with LF thickness (r = 0.958, P < 0.01), type I collagen level (r = 0.825, P < 0.01), and type III collagen level (r = 0.827, P < 0.01). miR-155 mimic increased mRNA and protein expression of collagen I and collagen III in fibroblasts isolated from LF, while miR-155 sponge decreased mRNA and protein expression of collagen I and III in fibroblasts. In conclusions, miR-155 is a fibrosis-associated miRNA and may play important role in the pathogenesis of LF hypertrophy. PMID:24963214

  7. The Combined Use of a Posterior Dynamic Transpedicular Stabilization System and a Prosthetic Disc Nucleus Device in Treating Lumbar Degenerative Disc Disease With Disc Herniations

    PubMed Central

    Aydin, Ahmet Levent; Oktenoglu, Tunc; Cosar, Murat; Ataker, Yaprak; Kaner, Tuncay; Ozer, Ali Fahir

    2008-01-01

    Background Prosthetic replacement of spinal discs is emerging as a treatment option for degenerative disc disease. Posterior dynamic transpedicular stabilization (PDTS) and prosthetic disc nucleus (PDN) devices have been used sporadically in spinal surgery. Methods This was a prospective study of 13 patients averaging 40.9 years of age with degenerative disc disease who underwent posterior placement of a PDN with a PDTS. The Oswestry low-back pain disability questionnaire and visual analog scale (VAS) for pain were used to assess patient outcomes at the 3rd, 6th, and 12th postoperative months. Lumbar range of motion was evaluated using a bubble inclinometer preoperatively and at 12 months postoperatively. Radiological parameters including lumbar lordosis angle (LL), segmental lordosis angle (?), disc height at the operated level (DHo), and disc height of the adjacent level (DHu) were evaluated. A typical midline posterior approach for complete discectomy was followed by the simultaneous placement of the PDN with PDTS. Results Both the Oswestry and VAS scores showed significant improvement postoperatively (P < .05). There were no significant differences in LL, ?, DHo, and DHu parameters. We observed complications in 3 patients including 2 patients who had the PDN device embedded into the adjacent corpus; 1 had massive endplate degeneration, and the other experienced interbody space infection. In 1 patient, the PDN device migrated to one side in the vertebral space. Conclusion The use of a PDN in combination with posterior dynamic instrumentation can help to restore the physiologic motion of the anterior and posterior column and could help to establish posterior dynamic instrumentation as an important treatment of degenerative disc disease. Theoretically this concept is superior, but practically we need more advanced technology to replace disc material. Because this study examined the combination of the PDN and stabilization instrumention, the results cannot be compared with those reported in the literature for either PDN alone or dynamic screws alone. Level of Evidence Prospective cohort study with good follow-up (level 1b).

  8. Is Degenerative Spondylolisthesis a Contraindication for Total Disc Replacement? Kineflex Lumbar Disc Replacement in 7 Patients With 24-Month Follow-up

    PubMed Central

    Sliwa, Karen; de Villiers, Malan; Weinberg, Ian R.; Sweet, Barry M.B.E.; Candy, Geoffrey P.

    2008-01-01

    Background Degenerative spondylolisthesis is associated with a significant segmental kyphosis at the level of the listhesis. We treated 7 disc spaces with Grade 2 listhesis and/or kyphosis of the slipped disc level with Kineflex disc replacement. Methods Out of a single-center prospective registry, involving 310 lumbar disc replacement patients, 7 patients underwent a single-level Kineflex disc replacement at the level of a degenerative spondylolisthesis with either segmental kyphosis or a Grade 2 slip. Preoperative and follow-up radiological parameters studied were: pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis L1-S1, degree of segmental listhesis, segmental lordosis, and range of motion (ROM). Clinical outcome measures were Visual Analog Scale pain score (VAS), Oswestry Disability Index (ODI), and patient satisfaction. Results Five replacements were performed at the L4-L5 level, and 2 were performed at a L3-4 level, above a pre-existing L4-S1 posterolateral fusion. Mean age was 50 (32–62) years. Average follow-up was 23.8 ± 13.1 months. Six of 7 patients considered their outcome as good or excellent. The mean VAS score decreased from 8.4 ± 1.9 to 2.7 ± 2.2 (P < .01). The ODI decreased from 45.2 ± 9.9 preoperatively to 19.7 ± 12.8 (P < .01). There were increases in lumbar lordosis (from 47.4o ± 10.6 to 61.3o ± 8.0 (P < .03)), in segmental lordosis (from 0.17° ± 7.0° to 16.4° ± 2.0° (P < .03)), and in sacral slope (from 34.5° ± 4.8° to 40.7° ± 4.5° (P < .03)). There were decreases in pelvic tilt (from 22.6° ± 6.3° to 15.5° ± 5.9° (P < .05)), and degree of segmental listhesis (from 24.4% ± 7.7 to 3.7% ± 3.4 (P < .03)). Pelvic incidence and ROM did not change. Conclusions Disc replacement resulted in significant improvement in clinical outcome and excellent sagittal balance and slip correction. However, the influence of improved sagittal spinal alignment on clinical outcomes needs to be investigated in larger studies including a control group. Clinical Relevance This study is the first focused on disc replacement in degenerative spondylolisthesis.

  9. 100 Consecutive Cases of Degenerative Lumbar Conditions Using a Non-Threaded Locking Screw System With a 90-Degree Locking Cap

    PubMed Central

    Cunningham, Bryan W.; Tortolani, P. Justin; Fedder, Ira L.; Sefter, John C.; Davis, Charles

    2009-01-01

    Background This prospective study analyzes the perioperative outcomes and long-term fusion success of 100 consecutive lumbar degenerative cases. The cases were managed using a non-threaded locking screw system, in conjunction with polyetheretherketone (PEEK) cages, for posterior lumbar interbody fusion (PLIF) procedures. These 100 cases were compared to another prospective study treating patients with the same inclusion and exclusion criteria using conventional plate-based pedicle screw spinal instrumentation augmented with carbon fiber interbody cages. Methods A total of 167 operative levels were treated in 100 patients (51 single-level, 39 two-level and 10 three-level cases). Eleven cases were revisions and 67 patients received interbody fusion cages. Patients had an average of 22.8 ± 4.0 months followup. Results: There was one instrumentation failure but no significant subsidence at the interbody fusion level. The disc space height was restored as part of the surgical procedure at the interbody cage levels: from 7.5 ± 2.3 mm preoperative to 9.0 ± 2.1 mm postoperative. There were 2 cases of pseudarthrosis (2 / 100 = 2%). The average operative time for 1-level cases was 111 ± 25 minutes; for 2-level cases it was 132.4 ± 21.8 minutes; and for 3-level cases it was 162.6 ± 33 minutes. Blood loss averaged 800 ± 473 cc for 1-level cases, 1055 ± 408 cc for 2 levels, and 1155 ± 714 cc for 3 levels. The length of stay was similar between the 3 groups (4.4 ± 1.2 days for single-level cases, 4.7 ± 1.1 for 2 levels, and 5.0 ± 1.1 for 3 levels; P > .05). There were 3 incidental durotomies, and 4 other patients developed infections postoperatively that required reoperation. Conclusion The disc and foraminal heights can be restored and maintained with a unilateral cage and pedicle screw construct. Unilateral transforaminal lumbar interbody fusion using a PEEK cage combined with a non-threaded locking pedicle screw and rod system results in similar fusion rates to those achieved using the bilateral Brantigan interbody fusion cage or a single BAK Vista implant. When compared to the bilateral Brantigan cages, decreased operative time (P < .001), decreased blood loss (P < .001) and reduced incidence of dural tears (P < .001) are advantages of using a non-threaded locking screw system and single PEEK interbody cage for lumbar degenerative conditions without compromising subsequent fusion rates.

  10. Two-year results of interspinous spacer (X-Stop) implantation in 175 patients with neurologic intermittent claudication due to lumbar spinal stenosis

    Microsoft Academic Search

    Johannes Kuchta; Rolf Sobottke; Peer Eysel; Patrick Simons

    2009-01-01

    The clinical outcome of patients with symptomatic lumbar spinal stenosis (LSS) was assessed during a follow-up period of 2 years\\u000a after X-Stop implantation. The X-Stop is the most commonly used interspinous distraction device in patients with neurogenic\\u000a intermittent claudication due to LSS. Between 2003 and 2007, more than 1,000 patients were examined in our centre with symptoms\\u000a of intermittent claudication due

  11. Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis Grades 1-2: Patient-Reported Clinical Outcomes and Cost-Utility Analysis

    PubMed Central

    Sulaiman, Wale A. R.; Singh, Manish

    2014-01-01

    Background Transforaminal lumbar interbody fusion (TLIF) is the standard surgical treatment for patients with lumbar degenerative spondylolisthesis who do not respond to a 6-week course of conservative therapy. A number of morbidities are associated with the conventional open-TLIF method, so minimally invasive surgery (MIS) techniques for TLIF (MIS-TLIF) have been introduced to reduce the trauma to paraspinal muscles and hasten postoperative recovery. Because providing cost-effective medical treatment is a core initiative of healthcare reforms, a comparison of open-TLIF and MIS-TLIF must include a cost-utility analysis in addition to an analysis of clinical effectiveness. Methods We compared patient-reported clinical functional outcomes and hospital direct costs in age-matched patients treated surgically with either open-TLIF or MIS-TLIF. Patients were followed for at least 1 year, and patient scores on the Oswestry Disability Index (ODI) and visual analog scale (VAS) were analyzed at 6 weeks, 6 months, and ?1 year postoperatively in the 2 treatment groups. Results Compared to their preoperative scores, patients in both the open-TLIF and MIS-TLIF groups had significant improvements in the ODI and VAS scores at each follow-up point, but no significant difference in functional outcome occurred between the open-TLIF and MIS-TLIF groups (P=0.46). However, open-TLIF is significantly more costly compared to MIS-TLIF (P=0.0002). Conclusion MIS-TLIF is a more cost-effective treatment than open-TLIF for patients with degenerative spondylolisthesis and is equally effective as the conventional open-TLIF procedure, although further financial analysis—including an analysis of indirect costs—is needed to better understand the full benefit of MIS-TLIF. PMID:24688330

  12. Single level Lumbar Fusion for Degenerative Disc Disease is Associated with Worse outcomes compared to Fusion for Spondylolisthesis in a Workers' Compensation Setting.

    PubMed

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

    2014-12-01

    Study Design. Retrospective cohort studyObjective. Compare lumbar fusion outcomes, return to work (RTW) status in particular, between workers' compensation (WC) subjects undergoing single level posterolateral fusion for either spondylolisthesis or degenerative disc disease (DDD)Summary of Background Data. Lumbar fusion for spondylolisthesis tends to yield more consistent outcomes than fusion for DDD and discogenic low back pain. Within the clinically distinct WC population, relatively few studies exist which evaluate lumbar fusion outcomes.Methods. 869 Ohio WC subjects were identified that underwent single level posterolateral lumbar fusion with or without posterior interbody fusion between 1993-2010 using CPT procedural and ICD-9 diagnostic codes. 269 underwent fusion for spondylolisthesis, and 620 of underwent fusion for DDD.Subjects were considered returned to work within a reasonable timeline if they made a stable RTW within 2 years of fusion and remained working for greater than 6 months of the following year. To determine predictors of RTW status, we performed a multivariate logistic regression analysis. We measured a number of secondary outcomes.Results. Fusion for spondylolisthesis was positively associated with RTW status (p = 0.050; OR 1.42,CI 1.00-2.00). 36.4% of the spondylolisthesis cohort and 24.4% of the DDD cohort returned to work in a reasonable timeline postoperatively.Other negative predictors included: age >50 at fusion (OR 0.66,CI 0.45-0.95), >2 years between injury and index fusion (OR 0.59,CI 0.41-0.84), permanent disability (OR 0.61,CI 0.43-0.86), legal representation (OR 0.67,CI 0.46-0.97), and psychological comorbidity before fusion (OR 0.30,CI 0.14-0.62).Subjects in the DDD cohort were prescribed opioid analgesics for an average of 294 of additional days postoperatively (p<0.001), which equated to 24,759 additional milligrams of morphine equivalents (p<0.001).Conclusions. Our study is supportive of the conclusion that DDD is a questionable indication for spinal fusion. Given the generally poor outcomes of this study, future studies should determine if lumbar fusion surgery is an effective treatment modality in similar WC patients. PMID:25494321

  13. Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion.

    PubMed

    Corniola, Marco V; Jägersberg, Max; Stienen, Martin N; Gautschi, Oliver P

    2015-03-01

    A variety of implant-related short and long-term complications after lumbar fusion surgery are recognized. Mid to long-term complications due to cage migration and/or cage subsidence are less frequently reported. Here, we report a patient with a complete cage migration into the superior adjacent vertebral body almost 20years after the initial posterior lumbar interbody fusion procedure. In this patient, the cage migration/subsidence was clinically silent, but a selective decompression for adjacent segment degenerative lumbar spinal stenosis was performed. We discuss the risk factors for cage migration/subsidence in view of the current literature. PMID:25455736

  14. Surgical Correction in Patients with Lumbar Degenerative Kyphosis Who Had Low Bone Mineral Density: An Analysis of 40 Patients with a Minimum Follow-Up of Two Years

    PubMed Central

    Kim, Ki Tack; Lee, Sang Hun; Huh, Dae Seok; Son, Eun Seok

    2015-01-01

    Study Design Retrospective study. Purpose To investigate influence of bone mineral density (BMD) on the surgical correction of lumbar degenerative kyphosis (LDK). Overview of Literature No studies so far have reported the influence of BMD on the surgical correction of LDK. Methods Forty LDK patients with more than 2 years follow-up were studied. Pelvic incidence (PI), pelvic tilt, sacral slope, sagittal vertical axis (SVA), lumbar lordosis (LL), and thoracic kyphosis were measured preoperatively, immediate postoperatively and at final follow-up. Adverse outcomes: proximal adjacent fractures, sagittal decompensation, pseudoarthrosis, and cage subsidence were documented. Results There were 37 females and 3 males. Average age was 65.1±4.5 years and mean follow-up was 34.2±16.7 months. 42.5% were Takemitsu type 3 curves, 27.5% type 2, 20.0% type 4 and 10.0% type 1. 37.5% had osteopenia, 40.0% osteoporosis and 22.5% had severe osteoporosis. SVA improved from 237.0±96.7 mm preoperatively to 45.3±41.8 mm postoperatively (p=0.000). LL improved from 10.5°±14.7° to -40.6°±10.9° postoperatively (p=0.000). At final follow-up SVA deteriorated to 89.8±72.2 mm and LL to 34.7°±15.8° (p=0.000). The association between late sagittal decompensation, pseudoarthrosis, or proximal adjacent fractures and osteoporosis was insignificant. The difference between immediate postoperative LL and PI (PIDiff) had a significant association with sagittal decompensation and pseudoarthrosis. Conclusions Osteoporosis did not influence the degree of correction, late sagittal decompensation, proximal adjacent fractures, and pseudoarthrosis in LDK. PIDiff had a significant association with sagittal decompensation and pseudoarthrosis. PMID:25705337

  15. Stand-alone cage for posterior lumbar interbody fusion in the treatment of high-degree degenerative disc disease: design of a new device for an “old” technique. A prospective study on a series of 116 patients

    Microsoft Academic Search

    Francesco Costa; Marco Sassi; Alessandro Ortolina; Andrea Cardia; Roberto Assietti; Alberto Zerbi; Martin Lorenzetti; Fabio Galbusera; Maurizio Fornari

    2011-01-01

    Chronic lumbar pain due to degenerative disc disease affects a large number of people, including those of fully active age.\\u000a The usual self-repair system observed in nature is a spontaneous attempt at arthrodesis, which in most cases leads to pseudoarthrosis.\\u000a In recent years, many possible surgical fusion techniques have been introduced; PLIF is one of these. Because of the growing

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

    Microsoft Academic Search

    Asgeir S Jakola; Andreas Sørlie; Sasha Gulati; Øystein P Nygaard; Stian Lydersen; Tore Solberg

    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

  17. “Outside-in” Technique, Clinical Results, and Indications with Transforaminal Lumbar Endoscopic Surgery: a Retrospective Study on 220 Patients on Applied Radiographic Classification of Foraminal Spinal Stenosis

    PubMed Central

    2014-01-01

    Objective To analyze and describe appropriate surgical indications for endoscopically performed transforaminal decompression with the outside-in technique with foraminoplasty in patients with lateral stenosis with and without herniated disc. Background and Significance Endoscopic microdiscectomy is growing in popularity for the removal of lumbar disc herniations. Recent advances in surgical techniques allow for percutaneous endoscopically assisted bony decompression as well. Materials and Methods A retrospective study of 220 consecutive patients undergoing percutaneous endoscopic transforaminal foraminoplasty and microdiscectomy at 228 levels was conducted with intent of identifying appropriate surgical indications in patients with monoradiculopathy. The mean follow up was 46 months ranging from 26 to 54 months. Preoperatively, foraminal and lateral recess stenosis was graded on preoperative MRI and CT scans by dividing the lumbar neuroforamen into three zones: a) entry zone, b) middle zone, and c) exit zone. In addition, the presence of disc herniation causing neural element compression in the lateral recess and neuroforamen was noted. Disc herniations, if present, were recorded as either extruded and contained disc herniations. Surgical outcomes were classified according to the Macnab criteria. In addition, reductions in VAS scores were assessed. Results According to the Macnab criteria, excellent and good results were obtained in 85% (186/220) of patients with monoradiculopathy. The mean VAS score decreased from 7.5 ± 1.5 preoperatively to 2.8 ± 1.9 at the final follow-up (P < 0.01). Concomitant extruded disc herniations and contained disc bulges were recorded in 24 and 82 patients, respectively. There were no approach-related complications. Clinical failures occurred in patients with bony stenosis in the lateral recess and entry zone of the neuroforamen. Less favorable outcomes were observed in patients with concomitant contained disc herniations when compared to extruded disc herniations (P < 0.03) as well in patients older than 50 years of age (P < 0.021). Conclusions Percutaneous, endoscopic decompression using outside-in technique works well in patients with monoradiculopathy due to lateral stenosis in the mid and exit zone of the neuroforamen. Decompression in the entry zone maybe inadequate using the transforaminal outside-in approach. Future studies with greater statistical power should determine as to whether pain relief was achieved via microdiscectomy or foraminoplasty. PMID:25694915

  18. 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

  19. Variation in eligibility criteria from studies of radiculopathy due to a herniated disc and of neurogenic claudication due to lumbar spinal stenosis: A structured literature review

    PubMed Central

    Genevay, S.; Atlas, S.J.; Katz, J.N.

    2009-01-01

    Study Design A structured literature review. Summary of the Background Data Widely recognized classification criteria for rheumatologic disorders have resulted in well-defined patient populations for clinical investigation. Objectives We sought to determine whether similar criteria were needed for back pain disorders by examining variability in eligibility criteria in published studies Methods Studies involving radiculopathy due to lumbar herniated disc (HD) and for neurogenic claudication due to lumbar spinal stenosis (LSS) were identified. Randomized controlled trials published between January 1, 2006 and October 1, 2008 in select peer reviewed journals were retrieved, their eligibility criteria were identified and categorized. Results Twelve eligible HD studies were identified. Thirteen unique categories of eligibility criteria were identified with a mean of 3.9 (+/?2.0) and a range from 0 to 8 categories per study. More categories were present for studies that included nonsurgical (5.6 +/? 2.5) treatment for studies with only surgical treatment (2.6 +/? 1.7) p= 0.04). Seven LSS studies met eligibility criteria, and 9 unique categories were identified. A mean of 5.0 (+/?2.2) categories with a range from 2 to 7 was used per study. Conclusion Wide variation in the number and type of eligibility criteria from randomized clinical trials of well defined back pain syndromes was identified. These results support the need for developing and disseminating international classification criteria for these clinical conditions. PMID:20228710

  20. Prevalence and Risk factors for Development of Venous Thromboembolism after Degenerative Spinal Surgery.

    PubMed

    Yoshioka, Katsuhito; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Tsuchiya, Hiroyuki

    2014-12-01

    Study Design. Prospective clinical study.Objective. To identify the incidence and risk factors for VTE associated with degenerative spinal surgery procedures at the different spinal levels for various pathologies.Background. Spinal surgery includes procedures for treatment of various pathologies at different spinal levels. There have been no studies on venous thromboembolism (VTE) after degenerative spinal surgery with respect to screening patients for both deep venous thrombosis (DVT) and pulmonary thromboembolism (PE).Methods. We prospectively investigated the occurrence of VTE after degenerative spinal surgery in 459 patients who were divided into five groups: group 1, patients with cervical degenerative disease treated with posterior decompression; group 2, patients with cervical degenerative disease treated with instrumentation for spinal fusion; group 3, patients with thoracolumbar degenerative disease treated with instrumentation for spinal fusion; group 4, patients with lumbar spinal stenosis treated with posterior decompression; group 5, patients with lumbar spondylolisthesis treated with one level posterior lumbar interbody fusion. A DVT and PE screening was performed for all patients. Binomial logistic regression analysis was used to assess the association of risk factors.Results. The incidence of VTE was 2.8%, 3.4%, 10.8%, 12.5%, and 10.1% in group 1,2,3,4, and 5, respectively. Female gender, advanced age, spinal level, and neurologic deficits, were all risk factors. Cervical spinal surgery in particular had an associated low risk. In patients with PE, three of the four had no DVT, indicating that screening for PE is also needed in high-risk patients.Conclusions. The prevalence of VTE following elective spinal surgery was different in each group. PMID:25494320

  1. Degenerative Scoliosis: A Review

    Microsoft Academic Search

    Suhel Kotwal; Matthias Pumberger; Alex Hughes; Federico Girardi

    Degenerative lumbar scoliosis is a coronal deviation of the spine that is prevalent in the elderly population. Although the\\u000a etiology is unclear, it is associated with progressive and asymmetric degeneration of the disc, facet joints, and other structural\\u000a spinal elements typically leading to neural element compression. Clinical presentation varies and is frequently associated\\u000a with axial back pain and neurogenic claudication.

  2. Minimally invasive transforaminal lumbar interbody fusion

    PubMed Central

    Jhala, Amit; Singh, Damandeep; Mistry, MS

    2014-01-01

    Background: The use of minimally invasive surgical (MIS) techniques represents the most recent modification of methods used to achieve lumbar interbody fusion. The advantages of minimally invasive spinal instrumentation techniques are less soft tissue injury, reduced blood loss, less postoperative pain and shorter hospital stay while achieving clinical outcomes comparable with equivalent open procedure. The aim was to study the clinicoradiological outcome of minimally invasive transforaminal lumbar interbody fusion. Materials and Methods: This prospective study was conducted on 23 patients, 17 females and 6 males, who underwent MIS-transforaminal lumbar interbody fusion (TLIF) followed up for a mean 15 months. The subjects were evaluated for clinical and radiological outcome who were manifested by back pain alone (n = 4) or back pain with leg pain (n = 19) associated with a primary diagnosis of degenerative spondylolisthesis, massive disc herniation, lumbar stenosis, recurrent disc herniation or degenerative disc disease. Paraspinal approach was used in all patients. The clinical outcome was assessed using the revised Oswestry disability index and Macnab criteria. Results: The mean age of subjects was 55.45 years. L4-L5 level was operated in 14 subjects, L5-S1 in 7 subjects; L3-L4 and double level was fixed in 1 patient each. L4-L5 degenerative listhesis was the most common indication (n = 12). Average operative time was 3 h. Fourteen patients had excellent results, a good result in 5 subjects, 2 subjects had fair results and 2 had poor results. Three patients had persistent back pain, 4 patients had residual numbness or radiculopathy. All patients had a radiological union except for 1 patient. Conclusion: The study demonstrates a good clinicoradiological outcome of minimally invasive TLIF. It is also superior in terms of postoperative back pain, blood loss, hospital stay, recovery time as well as medication use. PMID:25404767

  3. Degenerative cervical spondylolisthesis: a systematic review

    Microsoft Academic Search

    Sheng-Dan Jiang; Lei-Sheng Jiang; Li-Yang Dai

    2011-01-01

    Purpose  Degenerative cervical spondylolisthesis has received insufficient attention, in contrast to degenerative lumbar spondylolisthesis.\\u000a In fact, degenerative cervical spondylolisthesis may be more common than previously thought.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In order to provide appropriate guidelines for the treatment of degenerative cervical spondylolisthesis, a systematic review\\u000a of degenerative cervical spondylolisthesis was performed. An English literature search from January 1947 to November 2010\\u000a was completed with

  4. Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses

    PubMed Central

    Lurie, Jon D.; Tosteson, Anna N.A.; Deyo, Richard A.; Tosteson, Tor; Weinstein, James; Mirza, Sohail K.

    2014-01-01

    Study Design Retrospective analysis of Medicare claims linked to a multi-center clinical trial. Objective The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenosis, and degenerative spondylolisthesis. We compared the surgical indication derived from Medicare claims to that provided by SPORT surgeons, the “gold standard”. Summary of Background Data Administrative data are frequently used to report procedure rates, surgical safety outcomes, and costs in the management of spinal surgery. However, the accuracy of using diagnosis codes to classify patients by surgical indication has not been examined. Methods Medicare claims were link to beneficiaries enrolled in SPORT. The sensitivity and specificity of three claims-based approaches to group patients based on surgical indications were examined: 1) using the first listed diagnosis; 2) using all diagnoses independently; and 3) using a diagnosis hierarchy based on the support for fusion surgery. Results Medicare claims were obtained from 376 SPORT participants, including 21 with disc herniation, 183 with spinal stenosis, and 172 with degenerative spondylolisthesis. The hierarchical coding algorithm was the most accurate approach for classifying patients by surgical indication, with sensitivities of 76.2%, 88.1%, and 84.3% for disc herniation, spinal stenosis, and degenerative spondylolisthesis cohorts, respectively. The specificity was 98.3% for disc herniation, 83.2% for spinal stenosis, and 90.7% for degenerative spondylolisthesis. Misclassifications were primarily due to codes attributing more complex pathology to the case. Conclusion Standardized approaches for using claims data to accurately group patients by surgical indications has widespread interest. We found that a hierarchical coding approach correctly classified over 90% of spine patients into their respective SPORT cohorts. Therefore, claims data appears to be a reasonably valid approach to classifying patients by surgical indication. PMID:24525995

  5. Angiopoietin-Like Protein 2 Induced by Mechanical Stress Accelerates Degeneration and Hypertrophy of the Ligamentum Flavum in Lumbar Spinal Canal Stenosis

    PubMed Central

    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

  6. Percutaneous interspinous distraction device for the treatment of lumbar spinal canal stenosis: Clinical and radiographic results at 2-year follow-up

    PubMed Central

    Chaichankul, Chaiyos; Limthongkul, Worawat

    2014-01-01

    Objective To evaluate the effectiveness of the In- space (Synthes, Umkirch, Germany) and the correlation between radiographic parameters and clinical outcome in patients with lumbar spinal canal stenosis (LSS). Methods Between June 2009 and May 2013, 56 patients with LSS underwent In-space by one senior surgeon. All of the patients were evaluated both clinically and radiographic measurements before the procedure and each visit at the postoperative follow-up. Preoperative and postoperative X-ray imaging was performed before the procedure and at follow-up to assess the correlation with the clinical outcome. Radiological measurements and clinical outcomes were recorded to establish a relationship between the radiographic parameters and clinical outcome of this procedure. All patients had at least 2 years of follow-up. Results The mean VAS score of back pain decreased significantly (p < 0.05). Conclusions Our data suggest that percutaneous interspinous devices are a good alternative to treat LSS. The device offers significant decrease in back pain, leg pain and ODI score with 2-year lasting relief from symptoms. The increased intervertebral foramenal space explains the improvement of leg pain, but the mechanism of back pain relief remains unclear. A very weak correlation between the radiographic changes and improvement of pain was found. PMID:25694917

  7. 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

  8. 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

  9. Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics.

    PubMed

    Kluba, Torsten; Hofmann, Fabian; Bredanger, Sabine; Blumenstock, Gunnar; Niemeyer, Thomas

    2010-03-20

    This prospective study aimed to compare the efficacy of epidural (EDA) versus intravenous (PCA) application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal postoperative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA. PMID:21808704

  10. Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics

    PubMed Central

    Kluba, Torsten; Hofmann, Fabian; Bredanger, Sabine; Blumenstock, Gunnar; Niemeyer, Thomas

    2010-01-01

    This prospective study aimed to compare the efficacy of epidural (EDA) versus intravenous (PCA) application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal postoperative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA. PMID:21808704

  11. Two-year clinical outcomes of a multicenter randomized controlled trial comparing two interspinous spacers for treatment of moderate lumbar spinal stenosis

    PubMed Central

    2014-01-01

    Background Interspinous spacers are a minimally invasive surgical alternative for patients with lumbar spinal stenosis (LSS) unresponsive to conservative care. The purpose of this prospective, multicenter, randomized, controlled trial was to compare 2-year clinical outcomes in patients with moderate LSS treated with the Superion® (Experimental) or the X-Stop®, a FDA-approved interspinous spacer (Control). Methods A total of 250 patients with moderate LSS unresponsive to conservative care were randomly allocated to treatment with the Experimental (n?=?123) or Control (n?=?127) interspinous spacer and followed through 2 years post-treatment. Complication data were available for all patients and patient-reported outcomes were available for 192 patients (101 Experimental, 91 Control) at 2 years. Results Zurich Claudication Questionnaire (ZCQ) Symptom Severity and Physical Function scores improved 34% to 36% in both groups through 2 years (all p?

  12. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 3: assessment of economic outcome.

    PubMed

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

    2014-07-01

    A comprehensive economic analysis generally involves the calculation of indirect and direct health costs from a societal perspective as opposed to simply reporting costs from a hospital or payer perspective. Hospital charges for a surgical procedure must be converted to cost data when performing a cost-effectiveness analysis. Once cost data has been calculated, quality-adjusted life year data from a surgical treatment are calculated by using a preference-based health-related quality-of-life instrument such as the EQ-5D. A recent cost-utility analysis from a single study has demonstrated the long-term (over an 8-year time period) benefits of circumferential fusions over stand-alone posterolateral fusions. In addition, economic analysis from a single study has found that lumbar fusion for selected patients with low-back pain can be recommended from an economic perspective. Recent economic analysis, from a single study, finds that femoral ring allograft might be more cost-effective compared with a specific titanium cage when performing an anterior lumbar interbody fusion plus posterolateral fusion. PMID:24980580

  13. Lateral Lumbar Interbody Fusion for the Correction of Spondylolisthesis and Adult Degenerative Scoliosis in High-Risk Patients: Early Radiographic Results and Complications

    PubMed Central

    Waddell, Brad; Briski, David; Qadir, Rabah; Godoy, Gustavo; Houston, Allison Howard; Rudman, Ernest; Zavatsky, Joseph

    2014-01-01

    Background Lateral lumbar interbody fusion (LLIF) is not associated with many of the complications seen in other interbody fusion techniques. This study used computed tomography (CT) scans, the radiographic gold standard, to assess interbody fusion rates achieved utilizing the LLIF technique in high-risk patients. Methods We performed a retrospective review of patients who underwent LLIF between January 2008 and July 2013. Forty-nine patients underwent nonstaged or staged LLIF on 119 levels with posterior correction and augmentation. Per protocol, patients received CT scans at their 1-year follow-up. Of the 49 patients, 21 patients with LLIF intervention on 54 levels met inclusion criteria. Two board-certified musculoskeletal radiologists and the senior surgeon (JZ) assessed fusion. Results Of the 21 patients, 6 patients had had previous lumbar surgery, and the cohort's comorbidities included osteoporosis, diabetes, obesity, and smoking, among others. Postoperative complications occurred in 12 (57.1%) patients and included anterior thigh pain and weakness in 6 patients, all of which resolved by 6 months. Two cases of proximal junctional kyphosis occurred, along with 1 case of hardware pullout. Two cases of abdominal atonia occurred. By CT scan assessment, each radiologist found fusion was achieved in 53 of 54 levels (98%). The radiologists' findings were in agreement with the senior surgeon. Conclusion Several studies have evaluated LLIF fusion and reported fusion rates between 88%-96%. Our results demonstrate high fusion rates using this technique, despite multiple comorbidities in the patient population. Spanning the ring apophysis with large LLIF cages along with supplemental posterior pedicle screw augmentation can enhance stability of the fusion segment and increase fusion rates. PMID:24688329

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

    PubMed

    Elster, A D

    1989-12-01

    Bertolotti's syndrome refers to the association of back pain with lumbosacral transitional vertebrae. Such vertebrae were observed in 140 of 2,000 adults with back pain over a 4-year period of study. Each patient had radiographic evaluation of the lumbar spine by plain films as well as a sectional imaging modality (magnetic resonance [MR] or computed tomography [CT]). The overall incidence of structural pathology (eg, spinal stenosis and disc protrusion) detected by CT or MR was not apparently higher in patients with transitional vertebrae, but the distribution of these lesions was significantly different. Disc bulge or herniation, when it occurred, was nearly nine times more common at the interspace immediately above the transitional vertebra than at any other level. Spinal stenosis and nerve root canal stenosis were more common at or near the interspace above the transitional vertebra than at any other level. Degenerative change at the articulation between the transverse process of the transitional vertebra and the pelvis was an uncommon occurrence; when seen there was no significant correlation with the reported side of pain. It is postulated that hypermobility and altered stresses become concentrated in the spine at the level immediately above a lumbar transitional vertebra. Accelerated disc and facet joint degeneration at this level may then result. PMID:2533403

  15. Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity.

    PubMed

    Benglis, David M; Elhammady, Mohamed Samy; Levi, Allan D; Vanni, Steven

    2008-09-01

    Minimally invasive and interbody and instrumented fusion techniques are increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar spine. Advocates of minimal access spinal approaches list certain advantages over open procedures, including decreased postoperative pain and narcotic requirements, shorter hospital stays, less blood loss, and smaller incisions. The minimally invasive anterolateral approach allows access to the lumbar spine through the retroperitoneal space. We report on the short-term clinical and radiographic outcomes in four patients with mid to high lumbar coronal deformities treated at our institution with the anterolateral transpsoas minimally invasive approach. The primary presentation of these patients was back and leg pain. All patients showed improvement in their preoperative symptoms and solid arthrodesis at 6 months. Independent nonbiased patient pain analysis was also performed. Mean follow-up was 10 months (standard deviation, 1.4 mo), and mean hospital stay was 3.5 days (standard deviation, 1.9 d). One patient had additional posterior segmental instrumentation placed. Mean Cobb angles in the coronal plane were 28.5 degrees preoperatively and 18.3 degrees postoperatively (P < 0.05). We also present a historical perspective on retroperitoneal spine surgery, a regional anatomic description of the lumbosacral plexus and surrounding structures, and a description of the surgical technique as related to treatment of lumbar deformity. PMID:18812924

  16. Does 360° lumbar spinal fusion improve long-term clinical outcomes after failure of conservative treatment in patients with functionally disabling single-level degenerative lumbar disc disease? Results of 5-year follow-up in 75 postoperative patients

    PubMed Central

    Zigler, Jack E.; Delamarter, Rick B.

