Ostrofsky, Kelly R; Churchill, Steven E
Sex determination is critical for developing the biological profile of unidentified skeletal remains. When more commonly used elements (os coxa, cranium) for sexing are not available, methods utilizing other skeletal elements are needed. This study aims to assess the degree of sexual dimorphism of the lumbar vertebrae and develop discriminant functions for sex determination from them, using a sample of South African blacks from the Raymond A. Dart Collection (47 males, 51 females). Eleven variables at each lumbar level were subjected to univariate and multivariate discriminant function analyses. Univariate equations produced classification rates ranging from 57.7% to 83.5%, with the highest accuracies associated with dimensions of the vertebral body. Multivariate stepwise analysis generated classification rates ranging from 75.9% to 88.7%. These results are comparable to other methods for sexing the skeleton and indicate that measures of the lumbar vertebrae can be used as an effective tool for sex determination.
Fritscher, Karl; Leber, Stefan; Schmölz, Werner; Schubert, Rainer
For the planning of surgical interventions of the spine exact knowledge about 3D shape and the local bone quality of vertebrae are of great importance in order to estimate the anchorage strength of screws or implants. As a prerequisite for quantitative analysis a method for objective and therefore automated segmentation of vertebrae is needed. In this paper a framework for the automatic segmentation of vertebrae using 3D appearance models in a level set framework is presented. In this framework model information as well as gradient information and probabilities of pixel intensities at object edges in the unseen image are used. The method is tested on 29 lumbar vertebrae leading to accurate results, which can be useful for surgical planning and further analysis of the local bone quality.
Zhu, Zhongjiao; Huang, Peng; Chong, Yanxue; George, Suraj K; Wen, Bingtao; Han, Na; Liu, Zhiqiang; Kang, Lixin; Lin, Nie
Study design: Chronic strained lumbar disc herniation (LDH) cases were classified into bulging LDH, herniated LDH and prolapse LDH types according to imaging examination, and vertebrae disruptions were evaluated. Cytokines derived from the nucleus pulposus cells were detected, and their effects on osteoclastogenesis, as well as the mechanisms involved, were studied via an in vitro osteoclast differentiation system. Objective: To clarify the mechanisms of lumbar vertebrae resorption induced by lumbar herniation. Summary and background data: Chronic strained lumbar disc herniation induced vertebrae erosion exacerbates quality of patients’ life and clinical outcome. Although nucleus pulposus cells derived cytokines were reported to play an important role in this pathogenesis, the fundamental mechanisms underlying this process are still unclear. Methods: Chronic strained lumbar disc herniation patients were diagnosed with CT scan and T2-weighted magnetic resonance imaging. RNA was extracted from 192 surgical specimens of the herniated lumbar disc and 29 surgical excisions of the lumbar disc from spinal injury patients. The expressions of osteoclastogenesis related cytokines and chemokines were examined using real time PCR. Monocytes were induced into osteoclast with M-CSF and RANKL in vitro, while the IGF-1 and MCP-1 were added into the differentiation procedure in order to evaluate the effects and explore the molecular mechanisms. Results: Vertebrae erosion had a positive relationship with lumbar disc herniation severity types. In all of the osteoclastogenesis related cytokines, the IGF-1 and MCP-1 were the most highly expressed in the nucleus pulposus cells. IGF-1 enhances activation of NF-kB signaling directly, but MCP-1 upregulated the expression of RANK, so that enhanced cellular sensitivity to RANKL resulted in increasing osteoclastogenesis and activity. Conclusion: Lumbar herniation induced overexpression of IGF-1 and MCP-1 in nucleus pulposus cells aggravated
Suzuki, S; Okumura, H; Yamamuro, T
The trabecular mineral contents (TMCs) of the third lumbar vertebra in normal subjects and patients with spinal osteoporosis and with femoral neck fracture were measured by quantitative computed tomography (QCT) using a reference phantom. The present paper describes these results. The TMCs in patients with spinal osteoporosis and with femoral neck fracture were significantly lower than those in normal subjects. When evaluated in terms of the ratio to the mean trabecular mineral content (mTMC) in normal subjects of the same decade groups, it was assumed that there should be a threshold value of vertebral compression fracture, and that value was approximately 50% of the mTMC in normal subjects. A correlation was noted between the data of the QCT method and those of the microdensitometric method in the groups with vertebral compression fracture and with femoral neck fracture, but not in the group without vertebral fracture.
Ghosh, Subarna; Alomari, Raja'S.; Chaudhary, Vipin; Dhillon, Gurmeet
Lumbar vertebral fractures vary greatly in types and causes and usually result from severe trauma or pathological conditions such as osteoporosis. Lumbar wedge compression fractures are amongst the most common ones where the vertebra is severely compressed forming a wedge shape and causing pain and pressure on the nerve roots and the spine. Since vertebral segmentation is the first step in any automated diagnosis task, we present a fully automated method for robustly localizing and segmenting the vertebrae for preparation of vertebral fracture diagnosis. Our segmentation method consists of five main steps towards the CAD(Computer-Aided Diagnosis) system: 1) Localization of the intervertebral discs. 2) Localization of the vertebral skeleton. 3) Segmentation of the individual vertebra. 4) Detection of the vertebrae center line and 5) Detection of the vertebrae major boundary points. Our segmentation results are promising with an average error of 1.5mm (modified Hausdorff distance metric) on 50 clinical CT cases i.e. a total of 250 lumbar vertebrae. We also present promising preliminary results for automatic wedge compression fracture diagnosis on 15 cases, 7 of which have one or more vertebral compression fracture, and obtain an accuracy of 97.33%.
King, J D; Lowery, G L
The purposes of this study were to determine the long-term correction achieved by excision of lumbar hemivertebrae and the risk attendant. Seven patients had a follow-up of 41.14 months for lumbar hemivertebral excisions. Six had two-stage anterior vertebral body excision and, 7-8 days later, posterior lamina and pedicle excision with fusion. One patient had a single-stage correction. After surgery, the patients were in pantaloon casts or braces for a minimum of 6 months (supine, first 6-12 weeks). Hemivertebrae were at L2 (N = 1), L3 (N = 1), L4-L5 (N = 1), and L5-S1 (N = 4). Preoperative curves or hemivertebral angles averaged 36.6 degrees (range, 30-52 degrees). Average age was 7.5 years (range, 22 months to 12.5 years). Mean follow-up was 41.14 months. Surgical correction of the seven cases averaged 28.0 degrees. Two-stage procedures yielded 29.7 degrees correction with no complications; single-stage yielded 18 degrees correction, and the only complication was an L5 nerve root paresis.
Zhang, Yong; Zhou, Zhuang; Wu, Cheng'ai; Zhao, Danhui; Wang, Chao; Cai, Wei; Wang, Ling; Duanmu, Yangyang; Zhang, Chenxin; Tian, Wei
Objective To investigate the bone mineral density (BMD) of cervical vertebrae in a population-stratified manner and correlate with that of the lumbar vertebrae. Materials and Methods Five hundred and ninety-eight healthy volunteers (254 males, 344 females), ranging from 20 to 64 years of age, were recruited for volumetric BMD (vBMD) measurements by quantitative computed tomography. Basic information (age, height, weight, waistline, and hipline), and vBMD of the cervical and lumbar vertebrae (C2–7 and L2–4) were recorded. Comparisons among sex, age groups and different levels of vertebrae were analyzed using analysis of variance. Linear regression was performed for relevance of different vertebral levels. Results The vBMD of cervical and lumbar vertebrae was higher in females than males in each age group. The vBMD of the cervical and lumbar vertebrae in males and the vBMD of lumbar vertebrae in females decreased with aging. In each age group, the vBMD of the cervical vertebrae was higher than that of the lumbar vertebrae with gradual decreases from C2 to C7 except for C3; moreover, the vBMD of C6 and C7 was significantly different from that of C2–5. Correlations of vBMD among different cervical vertebrae (females: r = 0.62–0.94; males: r = 0.63–0.94) and lumbar vertebrae (males: r = 0.93–0.98; females: r = 0.82–0.97) were statistically significant at each age group. Conclusion The present study provided normative data of cervical vertebrae in an age- and sex-stratified manner. Sex differences in vBMD prominently vary with age, which can be helpful to design a more comprehensive pre-operative surgical plan. PMID:27587947
Kaya, Serdar; Solmaz, Ilker; Ilıca, A. Turan; Karaçalıoğlu, Özgür; Damla Yılmaz, Nalan; Başoğlu, Okşan; Kılıc, Selim; Izci, Yusuf
Evaluation of bone mineral density (BMD) of the ancient peoples has received great interest by anthropologists. The aims of this study are to investigate the lumbar vertebrae of the Iasos people during the Byzantine period, in order to determine the prevalence of bone loss and to interpret dietary conditions of ancient Mediterranean populations. Lumbar vertebrae belonging to twenty eight skeletons of the 6th c AD were analyzed by radiographs and dual energy X-ray absorptiometry. The BMD values for each biologic sex and age group were compared. The correlation between the BMD and radiological features was also analyzed. The mean BMD was 0.940 g/cm2. BMD was decreased by aging in both sexes, but it was not significant. Osteopenia was found in 11 (39%) and osteoporosis in 4 (14.3%) out 28 vertebrae. The BMD was normal in 13 (46%) out of 28 vertebrae. Osteopenia was present in 7 (38%) of 18 male vertebrae and 4 (40%) of 10 female vertebrae. The spine score was high in the male group and there was a strong positive correlation between the BMD and spine score for both sexes. This study revealed that the BMD decreased by aging and that osteopenia was a problem in both sexes of the Iasos people during the 6th c AD. There was no correlation between the BMD and radiological features for age groups and biological sexes.
Long, Teng; Tang, Tingting; Hao, Yongqiang; Zhu, Zhenan; Shao, Litian; Liu, Ming
The aim of the present study was to assess the role of simvastatin on osteoporosis of the vertebrae by examining the effect of simvastatin on the osteogenesis of the lumbar vertebra in ovariectomized (OVX) rats. A total of 60 6-month-old female Sprague Dawley rats were divided into one sham group and five ovariectomized groups, consisting of four simvastatin groups and one control group. Four dosages of simvastatin (5, 10, 20 and 40 mg/kg/d) were administered by gavage for three months. L4 vertebrae were examined by dual-energy X-ray absorptiometry (DEXA) and peripheral quantitative computed tomography (pQCT) to determine the mineral apposition rate (MAR). L5 vertebrae were examined using a compression biomechanical test. Although the measurements from DEXA, pQCT and MAR, and the biomechanical parameters in the OVX + simvastatin rats were higher than those for the OVX + vehicle group, no significant differences were detected. Therefore, simvastatin may not improve osteogenesis of the lumbar vertebra in OVX rats or prevent osteoporosis of the spinal vertebrae. PMID:28105128
Li, Yang; Liang, Wei; Zhang, Yinlong; An, Haibo; Tan, Jindong; Yang Li; Wei Liang; Yinlong Zhang; Haibo An; Jindong Tan; Li, Yang; Liang, Wei; Tan, Jindong; Zhang, Yinlong; An, Haibo
Automatic and accurate lumbar vertebrae detection is an essential step of image-guided minimally invasive spine surgery (IG-MISS). However, traditional methods still require human intervention due to the similarity of vertebrae, abnormal pathological conditions and uncertain imaging angle. In this paper, we present a novel convolutional neural network (CNN) model to automatically detect lumbar vertebrae for C-arm X-ray images. Training data is augmented by DRR and automatic segmentation of ROI is able to reduce the computational complexity. Furthermore, a feature fusion deep learning (FFDL) model is introduced to combine two types of features of lumbar vertebrae X-ray images, which uses sobel kernel and Gabor kernel to obtain the contour and texture of lumbar vertebrae, respectively. Comprehensive qualitative and quantitative experiments demonstrate that our proposed model performs more accurate in abnormal cases with pathologies and surgical implants in multi-angle views.
Rasoulian, Abtin; Rohling, Robert; Abolmaesumi, Purang
Segmentation of the spinal column from computed tomography (CT) images is a preprocessing step for a range of image-guided interventions. One intervention that would benefit from accurate segmentation is spinal needle injection. Previous spinal segmentation techniques have primarily focused on identification and separate segmentation of each vertebra. Recently, statistical multi-object shape models have been introduced to extract common statistical characteristics between several anatomies. These models can be used for segmentation purposes because they are robust, accurate, and computationally tractable. In this paper, we develop a statistical multi-vertebrae shape+pose model and propose a novel registration-based technique to segment the CT images of spine. The multi-vertebrae statistical model captures the variations in shape and pose simultaneously, which reduces the number of registration parameters. We validate our technique in terms of accuracy and robustness of multi-vertebrae segmentation of CT images acquired from lumbar vertebrae of 32 subjects. The mean error of the proposed technique is below 2 mm, which is sufficient for many spinal needle injection procedures, such as facet joint injections.
Sa, Ruhan; Owens, William; Wiegand, Raymond; Chaudhary, Vipin; Sa, Ruhan; Owens, William; Wiegand, Raymond; Chaudhary, Vipin; Owens, William; Sa, Ruhan; Wiegand, Raymond; Chaudhary, Vipin
Fully automatic localization of lumbar vertebrae from clinical X-ray images is very challenging due to the variation of X-ray quality, scale, contrast, number of visible vertebrae, etc. To overcome these challenges, we present a novel framework, where we accelerate a scale-invariant object detection method using Support Vector Machines (SVM) trained on Histogram of Oriented Gradients (HOG) features and segmenting a fine vertebra contour using Gradient Vector Flow (GVF) based snake model. Support Vector Machines trained on HOG features are now an object detection standard in many perception fields and have demonstrated good performance on medical images as well. However, the computational complexity and lack of robustness brought by rescaling the original images have prevented its applicability. The proposed multistage detection framework uses lower-level detection result to determine the rescaling regions to reduce the region of interest, thereby decreasing the execution time. We further refine the detection result by segmenting the contour of vertebra using GVF snake, where we use edge detection techniques to increase the robustness of the GVF snake. Finally, we experimentally demonstrate the effectiveness of this framework using a large set of clinical X-ray images.
