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Sample records for subjects requiring lumbar

  1. Effects of abdominal drawing-in during prone hip extension on the muscle activities of the hamstring, gluteus maximus, and lumbar erector spinae in subjects with lumbar hyperlordosis

    PubMed Central

    Kim, Tae-Woo; Kim, Yong-Wook

    2015-01-01

    [Purpose] The purpose of this study was to compare the effects of an abdominal drawing-in maneuver (ADIM), measured using a pressure bio-feedback unit, on the activities of the hamstring, gluteus maximus, and erector spinae muscles during prone hip extension. [Subjects and Methods] Thirty healthy adult subjects (14 male, 16 female), were recruited. Subjects’ lumbar lordosis and pelvic tilt angles were measured, and based on the results, the subjects were divided into two groups: a hyperlordotic lumbar angle (HLLA) group (n=15) and a normal lordotic lumbar angle (NLLA) group (n=15). The muscle activities of the hamstring and gluteus maximus, and of the erector spinae on the right side of the body, were recorded using surface electromyography. [Results] When performing ADIM with prone hip extension, the muscle activity of the gluteus maximus of the HLLA group significantly improved compared with that the NLLA group. [Conclusion] This study demonstrated that ADIM with prone hip extension was more effective at eliciting gluteus maximus activity in the HLLA group than in the NLLA group. Therefore, ADIM with prone hip extension may be useful for increasing the gluteus maximus activity of individuals with lumbar hyperlordosis. PMID:25729173

  2. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain

    PubMed Central

    2009-01-01

    Background Although the connective tissues forming the fascial planes of the back have been hypothesized to play a role in the pathogenesis of chronic low back pain (LBP), there have been no previous studies quantitatively evaluating connective tissue structure in this condition. The goal of this study was to perform an ultrasound-based comparison of perimuscular connective tissue structure in the lumbar region in a group of human subjects with chronic or recurrent LBP for more than 12 months, compared with a group of subjects without LBP. Methods In each of 107 human subjects (60 with LBP and 47 without LBP), parasagittal ultrasound images were acquired bilaterally centered on a point 2 cm lateral to the midpoint of the L2-3 interspinous ligament. The outcome measures based on these images were subcutaneous and perimuscular connective tissue thickness and echogenicity measured by ultrasound. Results There were no significant differences in age, sex, body mass index (BMI) or activity levels between LBP and No-LBP groups. Perimuscular thickness and echogenicity were not correlated with age but were positively correlated with BMI. The LBP group had ~25% greater perimuscular thickness and echogenicity compared with the No-LBP group (ANCOVA adjusted for BMI, p < 0.01 and p < 0.001 respectively). Conclusion This is the first report of abnormal connective tissue structure in the lumbar region in a group of subjects with chronic or recurrent LBP. This finding was not attributable to differences in age, sex, BMI or activity level between groups. Possible causes include genetic factors, abnormal movement patterns and chronic inflammation. PMID:19958536

  3. Predictive Factors for Subjective Improvement in Lumbar Spinal Stenosis Patients with Nonsurgical Treatment: A 3-Year Prospective Cohort Study

    PubMed Central

    Matsudaira, Ko; Hara, Nobuhiro; Oka, Hiroyuki; Kunogi, Junichi; Yamazaki, Takashi; Takeshita, Katsushi; Atsushi, Seichi; Tanaka, Sakae

    2016-01-01

    Objective To assess the predictive factors for subjective improvement with nonsurgical treatment in consecutive patients with lumbar spinal stenosis (LSS). Materials and Methods Patients with LSS were enrolled from 17 medical centres in Japan. We followed up 274 patients (151 men; mean age, 71 ± 7.4 years) for 3 years. A multivariable logistic regression model was used to assess the predictive factors for subjective symptom improvement with nonsurgical treatment. Results In 30% of patients, conservative treatment led to a subjective improvement in the symptoms; in 70% of patients, the symptoms remained unchanged, worsened, or required surgical treatment. The multivariable analysis of predictive factors for subjective improvement with nonsurgical treatment showed that the absence of cauda equina symptoms (only radicular symptoms) had an odds ratio (OR) of 3.31 (95% confidence interval [CI]: 1.50–7.31); absence of degenerative spondylolisthesis/scoliosis had an OR of 2.53 (95% CI: 1.13–5.65); <1-year duration of illness had an OR of 3.81 (95% CI: 1.46–9.98); and hypertension had an OR of 2.09 (95% CI: 0.92–4.78). Conclusions The predictive factors for subjective symptom improvement with nonsurgical treatment in LSS patients were the presence of only radicular symptoms, absence of degenerative spondylolisthesis/scoliosis, and an illness duration of <1 year. PMID:26863214

  4. Mechanical Characterization of the Human Lumbar Intervertebral Disc Subjected to Impact Loading Conditions

    NASA Astrophysics Data System (ADS)

    Jamison, David, IV

    Low back pain is a large and costly problem in the United States. Several working populations, such as miners, construction workers, forklift operators, and military personnel, have an increased risk and prevalence of low back pain compared to the general population. This is due to exposure to repeated, transient impact shocks, particularly while operating vehicles or other machinery. These shocks typically do not cause acute injury, but rather lead to pain and injury over time. The major focus in low back pain is often the intervertebral disc, due to its role as the major primary load-bearing component along the spinal column. The formation of a reliable standard for human lumbar disc exposure to repeated transient shock could potentially reduce injury risk for these working populations. The objective of this project, therefore, is to characterize the mechanical response of the lumbar intervertebral disc subjected to sub-traumatic impact loading conditions using both cadaveric and computational models, and to investigate the possible implications of this type of loading environment for low back pain. Axial, compressive impact loading events on Naval high speed boats were simulated in the laboratory and applied to human cadaveric specimen. Disc stiffness was higher and hysteresis was lower than quasi-static loading conditions. This indicates a shift in mechanical response when the disc is under impact loads and this behavior could be contributing to long-term back pain. Interstitial fluid loss and disc height changes were shown to affect disc impact mechanics in a creep study. Neutral zone increased, while energy dissipation and low-strain region stiffness decreased. This suggests that the disc has greater clinical instability during impact loading with progressive creep and fluid loss, indicating that time of day should be considered for working populations subjected to impact loads. A finite element model was developed and validated against cadaver specimen

  5. Should routine MRI of the lumbar spine be required prior to lumbar epidural steroid injection for sciatica pain?

    PubMed Central

    Ghaly, Ramis F.; Lissounov, Alexei; Candido, Kenneth D.; Knezevic, Nebojsa Nick

    2015-01-01

    Background: We describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies and applied therapies. Case Description: We present three patients; two female patients (37 and 38 years old) undergoing LESI for remotely diagnosed disc herniations, and one 61-year-old male receiving an LESI for a presumed, unverified lumbar intervertebral disc disorder. Following a worsening of symptoms after LESI, neurosurgical consultations ultimately determined the presence of, respectively, an epidural hematoma, a neurilemoma, and a lung cancer metastasis to the sacrum as the source of symptoms, instead of being due to the intervertebral disc pathology. Conclusions: We would like to emphasize several principles in the diagnosis and use of imaging of the lumbosacral region prior to undertaking invasive neuraxial procedures. PMID:25883840

  6. The Transition from Optional to Required Subjects.

    ERIC Educational Resources Information Center

    O'Grady, William; And Others

    1989-01-01

    Proposes that the optional subject phenomenon in early child language arises because children have not yet acquired the morphological elements (primarily modal and tense) necessary to distinguish subject-taking verbs (e.g., finite verbs) from their non-subject-taking counterparts (e.g., infinitives). (Author/CB)

  7. Risk of adjacent-segment disease requiring surgery after short lumbar fusion: results of the French Spine Surgery Society Series.

    PubMed

    Scemama, Caroline; Magrino, Baptiste; Gillet, Philippe; Guigui, Pierre

    2016-07-01

    OBJECTIVE Adjacent-segment disease (ASD) is an increasingly problematic complication following lumbar fusion surgery. The purpose of the current study was to determine the risk of ASD requiring surgical treatment after short lumbar or lumbosacral fusion. Primary spinal disease and surgical factors associated with an increased risk of revision were also investigated. METHODS This was a retrospective cohort study using the French Spine Surgery Society clinical data that included 3338 patients, with an average follow-up duration of 7 years (range 4-10 years). Clinical ASD requiring surgery was the principal judgment criterion; the length of follow-up time and initial spinal disease were also recorded. Kaplan-Meier survival analysis was performed. The correlation between primary spinal disease and surgery with an increased risk of revision was investigated. RESULTS During the follow-up period, 186 patients required revision surgery for ASD (5.6%). The predicted risk of ASD requiring revision surgery was 1.7% (95% CI 1.3%-2.2%) at 2 years, 3.8% (95% CI 4.9%-6.7%) at 4 years, 5.7% (95% CI 4.9%-6.7%) at 6 years, and 9% (95% CI 8.7%-10.6%) at 8 years. Initial spinal disease affected the risk of ASD requiring surgery (p = 0.0003). The highest risk was observed for degenerative spondylolisthesis. CONCLUSIONS ASD requiring revision surgery was predicted in 5.6% of patients 7 years after index short lumbar spinal fusion in the French Spine Surgery Society retrospective series. An increased risk of ASD requiring revision surgery associated with initial spinal disease showed the significance of the influence of natural degenerative history on adjacent-segment pathology. PMID:26967992

  8. Effects of anodal transcranial direct current stimulation over the leg motor area on lumbar spinal network excitability in healthy subjects.

    PubMed

    Roche, N; Lackmy, A; Achache, V; Bussel, B; Katz, R

    2011-06-01

    In recent years, two techniques have become available for the non-invasive stimulation of human motor cortex: transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). The effects of TMS and tDCS when applied over motor cortex should be considered with regard not only to cortical circuits but also to spinal motor circuits. The different modes of action and specificity of TMS and tDCS suggest that their effects on spinal network excitability may be different from that in the cortex. Until now, the effects of tDCS on lumbar spinal network excitability have never been studied. In this series of experiments, on healthy subjects, we studied the effects of anodal tDCS over the lower limb motor cortex on (i) reciprocal Ia inhibition projecting from the tibialis anterior muscle (TA) to the soleus (SOL), (ii) presynaptic inhibition of SOL Ia terminals, (iii) homonymous SOL recurrent inhibition, and (iv) SOL H-reflex recruitment curves. The results show that anodal tDCS decreases reciprocal Ia inhibition, increases recurrent inhibition and induces no modification of presynaptic inhibition of SOL Ia terminals and of SOL-H reflex recruitment curves. Our results indicate therefore that the effects of tDCS are the opposite of those previously described for TMS on spinal network excitability. They also indicate that anodal tDCS induces effects on spinal network excitability similar to those observed during co-contraction suggesting that anodal tDCS activates descending corticospinal projections mainly involved in co-contractions. PMID:21502292

  9. Novel genetic variants associated with lumbar disc degeneration in northern Europeans: a meta-analysis of 4600 subjects

    PubMed Central

    Williams, Frances M K; Bansal, Aruna T; van Meurs, Joyce B; Bell, Jordana T; Meulenbelt, Ingrid; Suri, Pradeep; Rivadeneira, Fernando; Sambrook, Philip N; Hofman, Albert; Bierma-Zeinstra, Sita; Menni, Cristina; Kloppenburg, Margreet; Slagboom, P Eline; Hunter, David J; MacGregor, Alex J; Uitterlinden, Andre G; Spector, Tim D

    2013-01-01

    Objective Lumbar disc degeneration (LDD) is an important cause of low back pain, which is a common and costly problem. LDD is characterised by disc space narrowing and osteophyte growth at the circumference of the disc. To date, the agnostic search of the genome by genome-wide association (GWA) to identify common variants associated with LDD has not been fruitful. This study is the first GWA meta-analysis of LDD. Methods We have developed a continuous trait based on disc space narrowing and osteophytes growth which is measurable on all forms of imaging (plain radiograph, CT scan and MRI) and performed a meta-analysis of five cohorts of Northern European extraction each having GWA data imputed to HapMap V.2. Results This study of 4600 individuals identified four single nucleotide polymorphisms with p<5×10−8, the threshold set for genome-wide significance. We identified a variant in the PARK2 gene (p=2.8×10−8) associated with LDD. Differential methylation at one CpG island of the PARK2 promoter was observed in a small subset of subjects (β=8.74×10−4, p=0.006). Conclusions LDD accounts for a considerable proportion of low back pain and the pathogenesis of LDD is poorly understood. This work provides evidence of association of the PARK2 gene and suggests that methylation of the PARK2 promoter may influence degeneration of the intervertebral disc. This gene has not previously been considered a candidate in LDD and further functional work is needed on this hitherto unsuspected pathway. PMID:22993228

  10. Pineal gland calcification, lumbar intervertebral disc degeneration and abdominal aorta calcifying atherosclerosis correlate in low back pain subjects: A cross-sectional observational CT study.

    PubMed

    Turgut, Ahmet Tuncay; Sönmez, Iclal; Cakıt, Burcu Duyur; Koşar, Pınar; Koşar, Uğur

    2008-06-01

    The goal of this cross-sectional observational study was to assess the possible impact of pineal gland calcification upon the intervertebral disc degeneration and abdominal aorta atherosclerosis in subjects with low back pain, and to investigate the course of these processes with aging. The study was carried out on 81 (66 women and 15 men) subjects: younger than 45 years (group X, n=22), 45-65 years of age (group Y, n=45), and older than 65 years (group Z, n=14). In addition to clinical data, computed tomography (CT) scan of the brain as well as X-ray and CT examination of the lumbar spine were recorded in this study. The degree of disc degeneration and calcification rates of aortic wall and pineal gland were independently determined by two radiologists. Both ratio of calcified pineal gland and density of pineal calcification increased progressively with aging. Also, both the degree of aortic wall calcification and disc degeneration score increased with advancing age. On CT scan, a positive correlation between degree of aortic wall calcification and disc degeneration score was found (r=0.306, p<0.01). Importantly, there was a positive association between calcification of the pineal gland and degenerative disc disease in X-ray or CT study (r=0.378 and r=0.295, p<0.005 and p<0.01, respectively), as well as between abdominal aorta atherosclerosis and pineal calcification (r=0.634, p<0.001). Our findings suggest that there is a significant interaction between pineal gland calcification and lumbar intervertebral disc degeneration and also abdominal aorta atherosclerosis. However, further studies with a larger subject cohorts are needed. PMID:18215511

  11. Sex differences in subjective and objective measures of pain, functional impairment, and health-related quality of life in patients with lumbar degenerative disc disease.

    PubMed

    Gautschi, Oliver P; Corniola, Marco V; Smoll, Nicolas R; Joswig, Holger; Schaller, Karl; Hildebrandt, Gerhard; Stienen, Martin N

    2016-05-01

    Sex differences in pain perception are known to exist; however, the exact pathomechanism remains unclear. This work aims to elucidate sex differences in subjective and objective measures of pain, functional impairment, and health-related quality of life (HRQoL) in patients with lumbar degenerative disc disease. In a prospective 2-center study, back and leg pain (visual analogue scale [VAS]), functional disability (Oswestry Disability Index and Roland-Morris Disability Index), and HRQoL (EuroQol-5D and Short Form [SF12]) were collected for consecutive patients undergoing lumbar spine surgery. Objective functional impairment (OFI) was estimated using age-adjusted and sex-adjusted cutoff values for the timed-up-and-go (TUG) test. A healthy cohort of n = 110 subjects served as the control group. Univariate and multivariate analyses were performed to test the association between sex and pain, subjective and OFIs, and HRQoL. The study comprised n = 305 patients (41.6% females). Female patients had more VAS back pain (P = 0.002) and leg pain (P = 0.014). They were more likely to report higher functional impairment in terms of Oswestry Disability Index (P = 0.005). Similarly, HRQoL measured with the EuroQol-5D index (P = 0.012) and SF12 physical composite score (P = 0.005) was lower in female patients. Female patients reported higher VAS back and leg pain, functional impairment, and reduced HRQoL than male patients. However, there were no sex differences with respect to the presence and degree of OFI measured by the TUG test using age-adjusted and sex-adjusted cutoff values. As such, the TUG may be a good test to overcome sex bias for the clinical assessment of patients with degenerative disc disease. PMID:26761383

  12. Lumbar corsets can decrease lumbar motion in golf swing.

    PubMed

    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 pointsRotational and extension forces on the lumbar spine may cause golf-related low back painWearing 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

  13. 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

  14. [Lumbar hernia].

    PubMed

    Teiblum, Sandra Sofie; Hjørne, Flemming Pii; Bisgaard, Thue

    2010-03-22

    Lumbar hernia is a rare condition. Lumbar hernia should be considered a rare differential diagnosis to unexplained back pain. Symptoms are scarce and diffuse and can vary with the size and content of the hernia. As there is a 25% risk of incarceration, operation is indicated even in asymptomatic hernias. We report a case of lumbar hernia in a woman with a slow growing mass in the lumbar region. She presented with pain and a computed tomography confirmed the diagnosis. She underwent open surgery and fully recovered with recurrence within the first half year. PMID:20334799

  15. Inclusion of Regional Poroelastic Material Properties Better Predicts Biomechanical Behavior of Lumbar Discs Subjected to Dynamic Loading

    PubMed Central

    Williams, Jamie R.; Natarajan, Raghu N.; Andersson, Gunnar B.J.

    2009-01-01

    Understanding the relationship between repetitive lifting and the breakdown of disc tissue over several years of exposure is difficult to study in vivo and in vitro. The aim of this investigation was to develop a three-dimensional poroelastic finite element model of a lumbar motion segment that reflects the biological properties and behaviors of in vivo disc tissues including swelling pressure due to the proteoglycans and strain dependent permeability and porosity. It was hypothesized that when modeling the annulus, prescribing tissue specific material properties will not be adequate for studying the in vivo loading and unloading behavior of the disc. Rather, regional variations of these properties, which are known to exist within the annulus, must also be included. Finite element predictions were compared to in vivo measurements published by Tyrrell et al., (Tyrrell et al., 1985) of percent change in total stature for two loading protocols, short-term creep loading and standing recovery and short-term cyclic loading with standing recovery. The model in which the regional variations of material properties in the annulus had been included provided an overall better prediction of the in vivo behavior as compared to the model in which the annulus properties were assumed to be homogenous. This model will now be used to study the relationship between repetitive lifting and disc degeneration. PMID:17156786

  16. 40 CFR 71.3 - Sources subject to permitting requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... they are subject to 40 CFR part 60, subpart AAA—-Standards of Performance for New Residential Wood... because they are subject to 40 CFR part 61, subpart M—National Emission Standard for Hazardous Air... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Sources subject to...

  17. Interexaminer reliability of the electromagnetic radiation receiver for determining lumbar spinal joint dysfunction in subjects with low back pain

    SciTech Connect

    Gemmell, H.A.; Jacobson, B.H.; Edwards, S.W.; Heng, B.J.