    2013-01-01

    Background Surgical treatment of patients with mechanical degenerative disc disease has been controversial, but improvements in clinical outcomes have been shown in properly selected patients with disease-specific diagnoses, with fusion arguably now becoming the “gold standard” for surgical management of these patients. No published study thus far has been designed for prospective enrollment of patients with specific inclusion/exclusion criteria in whom at least 6 months of conservative therapy has failed and who are then offered a standardized surgical procedure and are followed up for 5 years. Methods The study group was composed of the patients in the prospective, randomized Food and Drug Administration Investigational Device Exemption trial comparing ProDisc-L (Synthes Spine, West Chester, Pennsylvania) with 360° fusion for the treatment of single-level symptomatic disc degeneration. Of 80 patients randomized to 360° fusion after failure of non-operative care, 75 were treated on protocol with single-level fusions. Follow-up of this treatment cohort was 97% at 2 years and 75% at 5 years and serves as the basis for this report. Patients in the trial were required to have failure of at least 6 months of nonoperative care and in fact had failure of an average of 9 months of nonoperative treatment. The mean Oswestry Disability Index score indicated greater than 60% impairment. The mean entry-level pain score on a visual analog scale was greater than 8 of 10. Results After fusion, not only did patients have significant improvements in measurable clinical outcomes such as the Oswestry Disability Index score and pain score on a visual analog scale but there were also substantial improvements in their functional status and quality of life. Specifically, over 80% of patients in this study had improvements in recreational status that was maintained 5 years after index surgery, indicating substantial improvements in life quality that were not afforded by months of conservative care. The percentage of patients using narcotics at the 5-year follow-up visit was less than half the percentage of patients who had used narcotics as part of their prior conservative treatment. Conclusions The 5-year results of this post hoc analysis of 75 patients involved in a multicenter, multi-surgeon trial support 360° fusion surgery as a predictable and lasting treatment option to improve pain and function in properly selected patients with mechanical degenerative disc disease. These improvements occurred dramatically immediately after surgery and have been maintained through the scope of this follow-up period, with 98% follow-up at 2 years and 75% of patients available at 5 years. PMID:25694895

  17. Molecular and cellular mechanisms of aortic stenosis

    Microsoft Academic Search

    Ertan Yetkin; Johannes Waltenberger

    2009-01-01

    Calcific aortic stenosis is the most common cause of aortic valve replacement in developed countries, and this condition increases in prevalence with advancing age. The fibrotic thickening and calcification are common eventual endpoint in both non-rheumatic calcific and rheumatic aortic stenoses. New observations in human aortic valves support the hypothesis that degenerative valvular aortic stenosis is the result of active

  18. Endoscopic lumbar foraminotomy.

    PubMed

    Evins, Alexander I; Banu, Matei A; Njoku, Innocent; Elowitz, Eric H; Härtl, Roger; Bernado, Antonio; Hofstetter, Christoph P

    2015-04-01

    Foraminal stenosis frequently causes radiculopathy in lumbar degenerative spondylosis. Endoscopic transforaminal techniques allow for foraminal access with minimal tissue disruption. However, the effectiveness of foraminal decompression by endoscopic techniques has yet to be studied. We evaluate radiographic outcome of endoscopic transforaminal foraminotomies performed at L3-L4, L4-L5, and L5-S1 on cadaveric specimens. Before and after the procedures, three dimensional CT scans were obtained to measure foraminal height and area. Following the foraminotomies, complete laminectomies and facetectomies were performed to assess for dural tears or nerve root damage. L3-L4 preoperative foraminal height increased by 8.9%, from 2.12±0.13cm to 2.27±0.14cm (p<0.01), and foraminal area increased by 24.8% from 2.21±0.18cm(2) to 2.72±0.19cm(2) (p<0.01). At L4-L5, preoperative foraminal height was 1.87±0.17cm and area was 1.78±0.18cm(2). Endoscopic foraminotomies resulted in a 15.3% increase of foraminal height (2.11±0.15cm, p<0.05) and 44.8% increase in area of (2.51±0.21cm(2), p<0.01). At L5-S1, spondylitic changes caused diminished foraminal height (1.26±0.14cm) and foraminal area (1.17±0.18cm(2)). Postoperatively, foraminal height increased by 41.6% (1.74±0.09cm, p<0.05) and area increased by 98.7% (2.08±0.17cm(2), p<0.01). Subsequent inspection via a standard midline approach revealed one dural tear of an S1 nerve root. Endoscopic foraminotomies allow for effective foraminal decompression, though clinical studies are necessary to further evaluate complications and efficacy. PMID:25744073

  19. Kineflex lumbar artificial disc versus Charité lumbar total disc replacement for the treatment of degenerative disc disease: A randomized non-inferiority trial with minimum of 2 years’ follow-up

    PubMed Central

    Pettine, Kenneth; Hersh, Andrew

    2011-01-01

    Background The Kineflex lumbar artificial disc replacement device (SpinalMotion, Mountain View, California) is a semiconstrained, posterior center of rotation, metal-on-metal intervertebral disc prosthesis. We performed a prospective, randomized, non-inferiority trial comparing the Kineflex Disc with the Food and Drug Administration (FDA)–approved Charité device (DePuy Spine, Raynham, Massachusetts). Our objective was to evaluate the Kineflex Disc's safety and efficacy using validated outcomes measures—the visual analog scale (VAS) and the Oswestry Disability Index (ODI). Methods Sixty-four patients were randomized to receive either the Kineflex Disc or Charité device and were then followed up for up to 3 years. Patients completed VAS and ODI questionnaires and were evaluated clinically and radiologically for complication or device failure. Results were analyzed in terms of change in mean VAS score and ODI from baseline, as well as with a comparison of clinical success as defined by FDA investigational device exemption criteria. Non-inferiority was defined as a difference of less than 18 points in the VAS score and difference of less than 10 units on the ODI scale, in keeping with a previously established minimum clinically important difference. Results The mean improvement for the Kineflex Disc group at 24 months was 56.80 for the VAS score and 37.30 for the ODI. Similarly, the mean improvement in the Charité group was 54.43 for the VAS score and 38.40 for the ODI. At 2 years of follow-up, no difference was found in VAS scores between the two groups. The Kineflex Disc group was therefore found to be non-inferior (mean difference, 2.37; 95% confidence interval, ?12.5 to 17.3; P = .004). In addition, at 24 months, 83% of patients in the Kineflex Disc group and 85% of patients in the Charité group met FDA-defined criteria for clinical success, with no difference between groups (P = .802). Conclusions This level I evidence shows the Kineflex Disc to be non-inferior to the Charité device in terms of pain reduction (VAS score) and FDA-defined clinical success at 24 months’ follow-up. Both devices showed a high degree of safety.

  20. Lumbar Spine Disc Herniation Diagnosis with a Joint Shape Model

    E-print Network

    Corso, Jason J.

    Lumbar Spine Disc Herniation Diagnosis with a Joint Shape Model Raja S Alomari1 , Jason J Corso1 diagnosis of the DDD for lumbar spine. We design a classifier to automatically detect degenerated disc (also. Keywords: Lumbar Spine Diagnosis, MRI, Disc Degenerative Disease 1 Introduction Low Back Pain has a major

  1. Lumbar disc replacement: update.

    PubMed

    Heider, F C; Mayer, H M; Siepe, C J

    2015-06-01

    Over the last decades, fusion of lumbar spinal motion segments has represented the mainstay of treatment of lumbar degenerative conditions which failed to respond adequately to conservative therapy. Increasing demands and expectations from patients as well as the necessity to avoid fusion related negative side effects such as adjacent level disc degeneration, considerable complication and reoperation rates, cranial facet joint violations, pseudarthrosis and others led to the development of motion preserving technologies such as total lumbar disc replacement (TDR). The first and rudimentary attempts to preserve motion of lumbar motion segments can be dated back to the early 1950s. Over the past two to three decades, a variety of new implants with different motion characteristics have been developed and introduced into the market. Despite of the extensive knowledge which has been gained in this field of research, insurers in the United States have refused to reimburse surgeons due to fear of late complications and reoperations as well as unknown secondary costs, which led to a global decline in the numbers of TDR procedures. The current literature review intends to provide a concise summary of the adequate indications for TDR as well as outcome determining factors and delineate the role of TDR in the currently available armamentarium for the treatment of low back pain (LBP) resulting from degenerative disc disease (DDD) without instabilities or deformities. PMID:25649068

  2. Evaluation of Functional Outcomes in Individuals 10 Years after Posterior Lumbar Interbody Fusion with Corundum Implants and Decompression: A Comparison of 2 Surgical Techniques

    PubMed Central

    Truszczy?ska, Aleksandra; R?pa?a, Kazimierz; ?ukawski, Stanislaw; Trzaskoma, Zbigniew; Tarnowski, Adam; Drzal-Grabiec, Justyna; Cabak, Anna

    2014-01-01

    Background The purpose of this study was to evaluate lumbar spine-related functional disability in individuals 10 years after lumbar decompression and lumbar decompression with posterior lumbar interbody fusion (PLIF) with corundum implants surgery for degenerative stenosis and to compare the long-term outcome of these 2 surgical techniques. Material/Methods From 1998 to 2002, 100 patients with single-level lumbar stenosis were surgically treated. The patients were randomly divided into 2 groups that did not differ in terms of clinical or neurological symptoms. Group A consisted of 50 patients who were treated with PLIF and the use of porous ceramic corundum implants; the mean age was 57.74 and BMI was 27.34. Group B consisted of 50 patients treated with decompression by fenestration; mean age was 51.28 and the mean BMI was 28.84. Results There was no statistical significance regarding age, BMI, and sex. Both treatments revealed significant improvements. In group A, ODI decreased from 41.01% to 14.3% at 1 year and 16.3 at 10 years. In group B, ODI decreased from 63.8% to 18.36% at 1 year and 22.36% at 10 years. The difference between groups was statistically significant. There were no differences between the groups regarding the Rolland-Morris disability questionnaire and VAS at 1 and 10 years after surgery. Conclusions Long-term results evaluated according to the ODI, the Rolland-Morris disability questionnaire, and the VAS showed that the both methods significantly reduce patient disability, and this was maintained during next 10 years. The less invasive fenestration procedure was only slightly less favorable than surgical treatment of stenosis by both PLIF with corundum implants and decompression. PMID:25106708

  3. Problem: Heart Valve Stenosis

    MedlinePLUS

    ... of having three flaps that open for blood flow, two are fused together. This causes blood to pass through a smaller, restricted opening. Learn about the different types of stenosis: Aortic stenosis Tricuspid stenosis Pulmonary stenosis Mitral stenosis ...

  4. Skipping Posterior Dynamic Transpedicular Stabilization for Distant Segment Degenerative Disease

    PubMed Central

    Solmaz, Bilgehan; Aydin, Ahmet Levent; Gomleksiz, Cengiz; Ataker, Yaprak; Sasani, Mehdi; Oktenoglu, Tunc; Ozer, Ali Fahir

    2012-01-01

    Objective. To date, there is still no consensus on the treatment of spinal degenerative disease. Current surgical techniques to manage painful spinal disorders are imperfect. In this paper, we aimed to evaluate the prospective results of posterior transpedicular dynamic stabilization, a novel surgical approach that skips the segments that do not produce pain. This technique has been proven biomechanically and radiologically in spinal degenerative diseases. Methods. A prospective study of 18 patients averaging 54.94 years of age with distant spinal segment degenerative disease. Indications consisted of degenerative disc disease (57%), herniated nucleus pulposus (50%), spinal stenosis (14.28%), degenerative spondylolisthesis (14.28%), and foraminal stenosis (7.1%). The Oswestry Low-Back Pain Disability Questionnaire and visual analog scale (VAS) for pain were recorded preoperatively and at the third and twelfth postoperative months. Results. Both the Oswestry and VAS scores showed significant improvement postoperatively (P < 0.05). We observed complications in one patient who had spinal epidural hematoma. Conclusion. We recommend skipping posterior transpedicular dynamic stabilization for surgical treatment of distant segment spinal degenerative disease. PMID:23091736

  5. Aortic stenosis

    MedlinePLUS

    ... 10 years or longer after rheumatic fever occurs. Rheumatic fever is becoming rarer in the United States. Aortic stenosis occurs in about 2% of people over 65 years of age. It occurs more often in men than in women.

  6. Pyloric Stenosis

    MedlinePLUS

    ... problems such as dehydration and salt and fluid imbalances. Immediate treatment for pyloric stenosis is extremely important. ... from fluid losses, can cause salt and other imbalances in the blood that need to be corrected. ...

  7. Spinal Stenosis

    MedlinePLUS

    ... disk. Various devices may be used to enhance fusion and strengthen unstable segments of the spine following decompression surgery. Patients with spinal stenosis caused by spinal trauma or achondroplasia may ...

  8. 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 ...

  9. 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

  10. Minimally invasive procedures on the lumbar spine.

    PubMed

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

    2015-01-16

    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

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

    Microsoft Academic Search

    Malhar N. Kumar; Andrei Baklanov; Daniel Chopin

    2001-01-01

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

  12. 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 ...

  13. Limited Laminectomy and Restorative Spinoplasty in Spinal Canal Stenosis

    PubMed Central

    Sangwan, Sukhbir Singh; Garg, Rakesh; Kundu, Zile Singh; Gupta, Vinay; Kamboj, Pradeep

    2014-01-01

    Study Design Prospective cohort study. Purpose Evaluation of the clinico-radiological outcome and complications of limited laminectomy and restorative spinoplasty in spinal canal stenosis. Overview of Literature It is critical to achieve adequate spinal decompression, while maintaining spinal stability. Methods Forty-four patients with degenerative lumbar canal stenosis underwent limited laminectomy and restorative spinoplasty at our centre from July 2008 to December 2010. Four patients were lost to follow-up leaving a total of 40 patients at an average final follow-up of 32 months (range, 24-41 months). There were 26 females and 14 males. The mean±standard deviation (SD) of the age was 64.7±7.6 years (range, 55-88 years). The final outcome was assessed using the Japanese Orthopaedic Association (JOA) score. Results At the time of the final follow-up, all patients recorded marked improvement in their symptoms, with only 2 patients complaining of occasional mild back pain and 1 patient complaining of occasional mild leg pain. The mean±SD for the preoperative claudication distance was 95.2±62.5 m, which improved to 582±147.7 m after the operation, and the preoperative anterio-posterior canal diameter as measured on the computed tomography scan was 8.3±2.1 mm, which improved to 13.2±1.8 mm postoperatively. The JOA score improved from a mean±SD of 13.3±4.1 to 22.9±4.1 at the time of the final follow-up. As for complications, dural tears occurred in 2 patients, for which repair was performed with no additional treatment needed. Conclusions Limited laminectomy and restorative spinoplasty is an efficient surgical procedure which relieves neurogenic claudication by achieving sufficient decompression of the cord with maintenance of spinal stability. PMID:25187863

  14. Cervical Stenosis

    MedlinePLUS

    ... the tissues in the cervix thin (atrophy) Cervical stenosis may result in an accumulation of blood in the uterus (hematometra). In women who are still menstruating, menstrual blood mixed with cells from the uterus may flow backward into the pelvis, possibly causing endometriosis (see ...

  15. Complications of fluoroscopically guided transforaminal lumbar epidural injections

    Microsoft Academic Search

    Kenneth P. Botwin; Robert D. Gruber; Constantine G. Bouchlas; Francisco M. Torres-Ramos; Ted L. Freeman; Warren K. Slaten

    2000-01-01

    Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Freeman TL, Slaten WK. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil 2000;81:1045-50. Objectives: To assess the incidence of complications of fluoroscopically guided lumbar transforaminal epidural injections. Design: A retrospective cohort design study. Patients presenting with radiculopathy, caused by either lumbar spinal stenosis or herniated nucleus pulposus confirmed

  16. Endoscopic Foraminal Decompression Preceding Oblique Lateral Lumbar Interbody Fusion To Decrease The Incidence Of Post Operative Dysaesthesia

    PubMed Central

    Katzell, Jeffrey

    2014-01-01

    Background Lumbar interbody fusion has become a well established method to diminish axial back pain as well as radiculopathy in patients with degenerative disc disease, stenosis, and instability. The concept of indirect decompression of the neural foramen and spinal canal while performing fusion became popular in the mid 1990’s with description of ALIF techniques. Morphometric analysis confirmed the extent of decompression of posterior elements with interbody height restoration. In an attempt to diminish potential complications associated with anterior or posterior approaches to the spine for interbody fusion, and with the hope of accomplishing fusion in a less invasive manner, lateral lumbar interbody fusion has become quite popular. This transpsoas approach to the disc space has been associated with a high incidence of neurologic complications. Even though this is the first technique to routinely recommend EMG monitoring to increase safety in the approach, neurologic injuries still occur. A newer oblique lateral lumbar interbody (OLLIF) approach has recently been described to lessen the incidence of neurologic injury. This technique also advocates use of EMG testing to lessen neurologic trauma. In spite of this precaution, neurologic insult has not been eliminated. In fact, even in patients whose electrical stimulation thresholds suggested a safe entry space into the disc, transient dysaesthesia continues to occur in 20-25 percent of cases. Purpose This pilot study reflects data and observations of a subset of patients treated with endoscopic foraminotomy preceding oblique lateral lumbar interbody fusion (OLLIF) to assess specifically potential improvements in dysaesthesia rates. Methods A select subset of patients undergoing OLLIF failed to meet electrodiagnostic criteria for safe disc access through Kambin’s triangle. These patients underwent an endoscopic foraminotomy and exiting nerve decompression prior to discectomy, endplate preparation and cage insertion. Results Dysaesthesia did not occur in these patients whom otherwise would have likely been at risk for neurologic deficit. Conclusions These findings suggest that patients at risk for neurologic insult during oblique lateral lumbar interbody fusion can be protected by foraminoplasty. PMID:25694923

  17. Surgical Treatment of Adult Degenerative Scoliosis

    PubMed Central

    Kim, Young-Tae; Shin, Sang-hyun; Suk, Se-Il

    2014-01-01

    The rapid increase of elderly population has resulted in increased prevalence of adult scoliosis. Adult scoliosis is divided into adult idiopathic scoliosis and adult degenerative scoliosis. These two types of scoliosis vary in patient age, curve pattern and clinical symptoms, which necessitate different surgical indications and options. Back pain and deformity are major indications for surgery in adult idiopathic scoliosis, whereas radiating pain to the legs due to foraminal stenosis is what often requires surgery in adult degenerative scoliosis. When selecting a surgical method, major symptoms and underlying medical diseases should be carefully evaluated, not only to relieve symptoms but also to minimize postoperative complications. Surgical options for adult degenerative scoliosis include: decompression alone; decompression and limited short fusion; and decompression coupled with long fusion and correction of deformity. Decompression and limited short fusion can be applied to patients with a small Cobb's angle and normal sagittal imbalance. For those with a large Cobb's angle and positive sagittal imbalance, long fusion with correction of deformity is required. When long fusion is applied, a careful decision regarding the extent of fusion level should be made when selecting L5 or S1 as the distal fusion level and T10 or the thoracolumbar junction as the proximal fusion level. For the fusion extending to the sacrum, restoration of sagittal balance and rigid fixation with additional iliac screws should be considered. Any surgical procedures for adult degenerative scoliosis are known to have relatively high occurrences of complications; therefore, risks and benefits should be meticulously considered before selecting a surgical procedure. PMID:24967054

  18. Influence of preoperative nucleus pulposus status and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry

    PubMed Central

    2011-01-01

    Background Currently, herniated nucleus pulposus (HNP) with radiculopathy and other preconditions are regarded as relative or absolute contraindications for lumbar total disc replacement (TDR). In Switzerland it is left to the surgeon's discretion when to operate. The present study is based on the dataset of SWISSspine, a governmentally mandated health technology assessment registry. We hypothesized that preoperative nucleus pulposus status and presence or absence of radiculopathy has an influence on clinical outcomes in patients treated with mono-segmental lumbar TDR. Methods Between March 2005 and April 2009, 416 patients underwent mono-segmental lumbar TDR, which was documented in a prospective observational multicenter mode. The data collection consisted of perioperative and follow-up data (physician based) and clinical outcomes (NASS, EQ-5D). Patients were divided into four groups according to their preoperative status: 1) group degenerative disc disease ("DDD"): 160 patients without HNP and no radiculopathy, classic precondition for TDR; 2) group "HNP-No radiculopathy": 68 patients with HNP but without radiculopathy; 3) group "Stenosis": 73 patients without HNP but with radiculopathy, and 4) group "HNP-Radiculopathy": 132 patients with HNP and radiculopathy. The groups were compared regarding preoperative patient characteristics and pre- and postoperative VAS and EQ-5D scores using general linear modeling. Results Demographics in all four groups were comparable. Regarding the improvement of quality of life (EQ-5D) there were no differences across the four groups. For the two main groups DDD and HNP-Radiculopathy no differences were found in the adjusted postoperative back- and leg pain alleviation levels, in the stenosis group back- and leg pain relief were lower. Conclusions Despite higher preoperative leg pain levels, outcomes in lumbar TDR patients with HNP and radiculopathy were similar to outcomes in patients with the classic indication; this because patients with higher preoperative leg pain levels benefit from a relatively greater leg pain alleviation. The group with absence of HNP but presence of radiculopathy showed considerably less benefits from the operation, which is probably related to ongoing degenerative processes of the posterior segmental structures. This observational multicenter study suggests that the diagnoses HNP and radiculopathy, combined or alone, may not have to be considered as absolute or relative contraindications for mono-segmental lumbar TDR anymore, whereas patients without HNP but with radiculopathy seem to be suboptimal candidates for the procedure. PMID:22136141

  19. Ligamentum flavum cyst in the lumbar spine: a case report and review of the literature

    Microsoft Academic Search

    H. Taha; Y. Bareksei; W. Albanna; M. Schirmer

    2010-01-01

    Degenerative changes in the lumbar spine can be followed by cystic changes. Most reported intraspinal cysts are ganglion or\\u000a synovial cysts. Ligamentum flavum pseudocyst, as a cystic lesion in the lumbar spine, is a rare and unusual cause of neurologic\\u000a signs and symptoms and is usually seen in elderly persons (due to degenerative changes). They are preferentially located in\\u000a the

  20. Extradural Corticosteroid Injection in Management of Lumbar Nerve Root Compression

    PubMed Central

    Dilke, T. F. W.; Burry, H. C.; Grahame, R.

    1973-01-01

    The effect of extradural corticosteroid injection in patients with nerve root compression syndromes associated with degenerative disease of the lumbar intervertebral discs was assessed in a double-blind controlled trial on 100 consecutive inpatients assigned by random allocation to treatment and control groups. Assessment during admission and at three months revealed statistically highly significant differences in respect of relief of pain and resumption of normal occupation in favour of the group treated by extradural injection. This treatment seems to be a valuable adjunct to the management of lumbar nerve root compression syndromes associated with degenerative disc disease. PMID:4577015

  1. Molecular and cellular mechanisms of aortic stenosis.

    PubMed

    Yetkin, Ertan; Waltenberger, Johannes

    2009-06-12

    Calcific aortic stenosis is the most common cause of aortic valve replacement in developed countries, and this condition increases in prevalence with advancing age. The fibrotic thickening and calcification are common eventual endpoint in both non-rheumatic calcific and rheumatic aortic stenoses. New observations in human aortic valves support the hypothesis that degenerative valvular aortic stenosis is the result of active bone formation in the aortic valve, which may be mediated through a process of osteoblast-like differentiation in these tissues. Additionally histopathologic evidence suggests that early lesions in aortic valves are not just a disease process secondary to aging, but an active cellular process that follows the classical "response to injury hypothesis" similar to the situation in atherosclerosis. Although there are similarities with the risk factor and as well as with the process of atherogenesis, not all the patients with coronary artery disease or atherosclerosis have calcific aortic stenosis. This review mainly focuses on the potential vascular and molecular mechanisms involved in the pathogenesis of aortic valve stenosis. Namely extracellular matrix remodeling, angiogenesis, inflammation, and eventually osteoblast-like differentiation resulting in bone formation have been shown to play a role in the pathogenesis of calcific aortic stenosis. Several mediators related to underlying mechanisms, including growth factors especially transforming growth factor-beta1 and vascular endothelial growth factors, angiogenesis, cathepsin enzymes, adhesion molecules, bone regulatory proteins and matrix metalloproteinases have been demonstrated, however the target to be attacked is not defined yet. PMID:19386374

  2. Anatomic basis of minimal anterior extraperitoneal approach to the lumbar spine

    Microsoft Academic Search

    J. Y. Lazennec; B. Pouzet; S. Ramare; N. Mora; S. Hansen; R. Trabelsi; H. Guérin-Surville; G. Saillant

    1999-01-01

    Anterior lumbar spine approaches may be indicated for fusion in degenerative lumbar spine disorders or to fill discal and bone gaps after fracture reduction. We present an anterior extraperitoneal approach applicable to any discal and vertebral levels from T12 to S1. The anatomic study, based on 25 cadavers, highlights retroperitoneal dissection principles for easy kidney and duodenopancreatic mobilisation and direct

  3. Anatomic basis of minimal anterior extraperitoneal approach to the lumbar spine

    Microsoft Academic Search

    J. Y. Lazennec; B. Pouzet; S. Ramare; N. Mora; S. Hansen; R. Trabelsi; H. Guérin-Surville; G. Saillant

    1999-01-01

    Summary Anterior lumbar spine approaches may be indicated for fusion in degenerative lumbar spine disorders or to fill discal and bone gaps after fracture reduction. We present an anterior extraperitoneal approach applicable to any discal and vertebral levels from T12 to S1. The anatomic study, based on 25 cadavers, highlights retroperitoneal dissection principles for easy kidney and duodenopancreatic mobilisation and

  4. Current and Future Approaches to Lumbar Disc Surgery (A Literature Review)

    Microsoft Academic Search

    Cargill H. Alleyne Jr; Gerald E. Rodts Jr.

    Herniation may occur anywhere along the spine but most commonly in the lumbar region, usually between the fifth lumbar and first sacral vertebrae (L5-S1). The usual cause is degeneration of the posterior longitudinal ligaments and the annulus fibrosis, frequently occurring in adults 35 years and older. Surgical interventions to treat degenerative disc disease range from the widely accepted microdiscectomy to

  5. Minimally invasive versus open transforaminal lumbar interbody fusion

    PubMed Central

    Villavicencio, Alan T.; Roeca, Cassandra M.; Nelson, E. Lee; Mason, Alexander

    2010-01-01

    Background Available clinical data are insufficient for comparing minimally invasive (MI) and open approaches for transforaminal lumbar interbody fusion (TLIF). To date, a paucity of literature exists directly comparing minimally invasive (MI) and open approaches for transforaminal lumbar interbody fusion (TLIF). The purpose of this study was to directly compare safety and effectiveness for these two surgical approaches. Materials and Methods Open or minimally invasive TLIF was performed in 63 and 76 patients, respectively. All consecutive minimally invasive TLIF cases were matched with a comparable cohort of open TLIF cases using three variables: diagnosis, number of spinal levels, and history of previous lumbar surgery. Patients were treated for painful degenerative disc disease with or without disc herniation, spondylolisthesis, and/or stenosis at one or two spinal levels. Clinical outcome (self-report measures, e.g., visual analog scale (VAS), patient satisfaction, and MacNab's criteria), operative data (operative time, estimated blood loss), length of hospitalization, and complications were assessed. Average follow-up for patients was 37.5 months. Results: The mean change in VAS scores postoperatively was greater (5.2 vs. 4.1) in theopen TLIF patient group (P = 0.3). MacNab's criteria score was excellent/good in 67% and 70% (P = 0.8) of patients in open and minimally invasive TLIF groups, respectively. The overall patient satisfaction was 72.1% and 64.5% (P = 0.4) in open and minimally invasive TLIF groups, respectively. The total mean operative time was 214.9 min for open and 222.5 min for minimally invasive TLIF procedures (P = 0.5). The mean estimated blood loss for minimally invasive TLIF (163.0 ml) was significantly lower (P < 0.0001) than the open approach (366.8 ml). The mean duration of hospitalization in the minimally invasive TLIF (3 days) was significantly shorter (P = 0.02) than the open group (4.2 days). The total rate of neurological deficit was 10.5% in the minimally invasive TLIF group compared to 1.6% in the open group (P = 0.02). Conclusions: Minimally invasive TLIF technique may provide equivalent long-term clinical outcomes compared to open TLIF approach in select population of patients. The potential benefit of minimized tissue disruption, reduced blood loss, and length of hospitalization must be weighted against the increased rate of neural injury-related complications associated with a learning curve. PMID:20657693

  6. Lumbar spine: pretest predictability of CT findings

    SciTech Connect

    Giles, D.J.; Thomas, R.J.; Osborn, A.G.; Clayton, P.D.; Miller, M.H.; Bahr, A.L.; Frederick, P.R.; O'Connor, G.D.; Ostler, D.

    1984-03-01

    Demographic and symptomatic data gathered from 460 patients referred for lumbosacral CT examinations were analyzed to determine if the prescan probability of normal or abnormal findings could be predicted accurately. The authors were unable to predict the presence of herniated disk on the basis of patient-supplied data alone. Age was the single most significant predictor of an abnormality and was sharply related to degenerative disease and spinal stenosis.

  7. Footprint mismatch in lumbar total disc arthroplasty

    Microsoft Academic Search

    Gstoettner Michaela; Heider Denise; Michael Liebensteiner; Bach Christian Michael

    2008-01-01

    Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the\\u000a implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The\\u000a fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening\\u000a and biomechanical failure

  8. Indications for anterior lumbar interbody fusion.

    PubMed

    Mobbs, Ralph J; Loganathan, Aji; Yeung, Vivian; Rao, Prashanth J

    2013-08-01

    Anterior lumbar interbody fusion (ALIF) has become a widely recognized surgical technique for degenerative pathology of the lumbar spine. Spinal fusion has evolved dramatically ever since the first successful internal fixation by Hadra in 1891 who used a posterior approach to wire adjacent cervical vertebrae in the treatment of fracture-dislocation. Advancements were made to reduce morbidity including bone grafting substitutes, metallic hardware instrumentation and improved surgical technique. The controversy regarding which surgical approach is best for treating various pathologies of the lumbar spine still exists. Despite being an established treatment modality, current indications of ALIF are yet to be clearly defined in the literature. This article discusses the current literature on indications on ALIF surgery. PMID:24002831

  9. A Comparison of the Degree of Lateral Recess and Foraminal Enlargement With Facet Preservation in the Treatment of Lumbar Stenosis With Standard Surgical Tools Versus a Novel Powered Filing Instrument: A Cadaver Study

    PubMed Central

    Khoo, Larry T.; Yeung, Christopher A.; Yeung, Anthony T.

    2007-01-01

    Background The SurgiFile (SurgiFile, Inc., Carlsbad, California) is a specialized tool designed for the treatment of lateral recess and foraminal stenosis that allows surgeons to internally expand and decompress the entire length of the neural foramen while preserving the integrity of the overlying facet complex. Methods We used two cadaveric specimens in this study. After they removed the lamina and spinous processes of L2, L3, L4, and L5 from the dorsal spine, fellowship-trained spinal surgeons used the standard tools and the SurgiFile to the best of their experience and ability on alternating sides of each level to decompress the lateral recess and neural foramen while still preserving at least 50% of the dorsal facet complex. Using preoperative and postoperative fine-cut CT scans with axial and sagittal reconstructions, we evaluated the degree of decompression and the amount of preserved facet complex using analytical tests and recording the measurements. Results The difference between the proximal recess and lateral foramen of the groups was statistically significant in the axial CT images. On sagittal reconstruction CT images, the difference between the two groups was significant (P < 0.05, Wilcoxon) only for the lateral foramen. Although a strong trend toward better area change was evident for the proximal recess measurements in the experimental tool sides, this did not achieve statistical significance. Macroscopic and CT scans measurements showed that the amount of facetectomy for adequate decompression with the SurgiFile was less than the amount achieved with the standard tools. Conclusions For the treatment of spinal stenosis, this novel powered-file instrument provides surgeons with a new means of decompressing the lateral recess and neural foramina. In this cadaveric study, procedures performed with the SurgiFile tool showed a statistically superior degree of decompression as compared with the standard surgical instruments and techniques.

  10. Evaluation of a Modified POSSUM Scoring System for Predicting the Morbidity in Patients Undergoing Lumbar Surgery.

    PubMed

    Ying, Li; Bo, Bai; Huo-Yan, Wu; Hong, Zhuang

    2014-06-01

    For most spine surgeons, operative intervention is common for the treatment of lumbar disc herniation, lumbar stenosis, lumbar fracture or lumbar spondylolisthesis. However, with the increase in lumbar surgery, the complication rate increases accordingly. Whereas the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system has been widely used to predict morbidity in various surgical fields, the application of this system in lumbar surgery has not been reported. From January 2008 to January 2010, we recruited 158 patients (85 males and 73 females) with operation for lumbar disc herniation, lumbar stenosis, lumbar fracture, or lumbar spondylolisthesis. All patients were analyzed to compare the morbidity by a modified POSSUM scoring system. According to the modified POSSUM, the expected morbidity was 51 cases (32.3 %), whereas the observed mortality was 42 cases (26.6 %). The overall observed-to-expected ratio was 0.82, and the chi-squared test indicated no statistically significant difference between the expected and observed morbidities (? (2)?=?1.23, P?=?0.27), suggesting that the modified POSSUM can accurately estimate the outcome. The modified POSSUM scoring system we developed is a useful tool for predicting and evaluating morbidity in lumbar surgery. Further studies are required to investigate whether this scoring system can predict mortality. PMID:25177119

  11. Traumatic Intradural Lumbar Disc Herniation without Bone Injury

    PubMed Central

    Lee, Hyun-Woo

    2013-01-01

    Intradural lumbar disc herniation is a rare disease. According to the reports of intradural lumbar disc herniations, most cases have developed as a chronic degenerative disc diseases. Traumatic intradural lumbar disc herniations are even rarer. A 52-year-old man visited our emergency center with numbness in his left calf and ankle after falling accident. Initial impression by radiologic findings was a spinal subdural hematoma at the L1 level. A follow up image two weeks later, however, did not demonstrate any interval change. The patient was decided to have an operation. In operative findings, a ruptured disc particle penetrating the ventral and dorsal dura was indentified after laminectomy. It was assumed to be a traumatic outcome not a degenerative change. PMID:24757484

  12. Atherosclerotic renal artery stenosis

    Microsoft Academic Search

    Robert D. Safian

    2003-01-01

    Opinion statement  The clinical diagnosis of renal artery stenosis relies on a high index of suspicion and confirmation by noninvasive imaging\\u000a modalities. There are three distinct clinical syndromes associated with renal artery stenosis: renin-dependent hypertension,\\u000a essential hypertension, and ischemic nephropathy. Clinical features that should heighten suspicion for renal artery stenosis\\u000a include abrupt-onset or accelerated hypertension at any age, unexplained acute or

  13. Valvular Aortic Stenosis: A Proteomic Insight

    PubMed Central

    Gil-Dones, Felix; Martin-Rojas, Tatiana; Lopez-Almodovar, Luis F.; de la Cuesta, Fernando; Darde, Veronica M.; Alvarez-Llamas, Gloria; Juarez-Tosina, Rocio; Barroso, Gemma; Vivanco, Fernando; Padial, Luis R.; Barderas, Maria G.

    2010-01-01

    Calcified aortic valve disease is a slowly progressive disorder that ranges from mild valve thickening with no obstruction of blood flow, known as aortic sclerosis, to severe calcification with impaired leaflet motion or aortic stenosis. In the present work we describe a rapid, reproducible and effective method to carry out proteomic analysis of stenotic human valves by conventional 2-DE and 2D-DIGE, minimizing the interference due to high calcium concentrations. Furthermore, the protocol permits the aortic stenosis proteome to be analysed, advancing our knowledge in this area. Summary: Until recently, aortic stenosis (AS) was considered a passive process secondary to calcium deposition in the aortic valves. However, it has recently been highlighted that the risk factors associated with the development of calcified AS in the elderly are similar to those of coronary artery disease. Furthermore, degenerative AS shares histological characteristics with atherosclerotic plaques, leading to the suggestion that calcified aortic valve disease is a chronic inflammatory process similar to atherosclerosis. Nevertheless, certain data does not fit with this theory making it necessary to further study this pathology. The aim of this study is to develop an effective protein extraction protocol for aortic stenosis valves such that proteomic analyses can be performed on these structures. In the present work we have defined a rapid, reproducible and effective method to extract proteins and that is compatible with 2-DE, 2D-DIGE and MS techniques. Defining the protein profile of this tissue is an important and challenging task that will help to understand the mechanisms of physiological/pathological processes in aortic stenosis valves. PMID:20567634

  14. Evidence that bone mineral density plays a role in degenerative disc disease: the UK Twin Spine Study

    Microsoft Academic Search

    Gregory Livshits; Sergey Ermakov; Maria Popham; Alex J MacGregor; Philip N Sambrook; Timothy D Spector; Frances M K Williams

    2010-01-01

    ObjectiveOsteoarthritis (OA) and osteoporosis are often considered to lie at opposite ends of a spectrum of bone phenotypes. Lumbar degenerative disc disease (LDD) may be associated with low back pain (LBP) and is similar in many ways to OA. LDD is reported in small studies to be associated with increased spine bone mineral density (BMD). The present work aimed to

  15. Congenital subacromial stenosis

    Microsoft Academic Search

    Stephen S. Burkhart

    1995-01-01

    Congenital subacromial stenosis is a previously undescribed entity that causes narrowing of the height of the subacromial space without proximal migration of the humerus. This study comprised 25 shoulders with congenital subacromial stenosis. All patients had either an impingement syndrome or rotator cuff tear. The average acromiohumeral interval was 4.7 mm. Fifteen of the 25 shoulders (60%) had rotator cuff

  16. Grading of degenerative disk disease and functional impairment: imaging versus patho-anatomical findings

    Microsoft Academic Search

    Ulrich Quint; Hans-Joachim Wilke

    2008-01-01

    Degenerative instability affecting the functional spinal unit is discussed as a cause of symptoms. The value of imaging signs\\u000a for assessing the resulting functional impairment is still unclear. To determine the relationship between slight degrees of\\u000a degeneration and function, we performed a biomechanical study with 18 multisegmental (L2-S2) human lumbar cadaveric specimens.\\u000a The multidirectional spinal deformation was measured during the

  17. The impact of degenerative conditions in the spine on bone mineral density and fracture risk prediction

    Microsoft Academic Search

    P. von der Recke; M. A. Hansen; K. Overgaard; C. Christiansen

    1996-01-01

    We examined the impact of degenerative conditions in the spine (osteophytosis and endplate sclerosis) and aortic calcification in the lumbar region on bone mineral content\\/density (BMC\\/BMD) measured in the spine and forearm by absorptiometry and on fracture risk prediction. The radiographs of 387 healthy postmenopausal women, aged 68–72 years, were assessed in masked fashion for the presence of osteophytosis, endplate

  18. Taking it to the next level: lumbar radiculopathy from thoracic nerve schwannoma

    PubMed Central

    Ukaigwe, Anene; Olugbodi, Akintomi; Alweis, Richard L.

    2015-01-01

    Compression or irritation of the sciatic nerve and its branches, the common fibular and tibial nerves, causes sciatica which is a common syndrome characterized most often by radiating pain from the lower back down the legs and also manifesting as sensory and motor deficits. Sciatica is a common presentation of lumbosacral disc prolapse and degenerative disease of the lumbar spine in ambulatory settings. Schwannomas rarely cause sciatica; hence, it is seldom considered in evaluation of a patient with radiculopathy. Our patient presented with lumbar radiculopathy, mild degenerative changes on lumbar magnetic resonance imaging (MRI) scan, and failed conservative treatment. Myelopathy was confirmed with electromyogram (EMG). Thoracolumbar spine MRI revealed the schwannoma in the thoracic region. He recovered neurologic function after tumor excision. This case highlights the diagnostic challenge that may arise in evaluating a patient with lumbar radiculopathy, negative lumbosacral spine imaging, and failure of conservative therapy. PMID:25656663

  19. What Is Spinal Stenosis?

    MedlinePLUS

    ... bone spurs). Arthritis In some cases arthritis, a degenerative (gets worse over time) condition can cause spinal ... Tumors of the spine. ? Injuries. ? Paget's disease (a disease that affects the bones). ? Too much fluoride in the body. ? Calcium deposits ...