Simons, Craig J; Cobb, Loren; Davidson, Bradley S
In vivo measurement of lumbar spine configuration is useful for constructing quantitative biomechanical models. Positional magnetic resonance imaging (MRI) accommodates a larger range of movement in most joints than conventional MRI and does not require a supine position. However, this is achieved at the expense of image resolution and contrast. As a result, quantitative research using positional MRI has required long reconstruction times and is sensitive to incorrectly identifying the vertebral boundary due to low contrast between bone and surrounding tissue in the images. We present a semi-automated method used to obtain digitized reconstructions of lumbar vertebrae in any posture of interest. This method combines a high-resolution reference scan with a low-resolution postural scan to provide a detailed and accurate representation of the vertebrae in the posture of interest. Compared to a criterion standard, translational reconstruction error ranged from 0.7 to 1.6 mm and rotational reconstruction error ranged from 0.3 to 2.6°. Intraclass correlation coefficients indicated high interrater reliability for measurements within the imaging plane (ICC 0.97-0.99). Computational efficiency indicates that this method may be used to compile data sets large enough to account for population variance, and potentially expand the use of positional MRI as a quantitative biomechanics research tool.
Bartoněk, Luděk.; Janák, Vladislav; Keprt, Jiří
A new special second-generation computer-controlled device has been developed for measuring biomechanical characteristics of the lower part of the spine vertebras L1-L5 . During straining and measurement of the rigidity of the sample as a whole it is also necessary to observe the movement of individual parts of the sample and to measure their mechanical resistances. The measurement of displacement and rotation of individual parts of the studied model was evaluated by optical methods based on the principle of moiré interferometry and fast Fourier transform . During this device development and its verification the lumbar samples were replaced with a system of wooden rollers with system discrete rubber pads. The new computer-controlled device containing four stepper motors, four strain gauges and two CCD cameras.
Xu, Jia-Xin; Yang, Si-Dong; Wang, Bao-Lin; Yang, Da-Long; Ding, Wen-Yuan; Shen, Yong
Background: Upper lumbar disc herniation (ULDH) is easy to be misdiagnosed due to its special anatomical and atypical clinical features. Few studies have identified the relationship between ULDH and adjacent wedge-shaped vertebrae (WSV). Hypothesis: WSV may have some indicative relations withULDH. Patients and methods: Between January 2003 and October 2013, 47 patients (27 males and 20 females; mean age, 41.2 years) with single-level ULDH (as study group) and 47 sex- and age-matched healthy volunteers (as control group) were studied by radiograph. The two groups were compared with respect to age, sexual proportion, body mass index (BMI), kyphotic angle, and the proportion of WSV. Also, correlative analyses were conducted in the study group to investigate the relation between the kyphotic angle of target vertebrae and other factors including age, BMI, Cobb angle, JOA score and bone mineral density (BMD). Results: The average kyphotic angle in the study group was 11° (4°-22°), while the average kyphotic angle in the control group was 2° (0°-7°). Obviously, the mean kyphotic angle in the study group was statistically larger than that in the control group (t=13.797, P<0.001). The proportion of WSV in the study group was significantly larger than that in the control group (x2=36.380, P<0.0001). The correlations between kyphotic angles and other items (i.e., age, BMI, BMD, Cobb angle and JOA score) in the study group and the control group were low or uncorrelated. Conclusions: WSV are indicatively associated with adjacent ULDH. Thus, ULDH should be alerted when WSV are first found in radiograph and accompanied by clinical symptoms. PMID:25785106
Dong, Xuanliang Neil; Pinninti, Rajeshwar; Tvinnereim, Amy; Lowe, Timothy; Di Paolo, David; Shirvaikar, Mukul
The purpose of this study was to provide a novel stochastic assessment of inhomogeneous distribution of bone mineral density (BMD) from the Dual-energy X-ray Absorptiometry (DXA) scans of human lumbar vertebrae and identify the stochastic predictors that were correlated with the microarchitecture parameters of trabecular bone. Eighteen human lumbar vertebrae with intact posterior elements from 5 cadaveric spines were scanned in the posterior-anterior projection using a Hologic densitometer. The BMD map of human vertebrae was obtained from the raw data of DXA scans by directly operating on the transmission measurements of low- and high-energy X-ray beams. Stochastic predictors were calculated by fitting theoretical models onto the experimental variogram of the BMD map, rather than grayscale images, from DXA scans. In addition, microarchitecture parameters of trabecular bone were measured from the 3D images of human vertebrae acquired using a Micro-CT scanner. Significant correlations were observed between stochastic predictors and microarchitecture parameters. The sill variance, representing the standard deviation of the BMD map to some extent, had significantly positive correlations with bone volume, trabecular thickness, trabecular number and connectivity density. The sill variance was also negatively associated with bone surface to volume ratio and trabecular separation. This study demonstrates that the stochastic assessment of the inhomogeneous distribution of BMD from DXA scans of human lumbar vertebrae can reveal microarchitecture information of trabecular bone. However, future studies are needed to examine the potential of stochastic predictors from routine clinical DXA scans in providing bone fragility information complementary to BMD.
Yang, Jin Seo; Kang, Suk Hyung; Choi, Hyuk Jai
The prognosis of solitary plasmacytoma varies greatly, with some patients recovering after surgical removal or local fractional radiation therapy, and others progressing to multiple myeloma years later. Primary detection of progression to multiple myeloma is important in the treatment of solitary plasmacytoma. There have been several analyses of the risk factors involved in the early progression to multiple myeloma. We describe one case of solitary plasmacytoma of the lumbar vertebra that was treated with surgical decompression with stabilization and additional radiotherapy. The patient had no factors associated with rapid progression to multiple myeloma such as age, size, immunologic results, pathological findings, and serum free light chain ratio at the time of diagnosis. However, his condition progressed to multiple myeloma less than two months after the initial diagnosis of solitary plasmacytoma. We suggest that surgeons should be vigilant in watching for rapid progression to multiple myeloma even in case that the patient with solitary plasmacytoma has no risk factors for rapid progression to multiple myeloma. PMID:24379952
Kurutz, Márta; Donáth, Judit; Gálos, Miklós; Varga, Péter; Fornet, Béla
Objective To obtain the compressive load bearing and energy absorption capacity of lumbar vertebrae of osteoporotic elderly for the everyday medical praxis in terms of the simple diagnostic data, like computed tomography (CT), densitometry, age, and sex. Methods Compressive test of 54 osteoporotic cadaver vertebrae L1 and L2, 16 males and 38 females (age range 43–93, mean age 71.6 ± 13.3 years, mean bone mineral density (BMD) 0.377 ± 0.089 g/cm2, mean T-score −5.57 ± 0.79, Z-score −4.05 ± 0.77) was investigated. Based on the load-displacement diagrams and the measured geometrical parameters of vertebral bodies, proportional, ultimate and yield stresses and strains, Young’s modulus, ductility and energy absorption capacity were determined. Three vertebral regions were distinguished: superior, central and inferior regions, but certain parameters were calculated for the upper/ lower intermediate layers, as well. Cross-sectional areas, and certain bone tissue parameters were determined by image analysis of CT pictures of vertebrae. Sex- and age-related decline functions and trends of strength characteristics were determined. Results Size-corrected failure load was 15%–25% smaller in women, proportional and ultimate stresses were about 30%–35% smaller for women in any region, and 20%–25% higher in central regions for both sexes. Young’s moduli were about 30% smaller in women in any region, and 20%–25% smaller in the central region for both sexes. Small strains were higher in males, large strains were higher in females, namely, proportional strains were about 25% larger in men, yield and ultimate strains were quasi equal for sexes, break strains were 10% higher in women. Ultimate energy absorption capacity was 10%–20% higher in men; the final ductile energy absorption capacity was quasi equal for sexes in all levels. Age-dependence was stronger for men, mainly in central regions (ultimate load, male: r = −0.66, p < 0.01, female: r = −0.52, p
Klein, Anke; Nagel, Katrin; Gührs, Julian; Poodendaen, Chanasorn; Püschel, Klaus; Morlock, Michael M; Huber, Gerd
Stature estimation is important for identifying human remains. Analysis of body parts has become an important forensic tool during global operations in the context of cases in which human remains have been dismembered, mutilated or decomposed. However, unless almost the full skeleton or at least a long bone of the lower limb is available, accuracy is still limited to approximate body height. Especially with respect to single vertebral measurements, only a rough prediction is possible. Due to their complex geometry, vertebral measurements are possible at various locations. Nine locations have been considered in this study. Regression equations for stature estimation using lumbar vertebral geometry from computed tomography scans have been evaluated to identify the measurement which gives the most reliable body height estimation. The study group comprised a representative sample of a German metropolitan male population (42 autopsied individuals). Comparing the influence of various vertebral geometry measurements with body height resulted in a coefficient of correlation (R) of 0.19-0.53 and a 95% confidence interval (CI) of ± 11.6 up to ± 13.1cm. The largest correlation with a single vertebral measurement was achieved with the central height of the vertebral body of L2 as predictor; the standard error (SE) of the estimate was 5.9 cm. Using models from CT scans appeared superior to current invasive procedures that use direct measurements of the vertebral body, in terms of reproducibility and time efficiency. For fragmented non-skeletonized human bodies, height prediction based on an all-virtual model of the vertebrae is possible. However, the regression coefficient may be similar to classic caliper measurements that prove easier if skeletonized bones are available.
Vrtovec, Tomaž; Likar, Boštjan; Pernuš, Franjo
Quantitative measurement of vertebral rotation is important in surgical planning, analysis of surgical results, and monitoring of the progression of spinal deformities. However, many established and newly developed techniques for measuring axial vertebral rotation do not exploit three-dimensional (3D) information, which may result in virtual axial rotation because of the sagittal and coronal rotation of vertebrae. We propose a novel automatic approach to the measurement of the location and rotation of vertebrae in 3D without prior volume reformation, identification of appropriate cross-sections or aid by statistical models. The vertebra under investigation is encompassed by a mask in the form of an elliptical cylinder in 3D, defined by its center of rotation and the rotation angles. We exploit the natural symmetry of the vertebral body, vertebral column and vertebral canal by dividing the vertebral mask by its mid-axial, mid-sagittal and mid-coronal plane, so that the obtained volume pairs contain symmetrical parts of the observed anatomy. Mirror volume pairs are then simultaneously registered to each other by robust rigid auto-registration, using the weighted sum of absolute differences between the intensities of the corresponding volume pairs as the similarity measure. The method was evaluated on 50 lumbar vertebrae from normal and scoliotic computed tomography (CT) spinal scans, showing relatively large capture ranges and distinctive maxima at the correct locations and rotation angles. The proposed method may aid the measurement of the dimensions of vertebral pedicles, foraminae and canal, and may be a valuable tool for clinical evaluation of the spinal deformities in 3D.
Pigolkin, Yu I; Dubrovin, I A; Sedykh, E P; Mosoyan, A S
The objective of the present work was to study peculiar features of the injuries to three spinal regions in the victims of a head-on car collision found in the passenger compartments of modern motor vehicles equipped with seat belts and other safety means. It was shown that most frequent fatal injuries to the driver include the fractures of the cervical, thoracic, and lumbar vertebrae. These injuries are much less frequent in the passengers occupying the front and the right back seats. The multilayer and multiple character of the fractures in different parts of the spinal column in the car drivers is attributable to more pronounced spine flexion and extension associated with injuries of this kind. The fractures of the lower cervical vertebrae in the front seat passengers occur more frequently than injuries of a different type whereas the passengers of the back seats most frequently experience fractures of the upper cervical vertebrae. The passengers of the left back seat less frequently suffer from injuries to the thoracic spine than from the fractures of the cervical and lumbar vertebrae. The passengers of the central back seat most frequently experience fractures of the thoracic part of the vertebral column and the passengers occupying the right back seat fractures of the lumbar vertebrae.
Park, Si-Eun; Wang, Joong-San
[Purpose] The purpose of this case study was to identify the effects of joint mobilization using Kaltenborn-Evjenth orthopedic manual therapy (KEOMT) and proprioceptive neuromuscular facilitation (PNF) techniques on a patient with chronic low back pain (CLBP) and a lumbar transitional vertebra. [Methods] The intervention methods were joint mobilization using KEOMT and PNF techniques. The program consisted of 40-min sessions 3 days a week for 4 weeks. The spinal motion (thoracic and lumbar vertebrae), pain, and thickness of the multifidus were measured. [Results] The angle of spinal curvature increased, and the range of motions (ROMs) flexion and extension increased in the thoracic and lumbar vertebrae. The pain score as measured on a visual analogue scale (VAS) and the Oswestry disability index (ODI) score decreased. The thickness of the multifidus (L4) increased on the left and right sides. [Conclusion] These results suggest that joint mobilization using KEOMT and PNF techniques had a positive effect on the spinal motion, pain, and thickness of the multifidus of a patient with chronic low back pain and a lumbar transitional vertebra.