    1990-03-01

    Twenty subjects (6 male, 14 female) with low back pain were examined by two experienced and licensed chiropractic doctors (E1 and E2). Both examiners examined the patients using a Toftness Electromagnetic Radiation Receiver (EMRR) and by manual palpation (MP) of the spinous processes. Interexaminer reliability was calculated at three sites (L3, L4, L5) for the following combinations: (a) E1,MP--E2,MP; (b) E1,EMRR--E2,EMRR; (c) E1,MP--E2,EMRR; and (d) E2,MP--E1,EMRR, and intraexaminer reliability was calculated for the following variables: (e) E1,MP--E1,EMRR; and (f) E2,MP--E2,EMRR. Results of a Kappa coefficient analysis for interexaminer reliability of the stated combinations and at the specific sites were: (a) -0.071, 0.400, 0.200; (b) -0.013, 0.100, -0.120; (c) 0.286, 0.300, 0.200; (d) -0.081, 0.000, 0.048. These results predominantly indicate a poor to fair interexaminer reliability. The results of a Kappa coefficient analysis for intraexaminer reliability of the stated combinations were: (e) 0.111, 0.400, 0.737; (f) 0.000, 0.100, 0.368. These results indicate a poor to fair reliability. It was concluded that in subjects with low back pain the EMRR may not be a reliable indicator of spinal joint dysfunction.

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

    PubMed Central

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

    2016-01-01

    Study Design Observational study. Purpose To correlate lumbar lordosis and lumbar core strength in information technology (IT) professionals. Overview of Literature IT professionals have to work for long hours in a sitting position, which can affect lumbar lordosis and lumbar core strength. Methods Flexicurve was used to assess the lumbar lordosis, and pressure biofeedback was used to assess the lumbar core strength in the IT professionals. All subjects, both male and female, with and without complaint of low back pain and working for two or more years were included, and subjects with a history of spinal surgery or spinal deformity were excluded from the study. Analysis was done using Pearson's correlation. Results For the IT workers, no correlation was seen between lumbar lordosis and lumbar core strength (r=–0.04); however, a weak negative correlation was seen in IT people who complained of pain (r=–0.12), while there was no correlation of lumbar lordosis and lumbar core in IT people who had no complains of pain (r=0.007). Conclusions The study shows that there is no correlation of lumbar lordosis and lumbar core strength in IT professionals, but a weak negative correlation was seen in IT people who complained of pain. PMID:27340529

  19. The point-to-point test: A new diagnostic tool for measuring lumbar tactile acuity? Inter and intra-examiner reliability study of pain-free subjects.

    PubMed

    Adamczyk, Wacław; Sługocka, Anna; Saulicz, Oskar; Saulicz, Edward

    2016-04-01

    A two-point discrimination test (TPD) is commonly used to investigate lumbar tactile acuity. However, low inter-examiner reliability and difficulties in execution significantly limit its application. Therefore the aim of this study was to compare the inter- and intra-examiner reliability of a new approach, the point-to-point test (PTP), with the TPD. Twenty-one pain-free subjects attended the inter-examiner stage of the study. Eighteen of them were further recruited into an intra-examiner (reproducibility and repeatability) reliability study. PTP was performed on the three points plotted at the L3 spinal level. Point '0' overlapped with the L3 spinous process, from which points '1' and '2' were horizontally separated by 5 and 10 cm, respectively. Participants manually indicated a point previously touched by the examiner, while the distance (error) was measured. Reliability was determined with the intraclass correlation coefficient (ICC2,3). The results revealed good and moderate inter- and intra-examiner reliability at point '1' (ICC2,3 = 0.68-0.84) and good reliability at point '2' (ICC2,3 = 0.84-0.86). At point '0', reliability was moderate to poor (ICC2,3 = 0.13-0.63). TPD was characterised by a poor to moderate level of inter- (ICC2,1 = 0.51; ICC2,3 = 0.56) and intra-examiner reliability (ICC(2,1) = 0.50; ICC2,3 = 0.74). Our findings suggest that PTP is more reliable than TPD at two investigated points at the L3 spinal level. However, further research on PTP validity data is strongly warranted. PMID:26797175

  20. Mechanical contribution to lumbar stress injuries in female gymnasts.

    PubMed

    Hall, S J

    1986-12-01

    Because female gymnasts as a group display higher than average incidences of stress-related pathologies of the lumbar spine, it was of interest to evaluate mechanical factors which are potential contributors. Lumbar hyperextension and impact forces were quantified for performances of five commonly executed gymnastics skills by four competitive collegiate women gymnasts. The skills performed were the front walkover, the back walkover, and the front handspring, the back handspring, and the handspring vault. Wielke's (1983) radius method was used to quantify lumbar curvatures from film data during normal relaxed standing postures and during subject performances of the five selected skills. A force platform was used to monitor vertical and lateral ground reaction forces at the terminations of the respective skill performances. Of the skills examined, the handspring vault produced the highest vertical and lateral impact forces, and the back handspring and back walkover required the greatest amounts of lumbar hyperextension. During the front and back walkovers and during the back handspring, maximum lumbar hyperextension occurred very close to the time that impact force was sustained by either the hands or the feet. PMID:3784872

  1. Lumbar spine CT scan

    MedlinePlus

    CAT scan - lumbar spine; Computed axial tomography scan - lumbar spine; Computed tomography scan - lumbar spine; CT - lower back ... stopping.) A computer creates separate images of the spine area, called slices. These images can be stored, ...

  2. The effect of a lumbar support pillow on lumbar posture and comfort during a prolonged seated task

    PubMed Central

    2013-01-01

    Background Several risk factors exist for the development of low back pain, including prolonged sitting and flexed spinal curvature. Several investigators have studied lumbar support devices and spinal curvatures in sitting, however few have investigated a pain population and reported a quantitative measure of comfort. The purpose of the current project was to determine whether a lumbar support pillow, outfitted with a cut-out to accommodate the bulk of posterior pelvic soft tissue volume, is more effective than a standard chair in promoting a neutral spinal posture and improving subjective and objective measures of comfort in healthy individuals and patients with low back pain. Methods Twenty eight male participants with and without a history of low back pain sat in a standard office chair and in a chair with the lumbar support pillow for 30 minutes. Lumbar and thoracolumbar postures were measured through electromagnetic markers. Comfort was determined based on the least squares radius of centre of pressure shifting, measured at the buttock-chair interface as well as reported discomfort through visual analog scales. Chair support effects were assessed through ANOVA methods. The study was approved by the Canadian Memorial Chiropractic College research ethics board. Results There was a main effect of condition on lumbar posture (p = 0.006) and thoracolumbar posture (p = 0.014). In the lumbar region, the support and standard chair differed by 2.88° (95% CI; 1.01-4.75), with the lumbar support being closer to neutral than the standard chair. In the thoracolumbar region, the support and standard chair differed by -2.42° (95% CI; -4.22 to -0.62), with the standard chair being closer to neutral than the support device. The centre of pressure measure was significantly improved with the pillow (p = 0.017), however there were no subjective changes in comfort. Conclusions A lumbar support pillow with a cut-out for the posterior pelvic tissues improved an

  3. Differences in symmetry of lumbar region passive tissue characteristics between people with and people without low back pain

    PubMed Central

    Gombatto, Sara P.; Norton, Barbara J.; Scholtes, Sara A.; Van Dillen, Linda R.

    2008-01-01

    Background Several investigators have suggested that passive tissue characteristics of the lumbar region may be altered in people with low back pain. Passive stiffness of the lumbar region has been examined during physiological movements in healthy individuals and intersegmental spine mobility and stiffness have been examined in people with and people without low back pain. However, no investigators have examined differences in passive tissue characteristics of the lumbar region during a physiological movement between people with and people without low back pain. Methods Subjects were moved passively through a trunk lateral bending motion on a passive movement device. Lumbar region kinematics were measured with a motion capture system and force required to move the subject was measured with a force transducer. Lumbar region extensibility was defined as the maximum excursion of the lumbar region. Passive elastic energy was defined as the area under the torque-lumbar region angle curve. Differences in lumbar region extensibility and passive elastic energy between sides were examined in people with and people without low back pain (n = 41). Findings People in the Rotation with Extension low back pain subgroup demonstrated greater asymmetry of passive elastic energy than people without low back pain (P = 0.04). There were no differences between groups in symmetry of lumbar region extensibility (P = 0.37). Interpretation Asymmetry in passive elastic energy of the lumbar region may be related to the low back pain problem in the Rotation with Extension subgroup. The asymmetry in passive elastic energy may be associated with asymmetry of loading on the spine, which has been reported to be a risk factor for low back pain. Thus, it may be important to consider the asymmetry when planning an intervention strategy for people in the Rotation with Extension subgroup. PMID:18590942

  4. Outcome of Salvage Lumbar Fusion after Lumbar Arthroplasty

    PubMed Central

    Deutsch, Harel

    2014-01-01

    Study Design Retrospective review. Purpose This study aims to define the role of lumbar fusion for persistent back pains after the lumbar disc replacement. Overview of Literature Little is written about lumbar fusion after optimally placed lumbar arthroplasty in patients with persistent lower back pains. Methods Retrospective review of cases of lumbar artificial disc requiring subsequent fusion because of persistent back pains despite optimally placed artificial discs. Outcomes were evaluated using Oswestry Disability Index (ODI) and visual analogue scale (VAS). Clinical improvements indicated 25% improvement in ODI and VAS values. Results Five patients met the study criteria. The mean baseline ODI for the five patients was 52. The mean baseline VAS scores for back and leg pains were 76 and 26, respectively. All the five patients had optimally placed prosthesis. The indication for surgery was the constant low back pains found in all the patients. Revision surgery involved disc explantation and fusion in two of the patients and posterolateral fusion without removing the prosthesis in three. None of the patients achieved adequate pain control after the revision surgery despite the solid bony fusion documented by postoperative computed tomography. The mean ODI value after the fusion was 55. The mean values for back and leg pains VAS were 72 and 30, respectively. Conclusions Lack of good pain relief after successful lumbar artifical disc replacements may indicate different etiology for the back pains. The spine-treating surgeons should have a high threshold level to perform salvage fusion at that level. PMID:24596600

  5. 40 CFR 80.1235 - What gasoline is subject to the benzene requirements of this subpart?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false What gasoline is subject to the benzene requirements of this subpart? 80.1235 Section 80.1235 Protection of Environment ENVIRONMENTAL... Benzene Gasoline Benzene Requirements § 80.1235 What gasoline is subject to the benzene requirements...

  6. 40 CFR 80.1235 - What gasoline is subject to the benzene requirements of this subpart?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 16 2011-07-01 2011-07-01 false What gasoline is subject to the benzene requirements of this subpart? 80.1235 Section 80.1235 Protection of Environment ENVIRONMENTAL... Benzene Gasoline Benzene Requirements § 80.1235 What gasoline is subject to the benzene requirements...

  7. 40 CFR 80.1235 - What gasoline is subject to the benzene requirements of this subpart?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 17 2013-07-01 2013-07-01 false What gasoline is subject to the benzene requirements of this subpart? 80.1235 Section 80.1235 Protection of Environment ENVIRONMENTAL... Benzene Gasoline Benzene Requirements § 80.1235 What gasoline is subject to the benzene requirements...

  8. 40 CFR 80.1235 - What gasoline is subject to the benzene requirements of this subpart?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 17 2012-07-01 2012-07-01 false What gasoline is subject to the benzene requirements of this subpart? 80.1235 Section 80.1235 Protection of Environment ENVIRONMENTAL... Benzene Gasoline Benzene Requirements § 80.1235 What gasoline is subject to the benzene requirements...

  9. Lumbar Osteotomy.

    PubMed

    Wood, Kirkham B

    2016-04-01

    When a patient presents with spine problems, the spine surgeon would do well to avoid use of, reliance on, and acceptance of radiographs as the sole or primary source of information. Measurement of pelvic incidence and lumbar lordosis, although crucial, does not take into account the effort the patient must make to move, the level of involvement of other parts of the body, and the history of previous procedures and outcomes. Radiographs may show pathology that is not consistent with the appearance of the patient. How should we assess this situation? PMID:27015064

  10. Muscle fibre size and type distribution in thoracic and lumbar regions of erector spinae in healthy subjects without low back pain: normal values and sex differences

    PubMed Central

    MANNION, A. F.; DUMAS, G. A.; COOPER, R. G.; ESPINOSA, F. J.; FARIS, M. W.; STEVENSON, J. M.

    1997-01-01

    This study sought to investigate the normal muscle fibre size and type distribution of the human erector spinae, both in thoracic and lumbar regions, in a group of 31 young healthy male (n=17) and female (n=14) volunteers. Two percutaneous muscle biopsy samples were obtained under local anaesthesia, from the belly of the left erector spinae, at the levels of the 10th thoracic and 3rd lumbar vertebrae. Samples were prepared for routine histochemistry for the identification of fibre types. Fibre size (cross-sectional area (CSA) and narrow diameter (ND)) was quantified using computerised image analysis. The mean CSA/ND for each fibre type was greater in the thoracic than the lumbar region, but there was no difference between the 2 regions either for percentage type I (i.e. percentage distribution by number), percentage type I area (i.e. relative area of the muscle occupied by type I fibres) or the ratio describing the size of the type I fibre relative to that of the type II. Men had larger fibres than women, for each fibre type and at both sampling sites. In the men, each fibre type was of a similar mean size, whereas in the women the type I fibres were considerably larger than both the type II A and type II B fibres, with no difference between the latter two. In both regions of the erector spinae there was no difference between men and women for the proportion (%) of a given fibre type, but the percentage type I fibre area was significantly higher in the women. The erector spinae display muscle fibre characteristics which are clearly very different from those of other skeletal muscles, and which, with their predominance of relatively large type I (slow twitch) fibres, befit their function as postural muscles. Differences between thoracic and lumbar fascicles of the muscle, and between the muscles of men and women, may reflect adaptive responses to differences in function. In assessing the degree of any pathological change in the muscle of patients with low back pain

  11. 24 CFR 972.124 - Standards for identifying public housing developments subject to required conversion.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... housing developments subject to required conversion. 972.124 Section 972.124 Housing and Urban Development... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONVERSION OF PUBLIC HOUSING TO TENANT-BASED ASSISTANCE Required Conversion of Public Housing Developments Identifying Developments Subject to...

  12. 24 CFR 972.124 - Standards for identifying public housing developments subject to required conversion.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... housing developments subject to required conversion. 972.124 Section 972.124 Housing and Urban Development... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONVERSION OF PUBLIC HOUSING TO TENANT-BASED ASSISTANCE Required Conversion of Public Housing Developments Identifying Developments Subject to...

  13. 24 CFR 972.124 - Standards for identifying public housing developments subject to required conversion.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... housing developments subject to required conversion. 972.124 Section 972.124 Housing and Urban Development... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONVERSION OF PUBLIC HOUSING TO TENANT-BASED ASSISTANCE Required Conversion of Public Housing Developments Identifying Developments Subject to...

  14. 24 CFR 972.124 - Standards for identifying public housing developments subject to required conversion.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... housing developments subject to required conversion. 972.124 Section 972.124 Housing and Urban Development... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONVERSION OF PUBLIC HOUSING TO TENANT-BASED ASSISTANCE Required Conversion of Public Housing Developments Identifying Developments Subject to...

  15. 24 CFR 972.124 - Standards for identifying public housing developments subject to required conversion.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... housing developments subject to required conversion. 972.124 Section 972.124 Housing and Urban Development... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONVERSION OF PUBLIC HOUSING TO TENANT-BASED ASSISTANCE Required Conversion of Public Housing Developments Identifying Developments Subject to...

  16. 29 CFR 453.23 - Persons becoming subject to bonding requirements during fiscal year.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 2 2011-07-01 2011-07-01 false Persons becoming subject to bonding requirements during... STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS GENERAL STATEMENT CONCERNING THE BONDING... Persons becoming subject to bonding requirements during fiscal year. Considering the purpose of...

  17. 40 CFR 1043.60 - Operating requirements for engines and vessels subject to this part.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... vessels operate using only fuels meeting the specifications of 40 CFR part 80 for distillate fuel, they... operating requirements and restrictions applicable for engines and vessels subject to 40 CFR part 1042 or the requirements and restrictions applicable for fuels subject to 40 CFR part 80. (f) We may...

  18. 40 CFR 1043.60 - Operating requirements for engines and vessels subject to this part.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... domestically. Where the vessels operate using only fuels meeting the specifications of 40 CFR part 80 for... limits the operating requirements and restrictions applicable for engines and vessels subject to 40 CFR part 1042 or the requirements and restrictions applicable for fuels subject to 40 CFR part 80. (f)...

  19. 40 CFR 1043.60 - Operating requirements for engines and vessels subject to this part.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... vessels operate using only fuels meeting the specifications of 40 CFR part 80 for distillate fuel, they... operating requirements and restrictions applicable for engines and vessels subject to 40 CFR part 1042 or the requirements and restrictions applicable for fuels subject to 40 CFR part 80. (f) We may...

  20. 40 CFR 1043.60 - Operating requirements for engines and vessels subject to this part.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... domestically. Where the vessels operate using only fuels meeting the specifications of 40 CFR part 80 for... limits the operating requirements and restrictions applicable for engines and vessels subject to 40 CFR part 1042 or the requirements and restrictions applicable for fuels subject to 40 CFR part 80. (f)...

  1. 40 CFR 1043.60 - Operating requirements for engines and vessels subject to this part.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... domestically. Where the vessels operate using only fuels meeting the specifications of 40 CFR part 80 for... limits the operating requirements and restrictions applicable for engines and vessels subject to 40 CFR part 1042 or the requirements and restrictions applicable for fuels subject to 40 CFR part 80. (f)...

  2. 40 CFR 716.20 - Studies not subject to the reporting requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 32 2012-07-01 2012-07-01 false Studies not subject to the reporting requirements. 716.20 Section 716.20 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.20 Studies not subject to the reporting requirements....

  3. 40 CFR 716.20 - Studies not subject to the reporting requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 32 2013-07-01 2013-07-01 false Studies not subject to the reporting requirements. 716.20 Section 716.20 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.20 Studies not subject to the reporting requirements....

  4. 40 CFR 716.20 - Studies not subject to the reporting requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 31 2014-07-01 2014-07-01 false Studies not subject to the reporting requirements. 716.20 Section 716.20 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.20 Studies not subject to the reporting requirements....