  20. Footprint mismatch in lumbar total disc arthroplasty

    PubMed Central

    Michaela, Gstoettner; Denise, Heider; Liebensteiner, Michael

    2008-01-01

    Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening and biomechanical failure due to an incorrect center of rotation. The aim of the present study was to measure the dimensions of lumbar vertebrae based on CT scans and assess the accuracy of match in currently available lumbar disc prostheses. A total of 240 endplates of 120 vertebrae were included in the study. The sagittal and mediolateral diameter of the upper and lower endplates were measured using a digital measuring system. For the levels L4/L5 and L5/S1, an inappropriate size match was noted in 98.8% (Prodisc L) and 97.6% (Charite) with regard to the anteroposterior diameter. Mismatch in the anterior mediolateral diameter was noted in 79.3% (Prodisc L) and 51.2% (Charite) while mismatch in the posterior mediolateral diameter was observed in 91.5% (Prodisc L) and 78% (Charite) of the endplates. Surgeons and manufacturers should be aware of the size mismatch of currently available lumbar disc prostheses, which may endanger the safety and efficacy of the procedure. Larger footprints of currently available total disc arthroplasties are required. PMID:18791748

  1. Current status of bone graft options for anterior interbody fusion of the cervical and lumbar spine.

    PubMed

    Chau, Anthony Minh Tien; Xu, Lileane Liang; Wong, Johnny Ho-Yin; Mobbs, Ralph Jasper

    2014-01-01

    Anterior cervical discectomy and fusion (ACDF) and anterior lumbar interbody fusion (ALIF) are common surgical procedures for degenerative disc disease of the cervical and lumbar spine. Over the years, many bone graft options have been developed and investigated aimed at complimenting or substituting autograft bone, the traditional fusion substrate. Here, we summarise the historical context, biological basis and current best evidence for these bone graft options in ACDF and ALIF. PMID:23743981

  2. What Is Spinal Stenosis?

    MedlinePLUS

    ... publication. To order the Spinal Stenosis Q&A full-text version, please contact NIAMS using the contact information above. To view the complete text or to order online, visit ... NIAMS Site NIH… Turning Discovery Into Health ® Home | ...

  3. Treatment of carotid stenosis.

    PubMed

    Touzé, Emmanuel

    2012-11-01

    Carotid stenosis is frequent in the general population, especially in elderly people and is associated with a high risk of stroke and vascular events. In patients with asymptomatic carotid stenosis the overall annual risk of ipsilateral stroke has dramatically decreased over the past decades, due to improvement in medical management. Asymptomatic carotid stenosis is probably a better indicator of generalized atherosclerotic disease than of stroke risk, with an average risk of nonstroke death (mainly due to ischemic heart disease) generally higher than the risk of ipsilateral stroke. Management of risk factors, antiplatelet therapy, and statins are highly beneficial in these patients. Carotid surgery in patients with asymptomatic carotid stenosis is associated with a small absolute benefit compared to medical treatment. The prognosis of patients with symptomatic carotid stenosis is dramatically different from that of patients with asymptomatic carotid stenosis because the risk of stroke on medical treatment alone is very high and highest during the first few days and weeks. In these patients, endarterectomy is highly beneficial and the absolute benefit of is increased in patients with 70- 99% stenosis, men, patients over 75 years, and in those treated within 2 weeks after the last event. The meta-analysis of the 3 major European trials comparing endarterectomy to stenting in symptomatic stenosis has shown an increased risk of perioperative risk of any stroke or death in the stenting group (74% increase in risk in patients treated with stenting). However, the risk of stroke or death after stenting and surgery were equivalent below the age of 70 whereas there was a two-fold increase in risk of stenting over endarterectomy above this age. Thus, surgery remains the first line method in most cases but stenting is potentially an alternative in young patients. PMID:23259569

  4. Low-back pain, sciatica, cervical and lumbar spondylosis

    Microsoft Academic Search

    Nicholas WM Thomas

    2004-01-01

    Spondylosis is the progressive, age-related degenerative changes of the spine. The mid-cervical and lower-lumbar regions are particularly affected because of the distribution of mechanical stresses due to spinal motion and loading of the spinal segments when in the erect posture. These changes are usually asymptomatic apart from increasing stiffness and reduced mobility of the spine. When symptomatic, clinical features include

  5. Risk Factors for Adjacent Segment Disease Development after Lumbar Fusion

    PubMed Central

    Ptashnikov, Dmitry; Michaylov, Dmitry; Meng, Hao; Smekalenkov, Oleg; Zaborovskii, Nikita

    2015-01-01

    Study Design Retrospective cohort study. Purpose To identify factors which may be important in the occurrence of symptomatic adjacent segment disease (ASD) after lumbar fusion. Overview of Literature Many reports have been published about the risk factors for ASD after lumbar fusion. Despite on the great numbers of risk factors identified for ASD development, study results have been inconsistent and there is controversy regarding which are the most important. Methods This study evaluated 120 patients who underwent 360° fusion lumbar surgery from 2007 to 2012. We separated the population into two groups: the first group included 60 patients with long lumbar fusion (three or more levels) and the second group included 60 patients with short lumbar fusion (less than three levels). Results In the first group, symptomatic ASD was found in 19 cases during the one year follow-up. There were 14 cases with sagittal imbalance and 5 cases at the incipient stage of disc degeneration according to the preoperative magnetic resonance imaging. At the three year follow-up, symptomatic ASD was diagnosed in 31 cases, of which 17 patients had postoperative sagittal balance disturbance. In the second group, 10 patients had ASD at the one year follow-up. Among these cases, preoperative disc degenerative changes were identified in 8 patients. Sagittal imbalance was found only in 2 cases with symptomatic ASD at the one year follow-up. At the three year follow-up, the number of patients with symptomatic ASD increased to 14. Among them, 13 patients had initial preoperative adjacent disc degenerative changes. Conclusions Patients with postoperative sagittal imbalance have a statistically significant increased risk of developing symptomatic ASD due to an overloading the adjacent segments and limited compensatory capacities due to the large number of fixed mobile segments. In the case of a short fixation, preoperative degenerative changes are more important factors in the development of ASD.

  6. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain.

    PubMed

    Cohen, Steven P; Raja, Srinivasa N

    2007-03-01

    Lumbar zygapophysial joint arthropathy is a challenging condition affecting up to 15% of patients with chronic low back pain. The onset of lumbar facet joint pain is usually insidious, with predisposing factors including spondylolisthesis, degenerative disc pathology, and old age. Despite previous reports of a "facet syndrome," the existing literature does not support the use of historic or physical examination findings to diagnose lumbar zygapophysial joint pain. The most accepted method for diagnosing pain arising from the lumbar facet joints is with low-volume intraarticular or medial branch blocks, both of which are associated with high false-positive rates. Standard treatment modalities for lumbar zygapophysial joint pain include intraarticular steroid injections and radiofrequency denervation of the medial branches innervating the joints, but the evidence supporting both of these is conflicting. In this article, the authors provide a comprehensive review of the anatomy, biomechanics, and function of the lumbar zygapophysial joints, along with a systematic analysis of the diagnosis and treatment of facet joint pain. PMID:17325518

  7. Yoga and Lumbar Disc Degeneration Disease: MR Imaging Based Case Control Study

    Microsoft Academic Search

    Tzu-Chieh Cheng; Fu-Jen Catholic Uiversity; Chin-Ming Jeng

    Yoga is a popular exercise with evidence of var - ious physical and psychological benefits. However, most of these studies are based on subjective scales. To our k nowledge, there are ver y few original studies on MRI analyses of yoga prac - ticing individuals at present. Here we conducted a MRI-based case-control study of yoga and lumbar degenerative disc

  8. Screening for Carotid Artery Stenosis

    MedlinePLUS

    ... you. What is carotid artery stenosis? Carotid artery stenosis is the narrowing of the arteries that run along each side of the neck. These arteries provide blood flow to the brain. Over time, plaque (a fatty, ...

  9. [Spinal canal stenosis].

    PubMed

    Papanagiotou, P; Boutchakova, M

    2014-11-01

    Spinal stenosis is a narrowing of the spinal canal by a combination of bone and soft tissues, which can lead to mechanical compression of spinal nerve roots or the dural sac. The lumbal spinal compression of these nerve roots can be symptomatic, resulting in weakness, reflex alterations, gait disturbances, bowel or bladder dysfunction, motor and sensory changes, radicular pain or atypical leg pain and neurogenic claudication. The anatomical presence of spinal canal stenosis is confirmed radiologically with computerized tomography, myelography or magnetic resonance imaging and play a decisive role in optimal patient-oriented therapy decision-making. PMID:25398571

  10. Comparing Miniopen and Minimally Invasive Transforaminal Interbody Fusion in Single-Level Lumbar Degeneration

    PubMed Central

    Lo, Wei-Lun; Lin, Chien-Min; Yeh, Yi-Shian; Tseng, Yuan-Yun; Yang, Shun-Tai

    2015-01-01

    Degenerative diseases of the lumbar spine, which are common among elderly people, cause back pain and radicular symptoms and lead to a poor quality of life. Lumbar spinal fusion is a standardized and widely accepted surgical procedure used for treating degenerative lumbar diseases; however, the classical posterior approach used in this procedure is recognized to cause vascular and neurologic damage of the lumbar muscles. Various studies have suggested that using the minimally invasive transforaminal interbody fusion (TLIF) technique provides long-term clinical outcomes comparable to those of open TLIF approaches in selected patients. In this study, we compared the perioperative and short-term advantages of miniopen, MI, and open TLIF. Compared with open TLIF, MI-TLIF and miniopen TLIF were associated with less blood loss, shorter hospital stays, and longer operative times; however, following the use of these procedures, no difference in quality of life was measured at 6 months or 1 year. Whether miniopen TLIF or MI-TLIF can replace traditional TLIF as the surgery of choice for treating degenerative lumbar deformity remains unclear, and additional studies are required for validating the safety and efficiency of these procedures. PMID:25629037

  11. Comparing miniopen and minimally invasive transforaminal interbody fusion in single-level lumbar degeneration.

    PubMed

    Lo, Wei-Lun; Lin, Chien-Min; Yeh, Yi-Shian; Su, Yu-Kai; Tseng, Yuan-Yun; Yang, Shun-Tai; Lin, Jai-Wei

    2015-01-01

    Degenerative diseases of the lumbar spine, which are common among elderly people, cause back pain and radicular symptoms and lead to a poor quality of life. Lumbar spinal fusion is a standardized and widely accepted surgical procedure used for treating degenerative lumbar diseases; however, the classical posterior approach used in this procedure is recognized to cause vascular and neurologic damage of the lumbar muscles. Various studies have suggested that using the minimally invasive transforaminal interbody fusion (TLIF) technique provides long-term clinical outcomes comparable to those of open TLIF approaches in selected patients. In this study, we compared the perioperative and short-term advantages of miniopen, MI, and open TLIF. Compared with open TLIF, MI-TLIF and miniopen TLIF were associated with less blood loss, shorter hospital stays, and longer operative times; however, following the use of these procedures, no difference in quality of life was measured at 6 months or 1 year. Whether miniopen TLIF or MI-TLIF can replace traditional TLIF as the surgery of choice for treating degenerative lumbar deformity remains unclear, and additional studies are required for validating the safety and efficiency of these procedures. PMID:25629037

  12. Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review.

    PubMed

    Le Huec, Jean-Charles; Faundez, Antonio; Dominguez, Dennis; Hoffmeyer, Pierre; Aunoble, Stéphane

    2015-01-01

    The measure of radiographic pelvic and spinal parameters for sagittal balance analysis has gained importance in reconstructive surgery of the spine and particularly in degenerative spinal diseases (DSD). Fusion in the lumbar spine may result in loss of lumbar lordosis (LL), with possible compensatory mechanisms: decreased sacral slope (SS), increased pelvic tilt (PT) and decreased thoracic kyphosis (TK). An increase in PT after surgery is correlated with postoperative back pain. A decreased SS and/or abnormal sagittal vertical axis (SVA) after fusion have a higher risk of adjacent segment degeneration. High pelvic incidence (PI) increases the risk of sagittal imbalance after spine fusion and is a predictive factor for degenerative spondylolisthesis. Restoration of a normal PT after surgery is correlated with good clinical outcome. Therefore, there is a need for comparative prospective studies that include pre- and postoperative spinopelvic parameters and compare complication rate, degree of disability, pain and quality of life. PMID:25192690

  13. Pathogenesis and pathophysiology of aortic valve stenosis in adults.

    PubMed

    Olszowska, Maria

    2011-11-01

    Aortic stenosis (AS) is the most common form of valvular heart disease. AS of degenerative etiology is predominant. It is a persistent disease associated with the activation of 3 processes: lipid accumulation, inflammation, and calcification. Recent studies suggest that valve calcification is an actively regulated process that involves extracellular matrix remodeling, angiogenesis, and inflammation leading to bone formation. Many mechanisms and risk factors involved in the pathogenesis of AS are similar to those observed in atherosclerosis. The knowledge of these processes may play a significant role in adequate prevention and therapy of patients with AS, especially at an early stage. PMID:22129836

  14. Congenital oesophageal stenosis.

    PubMed Central

    Valerio, D; Jones, P F; Stewart, A M

    1977-01-01

    A case of congenital oesophageal stenosis presenting shortly after birth is reported. Treatment by daily dilatation with a bead on a continuous thread loop was carried on at home over several months. This proved to be a simple, safe, and effective treatment. Images Fig. 1 Fig. 2 PMID:869573

  15. Pathogenesis of degenerative temporomandibular joint arthritides

    Microsoft Academic Search

    Stephen B. Milam

    2005-01-01

    Over the past decade, remarkable progress has been made in the study of molecular mechanisms involved in degenerative temporomandibular joint arthritides. Based on recent findings, models of degenerative temporomandibular joint disease predict that mechanical loads trigger a cascade of molecular events leading to disease in susceptible individuals. These events involve the production or release of free radicals, cytokines, fatty acid

  16. Racial Differences in the Prevalence of Severe Aortic Stenosis

    PubMed Central

    Patel, Devin K.; Green, Kelly D.; Fudim, Marat; Harrell, Frank E.; Wang, Thomas J.; Robbins, Mark A.

    2014-01-01

    Background In an era of expanded treatment options for severe aortic stenosis, it is important to understand risk factors for the condition. It has been suggested that severe aortic stenosis is less common in African Americans, but there are limited data from large studies. Methods and Results The Synthetic Derivative at Vanderbilt University Medical Center, a database of over 2.1 million de?identified patient records, was used to identify individuals who had undergone echocardiography. The association of race with severe aortic stenosis was examined using multivariable logistic regression analyses adjusting for conventional risk factors. Of the 272 429 eligible patients (mean age 45 years, 44% male) with echocardiography, 14% were African American and 82% were Caucasian. Severe aortic stenosis was identified in 106 (0.29%) African?American patients and 2030 (0.91%) Caucasian patients (crude OR 0.32, 95% CI [0.26, 0.38]). This difference persisted in multivariable?adjusted analyses (OR 0.41 [0.33, 0.50], P<0.0001). African?American individuals were also less likely to have severe aortic stenosis due to degenerative calcific disease (adjusted OR 0.47 [0.36, 0.61]) or congenitally bicuspid valve (crude OR 0.13 [0.02, 0.80], adjusted OR dependent on age). Referral bias against those with severe valvular disease was assessed by comparing the prevalence of severe mitral regurgitation in Caucasians and African Americans and no difference was found. Conclusions These findings suggest that African Americans are at significantly lower risk of developing severe aortic stenosis than Caucasians. PMID:24870936

  17. Posterior Endoscopic Discectomy Using as Endoscopic Lumbar Discectomy System Developed in Japan

    Microsoft Academic Search

    Yutaka Hiraizumi

    The characteristics of the endoscopic lumbar discectomy system (ELDS) developed in Japan are introduced, and the first 50 cases are clinically evaluated. The patients included four cases of double disc herniation at two levels, one of cranially and three of caudally migrated discs, three of spinal canal stenosis, one of synovial cyst, and three of persistent ring apophysis. In four

  18. STIR Sequence for Depiction of Degenerative Changes in Posterior Stabilizing Elements in Patients with Lower Back Pain

    Microsoft Academic Search

    Hatice Lakadamyali; Nefise Cagla Tarhan; Tarkan Ergun; Banu Cakir; Ahmet Muhtesem Agildere

    2008-01-01

    OBJECTIVE. The aims of this study were to investigate whether degenerative posterior paraspinal changes are a cause of lower back pain and to determine the age- and sex-related distribution of these changes on MR images acquired with a STIR sequence. SuBJECTS AND METHODS. The lumbar MRI findings of 372 patients (141 men, 231 women; mean age, 51.2 years) with nonradicular

  19. Spinal Stenosis Presenting with Scrotal and Perianal Claudication

    PubMed Central

    Tan, Jun-Hao; Teo, Timothy WW; Hee, Hwan-Tak

    2015-01-01

    A 63-year-old gentleman presented with a one-year duration of progressive neurogenic claudication. However, unlike most patients who presents with leg symptoms, his pain was felt in his scrotal and perianal region. This was exacerbated with walking and standing, but he had immediate relief with sitting. An magnetic resonance imaging (MRI) was performed which showed severe central canal stenosis. An L3/4 and L4/5 surgical decompression and a transforaminal lumbar interbody fusion was performed, and the patient made good recovery with immediate resolution of symptoms. Although rare, spinal stenosis should be considered a differential when approaching a patient with perianal and scrotal claudication, even in the absence of leg claudication. An MRI is useful to confirm the diagnosis. This rare symptom may be a sign of severe cauda equina compression and we recommend decompression with predictable good results. PMID:25705342

  20. End Plate Disproportion and Degenerative Disc Disease: A Case-Control Study

    PubMed Central

    Poureisa, Masoud; Daghighi, Mohammad Hossein; Mesbahi, Sepideh; Hagigi, Amir

    2014-01-01

    Study Design Case-control. Purpose To determine whether a disproportion between two neighboring vertebral end plates is associated with degenerative disc disease. Overview of Literature Recently, it has been suggested that disproportion of the end plates of two adjacent vertebrae may increase the risk of disc herniation. Methods Magnetic resonance (MR) images (n=160) with evidence of grades I-II lumbar degenerative disc disease (modified Pfirrmann's classification) and normal MR images of the lumbar region (n=160) were reviewed. On midsagittal sections, the difference of anteroposterior diameter of upper and lower end plates neighboring a degenerated (in the case group) or normal (in the control group) intervertebral disc was calculated (difference of end plates [DEP]). Results Mean DEP was significantly higher in the case group at the L5-S1 level (2.73±0.23 mm vs. 2.21±0.12 mm, p=0.03). Differences were not statistically significant at L1-L2 (1.31±0.13 mm in the cases vs. 1.28±0.08 mm in the controls, p=0.78), L2-L3 (1.45±0.12 mm in the cases vs. 1.37±0.08 mm in the controls, p=0.58), L3-L4 (1.52±0.13 mm in the cases vs. 1.49±0.10 mm in the controls, p=0.88), and L4-L5 (2.15±0.21 mm in the cases vs. 2.04±0.20 mm in the controls, p=0.31) levels. The difference at the L5-S1 level did not remain significant after adjusting for body mass index (BMI), which was significantly higher in the patients. Conclusions End plate disproportion may be a significant, BMI-dependent risk factor for lumbar degenerative disc disease. PMID:25187856

  1. Surgical treatment of anal stenosis

    PubMed Central

    Brisinda, Giuseppe; Vanella, Serafino; Cadeddu, Federica; Marniga, Gaia; Mazzeo, Pasquale; Brandara, Francesco; Maria, Giorgio

    2009-01-01

    Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anaplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms. PMID:19399922

  2. Clinical Experiences of Transforaminal Balloon Decompression for Patients with Spinal Stenosis

    PubMed Central

    Kim, Sung Hoon; Koh, Won Uk; Park, Soo Jin; Choi, Woo Jong; Suh, Jeong Hun; Leem, Jeong Gil; Park, Pyung Hwan

    2012-01-01

    Lumbar spinal stenosis is a commonly treated with epidural injections of local anesthetics and corticosteroids, however, these therapies may relieve leg pain for weeks to months but do not influence functional status. Furthermore, the majority of patients report no substantial symptom change over the repeated treatment. Utilizing balloon catheters, we successfully treated with three patients who complained persistent symptoms despite repeated conventional steroid injections. Our results suggest that transforaminal decompression using a balloon catheter may have potential in the nonsurgical treatment of spinal stenosis by modifying the underlying pathophysiology. PMID:22259719

  3. Degenerative Joint Disorders, Including Condensing Osteitis

    Microsoft Academic Search

    Stephen P. Harden; Richard M. Blaquiere

    Degenerative disorders of the SCJ are commonly present radiographically but produce symptoms less frequently. When they do\\u000a the presence of local swelling, tenderness and an abnormal radiograph can give rise to concern. In these patients MRI or CT\\u000a should be used to exclude malignant or infective conditions while simultaneously differentiating the various degenerative\\u000a processes.

  4. A FULLY AUTOMATED METHOD OF ASSOCIATING AXIAL SLICES WITH A DISC BASED ON LABELING OF MULTI-PROTOCOL LUMBAR MRI

    E-print Network

    Chaudhary, Vipin

    stenosis, and degenerative disc disease [2]. Although MRI takes long scan time and is costly, it has and allows radiologists to detect other problems such as bone tumors and infections of the spine. Also, a radiologist can diagnose diseases a lot quicker based solely on those slices, rather than moving through

  5. 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

  6. A New Electrophysiological Method for the Diagnosis of Extraforaminal Stenosis at L5-S1

    PubMed Central

    Yoshida, Munehito; Yamada, Hiroshi; Hashizume, Hiroshi; Minamide, Akihito; Nakagawa, Yukihiro; Kawai, Masaki; Tsutsui, Shunji

    2014-01-01

    Study Design A retrospective study. Purpose To examine the effectiveness of using an electrodiagnostic technique as a new approach in the clinical diagnosis of extraforaminal stenosis at L5-S1. Overview of Literature We introduced a new effective approach to the diagnosis of extraforaminal stenosis at the lumbosacral junction using the existing electrophysiological evaluation technique. Methods A consecutive series of 124 patients with fifth lumbar radiculopathy were enrolled, comprising a group of 74 patients with spinal canal stenosis and a second group of 50 patients with extraforaminal stenosis at L5-S1. The technique involved inserting a pair of needle electrodes into the foraminal exit zone of the fifth lumbar spinal nerves, which were used to provide electrical stimulation. The compound muscle action potentials from each of the tibialis anterior muscles were recorded. Results The distal motor latency (DML) of the potentials ranged from 11.2 to 24.6 milliseconds in patients with extraforaminal stenosis. In contrast, the DML in patients with spinal canal stenosis ranged from 10.0 to 17.2 milliseconds. After comparing the DML of each of the 2 groups and at the same time comparing the differences in DML between the affected and unaffected side of each patient, we concluded there were statistically significant differences (p<0.01) between the 2 groups. Using receiver operating characteristic curve analysis, the cutoff values were calculated to be 15.2 milliseconds and 1.1 milliseconds, respectively. Conclusions This approach using a means of DML measurement enables us to identify and localize lesions, which offers an advantage in diagnosing extraforaminal stenosis at L5-S1. PMID:24761195

  7. Axial Rotation of the Lumbar Spinal Motion Segments Correlated with Concordant Pain on Discography: A Preliminary Study

    Microsoft Academic Search

    Donna G. Blankenbaker; Victor M. Haughton; Baxter P. Rogers; M. Elizabeth Meyerand; Jason P. Fine

    OBJECTIVE. One possible cause of back pain in patients with intervertebral disk degen- eration is decreased stability of the motion segment. Axial rotations between lumbar spinal ver- tebrae can be measured noninvasively with CT. We tested the hypothesis that larger axial rota- tions are found in motion segments with disks that test positive for concordant pain, which is considered by

  8. Aspectos medicolegales y bioéticos de la cirugía instrumentada de la columna lumbar degenerativa. Implicaciones en el manejo del dolor crónico

    Microsoft Academic Search

    F. J. Robaina Padrón

    2009-01-01

    Evidence-based medicine has still not been able to demonstrate the advantages of surgical treatment over medical therapy in patients with chronic degenerative lumbar and sciatic pain. Personal, professional and economic conflicts are involved in this disorder, and are the subject of the present article. The reputation of certain physicians is seen as a desirable asset by some companies that would

  9. Lumbar spinal epidural angiolipoma

    Microsoft Academic Search

    Kimon Nanassis; Parmenion Tsitsopoulos; Dimitrios Marinopoulos; Apostolos Mintelis; Philippos Tsitsopoulos

    2008-01-01

    Spinal angiolipomas are rare benign tumours most commonly found in the thoracic spine. A case of an extradural lumbar angiolipoma in a 47-year-old female is described. She had a recent history of lower back pain accompanied by sciatica. Lumbar MRI revealed a dorsal epidural mass at the L2–L3 level. The patient underwent a bilateral laminectomy, in which the tumour was

  10. Renal artery stenosis.

    PubMed

    Tafur-Soto, Jose David; White, Christopher J

    2015-02-01

    Atherosclerotic renal artery stenosis (RAS) is the single largest cause of secondary hypertension; it is associated with progressive renal insufficiency and causes cardiovascular complications such as refractory heart failure and flash pulmonary edema. Medical therapy, including risk factor modification, renin-angiotensin-aldosterone system antagonists, lipid-lowering agents, and antiplatelet therapy, is advised in all patients. Patients with uncontrolled renovascular hypertension despite optimal medical therapy, ischemic nephropathy, and cardiac destabilization syndromes who have severe RAS are likely to benefit from renal artery revascularization. Screening for RAS can be done with Doppler ultrasonography, CT angiography, and magnetic resonance angiography. PMID:25439331

  11. Advancement in idiopathic intracranial hypertension pathogenesis: focus on sinus venous stenosis.

    PubMed

    De Simone, Roberto; Ranieri, Angelo; Bonavita, Vincenzo

    2010-06-01

    Idiopathic intracranial hypertension is consistently associated with venous outflow disturbances. Sinus venous stenosis are found at magnetic resonance venography in the large majority of IIH patients and may have various conformations, ranging from functional smooth narrowings of sinus segments associated or not with definite flow gaps, to segmental hypoplasia or aplasia of one or more central venous collectors. Stenosis are currently believed to be a consequence of a primary altered cerebrospinal fluid (CSF) pressure since it may normalize after CSF subtraction with lumbar puncture or shunting procedures. In this paper a "self-sustained venous collapse" is proposed as a crucial causative mechanism in predisposed subjects, leading to a self-sustained intracranial hypertension in presence of a wide range of triggering factors. The proposed mechanisms predict the long-term remission of IIH syndromes frequently observed after a single or few serial CSF subtractions by lumbar puncture. PMID:20464580

  12. Intracranial arterial stenosis.

    PubMed

    Carvalho, Marta; Oliveira, Ana; Azevedo, Elsa; Bastos-Leite, António J

    2014-04-01

    Intracranial arterial stenosis (IAS) is usually attributable to atherosclerosis and corresponds to the most common cause of stroke worldwide. It is very prevalent among African, Asian, and Hispanic populations. Advancing age, systolic hypertension, diabetes mellitus, high levels of low-density lipoprotein cholesterol, and metabolic syndrome are some of its major risk factors. IAS may be associated with transient or definite neurological symptoms or can be clinically asymptomatic. Transcranial Doppler and magnetic resonance angiography are the most frequently used ancillary examinations for screening and follow-up. Computed tomography angiography can either serve as a screening tool for the detection of IAS or increasingly as a confirmatory test approaching the diagnostic accuracy of catheter digital subtraction angiography, which is still considered the gold (confirmation) standard. The risk of stroke in patients with asymptomatic atherosclerotic IAS is low (up to 6% over a mean follow-up period of approximately 2 years), but the annual risk of stroke recurrence in the presence of a symptomatic stenosis may exceed 20% when the degree of luminal narrowing is 70% or more, recently after an ischemic event, and in women. It is a matter of controversy whether there is a specific type of treatment other than medical management (including aggressive control of vascular risk factors and antiplatelet therapy) that may alter the high risk of stroke recurrence among patients with symptomatic IAS. Endovascular treatment has been thought to be helpful in patients who fail to respond to medical treatment alone, but recent data contradict such expectation. PMID:23850084

  13. Risk factors for degenerative spondylolisthesis: a systematic review

    PubMed Central

    DeVine, John G.; Schenk-Kisser, Jeannette M.; Skelly, Andrea C.

    2012-01-01

    Study design:?Systematic literature review. Rationale:?Many authors have postulated on various risk factors associated with the pathogenesis of degenerative spondylolisthesis (DS), yet controversies regarding those risk factors still exist. Objective:?To critically appraise and summarize evidence on risk factors for DS. Methods:?Articles published before October 15, 2011, were systematically reviewed using PubMed and bibliographies of key articles. Each article was subject to quality rating and was analyzed by two independent reviewers. Results:?From 382 citations, 30 underwent full-text review. Fourteen studies met inclusion criteria. All but two were considered poor quality. Female gender and higher facet joint angle were consistently associated with an increased risk of DS across multiple studies. Multiple studies also consistently reported no association between back pain and prolonged occupational sitting. Associations between age, parity, lumbosacral angle, lumbar lordosis, facet joint tropism, and pelvic inclination angles were inconsistent. Conclusions:?There appears to be consistent evidence to suggest that the risk of DS increases with increasing age and is greater for females and people with a greater facet joint angle. PMID:23230415

  14. Influence of IL-20 on lumbar disc degeneration:An experimental study

    PubMed Central

    Yang, Tianjing; Xu, Huaqing

    2015-01-01

    Objective: To determine the influence of IL-20 on the development of lumbar degeneration. Methods: The study design was prospective and carried out in Tianjin Fourth center Hospital, Tianjin, China between Jan 2012 and Jan 2014. Sixty-nine patients with degenerative disc disease treated surgically were included in experimental group, and fifteen patients with normal discs were included in control group. The evaluation of disc degeneration was performed using T2-weighted sagittal MRI according to the Modified Pfirrmann Grading System. After surgery, the intervertebral disc in both groups was collected and the content of proteoglycan and IL-20 were measured, the correlation between the content of IL-20, proteoglycan and the degeneration grade of lumbar disc was analyzed. Results: Compared to control group, the content of proteoglycan in experimental group is significantly lower (P=0.000), but IL-20 is significantly higher (P=0.001). In addition, with the advance of intervertebral disc degeneration, the content of IL-20 increase, while proteoglycan decrease gradually. There is significant correlation between the content of proteoglycan (p=0.001), IL-20 (p=0.002) and the degeneration grade of lumbar disc. Conclusion: In patients with degenerative disc disease, the content of IL-20 and proteoglycan has significant correlation with degeneration grade of lumbar disc, and IL-20 may promote the degeneration of lumbar disc by affecting the synthesis of proteoglycan.

  15. Differentiation between Symptomatic and Asymptomatic Extraforaminal Stenosis in Lumbosacral Transitional Vertebra: Role of Three-Dimensional Magnetic Resonance Lumbosacral Radiculography

    PubMed Central

    Kim, Jae Woon; Lee, Jae Kyo

    2012-01-01

    Objective To investigate the role of lumbosacral radiculography using 3-dimentional (3D) magnetic resonance (MR) rendering for diagnostic information of symptomatic extraforaminal stenosis in lumbosacral transitional vertebra. Materials and Methods The study population consisted of 18 patients with symptomatic (n = 10) and asymptomatic extraforaminal stenosis (n = 8) in lumbosacral transitional vertebra. Each patient underwent 3D coronal fast-field echo sequences with selective water excitation using the principles of the selective excitation technique (Proset imaging). Morphologic changes of the L5 nerve roots at the symptomatic and asymptomatic extraforaminal stenosis were evaluated on 3D MR rendered images of the lumbosacral spine. Results Ten cases with symptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. On 3D MR lumbosacral radiculography, indentation of the L5 nerve roots was found in two cases, while swelling of the nerve roots was seen in eight cases at the exiting nerve root. Eight cases with asymptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. Based on 3D MR lumbosacral radiculography, indentation or swelling of the L5 nerve roots was not found in any cases with asymptomatic extraforaminal stenosis. Conclusion Results from 3D MR lumbosacral radiculography Indicate the indentation or swelling of the L5 nerve root in symptomatic extraforaminal stenosis. Based on these findings, 3D MR radiculography may be helpful in the diagnosis of the symptomatic extraforaminal stenosis with lumbosacral transitional vertebra. PMID:22778561

  16. Lumbar spinal surgery - series (image)

    MedlinePLUS

    ... spinal column around the spinal cord. Symptoms of lumbar spine problems include: pain that extends (radiates) from the ... require physical therapy to optimize spinal mobility after lumbar spine surgery. Results are variable depending on the disease ...

  17. Interobserver discrepancies in distance measurements from lumbar spine CT scans

    SciTech Connect

    Beers, G.J.; Carter, A.P.; Leiter, B.E.; Tilak, S.P.; Shah, R.R.

    1985-02-01

    Lumbar spine computed tomographic (CT) scans of 10 patients were examined independently at two levels by five experienced radiologists. At each level the minimum midline sagittal diameter was measured, and at each intervertebral space the left foramen was measured for its minimum diameter. Statistically significant differences were found between the measurements of different observers, differences that in a number of cases could have led to disagreement over whether or not stenosis was present. There were reasonably strong correlations between different observers' readings of midline sagittal diameters but generally not of foraminal diameters. Reasons for discrepancies between observers in spine CT measurements are reviewed briefly.

  18. Degenerative disease of the cervical spine and its relationship to athletes.

    PubMed

    Triantafillou, Konstantinos M; Lauerman, William; Kalantar, S Babak

    2012-07-01

    Each sport presents with unique risk factors and different mechanisms of injury, and therefore extrapolation of the data from one sport to another makes comparison difficult. The current evidence exploring the relationship of athletes and degenerative changes of the cervical spine leaves much to be debated, and future prospective longitudinal studies will be needed to clarify our understanding further. Such research will help structure clinical recommendations and improve sports safety and the care of athletes of all ages. Currently, there is evidence to suggest that participation in collision sports is implicated in premature degeneration of the cervical spine. There is some evidence to suggest that the same is true with noncollision sports and activities that result in direct and indirect repetitive loads to the cervical spine over time. The risk factors have yet to be clearly identified. The natural history and sequelae of premature degeneration have yet to be elucidated. Cervical spondylosis also appears to increase the severity, but not the frequency, of irreversible neurologic injury during collision sport participation. Prudence dictates that we not ignore the present evidence suggesting a link between neuropraxia and cervical stenosis. Proper screening for cervical stenosis in patients with transient neuropraxia with subsequent cessation of participation in collision sports if severe stenosis is present is suggested. There is no consensus for RTP guidelines in the setting of transient neurologic injuries in the athlete when severe degeneration is present, and each case must be considered individually with regard to the sport involved. PMID:22657999

  19. Lumbar Disc Herniation in Adolescence

    Microsoft Academic Search

    Serdar Ozgen; Deniz Konya; O. Zafer Toktas; Adnan Dagcinar; M. Memet Ozek

    2007-01-01

    Lumbar disc herniation very rarely occurs in adolescence. The aim of this study was to assess the radiological, clinical and surgical features and case outcomes for adolescents with lumbar disc herniation, and to compare with adult cases. The cases of 17 adolescents (7 girls and 10 boys, age range 13–17 years) who were surgically treated for lumbar disc herniation in

  20. Clinical evaluation and surgical decision making for patients with lumbar discogenic pain and facet syndrome.

    PubMed

    Tessitore, Enrico; Molliqaj, Granit; Schatlo, Bawarjan; Schaller, Karl

    2015-05-01

    In industrialized countries, more than two thirds of the population suffers from low back pain (LBP) in their lifetime. LBP associated with lumbar disc herniation, stenosis, and instability is a well-known and documented entity. On the other hand, the lumbar discogenic pain and facet syndrome are difficult to be clearly identified, and they are not always detectable by imaging. This article describes the causes of these painful syndromes, which are typically without radicular component, explains the modern diagnostic procedures, and provides guidelines for surgical decision making. PMID:24801263

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

    SciTech Connect

    Chatterjee, Somenath; Bodhey, Narendra Kuber, E-mail: narendrakb2001@yahoo.co.in; Gupta, Arun Kumar; Periakaruppan, Alagappan [Sree Chitra Tirunal Institute for Medical Sciences and Technology, Department of Imaging Sciences and Interventional Radiology (India)

    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.

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

    Microsoft Academic Search

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

    2004-01-01

    The purpose of this study was to investigate the temporal evolution of type-1 end-plate changes on MRI in patients with degenerative disease of the lumbar spine and to evaluate whether any correlation exists between such evolution and the change in patients’ symptoms. Forty-four patients with 48 Modic type-1 end-plate changes (low TI signal and high T2 signal) were studied. All

  3. Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study

    Microsoft Academic Search

    Michael Putzier; Patrick Strube; Julia F. Funk; Christian Gross; Hans-Joachim Mönig; Carsten Perka; Axel Pruss

    2009-01-01

    The current gold standard in lumbar fusion consists of transpedicular fixation in combination with an interbody interponate\\u000a of autologous bone from iliac crest. Because of the limited availability of autologous bone as well as the still relevant\\u000a donor site morbidity after iliac crest grafting the need exists for alternative grafts with a comparable outcome. Forty patients\\u000a with degenerative spinal disease

  4. The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery

    Microsoft Academic Search

    Jason Braybrooke; Henry Ahn; Aimee Gallant; Michael Ford; Yigel Bronstein; Joel Finkelstein; Albert Yee

    2007-01-01

    A prospective observational study was conducted on patients undergoing posterior lumbar spine surgery for degenerative spinal\\u000a disorders. The study purpose was to evaluate the effect of wait time to surgery on patient derived generic and disease specific\\u000a functional outcome following surgery. A prolonged wait to surgery may adversely affect surgical outcome. Although there is\\u000a literature on the effect of wait

  5. Diagnostic Testing for Degenerative Disc Disease

    PubMed Central

    Hasz, Michael W.