Park, Si-Eun; Wang, Joong-San
[Purpose] The purpose of this case study was to identify the effects of joint mobilization using Kaltenborn-Evjenth orthopedic manual therapy (KEOMT) and proprioceptive neuromuscular facilitation (PNF) techniques on a patient with chronic low back pain (CLBP) and a lumbar transitional vertebra. [Methods] The intervention methods were joint mobilization using KEOMT and PNF techniques. The program consisted of 40-min sessions 3 days a week for 4 weeks. The spinal motion (thoracic and lumbar vertebrae), pain, and thickness of the multifidus were measured. [Results] The angle of spinal curvature increased, and the range of motions (ROMs) flexion and extension increased in the thoracic and lumbar vertebrae. The pain score as measured on a visual analogue scale (VAS) and the Oswestry disability index (ODI) score decreased. The thickness of the multifidus (L4) increased on the left and right sides. [Conclusion] These results suggest that joint mobilization using KEOMT and PNF techniques had a positive effect on the spinal motion, pain, and thickness of the multifidus of a patient with chronic low back pain and a lumbar transitional vertebra. PMID:26157278
thoracic and lumbar spine and the sacroiliac region. The lumbar spine is designed to bear considerable loads and provides truncal mobility. It is...Spinal instability has not been without controversy. Mechanical disorders can be described by joint kinematics and knowledge of the forces...have to focus primarily on joint kinematics. In spinal motion analysis, different parameters are used to describe the kinematics . B. Digital
Weiss, R; Walz, P H
A 9-year-old castrated male dromedary camel developed weakness and ataxia, progressing to sternal recumbency and hindlimb paralysis. Necropsy revealed multiple liver tumours and a mass in the 3rd lumbar vertebra, compressing the spinal cord. The hepatic and vertebral masses consisted of uniform sheets of primitive cells, with perivascular pseudorosettes and small numbers of neuroblastic Homer-Wright rosettes. Immunohistochemically, the tumour cells were uniformly positive for vimentin and variably positive for neuron-specific enolase and glial fibrillary acidic protein. The histopathological and immunohistochemical findings indicated a peripheral primitive neuroectodermal tumour (pPNET) exhibiting neuroblastic, glial and ependymomatous differentiation, probably reflecting the tumour's primitive multipotential neuroepithelial nature. To the authors' knowledge, this is the first reported case in the camel of a pPNET, presumably intraosseous in origin with hepatic metastasis, and morphologically similar to Ewing's sarcoma in man.
Cagan, Amanda; Morgan, Robert; Davis, Rick; Asis, Martin; Switzer, Julie; Polly, David W.
Background: Relatively few patients have dual-energy x-ray absorptiometry to quantify the magnitude of bone loss as they age. Recent work correlates mean computed tomography (CT) attenuation in the level I (L1) vertebra with bone mineral density (BMD), making it possible to objectively evaluate the magnitude of bone loss in osteoporosis by this method. The aims of this study were to evaluate the utility of using CT scans in patients with acute thoracic and lumbar spine fractures to diagnose osteoporosis and using CT attenuation to evaluate the association between age and BMD. Methods: We performed a retrospective study of patients with acute fractures of the thoracic or lumbar spine who had also undergone an abdominal (or L1) CT scan and compared mean CT attenuation in L1 against threshold values. We also compared differences in CT attenuation between younger (<65 years) and older (≥65 years) and older patients. Results: A total of 124 patients were evaluated (74 thoracic and 50 lumbar fractures). Overall, there was a strong correlation between age and bone density as measured by CT attenuation (r = −.76). Among those with thoracic fractures (<65 years), mean CT attenuation was 196.51 HU. Forty-one patients were ≥65 years and had mean CT attenuation of 105.90 HU (P < .001). In patients with lumbar fractures, 27 patients were <65 years and had a mean CT attenuation of 192.26 HU and 23 patients were ≥65 years and had mean CT attenuation of 114.31 HU (P < .001). At the threshold of 110 HU, set for specificity, the magnitude of difference between the age-stratified cohorts was greater in the thoracic spine (P < .0001 vs P = .003). Discussion: Using opportunistic CT, we demonstrate the relative frequency of osteoporosis in patients with acute fractures of the thoracic and lumbar spine and confirm that the association increases with age. The CT attenuation may provide a cheap and convenient method to help confirm a clinical diagnosis of osteoporosis in patients
Tan, L; Bai, X; Li, D
To assess the possible correlation between the shape and the direction of the small articular surface in the lower lumbar vertebrae and the degeneration of the intervertebral disc, we investigated with computed tomography (CT) and evaluated with statistics the small articular surface and the transverse interface-joint angle (TIFA) of the L4-5 and the L5-S1 in 152 cases who had normal or degenerative discs verified through CT, MRI or operation. The small articular surface was found arc in 69.1% of the L4-5 and in 23.0% of the L5-S1. The TIFA of the L4-5 was less than that of the L5-S1. There was no correlation between the ratio of degeneration of the intervertebral disc at the L4-5 and the TIFA of the L4-5 and the L5-S1, but the ratio of degeneration of the intervertebral disc at the L5-S1 had postive correlation with the TIFA of the L4-5, negative correlation with the TIFA of the L5-S1, and particular correlation with the TIFA of the L5-S1 and L4-5. These results suggest that the shape and direction of the lower lumbar facet joint are related to the lumbar degeneration of intervertebral disc and the causes of degeneration at the L4-5 disc differ from those at the L5-S1 disc in biomechanics.
Bouzakis, K D; Mitsi, S; Michailidis, N; Mirisidis, I; Mesomeris, G; Maliaris, G; Korlos, A; Kapetanos, G; Antonarakos, P; Anagnostidis, K
The mechanical strength properties of lumbar spine vertebrae are of great importance in a wide range of applications. Herein, through nanoindentations and appropriate evaluation of the corresponding results, trabecular bone struts stress-strain characteristics can be determined. In the frame of the present paper, an L2 fresh cadaveric vertebra, from which posterior elements were removed, was subjected to compression. With the aid of developed finite elements method based algorithms, the cortical shell and the cancellous core bulk elasticity moduli and stresses were determined, whereas the tested vertebra geometrical model used in these algorithms was considered as having a compound structure, consisting of the cancellous bone surrounded by the cortical shell. Moreover nanoindentations were conducted and an appropriate evaluation method of the obtained results was applied to extract stress-strain curves of individual lumbar spine vertebra trabecular bone struts. These data were used in the mathematical description of the vertebrae compression test. The vertebral cancellous bone structure was simulated by a beam elements network, possessing an equivalent porosity and different stiffnesses in vertical and horizontal direction. Thus, the measured course of the compression load versus the occurring specimen deformation was verified.
Kalam, Abul; Talegaonkar, Sushama; Vohora, Divya
Currently, the third generation aromatase inhibitors are the drugs of choice for treatment of early and advanced breast cancer in postmenopausal women. The negative impact of these drugs on bone health is the significant limiting factor during this therapy. Here we report the effect of two aromatase inhibitors viz. letrozole and exemestane alone and in combination with raloxifene on lumbar vertebrae and femoral diaphysis after one month of treatment but no discernible effects were observed on bone when tested by micro CT and strength test except in trabecular number which was reduced in lumbar vertebrae following letrozole and exemestane. Further studies with letrozole and exemestane should be done at higher doses for longer duration of time to check whether effects are observed in other parameters as well. The data is an extension of our published work in Mol. Cell Endocrinology (A. Kalam, S. Talegaonkar, D. Vohora, 2017)  describing letrozole-induced bone loss on femoral epiphysis and its reversal by raloxifene.
Álvarez, Alicia; Ercoli, Marcos D; Prevosti, Francisco J
We assessed the influence of a variety of aspects of locomotion and ecology including gait and locomotor types, maximal running speed, home range, and body size on postcranial shape variation in small to medium-sized mammals, employing geometric morphometric analysis and phylogenetic comparative methods. The four views analyzed, i.e., dorsal view of the penultimate lumbar vertebra, lateral view of the pelvis, posterior view of the proximal femur and proximal view of the tibia, showed clear phylogenetic signal and interesting patterns of association with movement. Variation in home range size was related to some tibia shape changes, while speed was associated with lumbar vertebra, pelvis and tibia shape changes. Femur shape was not related to any locomotor variables. In both locomotor type and high-speed gait analyses, locomotor groups were distinguished in both pelvis and tibia shape analyses. These results suggest that adaptations to both typical and high-speed gaits could explain a considerable portion of the shape of those elements. In addition, lumbar vertebra and tibia showed non-significant relationships with body mass, which suggests that they might be used in morpho-functional analyses and locomotor inferences on fossil taxa, with little or no bias for body size. Lastly, we observed morpho-functional convergences among several mammalian taxa and detected some taxa that achieve similar locomotor features following different morphological paths.
de Visser, Hans; Adam, Clayton J; Crozier, Stuart; Pearcy, Mark J
In cricket fast bowlers an increased incidence of stress fractures or lesions in the L4 pars interarticularis is observed, which shows a strong statistical correlation with the presence of hypertrophy in the contralateral Quadratus Lumborum (QL) muscle. This study aims to find a physical explanation for this correlation. A mathematical model was used to estimate the forces and moments on the L3 and L4 vertebrae in six postures attained during fast bowling. These forces and moments were used in finite element models to estimate the stresses in the pars interarticularis. Two scenarios were examined per posture: symmetric QL muscles, and right QL muscle volume 30% enlarged. Influence of muscle activation was also investigated. QL asymmetry only correlates with significant stress increases when stress levels are relatively low. When stress levels are high, due to extreme posture or muscle activation, asymmetry only causes small stress changes, suggesting that asymmetry is not the cause of stress fractures in the pars. There are even indications that asymmetry might help to reduce stresses, but more detailed knowledge of the size and activation of the lumbar muscles is needed to confirm this.
Wegrzyn, Julien; Roux, Jean-Paul; Farlay, Delphine; Follet, Hélène; Chapurlat, Roland
Whole bone strength is determined by bone mass, microarchitecture and intrinsic properties of the bone matrix. However, few studies have directly investigated the contribution of bone tissue material properties to whole bone strength in humans. This study assessed the role of bone matrix composition on whole lumbar vertebra mechanics. We obtained 17 fresh frozen human lumbar spines (8 W, 9 M, aged 76±11years). L3 bone mass was measured by DXA and microarchitecture by μ-CT with a 35 μm-isotropic resolution. Microarchitectural parameters were directly measured: Tb.BV/TV, SMI, Tb.Th, DA, Ct.Th, Ct.Po and radius of anterior cortical curvature. Failure load (N), stiffness (N/mm) and work to failure (N.mm) were extracted from quasi-static uniaxial compressive testing performed on L3 vertebral bodies. FTIRM analysis was performed on 2 μm-thick sections from L2 trabecular cores, with a Perkin-Elmer GXII Auto-image Microscope equipped with a wide band detector. Twenty measurements per sample were performed at 30∗100 μm of spatial resolution. Each spectrum was collected at 4 cm(-1) resolution and 50 scans in transmission mode. Mineral and collagen maturity, and mineralization and crystallinity index were measured. There was no association between the bone matrix characteristics and bone mass or microarchitecture. Mineral maturity, mineralization and crystallinity index were not related to whole vertebra mechanics. However, collagen maturity was positively correlated with whole vertebra failure load and stiffness (r=0.64, p=0.005 and r=0.54, p=0.025, respectively). The collagen maturity (3rd step) in combination with bone mass (i.e., BMC, 1st step) and microarchitecture (i.e., Tb.Th, 2nd step) improved the prediction of whole vertebra mechanical properties in forward stepwise multiple regression models, together explaining 71% of the variability in whole vertebra stiffness (p=0.001). In conclusion, we demonstrated a substantial contribution of collagen maturity, but
YANG, PINGLIN; HE, XIJING; LI, HAOPENG; ZANG, QUANJIN; WANG, GUOYU
The present study aimed to analyze the indications, feasibility, safety and clinical effects of total spondylectomy and spine reconstruction through posterior or combined anterior-posterior approaches for thoracic lumbar and sacral vertebrae tumors. Between December 2009 and May 2012, 10 patients with thoracic lumbar and sacral vertebrae tumors were retrospectively analyzed. Different surgical indications and approaches were used according to the affected segments, the extent of lesion involvement and the specific pathology results. One-stage posterior or combined anterior-posterior total spondylectomy and reconstruction was used for the treatment of complicated thoracic lumbar and sacral vertebral malignant tumors and invasive benign tumors. The duration of surgery, levels of intraoperative blood loss and transfusions, and the clinical effects were observed. The average surgical duration was 6.8 h (range, 4.8–12 h), with an average blood loss level of 3,200 ml (range, 1,500–10,000 ml) and an average transfusion level of 2,500 ml. During the average 15 months (range, 3–29 months) follow up, two patients succumbed and one patient experienced tumor recurrence. Neither tumor reoccurrence nor metastasis was observed in all other patients. Personalized surgical indications and approaches according to the affected segments, the extent of lesion involvement and the specific pathology results would aid in the reduction of pain, the improvement of nerve function and the reduction of tumor recurrence. PMID:26998076
Radek, Maciej; Radek, Andrzej; Rysz, Jacek; Maziarz, Zbigniew; Gadzicki, Mariusz
Introduction Lack of efficacy of pharmacotherapy and physiotherapy in spinal pain syndrome is an indication for intervertebral stabilizer implantation between the processes in the lumbar segment of the spine. Material and methods The group consisted of 32 patients qualified after radioisotopic single-photon emission computed tomography/computed tomography (SPECT/CT) examinations with assessment of bone metabolism and mineral density. For comparative purposes, the L2 vertebra was defined as normal. Parameters defined in the area of operated vertebrae were comparable to L2. Imaging examinations and a pain intensity test were performed before and 12 months after the procedure. Results In SPECT, osteotropic isotope (OI) activity in spinous bodies and processes was close to L2 values. Density assessed in CT of analysed vertebrae was close to L2. In the control examination, activity of OI in spinous bodies and processes was higher in the procedure area. Under the stabilizer, there was a strong positive correlation with the L2 parameters. The differences were statistically significant (p = 0.0002). The increase of OI activity in the elements above the stabilizer was variable. In the control examination, there was higher density of spinous processes and bodies above and under the stabilizer. The difference, compared to the L2 density, was statistically significant. Conclusions The radioisotopic method with SPECT/CT allows for the precise assessment of bone metabolism in the spine. After the procedure, a negative correlation was observed between bone metabolism changes and pain intensity test results. PMID:28144269
Chanapa, Patcharin; Yoshiyuki, Tohno; Mahakkanukrauh, Pasuk
Vertebral osteophytes are a characteristic feature of intervertebral disc degeneration. In the lumbar spinal region, the two major structures in close proximity anterior to the spine are the inferior vena cava and the abdominal aorta, both of which have been reported to be affected by osteophytes. The purpose of this study was to determine the distribution, classification and lengths of osteophytes in the lumbar vertebrae. One hundred and eighty lumbar columns of 90 males and 90 females from Chiang Mai, Thailand, in the age range 15 to 96 years (mean age, 63 years) were collected. The measuring length of osteophytes was assessed on vertebral body and articular facet. Statistical analysis was performed by descriptive analysis, chi-square and Pearson Correlation. Lumbar osteophytes were presented in 175 specimens (97.2%), 88 males and 87 females. The highest frequency was at L4, most were on the superior, inferior surface of body and articular facet (39.7%, 38.4%, and 22%), respectively. The greatest mean length was 3.47±2.21 mm at L5, and the longest length of anterior superior surface of body was 28.56 mm. The osteophyte length was significantly correlated directly with age (P<0.01), and males were significantly greater than females (P<0.05). The highest prevalence of osteophytes was on the anterior side of superior surface of body (30.4%), and the classification was traction. It can be proposed that the abdominal aorta could be damaged, especially a risk of rupture of abdominal aortic aneurysm.