  5. Lumbar paraganglioma.

    PubMed

    Dillard-Cannon, Erika; Atsina, Kofi-Buaku; Ghobrial, George; Gnass, Esteban; Curtis, Mark T; Heller, Joshua

    2016-08-01

    Spinal paragangliomas (SP) are benign and overall rare extra-adrenal neuroendocrine tumors often diagnosed during workup for lower back pain. Complete surgical resection achieves both symptomatic relief and cure. We present a 32-year-old man with a longstanding history of lumbago and bilateral lower extremity pain found to have a lumbar paraganglioma at the level of the L3 vertebrae. The clinical, histopathological, and radiological characteristics are described, including the rare finding of superficial siderosis on MRI of the brain. A laminectomy with microscopic dissection of the intradural mass achieved complete debulking without evidence of residual tumor. Excellent prognosis can be achieved with complete surgical resection of SP without the need for adjuvant therapy. Therefore, care should be taken to distinguish these spinal tumors from those that appear similar but are more aggressive. As such, the radiological finding of superficial siderosis should raise the suspicion for SP when a vascular intradural extramedullary spinal tumor is observed. PMID:27032749

  6. Subjective health complaints in patients with lumbar radicular pain and disc herniation are associated with a sex - OPRM1 A118G polymorphism interaction: a prospective 1-year observational study

    PubMed Central

    2014-01-01

    Background Earlier observations show that development of persistent pain may be associated with the genetic variability in the gene encoding for the μ-opioid receptor 1, the OPRM1 A118G (rs1799971). The aim of this study was to investigate the association between OPRM1 genotype and subjective health complaints in patients with radicular pain and disc herniation. Methods A prospective, 1-year observational study was conducted at a hospital back clinic, including 118 Caucasian patients with lumbar radicular pain and MRI confirmed disc herniation. Single nucleotide polymorphism genotyping regarding the OPRM1 A118G was performed. The data of individuals with AA versus AG or GG were analysed separately by linear mixed models. The Subjective Health Complaints Inventory (0-81) including 27 common complaints experienced the previous month on a scale from not at all (0) to severe (3) was used as outcome. Pain, prior duration of leg pain, age, smoking status, and lumbar disc surgery were considered as covariates. Results In total 23 of 118 patients were carriers of the OPRM1 G-allele. All patients except female carriers of the G-allele reported a decrease in pain from baseline to 1 year. Female carriers of the G-allele reported significantly higher subjective health complaints score during the study time span than male carriers of the G-allele when controlling for pain and pain duration. Conclusion The present data indicate that, when controlling for pain intensity and duration, subjective health complaints are associated with a sex - OPRM1 A118G polymorphism interaction in patients with radicular pain. PMID:24884878

  7. Relationship between physical work load and lumbar disc herniation.

    PubMed

    Ahsan, M K; Matin, T; Ali, M I; Ali, M Y; Awwal, M A; Sakeb, N

    2013-07-01

    Lumbar disc herniation (LDH) is a disabling problem. This retrospective case control study was done to evaluate the possible relevance of physical work load with Lumbar Disc Herniation. We have performed this study in the Spinal Surgery Unit of Department of Orthopaedic Surgery at BSMMU, Dhaka from July 2007 to June 2010 where 200 cases with Lumbar Disc Herniation and 200 control subjects matched by age, gender and area of residence were taken and analyzed. Chi-square test was computed for sex, area of residence, type of physical work and effort at work, whereas Odds ratio was computed for physical work load, stress at work and daily working period. The highest odds ratio (OR) was with the physical work load (OR: 03.48, CI: 01.84-06.59), hard work (OR: 03.14, CI: 01.74-05.65) and working period of >8 hours (OR: 01.34, CI: 0.75-02.38). Odds ratio for heavy load carrying at work was 03.48 and less job satisfaction or stress at work was 02.45. There was a statistically significant positive association between cumulative exposure of physical work load and lumbar disc herniation indicating an increased occurrence of herniation in heavy physical work load and occupation requiring harder efforts. PMID:23982545

  8. 40 CFR 80.1235 - What gasoline is subject to the benzene requirements of this subpart?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... benzene requirements of this subpart? 80.1235 Section 80.1235 Protection of Environment ENVIRONMENTAL... Benzene Gasoline Benzene Requirements § 80.1235 What gasoline is subject to the benzene requirements of... not include the volume and benzene content of the oxygenate in any compliance calculations or...

  9. 40 CFR 141.560 - Is my system subject to individual filter turbidity requirements?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... filter turbidity requirements? 141.560 Section 141.560 Protection of Environment ENVIRONMENTAL PROTECTION... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Individual Filter Turbidity Requirements § 141.560 Is my system subject to individual filter turbidity requirements? If your system is a...

  10. 40 CFR 141.560 - Is my system subject to individual filter turbidity requirements?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... filter turbidity requirements? 141.560 Section 141.560 Protection of Environment ENVIRONMENTAL PROTECTION... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Individual Filter Turbidity Requirements § 141.560 Is my system subject to individual filter turbidity requirements? If your system is a...

  11. 40 CFR 141.560 - Is my system subject to individual filter turbidity requirements?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... filter turbidity requirements? 141.560 Section 141.560 Protection of Environment ENVIRONMENTAL PROTECTION... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Individual Filter Turbidity Requirements § 141.560 Is my system subject to individual filter turbidity requirements? If your system is a...

  12. 40 CFR 141.560 - Is my system subject to individual filter turbidity requirements?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... filter turbidity requirements? 141.560 Section 141.560 Protection of Environment ENVIRONMENTAL PROTECTION... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Individual Filter Turbidity Requirements § 141.560 Is my system subject to individual filter turbidity requirements? If your system is a...

  13. Lumbar reservoir for intrathecal chemotherapy.

    PubMed

    Dyck, P

    1985-06-15

    The Ommaya ventricular reservoir has been the standby of intrathecal chemotherapy for more than a decade, in spite of some specific drawbacks. A general anaesthetic is often required. The scalp must be shaven. Ventricular puncture may not always be easy and keeping the ventricular catheter patent is sometimes difficult. Hence the author has adapted a commercially available lumbar peritoneal shunt system to function as a lumbar intrathecal reservoir. The procedure is simple and can be performed expeditiously under local anaesthesia. To date, eight cases have received intrathecal chemotherapy by this means. PMID:3838918

  14. 30 CFR 250.400 - Who is subject to the requirements of this subpart?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations General Requirements § 250.400 Who is subject to the...

  15. 40 CFR 80.200 - What gasoline is subject to the sulfur standards and requirements?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 17 2013-07-01 2013-07-01 false What gasoline is subject to the sulfur... (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Gasoline Sulfur Standards § 80.200 What gasoline is subject to the sulfur standards and requirements? For the purpose...

  16. 40 CFR 80.200 - What gasoline is subject to the sulfur standards and requirements?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 17 2014-07-01 2014-07-01 false What gasoline is subject to the sulfur... (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Gasoline Sulfur Standards § 80.200 What gasoline is subject to the sulfur standards and requirements? For the purpose...

  17. 40 CFR 80.200 - What gasoline is subject to the sulfur standards and requirements?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 16 2011-07-01 2011-07-01 false What gasoline is subject to the sulfur... (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Gasoline Sulfur Standards § 80.200 What gasoline is subject to the sulfur standards and requirements? For the purpose...

  18. 40 CFR 80.200 - What gasoline is subject to the sulfur standards and requirements?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 17 2012-07-01 2012-07-01 false What gasoline is subject to the sulfur... (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Gasoline Sulfur Standards § 80.200 What gasoline is subject to the sulfur standards and requirements? For the purpose...

  19. 40 CFR 80.200 - What gasoline is subject to the sulfur standards and requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false What gasoline is subject to the sulfur... (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Gasoline Sulfur Standards § 80.200 What gasoline is subject to the sulfur standards and requirements? For the purpose...

  20. 40 CFR 141.520 - Is my system subject to the updated watershed control requirements?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... watershed control requirements? 141.520 Section 141.520 Protection of Environment ENVIRONMENTAL PROTECTION... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Additional Watershed Control Requirements for Unfiltered Systems § 141.520 Is my system subject to the updated watershed...

  1. 40 CFR 141.520 - Is my system subject to the updated watershed control requirements?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... watershed control requirements? 141.520 Section 141.520 Protection of Environment ENVIRONMENTAL PROTECTION... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Additional Watershed Control Requirements for Unfiltered Systems § 141.520 Is my system subject to the updated watershed...

  2. 40 CFR 141.520 - Is my system subject to the updated watershed control requirements?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... watershed control requirements? 141.520 Section 141.520 Protection of Environment ENVIRONMENTAL PROTECTION... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Additional Watershed Control Requirements for Unfiltered Systems § 141.520 Is my system subject to the updated watershed...

  3. 40 CFR 141.520 - Is my system subject to the updated watershed control requirements?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... watershed control requirements? 141.520 Section 141.520 Protection of Environment ENVIRONMENTAL PROTECTION... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Additional Watershed Control Requirements for Unfiltered Systems § 141.520 Is my system subject to the updated watershed...

  4. 40 CFR 141.520 - Is my system subject to the updated watershed control requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... watershed control requirements? 141.520 Section 141.520 Protection of Environment ENVIRONMENTAL PROTECTION... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Additional Watershed Control Requirements for Unfiltered Systems § 141.520 Is my system subject to the updated watershed...

  5. 48 CFR 27.203 - Security requirements for patent applications containing classified subject matter.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Security requirements for patent applications containing classified subject matter. 27.203 Section 27.203 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Patents and Copyrights...

  6. 48 CFR 27.203 - Security requirements for patent applications containing classified subject matter.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Security requirements for patent applications containing classified subject matter. 27.203 Section 27.203 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Patents and Copyrights...

  7. 40 CFR 141.510 - Is my system subject to the new finished water reservoir requirements?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... finished water reservoir requirements? 141.510 Section 141.510 Protection of Environment ENVIRONMENTAL... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Finished Water Reservoirs § 141.510 Is my system subject to the new finished water reservoir requirements? All subpart H systems which...

  8. 40 CFR 141.510 - Is my system subject to the new finished water reservoir requirements?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... finished water reservoir requirements? 141.510 Section 141.510 Protection of Environment ENVIRONMENTAL... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Finished Water Reservoirs § 141.510 Is my system subject to the new finished water reservoir requirements? All subpart H systems which...

  9. 40 CFR 141.510 - Is my system subject to the new finished water reservoir requirements?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... finished water reservoir requirements? 141.510 Section 141.510 Protection of Environment ENVIRONMENTAL... Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Finished Water Reservoirs § 141.510 Is my system subject to the new finished water reservoir requirements? All subpart H systems which...

  10. 40 CFR 63.11081 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... control requirements of 40 CFR part 63, subpart R (§§ 63.422, 63.423, and 63.424) or 40 CFR part 63... the control requirements of 40 CFR part 63, subpart R (§§ 63.423 and 63.424). (3) A pipeline pumping... under 40 CFR part 70 or 40 CFR part 71 as a result of being subject to this subpart. However, you...

  11. 40 CFR 63.11081 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... control requirements of 40 CFR part 63, subpart R (§§ 63.422, 63.423, and 63.424) or 40 CFR part 63... the control requirements of 40 CFR part 63, subpart R (§§ 63.423 and 63.424). (3) A pipeline pumping... under 40 CFR part 70 or 40 CFR part 71 as a result of being subject to this subpart. However, you...

  12. The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients

    PubMed Central

    Jeong, Ui-Cheol; Sim, Jae-Heon; Kim, Cheol-Yong; Hwang-Bo, Gak; Nam, Chan-Woo

    2015-01-01

    [Purpose] The aim of this study was to examine the effects of exercise to strengthen the muscles of the hip together with lumbar segmental stabilization exercise on the lumbar disability index, lumbar muscle strength, and balance. [Subjects and Methods] This study randomly and equally assigned 40 participants who provided written consent to participate in this study to a lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus group (SMG + LES group) and a lumbar segmental stabilization exercise group. [Results] Each evaluation item showed a statistically significant effect. [Conclusion] Clinical application of exercise in this study showed that lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus resulted in a greater decrease in low back pain disability index and increase in lumbar muscle strength and balance ability than lumbar segmental stabilization exercise in chronic low back pain patients receiving the exercise treatments during the same period. PMID:26834359

  13. 40 CFR 141.560 - Is my system subject to individual filter turbidity requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Is my system subject to individual filter turbidity requirements? 141.560 Section 141.560 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems...

  14. 30 CFR 250.400 - Who is subject to the requirements of this subpart?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Who is subject to the requirements of this subpart? 250.400 Section 250.400 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling...

  15. 40 CFR 63.7985 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... conveyance and treatment of wastewater. (3) Ancillary equipment such as boilers and incinerators (only those... 40 Protection of Environment 14 2012-07-01 2011-07-01 true Am I subject to the requirements in... CFR part 63. Affiliated operations include, but are not limited to, mixing or dissolving of...

  16. 40 CFR 141.510 - Is my system subject to the new finished water reservoir requirements?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 23 2011-07-01 2011-07-01 false Is my system subject to the new finished water reservoir requirements? 141.510 Section 141.510 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems...

  17. 40 CFR 63.11865 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., that produce vinyl chloride monomer or other raw materials used in the production of polyvinyl chloride... Chloride and Copolymers Production What This Subpart Covers § 63.11865 Am I subject to the requirements in... polyvinyl chloride and copolymers production process units (PVCPU) as defined in § 63.12005 that are...

  18. 40 CFR 63.11865 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., that produce vinyl chloride monomer or other raw materials used in the production of polyvinyl chloride... Chloride and Copolymers Production What This Subpart Covers § 63.11865 Am I subject to the requirements in... polyvinyl chloride and copolymers production process units (PVCPU) as defined in § 63.12005 that are...

  19. 40 CFR 63.11865 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., that produce vinyl chloride monomer or other raw materials used in the production of polyvinyl chloride... Chloride and Copolymers Production What This Subpart Covers § 63.11865 Am I subject to the requirements in... polyvinyl chloride and copolymers production process units (PVCPU) as defined in § 63.12005 that are...

  20. 21 CFR 1314.115 - Distributions not subject to reporting requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... requirements. 1314.115 Section 1314.115 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE RETAIL SALE OF SCHEDULED LISTED CHEMICAL PRODUCTS Mail-Order Sales § 1314.115 Distributions not subject... section for an individual regulated person if the Administrator finds that drug products distributed...

  1. 40 CFR 141.501 - Who is subject to the requirements of subpart T?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Who is subject to the requirements of subpart T? 141.501 Section 141.501 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration...

  2. 40 CFR 1060.1 - Which products are subject to this part's requirements?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 34 2013-07-01 2013-07-01 false Which products are subject to this part's requirements? 1060.1 Section 1060.1 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR POLLUTION CONTROLS CONTROL OF EVAPORATIVE EMISSIONS FROM NEW AND IN-USE NONROAD AND STATIONARY EQUIPMENT Overview and Applicability...

  3. 77 FR 32128 - Cancellation of Bond Subject to Enhanced Bonding Requirements Upon CBP's Acceptance of Qualified...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-31

    ...'s satisfaction, that no contingent liability remains secured by the predecessor EBR bond and that... requirements (EBR) on importers of shrimp subject to AD/CVD. See 71 FR 62276, dated October 24, 2006. II... documentation that includes a statement as to the date the EBR no longer secured contingent liability, as...

  4. 40 CFR 60.5422 - What are my additional reporting requirements for my affected facility subject to VOC...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... requirements for my affected facility subject to VOC requirements for onshore natural gas processing plants? 60... Natural Gas Production, Transmission and Distribution § 60.5422 What are my additional reporting requirements for my affected facility subject to VOC requirements for onshore natural gas processing plants?...

  5. 40 CFR 60.5421 - What are my additional recordkeeping requirements for my affected facility subject to VOC...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... requirements for my affected facility subject to VOC requirements for onshore natural gas processing plants? 60... Natural Gas Production, Transmission and Distribution § 60.5421 What are my additional recordkeeping requirements for my affected facility subject to VOC requirements for onshore natural gas processing plants?...

  6. 40 CFR 60.5421 - What are my additional recordkeeping requirements for my affected facility subject to VOC...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... requirements for my affected facility subject to VOC requirements for onshore natural gas processing plants? 60... Natural Gas Production, Transmission and Distribution § 60.5421 What are my additional recordkeeping requirements for my affected facility subject to VOC requirements for onshore natural gas processing plants?...

  7. 40 CFR 60.5422 - What are my additional reporting requirements for my affected facility subject to VOC...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... requirements for my affected facility subject to VOC requirements for onshore natural gas processing plants? 60... Natural Gas Production, Transmission and Distribution § 60.5422 What are my additional reporting requirements for my affected facility subject to VOC requirements for onshore natural gas processing plants?...

  8. Automatic Lumbar Spondylolisthesis Measurement in CT Images.

    PubMed

    Liao, Shu; Zhan, Yiqiang; Dong, Zhongxing; Yan, Ruyi; Gong, Liyan; Zhou, Xiang Sean; Salganicoff, Marcos; Fei, Jun

    2016-07-01

    Lumbar spondylolisthesis is one of the most common spinal diseases. It is caused by the anterior shift of a lumbar vertebrae relative to subjacent vertebrae. In current clinical practices, staging of spondylolisthesis is often conducted in a qualitative way. Although meyerding grading opens the door to stage spondylolisthesis in a more quantitative way, it relies on the manual measurement, which is time consuming and irreproducible. Thus, an automatic measurement algorithm becomes desirable for spondylolisthesis diagnosis and staging. However, there are two challenges. 1) Accurate detection of the most anterior and posterior points on the superior and inferior surfaces of each lumbar vertebrae. Due to the small size of the vertebrae, slight errors of detection may lead to significant measurement errors, hence, wrong disease stages. 2) Automatic localize and label each lumbar vertebrae is required to provide the semantic meaning of the measurement. It is difficult since different lumbar vertebraes have high similarity of both shape and image appearance. To resolve these challenges, a new auto measurement framework is proposed with two major contributions: First, a learning based spine labeling method that integrates both the image appearance and spine geometry information is designed to detect lumbar vertebrae. Second, a hierarchical method using both the population information from atlases and domain-specific information in the target image is proposed for most anterior and posterior points positioning. Validated on 258 CT spondylolisthesis patients, our method shows very similar results to manual measurements by radiologists and significantly increases the measurement efficiency. PMID:26849859

  9. Lumbar (Open) Microscopic Discectomy

    MedlinePlus

    ... the most common surgical treatment for ruptured or herniated discs of the lumbar spine. When the outer wall ... a slipped or bulging disc. (See discussion of herniated disc for more information.) Once the inner disc material ...

  10. Herniated Lumbar Disc

    MedlinePlus

    ... 50. A herniated lumbar disc may also cause back pain, although back pain alone (without leg pain) can have many causes ... 90% success); surgery is less effective in relieving back pain. Nonsurgical treatment Your doctor may prescribe nonsurgical treatments ...

  11. Lumbar MRI scan

    MedlinePlus

    ... may need a lumbar MRI if you have: Low back pain that does not get better after treatment Leg ... spine Injury or trauma to the lower spine Low back pain and a history or signs of cancer Multiple ...

  12. [Congenital lumbar hernia].

    PubMed

    Peláez Mata, D J; Alvarez Muñoz, V; Fernández Jiménez, I; García Crespo, J M; Teixidor de Otto, J L

    1998-07-01

    Hernias in the lumbar region are abdominal wall defects that appear in two possible locations: the superior lumbar triangle of Grynfelt-Lesshaft and the inferior lumbar triangle of Petit. There are 40 cases reported in the pediatric literature, and only 16 are considered congenital, associated with the lumbocostovertebral syndrome and/or meningomyelocele. A new case is presented. A premature newborn with a mass in the left flank that increases when the patient cries and reduces easily. The complementary studies confirm the diagnosis of lumbar hernia and reveal the presence of lumbocostovertebral syndrome associated. At the time of operation a well defined fascial defect at the superior lumbar triangle of Grynfelt-Lesshaft is primarily closed. The diagnosis of lumbar hernia is not difficult to establish but it is necessary the screening of the lumbocostovertebral syndrome. We recommend the surgical treatment before 12 months of age; the objective is to close the defect primarily or to use prosthetic material if necessary. PMID:12602034

  13. 43 CFR 429.3 - What types of uses are subject to the requirements and processes established under this part?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false What types of uses are subject to the... are subject to the requirements and processes established under this part? Possession or occupancy of... appropriate by Reclamation, subject to the exclusions listed in § 429.4....

  14. 46 CFR 70.05-1 - United States flag vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 3 2011-10-01 2011-10-01 false United States flag vessels subject to the requirements... (CONTINUED) PASSENGER VESSELS GENERAL PROVISIONS Application § 70.05-1 United States flag vessels subject to the requirements of this subchapter. (a) This subchapter is applicable to all U.S.-flag...