    2012-01-01

    The diagnostic of degenerative disc disease should be reached with the help of various diagnostic studies. This article briefly review the information gained by the following tests: radiographs, computed tomography, magnetic resonance, and discography. The article explains how each modality provides a piece of the diagnostic puzzle and how discography confirms the origin of the patient's pain. PMID:22844603

  6. Restorative chemotherapy in degenerative hip disease

    Microsoft Academic Search

    Charles W. Denko

    1978-01-01

    Twenty patients with degenerative joint disease (DJD) of the hip were treated for prolonged periods with an extract of cartilage and bone marrow. Although clinical improvement, lessened joint pain and increased function, occurred in a majority of the patients, the most significant changes were in four who had concomitant x-ray improvement. These patients had roentgenographic evidence of recovery of joint

  7. Pathogenesis of degenerative temporomandibular joint arthritides.

    PubMed

    Milam, Stephen B

    2005-09-01

    Over the past decade, remarkable progress has been made in the study of molecular mechanisms involved in degenerative temporomandibular joint arthritides. Based on recent findings, models of degenerative temporomandibular joint disease predict that mechanical loads trigger a cascade of molecular events leading to disease in susceptible individuals. These events involve the production or release of free radicals, cytokines, fatty acid catabolites, neuropeptides, and matrix-degrading enzymes. Under normal circumstances, these molecules may be involved in the remodeling of articular tissues in response to changing functional demands. However, if functional demands exceed the adaptive capacity of the temporomandibular joint or if the affected individual is susceptible to maladaptive responses, then a disease state will ensue. An individual's susceptibility to degenerative temporomandibular joint disease may be determined by several factors, including genetic backdrop, sex, age, and nutritional status. It is hoped that, by furthering our understanding of the molecular events that underlie degenerative temporomandibular joint diseases, improved diagnostics and effective therapies for these debilitating conditions will be developed. PMID:16170470

  8. Management of carotid artery stenosis

    PubMed Central

    Louridas, George; Junaid, Asad

    2005-01-01

    OBJECTIVE To clarify the definition of carotid artery diseases, the appropriateness of screening for disease, investigation and management of patients presenting with transient ischemic attacks, and management of asymptomatic carotid bruits. SOURCES OF INFORMATION MEDLINE was searched using the terms carotid endarterectomy, carotid disease, and carotid stenosis. Most studies offer level II or III evidence. Consensus statements and guidelines from various neurovascular societies were also consulted. MAIN MESSAGE Patients with symptoms of hemispheric transient ischemic attacks associated with >70% stenosis of the internal carotid artery are at highest risk of major stroke or death. Risk is greatest within 48 hours of symptom onset; patients should have urgent evaluation by a vascular surgeon for consideration of carotid endarterectomy (CEA). Patients with 50% to 69% stenosis might benefit from urgent surgical intervention depending on clinical features and associated comorbidity. Patients with <50% stenosis do not benefit from surgery. Asymptomatic patients with >60% stenosis should be considered for elective CEA. CONCLUSION Symptomatic carotid artery syndromes need urgent carotid duplex evaluation to determine the need for urgent surgery. Those with the greatest degree of stenosis derive the greatest benefit from timely CEA. PMID:16060177

  9. Patient satisfaction with nursing after surgery due to cervical or lumbar discopathy

    PubMed Central

    Garczyk, Danuta; Jankowski, Roman; Misterska, Ewa; G?owacki, Maciej; ?ukiel, Ryszard; Kowalska, Anna M.

    2013-01-01

    Background Relationships between patient satisfaction with nursing and patient clinical data have not been fully resolved in a Polish sample. Our objectives were to determine clinical factors associated with patient satisfaction with nursing and investigate differences between patients treated surgically for cervical or lumbar discopathy and degenerative changes. Material/Methods This prospective and cross-sectional study included 63 consecutively selected patients treated surgically for lumbar discopathy and degenerative spine disease and 41 patients undergoing surgery for cervical discopathy and degenerative spine disease from 1st June 2009 to 31st September 2010 in the Department of Neurosurgery and Neurotraumatology of Poznan University of Medical Sciences. In the first stage of this study, socio-demographic data, medical history, and clinical patient characteristics were collected. A minimum 12-month follow-up formed the second part. Nineteen patients with lumbar discopathy were excluded because they were unable to answer the questionnaire. Finally, 44 consecutively selected patients treated surgically for lumbar discopathy and 41 patients undergoing surgery due to cervical discopathy were evaluated with the Polish version of the Newcastle Satisfaction with Nursing Scale (NSNS-PL). Results In patients with cervical and lumbar discopathy, the average Experiences of Nursing Care Subscale (ENCS) scores were 82.0 (SD 15.1) and 79.0 (SD 13.5), respectively, whereas the average Satisfaction with Nursing Care Subscale (SNCS) scores were 75.6 (SD 18.1) and 74.4 (SD 16.8), respectively. The study groups did not differ in regards to NSNS subscales. Associations between ENCS and SNCS scores were confirmed in both patient groups (rS=.73, p<0.001 and rS=.73, p<0.001, respectively). Conclusions Our study highlights the importance of assessing the association between patient characteristics and patient perception of quality of nursing care. Satisfaction with treatment outcome and conviction about undergoing the same treatment affected experiences and satisfaction with nursing in the cervical group only. PMID:24162443

  10. Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion.

    PubMed

    Shen, Xiaolong; Zhang, Hailong; Gu, Xin; Gu, Guangfei; Zhou, Xu; He, Shisheng

    2014-09-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has become an increasingly popular method of lumbar arthrodesis. However, there are few published studies comparing the clinical outcomes between unilateral and bilateral instrumented MIS TLIF. Sixty-five patients with degenerative lumbar spine disease were enrolled in this study. Thirty-one patients were randomized to the unilateral group and 34 to the bilateral group. Recorded demographic data included sex, age, preoperative diagnosis, and degenerated segment. Operative time, blood loss, hospital stay length, complication rates, and fusion rates were also evaluated. The Oswestry Disability Index (ODI) score and Visual Analog Scale (VAS) pain score data were obtained. All patients were asked to follow-up at 3 and 6 months after surgery, and once every 6 months thereafter. The mean follow-up was 26.6 months (range 18-36 months). The two groups were similar in sex, age, preoperative diagnosis, and operated level. The unilateral group had significantly shorter operative time, lower blood loss, and shorter hospital time than the bilateral group. The average postoperative ODI and VAS scores improved significantly in each group. No significant differences were found between the two groups in relation to ODI and VAS. All patients showed evidence of fusion at 12 months postoperatively. The total fusion rate, screw failure, and general complication rate were not significantly different. Results showed that single-level MIS TLIF with unilateral pedicle screw fixation would be sufficient in the management of preoperatively stable patients with lumbar degenerative disease. It seems that MIS TLIF with unilateral pedicle screw instrumentation is a better choice for single-level degenerative lumbar spine disease. PMID:24814852

  11. Lumbar Corsets Can Decrease Lumbar Motion in Golf Swing

    PubMed Central

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

    2013-01-01

    Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K.), full golf swings were monitored without a corset (WOC), with a soft corset (SC), and with a hard corset (HC), with each subject taking 3 swings. Changes in the angle between the pelvis and the thorax (maximum range of motion and angular velocity) in 3 dimensions (lumbar rotation, flexion-extension, and lateral tilt) were analyzed, as was rotation of the hip joint. Peak changes in lumbar extension and rotation occurred just after impact with the ball. The extension angle of the lumbar spine at finish was significantly lower under SC (38°) or HC (28°) than under WOC (44°) conditions (p < 0.05). The maximum angular velocity after impact was significantly smaller under HC (94°/sec) than under SC (177°/sec) and WOC (191° /sec) conditions, as were the lumbar rotation angles at top and finish. In contrast, right hip rotation angles at top showed a compensatory increase under HC conditions. Wearing a lumbar corset while swinging a golf club can effectively decrease lumbar extension and rotation angles from impact until the end of the swing. These effects were significantly enhanced while wearing an HC. Key points Rotational and extension forces on the lumbar spine may cause golf-related low back pain Wearing lumbar corsets during a golf swing can effectively decrease lumbar extension and rotation angles and angular velocity. Wearing lumbar corsets increased the rotational motion of the hip joint while reducing the rotation of the lumbar spine. PMID:24149729

  12. Percutaneous Endoscopic Lumbar Foraminotomy: An Advanced Surgical Technique and Clinical Outcomes

    PubMed Central

    Oh, Hyun-Kyong; Kim, Ho; Lee, Sang-Ho; Lee, Haeng-Nam

    2014-01-01

    BACKGROUND: Although several authors have reported the use of endoscopic techniques to treat lumbar foraminal stenosis, the practical application of these techniques has been limited to soft disc herniation. OBJECTIVE: To describe the details of the percutaneous endoscopic lumbar foraminotomy (ELF) technique for bony foraminal stenosis and to demonstrate the clinical outcomes. METHODS: Two years of prospective data were collected from 33 consecutive patients with lumbar foraminal stenosis who underwent ELF. The surgical outcomes were assessed using the visual analog scale, Oswestry Disability Index, and modified MacNab criteria. The procedure begins at the safer extraforaminal zone rather than the riskier intraforaminal zone. Then, a full-scale foraminal decompression can be performed using a burr and punches under endoscopic control. RESULTS: The mean age of the 18 female and 15 male patients was 64.2 years. The mean visual analog scale score for leg pain improved from 8.36 at baseline to 3.36 at 6 weeks, 2.03 at 1 year, and 1.97 at 2 years post-surgery (P < .001). The mean Oswestry Disability Index improved from 65.8 at baseline to 31.6 at 6 weeks, 19.7 at 1 year, and 19.3 at 2 years post-surgery (P < .001). Based on the modified MacNab criteria, excellent or good results were obtained in 81.8% of the patients, and symptomatic improvements were obtained in 93.9%. CONCLUSION: Percutaneous ELF under local anesthesia could be an efficacious surgical procedure for the treatment of foraminal stenosis. This procedure may offer safe and reproducible results, especially for elderly or medically compromised patients. ABBREVIATIONS: ELF,endoscopic lumbar foraminotomy ODI, Oswestry Disability Index VAS, visual analog scale PMID:24691470

  13. Nonrheumatic calcific aortic stenosis: an overview from basic science to pharmacological prevention.

    PubMed

    Parolari, Alessandro; Loardi, Claudia; Mussoni, Luciana; Cavallotti, Laura; Camera, Marina; Biglioli, Paolo; Tremoli, Elena; Alamanni, Francesco

    2009-03-01

    Calcific aortic stenosis is a frequent degenerative disease, which represents the most common indication for adult heart valve surgery, and carries substantial morbidity and mortality. Due to ageing populations in western countries, its prevalence is expected to increase in the coming years. Basic science studies suggest that the progression of aortic valve stenosis involves an active biological process, and that the molecular mechanisms promoting this development resemble those of atherosclerosis, as stenotic aortic valves are characterized by complex histological lesions, consisting of activated inflammatory cells, lipid deposits, extracellular matrix remodeling, calcific nodules, and bone tissue. This has led to the hypothesis that drugs effective in delaying atherosclerosis progression (e.g. statins) might also be able to prevent the progression of calcific aortic valve stenosis. The potential benefit of statin therapy, however, is controversial and widely debated, as recent randomized studies done in patients with moderate to severe degrees of aortic stenosis failed to consistently show substantial benefits of this class of drugs. This review focuses on various aspects of molecular mechanisms underlying calcific aortic valve stenosis and discusses recent experimental and clinical studies that address the potential benefit of targeted drug therapies. Taken together, current evidence suggests that the progression of calcific aortic stenosis is a multi-factorial process; the multitude of the mechanisms potentially involved in aortic valve stenosis indicates that drug therapy aimed at reducing its progression is necessarily multi-factorial and should address the earliest stages of the disease, as it is now evident that pharmacological treatment administered in more advanced stages of the disease may be ineffective or, at best, much less effective. PMID:19162497

  14. Comparison of Transforaminal Lumbar Interbody Fusion with Direct Lumbar Interbody Fusion: Clinical and Radiological Results

    PubMed Central

    Lee, Young Seok; Park, Seung Won; Chung, Chan

    2014-01-01

    Objective The use of direct lumbar interbody fusion (DLIF) has gradually increased; however, no studies have directly compared DLIF and transforaminal lumbar interbody fusion (TLIF). We compared DLIF and TLIF on the basis of clinical and radiological outcomes. Methods A retrospective review was performed on the medical records and radiographs of 98 and 81 patients who underwent TLIF and DLIF between January 2011 and December 2012. Clinical outcomes were compared with a visual analog scale (VAS) and the Oswestry disability index (ODI). The preoperative and postoperative disc heights, segmental sagittal/coronal angles, and lumbar lordosis were measured on radiographs. Fusion rates, operative time, estimated blood loss (EBL), length of hospital stay, and complications were assessed. Results DLIF was superior to TLIF regarding its ability to restore disc height, foraminal height, and coronal balance (p<0.001). As the extent of surgical level increased, DLIF displayed significant advantages over TLIF considering the operative time and EBL. However, fusion rates at 12 months post-operation were lower for DLIF (87.8%) than for TLIF (98.1%) (p=0.007). The changes of VAS and ODI between the TLIF and DLIF were not significantly different (p>0.05). Conclusion Both DLIF and TLIF are less invasive and thus good surgical options for treating degenerative lumber diseases. DLIF has higher potential in increasing neural foramina and correcting coronal balance, and involves a shorter operative time and reduced EBL, in comparison with TLIF. However, DLIF displayed a lower fusion rate than TLIF, and caused complications related to the transpsoas approach. PMID:25628805

  15. Is running associated with degenerative joint disease

    SciTech Connect

    Panush, R.S.; Schmidt, C.; Caldwell, J.R.; Edwards, N.L.; Longley, S.; Yonker, R.; Webster, E.; Nauman, J.; Stork, J.; Pettersson, H.

    1986-03-07

    Little information is available regarding the long-term effects, if any, of running on the musculoskeletal system. The authors compared the prevalence of degenerative joint disease among 17 male runners with 18 male nonrunners. Running subjects (53% marathoners) ran a mean of 44.8 km (28 miles)/wk for 12 years. Pain and swelling of hips, knees, ankles and feet and other musculoskeletal complaints among runners were comparable with those among nonrunners. Radiologic examinations (for osteophytes, cartilage thickness, and grade of degeneration) also were without notable differences among groups. They did not find an increased prevalence of osteoarthritis among the runners. Our observations suggest that long-duration, high-mileage running need to be associated with premature degenerative joint disease in the lower extremities.

  16. Is running associated with degenerative joint disease

    Microsoft Academic Search

    R. S. Panush; C. Schmidt; J. R. Caldwell; N. L. Edwards; S. Longley; R. Yonker; E. Webster; J. Nauman; J. Stork; H. Pettersson

    1986-01-01

    Little information is available regarding the long-term effects, if any, of running on the musculoskeletal system. The authors compared the prevalence of degenerative joint disease among 17 male runners with 18 male nonrunners. Running subjects (53% marathoners) ran a mean of 44.8 km (28 miles)\\/wk for 12 years. Pain and swelling of hips, knees, ankles and feet and other musculoskeletal

  17. Degenerative joint disease: cartilage or vascular disease?

    Microsoft Academic Search

    H. Imhof; M. Breitenseher; F. Kainberger; S. Trattnig

    1997-01-01

    The aetiology of degenerative joint diseases is multifactorial, but one main cause is overloading (mechanical stress). While\\u000a until recently it was well accepted that this represented primarily a disorder of cartilage with reactive subchondral changes,\\u000a there is now some evidence that it might be primarily a subchondral problem with secondary changes in the articular cartilage.\\u000a Early subchondral changes include redistribution

  18. 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

  19. Degenerative disease affecting the nervous system.

    PubMed

    Eadie, M J

    1974-03-01

    The term "degenerative disease" is one which is rather widely used in relation to the nervous system and yet one which is rarely formally and carefully defined. The term appears to be applied to disorders of the nervous system which often occur in later life and which are of uncertain cause. In the Shorter Oxford Dictionary the word degeneration is defined as "a change of structure by which an organism, or an organ, assumes the form of a lower type". However this is not quite the sense in which the word is applied in human neuropathology, where it is conventional to restrict the use of the word to those organic disorders which are of uncertain or poorly understood cause and in which there is a deterioration or regression in the level of functioning of the nervous system. The concept of degenerative disorder is applied to other organs as well as to the brain, and as disease elsewhere in the body may affect the nervous system, it seems reasonable to include within the topic of degenerative disorder affecting the nervous system those conditions in which the nervous system is involved as a result of primary degenerations in other parts of the body. PMID:25026144

  20. Lumbar spondylolysis: a review

    Microsoft Academic Search

    Antonio Leone; Alessandro Cianfoni; Alfonso Cerase; Nicola Magarelli; Lorenzo Bonomo

    2011-01-01

    Spondylolysis is an osseous defect of the pars interarticularis, thought to be a developmental or acquired stress fracture\\u000a secondary to chronic low-grade trauma. It is encountered most frequently in adolescents, most commonly involving the lower\\u000a lumbar spine, with particularly high prevalence among athletes involved in certain sports or activities. Spondylolysis can\\u000a be asymptomatic or can be a cause of spine

  1. Electrodiagnosis of lumbar radiculopathy.

    PubMed

    Barr, Karen

    2013-02-01

    The evaluation of patients with suspected lumbar radiculopathy is one of the most common reasons patients are referred for electrodiagnostic testing. The utility of this study depends on the expertise of the physician who plans, performs, and completes the study. This article reviews the strengths and weaknesses of electrodiagnosis to make this diagnosis, as well as the clinical reasoning of appropriate study planning. The current use of electrodiagnostic testing to determine prognosis and treatment outcomes is also discussed. PMID:23177032

  2. Comparison of the different surgical approaches for lumbar interbody fusion.

    PubMed

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

    2015-02-01

    This review will outline the history of spinal fusion. It will compare the different approaches currently in use for interbody fusion. A comparison of the techniques, including minimally invasive surgery and graft options will be included. Lumbar interbody fusion is a commonly performed surgical procedure for a variety of spinal disorders, especially degenerative disease. Currently this procedure is performed using anterior, lateral, transforaminal and posterior approaches. Minimally invasive techniques have been increasing in popularity in recent years. A posterior approach is frequently used and has good fusion rates and low complication rates but is limited by the thecal and nerve root retraction. The transforaminal interbody fusion avoids some of these complications and is therefore preferable in some situations, especially revision surgery. An anterior approach avoids the spinal cord and cauda equina all together, but has issues with visceral exposure complications. Lateral lumbar interbody fusion has a risk of lumbar plexus injury with dissection through the psoas muscle. Studies show less intraoperative blood loss for minimally invasive techniques, but there is no long-term data. Iliac crest is the gold standard for bone graft, although adjuncts such as bone morphogenetic proteins are being used more frequently, despite their controversial history. More high-level studies are needed to make generalisations regarding the outcomes of one technique compared with another. PMID:25439753

  3. Mesenteric Fibromatosis Causing Ureteral Stenosis

    PubMed Central

    Choi, Jae Young; Kang, Kyung Mo; Kim, Bum Soo

    2010-01-01

    Mesenteric fibromatosis is a rare benign disease characterized by proliferating fibrous tissue in the bowel mesentery. We report a case of aggressive mesenteric fibromatosis with ureteral stenosis arising in a 46-year-old woman who suffered from intermittent right abdominal pain. Computed tomography revealed a right retroperitoneal mass with right ureteral stenosis at the level of the right common iliac vessel. The mass was excised with resection of the affected segment of the ileum, ascending colon, and ureter, and end-to-end ureter anastomosis was performed. Pathological examination confirmed mesenteric fibromatosis. PMID:20664786

  4. Spinal stenosis: assessment of motor function, VEGF expression and angiogenesis in an experimental model in the rat

    Microsoft Academic Search

    Kazuyuki Watanabe; Shin-ichi Konno; Miho Sekiguchi; Shin-ichi Kikuchi

    2007-01-01

    Reduction of blood flow in compressed nerve roots is considered as one important mechanism of induction of neurogenic intermittent\\u000a claudication in lumbar spinal canal stenosis. Vascular endothelial growth factor (VEGF) is a potent stimulator of angiogenesis,\\u000a and is increased in expression in hypoxic conditions. The objective of this study was to examine if cauda equina compression\\u000a affects motor function and

  5. Preliminary results of a soft novel lumbar intervertebral prothesis (DIAM) in the degenerative spinal pathology

    Microsoft Academic Search

    Aldo Mariottini; S. Pieri; S. Giachi; B. Carangelo; A. Zalaffi; F. V. Muzii; L. Palma

    The authors report a series of 43 patients suffering from lower limb pain, almost constantly associated with chronic or acute backpain, treated by microsurgical nerve root decompression and by implantation of a soft intervertebral prothesis (DIAM). Satisfying results were obtained in 97% of cases, inducing the authors to consider the device a reliable tool for curing low-back pain and sciatica.

  6. Spinal cord compression due to undiagnosed thoracic meningioma following lumbar surgery in an elderly patient: a case report.

    PubMed

    Knafo, S; Lonjon, G; Vassal, M; Bouyer, B; Lonjon, N

    2013-12-01

    As spinal surgery in elderly patients is becoming increasingly frequent, comorbidities likely to be decompensated after such procedures must be kept in mind. We report here the case of an 82-year-old woman who presented rapidly progressive spinal cord compression following lumbar surgery for radiculopathy. Investigations showed a thoracic intradural extramedullary compressive lesion, which after removal turned out to be a meningioma. We suggest that radiculopathy and non-specific degenerative modifications partially masked this lesion, and that lumbar surgery caused this acute neurological deterioration. Therefore, we advice caution in older patients among whom such ambiguous clinical presentation is frequent. PMID:24210294

  7. [Submuscular approach to the lumbar spine and extraforaminal cage implantation].

    PubMed

    Magerl, F

    2011-02-01

    The posterior median approach to the lumbar spine may cause significant injury to the erector spinae muscles (ESM) which is minimized using the paralateral approach suggested by Ray. We have adopted this approach and have extended it into the disc space to allow cage implantation from outside the foramen (EPLIF - extraforaminal posterior lumbar interbody fusion). The initial exposure of the posterior vertebral elements between the ESM and the deep lumbar fascia is sufficient to attain the entry points of pedicle screws. The intervertebral foramen and posterior annulus fibrosus are then exposed after which distant lateral disc herniations may be removed, the foramen/lateral recess may be decompressed or an EPLIF performed following clearing and vertical distraction of the disc space. This is followed by ipsilateral transpedicular fixation (TpF), contralateral fixation (second approach) by TpF or translaminar screws. Indications are given for foraminal and extraforaminal disc herniation, stenosis of the foramen and/or of the lateral recess, posterolateral fusion, TpF and EPLIF. The submuscular approach and EPLIF have proven to be valuable alternatives to standard techniques. PMID:21301809

  8. Modified Posterior Lumbar Interbody Fusion for Radiculopathy Following Healed Vertebral Collapse of the Middle-Lower Lumbar Spine

    PubMed Central

    Yamashita, Tomoya; Sakaura, Hironobu; Miwa, Toshitada; Ohwada, Tetsuo

    2014-01-01

    Study Design?Retrospective study. Objectives?Lumbar radiculopathy is rarely observed in patients who have achieved bony healing of vertebral fractures in the middle-lower lumbar spine. The objectives of the study were to clarify the clinical features of such radiculopathy and to evaluate the preliminary outcomes of treatment using a modified posterior lumbar interbody fusion (PLIF) procedure. Methods?Fourteen patients with at least 2-year follow-up were enrolled in this study. The radiologic and clinical features of radiculopathy were retrospectively reviewed. As part of our modified PLIF procedure, a bone block was laid on chipped bone to fill the cavity of the fractured end plate and to flatten the cage–bone interface. Results?The morphologic features of spinal deformity in our patients typically consisted of the intradiscal vacuum phenomenon, spondylolisthesis, and a retropulsed intervertebral disk with a vertebral rim in the damaged segment. Cranial end plate fracture resulted in radiculopathy of the traversing nerve roots due to lateral recess stenosis. On the other hand, caudal end plate fracture led to unilateral radiculopathy of the exiting nerve root due to foraminal stenosis. The mean recovery rate based on the Japanese Orthopaedic Association score was 65.0%. Solid fusion was achieved in all but one case. Conclusions?Because of severe deterioration of the anterior column following end plate fracture, the foraminal zone must be decompressed in caudal end plate fractures. The modified PLIF procedure yielded satisfactory clinical outcomes due to anterior reconstruction and full decompression for both foraminal and lateral recess stenoses. PMID:25396106

  9. Modified posterior lumbar interbody fusion for radiculopathy following healed vertebral collapse of the middle-lower lumbar spine.

    PubMed

    Yamashita, Tomoya; Sakaura, Hironobu; Miwa, Toshitada; Ohwada, Tetsuo

    2014-12-01

    Study Design?Retrospective study. Objectives?Lumbar radiculopathy is rarely observed in patients who have achieved bony healing of vertebral fractures in the middle-lower lumbar spine. The objectives of the study were to clarify the clinical features of such radiculopathy and to evaluate the preliminary outcomes of treatment using a modified posterior lumbar interbody fusion (PLIF) procedure. Methods?Fourteen patients with at least 2-year follow-up were enrolled in this study. The radiologic and clinical features of radiculopathy were retrospectively reviewed. As part of our modified PLIF procedure, a bone block was laid on chipped bone to fill the cavity of the fractured end plate and to flatten the cage-bone interface. Results?The morphologic features of spinal deformity in our patients typically consisted of the intradiscal vacuum phenomenon, spondylolisthesis, and a retropulsed intervertebral disk with a vertebral rim in the damaged segment. Cranial end plate fracture resulted in radiculopathy of the traversing nerve roots due to lateral recess stenosis. On the other hand, caudal end plate fracture led to unilateral radiculopathy of the exiting nerve root due to foraminal stenosis. The mean recovery rate based on the Japanese Orthopaedic Association score was 65.0%. Solid fusion was achieved in all but one case. Conclusions?Because of severe deterioration of the anterior column following end plate fracture, the foraminal zone must be decompressed in caudal end plate fractures. The modified PLIF procedure yielded satisfactory clinical outcomes due to anterior reconstruction and full decompression for both foraminal and lateral recess stenoses. PMID:25396106

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

    PubMed Central

    Braaksma, Brian; Weinreb, Jeffrey H.; Nalbandian, Matthew; Spivak, Jeffrey M.; Petrizzo, Anthony

    2014-01-01

    Objective. The purpose of this study was to evaluate a new questionnaire to assess outcomes related to the midline anterior lumbar approach and to identify risk factors for negative patient responses. Methods. A retrospective review of 58 patients who underwent anterior lumbar surgery at a single institution for either degenerative disc disease or spondylolisthesis in 2009 was performed. The outcome measures included our newly developed Anterior Lumbar Surgery Questionnaire (ALSQ), ODI, and EQ-5D. Results. There were 58 patients available for followup, 27 women and 31 men. The average age at surgery was 50.8 years, with an average followup of 2.92 years. The average change in ODI was 34.94 (22.7) and EQ-5D was 0.28 (0.29). The rate of complications with the anterior approach was 10.3% and there was one male patient (3.2%) with retrograde ejaculation. Determination of the effectiveness of the new ALSQ revealed that it significantly correlated to the EQ-5D and ODI (P < 0.05). Smoking was associated with a negative response on thirteen questions. BMP use was not associated with a negative response on any sexual function questions. Conclusions. Our new Anterior Lumbar Surgery Questionnaire determines patient perceived complications related to the midline anterior lumbar surgical approach. PMID:25610657

  11. Clinical and radiographic outcomes after minimally invasive transforaminal lumbar interbody fusion

    PubMed Central

    Etame, Arnold B.; Wang, Anthony C.; Than, Khoi D.; Park, Paul

    2010-01-01

    Objective To evaluate outcomes after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Background MI-TLIF is a relatively novel technique for treating symptomatic spondylolisthesis and degenerative disc disease of the lumbar spine. It has become a popular option for lumbar arthrodesis largely because of its potential to minimize iatrogenic trauma to the soft tissue, paraspinous muscles as well as to neural elements. Methods Literature search using PubMed database. Results Eight retrospective clinical studies and 1 prospective clinical study were identified. No randomized studies were found. The indications for surgery were low-back pain and/or radicular symptoms secondary to spondylolisthesis and/or degenerative disc disease. Analysis of radiographic outcomes demonstrated a fusion rate greater than 90% in the vast majority of patients. Patients also experienced a significant improvement in functional outcome parameters at a mean follow-up of 20 months. Comparison of functional outcomes of MI-TLIF patients to a similar matched cohort of patients who underwent conventional open TLIF did not demonstrate any statistically significant difference between both cohorts. Conclusion For carefully selected patients, MI-TLIF has a very favorable long term outcome that is comparable to conventional open TLIF, with the added benefit of decreased adjacent tissue injury.

  12. 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

  13. Pars Stress Fracture (Lumbar Spondylolysis)

    MedlinePLUS

    ... Neck and Back) > Pars Stress Fracture Pars Stress Fracture Page Content Pars stress fractures occur in young athletes involved in repetitive bending ... an episode of low back pain Pars stress fracture, also called lumbar spondylolysis, is one of the ...

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

    SciTech Connect

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

    1984-03-01

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

  15. A Meta-Analysis of Unilateral versus Bilateral Pedicle Screw Fixation in Minimally Invasive Lumbar Interbody Fusion

    PubMed Central

    Liu, Zheng; Fei, Qi; Wang, Bingqiang; Lv, Pengfei; Chi, Cheng; Yang, Yong; Zhao, Fan; Lin, Jisheng; Ma, Zhao

    2014-01-01

    Study Design Meta-analysis. Background Bilateral pedicle screw fixation (PS) after lumbar interbody fusion is a widely accepted method of managing various spinal diseases. Recently, unilateral PS fixation has been reported as effective as bilateral PS fixation. This meta-analysis aimed to comparatively assess the efficacy and safety of unilateral PS fixation and bilateral PS fixation in the minimally invasive (MIS) lumbar interbody fusion for one-level degenerative lumbar spine disease. Methods MEDLINE/PubMed, EMBASE, BIOSIS Previews, and Cochrane Library were searched through March 30, 2014. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on unilateral versus bilateral PS fixation in MIS lumbar interbody fusion that met the inclusion criteria and the methodological quality standard were retrieved and reviewed. Data on participant characteristics, interventions, follow-up period, and outcomes were extracted from the included studies and analyzed by Review Manager 5.2. Results Six studies (5 RCTs and 1 CCT) involving 298 patients were selected. There were no significant differences between unilateral and bilateral PS fixation procedures in fusion rate, complications, visual analogue score (VAS) for leg pain, VAS for back pain, Oswestry disability index (ODI). Both fixation procedures had similar length of hospital stay (MD?=?0.38, 95% CI?=??0.83 to 1.58; P?=?0.54). In contrast, bilateral PS fixation was associated with significantly more intra-operative blood loss (P?=?0.002) and significantly longer operation time (P?=?0.02) as compared with unilateral PS fixation. Conclusions Unilateral PS fixation appears as effective and safe as bilateral PS fixation in MIS lumbar interbody fusion but requires less operative time and causes less blood loss, thus offering a simple alternative approach for one-level lumbar degenerative disease. PMID:25375315

  16. The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery

    PubMed Central

    Braybrooke, Jason; Ahn, Henry; Gallant, Aimee; Ford, Michael; Bronstein, Yigel; Finkelstein, Joel

    2007-01-01

    A prospective observational study was conducted on patients undergoing posterior lumbar spine surgery for degenerative spinal disorders. The study purpose was to evaluate the effect of wait time to surgery on patient derived generic and disease specific functional outcome following surgery. A prolonged wait to surgery may adversely affect surgical outcome. Although there is literature on the effect of wait time to surgery in surgical fields such as oncology, cardiac, opthamologic, and total joint arthroplasty, little is known regarding the effect of wait time to surgery as it pertains to the spinal surgical population. Consecutive patients undergoing elective posterior lumbar spinal surgery for degenerative disorders were recruited. Short-Form 36 and Oswestry disability questionnaires were administered (pre-operatively, and at 6 weeks, 6 months, and 1 year post-operatively). Patients completed a questionnaire regarding their experience with the wait time to surgery. The study cohort consisted of 70 patients with follow-up in 53/70 (76%). Time intervals from the onset of patient symptoms to initial consultation by family physician through investigations, spinal surgical consultation and surgery were quantified. Time intervals were compared to patient specific improvements in reported outcome following surgery using Cox Regression analysis. The effect of patient and surgical parameters on wait time was evaluated using the median time as a reference for those patients who had either a longer or shorter wait. Significant improvements in patient derived outcome were observed comparing post-operative to pre-operative baseline scores. The greatest improvements were observed in aspects relating to physical function and pain. A longer wait to surgery was associated with less improvement in outcome following surgery (SF-36 domains of BP, GH, RP, VT). A longer wait time to surgery negatively influences the results of posterior lumbar spinal surgery for degenerative conditions as quantified by patient derived functional outcome measures. The parameters of pain severity and physical aspects of function appear to be the most significantly affected. PMID:17701060

  17. [Occupational disease 2108. Degenerative changes of the cervical spine as a causality criterion in the assessment of discogenic diseases according to BeKV 2108].

    PubMed

    Hartwig, E; Schultheiss, M; Krämer, S; Ebert, V; Kinzl, L; Kramer, M

    2003-04-01

    With the second amendment to the Ordinance on Occupational Diseases (BeKV) of 18 December 1992, discogenic diseases of the spine are included in the disease register of occupational diseases for the first time. If occupations that impose stress on the spine have been practised for many years, the possibility exists of recognizing degenerative diseases as an occupational disease. In assessment practice, the radiological data on the spine exposed to stress is compared with that of regions which are remote from the stress (cervical/thoracic spine). This pattern of the distribution of degenerative disease is then used as the basis for determining a causal relationship between the occupation causing the stress and disease of the axial skeleton. The pattern of degeneration of the cervical spine was investigated in two groups, one with ( n =153) and one without ( n =333) occupations that impose stress on the lumbar spine. A cumulative score of degenerative changes was elaborated and presented as a new classification. No differences were found between the groups with regard to either the frequency of occurrence, segmental distribution or severity of disease. In both groups, degenerative changes correlated with age. The prevailing assessment practice is discussed on the basis of these data. PMID:12719851

  18. Annulo-nucleoplasty using Disc-FX in the management of lumbar disc pathology: Early results

    PubMed Central

    Kumar, Aravind; Siddharth M, Shah; Sambhav P, Shah; Tan, Justin

    2014-01-01

    Background Back pain due to Lumbar Disc Disease is a major clinical problem. The treatment options range from physiotherapy to fusion surgery. A number of minimally invasive procedures have also been developed in the recent past for its management. Disc-FX is a new minimally invasive technique that combines percutaneous discectomy, nuclear ablation and annular modification. Literature on its role in the management of lumbar disc pathology is scarce. Methods We included 24 consecutive patients who underwent the Disc-FX for back pain due to lumbar disc pathology non-responsive to non-operative treatment for a period of at least 6 months. Based on Magnetic Resonance Imaging (MRI) these patients fell into 2 groups – those with degenerative disc disease (DDD) (n = 12) and those with a contained lumbar disc herniation (CLDH)(n = 12). They were evaluated using the Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36) scores preoperatively and postoperatively. Results The mean age was 37.9 years (21-53 years). There were 17 males and 7 females. One patient in each subgroup was excluded from the final evaluation. Significant improvement was seen in all outcome measures. The overall rate of reintervention for persistent symptoms was 18.18% (4/22); in the CLDH subgroup, it was 36.36% (4/11). Conclusions and level of evidence Early results after the Disc-FX procedure suggest that it s a reasonable treatment option for patients with back pain due to lumbar disc disease, especially for those with DDD who fail conservative treatment. It could be an alternative to procedures like fusion or disc replacement. This study presents Level IV evidence. Clinical relevance We feel that our study establishes Disc-FX as a modality of treating symptomatic lumbar disc disease due to DDD. However, longer term prospective studies are needed to prove this and to evaluate its role in the treatment of patients with CLDH. PMID:25694914

  19. Retroperitoneal lymphocele after lumbar total disc replacement: a case report and review of literature

    PubMed Central

    Mohapatra, Bibhudendu; Kishen, Thomas; Loi, Ken W. K.; Diwan, Ashish D.

    2010-01-01

    Background Retroperitoneal lymphoceles (RPLs) caused by injury to the lymphatics are commonly seen after pelvic lymphadenectomy, renal transplantation, and gynecologic tumor resection surgeries. Degenerative disc disease still remains the major cause of low-back pain. Anterior lumbar spinal procedures, such as anterior lumbar interbody fusion and anterior lumbar arthroplasty, have been increasingly performed for treatment of axial back pain. RPLs, as an approach-related complication, though infrequent, have been reported after anterior lumbar spinal surgery. We report a case of RPL after total disc replacement of the lumbar spine. To our knowledge, there has been no prior report of RPL after total disc replacement managed by percutaneous aspiration only. Methods A 49-year-old woman who underwent total disc replacement at the L4-5 level presented with a postoperative complication of RPL. The imaging findings, clinical course, and treatment are discussed, and a review of literature is presented. Results The patient presented with significant abdominal swelling and discomfort at 4 weeks after surgery without any signs or symptoms of infection. Investigations showed an RPL. She was treated by multiple aspirations under ultrasound guidance. At 12 months’ follow-up, the patient had no further abdominal symptoms and had gone back to her routine activities and work with significant improvement in back pain. Conclusions RPL is an uncommon complication after anterior lumbar surgery and can be managed effectively if detected and diagnosed early. Although repeated aspiration is associated with high recurrence and infection, it is a safe and minimally invasive procedure to manage RPL.