Bott, Kirsten N; Sacco, Sandra M; Turnbull, Patrick C; Longo, Amanda B; Ward, Wendy E; Peters, Sandra J
Bone microarchitecture, bone mineral density (BMD), and bone strength are affected positively by impact activities such as running; however, there are discrepancies in the magnitude of these effects. These inconsistencies are mainly a result of varying training protocols, analysis techniques, and whether or not the skeletal sites measured are weight bearing. This study's purpose was to determine the effects of endurance running on sites that experience different weight bearing and load. Eight-week-old male Sprague-Dawley rats (n = 20) were randomly assigned to either a group with a progressive treadmill running protocol (25 m/min for 1 h, incline of 10%) or a nontrained control group for 8 weeks. The trabecular structure of the tibia, lumbar vertebra (L3), and mandible and the cortical structure at the tibia midpoint were measured using microcomputed tomography to quantify bone volume fraction (i.e., bone volume divided by total volume (BV/TV)), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and cortical thickness. BMD at the proximal tibia, lumbar vertebrae (L1-L3), and mandible was measured using dual energy X-ray absorptiometry. The tibia midpoint strength was measured by 3-point bending using a materials testing system. Endurance running resulted in superior bone structure at the proximal tibia (12% greater BV/TV (p = 0.03), 14% greater Tb.N (p = 0.01), and 19% lower Tb.Sp (p = 0.05)) but not at other sites. Contrary to our hypothesis, mandible bone structure was altered after endurance training (8% lower BV/TV (p < 0.01) and 15% lower Tb.Th (p < 0.01)), which may be explained by a lower food intake, resulting in less mechanical loading from chewing. These results highlight the site-specific effects of loading on the skeleton.
Hiyaoka, A; Yoshida, T; Cho, F; Yoshikawa, Y
We were able to measure bone mineral density (BMD), mean bone width and the area of the lumbar vertebrae in male African green monkeys with a dual-energy X-ray absorptiometry (DPX-alpha, Lunar, USA). For analysis of spinal bone mass, mean width and area of the bone, we scanned lumbar vertebrae L3-L5 using a pediatric analysis program. We used restraining bed made of formed polystyrol to support the animal in a supine position. The precision of the measuring technique was calculated by averaging the coefficients of variance of the 5 scans obtained in 5 animals aged from 5 to 7 years. The precision values for BMD, bone width and area were 1.9%, 0.9% and 2.6%, respectively. Furthermore, age-related changes in bone measurements were demonstrated using laboratory-bred males (n = 45) and, additionally, wild-originated males (n = 7, estimated ages over 15 years old). The values of B M D, bone width and area at 6 months old were about 0.3 g/cm2, 1.2cm and 4.5 cm2 respectively. These values increased with aging to about 0.7 g/cm2, 1.5 cm and 11cm2 at 5 years old, respectively, and were judged to reach plateau. However, animals over 10 years old and wild-originated animals which had been kept over 10 years in our breeding colony showed rather smaller BMD and area values than the animals aged 5 to 10 years. The animals aged between 5 and 10 years seemed to have retained a peak bone mass in this primate species.
Garo, Anaïs; Arnoux, Pierre Jean; Wagnac, Eric; Aubin, Carl Eric
Finite element models (FEM) dedicated to vertebral fracture simulations rarely take into account the rate dependency of the bone material properties due to limited available data. This study aims to calibrate the mechanical properties of a vertebral body FEM using an inverse method based on experiments performed at slow and fast dynamic loading conditions. A detailed FEM of a human lumbar vertebral body (23,394 elements) was developed and tested under compression at 2,500 and 10 mm s⁻¹. A central composite design was used to adjust the mechanical properties (Young modulus, yield stress, and yield strain) while optimizing four criteria (ultimate strain and stress of cortical and trabecular bone) until the failure load and energy at failure reached experimental results from the literature. At 2,500 mm s⁻¹, results from the calibrated simulation were in good agreement with the average experimental data (1.5% difference for the failure load and 0.1% for the energy). At 10 mm s⁻¹, they were in good agreement with the average experimental failure load (0.6% difference), and within one standard deviation of the reported range of energy to failure. The proposed method provides a relevant mean to identify the mechanical properties of the vertebral body in dynamic loadings.
Zhang, Lingyan; Li, Shaolin; Hao, Shuai; Yuan, Zhen
The goal for this study was to investigate if proton MRS (1H-MRS) and out-of-phase and in-phase MRI can quantify the fat deposition in bone marrow within the lumbar vertebra that can be used to distinguish well between osteoporosis patients and healthy control subjects. Sixty-eight subjects participated in this study. The diagnostic results from dual-energy x-ray absorptiometry served as the gold standard, which was able to separate the subjects into osteoporosis (38 subjects) and non-osteoporosis group (30 subjects). Then the 68 subjects were further scanned by 1H-MRS and in-phase and out-of-phase MRI and the findings from the imaging methods were also compared and analyzed. It was found that the measured signal intensity ratio (SIR), lipid-water ratio (LWR) and fat fraction (FF) in L2 vertebra from the two imaging methods were able to identify the fat deposition in bone marrow, which could be used to diagnose osteoporosis. Diagnostic accuracy for osteoporosis based on identified SIR, LRW and FF was analyzed by using ROC curves. Our findings suggested that statistically significant differences were identified between osteoporosis patients and healthy subjects. The sensitivity and specificity equal to 78.9% and 75.9% for SIR, 79.2% and 66.7% for LRW, 71.4% and 72.4% for FF, can be achieved when fat deposition-related parameters in bone marrow from the lumbar vertebra are used as classifiers. Our results showed that fat deposition-related parameters including fat content in bone marrow and water content in the lumbar vertebra are clearly different between the osteoporosis and non-osteoporosis group, suggesting that both 1H-MRS and in-phase and out-of-phase MRI can be used for diagnosing osteoporosis and monitoring its progression.
Wang, Yinong; Yao, Jianhua; Roth, Holger R.; Burns, Joseph E.; Summers, Ronald M.
Accurate spine segmentation allows for improved identification and quantitative characterization of abnormalities of the vertebra, such as vertebral fractures. However, in existing automated vertebra segmentation methods on computed tomography (CT) images, leakage into nearby bones such as ribs occurs due to the close proximity of these visibly intense structures in a 3D CT volume. To reduce this error, we propose the use of joint vertebra-rib atlases to improve the segmentation of vertebrae via multi-atlas joint label fusion. Segmentation was performed and evaluated on CTs containing 106 thoracic and lumbar vertebrae from 10 pathological and traumatic spine patients on an individual vertebra level basis. Vertebra atlases produced errors where the segmentation leaked into the ribs. The use of joint vertebra-rib atlases produced a statistically significant increase in the Dice coefficient from 92.5 +/- 3.1% to 93.8 +/- 2.1% for the left and right transverse processes and a decrease in the mean and max surface distance from 0.75 +/- 0.60mm and 8.63 +/- 4.44mm to 0.30 +/- 0.27mm and 3.65 +/- 2.87mm, respectively.
Amirjamshidi, Abbas; Roozbeh, Hadi; Sharifi, Give; Abdoli, Ali; Abbassioun, Kazem
Osteoid osteoma affects the spine in only 10% of cases. More than 50% of the spinal cases involve the lumbar and cervical vertebrae. Involvement of C-1 and C-2 vertebrae has previously been reported only very rarely in the published literature. The authors report 4 cases of upper cervical osteoid osteoma, 1 involving C-1 and the other 3 C-2, and they discuss different aspects of management in similar cases. The patients were 14, 17, 35, and 46 years old, and all presented with neck pain and various degrees of painful limitation of head rotation not ameliorated by ordinary analgesics. Radionuclide isotope bone scans, CT scanning, and MR imaging were helpful preoperative diagnostic modalities. The first attempt at eradication of the lesions failed in 2 cases and the lesions could be excised totally at a second approach. Postoperatively, the patients all became pain free and gained full range of neck motion. There has been no tumor recurrence and no sign of instability in short- to medium-term follow-up. Among the several etiologies mentioned for neck pain and torticollis, osteoid osteoma of the first 2 cervical vertebrae should be considered as a possible but rare cause. Even though different kinds of management have been mentioned for osteoid osteoma, resection of the lesion remains the best option for achieving a cure.
Lund, Michael Tillge; de Bruijne, Marleen; Tanko, Laszlo B.; Nielsen, Mads
Accurate and reliable identification and quantification of vertebral fractures constitute a challenge both in clinical trials and in diagnosis of osteoporosis. Various efforts have been made to develop reliable, objective, and reproducible methods for assessing vertebral fractures, but at present there is no consensus concerning a universally accepted diagnostic definition of vertebral fractures. In this project we want to investigate whether or not it is possible to accurately reconstruct the shape of a normal vertebra, using a neighbouring vertebra as prior information. The reconstructed shape can then be used to develop a novel vertebra fracture measure, by comparing the segmented vertebra shape with its reconstructed normal shape. The vertebrae in lateral x-rays of the lumbar spine were manually annotated by a medical expert. With this dataset we built a shape model, with equidistant point distribution between the four corner points. Based on the shape model, a multiple linear regression model of a normal vertebra shape was developed for each dataset using leave-one-out cross-validation. The reconstructed shape was calculated for each dataset using these regression models. The average prediction error for the annotated shape was on average 3%.
Logins, V.; Pontaga, I.; Saulgozis, J.
The penetration strength of trabecular bone tissue of human lumbar vertebrae was determined in vitro by the osteopenetrometer. The tests were performed in the frontal, middle, and back third of the vertebra body lateral side, in the upper and lower terminal plates, and in the processus spinosus in three vertebrae of the age group 1 (19-25 years), four vertebrae of the group 2 (40-60 years), and four of the group 3 (61-75 years). The data obtained show that the penetration of strength of the human lumbar vertebrae diminishes with age nonuniformly: the most expressed decrease appears in the frontal and middle parts of the lateral side and in the processus spinosus, but very little change appears under the terminal plates. The significant correlation between the penetration strength in the processus spinosus and in the vertebrae body could be useful for diagnostics of the vertebra state in vivo. According to the measured penetration strength in the processus spinosus, it is possible to indirectly estimate its value in the vertebra body.
Cho, Sung Ik; Lee, Jung Hwan
Lumbar intraspinal synovial cysts are included in the difference diagnosis of lumbar radiculopathy. Developing imaging modalities has result in increased reporting about these lesions. However, the case of bilateral new lumbar intraspinal synovial cysts after laminectomy has been rarely reported. We report of a rare case with bilateral lumbar intraspinal synovial cysts after laminectomy, requiring surgical excision. PMID:27799997
Liao, Shu; Zhan, Yiqiang; Dong, Zhongxing; Yan, Ruyi; Gong, Liyan; Zhou, Xiang Sean; Salganicoff, Marcos; Fei, Jun
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.
Formation of the vertebral column is a critical developmental stage in mammals that is strictly controlled in most species. The pig is quite unique as considerable variation exists in number of thoracic vertebra as well as number of lumbar vertebra. At least two genes have been identified that affec...
Brown, David; Sarbach, Olivier; Schnetter, Erik; Diener, Peter; Tiglio, Manuel; Hawke, Ian; Pollney, Denis
to turducken (turduckens, turduckening, turduckened, turduckened) [math.]: To stuff a black hole. We analyze and apply an alternative to black hole excision based on smoothing the interior of black holes with arbitrary initial data, and solving the vacuum Einstein evolution equations everywhere. By deriving the constraint propagation system for our hyperbolic formulation of the BSSN evolution system we rigorously prove that the constraints propagate causally and so any constraint violations introduced inside the black holes cannot affect the exterior spacetime. We present evolutions of Cook-Pfeiffer binary black hole initial configurations showing that these techniques appear to work robustly for generic data. We also present evidence from spherically symmetric evolutions that for the gauge conditions used the same stationary end-state is approached irrespective of the choice of initial data and smoothing procedure.