  15. 46 CFR 70.05-1 - United States flag vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 3 2012-10-01 2012-10-01 false United States flag vessels subject to the requirements... (CONTINUED) PASSENGER VESSELS GENERAL PROVISIONS Application § 70.05-1 United States flag vessels subject to the requirements of this subchapter. (a) This subchapter is applicable to all U.S.-flag...

  16. 46 CFR 70.05-1 - United States flag vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 3 2014-10-01 2014-10-01 false United States flag vessels subject to the requirements of this subchapter. 70.05-1 Section 70.05-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS GENERAL PROVISIONS Application § 70.05-1 United States flag vessels subject to the requirements of this subchapter....

  17. 46 CFR 70.05-1 - United States flag vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 3 2010-10-01 2010-10-01 false United States flag vessels subject to the requirements... (CONTINUED) PASSENGER VESSELS GENERAL PROVISIONS Application § 70.05-1 United States flag vessels subject to the requirements of this subchapter. (a) This subchapter is applicable to all U.S.-flag...

  18. 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

  19. Economic impact of minimally invasive lumbar surgery

    PubMed Central

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

    2015-01-01

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

  20. Lateral Lumbar Interbody Fusion

    PubMed Central

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

    2015-01-01

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

  1. Lateral Lumbar Interbody Fusion.

    PubMed

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

    2015-12-01

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

  2. 40 CFR 721.160 - Notification requirements for new chemical substances subject to section 5(e) orders.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... and other specific requirements for each new chemical substance that is the subject of a final order... substance, unless EPA determines that significant new use notification requirements are not needed for the substance. (2) If EPA determines that significant new use notification requirements are not needed for...

  3. 40 CFR 721.160 - Notification requirements for new chemical substances subject to section 5(e) orders.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... and other specific requirements for each new chemical substance that is the subject of a final order... substance, unless EPA determines that significant new use notification requirements are not needed for the substance. (2) If EPA determines that significant new use notification requirements are not needed for...

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

    PubMed Central

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

    2015-01-01

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

  5. Lumbar Repositioning Accuracy as a Measure of Proprioception in Patients with Back Dysfunction and Healthy Controls

    PubMed Central

    2011-01-01

    Study Design A control group cross-sectional design. Purpose To compare the difference in repositioning accuracy, as a measure of lumbar proprioception, between patients with back dysfunction and healthy subjects. Overview of Literature Evidence suggests that spinal stability might be compromised in patients with back dysfunction. Lumbar proprioception in back dysfunction has not, however, been adequately investigated. Methods Forty-five participants, representing three groups, took part in the study. Subjects in group one (n = 15) were healthy subjects. Subjects in group two (n = 15) had a history of non-specific mechanical back dysfunction, while subjects in group three (n = 15) had discogenic back dysfunction. Subjects were required to reproduce a target position of 30° lumbar flexion and the absolute error (AE) was calculated. Results The AEs between target and reproduced positions were calculated. The average repositioning AEs were 2.8, 7.5, and 7.1° for the control, mechanical, and discogenic back dysfunction groups respectively. Analysis of variance revealed significant difference between the three groups (p < 0.0002). The AEs were greater in the two back dysfunction groups compared to the control group. Post-hoc tests revealed significant difference in AEs between the control and mechanical group (p < 0.0003), and discogenic group (p < 0.0001), while there was no significant difference between the mechanical and discogenic back dysfunction groups (p = 0.73). Conclusions Differences in proprioception do exist between subjects with back dysfunction and normal subjects. The proprioceptive deficits do exist regardless of the cause of the back dysfunction, and may represent an important aspect of the patho-physiology of such a condition. PMID:22164313

  6. 40 CFR 80.820 - What gasoline is subject to the toxics performance requirements of this subpart?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false What gasoline is subject to the toxics... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Toxics Gasoline Toxics Performance Requirements § 80.820 What gasoline is subject to the toxics...

  7. 46 CFR 42.03-5 - U.S.-flag vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 2 2013-10-01 2013-10-01 false U.S.-flag vessels subject to the requirements of this... LINES DOMESTIC AND FOREIGN VOYAGES BY SEA Application § 42.03-5 U.S.-flag vessels subject to the... solely Great Lakes voyages. (1) All U.S. flag vessels which engage in foreign voyages or...

  8. 46 CFR 42.03-5 - U.S.-flag vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 2 2011-10-01 2011-10-01 false U.S.-flag vessels subject to the requirements of this... LINES DOMESTIC AND FOREIGN VOYAGES BY SEA Application § 42.03-5 U.S.-flag vessels subject to the... solely Great Lakes voyages. (1) All U.S. flag vessels which engage in foreign voyages or...

  9. 46 CFR 42.03-5 - U.S.-flag vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 2 2014-10-01 2014-10-01 false U.S.-flag vessels subject to the requirements of this... LINES DOMESTIC AND FOREIGN VOYAGES BY SEA Application § 42.03-5 U.S.-flag vessels subject to the... solely Great Lakes voyages. (1) All U.S. flag vessels which engage in foreign voyages or...

  10. 46 CFR 42.03-5 - U.S.-flag vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 2 2012-10-01 2012-10-01 false U.S.-flag vessels subject to the requirements of this... LINES DOMESTIC AND FOREIGN VOYAGES BY SEA Application § 42.03-5 U.S.-flag vessels subject to the... solely Great Lakes voyages. (1) All U.S. flag vessels which engage in foreign voyages or...

  11. 46 CFR 42.03-5 - U.S.-flag vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false U.S.-flag vessels subject to the requirements of this... LINES DOMESTIC AND FOREIGN VOYAGES BY SEA Application § 42.03-5 U.S.-flag vessels subject to the... solely Great Lakes voyages. (1) All U.S. flag vessels which engage in foreign voyages or...

  12. 40 CFR 80.820 - What gasoline is subject to the toxics performance requirements of this subpart?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 16 2011-07-01 2011-07-01 false What gasoline is subject to the toxics... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Toxics Gasoline Toxics Performance Requirements § 80.820 What gasoline is subject to the toxics...

  13. 40 CFR 80.820 - What gasoline is subject to the toxics performance requirements of this subpart?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 17 2012-07-01 2012-07-01 false What gasoline is subject to the toxics... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Toxics Gasoline Toxics Performance Requirements § 80.820 What gasoline is subject to the toxics...

  14. 40 CFR 80.820 - What gasoline is subject to the toxics performance requirements of this subpart?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 17 2013-07-01 2013-07-01 false What gasoline is subject to the toxics... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Toxics Gasoline Toxics Performance Requirements § 80.820 What gasoline is subject to the toxics...

  15. 40 CFR 80.820 - What gasoline is subject to the toxics performance requirements of this subpart?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 17 2014-07-01 2014-07-01 false What gasoline is subject to the toxics... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Toxics Gasoline Toxics Performance Requirements § 80.820 What gasoline is subject to the toxics...

  16. 49 CFR Appendix A to Part 541 - Light Duty Truck Lines Subject to the Requirements of This Standard

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 6 2011-10-01 2011-10-01 false Light Duty Truck Lines Subject to the Requirements of This Standard A Appendix A to Part 541 Transportation Other Regulations Relating to Transportation... VEHICLE THEFT PREVENTION STANDARD Pt. 541, App. A Appendix A to Part 541—Light Duty Truck Lines Subject...

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

    PubMed

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

    2016-05-01

    The aim of this article is to introduce a technique for lumbar intervertebral fusion that incorporates mobile microendoscopic discectomy (MMED) for lumbar degenerative disc disease. Minimally invasive transforaminal lumbar interbody fusion is frequently performed to treat degenerative diseases of the lumbar spine; however, the scope of such surgery and vision is limited by what the naked eye can see through the expanding channel system. To expand the visual scope and reduce trauma, we perform lumbar intervertebral fusion with the aid of a MMED system that provides a wide field through freely tilting the surgical instrument and canals. We believe that this technique is a good option for treating lumbar degenerative disc disease that requires lumbar intervertebral fusion. PMID:27384734

  18. Partial Facetectomy for Lumbar Foraminal Stenosis

    PubMed Central

    Kang, Kevin; Rodriguez-Olaverri, Juan Carlos; Razi, Afshin; Farcy, Jean Pierre

    2014-01-01

    Background. Several different techniques exist to address the pain and disability caused by isolated nerve root impingement. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, aggressive treatment often causes spinal instability or may require fusion for satisfactory results. We describe a novel technique for decompression of the lumbar nerve root and demonstrate its effectiveness in relief of radicular symptoms. Methods. Partial facetectomy was performed by removal of the medial portion of the superior facet in patients with lumbar foraminal stenosis. 47 patients underwent the procedure from 2001 to 2010. Those who demonstrated neurogenic claudication without spinal instability or central canal stenosis and failed conservative management were eligible for the procedure. Functional level was recorded for each patient. These patients were followed for an average of 3.9 years to evaluate outcomes. Results. 27 of 47 patients (57%) reported no back pain and no functional limitations. Eight of 47 patients (17%) reported moderate pain, but had no limitations. Six of 47 patients (13%) continued to experience degenerative symptoms. Five of 47 patients (11%) required additional surgery. Conclusions. Partial facetectomy is an effective means to decompress the lumbar nerve root foramen without causing spinal instability. PMID:25110591

  19. Biomechanical comparison of three stand-alone lumbar cages — a three-dimensional finite element analysis

    PubMed Central

    2013-01-01

    Background For anterior lumbar interbody fusion (ALIF), stand-alone cages can be supplemented with vertebral plate, locking screws, or threaded cylinder to avoid the use of posterior fixation. Intuitively, the plate, screw, and cylinder aim to be embedded into the vertebral bodies to effectively immobilize the cage itself. The kinematic and mechanical effects of these integrated components on the lumbar construct have not been extensively studied. A nonlinearly lumbar finite-element model was developed and validated to investigate the biomechanical differences between three stand-alone (Latero, SynFix, and Stabilis) and SynCage-Open plus transpedicular fixation. All four cages were instrumented at the L3-4 level. Methods The lumbar models were subjected to the follower load along the lumbar column and the moment at the lumbar top to produce flexion (FL), extension (EX), left/right lateral bending (LLB, RLB), and left/right axial rotation (LAR, RAR). A 10 Nm moment was applied to obtain the six physiological motions in all models. The comparison indices included disc range of motion (ROM), facet contact force, and stresses of the annulus and implants. Results At the surgical level, the SynCage-open model supplemented with transpedicular fixation decreased ROM (>76%) greatly; while the SynFix model decreased ROM 56-72%, the Latero model decreased ROM 36-91%, in all motions as compared with the INT model. However, the Stabilis model decreased ROM slightly in extension (11%), lateral bending (21%), and axial rotation (34%). At the adjacent levels, there were no obvious differences in ROM and annulus stress among all instrumented models. Conclusions ALIF instrumentation with the Latero or SynFix cage provides an acceptable stability for clinical use without the requirement of additional posterior fixation. However, the Stabilis cage is not favored in extension and lateral bending because of insufficient stabilization. PMID:24088294

  20. Lumbar Spinal Stenosis.

    PubMed

    Feeney, Richard

    2016-06-01

    Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In reply to a question, lumbar spinal stenosis, commonly a multifactorial disease that can have profound functional consequences, is considered, along with a discussion of physical and pharmacologic treatments and quality of life. PMID:27145444

  1. Factors to consider in identifying critical points in lumbar spine flexion relaxation.

    PubMed

    Zwambag, Derek P; Brown, Stephen H M

    2015-12-01

    Flexion relaxation (FR), a myoelectric silence of extensor muscles near end range of lumbar flexion, is commonly reported as the lumbar flexion angle at the instant the extensor muscles become silent. However, lumbar flexion angle alone is insufficient to characterize mechanisms that modulate FR. As FR requires the moment generated by passive lumbar extensor tissues to equilibrate the moment due to gravity, the inter-relationships between lumbar moment, flexion angle, and myoelectrical silence will provide added information in the understanding of FR. The purpose of this study was to examine the relationship between lumbar moment and flexion angle throughout various flexion manoeuvres. It was hypothesized that lumbar moment and flexion angle would not be linearly related and would be affected by lower limb position, range of motion, and the addition of mass to the torso. Eleven participants performed four different lumbar flexion trials. Results showed that lumbar flexion was correlated with the lumbar moment (r = 0.92); however an analysis of residuals found that these measures were not linearly related. The moment was, however, correlated (r = 0.99) and linearly related to the sine of trunk inclination (T12 rigid body with respect to global horizontal). Future studies of FR could use trunk inclination as a simple kinematic measure to predict relative changes in lumbar moment with flexion. PMID:26559463

  2. 49 CFR Appendix B to Part 544 - Issuers of Motor Vehicle Insurance Policies Subject to the Reporting Requirements Only in...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 6 2011-10-01 2011-10-01 false Issuers of Motor Vehicle Insurance Policies Subject to the Reporting Requirements Only in Designated States B Appendix B to Part 544 Transportation..., DEPARTMENT OF TRANSPORTATION INSURER REPORTING REQUIREMENTS Pt. 544, App. B Appendix B to Part 544—Issuers...

  3. The cortical and cerebellar representation of the lumbar spine.

    PubMed

    Boendermaker, Bart; Meier, Michael L; Luechinger, Roger; Humphreys, B Kim; Hotz-Boendermaker, Sabina

    2014-08-01

    Eight decades after Penfield's discovery of the homunculus only sparse evidence exists on the cortical representation of the lumbar spine. The aim of our investigation was the description of the lumbar spine's cortical representation in healthy subjects during the application of measured manual pressure. Twenty participants in the prone position were investigated during functional magnetic resonance imaging (fMRI). An experienced manual therapist applied non-painful, posterior-to-anterior (PA) pressure on three lumbar spinous processes (L1, L3, and L5). The pressure (30 N) was monitored and controlled by sensors. The randomized stimulation protocol consisted of 68 pressure stimuli of 5 s duration. Blood oxygenation level dependent (BOLD) responses were analyzed in relation to the lumbar stimulations. The results demonstrate that controlled PA pressure on the lumbar spine induced significant activation patterns. The major new finding was a strong and consistent activation bilaterally in the somatosensory cortices (S1 and S2). In addition, bilateral activation was located medially in the anterior cerebellum. The activation pattern also included other cortical areas probably related to anticipatory postural adjustments. These revealed stable somatosensory maps of the lumbar spine in healthy subjects can subsequently be used as a baseline to investigate cortical and subcortical reorganization in low back pain patients. PMID:24464423

  4. Footprint mismatch in lumbar total disc arthroplasty.

    PubMed

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

    2008-11-01

    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

  5. 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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-12-01

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

  8. 29 CFR 4.117 - Work subject to requirements of Walsh-Healey Act.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... required to be completely or substantially torn down into individual components parts; and (ii... following conditions exist: (i) The item or equipment is required to be completely or substantially...

  9. 29 CFR 4.117 - Work subject to requirements of Walsh-Healey Act.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... required to be completely or substantially torn down into individual components parts; and (ii... following conditions exist: (i) The item or equipment is required to be completely or substantially...

  10. 29 CFR 4.117 - Work subject to requirements of Walsh-Healey Act.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... required to be completely or substantially torn down into individual components parts; and (ii... following conditions exist: (i) The item or equipment is required to be completely or substantially...

  11. 29 CFR 4.117 - Work subject to requirements of Walsh-Healey Act.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... required to be completely or substantially torn down into individual components parts; and (ii... following conditions exist: (i) The item or equipment is required to be completely or substantially...

  12. 29 CFR 4.117 - Work subject to requirements of Walsh-Healey Act.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... required to be completely or substantially torn down into individual components parts; and (ii... following conditions exist: (i) The item or equipment is required to be completely or substantially...

  13. 40 CFR 63.2435 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... primary product of each PUG, and comply with the requirements of the subpart in 40 CFR part 63 that... plastics products), and 325992 (except the requirements do apply to photographic chemicals). (6) Tall...

  14. Lumbar discography: an update.

    PubMed

    Anderson, Mark W

    2004-01-01

    and then come back to reinject more contrast into the disk in question. As radiologists, we tend to focus on the technical aspects of a procedure and the anatomic/morphologic information it provides. However, it cannot be emphasized enough that when performing lumbar discography, the assessment of the patient's pain response during the injection is the most important component of the procedure, and requires not only technical skills, but an understanding of how best to avoid some of the pitfalls that can lead to inaccurate results. PMID:14976837

  15. 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

  16. 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

  17. [Lumbar spinal angiolipoma].

    PubMed

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

    2016-01-01

    Spinal angiolipomas are fairly infrequent benign tumours that are usually located in the epidural space of the thoracic column and represent 0.14% to 1.3% of all spinal tumours. Lumbar angiolipomas are extremely rare, representing only 9.6% of all spinal extradural angiolipomas. We report the case of a woman who complained of a lumbar pain of several months duration with no neurological focality and that had intensified in the last three days without her having had any injury or made a physical effort. The MR revealed an extradural mass L1-L2, on the posterior face of the medulla, decreasing the anteroposterior diameter of the canal. The patient symptoms improved after surgery. Total extirpation of the lesion is possible in most cases, and the prognosis is excellent even if the lesion is infiltrative. For this reason, excessively aggressive surgery is not necessary to obtain complete resection. PMID:27263067

  18. LUMBAR DISC HERNIATION

    PubMed Central

    Vialle, Luis Roberto; Vialle, Emiliano Neves; Suárez Henao, Juan Esteban; Giraldo, Gustavo

    2015-01-01

    Lumbar disc herniation is the most common diagnosis among the degenerative abnormalities of the lumbar spine (affecting 2 to 3% of the population), and is the principal cause of spinal surgery among the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (four to six weeks). The initial treatment should be conservative, managed through medication and physiotherapy, sometimes associated with percutaneous nerve root block. Surgical treatment is indicated if pain control is unsuccessful, if there is a motor deficit greater than grade 3, if there is radicular pain associated with foraminal stenosis, or if cauda equina syndrome is present. The latter represents a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence over the long term. PMID:27019834

  19. A methodology for quantifying seated lumbar curvatures.

    PubMed

    Leitkam, Samuel T; Bush, Tamara Reid; Li, Mingfei

    2011-11-01

    To understand the role seating plays in the support of posture and spinal articulation, it is necessary to study the interface between a human and the seat. However, a method to quantify lumbar curvature in commercially available unmodified seats does not currently exist. This work sought to determine if the lumbar curvature for normal ranges of seated posture could be documented by using body landmarks located on the anterior portion of the body. The development of such a methodology will allow researchers to evaluate spinal articulation of a seated subject while in standard, commercially available seats and chairs. Anterior measurements of boney landmarks were used to quantify the relative positions of the ribcage and pelvis while simultaneous posterior measurements were made of lumbar curvature. The relationship between the anterior and the posterior measures was compared. The predictive capacity of this approach was evaluated by determining linear and second-order regressions for each of the four postures across all subjects and conducting a leave-one-out cross validation. The relationships between the anterior and posterior measures were approximated by linear and second-order polynomial regressions (r(2 ) =  0.829, 0.935 respectively) across all postures. The quantitative analysis showed that openness had a significant relationship with lumbar curvature, and a first-order regression was superior to a second-order regression. Average standard errors in the prediction were 5.9° for the maximum kyphotic posture, 9.9° for the comfortable posture, 12.8° for the straight and tall, and 22.2° for the maximum lordotic posture. These results show predictions of lumbar curvature are possible in seated postures by using a motion capture system and anterior measures. This method of lumbar curvature prediction shows potential for use in the assessment of seated spinal curvatures and the corresponding design of seating to accommodate those curvatures; however

  20. Lumbar spine chordoma

    PubMed Central

    Hatem, M.A.