  20. Cine magnetic resonance imaging of aqueductal stenosis

    Microsoft Academic Search

    Chikafusa Kadowaki; Mitsuhiro Hara; Mitsuo Numoto; Kazuo Takeuchi; Isamu Saito

    1995-01-01

    Cerebral aqueductal stenosis is one of the most common causes of congenital and acquired hydrocephalus, but the etiology, pathophysiology and cerebrospinal fluid (CSF) dynamics of aqueductal stenosis have yet to be clarified. Utilizing cardiac gated cine magnetic resonance (MR) imaging, we evaluated aqueductal configuration and pulsatile motion of brain and CSF flow stimulated by cardiac pulsation in five patients with

  1. Supravalvular aortic stenosis: elastin arteriopathy.

    PubMed

    Merla, Giuseppe; Brunetti-Pierri, Nicola; Piccolo, Pasquale; Micale, Lucia; Loviglio, Maria Nicla

    2012-12-01

    Supravalvular aortic stenosis is a systemic elastin (ELN) arteriopathy that disproportionately affects the supravalvular aorta. ELN arteriopathy may be present in a nonsyndromic condition or in syndromic conditions such as Williams-Beuren syndrome. The anatomic findings include congenital narrowing of the lumen of the aorta and other arteries, such as branches of pulmonary or coronary arteries. Given the systemic nature of the disease, accurate evaluation is recommended to establish the degree and extent of vascular involvement and to plan appropriate interventions, which are indicated whenever hemodynamically significant stenoses occur. ELN arteriopathy is genetically heterogeneous and occurs as a consequence of haploinsufficiency of the ELN gene on chromosome 7q11.23, owing to either microdeletion of the entire chromosomal region or ELN point mutations. Interestingly, there is a prevalence of premature termination mutations resulting in null alleles among ELN point mutations. The identification of the genetic defect in patients with supravalvular aortic stenosis is essential for a definitive diagnosis, prognosis, and genetic counseling. PMID:23250899

  2. 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

  3. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...7 2013-10-01 2013-10-01 false Lumbar spine. 572.187 Section 572.187 Transportation...Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in...

  4. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...7 2012-10-01 2012-10-01 false Lumbar spine. 572.187 Section 572.187 Transportation...Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in...

  5. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...7 2014-10-01 2014-10-01 false Lumbar spine. 572.187 Section 572.187 Transportation...Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in...

  6. 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...

  7. Degenerative changes in adolescent spines: a comparison of motocross racers and age-matched controls.

    PubMed

    Daniels, David J; Luo, T David; Puffer, Ross; McIntosh, Amy L; Larson, A Noelle; Wetjen, Nicholas M; Clarke, Michelle J

    2015-03-01

    OBJECT Motocross racing is a popular sport; however, its impact on the growing/developing pediatric spine is unknown. Using a retrospective cohort model, the authors compared the degree of advanced degenerative findings in young motocross racers with findings in age-matched controls. METHODS Patients who had been treated for motocross-related injury at the authors' institution between 2000 and 2007 and had been under 18 years of age at the time of injury and had undergone plain radiographic or CT examination of any spinal region were eligible for inclusion. Imaging was reviewed in a blinded fashion by 3 physicians for degenerative findings, including endplate abnormalities, loss of vertebral body height, wedging, and malalignment. Acute pathological segments were excluded. Spine radiographs from age-matched controls were similarly reviewed and the findings were compared. RESULTS The motocross cohort consisted of 29 riders (mean age 14.7 years; 82% male); the control cohort consisted of 45 adolescents (mean age 14.3 years; 71% male). In the cervical spine, the motocross cohort had 55 abnormalities in 203 segments (average 1.90 abnormalities/patient) compared with 20 abnormalities in 213 segments in the controls (average 0.65/patient) (p = 0.006, Student t-test). In the thoracic spine, the motocross riders had 51 abnormalities in 292 segments (average 2.04 abnormalities/patient) compared with 25 abnormalities in 299 segments in the controls (average 1.00/patient) (p = 0.045). In the lumbar spine, the motocross cohort had 11 abnormalities in 123 segments (average 0.44 abnormalities/patient) compared with 15 abnormalities in 150 segments in the controls (average 0.50/patient) (p = 0.197). CONCLUSIONS Increased degenerative changes in the cervical and thoracic spine were identified in adolescent motocross racers compared with age-matched controls. The long-term consequences of these changes are unknown; however, athletes and parents should be counseled accordingly about participation in motocross activities. PMID:25555120

  8. Transplant Renal Artery Stenosis Presenting with Recurrent Acute Pulmonary Edema

    Microsoft Academic Search

    Wai-Choong Lye; See-Odd Leong; Evan J. C. Lee

    1996-01-01

    Renal artery stenosis of the transplant kidney occurs in approximately 6% of renal allograft recipients. Severe bilateral renal artery stenosis and unilateral renal artery stenosis to a single functioning kidney have been described as causes of recurrent pulmonary edema in nontransplant patients with normal cardiac function. We report 2 patients with severe transplant renal artery stenosis who presented with recurrent

  9. Endovascular advances for extracranial carotid stenosis.

    PubMed

    Eller, Jorge L; Dumont, Travis M; Sorkin, Grant C; Mokin, Maxim; Levy, Elad I; Snyder, Kenneth V; Nelson Hopkins, L; Siddiqui, Adnan H

    2014-02-01

    Carotid artery stenting has become a viable alternative to carotid endarterectomy in the management of carotid stenosis. Over the past 20 years, many trials have attempted to compare both treatment modalities and establish the indications for each one, depending on clinical and anatomic features presented by patients. Concurrently, carotid stenting techniques and devices have evolved and made endovascular management of carotid stenosis safe and effective. Among the most important innovations are devices for distal and proximal embolic protection and new stent designs. This paper reviews these advances in the endovascular management of carotid artery stenosis within the context of the historical background. PMID:24402498

  10. 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

  11. Hyperlipidaemia diagnosed at lumbar puncture.

    PubMed Central

    Burke, B. J.; McKee, J. I.; Hargreaves, T.

    1981-01-01

    A patient presenting with subarachnoid haemorrhage and high lipid concentrations in the cerebrospinal fluid (taken at lumbar puncture), who has later shown to have type V hyperlipidaemia is described. This case, so far as can be ascertained by the authors, is the first report of hyperlipidaemia being diagnosed from CSF examination. Images Fig. 1 PMID:7267506

  12. SPECT/CT imaging of the lumbar spine in chronic low back pain: a case report

    PubMed Central

    2011-01-01

    Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT) allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localisation to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was more quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies. PMID:21247412

  13. 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

  14. Congenital tracheobronchial stenosis in monozygotic twins

    Microsoft Academic Search

    K. S. Wong; R. Lien; T. Y. Lin

    1998-01-01

      \\u000a \\u000a Conclusion This case report shows that tracheobronchial stenosis may present in monozygotic twins. The pattern of malformation in twins\\u000a differs from cases described previously.

  15. Supravalvular aortic stenosis in William's syndrome.

    PubMed

    Mohan, Bishav; Mittal, Chander Mohan

    2011-07-01

    We report supravalvular aortic stenosis in a 12 year old patient who presented with mental retardation, malformed teeth, broad lower lips, pectus carinatum, clinodactyly, kyphoscoliosis with symptoms of shortness of breath. On examination presence of better volume pulse in right radial artery with ejection systolic murmur best heard in right 2(nd) intercostal space were noted. Patient was diagnosed as having William's syndrome with investigations demonstrating Supravalvular aortic stenosis with a gradient of 170 mm Hg. PMID:21976893

  16. 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

  17. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

    PubMed Central

    Iwatsuki, Koichi; Ohnishi, Yu-ichiro; Yoshimine, Toshiki

    2014-01-01

    A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an “intact” disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted. PMID:25276453

  18. Adjacent lumbar disc herniation after lumbar short spinal fusion.

    PubMed

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

    2014-01-01

    A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3-5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an "intact" disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted. PMID:25276453

  19. 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

  20. Renal artery stenosis - an update.

    PubMed

    Sattur, Sudhakar; Prasad, Hari; Bedi, Updesh; Kaluski, Edo; Stapleton, Dwight D

    2013-09-01

    Renal artery stenosis (RAS) is a common form of peripheral arterial disease. The most common cause of RAS is atherosclerosis. It is predominantly unilateral. The pathophysiologic mechanism stems from renal underperfusion resulting in the activation of the renin- angiotensin-aldosterone pathway. Even though the majority of patients with RAS are asymptomatic, it can clinically present with hypertension, nephropathy and congestive heart failure. This progressive disease can lead to resistant hypertension and end stage kidney failure. Screening patients for RAS with either Doppler ultrasonography, computed tomographic angiography, or magnetic resonance angiography is preferred. Adequate blood pressure control, goal-directed lipid-lowering therapy, smoking cessation, and other preventive measures form the foundation of management of patients with RAS. Catheter-based percutaneous revascularization with angioplasty and stenting showed modest clinical benefit for patients in small retrospective studies, but data from randomized clinical trials failed to confirm these beneficial results. The current ongoing Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial may provide more concrete data regarding the role of stenting in RAS. Surgical revascularization is considered only if catheter-based revascularization is unsuitable or unsuccessful. The American College of Cardiology/American Heart Association guidelines on evaluation and management of patients with RAS provide the framework for determining individualized assessment and treatment plans for patients with RAS. PMID:24113662

  1. Stem cell-based therapeutic applications in retinal degenerative diseases

    PubMed Central

    Huang, Yiming; Enzmann, Volker; Ildstad, Suzanne T.

    2012-01-01

    Retinal degenerative diseases that target photoreceptors or the adjacent retinal pigment epithelium (RPE) affect millions of people worldwide. Retinal degeneration (RD) is found in many different forms of retinal diseases including retinitis pigmentosa (RP), age-related macular degeneration (AMD), diabetic retinopathy, cataracts, and glaucoma. Effective treatment for retinal degeneration has been widely investigated. Gene-replacement therapy has been shown to improve visual function in inherited retinal disease. However, this treatment was less effective with advanced disease. Stem cell-based therapy is being pursued as a potential alternative approach in the treatment of retinal degenerative diseases. In this review, we will focus on stem cell-based therapies in the pipeline and summarize progress in treatment of retinal degenerative disease. PMID:20859770

  2. Determination of trunk motion patterns associated with permanent or transient stenosis of the lumbar spine

    Microsoft Academic Search

    M. Szpalski; F. Michel; J.-P. Hayez

    1996-01-01

    Dynamometric devices used to assess back function are becoming increasingly used in research as well as in clinical practice. These devices provide values for a variety of movement variables such as torque, displacement, and velocity, but they also enable the study of movement patterns. The purpose of this study was to determine the movement patterns of patients presenting with specific

  3. Intraspinal metalloma causing lumbar stenosis after interbody fusion with cylindrical titanium cages.

    PubMed

    Fernández-Baíllo, Nicomedes; Sánchez Marquez, José Miguel; Conde Gallego, Esther; Martín Esteban, Ana

    2012-12-01

    Intraspinal metallomas are rare. The authors present a case after implantation of two titanium threaded interbody cages at the L4L5 level, without posterior instrumentation. To their knowledge this is the first case due to intervertebral cages. The lack of additional instrumentation had probably allowed the cages to make contact. Subsequently, friction generated wear debris, which led to the formation of a granuloma, responsible for compression of the dural sac. Intraspinal metallosis should be kept in mind as an infrequent cause of delayed neurological symptoms after spinal surgery with metallic instrumentation. PMID:23409582

  4. Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis

    PubMed Central

    Hayashino, Yasuaki; Fukuhara, Shunichi; Kikuchi, Shinichi; Kaneda, Kiyoshi; Seichi, Atsushi; Chiba, Kazuhiro; Satomi, Kazuhiko; Nagata, Kensei; Kawai, Shinya

    2007-01-01

    No clinical diagnostic support tool can help identify patients with LSS. Simple diagnostic tool may improve the accuracy of the diagnosis of LSS. The aim of this study was to develop a simple clinical diagnostic tool that may help physicians to diagnose LSS in patients with lower leg symptoms. Patients with pain or numbness of the lower legs were prospectively enrolled. The diagnosis of LSS by experienced orthopedic specialists was the outcome measure. Multivariable logistic regression analysis identified factors that predicted LSS; a simple clinical prediction rule was developed by assigning a risk score to each item based on the estimated beta-coefficients. From December 2002 to December 2004, 104 orthopedic physicians from 22 clinics and 50 hospitals evaluated 468 patients. Two items of physical examination, three items of patients' symptom, and five items of physical examination were included in the final scoring system as a result of multiple logistic regression analysis. The sum of the risk scores for each patient ranged from ?2 to 16. The Hosmer–Lemeshow statistic was 11.30 (P = 0.1851); the area under the ROC curve was 0.918. The clinical diagnostic support tool had a sensitivity of 92.8% and a specificity of 72.0%. The prevalence of LSS was 6.3% in the bottom quartile of the risk score (?2 to 5) and 99.0% in the top quartile (12 to 16). We developed a simple clinical diagnostic support tool to identify patients with LSS. Further studies are needed to validate this tool in primary care settings. PMID:17549525

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

    PubMed Central

    Gupta, Ranjana; Mittal, Puneet; Mittal, Amit; Mittal, Kapish; Gupta, Sharad; Kaur, Ravleen

    2015-01-01

    Introduction: Back pain is a common clinical problem and is the frequent complaint for referral of lumbar spine magnetic resonance imaging (MRI). Coronal short tau inversion recovery sequence (STIR) can provide diagnostically significant information in small percentage of patients. Materials and Methods: MRI examinations of a total of 350 patients were retrospectively included in the study. MR sequences were evaluated in two settings. One radiologist evaluated sagittal and axial images only, while another radiologist evaluated all sequences, including coronal STIR sequence. After recording the diagnoses, we compared the MRI findings in two subsets of patients to evaluate additional merit of coronal STIR imaging. Results: With addition of coronal STIR imaging, significant findings were observed in 24 subjects (6.8%). Twenty-one of these subjects were considered to be normal on other sequences and in three subjects diagnosis was changed with the addition of coronal STIR. Additional diagnoses on STIR included sacroiliitis, sacroiliac joint degenerative disease, sacral stress/insufficiency fracture/Looser's zones, muscular sprain and atypical appendicitis. Conclusion: Coronal STIR imaging can provide additional diagnoses in a small percentage of patients presenting for lumbar spine MRI for back pain. Therefore, it should be included in the routine protocol for MR imaging of lumbar spine. PMID:25788815

  6. Posterior Lumbar Interbody Fusion Using an Unilateral Cage: A Prospective Study of Clinical Outcome and Stability

    PubMed Central

    Lee, Seok Ki; Kim, Seok Won; Ju, Chang Il; Lee, Sung Myung

    2014-01-01

    Objective The purpose of this study was to evaluate the clinical and radiological results of instrumented posterior lumbar interbody fusion (PLIF) using an unilateral cage. Methods Seventeen patients with unilateral radiculopathy who underwent bilateral percutaneous screw fixation with a single fusion cage inserted on the symptomatic side for treatment of focal degenerative lumbar spine disease were prospectively enrolled in this study. Their clinical results, radiological parameters, and related complications were assessed 10 days, 3 months, and 12 months postoperatively. Results There was no pseudarthrosis, instrumented fusion failure, significant cage subsidence, or retropulsion in any patient. The surgery restored the disc space height and maintained it as of 12 months postoperatively and did not exacerbate the lumbar lordotic and scoliotic angles. All patients had excellent or good outcomes according to the modified MacNab's criteria. The mean pain score according to the visual analogue scale was 7.5 preoperatively but had improved to 2.5 when reassessed 3 months postoperatively. The improvement was maintained as of 12 months postoperatively. Conclusion In cases of uncomplicated unilateral radiculopathy, PLIF using a single cage can be an effective and safe procedure with the advantage of preserving the posterior elements of the contralateral side. A shorter operative time and greater cost-effectiveness than for PLIF using bilateral cages can be expected. PMID:25110483

  7. Digitalized Design of Extraforaminal Lumbar Interbody Fusion: A Computer-Based Simulation and Cadaveric Study

    PubMed Central

    Yang, Mingjie; Zeng, Cheng; Guo, Song; Pan, Jie; Han, Yingchao; Li, Zeqing; Li, Lijun; Tan, Jun

    2014-01-01

    Purpose This study aims to investigate the feasibility of a novel lumbar approach named extraforaminal lumbar interbody fusion (ELIF), a newly emerging minimally invasive technique for treating degenerative lumbar disorders, using a digitalized simulation and a cadaveric study. Methods The ELIF surgical procedure was simulated using the Mimics surgical simulator and included dissection of the superior articular process, dilation of the vertebral foramen, and placement of pedicle screws and a cage. ELIF anatomical measures were documented using a digitalized technique and subsequently validated on fresh cadavers. Results The use of the Mimics allowed for the vivid simulation of ELIF surgical procedures, while the cadaveric study proved the feasibility of this novel approach. ELIF had a relatively lateral access approach that was located 8–9 cm lateral to the median line with an access depth of approximately 9 cm through the intermuscular space. Dissection of the superior articular processes could fully expose the target intervertebral discs and facilitate a more inclined placement of the pedicle screws and cage with robust enhancement. Conclusions According to the computer-based simulation and cadaveric study, it is feasible to perform ELIF. Further research including biomechanical study is needed to prove ELIF has a superior ability to preserve the posterior tension bands of the spinal column, with similar effects on spinal decompression, fixation, and fusion, and if it can enhance post-fusion spinal stability and expedites postoperative recovery. PMID:25157907

  8. Principal component and factor analysis to study variations in the aging lumbar spine.

    PubMed

    Khan, A A; Iliescu, D D; Sneath, R J; Hutchinson, C E; Shah, A A

    2015-03-01

    Human spine is a multifunctional structure of human body consisting of bones, joints, ligaments, and muscles which all undergo a process of change with the age. A sudden change in these features either naturally or through injury can lead to some serious medical conditions which puts huge burden on health services and economy. While aging is inevitable, the effect of aging on different areas of spine is of clinical significance. This paper reports the growth and degenerative pattern of human spine using principal component analysis. Some noticeable lumbar spine features such as vertebral heights, disc heights, disc signal intensities, paraspinal muscles, subcutaneous fats, psoas muscles, and cerebrospinal fluid were used to study the variations seen on lumbar spine with the natural aging. These features were extracted from lumbar spine magnetic resonance images of 61 subjects with age ranging from 2 to 93 years. Principal component analysis is used to transform complex and multivariate feature space to a smaller meaningful representation. PCA transformation provided 2-D visualization and knowledge of variations among spinal features. Further useful information about correlation among the spinal features is acquired through factor analysis. The knowledge of age related changes in spinal features are important in understanding different spine related problems. PMID:25486654

  9. Work-related outcomes after lumbar fusion

    Microsoft Academic Search

    William R. Klemme; Leila S. Nelson; Edgar G. Dawson; J. Kenneth Burkus; Kevin T. Foley; Stephen M. Papadopoulos

    2002-01-01

    Purpose of study: To date, there are few published data concerning work-related outcomes in patients undergoing lumbar fusion. The present observational study was designed to evaluate specific work-related outcomes in a population-based cohort of patients undergoing lumbar fusion.Methods used: A population-based database of 815 prospectively identified lumbar fusion patients was queried for patients with complete 2-year follow-up. From the resultant

  10. Case report and review of lumbar hernia

    PubMed Central

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

    2014-01-01

    Lumbar hernias are uncommon and about 300 cases have been reported till date. They commonly occur due to trauma, surgery and infection. They are increasingly being reported after motor vehicle collision injuries. However, spontaneous lumbar hernias are rare and are reported infrequently. It is treated with different surgical approaches and methods. We report a case of primary spontaneous lumbar hernia which was repaired by transperitonial laparoscopic approach using Vypro (polypropylene/polyglactin) mesh and covered with a peritoneal flap. PMID:25555145

  11. What is a lumbar puncture? Lumbar puncture (LP), also called a spinal

    E-print Network

    Baloh, Bob

    What is a lumbar puncture? Lumbar puncture (LP), also called a spinal tap, is the procedure doctors through) the bones of the spine until the spinal fluid is found. For testing, approxi- mately 2 to anticipate potential problems and minimize these risks. Lumbar Puncture Fact Sheet Memory & Aging Project

  12. Advances in susceptibility genetics of intervertebral degenerative disc disease.

    PubMed

    Zhang, Yin'gang; Sun, Zhengming; Liu, Jiangtao; Guo, Xiong

    2008-01-01

    The traditional view that the etiology of lumbar disc herniation is primarily due to age, gender, occupation, smoking and exposure to vehicular vibration dominated much of the last century. Recent research indicates that heredity may be largely responsible for the degeneration as well as herniation of intervertebral discs. Since 1998, genetic influences have been confirmed by the identification of several genes forms associated with disc degeneration. These researches are paving the way for a better understanding of the biologic mechanisms. Now, many researchers unanimously agree that lumbar disc herniation appears to be similar to other complex diseases, whose etiology has both environmental and hereditary influence, each with a part of contribution and relative risk. Then addressing the etiological of lumbar disc herniation, it is important to integrate heredity with the environment factors. For the purpose of this review, we have limited our discussion to several susceptibility genes associated with disc degeneration. PMID:18781226

  13. Application of Encapsulated Cell Technology for Retinal Degenerative Diseases

    Microsoft Academic Search

    Weng Tao; Rong Wen

    Encapsulated cell technology (ECT) is essentially a cell-based delivery system that can be used to deliver therapeutic agents\\u000a to the target tissue, including the central nervous system (CNS) and the eye to treat chronic disorders. In this chapter,\\u000a we focus on its application in retinal degenerative diseases.

  14. Premature degenerative shoulder changes in spinal cord injury patients

    Microsoft Academic Search

    Santosh Lal

    1998-01-01

    Shoulder pain and the resultant dysfunction is an expected problem in individuals with spinal cord injury. But there is a remarkable lack of information about the natural history, diagnosis, prevention and long term outcomes. Degenerative changes may develop prematurely in their shoulders, due to overuse and altered mechanical stresses, with or without symptoms was the hypothesis of this prospective study.

  15. Progressive Agraphia Can Be a Harbinger of Degenerative Dementia

    ERIC Educational Resources Information Center

    Fukui, Toshiya; Lee, Eiyai

    2008-01-01

    By investigating three patients with progressive agraphia, we explored the possibility that this entity is an early sign of degenerative dementia. Initially, these patients complained primarily of difficulties writing Kanji (Japanese morphograms) while other language and cognitive impairments were relatively milder. Impairments in writing Kana…

  16. Locking of the Metacarpophalangeal Joints in Degenerative Disease

    Microsoft Academic Search

    G. J. STEWART; E. A. WILLIAMS

    1981-01-01

    Nine cases of locking of the metacarpo-phalangeal joint are described. The previously asymptomatic middle finger joint in an elderly person was most likely to be affected. Radiology of the joint has shown degenerative changes in all cases. In two patients, spontaneous unlocking of the joint occurred and in a further six operative release was undertaken. The important anatomical features of

  17. Oxidative stress and degenerative temporomandibular joint disease: A proposed hypothesis

    Microsoft Academic Search

    Stephen B Milam; Gustavo Zardeneta; John P Schmitz

    1998-01-01

    The molecular events that underlie degenerative temporomandibular joint diseases are poorly understood. Recent studies have provided evidence that a variety of molecular species, including cytokines, matrix degrading enzymes, neuropeptides, and arachidonic acid catabolites may be involved. This paper advances the theory that mechanical stresses lead to the accumulation of damaging free radicals in affected articular tissues of susceptible individuals. This

  18. Pathogenesis of Degenerative Joint Disease in the Human Temporomandibular Joint

    Microsoft Academic Search

    Christine L. Haskin; Stephen B. Milam; Ivan L. Cameron

    1995-01-01

    The wide range of disease prevalences reported in epidemiological studies of temporomandibular degenerative joint disease reflects the fact that diagnoses are frequently guided by the presence or absence of non-specific signs and symptoms. Treatment is aimed at alleviating the disease symptoms rather than being guided by an understanding of the underlying disease processes. Much of our current understanding of disease

  19. Common mechanisms of amyloid oligomer pathogenesis in degenerative disease

    Microsoft Academic Search

    Charles G. Glabe

    2006-01-01

    Many age-related degenerative diseases, including Alzheimer's, Parkinson's, Huntington's diseases and type II diabetes, are associated with the accumulation of amyloid fibrils. The protein components of these amyloids vary widely and the mechanisms of pathogenesis remain an important subject of competing hypotheses and debate. Many different mechanisms have been postulated as significant causal events in pathogenesis, so understanding which events are

  20. The Importance of Proximal Fusion Level Selection for Outcomes of Multi-Level Lumbar Posterolateral Fusion

    PubMed Central

    Nam, Woo Dong

    2015-01-01

    Background There are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes. Methods We retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either 'good' or 'bad' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors. Results Twenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203). Conclusions The overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered. PMID:25729522

  1. Imbalanced Protein Expression Patterns of Anabolic, Catabolic, Anti-Catabolic and Inflammatory Cytokines in Degenerative Cervical Disc Cells: New Indications for Gene Therapeutic Treatments of Cervical Disc Diseases

    PubMed Central

    Mern, Demissew S.; Beierfuß, Anja; Fontana, Johann; Thomé, Claudius; Hegewald, Aldemar A.

    2014-01-01

    Degenerative disc disease (DDD) of the cervical spine is common after middle age and can cause loss of disc height with painful nerve impingement, bone and joint inflammation. Despite the clinical importance of these problems, in current publications the pathology of cervical disc degeneration has been studied merely from a morphologic view point using magnetic resonance imaging (MRI), without addressing the issue of biological treatment approaches. So far a wide range of endogenously expressed bioactive factors in degenerative cervical disc cells has not yet been investigated, despite its importance for gene therapeutic approaches. Although degenerative lumbar disc cells have been targeted by different biological treatment approaches, the quantities of disc cells and the concentrations of gene therapeutic factors used in animal models differ extremely. These indicate lack of experimentally acquired data regarding disc cell proliferation and levels of target proteins. Therefore, we analysed proliferation and endogenous expression levels of anabolic, catabolic, ant-catabolic, inflammatory cytokines and matrix proteins of degenerative cervical disc cells in three-dimensional cultures. Preoperative MRI grading of cervical discs was used, then grade III and IV nucleus pulposus (NP) tissues were isolated from 15 patients, operated due to cervical disc herniation. NP cells were cultured for four weeks with low-glucose in collagen I scaffold. Their proliferation rates were analysed using 3-(4, 5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide. Their protein expression levels of 28 therapeutic targets were analysed using enzyme-linked immunosorbent assay. During progressive grades of degeneration NP cell proliferation rates were similar. Significantly decreased aggrecan and collagen II expressions (P<0.0001) were accompanied by accumulations of selective catabolic and inflammatory cytokines (disintegrin and metalloproteinase with thrombospondin motifs 4 and 5, matrix metalloproteinase 3, interleukin-1?, interleukin-1 receptor) combined with low expression of anti-catabolic factor (metalloproteinase inhibitor 3) (P<0.0001). This study might contribute to inhibit inflammatory catabolism of cervical discs. PMID:24804684

  2. Spatial variation of wear on Charité lumbar discs.

    PubMed

    Prokopovich, P; Perni, S; Fisher, J; Hall, R M

    2011-11-01

    Total disc replacement (TDR) is a modern technique employed to treat degenerative disc disease that has the benefit of preserving motion compared with the clinically established spinal fusion. The wear performance of implants based on articulating designs is a key factor that determines their longevity and it is hypothesized that this will be the case for TDR devices. A detailed analysis of the surface of Charité lumbar disc replacements during simulated wear for five million cycles (MC), with inputs defined by the ISO18192-1 standard, is presented. After each million cycles the disc asperity heights, asperity curvature radii and their distributions on the surface of the core of the implant were determined at different locations. Two distinct areas on the surface of Charité polyethylene disc were identified based on the surface topography change during the wear simulation process. Within the area corresponding to the dome the initial roughness decreased, but after 2 MC the surface appeared to roughen with material build-up. More peripherally on the dome the surface roughness decreased after the first MC and remained constant. No effect was noticed on the rim. Furthermore, no statistical difference was noticed between the inferior and superior sides of the core of the disc. The study demonstrated that the wear on the two surfaces of the disc was uneven. This spatial variation is important in modelling the wear processes and providing strategies for reducing wear through enhanced design and modifications to the biotribological properties of the device. PMID:21745608

  3. Lumbar laminectomy with segmental continuous epidural anesthesia

    PubMed Central

    Kiran, Lakkam Vamsee; Radhika, Kusuma Srividhya; Parthasarathy, S.

    2014-01-01

    Lumbar laminectomies are usually performed under general anesthesia in the prone position. We report a case of lumbar laminectomy done under segmental continuous epidural anesthesia, so that direct visual intra-operative monitoring of the motor and sensory component of the lower extremities was possible.

  4. 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

  5. Hypertensive encephalopathy complicating transplant renal artery stenosis

    Microsoft Academic Search

    R. J. McGonigle; M. Bewick; J. A. Trafford; V. Parsons

    1984-01-01

    A 26-year-old female diabetic patient developed hypertensive encephalopathy with gross neurological abnormalities complicating renal artery stenosis of her transplant kidney. The elevated blood pressure was unresponsive to medical treatment. Surgical correction of the stenoses in the renal artery cured the hypertension and renal failure and led to the patient's complete recovery.

  6. Aqueduct stenosis. Case review and discussion

    Microsoft Academic Search

    J J McMillan; B Williams

    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

  7. Angioplasty for Symptomatic Intracranial Stenosis Clinical Outcome

    Microsoft Academic Search

    Michael P. Marks; Joan C. Wojak; Firas Al-Ali; Mahesh Jayaraman; Mary L. Marcellus; John J. Connors; Huy M. Do

    2010-01-01

    Background and Purpose—Medical treatment of symptomatic intracranial stenosis carries a high risk of stroke. This study was done to evaluate the clinical and angiographic outcomes after intracranial angioplasty for this disease. Methods—A total of 120 patients with 124 intracranial stenoses were treated by primary angioplasty. All patients had neurologic symptoms (stroke or transient ischemic attack) attributable to intracranial stenoses 50%.

  8. 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.

  9. Modification of the Secretion Pattern of Proteases, Inflammatory Mediators, and Extracellular Matrix Proteins by Human Aortic Valve is Key in Severe Aortic Stenosis*

    PubMed Central

    Alvarez-Llamas, Gloria; Martín-Rojas, Tatiana; de la Cuesta, Fernando; Calvo, Enrique; Gil-Dones, Felix; Dardé, Veronica M.; Lopez-Almodovar, Luis F.; Padial, Luis R.; Lopez, Juan-Antonio; Vivanco, Fernando; Barderas, Maria G.

    2013-01-01

    One of the major challenges in cardiovascular medicine is to identify candidate biomarker proteins. Secretome analysis is particularly relevant in this search as it focuses on a subset of proteins released by a cell or tissue under certain conditions. The sample can be considered as a plasma subproteome and it provides a more direct approximation to the in vivo situation. Degenerative aortic stenosis is the most common worldwide cause of valve replacement. Using a proteomic analysis of the secretome from aortic stenosis valves we could identify candidate markers related to this pathology, which may facilitate early diagnosis and treatment. For this purpose, we have designed a method to validate the origin of secreted proteins, demonstrating their synthesis and release by the tissue and ruling out blood origin. The nLC-MS/MS analysis showed the labeling of 61 proteins, 82% of which incorporated the label in only one group. Western blot and selective reaction monitoring differential analysis, revealed a notable role of the extracellular matrix. Variation in particular proteins such as PEDF, cystatin and clusterin emphasizes the link between aortic stenosis and atherosclerosis. In particular, certain proteins variation in secretome levels correlates well, not only with label incorporation trend (only labeled in aortic stenosis group) but, more importantly, with alterations found in plasma from an independent cohort of samples, pointing to specific candidate markers to follow up in diagnosis, prognosis, and therapeutic intervention. PMID:23704777

  10. Promises of stem cell therapy for retinal degenerative diseases

    Microsoft Academic Search

    Ian Yat-Hin Wong; Ming-Wai Poon; Rosita Tsz-Wai Pang; Qizhou Lian; David Wong

    With the development of stem cell technology, stem cell-based therapy for retinal degeneration has been proposed to restore\\u000a the visual function. Many animal studies and some clinical trials have shown encouraging results of stem cell-based therapy\\u000a in retinal degenerative diseases. While stem cell-based therapy is a promising strategy to replace damaged retinal cells and\\u000a ultimately cure retinal degeneration, there are

  11. Molecular mechanisms underlying the onset of degenerative aortic valve disease

    Microsoft Academic Search

    Daihiko Hakuno; Naritaka Kimura; Masatoyo Yoshioka; Keiichi Fukuda

    2009-01-01

    Morbidity from degenerative aortic valve disease is increasing worldwide, concomitant with the ageing of the general population\\u000a and the habitual consumption of diets high in calories and cholesterol. Immunohistologic studies have suggested that the molecular\\u000a mechanism occurring in the degenerate aortic valve resembles that of atherosclerosis, prompting the testing of HMG CoA reductase\\u000a inhibitors (statins) for the prevention of progression

  12. Degenerative joint disease: An example of calcium paradox

    Microsoft Academic Search

    Takuo Fujita

    1998-01-01

    :   Osteoporosis and degenerative arthropathy such as osteoarthritis and spondylosis deformans represent the two most common\\u000a diseases seen in later life, sharing some common clinical features such as pain, deformity, and restriction of motion. Augmented\\u000a bone resorption, possibly mediated by cytokines such as interleukin 1, and favorable therapeutic response to estrogen also\\u000a characterize both diseases. Both osteoarthritis of the knee

  13. Adenine Nucleotide Translocase, Mitochondrial Stress, and Degenerative Cell Death

    PubMed Central

    Liu, Yaxin

    2013-01-01

    Mitochondria are intracellular organelles involved in ATP synthesis, apoptosis, calcium signaling, metabolism, and the synthesis of critical metabolic cofactors. Mitochondrial dysfunction is associated with age-related degenerative diseases. How mitochondrial dysfunction causes cell degeneration is not well understood. Recent studies have shown that mutations in the adenine nucleotide translocase (Ant) cause aging-dependent degenerative cell death (DCD) in yeast, which is sequentially manifested by inner membrane stress, mitochondrial DNA (mtDNA) loss, and progressive loss of cell viability. Ant is an abundant protein primarily involved in ADP/ATP exchange across the mitochondrial inner membrane. It also mediates basal proton leak and regulates the mitochondrial permeability transition pore. Missense mutations in the human Ant1 cause several degenerative diseases which are commonly manifested by fractional mtDNA deletions. Multiple models have been proposed to explain the Ant1-induced pathogenesis. Studies from yeast have suggested that in addition to altered nucleotide transport properties, the mutant proteins cause a global stress on the inner membrane. The mutant proteins likely interfere with general mitochondrial biogenesis in a dominant-negative manner, which secondarily destabilizes mtDNA. More recent work revealed that the Ant-induced DCD is suppressed by reduced cytosolic protein synthesis. This finding suggests a proteostatic crosstalk between mitochondria and the cytosol, which may play an important role for cell survival during aging. PMID:23970947

  14. Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related?

    PubMed Central

    Goode, Adam P.; Carey, Timothy S.; Jordan, Joanne M.

    2013-01-01

    Lumbar spine osteoarthritis (OA) is very common, with estimates of prevalence ranging from 40–85 %. The process of degeneration of the spine has commonly been classified as OA (disc space narrowing together with vertebral osteophyte formation); however, anatomically, the facet joint is the only synovial joint in the spine that has a similar pathological degenerative process to appendicular joints. Low back pain (LBP) is also a common condition, with nearly 80 % of Americans experiencing at least one episode of LBP in their lifetime. The complex relationship between spine radiographs and LBP has many clinical and research challenges. Specific conservative treatments for spine degeneration have not been established; there has, however, been recent interest in use of exercise therapy, because of some moderate benefits in treating chronic LBP. An understanding of the relationship between spine degeneration and LBP may be improved with further population-based research in the areas of genetics, biomarkers, and pain pathways. PMID:23307577

  15. 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

  16. Gonadal dose reduction in lumbar spine radiography

    SciTech Connect

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

    1983-02-01

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

  17. 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

  18. One decade follow up after nucleoplasty in the management of degenerative disc disease causing low back pain and radiculopathy

    PubMed Central

    Cincu, Rafael; Lorente, Francisco de Asis; Gomez, Joaquin; Eiras, Jose; Agrawal, Amit

    2015-01-01

    Objectives: Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc. Methods: In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed. Results: There were 27 male and 23 female with followup mean follow up of 115 months (range 105–130 months) with a mean age was 52 years (range 26–74 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L3–4 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions. Conclusions: Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective.

  19. [Occupation and lumbar disk prolapse].

    PubMed

    Jensen, M V; Tüchsen, F

    1995-03-13

    All Danish occupational groups were screened for an increased risk of hospitalization due to a prolapsed lumbar intervertebral disc (PLID) (ICD-8: 725.11). A cohort of all gainfully employed Danes aged 20 to 59 years in 1981 was followed-up for 10 years for first hospitalization with PLID. A Standardized Hospitalization Ratio was calculated using all economically active persons as the reference group. Male groups with an elevated risk were found in building and construction, the iron and metal industry, in the food and nutrition sector and in occupational driving. Almost all groups of professional drivers had an elevated risk. Female groups with an elevated risk were mainly found in the same industries, but home helps, service workers in the private sector and sewing machine operators also had an elevated risk. We conclude that there are significant and systematic differences between occupational groups as concerns the risk of hospital admission due to PLID. PMID:7725550

  20. Fractures of the Thoracic and Lumbar Spine

    MedlinePLUS

    ... thoracic and lumbar spine. At the accident scene, EMS rescue workers will ? rst check vital signs, ... of Orthopaedic Surgeons. Before moving the patient, the EMS team must immobilize the patient in a cervical ( ...

  1. [Ischemic renal disease and renal artery stenosis].