Akbay, Atilla; Bozkurt, Gokhan; Ilgaz, Ozgur; Palaoglu, Selcuk; Akalan, Nejat; Benzel, Edward C
Screws, clamps and other spinal instrumentation materials are tested using healthy animal and healthy human vertebrae, but the application of similar tests to an osteoporotic vertebra is generally neglected because of high costs and limited availability of high quality and consistent osteoporotic vertebrae. The objective of this study is to develop an in-vitro method to decrease the mineral content of an animal vertebra utilizing decalcifying chemical agents that alters the bone mineral density and some biomechanical properties to such an extent that they biomechanically mimic the osteoporotic spine. This study was performed on 24 fresh calf lumbar vertebrae. Twelve out of these 24 vertebrae were demineralized and the others served as control. A hole was opened in the pedicles of each vertebrae and the bone mineral density was measured. Each vertebra was then placed into a beher-glass filled with hydrochloric acid decalcifier solution. The decalcifier solution was introduced through the holes in the pedicles with an infusion pump. The vertebrae were then subjected to DEXA to measure post process BMD. Pedicle screws were introduced into both pedicles of each vertebrae and pullout testing was performed at a rate of 5 mm/min. The difference of BMD measurements between pre- and post-demineralizing process were also statistically significant (p < 0.001). The difference of pullout loads between pre- and post-demineralizing process were also statistically significant (p < 0.001). The acid demineralizing process may be useful for producing a vertebra that has some biomechanical properties that are consistent with osteopenia or osteoporosis in humans.
Braun, Richard Andreas; Milito, Carlos Felipe do Rego Barros; Goldman, Suzan Menasce; Fernandes, Eloy de Ávila
Low back pain is often managed at all levels of healthcare. In general, diagnostic investigation begins with radiography of the lumbar spine. In addition to the most common findings, radiologists can identify increased density of a vertebral body, referred to as ivory vertebra. The objective of this study was to describe the main diseases that can present with this radiologic sign, such as Hodgkin lymphoma, Paget's disease, metastatic prostate cancer, breast cancer, and osteomyelitis. It is extremely important that radiologists be aware of this finding in order to inform the requesting physician of the possible etiologies, given that it can be the initial radiologic presentation for these diseases.
French, Heath D.; Somasundaram, Arjuna J.; Schaefer, Nathan R.; Laherty, Richard W.
Study Design Retrospective cohort study. Objective Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly, and they can be accurately identified on anteroposterior (AP) radiographs of the lumbosacral spine. This study attempts to determine the prevalence of this congenital anomaly and to increase awareness among all clinicians to reduce the risk of surgical and procedural errors in patients with LSTV. Methods A retrospective review of 5,941 AP and lateral lumbar radiographs was performed. Transitional vertebrae were identified and categorized under the Castellvi classification. Results The prevalence of LSTV in the study population was 9.9%. Lumbarized S1 and sacralized L5 were seen in 5.8 and 4.1% of patients, respectively. Conclusion LSTV are a common normal variant and can be a factor in spinal surgery at incorrect levels. It is essential that all clinicians are aware of this common congenital anomaly. PMID:25396103
Frenzel, Laurent; Suarez, Felipe; Chandesris, Marie-Olivia; Hermine, Olivier
The ivory vertebra sign seen on a standard radiograph of the spine should prompt investigations for a cause, which is most likely to be a bone metastasis, a lymphoma, or Paget's disease of bone. A diagnosis of idiopathic ivory vertebra can be given if no cause is identified. We report an unusual case of ivory vertebra sign that was due to systemic mastocytosis and improved with specific treatment. Although osteoporosis is the most common bone abnormality in systemic mastocytosis, an isolated sclerotic or lytic lesion may be found. The ivory vertebra sign should not be considered idiopathic until tests are done for mastocytosis, particularly given the availability of effective treatments.
Rasoulian, Abtin; Rohling, Robert N.; Abolmaesumi, Purang
Labeling and segmentation of the spinal column from CT images is a pre-processing step for a range of image- guided interventions. State-of-the art techniques have focused either on image feature extraction or template matching for labeling of the vertebrae followed by segmentation of each vertebra. Recently, statistical multi- object models have been introduced to extract common statistical characteristics among several anatomies. In particular, we have created models for segmentation of the lumbar spine which are robust, accurate, and computationally tractable. In this paper, we reconstruct a statistical multi-vertebrae pose+shape model and utilize it in a novel framework for labeling and segmentation of the vertebra in a CT image. We validate our technique in terms of accuracy of the labeling and segmentation of CT images acquired from 56 subjects. The method correctly labels all vertebrae in 70% of patients and is only one level off for the remaining 30%. The mean distance error achieved for the segmentation is 2.1 +/- 0.7 mm.
Background Clinical diagnosis and therapy for the lumbar disc herniation requires accurate vertebra segmentation. The complex anatomical structure and the degenerative deformations of the vertebrae makes its segmentation challenging. Methods An improved level set method, namely edge- and region-based level set method (ERBLS), is proposed for vertebra CT images segmentation. By considering the gradient information and local region characteristics of images, the proposed model can efficiently segment images with intensity inhomogeneity and blurry or discontinuous boundaries. To reduce the dependency on manual initialization in many active contour models and for an automatic segmentation, a simple initialization method for the level set function is built, which utilizes the Otsu threshold. In addition, the need of the costly re-initialization procedure is completely eliminated. Results Experimental results on both synthetic and real images demonstrated that the proposed ERBLS model is very robust and efficient. Compared with the well-known local binary fitting (LBF) model, our method is much more computationally efficient and much less sensitive to the initial contour. The proposed method has also applied to 56 patient data sets and produced very promising results. Conclusions An improved level set method suitable for vertebra CT images segmentation is proposed. It has the flexibility of segmenting the vertebra CT images with blurry or discontinuous edges, internal inhomogeneity and no need of re-initialization. PMID:23714300
Schultz, V A; Watson, A G
A three-month-old, male Chihuahua puppy with congenital absence of the distal 40% of the right thoracic limb was examined. The limb ended as a short, rounded, skin-covered stump. Radiography revealed a 40% shortened humerus tapered to a blunt end without its distal extremity. Dissection of the left thoracic limb identified luxation of the elbow joint and absence of the fourth digital pad. Alizarin-red staining and clearing demonstrated syndactylous fourth and fifth digits in the left thoracic limb and an anomalous eighth lumbar vertebra. This additional vertebra was unilaterally sacralized and constituted a lumbosacral transitional vertebra.
Tawara, Daisuke; Sakamoto, Jiro; Murakami, Hideki; Kawahara, Norio; Oda, Juhachi; Tomita, Katsuro
Osteoporosis can lead to bone compressive fractures in the lower lumbar vertebrae. In order to assess the recovery of vertebral strength during drug treatment for osteoporosis, it is necessary not only to measure the bone mass but also to perform patient-specific mechanical analyses, since the strength of osteoporotic vertebrae is strongly dependent on patient-specific factors, such as bone shape and bone density distribution in cancellous bone, which are related to stress distribution in the vertebrae. In the present study, patient-specific general (not voxel) finite element analyses of osteoporotic vertebrae during drug treatment were performed over time. We compared changes in bone density and compressive principal strain distribution in a relative manner using models for the first lumbar vertebra based on computer tomography images of four patients at three time points (before therapy, and after 6 and 12 months of therapy). The patient-specific mechanical analyses indicated that increases in bone density and decreases in compressive principal strain were significant in some osteoporotic vertebrae. The data suggested that the vertebrae were strengthened structurally and the drug treatment was effective in preventing compression fractures. The effectiveness of patient-specific mechanical analyses for providing useful and important information for the prognosis of osteoporosis is demonstrated.
Cardoso, Hugo F V; Ríos, Luis
The presacral vertebrae have various secondary centers of ossification, whose timing of fusion can be used for age estimation of human skeletal remains up to the middle to the latter third decade. However, detailed information about the age at which these secondary centers of ossification fuse has been lacking. In this study, the timing of epiphyseal union in presacral vertebrae was studied in a sample of modern Portuguese skeletons (57 females and 47 males) between the ages of 9 and 30, taken from the Lisbon documented skeletal collection. A detailed photographic record of these epiphyses and the age ranges for the different stages of epiphyseal union are provided. Partial union of epiphyses was observed from 11 to 27 years of age. In general, centers of ossification begin to fuse first in the cervical and lumbar vertebrae, followed by centers of ossification in the thoracic region. The first center of ossification to complete fusion is usually that of the mammillary process in lumbar vertebrae. This is usually followed by that of the transverse process, spinous transverse process, and annular ring, regardless of vertebra type. There were no statistically significant sex differences in timing of fusion, but there was a trend toward early maturation in females for some vertebra or epiphyses. Bilateral epiphyses did not show statistically significant differences in timing of fusion. This study offers information on timing of fusion of diverse epiphyseal locations useful for age estimation of complete or fragmented human skeletal remains.
Hegazy, Abdelmonem A; Hegazy, Raafat A
Despite the increasing recognition of the functional and clinical importance of lumbar lordosis, little is known about its description, particularly in Egypt. At the same time, magnetic resonance imaging (MRI) has been introduced as a noninvasive diagnostic technique. The aim of this study was to investigate the anatomy of the lumbar lordosis using midsagittal MRIs. Normal lumbar spine MRIs obtained from 93 individuals (46 males, 47 females; 25-57 years old) were evaluated retrospectively. The lumbar spine curvature and its segments "vertebrae and discs" were described and measured. The lumbar lordosis angle (LLA) was larger in females than in males. Its mean values increased by age. The lumbar height (LH) was longer in males than in females. At the same time, the lumbar breadth (LB) was higher in females than in males. Lumbar index (LI = LB/LH × 100) showed significant gender differences (P < 0.0001). Lordosis was formed by wedging of intervertebral discs and bodies of lower lumbar vertebrae. In conclusion, MRI might clearly reveal the anatomy of the lumbar lordosis. Use of LI in association with LLA could be useful in evaluation of lumbar lordosis.
Bursalı, Adem; Guvenal, Ahmet Burak; Yaman, Onur
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
Korez, Robert; Ibragimov, Bulat; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž
Automated and semi-automated detection and segmentation of spinal and vertebral structures from computed tomography (CT) images is a challenging task due to a relatively high degree of anatomical complexity, presence of unclear boundaries and articulation of vertebrae with each other, as well as due to insufficient image spatial resolution, partial volume effects, presence of image artifacts, intensity variations and low signal-to-noise ratio. In this paper, we describe a novel framework for automated spine and vertebrae detection and segmentation from 3-D CT images. A novel optimization technique based on interpolation theory is applied to detect the location of the whole spine in the 3-D image and, using the obtained location of the whole spine, to further detect the location of individual vertebrae within the spinal column. The obtained vertebra detection results represent a robust and accurate initialization for the subsequent segmentation of individual vertebrae, which is performed by an improved shape-constrained deformable model approach. The framework was evaluated on two publicly available CT spine image databases of 50 lumbar and 170 thoracolumbar vertebrae. Quantitative comparison against corresponding reference vertebra segmentations yielded an overall mean centroid-to-centroid distance of 1.1 mm and Dice coefficient of 83.6% for vertebra detection, and an overall mean symmetric surface distance of 0.3 mm and Dice coefficient of 94.6% for vertebra segmentation. The results indicate that by applying the proposed automated detection and segmentation framework, vertebrae can be successfully detected and accurately segmented in 3-D from CT spine images.
Damur-Djuric, Natascha; Steffen, Frank; Hässig, Michael; Morgan, Joe P; Flückiger, Mark A
The prevalence of lumbosacral transitional vertebrae (LTV) was determined by reviewing the pelvic radiographs of 4000 medium- and large-breed dogs of 144 breeds routinely screened for canine hip dysplasia. An LTV was seen in 138 (3.5%) dogs. The prevalence was higher in German Shepherd dogs and Greater Swiss Mountain dogs than in the other breeds, suggesting a genetic predisposition. There was no gender predisposition. The transverse processes of the LTV were divided into three types based on their morphological characteristics: lumbar type or type 1; intermediate type or type 2; and sacral type or type 3. In a symmetric LTV, both transverse processes are of the same type, while in an asymmetric LTV they are not. The frequency of occurrence of symmetric and asymmetric LTV was similar. In symmetric LTV, intermediate-type transverse processes predominated. Most of the asymmetric LTV had an intermediate-type transverse process combined with a lumbar or sacral type, respectively. Highly asymmetric LTV were often angled relative to the adjacent vertebrae. We hypothesize that an LTV is not the result of transformation of a lumbar into a sacral vertebra or vice versa, but rather is an autonomous intermediate type of vertebra. It occurs when the point of contact of the pelvis with the vertebral column is slightly cranial or caudal to its normal position. The resulting formative stimulus on the vertebral ossification centers, sagittally still separated, causes the various morphologies seen in LTV including the asymmetric variations.
In contrast to lampreys and jawed vertebrates, hagfishes were thought to lack vertebrae. Now, long overlooked vertebral rudiments have been analysed in hagfish, suggesting that vertebrae existed in the last common ancestor of all vertebrates.
Camp, Jon; Zhao, Kristin; Morel, Etienne; White, Dan; Magnuson, Dixon; Gay, Ralph; An, Kai-Nan; Robb, Richard
We hypothesize that the vertebra-to-vertebra patterns of spinal flexion and extension motion of persons with lower back pain will differ from those of persons who are pain-free. Thus, it is our goal to measure the motion of individual lumbar vertebrae noninvasively from dynamic fluoroscopic sequences. Two-dimensional normalized mutual information-based image registration was used to track frame-to-frame motion. Software was developed that required the operator to identify each vertebra on the first frame of the sequence using a four-point "caliper" placed at the posterior and anterior edges of the inferior and superior end plates of the target vertebrae. The program then resolved the individual motions of each vertebra independently throughout the entire sequence. To validate the technique, 6 cadaveric lumbar spine specimens were potted in polymethylmethacrylate and instrumented with optoelectric sensors. The specimens were then placed in a custom dynamic spine simulator and moved through flexion-extension cycles while kinematic data and fluoroscopic sequences were simultaneously acquired. We found strong correlation between the absolute flexionextension range of motion of each vertebra as recorded by the optoelectric system and as determined from the fluoroscopic sequence via registration. We conclude that this method is a viable way of noninvasively assessing twodimensional vertebral motion.