    2015-01-01

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

  1. Lumbar spinal surgery - series (image)

    MedlinePlus

    ... of bones (vertebrae) separated by soft cushions (intervertebral discs). ... Lumbar (lower back) spine disease is usually caused by herniated ... bodies (osteophytes), which compress spinal nerves, trauma, and ...

  2. Safety of CT-Guided Lumbar Nerve Root Infiltrations

    PubMed Central

    Gossner, Johannes

    2014-01-01

    Summary Selective nerve root infiltrations are frequently performed in patients with lumbar radiculopathy. Computed tomography (CT) is now commonly used for image guidance. Despite the widespread use of CT-guided lumbar nerve root infiltrations few studies have systematically examined the safety of this approach. In a two-year period, 231 lumbar nerve root infiltrations were performed on in-patients and were retrospectively reviewed. No major complications like inflammation (especially spondylodiscitis), large haematomas requiring surgery, severe allergic reactions or spinal ischaemia occurred. In accordance with other published studies, CT-guided lumbar nerve root infiltrations seem to be safe. To minimize the risk of catastrophic neurological complications due to spinal ischaemia, careful needle placement dorsal to the nerve root and the use of a non-particulate corticosteroid, like dexamethasone, are advocated. PMID:25363255

  3. Sensitivity of lumbar spine loading to anatomical parameters.

    PubMed

    Putzer, Michael; Ehrlich, Ingo; Rasmussen, John; Gebbeken, Norbert; Dendorfer, Sebastian

    2016-04-11

    Musculoskeletal simulations of lumbar spine loading rely on a geometrical representation of the anatomy. However, this data has an inherent inaccuracy. This study evaluates the influence of defined geometrical parameters on lumbar spine loading utilising five parametrised musculoskeletal lumbar spine models for four different postures. The influence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine was studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most influential. These parameters can be easily acquired from X-rays and should be used to morph a musculoskeletal lumbar spine model for subject-specific approaches with respect to bone geometry. Furthermore, the model was very sensitive to uncommon configurations and therefore, it is advised that stiffness properties of discs and ligaments should be individualised. PMID:26680014

  4. 50 CFR 300.184 - Species subject to permitting, documentation, reporting, and recordkeeping requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... requirements of this subpart, regardless of ocean area of catch. (a) Bluefin tuna. (1) The requirements of this subpart apply to bluefin tuna products including those identified by the following subheading numbers from the Harmonized Tariff Schedule of the United States (HTS): (i) Fresh or chilled bluefin tuna (No....

  5. 50 CFR 300.184 - Species subject to permitting, documentation, reporting, and recordkeeping requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... requirements of this subpart, regardless of ocean area of catch. (a) Bluefin tuna. (1) The requirements of this subpart apply to bluefin tuna products including those identified by the following subheading numbers from the Harmonized Tariff Schedule of the United States (HTS): (i) Fresh or chilled bluefin tuna (No....

  6. 46 CFR 188.05-1 - Vessels subject to requirements of this subchapter.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., except those covered by columns 2 and 3. All vessels carrying dangerous cargoes, when required by 46 CFR... required by 46 CFR part 98. None. None. All vessels carrying cargoes in bulk that are listed in part 153... conditions. The provisions of 49 CFR parts 171 through 179 apply whenever packaged hazardous materials are...

  7. 46 CFR 24.05-1 - Vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... by columns 2 and 3. All vessels carrying dangerous cargoes, when required by 46 CFR part 98 All..., when required by 46 CFR part 98 None None All vessels carrying cargoes in bulk that are listed in part... conditions. The provisions of 49 CFR parts 171 through 179 apply whenever packaged hazardous materials are...

  8. 46 CFR 90.05-1 - Vessels subject to requirements of this subchapter.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... vessels carrying dangerous cargoes, when required by 46 CFR part 98 All vessels not covered by columns 2... dangerous cargoes, when required by 46 CFR part 98 None None All vessels carrying cargoes in bulk that are... conditions. The provisions of 49 CFR parts 171 through 179 apply whenever packaged hazardous materials are...

  9. Lumbar intervertebral disc degeneration and related factors in Korean firefighters

    PubMed Central

    Jang, Tae-Won; Ahn, Yeon-Soon; Byun, Junsu; Lee, Jong-In; Kim, Kun-Hyung; Kim, Youngki; Song, Han-Soo; Lee, Chul-Gab; Kwon, Young-Jun; Yoon, Jin-Ha; Jeong, Kyoungsook

    2016-01-01

    Objectives The job of firefighting can cause lumbar burden and low back pain. This study aimed to identify the association between age and lumbar intervertebral disc degeneration and whether the association differs between field and administrative (non-field) firefighters. Methods Subjects were selected using a stratified random sampling method. Firefighters were stratified by geographic area, gender, age and type of job. First, 25 fire stations were randomly sampled considering regional distribution. Then firefighters were stratified by gender, age and their job and randomly selected among the strata. A questionnaire survey and MRI scans were performed, and then four radiologists used Pfirrmann classification methods to determine the grade of lumbar intervertebral disc degeneration. Results Pfirrmann grade increased with lumbar intervertebral disc level. Analysis of covariance showed that age was significantly associated with lumbar intervertebral disc degeneration (p<0.05). The value of β (parameter estimate) was positive at all lumbar intervertebral disc levels and was higher in the field group than in the administrative group at each level. In logistic regression analysis, type of job was statistically significant only with regard to the L4–5 intervertebral disc (OR 3.498, 95% CI 1.241 to 9.860). Conclusions Lumbar intervertebral disc degeneration is associated with age, and field work such as firefighting, emergency and rescue may accelerate degeneration in the L4–5 intervertebral disc. The effects of field work on lumbar intervertebral disc degeneration were not clear in discs other than at the level L4–5. PMID:27354080

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

    PubMed

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

    2014-11-01

    Although the lumbar spine region is the most common site of injury in golfers, little research has been done on intervertebral loads in relation to the anatomical-morphological differences in the region. This study aimed to examine the biomechanical effects of anatomical-morphological differences in the lumbar lordosis on the lumbar spinal joints during a golf swing. The golf swing motions of ten professional golfers were analyzed. Using a subject-specific 3D musculoskeletal system model, inverse dynamic analyses were performed to compare the intervertebral load, the load on the lumbar spine, and the load in each swing phase. In the intervertebral load, the value was the highest at the L5-S1 and gradually decreased toward the T12. In each lumbar spine model, the load value was the greatest on the kypholordosis (KPL) followed by normal lordosis (NRL), hypolordosis (HPL), and excessive lordosis (EXL) before the impact phase. However, results after the follow-through (FT) phase were shown in reverse order. Finally, the load in each swing phase was greatest during the FT phase in all the lumbar spine models. The findings can be utilized in the training and rehabilitation of golfers to help reduce the risk of injury by considering individual anatomical-morphological characteristics. PMID:25162173

  11. 40 CFR 62.15035 - Is my small municipal waste combustion unit subject to different requirements based on plant...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 9 2012-07-01 2012-07-01 false Is my small municipal waste combustion unit subject to different requirements based on plant capacity? 62.15035 Section 62.15035 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF STATE PLANS FOR...

  12. 40 CFR 62.15035 - Is my small municipal waste combustion unit subject to different requirements based on plant...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 8 2010-07-01 2010-07-01 false Is my small municipal waste combustion... Combustion Units Constructed on or Before August 30, 1999 Applicability of This Subpart § 62.15035 Is my small municipal waste combustion unit subject to different requirements based on plant capacity?...

  13. 49 CFR Appendix A to Part 541 - Light Duty Truck Lines Subject to the Requirements of This Standard

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 6 2010-10-01 2010-10-01 false Light Duty Truck Lines Subject to the Requirements of This Standard A Appendix A to Part 541 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR VEHICLE THEFT PREVENTION STANDARD Pt....

  14. 40 CFR 62.15035 - Is my small municipal waste combustion unit subject to different requirements based on plant...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... combustion capacity greater than 250 tons per day of municipal solid waste. (See the definition of municipal... capacity of no more than 250 tons per day of municipal solid waste. (See the definition of municipal waste... small municipal waste combustion unit subject to different requirements based on plant capacity?...

  15. Elevating Instruction for Secondary-School Students with Learning Disabilities by Demystifying the Highly Qualified Subject Matter Requirement

    ERIC Educational Resources Information Center

    McKenzie, Robert G.

    2009-01-01

    The highly qualified mandate of the No Child Left Behind Act and Individuals with Disabilities Education Act has created unnecessary confusion, particularly among secondary-school special educators and administrators with respect to instruction in core academic subjects. The pursuit of compliance solutions to meet this requirement has generally…

  16. 40 CFR 63.2435 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... primary product of each PUG, and comply with the requirements of the subpart in 40 CFR part 63 that... coating ingredients; coating mixing for viscosity adjustment, color tint or additive blending, or...

  17. 40 CFR 63.2435 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... primary product of each PUG, and comply with the requirements of the subpart in 40 CFR part 63 that... the Printing and Publishing Industry), JJJJ (NESHAP: Paper and Other Web Coating), future MMMM...

  18. 40 CFR 262.203 - How an eligible academic entity indicates it will be subject to the requirements of this subpart.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... indicates it will be subject to the requirements of this subpart. 262.203 Section 262.203 Protection of... entity indicates it will be subject to the requirements of this subpart. (a) An eligible academic entity... Identification Form (EPA Form 8700-12), that it is electing to be subject to the requirements of this subpart...

  19. 28 CFR 28.23 - Evidence subject to the preservation requirement.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... requirement. 28.23 Section 28.23 Judicial Administration DEPARTMENT OF JUSTICE DNA IDENTIFICATION SYSTEM... guilt or innocence through DNA testing to determine whether the defendant is the source of the material... excluding the defendant as the source of its DNA. Example 1. In a murder case in which the victim...

  20. 28 CFR 28.23 - Evidence subject to the preservation requirement.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... requirement. 28.23 Section 28.23 Judicial Administration DEPARTMENT OF JUSTICE DNA IDENTIFICATION SYSTEM... guilt or innocence through DNA testing to determine whether the defendant is the source of the material... excluding the defendant as the source of its DNA. Example 1. In a murder case in which the victim...

  1. 40 CFR 63.2435 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... primary product of each PUG, and comply with the requirements of the subpart in 40 CFR part 63 that... 112(b) of the CAA or hydrogen halide and halogen HAP, as defined in § 63.2550. (3) The MCPU is not...

  2. 40 CFR 63.2435 - Am I subject to the requirements in this subpart?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... polymer into its end use); compounding operations (in which blending, melting, and resolidification of a... melting or mixing the polymer and then forcing it or pulling it through an orifice to create an extruded... primary product of each PUG, and comply with the requirements of the subpart in 40 CFR part 63...

  3. 40 CFR 141.510 - Is my system subject to the new finished water reservoir requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... finished water reservoir requirements? 141.510 Section 141.510 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Finished Water Reservoirs § 141.510...

  4. 29 CFR 453.23 - Persons becoming subject to bonding requirements during fiscal year.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... fiscal year. 453.23 Section 453.23 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS GENERAL STATEMENT CONCERNING THE BONDING REQUIREMENTS OF THE LABOR-MANAGEMENT REPORTING AND DISCLOSURE ACT OF 1959 Miscellaneous Provisions §...

  5. 28 CFR 28.23 - Evidence subject to the preservation requirement.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... requirement. 28.23 Section 28.23 Judicial Administration DEPARTMENT OF JUSTICE DNA IDENTIFICATION SYSTEM... guilt or innocence through DNA testing to determine whether the defendant is the source of the material... excluding the defendant as the source of its DNA. Example 1. In a murder case in which the victim...

  6. 28 CFR 28.23 - Evidence subject to the preservation requirement.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... requirement. 28.23 Section 28.23 Judicial Administration DEPARTMENT OF JUSTICE DNA IDENTIFICATION SYSTEM... guilt or innocence through DNA testing to determine whether the defendant is the source of the material... excluding the defendant as the source of its DNA. Example 1. In a murder case in which the victim...

  7. 28 CFR 28.23 - Evidence subject to the preservation requirement.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... requirement. 28.23 Section 28.23 Judicial Administration DEPARTMENT OF JUSTICE DNA IDENTIFICATION SYSTEM... guilt or innocence through DNA testing to determine whether the defendant is the source of the material... excluding the defendant as the source of its DNA. Example 1. In a murder case in which the victim...

  8. [Vascular complications associated with lumbar spinal surgery].

    PubMed

    Riedemann-Wistuba, M; Alonso-Pérez, M; Llaneza-Coto, J M

    2016-01-01

    Although there are currently less invasive techniques available for the treatment of spinal injuries, open surgery is still required in many cases. Vascular injuries occurring during lumbar spine surgery, although uncommon, are of great importance due to their potential gravity. Clinical manifestations vary from an acute hemorrhagic shock that needs urgent treatment to save the patient's life, to insidious injuries or an asymptomatic evolution, and should be studied to choose the best therapeutic alternative. Four cases are reported that represent this range of possibilities and emphasize the importance of a careful surgical technique during lumbar spine interventions, and the need for high clinical suspicion, essential for the early diagnosis of these vascular complications. The current therapeutic options are also discussed. PMID:25662569

  9. Upper lumbar disk herniations.

    PubMed

    Cedoz, M E; Larbre, J P; Lequin, C; Fischer, G; Llorca, G

    1996-06-01

    Specific features of upper lumbar disk herniations are reviewed based on data from the literature and from a retrospective study of 24 cases treated surgically between 1982 and 1994 (seven at L1-L2 and 17 at L2-L3). Clinical manifestations are polymorphic, misleading (abdominogenital pain suggestive of a visceral or psychogenic condition, meralgia paresthetica, isolated sciatica; femoral neuralgia is uncommon) and sometimes severe (five cases of cauda equina syndrome in our study group). The diagnostic usefulness of imaging studies (radiography, myelography, computed tomography, magnetic resonance imaging) and results of surgery are discussed. The risk of misdiagnosis and the encouraging results of surgery are emphasized. PMID:8817752

  10. Mimickers of lumbar radiculopathy.

    PubMed

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

    2015-01-01

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

  11. Optimisation of Composite Sandwich Structures Subjected to Combined Torsion and Bending Stiffness Requirements

    NASA Astrophysics Data System (ADS)

    Li, Xiang; Li, Gangyan; Wang, Chun H.

    2012-06-01

    This research is motivated by the rapidly increasing use of composite sandwich structures to reduce weight and improve energy efficiency in a wide range of industries such as automotive, aerospace and civil infrastructure. The paper presents a minimum-weight optimization method for sandwich structures to meet both torsion and bending rigidity requirements. This multiple inequality-constrained optimisation problem is formulated using the Lagrange multiplier method. Solving the resulting equations reveals the optimum solution that can satisfy both flexural and torsion stiffness requirements depend on the stiffness ratio relative to elastic modulus ratio. To illustrate the newly developed optimum design solutions, numerical examples are presented for sandwich structures made of either isotropic face skins or orthotropic composite face skins.

  12. The effects of gait with use of smartphone on repositioning error and curvature of the lumbar spine

    PubMed Central

    Yoon, Jeong-Oh; Kang, Min-Hyeok; Kim, Jun-Seok; Oh, Jae-Seop

    2015-01-01

    [Purpose] This study evaluated the effect of smartphone use on lumbar spine repositioning error and lumbar curvature while walking on a treadmill. [Subjects] A total of 20 healthy individuals (18 males and 2 females) volunteered for this study. [Methods] The subjects walked for 20 min on a treadmill while using a smartphone. To determine the effect of smartphone use, lumbar repositioning error was measured using an electronic goniometer while lumbar curvature was assessed using a Spinal Mouse before and immediately after treadmill use. Differences in the lumbar repositioning error and lumbar curvature data between the pre- and post-walking were compared using the paired t-test. [Results] The lumbar spine repositioning error was significantly greater post-walking compared with pre-walking (6.70±2.91° vs. 3.02±1.79°). There was no significant difference in lumbar curvature between pre- and post-walking (14.24±3.18° vs. 13.94±3.12°). [Conclusion] These findings indicate that the lumbar repositioning error increased immediately after walking while using a smartphone, but that the lumbar curvature was unchanged. PMID:26357430

  13. 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

  14. Herniated lumbar disc

    PubMed Central

    2011-01-01

    Introduction Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30 to 50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgery for herniated lumbar disc? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 37 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics, antidepressants, bed rest, corticosteroids (epidural injections), cytokine inhibitors (infliximab), discectomy (automated percutaneous, laser, microdiscectomy, standard), exercise therapy, heat, ice, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), percutaneous disc decompression, spinal manipulation, and traction. PMID:21711958

  15. Insulin requirement profiles in Japanese hospitalized subjects with type 2 diabetes treated with basal-bolus insulin therapy.

    PubMed

    Shimoda, Seiya; Okubo, Mina; Koga, Kotaro; Sekigami, Taiji; Kawashima, Junji; Kukidome, Daisuke; Igata, Motoyuki; Ishii, Norio; Shimakawa, Akiko; Matsumura, Takeshi; Motoshima, Hiroyuki; Furukawa, Noboru; Nishida, Kenro; Araki, Eiichi

    2015-01-01

    To assess the total daily inulin dose (TDD) and contribution of basal insulin to TDD and to identify the predictive factors for insulin requirement profiles in subjects with type 2 diabetes, we retrospectively examined insulin requirement profiles of 275 hospitalized subjects treated with basal-bolus insulin therapy (BBT) (mean age, 60.1 ± 12.9 years; HbA1c, 10.2 ± 4.5%). Target plasma glucose level was set between 80 and 129 mg/dL before breakfast and between 80 and 179 mg/dL at 2-hour after each meal without causing hypoglycemia. We also analyzed the relationship between the insulin requirement profiles (TDD and basal/total daily insulin ratio [B/TD ratio]) and insulin-associated clinical parameters. The mean TDD was 0.463 ± 0.190 unit/kg/day (range, 0.16-1.13 unit/kg/day). The mean B/TD ratio was 0.300 ± 0.099 (range, 0.091-0.667). A positive correlation of TDD with B/TD ratio was revealed by linear regression analysis (r=0.129, p=0.03). Stepwise multiple regression analysis identified post-breakfast glucose levels before titrating insulin as an independent determinant of the insulin requirement profile [Std β (standard regression coefficient) = 0.228, p<0.01 for TDD, Std β = -0.189, p<0.01 for B/TD ratio]. The TDD was <0.6 unit/kg/day and the B/TD ratio was <0.4 in the majority (70.2%) of subjects in the present study. These findings may have relevance in improving glycemic control and decreasing the risk of hypoglycemia and weight gain in subjects with type 2 diabetes treated with BBT. PMID:25392020

  16. Microvesicle phenotypes are associated with transfusion requirements and mortality in subjects with severe injuries

    PubMed Central

    Matijevic, Nena; Wang, Yao-Wei W.; Holcomb, John B.; Kozar, Rosemary; Cardenas, Jessica C.; Wade, Charles E.