    PubMed

    Lenz, T

    2015-03-01

    Severe renal artery stenosis may cause renovascular hypertension; in case of bilateral narrowing or in a stenotic solitary or transplant kidney, renal insufficiency (ischemic renal disease) or rarely pulmonary flash edema may occur. In most cases arteriosclerotic disease is the underlying cause; less prevalent are the various manifestations of fibromuscular disease. Renal artery stenosis may be treated by revasularization, using either percutaneous (balloon angioplasty, stenting) or rarely open surgical procedures, both with excellent primary patency rates. However, randomized trials of renal artery angioplasty or stenting in patients with arteriosclerotic lesions have failed to demonstrate a longer-term benefit with regard to hypertension control and renal dysfunction over medical management alone. Careful patient selection is essential to maximize the potential benefit (e.g., in patients with refractory hypertension, progressive renal failure or recurrent pulmonary flash edema). PMID:25608998

  2. Pulsatile spiral blood flow through arterial stenosis.

    PubMed

    Linge, Fabian; Hye, Md Abdul; Paul, Manosh C

    2014-11-01

    Pulsatile spiral blood flow in a modelled three-dimensional arterial stenosis, with a 75% cross-sectional area reduction, is investigated by using numerical fluid dynamics. Two-equation k-? model is used for the simulation of the transitional flow with Reynolds numbers 500 and 1000. It is found that the spiral component increases the static pressure in the vessel during the deceleration phase of the flow pulse. In addition, the spiral component reduces the turbulence intensity and wall shear stress found in the post-stenosis region of the vessel in the early stages of the flow pulse. Hence, the findings agree with the results of Stonebridge et al. (2004). In addition, the results of the effects of a spiral component on time-varying flow are presented and discussed along with the relevant pathological issues. PMID:23477498

  3. Post intubation tracheal stenosis in children.

    PubMed

    Caruselli, Marco; Amici, Mirco; Galante, Dario; Paut, Olivier; De Francisci, Giovanni; Carboni, Laura

    2014-08-12

    Many authors have reported that tracheal stenosis is a complication that can follow tracheal intubation in both adults and children. The symptoms, when they do appear, can be confused with asthma, with subsequent treatment providing only mild and inconsistent relief. We report here the case of an 8 year old girl admitted to our hospital for whooping cough that was not responding to therapy. PMID:25635215

  4. Post Intubation Tracheal Stenosis in Children

    PubMed Central

    Caruselli, Marco; Amici, Mirco; Galante, Dario; Paut, Olivier; De Francisci, Giovanni; Carboni, Laura

    2014-01-01

    Many authors have reported that tracheal stenosis is a complication that can follow tracheal intubation in both adults and children. The symptoms, when they do appear, can be confused with asthma, with subsequent treatment providing only mild and inconsistent relief. We report here the case of an 8 year old girl admitted to our hospital for whooping cough that was not responding to therapy. PMID:25635215

  5. Developmental spinal canal stenosis and somatotype.

    PubMed Central

    Nightingale, S

    1989-01-01

    The hypothesis that somatotype and cervical spine developmental canal stenosis may be associated has been investigated by anthropometry and measurement of lateral projection cervical spine radiographs. A significant association of canal size with somatotype has been found such that those with developmentally narrow canals are more likely to have relatively shorter long-bones, particularly in the upper arm, and longer trunks. Images PMID:2769282

  6. Sleep apnoea in severe aortic stenosis

    Microsoft Academic Search

    Christian Prinz; Thomas Bitter; Olaf Oldenburg; Lothar Faber; Dieter Horstkotte; Cornelia Piper

    2011-01-01

    BackgroundThere are as yet no data on the prevalence of sleep apnoea in patients with severe aortic stenosis (AS).AimsTo assess the occurrence, severity and clinical correlates of sleep apnoea in patients with AS.MethodsDuring a 4-month period in 2010, 67 patients were consecutively included in this study, 42 of which (19 men; mean±SD age 72±9 years) had severe AS (aortic valve

  7. Punctal stenosis: definition, diagnosis, and treatment

    PubMed Central

    Soiberman, Uri; Kakizaki, Hirohiko; Selva, Dinesh; Leibovitch, Igal

    2012-01-01

    Acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. This condition is a rare cause of symptomatic epiphora, but its incidence may be higher in patients with chronic blepharitis, in those treated with various topical medications, including antihypertensive agents, and especially in patients treated with taxanes for cancer. The purpose of this review is to cover the medical literature, focusing in particular on definition, incidence, risk factors, etiology and treatment options. PMID:22848141

  8. Posteroanterior versus anteroposterior lumbar spine radiology

    SciTech Connect

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

    1990-03-01

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

  9. Design concepts in lumbar total disc arthroplasty

    Microsoft Academic Search

    Fabio Galbusera; Chiara M. Bellini; Thomas Zweig; Stephen Ferguson; Manuela T. Raimondi; Claudio Lamartina; Marco Brayda-Bruno; Maurizio Fornari

    2008-01-01

    The implantation of lumbar disc prostheses based on different design concepts is widely accepted. This paper reviews currently\\u000a available literature studies on the biomechanics of TDA in the lumbar spine, and is targeted at the evaluation of possible\\u000a relationships between the aims of TDA and the geometrical, mechanical and material properties of the various available disc\\u000a prostheses. Both theoretical and

  10. Fluid dynamics of aortic valve stenosis

    NASA Astrophysics Data System (ADS)

    Keshavarz-Motamed, Zahra; Maftoon, Nima

    2009-11-01

    Aortic valve stenosis, which causes considerable constriction of the flow passage, is one of the most frequent cardiovascular diseases and is the most common cause of the valvular replacements which take place for around 100,000 per year in North America. Furthermore, it is considered as the most frequent cardiac disease after arterial hypertension and coronary artery disease. The objective of this study is to develop an analytical model considering the coupling effect between fluid flow and elastic deformation with reasonable boundary conditions to describe the effect of AS on the left ventricle and the aorta. The pulsatile and Newtonian blood flow through aortic stenosis with vascular wall deformability is analyzed and its effects are discussed in terms of flow parameters such as velocity, resistance to flow, shear stress distribution and pressure loss. Meanwhile we developed analytical expressions to improve the comprehension of the transvalvular hemodynamics and the aortic stenosis hemodynamics which is of great interest because of one main reason. To medical scientists, an accurate knowledge of the mechanical properties of whole blood flow in the aorta can suggest a new diagnostic tool.

  11. Anterior pericardial tracheoplasty for congenital tracheal stenosis.

    PubMed

    Heimansohn, D A; Kesler, K A; Turrentine, M W; Mahomed, Y; Means, L; Matt, B; Weisberger, E; Brown, J W

    1991-11-01

    Congenital tracheal stenosis may be a life-threatening anomaly not relieved by airway intubation. Over the past 7 years, anterior pericardial tracheoplasty has been used at our institution for treatment of congenital long-segment tracheal stenosis in infants with impeding airway obstruction. Case histories of eight patients undergoing nine anterior pericardial tracheoplasties have been reviewed to assess this technique. Of these patients, six have required preoperative tracheal intubation before repair to maintain ventilation. The surgical technique of anterior pericardial tracheoplasty includes a median sternotomy approach with partial normothermic cardiopulmonary bypass. An anterior tracheotomy through all hypoplastic rings allows enlargement with autologous pericardium to 1.5 times the predicted normal diameter. After insertion, the pericardium and hypoplastic tracheal cartilages are suspended to surrounding mediastinal structures, which prevents airway collapse. Seven of eight infants have survived without tracheoplasty dehiscence or wound infections. Five were ultimately extubated and are currently free of symptoms from 6 months to 5 years after anterior pericardial tracheoplasty. The other two survivors had residual stenosis as a result of complications of prior tracheostomy. One of these patients has undergone a successful second anterior pericardial tracheoplasty and is currently extubated and well. The other is palliated at 6 months with a tracheostomy awaiting a second anterior pericardial tracheoplasty. Our review of anterior pericardial tracheoplasty has demonstrated the safety, utility, and at least medium-term benefit of this procedure in infants of any age and weight. PMID:1943189

  12. Computed tomography-guided percutaneous facet screw fixation in the lumbar spine. Technical note.

    PubMed

    Kang, Ho Yeong; Lee, Sang-Ho; Jeon, Sang Hyeop; Shin, Song-Woo

    2007-07-01

    The authors describe a new minimally invasive technique for posterior supplementation using percutaneous translaminar facet screw (TFS) fixation with computed tomography (CT) guidance. Oblique axial images were used to determine facet screw fixation sites. After the induction of local anesthesia and conscious sedation, a guide pin was inserted and guided with a laser mounted on the CT gantry. Cannulated TFSs were placed via a percutaneous approach. From December 2002 to August 2003, 18 patients underwent CT-guided TFS. In 17 of these patients this procedure was supplementary to anterior lumbar interbody fusion, which had been performed several days earlier; in the remaining patient, CT-guided TFS fixation was undertaken as the primary therapy. Twelve patients had painful degenerative disc disease or unstable degenerative spondylolisthesis, three had infections, and three had deformities. All screws were inserted accurately and there were no complications. This new minimally invasive surgical technique may offer an alternative to pedicle screw fixation as a method of posterior supplementation. PMID:17633496

  13. 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

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

    SciTech Connect

    Stuart, B.O. (Armstrong Aerospace Medical Research Lab., Wright-Patterson AFB, OH (US))

    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.

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

    PubMed Central

    Weise, Lutz; Suess, Olaf; Picht, Thomas; Kombos, Theodoros

    2008-01-01

    Objective: Transpedicular screws are commonly and successfully used for posterior fixation in spinal instability, but their insertion remains challenging. Even using navigation techniques, there is a misplacement rate of up to 11%. The aim of this study was to assess the accuracy of a novel pedicle screw system. Methods: Thoracic and lumbar fusions were performed on 67 consecutive patients for tumor, trauma, degenerative disease or infection. A total of 326 pedicular screws were placed using a novel wire-guided, cannulated, polyaxial screw system (XIA Precision®, Stryker). The accuracy of placement was assessed postoperatively by CT scan, and the patients were followed-up clinically for a mean of 16 months. Results: The total medio-caudal pedicle wall perforation rate was 9.2% (30/326). In 19 of these 30 cases a cortical breakthrough of less than 2 mm occurred. The misplacement rate (defined as a perforation of 2 mm or more) was 3.37% (11/326). Three of these 11 screws needed surgical revision due to neurological symptoms or CSF leakage. There have been no screw breakages or dislocations over the follow up-period. Conclusion: We conclude that the use of this cannulated screw system for the placement of pedicle screws in the thoracic and lumbar spine is accurate and safe. The advantages of this technique include easy handling without a time-consuming set up. Considering the incidence of long-term screw breakage, further investigation with a longer follow-up period is necessary. PMID:22915906

  16. Delayed stenosis following stentriever use in acute stroke intervention.

    PubMed

    Macke, Jeremy James; Bellew, Michael P; Hellinger, Frank R

    2015-05-01

    We report two cases of delayed post-embolectomy stenosis-that is, a new stenosis in the vascular bed of a previous endovascular embolectomy. The first case was discovered incidentally in a patient returning after embolectomy for evaluation of cerebral aneurysms. The second case was discovered on an MR angiogram obtained to screen for stenosis. This was prompted by our experience with the first case. To our knowledge, this phenomenon has not been reported previously. PMID:24778140

  17. 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

  18. Biomarkers in Aortic Stenosis - B.A.S.S.

    ClinicalTrials.gov

    2013-01-15

    Aortic Stenosis; Mitral Valve Replacement; Aortic Valve Replacement; Prosthetic Heart Valve Dysfunction; Aortic Insufficiency; Mitral Insufficiency; Hypertrophic Cardiomyopathy; Tricuspid Regurgitation With Pacemaker/Defibrillator Leads

  19. Integrating degenerative mechanisms in bone and cartilage: a multiscale approach.

    PubMed

    Fernandez, Justin W; Shim, Vickie B; Hunter, Peter J

    2012-01-01

    At the whole organ level, degenerative mechanisms in bone and cartilage are primarily attributed to modifications in loading pattern. Either a change in magnitude or location can initiate a degenerative path. At the micro scale we often see changes in structure such as porosity increase in bone and fibrillation in cartilage. These changes contribute to a reduced structural integrity that weakens the bulk strength of tissue. Finally, at the cell level we have modeling and remodeling pathways that may be disrupted through disease, drugs and altered stimulus from the micro and macro scales. In order to understand this entire process and the roles each level plays a multiscale modeling framework is necessary. This framework can take whole body loadings and pass information through finer spatial scales in order to understand how everyday dynamic movements influence micro and cellular response. In a similar manner, cellular and microstructural processes regulate whole bulk properties and modify whole organ strength. In this study we highlight the multiscale links developed as part of the open-source ontologies for the Physiome Project using the lower limb as an example. We consider the influence of remodeling in (i) anabolic treatments in cortical bone; and (ii) subchondral bone and cartilage degeneration. PMID:23367446

  20. Lumbar extraforaminal decompression: A technical note and retrospective study looking at potential complications as an outpatient procedure

    PubMed Central

    Miller, Justin W.; Sasso, Rick C.

    2011-01-01

    Background Lumbar disc herniation and stenosis that results in compression of a nerve root lateral to the foramen is defined as extraforaminal. In recent years the recognition of such pathology has increased with technology and greater awareness. Various approaches and techniques have been developed for extraforaminal decompression in the lumbar region. The purpose of this study was two fold: 1) Determine the safety of treating patients operatively via a paramedian muscle splitting approach on an outpatient basis, and 2) Highlight the technical aspects of the approach to the extraforaminal region. Methods One hundred consecutive extraforaminal decompressions were performed from 1992 to 2007 by a single surgeon. A retrospective review was performed consisting of chart reviews. Summary statistics and the Pierson Chi-square test were used to analyze the data. The primary outcome measure was the need for hospital admission or readmission following surgical decompression. Results Seven of 100 patients (7%) were required to remain in the hospital for twenty-three hour observation due to Medicare requirements. Five (5%) of the patients originally scheduled for an outpatient procedure were converted to inpatient status due to postoperative pain. All were released within 2 days (average 1.25 days). Only one (1%) patient was readmitted for urinary retention that resolved without incident. There was no significant difference (P = 0.137) in complication rate between our control and those that underwent extraforaminal decompression. Conclusions Extraforaminal lumbar decompression as an outpatient procedure can be done safely without the need for hospital admission.

  1. Lumbar-pelvic range and coordination during lifting tasks

    E-print Network

    Maduri, Anupama; Pearson, Bethany L.; Wilson, Sara E.

    2008-01-01

    , the passive musculature can contribute to further limiting the functional neutral range of lumbar motion. Movement out of this functional neutral range could potentially put greater loads on these structures. In this study, the range of lumbar curvature...

  2. 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.

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 2012-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19...3-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the part of...

  4. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 2014-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19...3-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the part of...

  5. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 2011-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19...3-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the part of...

  6. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 2013-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19...3-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the part of...

  7. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Lumbar spine flexure. 572.85 Section 572.85...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected to continuously...paragraph (b) of this section, the lumbar spine assembly shall flex by an amount that...

  8. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Lumbar spine and pelvis. 572.115 Section 572...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to those for...

  9. Therapeutic Options in Lithiasis of the Lumbar Ureter

    Microsoft Academic Search

    Miguel Arrabal-Mart??n; Manuel Pareja-Vilches; Francisco Gutiérrez-Tejero; José Luis Miján-Ortiz; Francisco Palao-Yago; Armando Zuluaga-Gómez

    2003-01-01

    Introduction: In the past 25 years, the treatment of lithiasis of the lumbar ureter has evolved from ureterolithotomy to extracorporeal shockwave lithotripsy and\\/or endoscopic lithotripsy. Our objective has been to analyse the results of extracorporeal lithotripsy and endoscopic surgery in lithiasis of the lumbar ureter.Materials and Methods: We have analysed 734 single calculi of the lumbar ureter treated during the

  10. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Lumbar spine and pelvis. 572.115 Section...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to...

  11. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Lumbar spine and pelvis. 572.115 Section...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to...

  12. Introduction Functional in vivo studies of the lumbar spine using

    E-print Network

    Blanz, Volker

    Introduction Functional in vivo studies of the lumbar spine using open MRI systems are described in the locomotor system of the lumbar spine and their effects on CSF space and relevant nerve roots has not been-Definition 3D Studies of the Lumbar Spine Using Magnetic Resonance Imaging K. E. W. Eberhardt1 , B. F. Tomandl1

  13. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Lumbar spine flexure. 572.85 Section...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected...paragraph (b) of this section, the lumbar spine assembly shall flex by an...

  14. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Lumbar spine flexure. 572.85 Section...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected...paragraph (b) of this section, the lumbar spine assembly shall flex by an...

  15. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Lumbar spine and pelvis. 572.115 Section...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to...

  16. 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.edu Abstract The Robotic Lumbar Spine (RLS) is a 15 degreeoffreedom, fully cableactuated robotic

  17. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Lumbar spine flexure. 572.85 Section...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected...paragraph (b) of this section, the lumbar spine assembly shall flex by an...

  18. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Lumbar spine flexure. 572.85 Section...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected...paragraph (b) of this section, the lumbar spine assembly shall flex by an...

  19. 49 CFR 572.115 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Lumbar spine and pelvis. 572.115 Section...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to...

  20. Risk of atrophy in kidneys with atherosclerotic renal artery stenosis

    Microsoft Academic Search

    Michael T Caps; R Eugene Zierler; Nayak L Polissar; Robert O Bergelin; Kirk W Beach; Kim Cantwell-Gab; Alder Casadei; Robert C Davidson; D Eugene Strandness

    1998-01-01

    Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. The goal of this study was to determine the incidence of and risk factors for renal atrophy among kidneys with atherosclerotic renal artery stenosis (ARAS). Participants with at least one ARAS were followed prospectively with duplex scans performed every six months. Renal atrophy was defined as a reduction in renal

  1. Pulmonary Vein Stenosis After Catheter Ablation of Atrial Fibrillation

    Microsoft Academic Search

    Ivan M. Robbins; Edward V. Colvin; Thomas P. Doyle; W. Evans Kemp; James E. Loyd; William S. McMahon; G. Neal Kay

    Background—This report describes the complication of pulmonary vein stenosis with resultant severe pulmonary hypertension that developed in 2 patients after successful catheter ablation of chronic atrial fibrillation. Methods and Results—Three months after successful catheter ablation of atrial fibrillation, both patients developed progressive dyspnea and pulmonary hypertension. Both were found to have severe stenosis of all 4 pulmonary veins near the

  2. A family study of hydrocephalus resulting from aqueduct stenosis

    Microsoft Academic Search

    F M Howard; K Till; C O Carter

    1981-01-01

    Stenosis of the aqueduct of Sylvius accounts for about one third of cases of congenital hydrocephalus. At least 32 families have been reported in which the aqueduct stenosis is inherited in an X linked fashion. In half of these families, flexed adducted thumbs were noted in some affected family members. Occasionally other male members were mentally retarded, suggesting limited expression

  3. Percutaneous transvenous angioplasty in the treatment of vascular access stenosis

    Microsoft Academic Search

    Gerald A Beathard

    1992-01-01

    Percutaneous transvenous angioplasty in the treatment of vascular access stenosis. This study was undertaken to evaluate percutaneous transvenous angioplasty (PTVA) for the treatment of all types of vascular access stenosis in a large population of dialysis patients. Stenoses were identified by venography in patients who met a set of clinical criteria indicating the need for evaluation. The lesions were classified

  4. Traumatic lumbar hernia: report of a case.

    PubMed

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

    2008-12-01

    Traumatic lumbar hernias are very rare. Here, we present a case of secondary lumbar hernia. A 44-year-old man sustained a crushing injury. On admission, ecchymotic, fluctuating swelling was present on his left flank with normal vital signs. Subcutaneous intestinal segments were revealed at his left flank on abdominal CT. Emergency laparotomy revealed a 10-cm defect on the left postero-lateral abdominal wall. The splenic flexure was herniated through the defect. Herniated segments was reduced, the defect was repaired with a polypropylene mesh graft. There was also a serosal tear and an ischemic area 3mm wide on the splenic flexure and was repaired primarily. The patient had an uneventful recovery. Most traumatic lumbar hernias are caused by blunt trauma. Trauma that causes abdominal wall disruption also may cause intraabdominal organ injury. Abdominal CT is useful in the diagnosis and allows for diagnosis of coexisting organ injury. Emergency laparotomy should be performed to repair possible coexisting injuries. PMID:19059139

  5. 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

  6. Feline degenerative joint disease: a genomic and proteomic approach.

    PubMed

    Gao, Xiangming; Lee, Junyu; Malladi, Sukhaswami; Melendez, Lynda; Lascelles, B Duncan X; Al-Murrani, Samer

    2013-06-01

    The underlying disease mechanisms for feline degenerative joint disease (DJD) are mostly unidentified. Today, most of what is published on mammalian arthritis is based on human clinical findings or on mammalian models of human arthritis. However, DJD is a common occurrence in the millions of domestic felines worldwide. To get a better understanding of the changes in biological pathways that are associated with feline DJD, this study employed a custom-designed feline GeneChip, and the institution's unique access to large sample populations to investigate genes and proteins from whole blood and serum that may be up- or down-regulated in DJD cats. The GeneChip results centered around three main pathways that were affected in DJD cats: immune function, apoptosis and oxidative phosphorylation. By identifying these key disease-associated pathways it will then be possible to better understand disease pathogenesis and diagnose it more easily, and to better target it with pharmaceutical and nutritional intervention. PMID:23295270

  7. 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

  8. Horner syndrome due to vertebral artery stenosis.

    PubMed

    Kim, Chul Han

    2013-11-01

    The author reports a rare case of Horner syndrome in a patient who resulted from stenosis of the vertebral artery after blunt trauma. A 31-year-old man was transferred to our department for evaluation of left medial orbital wall and nasal bone fractures. Five days ago, he was hospitalized due to multiple second to fourth rib fractures of the right chest following blunt trauma of the face, neck, and chest. Surgery was performed. Ten days later, he complained of drooping of the right eyelid. Physical examination revealed a discrete miosis and ptosis with normal levator function in the right eye. A workup for Horner syndrome was performed. Magnetic resonance angiography of the head and neck revealed a stenosis of the distal part of the right vertebral artery without the abnormality of carotid artery. He wore a cervical collar and underwent anticoagulation. However, Horner syndrome was not resolved over the next 12 months. Acute traumatic Horner syndrome may be associated with vertebral artery dissection in which the possibility of life-threatening injury can be masked. PMID:24220402

  9. Targeted disruption of Mig6 in the mouse genome leads to early onset degenerative joint disease

    Microsoft Academic Search

    Yu-Wen Zhang; Yanli Su; Nathan Lanning; Pamela J. Swiatek; Roderick T. Bronson; Robert Sigler; Richard W. Martin; George F. Vande Woude

    2005-01-01

    Degenerative joint disease, also known as osteoarthritis, is the most common joint disorder in human beings. The molecular mechanism underlying this disease is not fully understood. Here, we report that disruption of mitogen-inducible gene 6 (Mig-6) in mice by homologous recombination leads to early onset degenerative joint disease, which is revealed by simultaneous enlargement and deformity of multiple joints, degradation

  10. DISEASE IN WILDLIFE OR EXOTIC SPECIES Characterization of Degenerative Changes in the

    E-print Network

    Athanasiou, Kyriacos

    DISEASE IN WILDLIFE OR EXOTIC SPECIES Characterization of Degenerative Changes of the functional demands on the joint. Degenerative joint disease was observed in both cases and this was more of the temporomandibular joint (TMJ) is composed of the temporal bone dorsally, the mandibular condyle ventrally

  11. Iatrogenic lumbar meningocoele: report of three cases

    PubMed Central

    Rinaldi, Italo; Hodges, Thomas O.

    1970-01-01

    We have reported three cases of iatrogenic lumbar meningocoeles after surgery for herniated lumbar intervertebral discs. We reject the term spurious, pseudo, or false as given by earlier writers. We feel that, in reality, these sacs are true meningocoeles, with complete arachnoidal lining and freely communicating with the intraspinal subarachnoid space. We have also given a brief outline of the clinical features, elucidated the mechanisms operative in the production of symptoms, and suggested the cardinal features of radiographic diagnosis. Prevention is, of course, the best way to avoid this complication. If a dural tear does occur, every effort should be made to suture it in a watertight manner. Images PMID:4918460

  12. Computed tomography of the postoperative lumbar spine

    SciTech Connect

    Teplick, J.G.; Haskin, M.E.

    1983-11-01

    In the postoperative patient ordinary radiographs of the spine generally add very little information, revealing the usual postoperative bone changes and often postoperative narrowing of the intervertebral space. Myelography may sometimes be informative, showing evidence of focal arachnoiditis or a focal defect at the surgical site. However, the latter finding is difficult to interpret. As experience with high-resolution CT scanning of the lumbar spine has been increasing, it is becoming apparent that this noninvasive and easily performed study can give considerably more information about the postoperative spine than any of the other current imaging methods. About 750 patients with previous lumbar laminectomies had CT scanning within a 28 month period.

  13. 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.

  14. Prostaglandin E1 but not corticosteroid increases nerve root blood flow velocity after lumbar diskectomy in surgical patients.

    PubMed

    Fukusaki, Makoto; Miyako, Masahiko; Miyoshi, Hiroshi; Takada, Masafumi; Terao, Yoshiaki; Konishi, Hiroaki; Sumikawa, Koji

    2003-04-01

    The purpose of this study was to clarify whether prostaglandin E1 (PGE(1)) or corticosteroid could increase blood flow in the nerve root because neurologic symptoms in spinal stenosis may be based on the vascular insufficiency in the nerve root. Fifty-seven patients undergoing lumbar diskectomy were randomly assigned to one of three groups. Each group received one of three protocols for intravenous injection: 10 mL of saline solution, group A (n = 19); 10 mL of PGE(1) (20 microg) solution, group B (n = 19); and 10 mL of dexamethasone (8 mg) solution, group C (n = 19). After lumbar diskectomy, a probe for laser Doppler flowmetry was placed directly on the lumbar nerve root. Nerve root blood flow (RBF) velocity and mean arterial pressure (MAP) were measured before injection (T0), 5 minutes after the start of injection (T1), 10 minutes after the start of injection (T2), and 10 minutes after the end of injection (T3). In groups A and C, these did not change throughout the time course. In group B, MAP decreased significantly at T1 (92%; P <.001), T2 (89%; P <.0001), and T3 (91%; P <.0001), while RBF velocity increased significantly at T1 (125%; P <.05), T2 (128%; P <.05), and T3 (121%; P <.05) compared with T0. The values in group B were different from those in group A (P <.05) and group C (P <.05) at T1 and T2. The results show that intravenous injection of low-dose PGE(1), but not corticosteroid, increases RBF velocity after lumbar diskectomy. PMID:12657990

  15. Electrophysiological and cognitive effects of lumbar myelography with iopamidol: comparison with diagnostic lumbar puncture.

    PubMed

    Provinciali, L; Ceravolo, M G; Signorino, M; Baroni, M; Pasquini, U; Cerrutti, R; Salvolini, U

    1993-01-01

    To assess the influence of contrast medium on cortical function, we studied 20 patients undergoing lumbar myelography with iopamidol and 10 patients undergoing diagnostic lumbar puncture (controls). The examinations performed before and 6 and 24 h after myelography (or lumbar puncture) included a neuropsychological battery and an electrophysiological evaluation. In the patients cranial CT was performed thrice to assess passage of contrast medium from the cerebrospinal fluid into the brain. Neither patients nor controls had significantly different scores on neuropsychological testing after the diagnostic examinations. A transient slowing of basal EEG activity could be detected in 2 patients and 3 controls 6 h after the lumbar puncture. In 3 patients CT showed a transient increase in density of the brain. None of the parameters studied was significantly affected by myelography with iopamidol. CT findings support the hypothesis of early clearance of iopamidol from brain tissue, explaining its low neurotoxicity. PMID:8232868

  16. 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

  17. Sinus venous stenosis-associated idiopathic intracranial hypertension without papilledema as a powerful risk factor for progression and refractoriness of headache.

    PubMed

    De Simone, Roberto; Ranieri, Angelo; Montella, Silvana; Marchese, Mario; Bonavita, Vincenzo

    2012-06-01

    Data from two recent studies strongly support the hypothesis that idiopathic intracranial hypertension without papilledema (IIHWOP) could represent a powerful risk factor for the progression of pain in primary headache individuals. The first study highlights that an asymptomatic IIHWOP is much more prevalent than believed in the general population and occurs only in central venous stenosis carriers. In the second study, about one half of a large consecutive series of unresponsive primary chronic headache patients shows significant sinus venous stenosis. A continuous or intermittent IIHWOP was detectable in 91% of this subgroup and in no patient with normal venography. Moreover, after the lumbar puncture, a 2- to 4-week improvement in headache frequency was observed in most of the intracranial hypertensive patients. These findings strongly suggest that patients prone to primary headache who carry central venous outflow abnormalities are at high risk of developing a comorbid IIHWOP, which in turn is responsible for the progression and the unresponsiveness of the pain. Based on the available literature data, we propose that central sinus stenosis-related IIHWOP, although highly prevalent among otherwise healthy people, represents an important modifiable risk factor for the progression and refractoriness of pain in patients predisposed to primary headache. The mechanism could refer to up to one half of the primary chronic headache patients with minimal response to treatments referring to specialized headache clinics. Due to the clinical and taxonomic relevance of this hypothesis further studies are urgently needed. PMID:22382759

  18. Tadpole system as new lumbar spinal instrumentation

    Microsoft Academic Search

    Yuichi Kasai; Tadashi Inaba; Koji Akeda; Atsumasa Uchida

    2008-01-01

    BACKGROUND: There have been reports of serious complications associated with pedicle screw fixation, including nerve root injuries caused by accidental screw insertion. We have developed a new system of lumbar spinal instrumentation that we call Tadpole system®. The purposes of this report were to show the results of a biomechanical study and the short-term outcome of a clinical study, as

  19. LUMBAR STRAIN: Back to the Basics

    Microsoft Academic Search

    Gaetano P. Monteleone

    3. Muscles- the large thoracolumbar fascia represents a grouping of fascia and several muscles. Paraspinal muscle group and abdominal musculature are other important anatomical support for the back. Remember that muscle groups for the anterior and posterior legs are instrumental in lumbar biomechanics. III. History æ Location- consider if dermatomal Vs nondermatomal pattern æ ? Radiation- radiation into the leg

  20. Ontogeny of Androgen Receptor Immunoreactivity in Lumbar

    E-print Network

    Breedlove, Marc

    Ontogeny of Androgen Receptor Immunoreactivity in Lumbar Motoneurons and in the Sexually Dimorphic, University of California, Los Angeles, California 90095-1527 ABSTRACT We documented the ontogeny of androgen retrodorsolat- eral nucleus (RDLN). We also assessed the ontogeny of AR immunoreactivity in the rat sexually

  1. 49 CFR 572.187 - Lumbar spine.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...CONTINUED) ANTHROPOMORPHIC TEST DEVICES 2re Side Impact Crash Test Dummy, 50th Percentile Adult Male § 572.187 Lumbar...The maximum rotation in the lateral direction of the reference plane of the headform (175-9000) as shown in Figure...

  2. Acute Sciatic Neuritis following Lumbar Laminectomy

    PubMed Central

    Hitchon, Patrick; Reddy, Chandan G.

    2014-01-01

    It is commonly accepted that the common cause of acute/chronic pain in the distribution of the lumbosacral nerve roots is the herniation of a lumbar intervertebral disc, unless proven otherwise. The surgical treatment of lumbar disc herniation is successful in radicular pain and prevents or limits neurological damage in the majority of patients. Recurrence of sciatica after a successful disc surgery can be due to many possible etiologies. In the clinical setting we believe that the term sciatica might be associated with inflammation. We report a case of acute sciatic neuritis presented with significant persistent pain shortly after a successful disc surgery. The patient is a 59-year-old female with complaint of newly onset sciatica after complete pain resolution following a successful lumbar laminectomy for acute disc extrusion. In order to manage the patient's newly onset pain, the patient had multiple pain management visits which provided minimum relief. Persistent sciatica and consistent physical examination findings urged us to perform a pelvic MRI to visualize suspected pathology, which revealed right side sciatic neuritis. She responded to the electrical neuromodulation. Review of the literature on sciatic neuritis shows this is the first case report of sciatic neuritis subsequent to lumbar laminectomy. PMID:25024708

  3. Lumbar Extradural Hemangiomas: Report of Three Cases

    Microsoft Academic Search

    Antoni Rovira; Alex Rovira; Jaume Capellades; Martin Zauner; Rosa Bell; Mariana Rovira

    Summary: The CT, MR, and histologic findings of three patients with surgically proved lumbar extradural cavern- ous and arteriovenous hemangiomas are reported. All three patients suffered from radicular and low back pain that disappeared completely or nearly so after total surgical ex- cision. In each case, neuroimaging studies showed a well- defined ventrally located extradural mass with no bone in-

  4. Pulmonary stenosis is a predictor of unfavorable outcome after surgery for supravalvular aortic stenosis.

    PubMed

    Kasnar-Samprec, Jelena; Hörer, Jürgen; Bierwirth, Hanna; Prodan, Zsolt; Cleuziou, Julie; Eicken, Andreas; Lange, Rüdiger; Schreiber, Christian

    2012-10-01

    We sought to evaluate whether the presence of pulmonary stenosis (PS), amongst other factors, influences the mortality and the rate of reoperations in the long-term follow-up of patients with supravalvular aortic stenosis (SVAS). We identified all patients with SVAS from our surgical database. The patients with multi-level aortic stenosis or concomitant cardiac procedures were excluded from this study. Follow-up (100 %) was conducted between 2008 and 2010. Twenty-six patients underwent surgery for SVAS between 1974 and 2006. Seventeen patients (65 %) were diagnosed with Williams-Beuren-Syndrome, six (17 %) had a diffuse form of SVAS and 10 (39 %) had PS. No patient had a surgical or interventional procedure for PS at the initial operation or during follow-up. There was no statistically significant association between PS and WBS (p = 0.30) or diffuse form of SVAS (p = 0.13). Patients with PS were operated at younger age (p = 0.028). Median follow-up time was 14.6 years. Overall mortality was 11.5 %. One patient with preoperatively severely decreased LV-function died 27 days postoperatively. Two late deaths occurred 7 and 10 years after the initial operation. Reoperations were required in 4 patients (15 %), 4-19 years after the original operation, due to aortic arch stenosis, supravalvular restenosis or poststenotic aortic dilatation. PS was found to be a risk factor for reoperation (p = 0.005) and for the combined reoperation/death end-point (p = 0.003). PS in patients with SVAS is a risk factor for reoperations in the aortic region and might be considered an indicator of the severity of the arterial disease and a predictor of an unfavourable outcome. PMID:22438017

  5. FAMM Flap in Reconstructing Postsurgical Nasopharyngeal Airway Stenosis

    PubMed Central

    Nangole, Ferdinand Wanjala; Khainga, Stanley Ominde

    2014-01-01

    Introduction. Postsurgical nasopharyngeal airway stenosis can be a challenge to manage. The stenosis could be as a result of any surgical procedure in the nasopharyngeal region that heals extensive scarring and fibrosis. Objective. To evaluate patients with nasopharyngeal stenosis managed with FAMM flap. Study Design. Prospective study of patients with nasopharyngeal stenosis at the Kenyatta National Hospital between 2010 and 2013 managed with FAMM flap. Materials and Methods. Patients with severe nasopharyngeal airway stenosis were reviewed and managed with FAMM flaps at the Kenyatta National Hospital. Postoperatively they were assessed for symptomatic improvement in respiratory distress, patency of the nasopharyngeal airway, and donor site morbidity. Results. A total of 8 patients were managed by the authors in a duration of 4 years with nasopharyngeal stenosis. Five patients were managed with unilateral FAMM flaps in a two-staged surgical procedure. Four patients had complete relieve of the airway obstruction with a patent airway created. One patient had a patent airway created though with only mild improvement in airway obstruction. Conclusion. FAMM flap provides an alternative in the management of postsurgical severe nasopharyngeal stenosis. It is a reliable flap that is easy to raise and could provide adequate epithelium for the stenosed pharynx. PMID:25328699

  6. Left ventricular remodelling in aortic stenosis.

    PubMed

    Rassi, Andrew N; Pibarot, Philippe; Elmariah, Sammy

    2014-09-01

    Aortic stenosis (AS) is a progressive condition associated with high mortality if not treated. The hemodynamic effects of AS have serious implications for the left ventricle. In this review, we describe the responses of the left ventricle to AS by highlighting the process of adaptive remodelling, which begins as a beneficial compensatory mechanism but ultimately transitions to a maladaptive process with potentially irreversible consequences. We discuss the impact of left ventricular (LV) remodelling on diastolic and systolic function and on the development of symptoms. In addition, we review the adverse consequences of maladaptive LV remodelling on clinical outcomes before and after aortic valve replacement. The relative irreversibility of maladaptive remodelling and the clear relationship between its progression and clinical outcomes suggest a need to incorporate measures of LV performance beyond simply systolic function when deciding on the timing of valve replacement. PMID:25151283

  7. Diagnosis and Management of Valvular Aortic Stenosis

    PubMed Central

    Czarny, Matthew J; Resar, Jon R

    2014-01-01

    Valvular aortic stenosis (AS) is a progressive disease that affects 2% of the population aged 65 years or older. The major cause of valvular AS in adults is calcification and fibrosis of a previously normal tricuspid valve or a congenital bicuspid valve, with rheumatic AS being rare in the United States. Once established, the rate of progression of valvular AS is quite variable and impossible to predict for any particular patient. Symptoms of AS are generally insidious at onset, though development of any of the three cardinal symptoms of angina, syncope, or heart failure portends a poor prognosis. Management of symptomatic AS remains primarily surgical, though transcatheter aortic valve replacement (TAVR) is becoming an accepted alternative to surgical aortic valve replacement (SAVR) for patients at high or prohibitive operative risk. PMID:25368539

  8. Infantile hypertrophic pyloric stenosis in twins

    PubMed Central

    Kundal, Vijay Kumar; Gajdhar, Mufique; Shukla, Arvind Kumar; Kundal, Raksha

    2013-01-01

    Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical cause of vomiting, which requires surgery in infant. There is the complete or partial obstruction of pylorus due to hypertrophy of circular muscle of the pylorus leading gastric outlet obstruction. The occurrence of IHPS in dizygotic twins is rarer and the theory of genetic origin alone does not explain it. Recent literature points to the association of bottle feeding in singletons to be a major aetiological factor for this condition. Here, we present a rare case of dizygotic twins who were bottle-fed and were affected with IHPS. We review the literature and focus on the question of whether this condition in twins supports a genetic or environmental origin of IHPS. PMID:23576655

  9. Pathophysiology of subglottic tracheal stenosis in childhood.

    PubMed

    Minnigerode, B; Richter, H G

    1987-01-01

    Two particularly problematic clinical entities are chosen from the many possible causes of the pathophysiology of subglottic tracheal stenoses in childhood: malformations of the "hard" and "soft" types of stenosis occurring typically as primary lesions; and stenoses caused by trauma (following intubation or faulty tracheostomy) as the most common secondary lesions. It is shown with reference to experimental investigations that subepithelial layers play the leading role in the origin of stenoses, in contrast to hitherto existing ideas based on clinical observations. Traumatic stenoses caused by unphysiological mechanical stressing show striking parallels to those in other age groups, suggesting the conclusion that a reaction of the mesenchymal tissue layers of the airway regions in question is a typical response to mechanical forces. PMID:3107065

  10. Cell-based therapies for retinal degenerative diseases: a thousand strategies.

    PubMed

    Lewallen, Michelle; Xie, Ting

    2013-01-01

    Retinal neuronal death causes a severe and irreversible loss of visual function in the patients of retinitis pigmentosa, age-related macular degeneration and glaucoma, but these degenerative diseases currently still lack effective medical treatments. The restorative properties of stem cells hold the promise in the treatment of these retinal degenerative diseases. The exciting progress has been made on stem cell research in the last decade. Many different stem cell types have been explored for their potential in treating the retinal degenerative diseases, including embryonic stem cells, induced pluripotent stem cells, mesenchymal stem cells and retinal stem cells. This review will summarize the recent progress in this exciting area. PMID:23733127

  11. Radiation-induced stenosis of the left main coronary artery

    SciTech Connect

    Tenet, W.; Missri, J.; Hager, D.