Zernicke, R. F.; Vailas, A. C.; Grindeland, R. E.; Kaplansky, A.; Salem, G. J.; Martinez, D. A.
The biomechanical and biochemical responses of lumbar vertebral bodies during a 12.5-day spaceflight (Cosmos 1887 biosatellite) were determined for rapidly growing rats (90-day-old, Czechoslovakian-Wistar). By use of age-matched vivarium controls (normal cage environment) and synchronous controls (simulated flight conditions), as well as a basal control group (killed before lift-off on the 1st day of flight), the combined influences of growth and space-flight could be examined. Centra of the sixth lumbar vertebrae (L6) were compressed to 50% strain at a fast strain rate while immersed in physiological buffer (37 degrees C). The body masses of vivarium and synchronous controls were significantly heavier than either the flight or basal controls. The flight group had an L6 vertebral body compressional stiffness that was 39% less than the vivarium controls, 47% less than the synchronous control, and 16% less than the basal controls. In addition, the average initial maximum load of the flight L6 was 22% less than vivarium controls and 18% less than the synchronous controls, whereas the linear compressional load of the flight group averaged 34% less than the vivarium and 25% less than the synchronous groups. The structural properties of the vertebrae from the 12.5-day-younger basal group closely resembled the flight vertebrae. Calcium, phosphorous, and hydroxyproline concentrations were not significantly different among the groups. Nevertheless, the lack of strength and stiffness development in spaceflight, coupled with a smaller proportion of mature hydroxypyridinoline cross-links, suggested that the 12.5 days of spaceflight slowed the maturation of trabecular bone in the vertebral bodies of rapidly growing rats.
Chen, Xinmin; Milne, Nick; O'Higgins, Paul
The present study was designed to investigate how the form of the marsupial thoracolumbar vertebrae varies to cope with the particular demands of diverse loading and locomotor behaviors. The vertebral columns of 10 species of Macropodidae, with various body masses and modes of locomotion, together with two other arboreal marsupials, koala and cuscus, were selected. Seventy-four three-dimensional landmark coordinates were acquired on each of the 10 last presacral vertebrae of the 70 vertebral columns. The interspecific variations of the third lumbar vertebra (L3, which approximates the mean) and the transitional patterns of the thoracolumbar segments were examined using the combined approach of generalized Procrustes analysis (GPA) and principal components analysis (PCA). The results of analyses of an individual vertebra (L3) and of the transitional patterns indicate significant interspecific differences. In the L3 study the first PC shows allometric shape variation, while the second PC seems to relate to adaptation for terrestrial versus arboreal locomotion. When the L3 vertebrae of the common spotted cuscus and koala are included for comparison, the vertebra of the tree kangaroo occupies an intermediate position between the hopping kangaroo and these arboreal marsupials. The L3 vertebrae in the arboreal marsupials possess a distinct dorsoventrally expanded vertebral body, and perpendicularly orientated spinous and transverse processes. The results of the present study suggest that vertebral shape in the kangaroo and wallaroos provides a structural adaptation to hopping through a relatively enlarged loading area and powerful lever system. In contrast, the small-sized bettongs (or rat kangaroos) have a relatively flexible column and elongated levers for the action of back muscles that extend and laterally flex the spine. The complex pattern of vertebral shape transition in the last 10 presacral vertebrae was examined using PCAs that compare between species
Jancuska, Jeffrey M.; Spivak, Jeffrey M.
Background Lumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant associated with altered patterns of degenerative spine changes. This review will focus on the clinical significance of LSTV, disruptions in normal spine biomechanics, imaging techniques, diagnosis, and treatment. Methods A Pubmed search using the specific key words “LSTV,” “lumbosacral transitional vertebrae,” and “Bertolotti's Syndrome” was performed. The resulting group of manuscripts from our search was evaluated. Results LSTV are associated with alterations in biomechanics and anatomy of spinal and paraspinal structures, which have important implications on surgical approaches and techniques. LSTV are often inaccurately detected and classified on standard AP radiographs and MRI. The use of whole-spine images as well as geometric relationships between the sacrum and lumbar vertebra increase accuracy. Uncertainty regarding the cause, clinical significance, and treatment of LSTV persists. Some authors suggest an association between LSTV types II and IV and low back pain. Pseudoarticulation between the transverse process and the sacrum creates a “false joint” susceptible to arthritic changes and osteophyte formation potentially leading to nerve root entrapment. The diagnosis of symptomatic LSTV is considered with appropriate patient history, imaging studies, and diagnostic injections. A positive radionuclide study along with a positive effect from a local injection helps distinguish the transitional vertebra as a significant pain source. Surgical resection is reserved for a subgroup of LSTV patients who fail conservative treatment and whose pain is definitively attributed to the anomalous pseudoarticulation. Conclusions Due to the common finding of low back pain and the wide prevalence of LSTV in the general population, it is essential to differentiate between symptoms originating from an anomalous psuedoarticulation from other potential
Park, Young-Seop; Hyun, Seung-Jae; Choi, Ho Yong; Kim, Ki-Jeong; Jahng, Tae-Ahn
OBJECTIVE The aim of this study was to investigate the risk of upper instrumented vertebra (UIV) fractures associated with UIV screw fixation (unicortical vs bicortical) and polymethylmethacrylate (PMMA) augmentation after adult spinal deformity surgery. METHODS A single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥ 4 levels (that is, the lower instrumented vertebra at the sacrum or pelvis and the UIV of the thoracolumbar spine [T9-L2]) were retrospectively reviewed. Age, sex, follow-up duration, sagittal UIV angle immediately postoperatively including several balance-related parameters (lumbar lordosis [LL], pelvic incidence, and sagittal vertical axis), bone mineral density, UIV screw fixation type, UIV PMMA augmentation, and UIV fracture were evaluated. Patients were divided into 3 groups: Group U, 15 patients with unicortical screw fixation at the UIV; Group P, 16 with bicortical screw fixation and PMMA augmentation at the UIV; and Group B, 21 with bicortical screw fixation without PMMA augmentation at the UIV. RESULTS The mean number of levels fused was 6.5 ± 2.5, 7.5 ± 2.5, and 6.5 ± 2.5; the median age was 50 ± 29, 72 ± 6, and 59 ± 24 years; and the mean follow-up was 31.5 ± 23.5, 13 ± 6, and 24 ± 17.5 months in Groups U, P, and B, respectively (p > 0.05). There were no significant differences in balance-related parameters (LL, sagittal vertical axis, pelvic incidence-LL, and so on) among the groups. UIV fracture rates in Groups U (0%), P (31.3%), and B (42.9%) increased in sequence by group (p = 0.006). UIV bicortical screw fixation increased the risk for UIV fracture (OR 5.39; p = 0.02). CONCLUSIONS Bicortical screw fixation at the UIV is a major risk factor for early UIV compression fracture, regardless of whether a thoracolumbosacral orthosis is used. To reduce the proximal junctional failure, unicortical screw fixation at the UIV is essential in adult spinal deformity correction surgery.
Holte, D C; Winter, R B; Lonstein, J E; Denis, F
The results of anterior and posterior excision or wedge resection of a hemivertebra and arthrodesis of the spine were reviewed retrospectively for thirty-seven patients. The degree of correction that was obtained and maintained, the balance and alignment of the trunk, changes in pelvic obliquity, and associated complications were evaluated. The average age at the time of the operation was twelve years (range, six months to forty-two years). The average duration of follow-up was six years (range, two to nineteen years). The resection was at the mid-thoracic level in six patients, at the thoracolumbar level in nine, at the mid-lumbar level in seven, and at the lumbosacral level in seventeen. (Two patients had an excision of a hemivertebra at two levels.) Instrumentation was used in twenty-eight patients. Postoperatively, all patients were managed with a body cast, with a unilateral or bilateral pantaloon extension, for four to six months. The instrumentation allowed early walking and the use of a unilateral rather than a bilateral pantaloon extension. The index curve (the curve containing the hemivertebra) averaged 54 degrees (range, 18 to 132 degrees) preoperatively, 33 degrees (range, 0 to 105 degrees) postoperatively, and 35 degrees (range, 0 to 110 degrees) at the most recent follow-up evaluation. A measurable improvement in balance was achieved and maintained in nineteen patients. Pelvic obliquity did not change appreciably, as it was related primarily to limb-length inequality in this series. Complications included a temporary nerve-root lesion in seven patients, a permanent neurological deficit involving the first sacral nerve root in one patient, a pseudarthrosis in three patients, and a wound infection in three patients. Six patients had extension of the arthrodesis to include additional vertebrae.
Amonoo-Kuofi, H S; el-Badawi, M G; Fatani, J A; Butt, M M
The lumbosacral spines of two fetal and twelve adult cadavers have been studied by dissection. Evidence shows that the fifth lumbar intervertebral foramen is crossed on its external aspect by a strong, cord-like corporotransverse ligament passing obliquely downwards, forwards and medially from the inferior aspect of the accessory process of the fifth lumbar vertebra to the lateral surface of the intervertebral disc and the adjacent parts of the bodies of the fifth and first sacral vertebrae. Superficially, the ligament is related to another flat band--the lumbosacral hood. Together these ligaments separate and provide openings for the sympathetic ramus, the ventral ramus and blood vessels related to the intervertebral foramen. On the dorsal aspect, a tripartite ligament, the mamillo-transverso-accessory ligament, bears important relationships to the subdivisions of the dorsal ramus and also the zygapophyseal joint. The significance of these findings is discussed. Images Fig. 2 Fig. 3 Fig. 4 Fig. 1 Fig. 5 PMID:3248957
Raoult, Vincent; Peddemors, Victor M; Zahra, David; Howell, Nicholas; Howard, Daryl L; de Jonge, Martin D; Williamson, Jane E
Determining the age of sharks using vertebral banding is a vital component of management, but the causes of banding are not fully understood. Traditional shark ageing is based on fish otolith ageing methods where growth bands are assumed to result from varied seasonal calcification rates. Here we investigate these assumptions by mapping elemental distribution within the growth bands of vertebrae from six species of sharks representing four different taxonomic orders using scanning x-ray fluorescence microscopy. Traditional visual growth bands, determined with light microscopy, were more closely correlated to strontium than calcium in all species tested. Elemental distributions suggest that vertebral strontium bands may be related to environmental variations in salinity. These results highlight the requirement for a better understanding of shark movements, and their influence on vertebral development, if confidence in age estimates is to be improved. Analysis of shark vertebrae using similar strontium-focused elemental techniques, once validated for a given species, may allow more successful estimations of age on individuals with few or no visible vertebral bands.
Raoult, Vincent; Peddemors, Victor M.; Zahra, David; Howell, Nicholas; Howard, Daryl L.; de Jonge, Martin D.; Williamson, Jane E.
Determining the age of sharks using vertebral banding is a vital component of management, but the causes of banding are not fully understood. Traditional shark ageing is based on fish otolith ageing methods where growth bands are assumed to result from varied seasonal calcification rates. Here we investigate these assumptions by mapping elemental distribution within the growth bands of vertebrae from six species of sharks representing four different taxonomic orders using scanning x-ray fluorescence microscopy. Traditional visual growth bands, determined with light microscopy, were more closely correlated to strontium than calcium in all species tested. Elemental distributions suggest that vertebral strontium bands may be related to environmental variations in salinity. These results highlight the requirement for a better understanding of shark movements, and their influence on vertebral development, if confidence in age estimates is to be improved. Analysis of shark vertebrae using similar strontium-focused elemental techniques, once validated for a given species, may allow more successful estimations of age on individuals with few or no visible vertebral bands. PMID:27424768
Gao, Maofeng; Zou, Jun; Zhang, Zhigang; Luo, Zongping; Yang, Huilin
Pedicle-lengthening osteotomy (PLO) is a minimally invasive and effective surgical procedure for lumbar spinal stenosis syndrome. Compared with traditional surgery, PLO can effectively enlarge the spinal canal while minimizing the disruption of posterior anatomical structures of the lumbar vertebra, leading to reduced postoperative perineural scarring adhesion and good clinical outcomes using minimally invasive procedures. However, PLO is still in its early stages, and only a few relevant experimental and clinical studies have been reported. The present study was performed to investigate the influence of PLO on the stability of lumbar vertebrae. The results indicated that PLO can effectively enlarge the spinal canal, and no lumbar spondylolisthesis or other complications occurred in this study. Moreover, this procedure does not significantly affect the stability of the lumbar spine, suggesting a possible clinical application. PMID:27347315
Gupta, S P; Agarwal, Anil
Intraosseous neurilemmoma (schwannoma) is a rare bone tumor with incidence less than 0.2% of all primary bone tumors. It is a benign neoplasm arising from the schwann cells of the nerve sheath. When they occur, they are usually found in the mandible. This paper reports an unusual occurrence of intraosseous neurilemmoma in L2 vertebral body. This patient presented with complaints of backache and progressively increasing weakness in both lower limbs. Roetengenograms showed an osteolytic lesion of L2 vertebra localized in the left half of the body and pedicle. Computed tomograph revealed a large soft tissue component of the tumor mass with thecal sac compression. A computed tomograph assisted needle biopsy revealed the tumor to be neurilemmoma. Subsequently, during decompression, it was possible to shell out tumor from surrounding tissues. Remaining tumor was curettedfrom bone and the cavity packed with autograft. The recovery was uneventful with incorporation of graft. The aim of this article is to highlight intraosseous neurilemmoma as a possible differential diagnosis in bony tumors. Intraosseous neurilemmoma of lumbar vertebrae is an extremely rare occurrence and till date only four cases are reported in English literature.