    2015-01-01

    Background Severe injury often results in substantial bleeding and mortality. Injury provokes cellular activation and release of extracellular vesicles. Circulating microvesicles (MVs) are predominantly platelet-derived and highly procoagulant. They support hemostasis and vascular function. The roles of MVs in survival after severe injury are largely unknown. We hypothesized that altered MV phenotypes would be associated with transfusion requirements and poor outcomes. Methods This single-centre study was approved by the Institutional Review Board. The study cohort consisted of patients with major trauma requiring blood product transfusion and 26 healthy controls. Plasma samples for MVs were collected upon admission to the emergency department (n=169) and post-resuscitation (n=42), and analysed by flow cytometry for MV counts and cellular origin: platelet (PMV), erythrocyte (RMV), leukocyte (LMV), endothelial (EMV), tissue factor (TFMV), and annexin V (AVMV). Twenty-four hour mortality is the outcome measurement used to classify survivors versus non-survivors. Data were compared over time and analysed with demographic and clinical data. Results The median age was 34 (IQR 23, 51), 72% were male, Injury Severity Score was 29 (IQR 19, 36), and 24 h mortality was 13%. MV levels and phenotypes differed between patients and controls. Elevated admission EMVs were found both in survivors (409/µL) and non-survivors (393/µL) compared to controls (23/µL, p<0.001) and persisted over time. Admission levels of PMV, AVMV, RMV, and TFMV were significantly lower in patients who died compared to survivors, but were not independently associated with the 24 h mortality rate. Patients with low MV levels at admission received the most blood products within the first 24 h. AVMV and PMV levels either increased over time or stabilized in survivors but decreased in non-survivors, resulting in significantly lower levels at intensive care unit admission in non-survivors (1,048 vs. 1

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

    PubMed

    Choi, Seyoung; Lee, Minsun; Kwon, Byongan

    2014-01-01

    Individual pelvic sacral angle was measured, compared and analyzed for the 6 male and female adults who were diagnosed with lumbar spinal stenosis, foraminal stenosis and mild spondylolisthesis in accordance with spinal parameters, pelvic parameters and occlusion state of sacroiliac joint presented by the author of this thesis based on the fact that the degree of lumbar excessive lordosis that was one of the causes for lumbar pain was determined by sacral slope. The measured values were compared with the standard values of the average normal range from 20 s to 40 s of normal Koreans stated in the study on the change in lumbar lordosis angle, lumbosacral angle and sacral slope in accordance with the age by Oh et al. [5] and sacral slope and pelvic sacral slope of each individual of the subjects for measurement were compared. Comparing the difference between the two tilt angles possessed by an individual is a comparison to determine how much the sacroiliac joint connecting pelvis and sacral vertebrae compensated and corrected the sacral vertebrae slope by pelvic tilt under the condition of synarthrodial joint.Under the condition that the location conforming to the line in which the sagittal line of gravity connects with pelvic ASIS and pubic pubic tuberele is the neutral location of pelvic tilt, sacral slope being greater than pelvic sacral slope means pelvic anterior tilting, whereas sacral slope being smaller than pelvic sacral slope means pelvic posterior tilting. On that account, male B, female A and female C had a pelvic posterior tilting of 16 degrees, 1 degree and 5 degrees respectively, whereas male A, male C and female B had a pelvic anterior tilting of 3 degrees, 9 degrees and 4 degrees respectively. In addition, the 6 patients the values of lumbar lordosis angle, lumbosacral angle and sacral slope that were almost twice as much as the normal standard values of Koreans. It is believed that this is because the pelvic sacral slope maintaining an angle that is

  18. 49 CFR 572.85 - Lumbar spine flexure.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... rotate from its initial position in accordance with Figure No. 18 of § 572.21 (49 CFR part 572) by 40 degrees at a force level of not less than 18 pounds and not more than 22 pounds, and straighten upon... Lumbar spine flexure. (a) When subjected to continuously applied force in accordance with paragraph...

  19. Low back pain and lumbar angles in Turkish coal miners

    SciTech Connect

    Sarikaya, S.; Ozdolap, S.; Gumustas, S.; Koc, U.

    2007-02-15

    This study was designed to assess the incidence of low back pain among Turkish coal miners and to investigate the relationship between angles of the lumbar spine and low back pain in coal miners. Fifty underground workers (Group I) and 38 age-matched surface workers (Group II) were included in the study. All the subjects were asked about low back pain in the past 5 years. The prevalence of low back pain was higher in Group I than in Group II (78.0%, 32.4%, respectively, P {lt} 0.001). The results of the study showed that low back pain occurred in 78.0% of Turkish coal miners. Although the nature of the occupation may have influenced coal miners' lumbar spinal curvature, lumbar angles are not a determinant for low back pain in this population. Further extensive studies involving ergonomic measurements are needed to validate our results for Turkish coal mining industry.

  20. The Changes of Trunk Motion Rhythm and Spinal Loading During Trunk Flexion and Extension Motions Caused by Lumbar Muscle Fatigue.

    PubMed

    Hu, Boyi; Ning, Xiaopeng

    2015-09-01

    Previous studies indicated that lumbar extensor muscle fatigue could potentially affect lumbar-pelvic rhythm and influence spinal loading during trunk motions. In this study, the effects of lumbar extensor muscle fatigue on the normalized lumbar-pelvic rotation rhythm and the associated L5/S1 joint loading during weight lifting and lowering tasks were investigated. Thirteen volunteers performed lifting and lowering of a 20-lbs box both before and after lumbar extensor muscle fatigue, which was generated through a static weight holding task. The normalized lumbar-pelvic motion ratio (L/P ratio) and the external moment on the L5/S1 joint were calculated and compared. Results showed that subjects demonstrated significantly larger normalized L/P ratios during both weight lifting and lowering tasks with the influence of fatigue. In addition, although the spinal loadings remain unchanged at the beginning and ending of both lifting and lowering motions, significantly larger L5/S1 joint moments were observed during both motions after fatigue. Such changes indicate potentially elevated risk of back injury. In a clinical setting, the current results demonstrated that lumbar muscle fatigue could cause transient changes in lumbar-pelvic motion rhythm. Therefore, lumbar muscle fatigue must be avoided when using lumbar-pelvic motion rhythms for patient diagnosis or rehabilitation assessment. PMID:25589373

  1. Contribution of Hamstring Fatigue to Quadriceps Inhibition Following Lumbar Extension Exercise

    PubMed Central

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

    2006-01-01

    The purpose of this study was to determine the contribution of hamstrings and quadriceps fatigue to quadriceps inhibition following lumbar extension exercise. Regression models were calculated consisting of the outcome variable: quadriceps inhibition and predictor variables: change in EMG median frequency in the quadriceps and hamstrings during lumbar fatiguing exercise. Twenty-five subjects with a history of low back pain were matched by gender, height and mass to 25 healthy controls. Subjects performed two sets of fatiguing isometric lumbar extension exercise until mild (set 1) and moderate (set 2) fatigue of the lumbar paraspinals. Quadriceps and hamstring EMG median frequency were measured while subjects performed fatiguing exercise. A burst of electrical stimuli was superimposed while subjects performed an isometric maximal quadriceps contraction to estimate quadriceps inhibition after each exercise set. Results indicate the change in hamstring median frequency explained variance in quadriceps inhibition following the exercise sets in the history of low back pain group only. Change in quadriceps median frequency explained variance in quadriceps inhibition following the first exercise set in the control group only. In conclusion, persons with a history of low back pain whose quadriceps become inhibited following lumbar paraspinal exercise may be adapting to the fatigue by using their hamstring muscles more than controls. Key Points A neuromuscular relationship between the lumbar paraspinals and quadriceps while performing lumbar extension exercise may be influenced by hamstring muscle fatigue. QI following lumbar extension exercise in persons with a history of LBP group may involve significant contribution from the hamstring muscle group. More hamstring muscle contribution may be a necessary adaptation in the history of LBP group due to weaker and more fatigable lumbar extensors. PMID:24198683

  2. Lumbar corpectomy for correction of degenerative scoliosis from osteoradionecrosis reveals a delayed complication of lumbar myxopapillary ependymoma.

    PubMed

    Palejwala, Sheri K; Lawson, Kevin A; Kent, Sean L; Martirosyan, Nikolay L; Dumont, Travis M

    2016-08-01

    Osteoradionecrosis is a known complication following radiation therapy, presenting most commonly in the cervical spine as a delayed consequence of radiation that is often necessary in the management of head and neck cancers. In contrast, osteoradionecrosis has rarely been described in the lumbar spine. Here we describe, to our knowledge, the first reported case of lumbar spine osteoradionecrosis, after adjuvant radiation for a primary spinal cord tumor, leading to progressive degenerative scoliosis which required subsequent operative management. Established guidelines recommend that mature bone can tolerate a dose of up to 6000 cGy without injury. However, once bone has been exposed to radiation over this level progressive soft tissue changes may lead to devascularization, leaving the bone vulnerable to osteonecrosis, specifically when manipulated. Radiation necrosis can be progressive and lead to eventual mechanical instability requiring debridement and surgical fixation. In the setting of the lumbar spine, osseous necrosis can lead to biomechanical instability, deformity, pain, and neurologic deficit. PMID:27056674

  3. Effects of muscle extension strength exercise on trunk muscle strength and stability of patients with lumbar herniated nucleus pulposus.

    PubMed

    Jeon, Kyoungkyu; Kim, Taeyoung; Lee, Sang-Ho

    2016-05-01

    [Purpose] The purpose of this study was to provide the data for constructing an integrated exercise program to help restore muscle strength and stability through extension strength exercise in adult females with lumbar disc herniation. [Subjects and Methods] An 8-week exercise program for lumbar muscle extension strength and stabilization was performed by 26 females older than 20 with lumbar disc herniation findings. [Results] Significant differences were found in lumbar extension muscle strength at every angle of lumbar flexion after participation in the 8-week stabilization exercise program; but there was no significant difference in the weight distribution index. [Conclusion] An integrated exercise program aiming to strengthen lumbar spine muscles, reduce pain and stabilize the trunk can help to maintain muscle strength and balance. In addition, improvement in extension strength is expected to be helpful in daily life by securing the range of joint motion and improving the strength and stability. PMID:27313342

  4. Effects of muscle extension strength exercise on trunk muscle strength and stability of patients with lumbar herniated nucleus pulposus

    PubMed Central

    Jeon, Kyoungkyu; Kim, Taeyoung; Lee, Sang-Ho

    2016-01-01

    [Purpose] The purpose of this study was to provide the data for constructing an integrated exercise program to help restore muscle strength and stability through extension strength exercise in adult females with lumbar disc herniation. [Subjects and Methods] An 8-week exercise program for lumbar muscle extension strength and stabilization was performed by 26 females older than 20 with lumbar disc herniation findings. [Results] Significant differences were found in lumbar extension muscle strength at every angle of lumbar flexion after participation in the 8-week stabilization exercise program; but there was no significant difference in the weight distribution index. [Conclusion] An integrated exercise program aiming to strengthen lumbar spine muscles, reduce pain and stabilize the trunk can help to maintain muscle strength and balance. In addition, improvement in extension strength is expected to be helpful in daily life by securing the range of joint motion and improving the strength and stability. PMID:27313342

  5. The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients

    PubMed Central

    Heo, Min-Yeong; Kim, Kyoung; Hur,, Beom-Young; Nam, Chan-Woo

    2015-01-01

    [Purpose] To investigate whether pain, balance, and stabilization of the lumbar region can be improved through thoracic mobilization in addition to lumbar stabilizaing exercises. [Subjects and Methods] This study recruited 36 subjects with chronic low back pain lasting more than 12 weeks. The subjects recruited for this study participated voluntarily, and provided their signed consent to participation. [Results] Improvement in balance was largest in the lumbar stabilization exercise group, followed by the thoracic mobilization and exercise group, and the traditional physical therapy group, in decreasing order of effect. [Conclusion] In conclusion, lumbar stabilization exercises combined with thoracic mobilization had greater effects on stabilization of the lumbar region pain relief, and improvement of the function of the patients with chronic low back pain. PMID:26834365

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-10-01

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

  8. Diagnosis, treatment, and complications of adult lumbar disk herniation: evidence-based data for the healthcare professional.

    PubMed

    Klineberg, Eric; Ching, Alexander; Mundis, Greg; Burton, Douglas; Bess, Shay

    2015-01-01

    Lumbar disk herniation is a commonly seen disorder that requires care by spinal surgeons and healthcare professionals. Although there has been substantial research on the diagnosis, treatment, complications, and outcomes of lumbar disk herniation, patient management varies. A review and evaluation of the literature (with special regard for high-quality randomized studies) and familiarity with best practices guidelines for the evaluation, management, and treatment of adult lumbar disk herniation will enhance the optimal delivery of health care to affected patients. PMID:25745924

  9. The relationship between sagittal curvature and extensor muscle volume in the lumbar spine.

    PubMed

    Meakin, Judith R; Fulford, Jonathan; Seymour, Richard; Welsman, Joanne R; Knapp, Karen M

    2013-06-01

    A previous modelling study predicted that the forces applied by the extensor muscles to stabilise the lumbar spine would be greater in spines that have a larger sagittal curvature (lordosis). Because the force-generating capacity of a muscle is related to its size, it was hypothesised that the size of the extensor muscles in a subject would be related to the size of their lumbar lordosis. Magnetic resonance imaging (MRI) data were obtained, together with age, height, body mass and back pain status, from 42 female subjects. The volume of the extensor muscles (multifidus and erector spinae) caudal to the mid-lumbar level was estimated from cross-sectional area measurements in axial T1-weighted MRIs spanning the lumbar spine. Lower lumbar curvature was determined from sagittal T1-weighted images. A stepwise linear regression model was used to determine the best predictors of muscle volume. The mean lower lumbar extensor muscle volume was 281 cm(3) (SD = 49 cm(3)). The mean lower lumbar curvature was 30 ° (SD = 7 °). Five subjects reported current back pain and were excluded from the regression analysis. Nearly half the variation in muscle volume was accounted for by the variables age (standardised coefficient, B = -3.2, P = 0.03) and lower lumbar curvature (B = 0.47, P = 0.002). The results support the hypothesis that extensor muscle volume in the lower lumbar spine is related to the magnitude of the sagittal curvature; this has implications for assessing muscle size as an indicator of muscle strength. PMID:23600615

  10. A minimally invasive technique for percutaneous lumbar facet augmentation: Technical description of a novel device

    PubMed Central

    Smith, Zachary A.; Armin, Sean; Raphael, Dan; Khoo, Larry T.

    2011-01-01

    Background: We describe a new posterior dynamic stabilizing system that can be used to augment the mechanics of the degenerating lumbar segment. The mechanism of this system differs from other previously described surgical techniques that have been designed to augment lumbar biomechanics. The implant and technique we describe is an extension-limiting one, and it is designed to support and cushion the facet complex. Furthermore, it is inserted through an entirely percutaneous technique. The purpose of this technical note is to demonstrate a novel posterior surgical approach for the treatment of lumbar degenerative. Methods: This report describes a novel, percutaneously placed, posterior dynamic stabilization system as an alternative option to treat lumbar degenerative disk disease with and without lumbar spinal stenosis. The system does not require a midline soft-tissue dissection, nor subperiosteal dissection, and is a truly minimally invasive means for posterior augmentation of the functional facet complex. This system can be implanted as a stand-alone procedure or in conjunction with decompression procedures. Results: One-year clinical results in nine individual patients, all treated for degenerative disease of the lower lumbar spine, are presented. Conclusions: This novel technique allows for percutaneous posterior dynamic stabilization of the lumbar facet complex. The use of this procedure may allow a less invasive alternative to traditional approaches to the lumbar spine as well as an alternative to other newly developed posterior dynamic stabilization systems. PMID:22145084

  11. The fibre type composition of thoracic and lumbar paravertebral muscles in man.

    PubMed Central

    Sirca, A; Kostevc, V

    1985-01-01

    Samples of longissimus and multifidi muscles at the thoracic and lumbar levels of the spine were examined histochemically on autopsy specimens from 21 adult male subjects (aged 22 to 46 years) and on biopsies from 17 adult patients during surgery for disorders of the lumbar intervertebral disc. In the superficial and deep thoracic muscles, 74% of fibres were of the Type I variety. In the lumbar region, Type I fibres amounted to 57% in the superficial, and to 63% in the deep muscles. The diameter of Type I fibres was significantly greater than that of Type II fibres. Images Fig. 1 PMID:2934358

  12. The fibre type composition of thoracic and lumbar paravertebral muscles in man.

    PubMed

    Sirca, A; Kostevc, V

    1985-08-01

    Samples of longissimus and multifidi muscles at the thoracic and lumbar levels of the spine were examined histochemically on autopsy specimens from 21 adult male subjects (aged 22 to 46 years) and on biopsies from 17 adult patients during surgery for disorders of the lumbar intervertebral disc. In the superficial and deep thoracic muscles, 74% of fibres were of the Type I variety. In the lumbar region, Type I fibres amounted to 57% in the superficial, and to 63% in the deep muscles. The diameter of Type I fibres was significantly greater than that of Type II fibres. PMID:2934358

  13. The effect of lumbar stabilization exercise on the pulmonary function of stroke patients

    PubMed Central

    Oh, Dae-Sik; Park, Si-Eun

    2016-01-01

    [Purpose] This study was aimed at assessing the effect of lumbar stabilization exercise on the pulmonary function of stroke patients. [Subjects and Methods] The subjects were randomly allocated into lumbar stabilization exercise group and a general physical therapy group. The program consisted of 30-min sessions conducted 3 days a week for 8 weeks. Pulmonary function was assessed based on lung performance parameters, including forced vital capacity, forced expiratory volume at 1 second, ratio of forced expiratory volume at 1 second to forced vital capacity, and peak expiratory flow. [Results] In the assessment of pulmonary function, the values of all the lung performance parameters were significantly increased in the lumbar stabilization exercise group but were significantly decreased in the general physical therapy group. [Conclusion] These results indicate that lumbar stabilization exercise had a more positive effect on pulmonary function than general physical therapy. PMID:27390442

  14. The effect of lumbar stabilization exercise on the pulmonary function of stroke patients.

    PubMed

    Oh, Dae-Sik; Park, Si-Eun

    2016-06-01

    [Purpose] This study was aimed at assessing the effect of lumbar stabilization exercise on the pulmonary function of stroke patients. [Subjects and Methods] The subjects were randomly allocated into lumbar stabilization exercise group and a general physical therapy group. The program consisted of 30-min sessions conducted 3 days a week for 8 weeks. Pulmonary function was assessed based on lung performance parameters, including forced vital capacity, forced expiratory volume at 1 second, ratio of forced expiratory volume at 1 second to forced vital capacity, and peak expiratory flow. [Results] In the assessment of pulmonary function, the values of all the lung performance parameters were significantly increased in the lumbar stabilization exercise group but were significantly decreased in the general physical therapy group. [Conclusion] These results indicate that lumbar stabilization exercise had a more positive effect on pulmonary function than general physical therapy. PMID:27390442

  15. [Congenital lumbar hernia and bilateral renal agenesis].