    1986-01-01

    A case of isolated left main coronary artery stenosis ten years following irradiation of the mediastinum for Hodgkin's disease is presented. Aortic biopsies were consistent with changes suggestive of radiation arteritis.

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

    MedlinePLUS

    ... the percentage of blood vessel blockage and the patient’s overall risk of a first or second stroke. Another especially ... Intracranial Stenosis ( SAMMPRIS ) showed that, in these high risk patients, the group who participated in the medical regimen ...

  13. 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.

  14. [Exertion-induced lactic acidosis in celiac artery stenosis].

    PubMed

    Jungo, O

    1990-03-10

    A well-trained young male developed effort-induced dyspnea due to marked lactic acidosis. In the absence of cardiopulmonary problems, enzyme defects, primary hepatopathy or myopathy, abdominal angiography revealed subtotal stenosis, and duplex sonography (15 years later) total occlusion, of the celiac trunk associated with hepatic steal syndrome. We suggest that the marked, effort-induced lactic acidosis may be a metabolic consequence of Dunbar syndrome (stenosis of the celiac trunk due to compression by the crura diaphragmatica). PMID:2315654

  15. Arterial Blood Flow Through a Nonsymmetrical Stenosis with Applications

    NASA Astrophysics Data System (ADS)

    Srivastava, Vijai

    1995-12-01

    The problem of blood flow through an axially nonsymmetric but radially symmetric stenosed tube when blood is represented by a Casson fluid and a Newtonian fluid, is investigated. The equations governing the flow obtained from the proposed model are solved and closed-form expressions for blood flow characteristics, namely, the dimensionless resistance to flow, the wall shear stress and the shearing stress on the wall at the maximum height of the stenosis, are derived. The results obtained are discussed in brief both qualitatively and quantitatively by comparing with related studies in the literature. It is shown that the resistance to flow decreases with increasing values of the parameter determining the stenosis shape and that the maximum resistance is attained in the case of symmetric stenosis. The magnitudes of the resistance to flow are always higher in the case of a Casson fluid model than in the case of a Newtonian fluid model. The wall shear stress and the shearing stress on the wall at the maximum height of the stenosis possess a character similar to the resistance to flow with respect to the Casson fluid parameter; however, the latter is independent of the stenosis shape and the former posseses a character different from the resistance to flow with respect to the parameter determining the stenosis shape. The analysis results are finally used to estimate the blood flow characteristics in different blood vessels using the numerical data from literature.

  16. Cervical Stenosis in a Patient with Arthrogryposis: Case Report

    PubMed Central

    Du, Jerry; Aichmair, Alexander; Lykissas, Marios; Girardi, Federico

    2014-01-01

    Study Design?Case report. Objective?Amyoplasia-type arthrogryposis is a rare congenital disease that presents as multiple contractures involving various areas of the body. To the authors' knowledge, there have been no reports of adults with amyoplasia in the current literature. We report a case of an adult patient with cervical stenosis in the setting of amyoplasia. Patients and Methods?A 48-year-old patient with amyoplasia and over 30 previous orthopedic reconstructive surgeries presented with neck pain radiating down his left shoulder and into the fingers, dysesthesia in his fingertips, and left-sided periauricular headache. A diagnosis of central spinal canal stenosis and bilateral foraminal stenosis at C3–C7 with radiculopathy was made based on computed tomography scans. Because of a prior right-side sternocleidomastoid muscle transfer, a left-side C3–C4, C5–C7 anterior cervical discectomy and fusion procedure was performed. Results?The patient experienced significant improvement in symptoms that was transient. Symptoms returned to preoperative values after 1?year, despite significant and persistent improvement in stenosis. Conclusions?Both amyoplasia and cervical stenosis can manifest in neurologic symptoms. Distinguishing the causing pathology can be challenging. The radiographic improvement of cervical stenosis in a patient with amyoplasia is not always associated with long-standing pain relief. PMID:24715873

  17. Cervical stenosis in a patient with arthrogryposis: case report.

    PubMed

    Du, Jerry; Aichmair, Alexander; Lykissas, Marios; Girardi, Federico

    2014-04-01

    Study Design?Case report. Objective?Amyoplasia-type arthrogryposis is a rare congenital disease that presents as multiple contractures involving various areas of the body. To the authors' knowledge, there have been no reports of adults with amyoplasia in the current literature. We report a case of an adult patient with cervical stenosis in the setting of amyoplasia. Patients and Methods?A 48-year-old patient with amyoplasia and over 30 previous orthopedic reconstructive surgeries presented with neck pain radiating down his left shoulder and into the fingers, dysesthesia in his fingertips, and left-sided periauricular headache. A diagnosis of central spinal canal stenosis and bilateral foraminal stenosis at C3-C7 with radiculopathy was made based on computed tomography scans. Because of a prior right-side sternocleidomastoid muscle transfer, a left-side C3-C4, C5-C7 anterior cervical discectomy and fusion procedure was performed. Results?The patient experienced significant improvement in symptoms that was transient. Symptoms returned to preoperative values after 1?year, despite significant and persistent improvement in stenosis. Conclusions?Both amyoplasia and cervical stenosis can manifest in neurologic symptoms. Distinguishing the causing pathology can be challenging. The radiographic improvement of cervical stenosis in a patient with amyoplasia is not always associated with long-standing pain relief. PMID:24715873

  18. Hybrid dynamic stabilization with posterior spinal fusion in the lumbar spine

    PubMed Central

    Hudson, William R. S.; Gee, John Eric; Billys, James B.; Castellvi, Antonio E.

    2011-01-01

    Background Instrumented lumbar arthrodesis has been established as the gold standard in the care of patients with degenerative disc disease. However, spinal fusion results in the elimination of motion of the functional spinal unit and has been implicated in the development of adjacent-level degeneration. Motion-preserving devices such as the dynamic rod allow for stabilization of a pathologic motion segment above a fused segment and create a transitional zone (index level) that decreases the loads applied to the supra-adjacent normal segment. Methods After institutional review board approval, 28 patients were included in this prospective, consecutive, nonrandomized clinical trial. Each subject was consented for dynamic stabilization. There was no attempt at fusion at the dynamic level. The cohort underwent a posterior lateral spinal fusion with single- or 2-level transforaminal lumbar interbody fusion by use of a cage, with superior-level posterior dynamic instrumentation. Functional clinical outcomes were measured with a 100-point visual analog scale, Oswestry Disability Index, and Short Form 36 questionnaire. Radiographic measurements, fusion evaluation, complications, and screw loosening were recorded. Results A minimum of 24 months’ follow-up data included 22 patients. No device failure or screw breakage was identified. Postoperative range of motion averaged 2.5° at the index level, and the superior adjacent-level range of motion remained unchanged (P > .05). Disc height was preserved at all levels (P > .05). Of 180 screws, 6 (3%) showed radiographic loosening. Functional outcomes showed significant improvement in mean postoperative visual analog scale score by 24.7 points (P < .01) and Oswestry Disability Index by 27.6 points (P < .01), as well as the Short Form 36 physical (P < .01) and mental (P < .05) components from baseline to 2-year follow-up. Conclusions Our preliminary results at 2 years are satisfactory. Clinical Relevance Ultimately, further follow-up will assess the potential for this treatment to delay adjacent-level changes in the long term.

  19. 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.

  20. The lateral transpsoas approach to the lumbar and thoracic spine: A review

    PubMed Central

    Arnold, Paul M.; Anderson, Karen K.; McGuire, Robert A.

    2012-01-01

    Background: In the last several years, the lateral transpsoas approach to the thoracic and lumbar spine, also known as extreme lateral interbody fusion (XLIF) or direct lateral interbody fusion (DLIF), has become an increasingly common method to achieve fusion. Several recent large series describe several advantages to this approach, including less tissue dissection, smaller incisions, decreased operative time, blood loss, shorter hospital stay, reduced postoperative pain, enhanced fusion rates, and the ability to place instrumentation through the same incision. Indications for this approach have expanded and now include degenerative disease, tumor, deformity, and infection. Methods: A lateral X-ray confirms that the patient is in a truly lateral position. Next, a series of tubes and dilators are used, along with fluoroscopy, to identify the mid-position of the disk to be incised. After continued dilation, the optimal site to enter the disk space is the midpoint of the disk, or a position slightly anterior to the midpoint of the disk. XLIF typically allows for a larger implant to be inserted compared to TLIF or PLIF, and, if necessary, instrumentation can be inserted percutaneously, which would allow for an overall minimally invasive procedure. Results: Fixation techniques appear to be equal between XLIF and more traditional approaches. Some caution should be exercised because common fusion levels of the lumbar spine, including L4-5 and L4-S1, are often inaccessible. In addition, XLIF has a unique set of complications, including neural injuries, psoas weakness, and thigh numbness. Conclusion: Additional studies are required to further evaluate and monitor the short and long-term safety, efficacy, outcomes, and complications of XLIF procedures. PMID:22905326

  1. First Cases of Degenerative Brain Disease CTE Found in Veterans with Blast Injuries

    MedlinePLUS

    ... degenerative brain disease CTE found in veterans with blast injuries Follow NINDSnews For release: Friday, June 29, 2012 Some veterans who experience blast-related head injuries on the battlefield can develop ...

  2. Hemophilic pseudotumor of the first lumbar vertebra

    PubMed Central

    Nachimuthu, Gurusamy; Arockiaraj, Justin; Krishnan, Venkatesh; Sundararaj, Gabriel David

    2014-01-01

    Hemophilic pseudotumor involving the spine is extremely uncommon and presents a challenging problem. Preoperative planning, angiography, intra and perioperative monitoring with factor VIII cover and postoperative care for hemophilic pseudotumor is vital. Recognition of the artery of Adamkiewicz in the thoracolumbar junction helps to avoid intraoperative neurological injury. We report the case of a 26-year-old male patient with hemophilia A, who presented with a massive pseudotumor involving the first lumbar vertebra and the left iliopsoas. Preoperative angiography revealed the artery of Adamkiewicz arising from the left first lumbar segmental artery. Excision of pseudotumor was successfully carried out with additional spinal stabilization. At 2 years followup, there was no recurrence and the patient was well stabilized with a satisfactory functional status. Surgical excision gives satisfactory outcome in such cases. PMID:25404776

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 false Lumbar spine, abdomen, and pelvis assembly and test procedure...Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The...

  4. 49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 false Lumbar spine, abdomen, and pelvis assembly and test procedure...Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 false Lumbar spine, abdomen, and pelvis assembly and test procedure...Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The...

  6. 49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 false Lumbar spine, abdomen, and pelvis assembly and test procedure...Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The...

  7. Tuina therapy for prolapsed lumbar intervertebral disc

    Microsoft Academic Search

    Zhang Bi-meng; Wu Huan-gan; Shen Jian

    2004-01-01

    Recurrent low back pain and reflex sciatica of lower limbs are the two leading symptoms of prolapsed lumbar intervertebral\\u000a disc, which can be confirmed in the history, symptoms, signs and imaging examination such as CT scan and MRI. It should be\\u000a differentiated from those conditions characterized by lumbago and\\/or possible sciatica. Tuina was performed mostly on the\\u000a Bladder Meridian, Gallbladder

  8. [Renal actinomycosis with fistulized lumbar abscess].

    PubMed

    Mallick, S; Klein, J F

    2000-09-01

    The authors report a case of renal actinomycosis in an adolescent presenting with two fistulized lumbar abscesses. This rare disease, which generally has a good prognosis, is difficult to diagnose, both clinically and radiologically. The positive diagnosis is based on histological examination, more frequently of the nephrectomy operative specimen, than ultrasound-guided fine needle aspiration biopsy of an atypical renal tumour. Conservative treatment with high-dose penicillin gives excellent results. PMID:11064902

  9. Herniation of the upper lumbar discs

    Microsoft Academic Search

    E. Pásztor; I. Szarvas

    1981-01-01

    Summary On the basis of investigations involving 134 patients operated on at the National Institute of Neurosurgery, Budapest, the authors point out that herniations of the intervertebral discs at L 1\\/2, L 2\\/3, L 3\\/4 levels are characterized by more severe neurological changes. Paresis and autonomic disorders occur much more frequently than in lower lumbar disc herniations: paresis was found

  10. Fractures of the Thoracic and Lumbar Spine

    Microsoft Academic Search

    Robert N. Hensinger; Clifford L. Craig

    \\u000a Injuries of the thoracic and lumbar spine in children are rare. The potential for continued growth, the presence of healthy\\u000a disc tissue, the elasticity of the soft tissues, and well-mineralized bone distinguish these injuries from those in the adult.\\u000a The immature spine has the capacity to remodel the vertebral body, but not the posterior elements. Restoration of height of\\u000a a

  11. Sacralization of L5 in Radiological Studies of Degenerative Spondylolisthesis at L4-L5

    PubMed Central

    Kong, Chae-Gwan; Park, Jong-Soo

    2008-01-01

    Study Design Radiological analysis. Purpose To investigate sacralization of L5 on radiological studies of degenerative spondylolisthesis at L4-L5. Overview of Literature Degenerative spondylolisthesis commonly develops at L4-L5. Sacralization of L5 is thought to cause stress concentration at this level, which accentuates degenerative changes and promotes development of degenerative spondylolisthesis. However, there has been no study dedicated to determining whether the presence of sacralization at L5 influences the radiological findings in degenerative spondylolisthesis at L4-L5. Methods Seventy-eight patients with degenerative spondylolisthesis at L4-L5 were classified into two groups according to the presence of L5 sacralization: with (n=54) and without (n=24). Four radiographic parameters were measured and compared between the two groups: anterior slippage of L4 on L5 (% slip), facet orientation of L4-L5 (degrees), facet osteoarthritis of L4-L5 by Fujiwara's criteria (1~4 grades), and disc degeneration of L4-L5 by Frymoyer's criteria (grades 1~5). Results There was no significant difference in the degree of anterior slippage of L4 on L5 (17.02±6.21 versus 16.65±4.87, p=0.809), facet orientation (54.99±12.18 versus 56.23±4.35, p=0.642), facet osteoarthritis (3.43±0.59 versus 3.53±0.37, p=0.527), or disc degeneration (4.50±0.51 versus 4.35±0.61, p=0.340) between the two groups. Conclusions Our study shows that the influence of sacralization of L5 on radiological findings in degenerative spondylolisthesis at L4-L5 may be less significant than previously expected. Further studies in large patient groups are needed to clarify the role of L5 sacralization on the development of degenerative spondylolisthesis at L4-L5. PMID:20411140

  12. Detection of degenerative disease of the temporomandibular joint by bone scintigraphy: concise communication

    SciTech Connect

    Goldstein, H.A.; Bloom, C.Y.

    1980-10-01

    Nine patients with facial pain were evaluated with limited bone scans. The scintigrams correlated with microscopy in all patients, although radiographs correlated with microscopy in only five patients. The degenerative disease process in the temporomandibular joint was more extensive in the patients with radiographic and scintigraphic abnormalities than in those with scintigraphic abnormalities alone. The limited bone scan appears useful in detecting early degenerative changes in the temporomandibular joint.

  13. Do musculoskeletal degenerative diseases affect mortality and cause of death after 10 years in Japan?

    Microsoft Academic Search

    Masaki Tsuboi; Yukiharu Hasegawa; Yukihiro Matsuyama; Sadao Suzuki; Koji Suzuki; Shiro Imagama

    2011-01-01

    There are several reports from Europe and the United States on mortality from musculoskeletal degenerative diseases; however,\\u000a no reports have been published from Japan. This study is the first that has examined whether musculoskeletal degenerative\\u000a diseases affect life prognosis in Japan. As many as 944 persons who were 60 years of age and older and who underwent one or\\u000a more musculoskeletal

  14. The First Clinical Trial of Beta-Calcium Pyrophosphate as a Novel Bone Graft Extender in Instrumented Posterolateral Lumbar Fusion

    PubMed Central

    Lee, Jae Hyup; Jeung, Ul-Oh; Park, Kun-Woo; Kim, Min-Seok; Lee, Choon-Ki

    2011-01-01

    Background Porous ?-calcium pyrophosphate (?-CPP) was developed to improve the fusion success of posterolateral lumbar fusion (PLF). The possibility of accomplishing PLF using a mixture of porous ?-CPP and iliac bone was studied. This paper reports the radiologic results of PLF using the ?-CPP plus autograft for lumbar degenerative disease as a bone graft extender. Methods A prospective, case-matched, radiographic study evaluating the results of short segment lumbar fusion using a ?-CPP plus autograft was performed to compare the efficacy of ?-CPP plus autograft with that of an autograft alone for short segment lumbar fusion. Thirty one consecutive patients (46 levels) underwent posterolateral fusion with pedicle screw fixation and additional posterior lumbar interbody fusion. In all patients, 3 mL of ?-CPP plus 3 mL of autogenous bone graft was placed randomly in one side of a posterolateral gutter, and 6 mL of autogenous iliac bone graft was placed on the other. The fusion rates, volumes of fusion masses, and bone absorption percentage were evaluated postoperatively using simple radiographs and 3 dimensional computed tomography (3D-CT) scans. Results The control sides treated with an autograft showed significantly better Lenke scores than the study sides treated with ?-CPP at 3 and 6 months postoperatively, but there was no difference between the two sides at 12 months. The fusion rates (confirmed by 3D-CT) were 87.0% in the ?-CPP group and 89.1% in the autograft group, which were not significantly different. The fusion mass volumes and bone absorption percentage at 12 months postoperatively were 2.49 mL (58.4%) and 1.89 mL (69.5%) for the ?-CPP and autograft groups, respectively, and mean fusion mass volume was significantly higher in the ?-CPP group. Conclusions ?-CPP combined with an autograft is as effective as autologous bone for grafting during instrumented posterolateral spinal fusion. These findings suggest that ?-CPP bone chips can be used as a novel bone graft extender for short-segment posterolateral spinal fusion. PMID:21909472

  15. Degenerative effects in rat eyes after experimental ocular hypertension

    PubMed Central

    Scarsella, G.; Nebbioso, M.; Stefanini, S.; Librando, A.; Pescosolido, N.

    2012-01-01

    This study was used to evaluate the degenerative effects on the retina and eye-cup sections after experimental induction of acute ocular hypertension on animal models. In particular, vascular events were directly focused in this research in order to assess the vascular remodeling after transient ocular hypertension on rat models. After local anaesthesia by administration of eye drops of 0.4% oxibuprocaine, 16 male adult Wistar rats were injected in the anterior chamber of the right eye with 15 µL of methylcellulose (MTC) 2% in physiological solution. The morphology and the vessels of the retina and eye-cup sections were examined in animals sacrificed 72 h after induction of ocular hypertension. In retinal fluorescein angiographies (FAGs), by means of fluorescein isothiocyanate-coniugated dextran (FITC), the radial venules showed enlargements and increased branching, while the arterioles appeared focally thickened. The length and size of actually perfused vessels appeared increased in the whole superficial plexus. In eye-cup sections of MTC-injected animals, in deep plexus and connecting layer there was a bigger increase of vessels than in controls. Moreover, the immunolocalization of astrocytic marker glial fibrillary acidic protein (GFAP) revealed its increased expression in internal limiting membrane and ganglion cell layer, as well as its presence in Müller cells. Finally, the pro-angiogenic factor vascular endothelial growth factor (VEGF) was found to be especially expressed by neurones of ganglion cell layer, both in control and in MTC-injected eyes. The data obtained in this experimental model on the interactions among glia, vessels and neurons should be useful to evaluate if also in glaucomatous patients the activation of vessel-adjacent glial cells might play key roles in following neuronal dysfunction. PMID:23361238

  16. Regenerative Therapies for Equine Degenerative Joint Disease: A Preliminary Study

    PubMed Central

    Broeckx, Sarah; Zimmerman, Marieke; Crocetti, Sara; Suls, Marc; Mariën, Tom; Ferguson, Stephen J.; Chiers, Koen; Duchateau, Luc; Franco-Obregón, Alfredo

    2014-01-01

    Degenerative joint disease (DJD) is a major cause of reduced athletic function and retirement in equine performers. For this reason, regenerative therapies for DJD have gained increasing interest. Platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) were isolated from a 6-year-old donor horse. MSCs were either used in their native state or after chondrogenic induction. In an initial study, 20 horses with naturally occurring DJD in the fetlock joint were divided in 4 groups and injected with the following: 1) PRP; 2) MSCs; 3) MSCs and PRP; or 4) chondrogenic induced MSCs and PRP. The horses were then evaluated by means of a clinical scoring system after 6 weeks (T1), 12 weeks (T2), 6 months (T3) and 12 months (T4) post injection. In a second study, 30 horses with the same medical background were randomly assigned to one of the two combination therapies and evaluated at T1. The protein expression profile of native MSCs was found to be negative for major histocompatibility (MHC) II and p63, low in MHC I and positive for Ki67, collagen type II (Col II) and Vimentin. Chondrogenic induction resulted in increased mRNA expression of aggrecan, Col II and cartilage oligomeric matrix protein (COMP) as well as in increased protein expression of p63 and glycosaminoglycan, but in decreased protein expression of Ki67. The combined use of PRP and MSCs significantly improved the functionality and sustainability of damaged joints from 6 weeks until 12 months after treatment, compared to PRP treatment alone. The highest short-term clinical evolution scores were obtained with chondrogenic induced MSCs and PRP. This study reports successful in vitro chondrogenic induction of equine MSCs. In vivo application of (induced) MSCs together with PRP in horses suffering from DJD in the fetlock joint resulted in a significant clinical improvement until 12 months after treatment. PMID:24465787

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

    PubMed

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

    2014-05-01

    The goal of this review is to discuss the mechanisms of postural degeneration, particularly the loss of lumbar lordosis commonly observed in the elderly in the context of evolution, mechanical, and biological studies of the human spine and to synthesize recent research findings to clinical management of postural malalignment. Lumbar lordosis is unique to the human spine and is necessary to facilitate our upright posture. However, decreased lumbar lordosis and increased thoracic kyphosis are hallmarks of an aging human spinal column. The unique upright posture and lordotic lumbar curvature of the human spine suggest that an understanding of the evolution of the human spinal column, and the unique anatomical features that support lumbar lordosis may provide insight into spine health and degeneration. Considering evolution of the skeleton in isolation from other scientific studies provides a limited picture for clinicians. The evolution and development of human lumbar lordosis highlight the interdependence of pelvic structure and lumbar lordosis. Studies of fossils of human lineage demonstrate a convergence on the degree of lumbar lordosis and the number of lumbar vertebrae in modern Homo sapiens. Evolution and spine mechanics research show that lumbar lordosis is dictated by pelvic incidence, spinal musculature, vertebral wedging, and disc health. The evolution, mechanics, and biology research all point to the importance of spinal posture and flexibility in supporting optimal health. However, surgical management of postural deformity has focused on restoring posture at the expense of flexibility. It is possible that the need for complex and costly spinal fixation can be eliminated by developing tools for early identification of patients at risk for postural deformities through patient history (genetics, mechanics, and environmental exposure) and tracking postural changes over time. PMID:24785474

  18. Risk Factors for Recurrent Lumbar Disc Herniations

    PubMed Central

    2014-01-01

    The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future. PMID:24761206

  19. Lumbar disk herniation with contralateral symptoms.

    PubMed

    Sucu, Hasan Kamil; Gelal, Fazil

    2006-05-01

    The aim of the study is to determine if leg pain can be caused by contralateral lumbar disk herniation and if intervention from only the herniation side would suffice in these patients. Five patients who had lumbar disk herniations with predominantly contralateral symptoms were operated from the side of disk herniation without exploring or decompressing the symptomatic side. Patients were evaluated pre- and postoperatively. To our knowledge, this is the first reported series of such patients who were operated only from the herniation side. The possible mechanisms of how contralateral symptoms predominate in these patients are also discussed. In all patients, the shape of disk herniations on imaging studies were quite similar: a broad-based posterior central-paracentral herniated disk with the apex deviated away from the side of the symptoms. The symptoms and signs resolved in the immediate postoperative period. Our data clears that sciatica can be caused by contralateral lumbar disk herniation. When operation is considered, intervention only from the herniation side is sufficient. It is probable that traction rather than direct compression is responsible from the emergence of contralateral symptoms. PMID:16231173

  20. Augmentation of intertransverse process lumbar fusion.

    PubMed

    Nawrocki, Michael A; Martinez, Steven A; Hughes, Joanne; Lincoln, James D; Shih, Mei-Shu; Zheng, Hellen; Carroll, William J

    2006-01-01

    Spinal fusion surgery for alleviation of intractable lower back pain in humans is currently a primary therapeutic technique, with failure rates averaging between 5 to 35%. Implanted and external source-based electrical stimulation devices have been investigated in an attempt to increase osteogenesis at the fusion site in an attempt to reduce spinal fusion failure rates. The purpose of our study was to evaluate the efficacy of two co-processor systems and an additional system with an SIS generation field at 15.8 mA (rms) using biomechanical, dual-energy X-ray absorptiometry (DXA), and histomorphometric analyses, in rabbits following dorsolateral (= posteriolateral [in humans]) spinal fusion. Fifty-six male New Zealand White underwent bilateral lumbar spinal fusion by performing decortication of the transverse processes of lumbar vertebrae four and five with placement of autogenic cancellous bone graft harvested from the ilial wings. Four study groups were designated based on the type of IES device used for stimulation or as a control. Eight weeks after surgery all subjects were sacrificed and the quality and strength of the fusion masses were compared using radiographic, biomechanical, histomorphometry, and qualitative histological evaluation. While some variation existed within and between groups, Group 2 showed a significant improvement in all parameters measured as compared to the control group (P < 0.05). The use of adjunct non-invasive surface IES for improving bony fusion rates for patients undergoing lumbar spinal fusion is supported by this study. PMID:16810348

  1. Lumbar Disk Herniation Surgery: Outcome and Predictors

    PubMed Central

    Sedighi, Mahsa; Haghnegahdar, Ali

    2014-01-01

    Study Design?A retrospective cohort study. Objectives?To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods?We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results?Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion?Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire–Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population. Predictive factors for ineffective surgical treatment for lumbar disk herniation were female sex and negative preoperative straight leg raising. Age, level of education, and preoperative VAS for low back pain were other factors that showed prediction power. PMID:25396104

  2. Lumbar disk herniation surgery: outcome and predictors.

    PubMed

    Sedighi, Mahsa; Haghnegahdar, Ali

    2014-12-01

    Study Design?A retrospective cohort study. Objectives?To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods?We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results?Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion?Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire-Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population. Predictive factors for ineffective surgical treatment for lumbar disk herniation were female sex and negative preoperative straight leg raising. Age, level of education, and preoperative VAS for low back pain were other factors that showed prediction power. PMID:25396104

  3. Technical Report of Free Hand Pedicle Screw Placement using the Entry Points with Junction of Proximal Edge of Transverse Process and Lamina in Lumbar Spine: Analysis of 2601 Consecutive Screws

    PubMed Central

    Oh, Chang Hyun; Kim, Yongjung J.; Hyun, Dongkeun; Park, Hyeong-Chun

    2013-01-01

    Objective A variety of different pedicle screws entry point techniques are used for the lumbar pedicle screws placement. This study reported Kim's entry point of lumbar pedicle screws with free hand technique and the accuracy of this technique. Methods We retrospectively reviewed the 584 cases with free hand placed lumbar pedicle screw placement. The diagnosis included 491 cases with degenerative spine, 59 cases with trauma, 29 cases with metastatic disease, and 5 cases with scoliosis. A total of 2601 lumbar pedicle screws were placed, and the entry points of lumbar pedicle screws were the junction of proximal edge of transverse process and lamina. Incidence and extent of cortical breach by misplaced pedicle screw was determined by review of intra-operative and post-operative radiographs and/or computed tomography. Results Among the total 2601 lumbar free hand placed pedicle screws, 114 screws (4.4%) in 79 patients (13.5%) were repositioned screws with suspected screw malposition during operation, and 37 screws (1.4%) in 31 patients (5.3%) were identified as moderate to severe breaching the pedicle after post-operative imaging studies. Among the patient with malpositioned screws, 3 patients showed nerve irritation sign of the lesion, and 2 cases were symptom improved after nerve block and conservative management, and 1 case was removed the screw after the failure of the treatment. Conclusion Free hand pedicle screw placement based on external landmark with the junction of proximal edge of transverse process and lamina showed acceptable safety and accuracy and avoidance of radiation exposure. PMID:24757450

  4. Operative Treatment of Combined Aortic Stenosis and Coronary Artery Disease

    PubMed Central

    Kadric, Nedzad; Kabil, Emir; Mujanovic, Emir; Hadziselimovic, Mehdin; Jahic, Mirza; Rajkovic, Stojan; Osmanovic, Enes; Avdic, Sevleta; Keranovic, Suad; Behrem, Adnan

    2015-01-01

    Introduction: The aortic valve replacement is a standard operating procedure in patients with severe aortic stenosis. Structure of patients undergoing surgery ranges from young population with isolated mitral valvular disease to the elderly population, which is in addition to the underlying disease additionally burdened with comorbidity. One of the most commonly present factors that further complicate the surgery is coronary heart disease that occurs in, almost, one third of patients with aortic stenosis. The aim is to compare the results of surgery for aortic valve replacement with or without coronary artery bypass graft (CABG). Patients and Methods: From August 2008 to January 2013 in our center operated on 120 patients for aortic stenosis. Of this number, 75 were men and 45 women. The average age was 63.37 years (16-78). Isolated aortic valve replacement was performed in 89 patients and in 31 patients underwent aortic valve replacement and coronary bypass surgery. Implanted 89 biological and 31 mechanical valves. Results: Patients with associated aortic stenosis and coronary artery disease were more expressed symptomatic symptoms preoperatively to patients with isolated aortic stenosis who were on average younger age. Intra-hospital morbidity and mortality was more pronounced in the group of patients with concomitant aortic valve replacement and coronary bypass surgery. Morbidity was recorded in 17 patients (14.3%) in both groups, while the mortality rate in both groups was 12 patients (10.1%). Conclusion: Evaluation of preoperative risk factors and comorbidity in patients with aortic stenosis and coronary artery disease contributes to a significant reduction in intraoperative and postoperative complications. Also, early diagnosis of associated coronary artery disease and aortic stenosis contributes to timely decision for surgery thus avoiding subsequent ischaemic changes and myocardial damage. PMID:25870480

  5. 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

  6. Comparison of Total Disc Replacement with lumbar fusion: a meta-analysis of randomized controlled trials.

    PubMed

    Nie, Hongfei; Chen, Guo; Wang, Xiandi; Zeng, Jiancheng

    2015-01-01

    A meta-analysis was performed to evaluate whether a beneficial clinical effect of the Total Disc Replacement (TDR) over lumbar fusion for the treatment of patients with Degenerative Disc Disease (DDD). An electronic search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE from their inception to 2012 was completed, and we assessed risk bias and retrieved relevant data, and meta-analysis was performed, if appropriate. Oswestry Disability Index (ODI), Visual Analog Score (VAS), patient satisfaction or VAS patient satisfaction, narcotic use, overall success rate, reoperation rate, work status, "surgery again?", complications and radiographic outcomes were evaluated. Six RCTs were included in this meta-analysis. At 2 years, TDR was demonstrated to be more beneficial for patients compared to lumbar fusion in the following outcomes, including ODI scores (MD:-4.87, 95% CI: -7.77 to -1.97, p=0.001), patient satisfaction (OR:1.91, 95% CI: 1.27 to 2.86, p=0.002) and VAS patient satisfaction (MD:9.10, 95% CI: 3.20 to 14.99, p=0.002), the percentage of using narcotics (OR=0.54, 95%CI: 0.31 to 0.96, p=0.03), overall success rate (OR:1.68, 95% CI: 1.26 to 2.25, p=0.005), the rate of patients to chose the same surgical treatment again (OR:2.38, 95% CI: 1.72 to 3.28, p < 0.001), and complications (OR=0.50, 95%CI: 0.29 to 0.84, p=0.008). Other outcomes, including re-operation rate (OR:0.62, 95% CI: 0.36 to 1.06, p=0.08) and work status (OR=1.05, 95% CI: 0.75 to 1.47, p=0.80), were demonstrated to be no differences between the two groups. In a long-term of follow-up (2 years), TDR shows a significant superiority for the treatment of lumbar DDD compared with fusion. PMID:25604372

  7. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    PubMed Central

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Holt, Tim; Cummings, John

    2014-01-01

    Introduction Low back pain is common and originates in the sacroiliac (SI) joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US). Methods A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3), an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date), and continuous enrollment for ?1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars) were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592) per privately-insured patient (N=78,533). Among patients with lumbar spinal fusion (N=434), attributable 3-year mean costs were $91,720 (SD $75,502) per patient compared to $15,776 (SD $27,542) per patient among patients without lumbar spinal fusion (N=78,099). Overall, inpatient hospitalizations (19.4%), hospital outpatient visits and procedures (14.0%), and outpatient pain medications (9.6%) accounted for the largest proportion of costs. The estimated 3-year insurance payments attributable to SI joint disruption were $1.6 billion per 100,000 commercial payer beneficiaries. Conclusion The economic burden of SI joint disruption among privately-insured patients in the US is substantial, highlighting the need for more cost-effective therapies. PMID:24596468

  8. Renal artery stenosis: epidemiology and treatment.

    PubMed

    Weber, Benjamin R; Dieter, Robert S

    2014-01-01

    Renal artery stenosis (RAS) is a frequently encountered problem in clinical practice. The disease encompasses a broad spectrum of pathophysiologies and is associated with three major clinical syndromes: ischemic nephropathy, hypertension, and destabilizing cardiac syndromes. The two most common etiologies are fibromuscular dysplasia and atherosclerotic renal artery disease with atherosclerotic disease accounting for the vast majority of cases. Atherosclerotic renovascular disease has considerable overlap with atherosclerotic disease elsewhere and is associated with a poor prognosis. A wide range of diagnostic modalities and treatment approaches for RAS are available to clinicians, and with the advent of endovascular interventions, selecting the best course for a given patient has only grown more challenging. Several clinical trials have demonstrated some benefit with revascularization but not to the extent that many had hoped for or expected. Furthermore, much of the existing data is only marginally useful given significant flaws in study design and inherent bias. There remains a need for further identification of subgroups and appropriate indications in hopes of maximizing outcomes and avoiding unnecessary procedures in patients who would not benefit from treatment. In recent decades, the study of RAS has expanded and evolved rapidly. In this review, we will attempt to summarize the amassed body of literature with a focus on the epidemiology of RAS including prevalence, overlap with other atherosclerotic disease, and prognosis. We will also outline existing diagnostic and treatment approaches available to clinicians as well as summarize the findings of several major clinical trials. Finally, we will offer our perspective on future directions in the field. PMID:24868169

  9. Renal artery stenosis: epidemiology and treatment

    PubMed Central

    Weber, Benjamin R; Dieter, Robert S

    2014-01-01

    Renal artery stenosis (RAS) is a frequently encountered problem in clinical practice. The disease encompasses a broad spectrum of pathophysiologies and is associated with three major clinical syndromes: ischemic nephropathy, hypertension, and destabilizing cardiac syndromes. The two most common etiologies are fibromuscular dysplasia and atherosclerotic renal artery disease with atherosclerotic disease accounting for the vast majority of cases. Atherosclerotic renovascular disease has considerable overlap with atherosclerotic disease elsewhere and is associated with a poor prognosis. A wide range of diagnostic modalities and treatment approaches for RAS are available to clinicians, and with the advent of endovascular interventions, selecting the best course for a given patient has only grown more challenging. Several clinical trials have demonstrated some benefit with revascularization but not to the extent that many had hoped for or expected. Furthermore, much of the existing data is only marginally useful given significant flaws in study design and inherent bias. There remains a need for further identification of subgroups and appropriate indications in hopes of maximizing outcomes and avoiding unnecessary procedures in patients who would not benefit from treatment. In recent decades, the study of RAS has expanded and evolved rapidly. In this review, we will attempt to summarize the amassed body of literature with a focus on the epidemiology of RAS including prevalence, overlap with other atherosclerotic disease, and prognosis. We will also outline existing diagnostic and treatment approaches available to clinicians as well as summarize the findings of several major clinical trials. Finally, we will offer our perspective on future directions in the field. PMID:24868169

  10. Secreted Wnt Modulators in Symptomatic Aortic Stenosis

    PubMed Central

    Askevold, Erik Tandberg; Gullestad, Lars; Aakhus, Svend; Ranheim, Trine; Tønnessen, Theis; Solberg, Ole G.; Aukrust, Pål; Ueland, Thor

    2012-01-01

    Background Valve calcification and inflammation play key roles in the development of aortic stenosis (AS). The Wnt pathways have been linked to inflammation, bone metabolism, angiogenesis, and heart valve formation. We hypothesized that soluble Wnt modulators may be dysregulated in symptomatic AS. Methods and Results We measured circulating levels (n=136) and aortic valve tissue expression (n=16) of the secreted Wnt modulators secreted frizzled related protein-3, dickkopf-1 (DKK-1), and Wnt inhibitory factor-1 (WIF-1) by enzyme immunoassay, immunostaining, and RT-PCR in patients with symptomatic, severe AS and investigated associations with echocardiographic parameters of AS and cardiac function. Finally, we assessed the prognostic value of these Wnt modulators in relation to all-cause mortality (n=35) during long-term follow-up (median 4.6 years; survivors, 4.8 years; nonsurvivors, 1.9 years) in these patients. Our main findings were: (1) serum levels of all Wnt modulators were markedly elevated in patients with symptomatic AS (mean increase 231% to 278%, P<0.001), (2) all Wnt modulators were present in calcified aortic valves but correlated poorly with systemic levels or degree of AS, (3) some modulators (ie, WIF-1) were associated with the degree of myocardial function and valvular calcification, (4) all Wnt modulators, and DKK-1 in particular, predicted long-term mortality in these patients also after adjusting for conventional predictors including NT-proBNP. Conclusions Together, these in vivo data support the involvement of Wnt signaling in the development of AS and suggest that circulating Wnt modulators should be further investigated as risk markers in larger AS populations, including patients with asymptomatic disease. PMID:23316316

  11. Characterization of the cephalic arch and location of stenosis

    PubMed Central

    Bennett, Shelby; Hammes, Mary S.; Blicharski, Tom; Watson, Sydeaka; Funaki, Brian

    2015-01-01

    Purpose The purpose of this study is to accurately characterize the cephalic arch segments into four domains and to enable more specific evaluation of cephalic arch stenosis (CAS) and determine the frequency of stenosis in each domain. Methods After Institutional Review Board (IRB) approval, a retrospective chart review was done to define a population of patients receiving hemodialysis who developed CAS as apparent on clinically indicated radiologic imaging. A standardized approach was devised to categorize four domains of the cephalic arch. Domain I was defined as the peripheral portion of the arch and Domain IV was the distal portion of the cephalic vein near termination with the axillary vein. The magnitude of stenosis as measured by percentage was determined and compared in the four domains. Results The most frequent location for stenosis was found in domain IV when compared with domains II or I (p<0.01). The magnitude of stenosis differed across all domains (p<0.001) with the least common place for CAS in domain I. Treatment of CAS included angioplasty in all, thrombectomy in eight, and stent placement in five. Conclusions CAS occurs most commonly in the terminal portion of the arch. Four standardized domains have been defined; future work will validate these findings and determine the best intervention for each domain. PMID:25198819

  12. [Aortic stenosis with left ventricular dysfunction: evaluation and management].