Choudhury, A R; Taylor, J C
Twenty-eight patients presenting with low back pain, associated with sciatic or femoral neuropathy, were found to have lateral recess stenosis occurring as a result of hypertrophy of the facet joints, with preservation within normal limits of the sagittal AP diameter of the lumbar canal. Pathology was believed to be traumatic in origin, and the variable nature of the adhesions suggested recurrent inflammation; the hypertrophy of the facet joints may have been the result of traumatic inflammatory hyperaemia. Radiological investigations were unhelpful. The diagnosis of the condition was made at the time of surgical exploration by the findings of alteration of the facet joints, adhesions and fixity of the nerve roots, normal sagittal AP diameter of the canal, and absence of other significant lesions. Gratifying results were obtained with decompression by wide laminectomy with excision of overhanging facet joints and release of adhesions. PMID:894321
Hassel, B; Farman, A G
Lateral cephalometric and left hand-wrist radiographs from the Bolton-Brush Growth Center at Case Western Reserve University were reviewed a posteriori to develop a cervical vertebrae maturation index (CVMI). By using the lateral profiles of the second, third and fourth cervical vertebrae, it was possible to develop a reliable ranking of patients according to the potential for future adolescent growth potential.
Engelke, Elisabeth C; Post, Christina; Pfarrer, Christiane D; Sager, Martin; Waibl, Helmut R
The incidence of human spinal column disease remains high, and animal models still play important roles in prophylactic, diagnostic, and therapeutic research. Because of their similar size to humans, pigs remain an important spine model. For pigs to serve as a model for the human spine, basic similarities and differences must be understood. In this study, morphometric data of the lumbar spine of Munich miniature pigs (Troll) were recorded radiologically, evaluated, and compared with recorded human data. Whereas humans have a constant number of 5 lumbar vertebrae, Munich minipigs had 5 or 6 lumbar vertebrae. Compared with their human counterparts, the lumbar vertebral bodies of the minipigs were remarkably larger in the craniocaudal (superior–inferior) direction and considerably smaller in the dorsoventral and laterolateral directions. The porcine vertebral canal was smaller than the human vertebral canal. The spinal cord extended into the caudal part of the porcine lumbar vertebral canal and thus did not terminate as cranial, as seen in humans. The lumbar intervertebral spaces of the pig were narrower in craniocaudal direction than human intervertebral spaces. These differences need to be considered when planning surgical actions, not only to avoid pain and irreversible damage to the minipigs but also to achieve accurate scientific results. PMID:27177570
Leichtle, C. I.; Rothstock, S.; Happel, J.; Walter, F.; Shiozawa, T.; Leichtle, U. G.
Objectives Cement augmentation of pedicle screws could be used to improve screw stability, especially in osteoporotic vertebrae. However, little is known concerning the influence of different screw types and amount of cement applied. Therefore, the aim of this biomechanical in vitro study was to evaluate the effect of cement augmentation on the screw pull-out force in osteoporotic vertebrae, comparing different pedicle screws (solid and fenestrated) and cement volumes (0 mL, 1 mL or 3 mL). Materials and Methods A total of 54 osteoporotic human cadaver thoracic and lumbar vertebrae were instrumented with pedicle screws (uncemented, solid cemented or fenestrated cemented) and augmented with high-viscosity PMMA cement (0 mL, 1 mL or 3 mL). The insertion torque and bone mineral density were determined. Radiographs and CT scans were undertaken to evaluate cement distribution and cement leakage. Pull-out testing was performed with a material testing machine to measure failure load and stiffness. The paired t-test was used to compare the two screws within each vertebra. Results Mean failure load was significantly greater for fenestrated cemented screws (+622 N; p ⩽ 0.001) and solid cemented screws (+460 N; p ⩽ 0.001) than for uncemented screws. There was no significant difference between the solid and fenestrated cemented screws (p = 0.5). In the lower thoracic vertebrae, 1 mL cement was enough to significantly increase failure load, while 3 mL led to further significant improvement in the upper thoracic, lower thoracic and lumbar regions. Conclusion Conventional, solid pedicle screws augmented with high-viscosity cement provided comparable screw stability in pull-out testing to that of sophisticated and more expensive fenestrated screws. In terms of cement volume, we recommend the use of at least 1 mL in the thoracic and 3 mL in the lumbar spine. Cite this article: C. I. Leichtle, A. Lorenz, S. Rothstock, J. Happel, F. Walter, T. Shiozawa, U. G. Leichtle. Pull
Jia, Pu; Tang, Hai; Chen, Hao; Bao, Li; Feng, Fei; Yang, He; Li, Jinjun
A sandwich vertebra is formed after multiple osteoporotic vertebral fractures treated by percutaneous vertebroplasty, which has a risk of developing new fractures. The purpose of our study was to (i) investigate the occurrence of new fractures in sandwich vertebra after cement augmentation procedures and to (ii) evaluate the clinical outcomes after prophylactic vertebral reinforcement applied with resorbable bone cement. From June 2011 to 2014, we analysed 55 patients with at least one sandwich vertebrae and treated with percutaneous vertebroplasty. Eighteen patients were treated by prophylactic vertebroplasty with a resorbable bone cement to strengthen the sandwich vertebrae as the prevention group. The others were the non-prevention group. All patients were examined by spinal radiographs within 1 day, 6 months, 12 months, 24 months and thereafter. The incidence of sandwich vertebra is 8.25% (55/667) in our study. Most sandwich vertebrae (69.01%, 49/71) are distributed in the thoracic–lumbar junction. There are 24 sandwich vertebrae (18 patients) and 47 sandwich vertebrae (37 patients) in either prevention group or non-prevention group, respectively. No significant difference is found between age, sex, body mass index, bone mineral density, cement disk leakage, sandwich vertebrae distribution or Cobb angle in the two groups. In the follow-up, 8 out of 37 (21.6%) patients (with eight sandwich vertebrae) developed new fractures in non-prevention’ group, whereas no new fractures were detected in the prevention group. Neither Cobb angle nor vertebral compression rate showed significant change in the prevention group during the follow-up. However, in the non-prevention group, we found that Cobb angle increased and vertebral height lost significantly (P < 0.05). Prophylactic vertebroplasty procedure applied with resorbable bone cement could decrease the rate of new fractures of sandwich vertebrae. PMID:28149529
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, ...
A hemangioma is a non-cancerous (benign) growth of blood vessels. They are the most common benign blood vessel ( ... time and occasionally with medication. Large or disfiguring hemangiomas may require surgical excision.
Ko, Sanghyung; Park, Noh Kyoung; Cho, Kyoung Jin; Baek, Jung Hyun; Lim, Jeong-Wook; Choi, Dongjin
Intestinal entrapment between two vertebral bodies is very rare. In all previous cases, it occurred by major trauma. However, the bowel entrapment between two vertebral bodies without trauma has never been reported, not to mention as the cause of lower extremity radicular pain. We describe the case of an 82-year-old female patient with right lower extremity radicular pain without recent trauma history. The patient was diagnosed sigmoid colon entrapment between the L5 and S1 vertebrae by lumbar spinal computerized tomography and magnetic resonance imaging, and showed improvement in radicular pain after manual reduction of interpositioned colon during surgery. Intestinal entrapment between two vertebrae without trauma is caused by degenerative and vacuum changes of the intervertebral disc combined with the anterior longitudinal ligament injury. PMID:26619145
Sparrey, Carolyn J; Bailey, Jeannie F; Safaee, Michael; Clark, Aaron J; Lafage, Virginie; Schwab, Frank; Smith, Justin S; Ames, Christopher P
The goal of this review is to discuss the mechanisms of postural degeneration, particularly the loss of lumbar lordosis commonly observed in the elderly in the context of evolution, mechanical, and biological studies of the human spine and to synthesize recent research findings to clinical management of postural malalignment. Lumbar lordosis is unique to the human spine and is necessary to facilitate our upright posture. However, decreased lumbar lordosis and increased thoracic kyphosis are hallmarks of an aging human spinal column. The unique upright posture and lordotic lumbar curvature of the human spine suggest that an understanding of the evolution of the human spinal column, and the unique anatomical features that support lumbar lordosis may provide insight into spine health and degeneration. Considering evolution of the skeleton in isolation from other scientific studies provides a limited picture for clinicians. The evolution and development of human lumbar lordosis highlight the interdependence of pelvic structure and lumbar lordosis. Studies of fossils of human lineage demonstrate a convergence on the degree of lumbar lordosis and the number of lumbar vertebrae in modern Homo sapiens. Evolution and spine mechanics research show that lumbar lordosis is dictated by pelvic incidence, spinal musculature, vertebral wedging, and disc health. The evolution, mechanics, and biology research all point to the importance of spinal posture and flexibility in supporting optimal health. However, surgical management of postural deformity has focused on restoring posture at the expense of flexibility. It is possible that the need for complex and costly spinal fixation can be eliminated by developing tools for early identification of patients at risk for postural deformities through patient history (genetics, mechanics, and environmental exposure) and tracking postural changes over time.
Macintosh, J E; Bogduk, N
The lumbar erector spinae consists of two muscles--iliocostalis lumborum and longissimus thoracis--each with distinct thoracic and lumbar parts. The thoracic parts consist of tiny muscle bellies with segmental origins from the thorax and long caudal tendons that form the erector spinae aponeurosis. The lumbar fibers arise from the lumbar accessory processes and the L1-4 transverse processes, and insert independently of the erector spinae aponeurosis into the ilium. The intrinsic lumbar fibers of the erector spinae are poorly described in the literature, and the existence of the iliocostalis lumborum pars lumborum has rarely been recognized even though it constitutes a substantial portion of the total muscle mass acting directly on the lumbar vertebrae.
Parmar, K A; Solomon, M; Loefler, A; Dalton, S
A case report is presented of a patient with an anterosuperior osteophytic bone bridge of the sacroiliac joint causing lumbar back pain. After prolonged physiotherapy, the bone bridge was excised, with complete resolution of the symptoms. Excision should only be considered in cases of symptomatic sacroiliac joint pain that does not respond to rehabilitation programmes and conservative treatment.
Ogden, Kent; Ordway, Nathaniel; Diallo, Dalanda; Tillapaugh-Fay, Gwen; Aslan, Can
3D printer applications in the biomedical sciences and medical imaging are expanding and will have an increasing impact on the practice of medicine. Orthopedic and reconstructive surgery has been an obvious area for development of 3D printer applications as the segmentation of bony anatomy to generate printable models is relatively straightforward. There are important issues that should be addressed when using 3D printed models for applications that may affect patient care; in particular the dimensional accuracy of the printed parts needs to be high to avoid poor decisions being made prior to surgery or therapeutic procedures. In this work, the dimensional accuracy of 3D printed vertebral bodies derived from CT data for a cadaver spine is compared with direct measurements on the ex-vivo vertebra and with measurements made on the 3D rendered vertebra using commercial 3D image processing software. The vertebra was printed on a consumer grade 3D printer using an additive print process using PLA (polylactic acid) filament. Measurements were made for 15 different anatomic features of the vertebral body, including vertebral body height, endplate width and depth, pedicle height and width, and spinal canal width and depth, among others. It is shown that for the segmentation and printing process used, the results of measurements made on the 3D printed vertebral body are substantially the same as those produced by direct measurement on the vertebra and measurements made on the 3D rendered vertebra.
Semlali, S; Fikri, M; Nassar, I; El Quessar, A; El Hassani, Mr; Chakir, N; Jiddane, M
The authors report three cases of non-tuberculous epidural abscess. Presenting symptoms included lumbar back pain, muscle spasms, soft tIssue swelling, and neurological deficits in all three cases. MR imaging was helpful for diagnosis and showed involvement of perivertebral soft tissues and an epidural abscess of variable size. There was no significant involvement of intervertebral disks or vertebrae. Diagnosis was confirmed by bacteriologic exam. Clinical outcome was favourable with antibiotic treatment.
Feltrin, G P; Macchi, V; Saccavini, C; Tosi, E; Dus, C; Fassina, A; Parenti, A; De Caro, R
Osteoporosis is characterized by bone mineral density (BMD) decreasing and spongy bone rearrangement with consequent loss of elasticity and increased bone fragility. Quantitative computed tomography (QCT) quantifies bone mineral content but does not describe spongy architecture. Analysis of trabecular pattern may provide additional information to evaluate osteoporosis. The aim of this study was to determine whether the fractal analysis of the microradiography of lumbar vertebrae provides a reliable assessment of bone texture, which correlates with the BMD. The lumbar segment of the spine was removed from 22 cadavers with no history of back pain and examined with standard x-ray, traditional tomography, and quantitative computed tomography to measure BMD. The fractal dimension, which quantifies the image fractal complexity, was calculated on microradiographs of axial sections of the fourth lumbar vertebra to determine its characteristic spongy network. The relationship between the values of the BMD and those of the fractal dimension was evaluated by linear regression and a statistically significant correlation (R = 0.96) was found. These findings suggest that the application of fractal analysis to radiological analyses can provide valuable information on the trabecular pattern of vertebrae. Thus, fractal dimensions of trabecular bone structure should be considered as a supplement to BMD evaluation in the assessment of osteoporosis.
Long, L. Rodney; Thoma, George R.
We are currently working toward developing computer-assisted methods for the indexing of a collection of 17,000 digitized x-ray images by biomedical content. These images were collected as part of a nationwide health survey and form a research resource for osteoarthitis and bone morphometry. This task requires the development of algorithms to robustly analyze the x-ray contents for key landmarks, to segment the vertebral bodies, to accurately measure geometric features of the individual vertebrae and inter-vertebral areas, and to classify the spine anatomy into normal or abnormal classes for conditions of interest, including anterior osteophytes and disc space narrowing. Subtasks of this work have been created and divided among collaborators. In this paper, we provide a technical description of the overall task, report on progress made by collaborators, and provide the most recent results of our own research into obtaining first-order location of the spine region of interest by automated methods. We are currently concentrating on images of the cervical spine, but will expand the work to include the lumbar spine as well. Development of successful image processing techniques for computer-assisted indexing of medical image collections is expected to have a significant impact within the medical research and patient care systems.