    PubMed

    Barrero Candau, R; Garrido Morales, M

    2007-04-01

    We report a new case of congenital lumbar hernia. This is first case reported of congenital lumbar hernia and bilateral renal agenesis. We review literature and describe associated malformations reported that would be role out in every case of congenital lumbar hernia. PMID:17650728

  16. Efficacy of alfacalcidol and alendronate on lumbar bone mineral density in osteoporotic patients using proton pump inhibitors

    PubMed Central

    Asaoka, Daisuke; Nagahara, Akihito; Hojo, Mariko; Matsumoto, Kenshi; Ueyama, Hiroya; Matsumoto, Kohei; Izumi, Kentaro; Takeda, Tsutomu; Komori, Hiroyuki; Akazawa, Yoichi; Shimada, Yuji; Osada, Taro; Watanabe, Sumio

    2016-01-01

    It has been indicated that proton pump inhibitor (PPI) use is associated with a loss of the anti-fracture efficacy of alendronate (AD). However, there are few prospective studies that have investigated the efficacy of AD on lumbar bone mineral density (BMD) in osteoporotic patients who are using PPIs. Thus, the aim of the present study was to investigate the efficacy of alfacalcidol (AC) and AD on lumbar BMD in osteoporotic patients using PPIs. A prospective, randomized, active control study enrolled such osteoporotic patients (age, ≥50 years). The patients were randomly assigned to receive AC (1 µg/day) or AD (35 mg/week) and were followed up for one year. Patient profiles were maintained, and lumbar BMD, bone-specific alkaline-phosphatase (BAP) and collagen type-I cross-linked N-telopeptide (NTX), upper gastrointestinal endoscopy results, and the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) were evaluated. Percentage changes in lumbar BMD, NTX, BAP, and change in FSSG score from baseline to the end of one year of treatment were investigated. Sixteen patients were eligible for analysis (eight assigned to receive AC, eight assigned to receive AD). The percentage change in lumbar BMD from baseline to the end of treatment was −0.4±4.0% for the AC group vs. 6.8±6.3% for the AD group (P=0.015). No significant percentage change of BAP and NTX between the two groups was observed. Subsequent to one year of treatment, the FSSG score did not change from the baseline values for either study group, and no new bone fractures or esophagitis were observed in either group of patients. The findings demonstrated that in osteoporotic patients using concomitant PPIs, there was a greater increase in lumbar BMD after one year of treatment with AD compared with AC. However, the number of study subjects was small; thus, further, large prospective studies are required to determine the effect of AD in osteoporotic patients using concomitant PPIs. PMID

  17. Reliability of lumbar spinal palpation, range of motion, and determination of position

    PubMed Central

    Troke, Michael; Schuit, Dale; Petersen, Cheryl M

    2007-01-01

    Background The study purposes were to investigate the level of agreement of palpation of lumbar spinous processes between examiners, test-retest repeatability of lumbar spine range of motion, and the reliability of upright position measures in asymptomatic subjects. Methods The modified CA 6000 spinal motion apparatus with a new skin fixation system was used by three operators for the test-retest spine measurements (3 days apart), and to obtain measures at one session of spinal position. Mean ranges of motion in all planes for 22 asymptomatic subjects were reported using the Intra-class Correlation Coefficient. Results Overall, differences in palpation agreement for lumbar segments occurred in three subjects and did not affect range of motion values. For upright spinal position, ICC (2,3) values for sagittal, coronal, and horizontal plane positions were 0.96, 0.80, and 0.98 respectively. There were statistically significant differences between examiners for position values, determined by the Bonferroni t-test (p < 0.05), but the magnitude of the differences were 2 degrees or less, and not considered clinically important. Conclusion Results suggest that lumbar spinal motion measurements and position determination between different operators can be consistent particularly if utilizing the modified instrument. Static lumbar position also appears to be recorded reliably between different operators. Results justify progression to multi-center lumbar research using the modified CA 6000 and the work is considered relevant to medical clinicians working with spinal dysfunction, surgical interventions, or occupational health. PMID:17971222

  18. Lumbar discogram resulting from lumbar interlaminar epidural injection.

    PubMed

    Huang, Jeffrey; Kwa, Andre

    2004-06-01

    Lumbar discography is a diagnostic modality to determine whether the intervertebral disc is the cause of pain. The injection of radiopaque contrast into the nucleus pulposus of the disc can reveal the internal details of the disc. We describe a case of inadvertent lumbar discogram resulting from an attempted lumbar interlaminar epidural injection at L5-S1 under fluoroscopy. The patient did not have a postdural puncture headache or nerve root irritation. The potential triangle in the lateral aspect of spinal cord may be the explanation for this situation, because this triangle is composed of the exiting nerve root laterally, the lateral margin of the dura medially, and the pedicle as its base. The L5-S1 disc is located in the center of the triangle. In our case, the Tuohy needle was placed possibly in the center of the triangle, too laterally to puncture the dura. Hence, the patient did not suffer from postdural puncture headache. The needle was probably inferior to the nerve root, and no obvious nerve root trauma or irritation occurred. This potential triangle may provide alternative access for lumbar discography at the L5-S1 level. PMID:15261324

  19. Enhanced muscle activity during lumbar extension exercise with pelvic stabilization

    PubMed Central

    Lee, Ho-Seong

    2015-01-01

    The purpose of this study was to investigate whether pelvic stabilization affects multifidus (MF) and iliocostalis lumborum (IL) muscle activities during dynamic extension exercise. Nine males (age, 25.1±6.3 yr; height, 176.6±2.4 cm; body mass, 74.9±6.7 kg) performed an isometric lumbar extension strength test and dynamic exercise in an upright seated position with or without pelvic stabilization. The electromyography and muscle strength of the MF and IL muscles were measured when the subjects performed the isometric lumbar extension strength test at the trunk angle 110°, 146°, and 182°. In addition, the trunk extensor muscle activities were measured using 50% muscle strength of maximum isometric strength during a dynamic trunk extension exercise. The MF and IL muscle activities were significantly higher at 110°, 146°, and 182° with pelvic stabilization than that without pelvic stabilization during the isometric lumbar extension strength test (P<0.05) and the dynamic exercise (P<0.05). These results suggest that the lumbar extension exercise with pelvic stabilization may be more effective for MF and IL muscle activity compared to that without pelvic stabilization. PMID:26730390

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

    PubMed Central

    Robinson, Yohan; Sandén, Bengt

    2009-01-01

    Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI). Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR) are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures. Results Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI. Conclusion Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied. PMID:19619332

  1. The "temporalis-inhibitory reflex" in post-lumbar puncture headache.

    PubMed

    Wallasch, T M; Niemann, U; Strenge, H

    1992-01-01

    Nausea and rigidity of the neck muscles, typical symptoms of post-lumbar puncture syndrome (PPS), may also be found in patients suffering from chronic headache of the tension-type. A decreased duration of the late suppression period of temporal muscle activity indicating a central disturbance of pericranial muscle control, can be observed in these patients. We have studied the temporalis-inhibitory reflex in 47 neurological inpatients requiring lumbar puncture. There were no significant differences of latencies or durations of temporalis silent periods between patients with and without PPS before, and 48 h following, lumbar puncture. PMID:1292957

  2. The effects of transcutaneous neuromuscular electrical stimulation on the activation of deep lumbar stabilizing muscles of patients with lumbar degenerative kyphosis

    PubMed Central

    Kim, So Yeon; Kim, Jin Hyun; Jung, Gil Su; Baek, Seung Ok; Jones, Rodney; Ahn, Sang Ho

    2016-01-01

    [Purpose] To investigate the effectiveness of three different neuromuscular electrical stimulation (NMES) protocols for the deep lumbar stabilizing muscles of patients with lumbar degenerative kyphosis (LDK). [Subjects and Methods] Twenty patients with LDK were recruited. Three stimulation protocols were investigated: stimulation of the abdominal muscles (protocol A); stimulation of the lumbar muscles (protocol B); and simultaneous stimulation of the abdominal and lumbar muscles (protocol A+B). Images of the obliquus externus (OE), obliquus internus (OI), transversus abdominis (TrA), and lumbar multifidus (LM) muscles were captured by real-time ultrasound imaging (RUSI). [Results] The thickness of LM was significantly greater during stimulation than at rest for all three protocols. Thicknesses of the abdominal muscles (TrA, OI, and OE) were significantly greater during stimulation than at rest for protocols A and A+B. Thickness increases in LM were significantly greater during protocols B and A+B, but not during protocol A. Thickness increases in the abdominal muscles (TrA, OI, and OE) were significantly greater during protocols A and A+B, but not during protocol B. [Conclusion] NMES can significantly activate the deep lumbar stabilizing muscles of patients with LDK. Protocol A+B of NMES is recommended to aid postural correction and low back pain (LBP) in patients with LDK. PMID:27064323

  3. Operative Management of Lumbar Degenerative Disc Disease

    PubMed Central

    Lee, Yu Chao; Osti, Orso Lorenzo

    2016-01-01

    Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term. PMID:27559465

  4. Operative Management of Lumbar Degenerative Disc Disease.

    PubMed

    Lee, Yu Chao; Zotti, Mario Giuseppe Tedesco; Osti, Orso Lorenzo

    2016-08-01

    Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term. PMID:27559465

  5. Management of lumbar spinal stenosis.

    PubMed

    Lurie, Jon; Tomkins-Lane, Christy

    2016-01-01

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

  6. 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

  7. Lumbar epidural varices: An unusual cause of lumbar claudication.

    PubMed

    Subbiah, Meenakshisundaram; Yegumuthu, Krishnan

    2016-01-01

    Lumbar epidural varices can also present with radiculopathy similar to acute intervertebral disc prolapse (IVDP). However as the magnetic resonance imaging (MRI) in these patients are usually normal without significant compressive lesions of the nerve roots, the diagnosis is commonly missed or delayed leading to persistent symptoms. We present a rare case of acute severe unilateral claudication with a normal MRI unresponsive to conservative management who was treated surgically. The nerve root on the symptomatic side was found to be compressed by large anterior epidural varices secondary to an abnormal cranial attachment of ligamentum flavum. Decompression of the root and coagulation of the varices resulted in complete pain relief. To conclude, lumbar epidural varices should be considered in the differential diagnosis of acute onset radiculopathy and claudication in the absence of significant MRI findings. PMID:27512228

  8. Lumbar epidural varices: An unusual cause of lumbar claudication

    PubMed Central

    Subbiah, Meenakshisundaram; Yegumuthu, Krishnan

    2016-01-01

    Lumbar epidural varices can also present with radiculopathy similar to acute intervertebral disc prolapse (IVDP). However as the magnetic resonance imaging (MRI) in these patients are usually normal without significant compressive lesions of the nerve roots, the diagnosis is commonly missed or delayed leading to persistent symptoms. We present a rare case of acute severe unilateral claudication with a normal MRI unresponsive to conservative management who was treated surgically. The nerve root on the symptomatic side was found to be compressed by large anterior epidural varices secondary to an abnormal cranial attachment of ligamentum flavum. Decompression of the root and coagulation of the varices resulted in complete pain relief. To conclude, lumbar epidural varices should be considered in the differential diagnosis of acute onset radiculopathy and claudication in the absence of significant MRI findings. PMID:27512228

  9. 49 CFR Appendix A to Part 544 - Issuers of Motor Vehicle Insurance Policies Subject to the Reporting Requirements in Each State...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 6 2011-10-01 2011-10-01 false Issuers of Motor Vehicle Insurance Policies Subject to the Reporting Requirements in Each State in Which They Do Business A Appendix A to Part 544... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION INSURER REPORTING REQUIREMENTS Pt. 544, App. A Appendix A to...

  10. 36 CFR 51.78 - Will a concession contract require a franchise fee and will the franchise fee be subject to...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false Will a concession contract require a franchise fee and will the franchise fee be subject to adjustment? 51.78 Section 51.78 Parks... Concession Contract Provisions § 51.78 Will a concession contract require a franchise fee and will...

  11. 36 CFR 51.78 - Will a concession contract require a franchise fee and will the franchise fee be subject to...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 1 2011-07-01 2011-07-01 false Will a concession contract require a franchise fee and will the franchise fee be subject to adjustment? 51.78 Section 51.78 Parks... Concession Contract Provisions § 51.78 Will a concession contract require a franchise fee and will...

  12. [Spontaneous resolution of a lumbar disc herniation].

    PubMed

    Gelabert-González, M; Serramito-García, R; Aran-Echabe, E; García-Allut, A

    2007-04-01

    Lumbar disc herniation is a common cause of lower leg radiculopathy and the most effective methods of treatment remain in question. Both surgical and nonsurgical treatments may provide a successful outcome in appropriately selected patients. The spontaneous resolution of herniated lumbar discs is a well-established phenomenon. The authors present a case of spontaneous regression of a herniated lumbar nucleus pulpous in a patient with radiculopathy. PMID:17497061

  13. The human lumbar dorsal rami.

    PubMed Central

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

    1982-01-01

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

  14. Return to Work After Lumbar Microdiscectomy - Personalizing Approach Through Predictive Modeling.

    PubMed

    Papić, Monika; Brdar, Sanja; Papić, Vladimir; Lončar-Turukalo, Tatjana

    2016-01-01

    Lumbar disc herniation (LDH) is the most common disease among working population requiring surgical intervention. This study aims to predict the return to work after operative treatment of LDH based on the observational study including 153 patients. The classification problem was approached using decision trees (DT), support vector machines (SVM) and multilayer perception (MLP) combined with RELIEF algorithm for feature selection. MLP provided best recall of 0.86 for the class of patients not returning to work, which combined with the selected features enables early identification and personalized targeted interventions towards subjects at risk of prolonged disability. The predictive modeling indicated at the most decisive risk factors in prolongation of work absence: psychosocial factors, mobility of the spine and structural changes of facet joints and professional factors including standing, sitting and microclimate. PMID:27225576

  15. Laparoscopic total extraperitoneal repair of lumbar hernia

    PubMed Central

    Lim, Man Sup; Lee, Hae Wan; Yu, Chang Hee

    2011-01-01

    Lumbar hernia is a rare surgical entity without a standard method of repair. With advancements in laparoscopic techniques, successful lumbar herniorrhaphy can be achieved by the creation of a completely extraperitoneal working space and secure fixation of a wide posterior mesh. We present a total extraperitoneal laparoendoscopic repair of lumbar hernia, which allowed for minimal invasiveness while providing excellent anatomical identification, easy mobilization of contents and wide secure mesh fixation. A total extraperitoneal method of lumbar hernia repair by laparoscopic approach is feasible and may be an ideal option. PMID:22111086

  16. Impact loading of the lumbar spine during football blocking.

    PubMed

    Gatt, C J; Hosea, T M; Palumbo, R C; Zawadsky, J P

    1997-01-01

    The purpose of our study was to determine the impact force to the lumbar spine when football players hit a blocking sled. We quantified the loads at the L4-5 motion segment throughout the blocking sequence. Five Division I-A college football linemen were subjects for our study. Kinematic data were obtained while the subjects hit a blocking sled instrumented with a force plate. Three plane forces were then calculated from these data. The average impact force measured at the blocking sled was 3013 +/- 598 N. The average peak compression force at the L4-5 motion segment was 8679 +/- 1965 N. The average peak anteroposterior shear force was 3304 +/- 1116 N, and the average peak lateral shear force was 1709 +/- 411 N. The magnitude of the loads on the L4-5 motion segment during football blocking exceed those determined during fatigue studies to cause pathologic changes in both the lumbar disk and the pars interarticularis. These data suggest that the mechanics of repetitive blocking may be responsible for the increased incidence of lumbar spine injury incurred by football linemen. PMID:9167810

  17. Lumbar Catheter Placement Using Paramedian Approach Under Fluoroscopic Guidance

    PubMed Central

    Qureshi, Adnan I.; Khan, Asif A.; Malik, Ahmed A.; Afzal, Mohammad Rauf; Herial, Nabeel A.; Qureshi, Mushtaq H.; Suri, M. Fareed K.

    2016-01-01

    Background Lumbar catheter placement under fluoroscopic guidance may reduce the rate of technical failures and associated complications seen with insertion guided by manually palpable landmarks. Methods We reviewed our experience with 43 attempted lumbar catheter placements using paramedian approach under fluoroscopic guidance and ascertained rates of technical success, and clinical events. Results Among the 43 patients, 18, 1, and 1 patients were on aspirin (with dipyrimadole in 2), clopidogrel, and combination of both, respectively. Lumbar catheter placement was successful in 42 of 43 attempted placements. Floroscopic guidance was critical in three patients; one patient had severe cerebrospinal fluid (CSF) depletion (empty thecal sac phenomenon) following pituitary surgery leading to no cerebrospinal fluid return despite correct placement confirmation under fluoroscopy. Two patients had spinal needle placement at the junction between epidural and cerebrospinal fluid spaces (junctional position) leading to cerebrospinal fluid return but inability to introduce the lumbar catheter. After confirmation of position by the injection of contrast or radiographic landmarks the needle was advanced by indenting the subcutaneous tissue or reinserting at a spinal level above the first insertion. The lumbar catheter remained in position over a mean period (±standard deviation) of 4.1(±2.3) days. Improvement in hydrocephalus was seen in two patients with intracranial mass lesions. One patient developed cerebrospinal fluid leakage through the insertion track following removal of catheter and required skin suturing at the site of insertion. Conclusions We observed a high technical success rate with low rate of complications even in patients with intracranial mass lesions, those on ongoing antiplatelet medications or in whom insertion would not be possible guided by manually palpable landmarks. PMID:26958156

  18. Minimally Invasive Lumbar Discectomy

    MedlinePlus Videos and Cool Tools

    ... together the entire ensemble required to deliver the care we provide. You know, besides my valuable colleague, ... modalities that are available are excellent, including chiropractic care. I do not -- you know, for some reason ...

  19. Lumbar lordosis of extinct hominins.

    PubMed

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

    2012-01-01

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

  20. Retroperitoneal laparoscopic bilateral lumbar sympathectomy.

    PubMed

    Segers, B; Himpens, J; Barroy, J P

    2007-06-01

    The first retroperitoneal lumbar sympathectomy was performed in 1924 by Julio Diez. The classic procedure for sympathectomy is open surgery. We report a unilateral laparoscopic retroperitoneal approach to perform bilateral lumbar sympathectomy. This approach was performed for a 43-year-old man with distal arterial occlusive disease and no indication for direct revascularization. His predominant symptoms were intermittent claudication at 100 metres and cold legs. The patient was placed in a left lateral decubitus position. The optical system was placed first in an intra-abdominal position to check that the trocars were well positioned in the retroperitoneal space. The dissection of retroperitoneum was performed by CO2 insufflation. The inferior vena cava was reclined and the right sympathetic chain was individualized. Two ganglia (L3-L4) were removed by bipolar electro-coagulation. The aorta was isolated on a vessel loop and careful anterior traction allowed a retro-aortic pre-vertebral approach between the lumbar vessels. The left sympathetic chain was dissected. Two ganglia (L3-L4) were removed by bipolar electro-coagulation. PMID:17685269

  1. Adjacent Segment Pathology after Lumbar Spinal Fusion.

    PubMed

    Lee, Jae Chul; Choi, Sung-Woo

    2015-10-01

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

  2. Lumbar discectomy: developing and implementing a day surgery protocol.

    PubMed

    Doerksen, Kathy; Dusik-Sharpe, Jodi

    2003-09-01

    In some centres, patients who require a lumbar discectomy are successfully discharged the day of surgery. With the ongoing pressure to provide safe care for patients within certain bed limitations, this option was considered. Using a continuous quality improvement method, a prospective review of patients undergoing a single-level lumbar discectomy was monitored. Based on pre-set criteria, patients were included or excluded in the day surgery protocol and both groups were monitored. A large component of nursing education was provided for all patients, and will be highlighted. Data retrieved for both groups included demographics, length of operation, length in recovery room, length of hospital stay required, and the re-admission rate. There were 47 patients monitored over 11 months. Of the 34 patients entered in the protocol, seven required an overnight length of stay. The reasons for the extended length admission will be described. Of the 13 patients excluded from the protocol, one did not require an overnight stay. Following review of the data, the criteria for inclusion of patients into the protocol has been altered and patients can safely proceed with day surgery for lumbar discectomy. PMID:14618998

  3. [Influence of the weather on the course of lumbar syndromes].