    PubMed

    Hanania, G; Terdjman, M; Montely, J M; Maroni, J P

    2002-11-01

    Aortic stenosis is the most frequent valvulopathy in France today. Valve replacement has transformed the prognosis, when indications are present before the appearance of irreversible left ventricular dysfunction. However, some patients are still not seen before this time or their surgery was deferred. Thus, the postoperative prognosis depends on the reversibility of this dysfunction which can occur even when the stenosis is severe and essentially reflects the elevated afterload. The prognosis is less favorable once myocardial fibrosis has developed in response to left ventricular hypertrophy or when ischemic cardiopathy contributes to this dysfunction. The diagnosis and prognosis are based on the confirmation of the presence of a severe stenosis and that the removal of this obstacle will lead to regression of the dysfunction. For this, Doppler echocardiography is determinant, as combined with a dobutamine test, it is able to evaluate the tightness of the stenosis, the severity of the left ventricular dysfunction and its reversibility. When the stenosis is severe with contractile reserve, indicating a better postoperative prognosis, dobutamine does not induce an appreciable change of the aortic area, but the mean pressure gradient, often low prior to dobutamine administration, rises. Although the surgical risk remains higher in the presence of left ventricular dysfunction, the ultimate prognosis is more favorable when the test suggests regression is possible. PMID:12515104

  13. 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

  14. The European multicenter trial on the safety and efficacy of guided oblique lumbar interbody fusion (GO-LIF)

    PubMed Central

    2010-01-01

    Background Because of the implant-related problems with pedicle screw-based spinal instrumentations, other types of fixation have been tried in spinal arthrodesis. One such technique is the direct trans-pedicular, trans-discal screw fixation, pioneered by Grob for spondylolisthesis. The newly developed GO-LIF procedure expands the scope of the Grob technique in several important ways and adds security by means of robotic-assisted navigation. This is the first clinical trial on the GO-LIF procedure and it will assess safety and efficacy. Methods/Design Multicentric prospective study with n = 40 patients to undergo single level instrumented spinal arthrodesis of the lumbar or the lumbosacral spine, based on a diagnosis of: painful disc degeneration, painful erosive osteochondrosis, segmental instability, recurrent disc herniation, spinal canal stenosis or foraminal stenosis. The primary target criteria with regards to safety are: The number, severity and cause of intra- and perioperative complications. The number of significant penetrations of the cortical layer of the vertebral body by the implant as recognized on postoperative CT. The primary target parameters with regards to feasibility are: Performance of the procedure according to the preoperative plan. The planned follow-up is 12 months and the following scores will be evaluated as secondary target parameters with regards to clinical improvement: VAS back pain, VAS leg pain, Oswestry Disability Index, short form - 12 health questionnaire and the Swiss spinal stenosis questionnaire for patients with spinal claudication. The secondary parameters with regards to construct stability are visible fusion or lack thereof and signs of implant loosening, implant migration or pseudarthrosis on plain and functional radiographs. Discussion This trial will for the first time assess the safety and efficacy of guided oblique lumbar interbody fusion. There is no control group, but the results, the outcome and the rate of any complications will be analyzed on the background of the literature on instrumented spinal fusion. Despite its limitations, we expect that this study will serve as the key step in deciding whether a direct comparative trial with another fusion technique is warranted. Trial Registration Clinical Trials NCT00810433 PMID:20819219

  15. Lumbar disc nucleoplasty using coblation technology: clinical outcome

    Microsoft Academic Search

    Alaa Azzazi; Sherif AlMekawi; Mostafa Zein

    2010-01-01

    Background and purposeAlthough the standard treatment for lumbar disc herniation is lumbar microdiscectomy, nucleoplasty offers a new technique with encouraging results in well selected cases. Nucleoplasty is a minimally invasive technique that manages intradiscal herniation through energy based removal of part of the nucleus pulposus. The purpose of this study was to assess the safety and clinical outcome of the

  16. Circumferential cells of the developing Rana catesbeiana lumbar spinal cord

    Microsoft Academic Search

    H. Lee Campbell; Michael S. Beattie; Jacqueline C. Bresnahan

    1987-01-01

    Neural elements in the lumbar enlargement of the developing Rana catesbeiana spinal cord were labelled by placing chips of dessicated horseradish peroxidase (HRP) into various lesions of the spinal cord. Of the elements labelled in the lumbar enlargement, a population of cells circumjacent to the gray matter was seen to be distinct from all others on the basis of their

  17. 49 CFR 572.43 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...Transportation 7 2010-10-01 2010-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation...Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a fully...

  18. Mechanical differences between lumbar and tail discs in the mouse

    Microsoft Academic Search

    Joseph J. Sarver; Dawn M. Elliott

    2005-01-01

    The mouse lumbar and tail discs are both used as models to study disc degeneration; however, the mechanical behavior of these two levels has not been compared. The objective of this study was to compare the elastic and viscoelastic mechanical properties of lumbar and tail discs of the mouse under axial compression–tension loading. We hypothesized that tail discs would have

  19. CT Evaluation of Lumbar Interbody Fusion: Current Concepts

    Microsoft Academic Search

    Alan L. Williams; Matthew F. Gornet; J. Kenneth Burkus

    Operative techniques for fusing an unstable por- tion of the lumbar spine or immobilizing a painful vertebral motion segment have been in use for many years. Lumbar fusion procedures initially were used to treat patients with infections (tuberculous spondy- litis) or misaligned spines (isthmic spondylolisthesis) (1-8). Early techniques involving the use of harvested autogenous bone graft without instrumentation were largely

  20. 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

  1. Low-Back Pain Following Surgery for Lumbar Disc Herniation

    Microsoft Academic Search

    TOMOAKI TOYONE; TADASHI TANAKA; DAISUKE KATO; RYUTAKU KANEYAMA

    Background: Lumbar disc herniation often causes sciatica. Although surgery may provide relief of sciatic pain, it is uncertain how surgery affects the relief of low-back pain. The purpose of the present prospective study was to assess the efficacy of discectomy in the treatment of low-back pain associated with lumbar disc herniation. Methods: Between 1998 and 2001, forty consecutive patients with

  2. 49 CFR 572.43 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Transportation 7 2013-10-01 2013-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation...Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a...

  3. 49 CFR 572.43 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...Transportation 7 2014-10-01 2014-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation...Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a...

  4. 49 CFR 572.43 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...Transportation 7 2011-10-01 2011-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation...Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a...

  5. 49 CFR 572.43 - Lumbar spine and pelvis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...Transportation 7 2012-10-01 2012-10-01 false Lumbar spine and pelvis. 572.43 Section 572.43 Transportation...Side Impact Dummy 50th Percentile Male § 572.43 Lumbar spine and pelvis. (a) When the pelvis of a...

  6. Effects of external trunk loads on lumbar spine stability

    Microsoft Academic Search

    Jacek Cholewicki; Adam P. D Simons; Andrea Radebold

    2000-01-01

    Stability of the lumbar spine is an important factor in determining spinal response to sudden loading. Using two different methods, this study evaluated how various trunk load magnitudes and directions affect lumbar spine stability. The first method was a quick release procedure in which effective trunk stiffness and stability were calculated from trunk kinematic response to a resisted-force release. The

  7. Recurrent versus residual carotid stenosis. Incidence detected by Doppler ultrasound.

    PubMed Central

    Barnes, R W; Nix, M L; Wingo, J P; Nichols, B T

    1986-01-01

    A sterile Doppler probe was used for intraoperative monitoring of the integrity of carotid endarterectomy of 125 vessels of 107 patients. Our objective was to reduce the contribution of residual carotid lesions to recurrent stenosis, which was evaluated by Doppler spectrum analysis in the early (less than 3 months, 66 arteries) and late (3-77 months, mean 32 months, 47 arteries) postoperative period. Intraoperative Doppler monitoring detected residual occlusion in six (4.8%) external carotid arteries and stenosis in ten (8.0%) internal carotid arteries permitting selected arteriography and correction of all significant lesions. Follow-up revealed one (1.5%) asymptomatic common carotid occlusion at 6 weeks and three (6.4%) asymptomatic internal carotid stenoses at 6, 10 and 25 months after operation. When compared to previous published experience, these results suggest that intraoperative correction of residual carotid obstruction detected by Doppler ultrasound may reduce the incidence of postoperative "recurrent" carotid stenosis. PMID:3521510

  8. [How I explore ... a suspicion of renal artery stenosis].

    PubMed

    Krzesinski, J M; Turatzinze, L

    1999-08-01

    Renal artery stenosis can present 2 clinical pictures, sometimes associated and potentially treatable, due mainly to atherosclerosis, but also to fibromuscular dysplasia. The first possible presentation is renovascular hypertension which represents 1% of unselected hypertensive populations. The second possible presentation is ischemic renal disease, which represent 10% of the new indications for dialysis therapy and has a 50% mortality rate at 3 years. To explore this disease, arteriography, the gold standard, must be reserved for confirmation and treatment. Hypertension induced by the stenosis is best approached by captopril renal MAG 3 scintigraphy. Measurement of the stenosis severity can be performed either by duplex ultrasonography, magnetic resonance angiography or spinal CT angiography according to patients' characteristics, local experience and facilities. This disease must be searched in the presence of renal insufficiency of unknown cause or refractory hypertension. PMID:10548900

  9. Sinus venous stenosis, intracranial hypertension and progression of primary headaches.

    PubMed

    De Simone, Roberto; Ranieri, Angelo; Montella, Silvana; Marchese, Mario; Persico, Pasquale; Bonavita, Vincenzo

    2012-05-01

    The recently advanced hypothesis that idiopathic intracranial hypertension without papilledema (IIHWOP) is a powerful risk factor for the progression of pain in individuals prone to episodic primary headache implies that IIHWOP is much more prevalent than it is believed to be in the general population and that it can run almost asymptomatic in most of the affected individuals. In this review, we discuss the evidence available supporting that: (a) sinus venous stenosis-associated IIHWOP is much more prevalent than believed in the general population and can run without symptoms or signs of raised intracranial pressure in most of individuals affected, (b) sinus venous stenosis is a very sensitive and specific predictor of intermittent or continuous idiopathic intracranial hypertension with or without papilledema, even in asymptomatic individuals, (c) in primary headache prone individuals, a comorbidity with a hidden stenosis-associated IIHWOP represents a very common, although largely underestimated, modifiable risk factor for the progression and refractoriness of headache. PMID:22644164

  10. 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

  11. Collapse in High-Grade Stenosis during Pulsatile Flow Experiments

    NASA Astrophysics Data System (ADS)

    Kobayashi, Shunichi; Tang, Dalin; Ku, David N.

    It has been hypothesized that blood flow through high grade stenotic arteries may produce conditions in which elastic flow choking may occur. The development of atherosclerotic plaque fracture may be exacerbated by the compressive stresses during collapse. This study explored the effects of pulsatile flow on stenotic flow collapse. Pulsatile flow was produced using a gear pump controlled by a digitized physiologic waveform. Upstream and downstream mean pressures and pulsatile flow rates were measured and digitized. An improved model of arterial stenosis was created using an elastomer with an incremental modulus of elasticity matched to a bovine carotid artery in the relevant range of collapse. Additionally, the model retained a very thick wall in the stenotic region similar to arterial disease. Flow choking was observed for pulsatile pressure drops close to those previously reported for steady flow. The phase difference between flow rate and pressure between upstream and downstream of the stenosis occurred by the compliance of tube and stenosis resistance. For 80% nominal stenosis by diameter and 100+/-30mmHg upstream pressure, collapse occurred for average pulsatile pressure drops of 93mmHg. Pulsatile flow experiments in this model revealed the range of conditions for the flow choking and the paradoxical collapse of the stenosis during systole with expansion during diastole. The stenosis severity was dynamic through the pulse cycle and was significantly greater under flow than the nominal severity. The results indicate that flow choking and stenotic compression may be significant in thick-walled arterial stenoses subjected to pulsatile flow.

  12. A Morphometric Study of the Lumbar Interspinous Space in 100 Stanford University Medical Center Patients

    PubMed Central

    Jang, Donghwan

    2014-01-01

    Objective With the increased use of interspinous spacers in the treatment of lumbar stenosis, knowledge of the geometry of the interspinous space is important. To prevent dislodgment of an interspinous spacer, the accurate depth and width of the interspinous space needs to be established to facilitate the best intraoperative selection of correct spacer size. Methods To determine the depth and width of the interspinous space, two methods are available which utilize plain film and magnetic resonance imaging (MRI). Data analysis of the interspinous depth and width was undertaken in 100 patients. Results The standard deviations were variable, since skin thickness (zone 1) was altered by sex and age. The difference in the zone 1 distance between adjacent interspinous processes varied according to gender (p<0.05), but was not influenced by age [p=0.32 by analysis of variance between groups (ANOVA)]. Zone 2, the supraspinous, and zone 3, the interspinous ligament depths, comprise the operative working area during insertion of an interspinous spacer. There were no differences with regard to gender or age (p>0.05). For zones 6 and 7, the interspinous distances at the narrowest and widest points, respectively, were found to decrease with the aging process, but the decrease was not statistically significant. There were no differences with regard to gender (p>0.05). Conclusion This study provides additional information on the interspinous space. This statistical data are valuable for use in the design of interspinous spacers. PMID:25132932

  13. Congenital ureteric stenosis: a study of 17 children

    Microsoft Academic Search

    Lavanya Kannaiyan; Sampath Karl; John Mathai; Jacob Chacko; Sudipta Sen

    2009-01-01

    Aim  To review cases of congenital ureteric stenosis treated in the period between 1999 and 2007. We propose to analyze the type\\u000a of presentation, management and results.\\u000a \\u000a \\u000a \\u000a Material and methods  We report 17 children aged 20 days to 8 years with obstructive uropathy due to congenital stenosis of the ureter at one or\\u000a more levels. This condition could be mistaken for the more common

  14. Description and design considerations of a randomized clinical trial investigating the effect of a multidisciplinary cognitive-behavioural intervention for patients undergoing lumbar spinal fusion surgery

    PubMed Central

    2014-01-01

    Background The ideal rehabilitation strategy following lumbar spinal fusion surgery has not yet been established. This paper is a study protocol, describing the rationale behind and the details of a cognitive-behavioural rehabilitation intervention for lumbar spinal fusion patients based on the best available evidence. Predictors of poor outcome following spine surgery have been identified to provide targets for the intervention, and the components of the intervention were structured in accordance with the cognitive-behavioural model. The study aims to compare the clinical and economical effectiveness of a cognitive-behavioural rehabilitation strategy to that of usual care for patients undergoing lumbar spinal fusion surgery. Methods/Design The study is a randomized clinical trial including 96 patients scheduled for lumbar spinal fusion surgery due to degenerative disease or spondylolisthesis. Patients were recruited in the period October 2011 to July 2013, and the follow-up period is one year from date of surgery. Patients are allocated on a 1:2 ratio (control: intervention) to either treatment as usual (control group), which implies surgery and the standard postoperative rehabilitation, or in addition to this, a patient education focusing on pain behaviour and pain coping (intervention group). It takes place in a hospital setting, and consists of six group-based sessions, managed by a multidisciplinary team of health professionals. The primary outcomes are disability (Oswestry Disability Index) and sick leave, while secondary outcomes include coping (Coping Strategies Questionnaire), fear-avoidance belief (Fear Avoidance Belief Questionnaire), pain (Low Back Pain Rating Scale, pain index), mobility during hospitalization (Cumulated Ambulation Score), generic health-related quality of life (EQ-5D) and resource use. Outcomes are measured using self report questionnaires, medical records and national registers. Discussion It is expected that the intervention can provide better functional outcome, less pain and earlier return to work after lumbar spinal fusion surgery. By combining knowledge and evidence from different knowledge areas, the project aims to provide new knowledge that can create greater consistency in patient treatment. We expect that the results can make a significant contribution to development of guidelines for good rehabilitation of patients undergoing lumbar spinal fusion. Trial registration Current Controlled Trials ISRCTN42281022. PMID:24581321

  15. Natural progression of low-gradient severe aortic stenosis with preserved ejection fraction.

    PubMed

    Innasimuthu, Antony Leslie; Kumar, Sanjay; Lazar, Jason; Katz, William E

    2014-06-01

    Because the natural progression of low-gradient aortic stenosis (LGAS) has not been well defined, we performed a retrospective study of 116 consecutive patients with aortic stenosis who had undergone follow-up echocardiography at a median interval of 698 days (range, 371-1,020 d). All patients had preserved left ventricular ejection fraction (>0.50) during and after follow-up. At baseline, patients were classified by aortic valve area (AVA) as having mild stenosis (?1.5 cm(2)), moderate stenosis (?1 to <1.5 cm(2)), or severe stenosis (<1 cm(2)). Severe aortic stenosis was further classified by mean gradient (LGAS, mean <40 mmHg; high-gradient aortic stenosis [HGAS], mean ?40 mmHg). We compared baseline and follow-up values among 4 groups: patients with mild stenosis, moderate stenosis, LGAS, and HGAS. At baseline, 30 patients had mild stenosis, 54 had moderate stenosis, 24 had LGAS, and 8 had HGAS. Compared with the moderate group, the LGAS group had lower AVA but similar mean gradient. Yet the actuarial curves for progressing to HGAS were significantly different: 25% of patients in LGAS reached HGAS status significantly earlier than did 25% of patients in the moderate-AS group (713 vs 881 d; P=0.035). Because LGAS has a high propensity to progress to HGAS, we propose that low-gradient aortic stenosis patients be closely monitored as a distinct subgroup that warrants more frequent echocardiographic follow-up. PMID:24955041

  16. Lipid profile of patients with aortic stenosis might be predictive of rate of progression

    Microsoft Academic Search

    Mehmet Birhan Yilmaz; Umit Guray; Yesim Guray; Gokhan Cihan; Vedat Caldir; Serkan Cay; Halil L Kisacik; Sule Korkmaz

    2004-01-01

    BackgroundAortic stenosis is one of the most commonly encountered valvular pathology requiring surgery in developed countries. There are similarities between risk factors for coronary atherosclerosis and the development of aortic stenosis. We designed a retrospective study, evaluated the lipid profile and previous echocardiographic recordings of patients with aortic stenosis, and searched the association of rate of progression and lipid profile.

  17. Altered “Ribostasis”: RNA-protein granule formation or persistence in the development of degenerative disorders

    PubMed Central

    Ramaswami, Mani; Taylor, J. Paul; Parker, Roy

    2013-01-01

    SUMMARY The molecular processes that contribute to degenerative diseases are not well understood. Recent observations suggest that some degenerative diseases are promoted by the accumulation of nuclear or cytoplasmic RNA-protein (RNP) aggregates, which can be related to endogenous RNP granules. RNP aggregates arise commonly in degenerative diseases because RNA binding proteins commonly self-assemble, in part through prion-domains, which can form self-propagating ?-amyloids. RNP aggregates may be toxic due to multiple perturbations of post-transcriptional control, thereby disrupting the normal ribostasis of the cell. This suggests that understanding and modulating RNP assembly or clearance may be effective approaches to develop therapies for these diseases. PMID:23953108

  18. Anterior Cervical Corpectomy and Fusion Accelerates Degenerative Disease at Adjacent Vertebral Segments

    PubMed Central

    Pickett, Gwynedd E.; Theodore, Nicholas; Sonntag, Volker K.H.

    2008-01-01

    Background Anterior cervical corpectomy provides the most direct and thorough surgical approach for anterior decompression when spinal cord compression is found directly behind the vertebral body. However, anterior cervical fusion has been shown to be associated with the development of new degenerative changes at levels immediately adjacent to the fused segments. Th e incidence of adjacent segment disease (ASD) following anterior cervical corpectomy has not been widely reported. We set out to determine the incidence of clinical ASD following anterior cervical corpectomy. Methods We retrospectively reviewed all available medical charts and radiographic studies of all cases of anterior cervical corpectomy performed at the Barrow Neurological Institute over a 4-year period with a minimum 24-month follow-up. Factors assessed included the success of arthrodesis, the presence of degenerative changes on serial follow-up radiographs, and the development of new neurological symptoms. Results Seventy-six patients met the criteria for inclusion: 54 had undergone a 1-level corpectomy, 18 underwent a 2-level corpectomy, and 4 underwent a 3- or 4-level corpectomy. Arthrodesis was performed with either allograft or autograft and anterior cervical plating. All patients achieved successful fusion. Follow-up was available for a minimum of 2 years in all cases, with a mean length of 3.6 years. Sixteen patients (21%) eventually developed radiological and clinical evidence of degenerative changes at adjacent levels. In 10 of 11 patients who developed clinical symptoms within 2 years, the changes represented progression of pre-existing, asymptomatic degenerative disease. Five patients developed degenerative changes more than 5 years after surgery; these were all associated with an unrelated new insult to the cervical spine such as trauma. Conclusions Anterior cervical corpectomy with fixation can accelerate degenerative changes identified preoperatively at adjacent, asymptomatic levels of the cervical spine. Level of Evidence Retrospective cohort study (level 2b).

  19. Degenerative Pannus Mimicking Clival Chordoma Resected via an Endoscopic Transnasal Approach.

    PubMed

    Khaldi, Ahmad; Griauzde, Julius; Duckworth, Edward A M

    2011-05-01

    Lesions of the lower clivus represent a technically challenging subset of skull base disease that requires careful treatment. A 75-year-old woman with tongue atrophy was referred for resection of a presumed clival chordoma. The lesion was resected via an endoscopic transnasal transclival approach with no complications. Pathology revealed only chronic inflammatory tissue consistent with a degenerative pannus. Degenerative pannus should be included in the differential diagnosis of lower clival extradural lesions. The endoscopic transnasal transclival corridor should be considered for resection of such lesions as an alternative to larger, more morbid, traditional skull base approaches. PMID:23984195

  20. Degenerative Pannus Mimicking Clival Chordoma Resected via an Endoscopic Transnasal Approach

    PubMed Central

    Khaldi, Ahmad; Griauzde, Julius; Duckworth, Edward A.M.

    2011-01-01

    Lesions of the lower clivus represent a technically challenging subset of skull base disease that requires careful treatment. A 75-year-old woman with tongue atrophy was referred for resection of a presumed clival chordoma. The lesion was resected via an endoscopic transnasal transclival approach with no complications. Pathology revealed only chronic inflammatory tissue consistent with a degenerative pannus. Degenerative pannus should be included in the differential diagnosis of lower clival extradural lesions. The endoscopic transnasal transclival corridor should be considered for resection of such lesions as an alternative to larger, more morbid, traditional skull base approaches. PMID:23984195

  1. 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.

  2. Morphological structure and variations of lumbar plexus in human fetuses.

    PubMed

    Yasar, Soner; Kaya, Serdar; Temiz, Ca?lar; Tehli, Ozkan; Kural, Cahit; Izci, Yusuf

    2014-04-01

    The objective of this study is to study the anatomy of lumbar plexus on human fetuses and to establish its morphometric characteristics and differences compared with adults. Twenty lumbar plexus of 10 human fetal cadavers in different gestational ages and genders were dissected. Lumbar spinal nerves, ganglions, and peripheral nerves were exposed. Normal anatomical structure and variations of lumbar plexus were investigated and morphometric analyses were performed. The diameters of lumbar spinal nerves increased from L1 to L4. The thickest nerve forming the plexus was femoral nerve, the thinnest was ilioinguinal nerve, the longest nerve through posterior abdominal wall was iliohypogastric nerve, and the shortest nerve was femoral nerve. Each plexus had a single furcal nerve and this arose from L4 nerve in all fetuses. No prefix or postfix plexus variation was observed. In two plexuses, L1 nerve was in the form of a single branch. Also, in two plexuses, genitofemoral nerve arose only from L2 nerve. Accessory obturator nerve was observed in four plexuses. According to these findings, the morphological pattern of the lumbar plexus in the fetus was found to be very similar to the lumbar plexus in adults. PMID:22696243

  3. A family study of hydrocephalus resulting from aqueduct stenosis.

    PubMed

    Howard, F M; Till, K; Carter, C O

    1981-08-01

    Stenosis of the aqueduct of Sylvius accounts for about one third of cases of congenital hydrocephalus. At least 32 families have been reported in which the aqueduct stenosis is inherited in an X linked fashion. In half of these families, flexed adducted thumbs were noted in some affected family members. Occasionally other male members were mentally retarded, suggesting limited expression of the gene. The problem of giving genetic advice to an isolated, clinically unremarkable, case of aqueduct stenosis remains, so a family study was undertaken based on 24 such cases seen at The Hospital for Sick Children over a 19-year period. There were 15 male and nine female index patients. The diagnosis was confirmed in all cases by air encephalogram. One boy had a radial club hand and another developed clasped thumbs secondary to spasticity. No cases had hyaloidoretinal dysplasia. The 15 boys had 18 brothers and 19 sisters, of whom one sister was similarly affected. The nine girls had 12 sibs, none of whom was affected. This study, combined with a similar study in the USA, suggests that the empirical risk of recurrence of a sporadic case of aqueduct stenosis is about 4.5%. PMID:7277416

  4. Congenital Esophageal Stenosis: Clinical and Endoscopic Features in Adults

    Microsoft Academic Search

    Ziad Younes; David A. Johnson

    1999-01-01

    Background: Congenital esophageal stenosis (CES) is an uncommon anomaly that reportedly rarely goes undiagnosed until adulthood. One variant of CES includes patients with multiple cartilaginous rings described usually in the mid‐distal esophagus. Methods: Ten patients with CES seen over the past 7 years were interviewed and their clinical and endoscopic records reviewed. Results: Eight patients were male and age at

  5. Management of Postintubation Tracheal Stenosis: Appropriate Indications Make Outcome Differences

    Microsoft Academic Search

    Antoine E. Melkane; Nayla E. Matar; Amine C. Haddad; Michel N. Nassar; Homère G. Almoutran; Ziad Rohayem; Mohammad Daher; Georges Chalouhy; George Dabar

    2010-01-01

    Background: Laryngotracheal stenosis is difficult to treat and its etiologies are multiple; nowadays, the most common ones are postintubation or posttracheostomy stenoses. Objective: To provide an algorithm for the management of postintubation laryngotracheal stenoses (PILTS) based on the experience of a tertiary care referral center. Methods: A retrospective study was conducted on all patients treated for PILTS over a 10-year

  6. Congenital bicuspid stenosis with left ventricular hypoplasia in a kitten.

    PubMed

    van Nie, C J; van Messel, M A; Straatman, T J

    1980-01-15

    Congenital bicuspid stenosis with left ventricular hypoplasia was diagnosed in a kitten. Clinical weakness, dyspnoea and marked cardiomegaly (X rays) were related to postmortem findings. The cardiomegaly had resulted from an enlargement of the left auricular appendage. It is supposed the cardiomegaly developed after the closing of the foramen ovale. PMID:6444341

  7. Congenital bicuspid stenosis with left ventricular hypoplasia in a kitten.

    PubMed

    van Nie, C J; van Messel, M A; Straatman, T J

    1980-01-01

    Summary Congenital bicuspid stenosis with left ventricular hypoplasia was diagnosed in a kitten. Clinical weakness, dyspnoea and marked cardiomegaly (X rays) were related to postmortem findings. The cardiomegaly had resulted from an enlargement of the left auricular appendage. It is supposed the cardiomegaly developed after the closing of the foramen ovale. PMID:22039859

  8. Congenital urethral stenosis in a male miniature piglet

    PubMed Central

    Pouleur-Larrat, Bénédicte; Maccolini, Edouard; Carmel, Eric Norman; Hélie, Pierre

    2014-01-01

    A 2-month-old male miniature pig showed progressive abdominal pain, pollakiuria, and stranguria that progressed to complete urinary obstruction. Postmortem examination revealed idiopathic urethral stenosis at the level of the recess, of probable congenital origin. Urinary tract malformations should be included in the differential diagnosis of miniature piglets with urinary disorders. PMID:24891635

  9. Non-invasive assessment of aortic stenosis by Doppler ultrasound

    Microsoft Academic Search

    L Hatle; B A Angelsen; A Tromsdal

    1980-01-01

    The peak pressure drop across the aortic valve in aortic stenosis has been measured by Doppler ultrasound. Maximum velocity in the Doppler signal from the aortic jet was recorded using a maximum frequency estimator. With an angle close to zero between ultrasound beam and maximal velocity in the jet, peak pressure drop can be calculated from the maximal velocity measured;

  10. 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.

  11. Celiac axis stenosis and lethal liver ischemia after pancreaticoduodenectomy.

    PubMed

    Lipska, Ludmila; Visokai, Vladimir; Levy, Miroslav; Koznar, Boris; Zaruba, Pavel

    2009-01-01

    Celiac axis stenosis can lead to a fatal hepatic ischemia after pancreaticoduodenectomy unless a simultaneous revascularisation of the celiac circulation is performed. In the present study are reported three cases of celiac axis stenosis, all of which had histologically confirmed periampullary cancer. Case 1: a 50-year-old male with a history of myocardial infarction and liver steatosis; visceral arteriography prior to the surgery demonstrated a celiac axis stenosis. Whipple operation was performed. After removing the specimen, no signs of liver ischemia were found (liver was cholestatic) and pulsation of the hepatic artery was strong. The patient died on the second postoperative day after an abrupt irreversible cardiac arrest. Autopsy proved acute severe hepatic ischemia. Case 2: a 64-year-old female. Preoperative visceral angiography showed significant celiac axis stenosis. As a first step of surgery the root of the celiac trunk was exposed, a fibrotic ring around it was divided. Standard D1 pylorus preserving pancreaticoduodenectomy was performed. Case 3: a 58-year-old female without preoperative angiography, indicated for surgery. After an occlusion test of the gastroduodenal artery the liver became ischemic. Division of the fibrotic ring around celiac axis was performed together with a standard D1 pylorus preserving pancreaticoduodenectomy. No postoperative complications were reported in both case 2 and 3. PMID:19760970

  12. Mitral stenosis and acute ST elevation myocardial infarction

    PubMed Central

    Cardoz, Joseph; George, Raju

    2015-01-01

    We describe a patient who presented with acute (inferior wall) ST elevation myocardial infarction. Her echocardiogram showed severe mitral stenosis with ball valve thrombus in the left atrial body and thrombus in the left atrial appendage. Coronary angiogram revealed thromboembolic material in the right coronary artery. Mitral valve replacement was scheduled. PMID:25829656

  13. Venous Thrombosis and Stenosis After Implantation of Pacemakers and Defibrillators

    Microsoft Academic Search

    Grzegorz Rozmus; James P. Daubert; David T. Huang; Spencer Rosero; Burr Hall; Charles Francis

    2005-01-01

    Venous complications of pacemaker\\/ implantable cardioverter defibrillator (ICD) system implantation rarely cause immediate clinical problems. The challenge starts when patients come for system revision or upgrade. Numerous reports of venous complications such as stenosis, occlusions, and superior vena cava syndrome have been published. We reviewed current knowledge of these complications, management, and their impact on upgrade\\/revision procedures. One study has

  14. Parkinsonism associated with obstructive hydrocephalus due to idiopathic aqueductal stenosis

    Microsoft Academic Search

    M Zeidler; P J Dorman; I T Ferguson; D E Bateman

    1998-01-01

    Two cases of parkinsonism after recurrent obstructive hydrocephalus due to idiopathic aqueductal stenosis are reported. In both patients an extrapyramidal syndrome was noted in the absence of contemporaneous evidence of hydrocephalus or shunt failure. One of the patients underwent a shunt operation, but showed no clinical improvement. However, both patients improved after the administration of dopaminergic therapy. The seven previously

  15. Ventriculocisternostomy for stenosis of the aqueduct of sylvius

    Microsoft Academic Search

    G. Guiot

    1973-01-01

    Summary A simple and benign ventriculo-cisternostomy technique is proposed for alleviation of the hydrocephalus by aqueduct stenosis. Following opacification of the 3rd ventricle, a leucotome is introduced near the coronal suture 15 mm from the midline and guided under television control through the foramen of Monro towards the 3rd ventricular floor which is perforated. Subsequently, the aperture is enlarged with

  16. Prenatal diagnosis of X linked hydrocephalus without aqueductal stenosis

    Microsoft Academic Search

    V Váradi; K Csécsei; G T Szeifert; Z Tóth; Z Papp

    1987-01-01

    The outcome of four successive pregnancies in a woman heterozygous for X linked hydrocephalus is described. The last two were scanned by ultrasound. In one, a good prognosis was given; the fetus was male but there was no evidence of dilated cerebral ventricles. In the other, hydrocephalus was diagnosed. The absence of aqueductal stenosis in this case supports the hypothesis

  17. Clinical features of late-onset idiopathic aqueductal stenosis

    Microsoft Academic Search

    Toru Fukuhara; Mark G Luciano

    2001-01-01

    BACKGROUNDAlthough late-onset idiopathic aqueductal stenosis (LIAS) is considered a good indication for endoscopic third ventriculostomy (ETV), the characteristics of this clinical entity have seldom been reported in the magnetic resonance (MR) imaging era. The authors reviewed their patients with LIAS who were treated by ETV to confirm its clinical features and response to treatment.METHODSThe study group was composed of 31

  18. New mutant mouse with communicating hydrocephalus and secondary aqueductal stenosis

    Microsoft Academic Search

    Adam Borit; Richard L. Sidman

    1972-01-01

    A new mutation resulting in hydrocephalus in the mouse is described. Inheritance is autosomal recessive. The disease becomes evident a few days after birth by the presence of generalized ventricular dilatation. This early phase is followed after 2 weeks of age by a phase of superimposed aqueductal stenosis, which appears to be secondary to compression of the midbrain by the

  19. 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.

  20. Bilateral photoplethysmography studies of the leg arterial stenosis

    Microsoft Academic Search

    Renars Erts; Janis Spigulis; Indulis Kukulis; Maris Ozols

    2005-01-01

    A newly developed portable multi-channel photoplethysmography (PPG) device has been used for comparative studies of 20 healthy control subjects and 45 patients with diagnosed arterial stenosis in a leg. The peripheral blood pulsations were detected simultaneously at four body sites---the same fingers and toes of both arms and legs. The PPG pulses recorded at the periphery of the stenotic leg,