    PubMed

    Machalek, A; Tilscher, H; Friedrich, M; Polt, E

    1980-01-01

    Sensation of pain during lumbar syndromes is correlated with weather situations, the definition of which takes into consideration traditional as well as new methods of weather classification. To this end, it was necessary to develop an algesia index for the purpose of defining the subjective pain sensation by classifying it in different groups enabling the application of medico-meteorological statistics. The medical data were correlated with the following meteorological arametes: Weather-phase scheme according to Brezowsky-Ungeheuer; temperature-humidity environment; weather situations for Central Europe; synoptic index cycle; advention of temperature in medium altitudes of the atmosphere; vorticity for cyclogenesis. The following results were obtained: Pain sensation in the lumbar area shows a significant dependence on weather situations. Althoguh singular meteorological parameters are not important, the human body is affected primarily by the sum total of all weather elements. PMID:6447957

  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. Chronic lumbar spine and radicular pain: pathophysiology and treatment.

    PubMed

    Wheeler, Anthony H; Murrey, Daniel B

    2002-04-01

    The lumbar spine forms the foundation and infrastructure of an organic skyscraper equipped with the physiologic capacity to act as a crane for lifting and a crankshaft for walking. Subjected to aging like other "human machinery," the lumbar spine adapts to the wear and tear of gravity and biomechanical loading through structural and neurochemical changes. Many of the changes are maladaptive, resulting in pain, physical and functional disability, and altered neurophysiologic circuitry. Some compensatory reactions are constructive, but others cause more interference with the organism's capacity to cope. A conceptional understanding of the multifaceted structural, biomechanical, biochemical, medical, and psychosocial influences that compose this mix elucidates the complexity of applying effective treatments. PMID:11872180

  6. Relationship of body composition, knee extensor strength, and standing balance to lumbar bone mineral density in postmenopausal females

    PubMed Central

    Shin, Seungsub; Lee, Kyeongjin; Song, Changho

    2016-01-01

    [Purpose] This study aimed to investigate correlations between lumbar bone mineral density (BMD) and general characteristics of postmenopausal females, including body composition, knee extensor strength, standing balance, and femur BMD. [Subjects and Methods] A total of 40 postmenopausal females (55.6 ± 4.6 years) who were caregivers or guardians of patients in the K hospital were included in the study. The weight, height, body composition, left and right knee extensor strength, standing balance, femur BMD, and lumbar BMD measurements of the subjects were obtained. [Results] The effect of measurement variables on lumbar BMD was examined. Increases in age and menopausal duration were observed to significantly increase lumbar BMD, whereas an increase in height was found to significantly decrease lumbar BMD. An increase in soft lean mass, skeletal muscle mass, fat-free mass, and femur BMD was also associated with significantly decreased lumbar BMD. [Conclusion] Age, menopausal duration, soft lean mass, skeletal muscle mass, and fat-free mass were factors that decreased lumbar BMD in menopausal females. This study is expected to provide basic knowledge for osteoporosis prevention and treatment programs for postmenopausal females. PMID:27512276

  7. Relationship of body composition, knee extensor strength, and standing balance to lumbar bone mineral density in postmenopausal females.

    PubMed

    Shin, Seungsub; Lee, Kyeongjin; Song, Changho

    2016-07-01

    [Purpose] This study aimed to investigate correlations between lumbar bone mineral density (BMD) and general characteristics of postmenopausal females, including body composition, knee extensor strength, standing balance, and femur BMD. [Subjects and Methods] A total of 40 postmenopausal females (55.6 ± 4.6 years) who were caregivers or guardians of patients in the K hospital were included in the study. The weight, height, body composition, left and right knee extensor strength, standing balance, femur BMD, and lumbar BMD measurements of the subjects were obtained. [Results] The effect of measurement variables on lumbar BMD was examined. Increases in age and menopausal duration were observed to significantly increase lumbar BMD, whereas an increase in height was found to significantly decrease lumbar BMD. An increase in soft lean mass, skeletal muscle mass, fat-free mass, and femur BMD was also associated with significantly decreased lumbar BMD. [Conclusion] Age, menopausal duration, soft lean mass, skeletal muscle mass, and fat-free mass were factors that decreased lumbar BMD in menopausal females. This study is expected to provide basic knowledge for osteoporosis prevention and treatment programs for postmenopausal females. PMID:27512276

  8. Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion

    PubMed Central

    Rodríguez-Vela, J.; Joven-Aliaga, E.; Herrera, A.; Vicente, J.; Suñén, E.; Loste, A.; Tabuenca, A.

    2009-01-01

    It has been widely reported a vascular and neurologic damage of the lumbar muscles produced in the classic posterior approach for lumbar spinal fusions. The purpose of this study is to demonstrate a better clinical and functional outcome in the postoperative and short term in patients undergoing minimal invasive surgery (“mini-open”) for this lumbar spinal arthrodesis. We designed a prospective study with a 30 individuals cohort randomized in two groups, depending on the approach performed to get a instrumented lumbar circumferential arthrodesis: “classic posterior” (CL group) or “mini-open” approach (MO group). Several clinical and functional parameters were assessed, including blood loss, postoperative pain, analgesic requirements and daily life activities during hospital stay and at the 3-month follow-up. Patients of the “mini-open approach” group had a significant lower blood loss and hospital stay during admission. They also had significant lower analgesic requirements and faster recovery of daily life activities (specially moderate efforts) when compared to the patients of the “classic posterior approach” group. No significant differences were found between two groups in surgery timing, X-rays exposure or sciatic postoperative pain. This study, inline with previous investigations, reinforces the concept of minimizing the muscular lumbar damage with a mini-open approach for a faster and better recovery of patients’ disability in the short term. Further investigations are necessary to confirm these findings in the long term, and to verify the achievement of a stable lumbar spinal fusion. PMID:19399538

  9. A sloped seat wedge can change the kinematics of the lumbar spine of seated workers with limited hip flexion.

    PubMed

    Kim, Ji-Won; Kang, Min-Hyeok; Noh, Kyung-Hee; Kim, Jun-Seok; Oh, Jae-Seop

    2014-08-01

    [Purpose] The purpose of this study was to determine whether a wedge type seat decreases the lumbar flexion angle of seated workers with limited hip flexion. [Subjects] Twelve sedentary workers with limited hip flexion were recruited. [Methods] Three seat surfaces were used: a level surface, a forward-inclining wedge, and a backward-reclining wedge. The angles of lumbar flexion and pelvic tilt were measured using a three-dimensional motion analysis system. Differences in kinematic data of the subjects seated on the three seat surfaces were analyzed using repeated one-way analysis of variance. [Results] The degree of lumbar flexion decreased significantly when using the forward-inclining wedge compared with the level surface and backward-reclining wedge. [Conclusion] These findings suggest that sitting on a forward-inclining wedge may be useful for minimizing the compensatory lumbar flexion of individuals with limited hip flexion who work in a seated position. PMID:25202175

  10. Effect of Foot Hyperpronation on Lumbar Lordosis and Thoracic Kyphosis in Standing Position Using 3-Dimensional Ultrasound-Based Motion Analysis System

    PubMed Central

    Farokhmanesh, Khatere; Shirzadian, Toraj; Mahboubi, Mohammad; Shahri, Mina Neyakan

    2014-01-01

    Based on clinical observations, foot hyperpronation is very common. Excessive pronation (hyperpronation) can cause malalignment of the lower extremities. This most often leads to functional and structural deficits. The aim of this study was to assess the effect of foot hyperpronation on lumbar lordosis and thoracic kyphosis. Thirty five healthy subjects (age range, 18030 years) were asked to stand on 4 positions including a flat surface (normal position) and on wedges angled at 10, 15, and 20 degrees. Sampling was done using simple random sampling. Measurements were made by a motion analysis system. For data analysis, the SPSS software (ver. 18) using paired t-test and repeated measures analysis of variance (ANOVA) was applied. The eversion created by the wedges caused a significant increase in lumbar lordosis and thoracic kyphosis. The most significant change occurred between two consecutive positions of flat surface and the first wedge. The t-test for repeated measures showed a high correlation between each two consecutive positions. The results showed that with increased bilateral foot pronation, lumbar lordosis and thoracic kyphosis increased as well. In fact, each of these results is a compensation phenomenon. Further studies are required to determine long-term results of excessive foot pronation and its probable effect on damage progression. PMID:25169004

  11. [Neonatal occlusion due to a lumbar hernia].

    PubMed

    Hunald, F A; Ravololoniaina, T; Rajaonarivony, M F V; Rakotovao, M; Andriamanarivo, M L; Rakoto-Ratsimba, H

    2011-10-01

    A Petit lumbar hernia is an uncommon hernia. Congenital forms are seen in children. Incarceration may occur as an unreducible lumbar mass, associated with bilious vomiting and abdominal distention. Abdominal X-ray shows sided-wall bowel gas. In this case, reduction and primary closure must be performed as emergency repair. PMID:21868206

  12. The lumbar shield: a preliminary report.

    PubMed

    Feild, J R; McHenry, H

    1978-01-01

    Postoperative perineural adhesions between the lumbar nerve root and the partially removed intervertebral disc are thought to be a cause of failure of the standard operative procedure for the removal of a ruptured lumbar intervertebral disc. Attempts have been made to reduce postoperative perineural adhesions by the use of epidural muscle, fat, gelatin sponge, silicone, and steroids. The present communication introduces a new implantable silicone device, a lumbar shield, designed to: (a) provide a radiopaque marker on the dorsal perimeter of the excavated lumbar disc so that the presence or absence of a recurrent disc herniation can easily be determined on plain postoperative x-ray films, (b) provide ready access to the operative site in the event of a recurrent disc herniation, (c) prevent postoperative perineural adhesions between the lumbar dura and the nerve root and the partially removed intervertebral disc, and (d) prevent postoperative adhesions between the lumbar dura and the nerve root and the paraspinal muscles. Satisfactory results of lumbar disc surgery over the past 44 years have occurred in about 90% of routine patients. The value of the lumbar shield in 82 patients (59 routine and 23 workmen's compensation/medicolegal patients) followed for 6 months is described. A satisfactory result, i.e., relief of pain or the presence of occasional postoperative pain, occurred in 85% of routine patients at 1 month, 97% at 3 months, and 95% at 6 months. PMID:683493

  13. Lumbar Epidural Varix Mimicking Disc Herniation

    PubMed Central

    Bursalı, Adem; Guvenal, Ahmet Burak; Yaman, Onur

    2016-01-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4–5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  14. Lumbar Epidural Varix Mimicking Disc Herniation.

    PubMed

    Bursalı, Adem; Akyoldas, Goktug; Guvenal, Ahmet Burak; Yaman, Onur

    2016-07-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  15. 46 CFR 70.05-1 - United States flag vessels subject to the requirements of this subchapter.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... covered by columns 2 and 3. All vessels carrying dangerous cargoes, when required by 46 CFR part 98 All... dangerous cargoes, when required by 46 CFR part 98 None None All vessels carrying cargoes in bulk that are... conditions. The provisions of 49 CFR parts 171 through 179 apply whenever packaged hazardous materials are...

  16. 40 CFR Table 20 to Subpart G of... - Wastewater-Periodic Reporting Requirements for Control Devices Subject to § 63.139 Used To Comply...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., Table 20 Table 20 to Subpart G of Part 63—Wastewater—Periodic Reporting Requirements for Control Devices... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Wastewater-Periodic Reporting Requirements for Control Devices Subject to § 63.139 Used To Comply With §§ 63.13 Through 63.139 20 Table...

  17. 40 CFR Table 20 to Subpart G of... - Wastewater-Periodic Reporting Requirements for Control Devices Subject to § 63.139 Used To Comply...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., Table 20 Table 20 to Subpart G of Part 63—Wastewater—Periodic Reporting Requirements for Control Devices... 40 Protection of Environment 10 2013-07-01 2013-07-01 false Wastewater-Periodic Reporting Requirements for Control Devices Subject to § 63.139 Used To Comply With §§ 63.13 Through 63.139 20 Table...

  18. 40 CFR Table 20 to Subpart G of... - Wastewater-Periodic Reporting Requirements for Control Devices Subject to § 63.139 Used To Comply...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., Table 20 Table 20 to Subpart G of Part 63—Wastewater—Periodic Reporting Requirements for Control Devices... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Wastewater-Periodic Reporting Requirements for Control Devices Subject to § 63.139 Used To Comply With §§ 63.13 Through 63.139 20 Table...

  19. Lumbar Mechanics in Tennis Groundstrokes: Differences in Elite Adolescent Players With and Without Low Back Pain.

    PubMed

    Campbell, Amity; Straker, Leon; Whiteside, David; O'Sullivan, Peter; Elliott, Bruce; Reid, Machar

    2016-02-01

    Adolescent tennis players are at risk for low back pain (LBP). Recent research has demonstrated a potential mechanical etiology during serves; however, groundstrokes have also been suggested to load this region. Therefore, this study compared lumbar mechanics between players with and without a history of LBP during open and square stance tennis forehands and backhands. Nineteen elite, adolescent, male tennis players participated, 7 with a history of recurrent disabling LBP and 12 without. Differences in three-dimensional lumbar kinetics and kinematics were compared between pain/no pain groups and groundstrokes using linear mixed models (P < .01). There were no significant differences between pain/no pain groups. Relative to a right-handed player, groundstroke comparisons revealed that forehands had greater racquet velocity, greater lumbar right lateral flexion force, as well as upper lumbar extension/rightward rotation and lower lumbar right rotation/lateral flexion movements that were closer to or further beyond end of range than backhands. Backhands required upper lumbar leftward rotation that was beyond end range, while forehands did not. Given that players typically rotated near to their end of range during the backswing of both forehands and backhands, independent of pain, groundstrokes may contribute to the cumulative strain linked to LBP in tennis players. PMID:26367081

  20. Plexiform Schwannoma of Lumbar Region

    PubMed Central

    Parihar, Asmita; Verma, Sarika; Suri, Tarun; Agarwal, Anil; Bansal, Kalpana

    2015-01-01

    Plexiform schwannoma is an unusual peripheral nerve sheath tumor. It can mimic plexiform neurofibroma. A five-year-old girl presented with painful swelling in left lumbar region. Radiologic investigations showed a multinodular tumor in the subcutaneous plane of lumbosacral region. A complete excision and histopathologic examination revealed a plexiform tumor composed of hypocellular and hypercellular areas with verocay bodies. The tumor cells showed strong positivity for S-100 protein, rendering a final diagnosis of plexiform schwannoma. The child has been free of recurrence in 12-month follow-up. PMID:26064806

  1. Comparison of lumbar spine stabilization exercise versus general exercise in young male patients with lumbar disc herniation after 1 year of follow-up

    PubMed Central

    Ye, Chaoqun; Ren, Jixin; Zhang, Jianzheng; Wang, Chongwei; Liu, Zhi; Li, Fang; Sun, Tiansheng

    2015-01-01

    Objective: The safest and most effective conservative treatment for patients with lumbar disc herniation (LDH) has not been established. The purpose of this study was to evaluate the effect of lumbar spine stabilization exercise (LSSE) and general exercise (GE) on pain intensity and functional capacity in young male patients with LDH. Methods: Sixty-three young male adults aged 20 to 29 years with the diagnosis of LDH were enrolled and divided into an LSSE group (n=30) and a GE group (n=33). Patients in both groups received low-power laser (LPL) therapy during the first week of the onset of LDH. Patients in the GE group underwent a GE program. Patients in the LSSE group followed an LSSE program for 3 months. All of the patients were subjected to pain intensity and functional capacity evaluations four times: at pre-and post-LPL therapy, and at 3 months and 1 year post-exercise. Pain intensity of the lower back and legs was evaluated with the visual analogue scale (VAS), and functional capacity was evaluated with the Oswestry Disability Index (ODI). Results: Both groups showed a significant reduction in VAS and ODI scores at 3 and 12 months post-exercise compared with before treatment (P<0.001). The LSSE group showed a significant reduction in the average score of the VAS for low back pain (P=0.012) and the ODI (P=0.003) at 12 months post-exercise compared with the GE group. Conclusions: LSSE and GE are considered as effective interventions for young male patients with LDH. Moreover, LSSE is more effective than GE, and physical therapy, such as LPL, is required during acute LDH. PMID:26309670

  2. 15 CFR Supplement No. 2 to Part 744 - List of Items Subject to the Military End-Use License Requirement of § 744.21

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 15 Commerce and Foreign Trade 2 2013-01-01 2013-01-01 false List of Items Subject to the Military End-Use License Requirement of § 744.21 No. Supplement No. 2 to Part 744 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE EXPORT...

  3. 15 CFR Supplement No. 2 to Part 744 - List of Items Subject to the Military End-Use License Requirement of § 744.21

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 15 Commerce and Foreign Trade 2 2014-01-01 2014-01-01 false List of Items Subject to the Military End-Use License Requirement of § 744.21 No. Supplement No. 2 to Part 744 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE EXPORT...

  4. 40 CFR 262.203 - How an eligible academic entity indicates it will be subject to the requirements of this subpart.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 26 2011-07-01 2011-07-01 false How an eligible academic entity... Unwanted Material for Laboratories Owned by Eligible Academic Entities § 262.203 How an eligible academic entity indicates it will be subject to the requirements of this subpart. (a) An eligible academic...

  5. 40 CFR 262.203 - How an eligible academic entity indicates it will be subject to the requirements of this subpart.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false How an eligible academic entity... Unwanted Material for Laboratories Owned by Eligible Academic Entities § 262.203 How an eligible academic entity indicates it will be subject to the requirements of this subpart. (a) An eligible academic...

  6. 40 CFR 63.44 - Requirements for constructed or reconstructed major sources subject to a subsequently promulgated...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Section 63.44 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES Requirements for Control Technology Determinations for Major Sources in Accordance With Clean Air Act Sections,...

  7. 40 CFR 63.44 - Requirements for constructed or reconstructed major sources subject to a subsequently promulgated...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Section 63.44 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES Requirements for Control Technology Determinations for Major Sources in Accordance With Clean Air Act Sections,...

  8. 40 CFR 63.44 - Requirements for constructed or reconstructed major sources subject to a subsequently promulgated...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Section 63.44 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES Requirements for Control Technology Determinations for Major Sources in Accordance With Clean Air Act Sections,...

  9. 40 CFR 63.44 - Requirements for constructed or reconstructed major sources subject to a subsequently promulgated...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... the reopening procedures in 40 CFR part 70 or part 71, whichever is relevant, to incorporate the... (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES Requirements for... determination under section 112(j) of the Act that is applicable to a stationary source or group of...

  10. 40 CFR 63.44 - Requirements for constructed or reconstructed major sources subject to a subsequently promulgated...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... the reopening procedures in 40 CFR part 70 or part 71, whichever is relevant, to incorporate the... (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES Requirements for... determination under section 112(j) of the Act that is applicable to a stationary source or group of...