Ehm, Matthias; Klinder, Tobias; Kneser, Reinhard; Lorenz, Cristian
In this paper, we describe and compare methods for automatically identifying individual vertebrae in arbitrary CT images. The identification is an essential precondition for a subsequent model-based segmentation, which is used in a wide field of orthopedic, neurological, and oncological applications, e.g., spinal biopsies or the insertion of pedicle screws. Since adjacent vertebrae show similar characteristics, an automated labeling of the spine column is a very challenging task, especially if no surrounding reference structures can be taken into account. Furthermore, vertebra identification is complicated due to the fact that many images are bounded to a very limited field of view and may contain only few vertebrae. We propose and evaluate two methods for automatically labeling the spine column by evaluating similarities between given models and vertebral objects. In one method, object boundary information is taken into account by applying a Generalized Hough Transform (GHT) for each vertebral object. In the other method, appearance models containing mean gray value information are registered to each vertebral object using cross and local correlation as similarity measures for the optimization function. The GHT is advantageous in terms of computational performance but cuts back concerning the identification rate. A correct labeling of the vertebral column has been successfully performed on 93% of the test set consisting of 63 disparate input images using rigid image registration with local correlation as similarity measure.
Quilici, F.A.; Cordeiro, F.; Reis, J.A.; Kagohara, O.; Simões Neto, J.
The main controversy of colon-rectal laparoscopic surgery comes from its use as a cancer treatment. Two points deserve special attention: the incidence of portsite tumor implantation and the possibility of performing radical cancer surgery, such as total mesorectum excision. Once these points are addressed, the laparoscopic approach will be used routinely to treat rectal cancer. To clarify these points, 32 patients with cancer of the lower rectum participated in a special protocol that included preoperative radiotherapy and laparoscopic total mesorectum excision. All data were recorded. At the same time, all data recorded from the experience of a multicenter laparoscopic group (Brazilian Colorectal Laparoscopic Surgeons – 130 patients with tumor of the lower rectum) were analyzed and compared with the data provided by our patients. Analysis of the results suggests that a laparoscopic approach allows the same effective resection as that of conventional surgery and that preoperative irradiation does not influence the incidence of intraoperative complications. The extent of lymph nodal excision is similar to that obtained with open surgery, with an average of 12.3 lymph nodes dissected per specimen. The rate of local recurrence was 3.12%. No port site implantation of tumor was noted in this series of patients with cancer of the lower rectum. PMID:12113422
Bontempo, Nicholas A; Weiss, Arnold-Peter C
Arthroscopy is an advancing field in orthopedics, the applications of which have been expanding over time. Traditionally, excision of ganglion cysts has been done in an open fashion. However, more recently, studies show outcomes following arthroscopic excision to be as good as open excision. Cosmetically, the incisions are smaller and heal faster following arthroscopy. In addition, there is the suggested benefit that patients will regain function and return to work faster following arthroscopic excision. More prospective studies comparing open and arthroscopic excision of ganglion cysts need to be done in order to delineate if there is a true functional benefit.
Putzer, Michael; Ehrlich, Ingo; Rasmussen, John; Gebbeken, Norbert; Dendorfer, Sebastian
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.
Forsberg, Daniel; Sjöblom, Erik; Sunshine, Jeffrey L
The purpose of this study was to investigate the potential of using clinically provided spine label annotations stored in a single institution image archive as training data for deep learning-based vertebral detection and labeling pipelines. Lumbar and cervical magnetic resonance imaging cases with annotated spine labels were identified and exported from an image archive. Two separate pipelines were configured and trained for lumbar and cervical cases respectively, using the same setup with convolutional neural networks for detection and parts-based graphical models to label the vertebrae. The detection sensitivity, precision and accuracy rates ranged between 99.1-99.8, 99.6-100, and 98.8-99.8% respectively, the average localization error ranges were 1.18-1.24 and 2.38-2.60 mm for cervical and lumbar cases respectively, and with a labeling accuracy of 96.0-97.0%. Failed labeling results typically involved failed S1 detections or missed vertebrae that were not fully visible on the image. These results show that clinically annotated image data from one image archive is sufficient to train a deep learning-based pipeline for accurate detection and labeling of MR images depicting the spine. Further, these results support using deep learning to assist radiologists in their work by providing highly accurate labels that only require rapid confirmation.
Minars, Michael; Burch, James; Masella, Richard; Meister, Malcolm
This study's objective was to familiarize the profession with determining skeletal maturation and skeletal age, and predicting growth potential by using cervical vertebrae images of lateral cephalograms. The investigation was done through repeated evaluations of 30 randomly selected, pretreatment lateral cepaholometric radiographs. The accuracy of determining skeletal age and growth potential with lateral cephalograms was found to be R=0.98 (highly accurate) by statistical analysis.
Roshi, D. A.
Radio frequency interference (RFI) is increasingly affecting radio astronomy research. A few years ago, active research to investigate the possibility of observing in the presence of interference using RFI mitigation techniques was initiated. In this paper, I briefly discuss four RFI mitigation/excision projects. These projects are:- (1) A technique to suppress double sideband amplitude modulated interference in which I show that an astronomical signal in the presence of a DSB interference can be observed with a signal-to-noise ratio factor of 2 less compared to observations if the RFI were not present. (2) Techniques to suppress interference due to synchronization signals in composite video signals are presented. A combination of noise-free modelling of the synchronization signals and adaptive filtering is used for suppressing the interference. (3) Design techniques to minimize spurious pick-up at the analog input of an analog-to-digital converter are discussed. (4) Spectral RFI excision using a spectral channel weighted scheme and its application to Green Bank telescope observations are also presented.
Barden, Howard S; Markwardt, Paul; Payne, Randy; Hawkins, Brent; Frank, Matt; Faulkner, Kenneth G
Modern bone densitometry systems using dual-energy X-ray absorptiometry (DXA) automatically analyze lumbar spine scans and provide clinically important information concerning spine bone mineral density (BMD) and fracture risk. Lumbar spine BMD accurately reflects skeletal health and fracture risk in most cases, but degenerative diseases associated with aging may lead to the formation of reactive bone (osteophytes) and other confounding conditions that elevate BMD without a concomitant increase in bone strength or decrease in fracture risk. Automated densitometry software known as computer-aided densitometry (CAD) (GE Medical Systems Lunar) assists the user in identifying scans with common acquisition and analysis irregularities known to influence BMD values. Visual examination of 231 female spine scans measured with DXA found abnormal conditions that could influence BMD results in 29% of scans. The sensitivity and specificity of several criteria for identifying scans with conditions that could influence BMD were determined. A good criterion for identifying scans with abnormal conditions was a T-score difference of greater than 0.9 or 1.0 between L1-L4 mean and individual vertebrae. Criteria for excluding affected vertebrae were determined. Exclusion of affected vertebrae resulted in a mean BMD decrease of nearly 0.6 SD (T-score) among affected scans.
Ediriweera, E R H S S; Gunathilka, H D P; Weerasinghe, K D C M; Kalawana, O T M R K S B
According to Ayurveda, Kati Shoola is a disease with pain in lumbar region. Lumbar spondylolisthesis, anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below, is one of the common causes. Current case study was carried out at Ayurveda Teaching hospital, Borella, to evaluate the efficacy of a treatment regimen used by Sri Lankan traditional physician family "Weerasinghe." A 59-year-old female with a 9-month history of lumbar spondylolisthesis was treated with this regimen. The patient had progressive pain in left lower back, right and left buttocks, and difficulty in bending forward over 5°. X-ray of lumbo sacral region indicated that patient was suffering from Grade 3 lumbar spondylolisthesis. She was treated for 65 days with four treatment packages consisting of 13 prepared medicines. The response to the treatment was recorded and therapeutic effects were evaluated through symptomatic relief. Clinical symptoms were significantly reduced and degree of anterior flexion increased from 5° to 90°. However, X-rays indicated that the patient was still suffering from Grade 3 lumbar spondylolisthesis. This regimen is effective in successfully treating Kati Shoola (lumbar spondylolisthesis) by helping to reduce the symptoms and improving the degree of anterior flexion.
Ediriweera, E. R. H. S. S.; Gunathilka, H. D. P.; Weerasinghe, K. D. C. M.; Kalawana, O. T. M. R. K. S. B.
According to Ayurveda, Kati Shoola is a disease with pain in lumbar region. Lumbar spondylolisthesis, anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below, is one of the common causes. Current case study was carried out at Ayurveda Teaching hospital, Borella, to evaluate the efficacy of a treatment regimen used by Sri Lankan traditional physician family “Weerasinghe.” A 59-year-old female with a 9-month history of lumbar spondylolisthesis was treated with this regimen. The patient had progressive pain in left lower back, right and left buttocks, and difficulty in bending forward over 5°. X-ray of lumbo sacral region indicated that patient was suffering from Grade 3 lumbar spondylolisthesis. She was treated for 65 days with four treatment packages consisting of 13 prepared medicines. The response to the treatment was recorded and therapeutic effects were evaluated through symptomatic relief. Clinical symptoms were significantly reduced and degree of anterior flexion increased from 5° to 90°. However, X-rays indicated that the patient was still suffering from Grade 3 lumbar spondylolisthesis. This regimen is effective in successfully treating Kati Shoola (lumbar spondylolisthesis) by helping to reduce the symptoms and improving the degree of anterior flexion. PMID:24049411
Stemper, Brian D; Yoganandan, Narayan; Baisden, Jamie L; Umale, Sagar; Shah, Alok S; Shender, Barry S; Paskoff, Glenn R
Experimental testing incorporating lumbar columns and isolated components is essential to advance the understanding of injury tolerance and for the development of safety enhancements. This study incorporated a whole column axial acceleration model and an isolated vertebral body model to quantify compression rates during realistic loading and compressive tolerance of vertebrae. Eight lumbar columns and 53 vertebral bodies from 23 PMHS were used. Three-factor ANOVA was used to determine significant differences (p<0.05) in physiologic and failure biomechanics based on compression rate, spinal level, and gender. Results demonstrated a significant increase in ultimate force (i.e., fracture) from lower to higher compression rates. Ultimate stress also increased with compression rate. Displacement and strain to failure were consistent at both compression rates. Differences in ultimate mechanics between vertebral bodies obtained from males and females demonstrated non-significant trends, with female vertebral bodies having lower ultimate force that would be associated with decreased injury tolerance. This was likely a result of smaller vertebrae in that population. Combined with existing literature, results presented in this manuscript contribute to the understanding of lumbar spine tolerance during axial loading events that occur in both military and civilian environments with regard to effects of compression rate and gender.
Debove, Clotilde; Lefèvre, Jérémie H; Parc, Yann
On the same principle than total mesorectal excision in rectal cancer, the effect of complete mesocolic excision on short and long-term outcomes is actually evaluated for colonic adenocarcinoma. This method, usually performed for left colectomy, offers a surgical specimen of higher quality, with a larger number of lymph nodes harvested. For right colectomy, surgical specifications make it less common complete mesocolic excision and conventional surgery offer comparable outcomes, as regards to postoperative morbidity and mortality rates. No differences are identified between laparoscopic and open surgery. On oncologic outcomes, only two studies report a higher free-disease survival after complete mesocolic excision. Then, there is evidence that complete mesocolic excision offers a higher rate of specimen with extensive lymph node resection, without increased morbidity rate. However, there is limited evidence that it leads to improve long-term oncological outcomes.
Bastir, Markus; Higuero, Antonio; Ríos, Luís; García Martínez, Daniel
Sexual dimorphism is important for intraspecific variation and well studied in the human skeleton. In the thoracic part of the spine sexual dimorphism is expected for differences in the respiratory system related to body mass, lung capacity, and energetics, and in the reproductive system for adaptations to pregnancy (lower spine lordosis, posture). However, little is known about sexual dimorphism in this anatomical region. We use three-dimensional (3D)-geometric morphometrics to test hypotheses on sexual dimorphism in the first 10 thoracic vertebrae (T1-T10). Forty-six 3D-landmarks were measured on vertebrae of 24 adult females and males of known age and sex. Results confirm that male vertebrae are consistently larger than female ones. Males show more dorsally oriented transverse processes and relatively larger vertebral bodies in upper and lower thoracic vertebrae. Sexual dimorphism in lower thoracic vertebrae affects the orientation of the spinous processes, which is more horizontal in females but more caudal in males. Such regional pattering of sexual dimorphism emerges also from principal component analyses reflecting a complex interaction between the effects of sex and serial position on shape variation. Greater dorsal orientation of male transverse processes reorients the ribs and could lead to greater radial thorax diameters. This fits with greater male respiratory capacities, but may indicate also greater invagination of the male spine within the thorax. Horizontal orientation of the spinous processes in females could allow for a greater thoraco-lumbar lordosis during pregnancy, but more comparative research is necessary to test these hypotheses.
Simova-Curd, S; Nitzl, D; Pospischil, A; Hatt, J-M
An 11-year-old male chinchilla was presented for investigation of progressive weight loss, apathy, anorexia, changes in faecal quality and alopecia on the tip of the tail. On clinical examination, a stiffness of the back legs was noted. Abdominal palpation revealed a hard immobile, irregular structure in the region of the last lumbar vertebrae. Subsequent radiography and ultrasonography suggested the presence of neoplasia. The following day the chinchilla was showing hindlimb paralysis, and there was severe self-trauma to the distal 5 cm of the tail. In view of the rapid clinical deterioration, the chinchilla was euthanased with the owner's consent. Macroscopic examination supported the clinical suspicion of neoplasia. Histopathological examination revealed a reactive osteoblastic osteosarcoma. To the author's knowledge, this is the first report of osteosarcoma in chinchillas.
Zhang, Y; Wang, B
There are two objectives in this study: the first is to estimate skeletal age by lateral cephalomatric roentgengram of cervical vertebrae instead of X-ray of handwrist, the second is to study the rules of cervical vertebrae's growth and development of children from Beijing. The Auto CAD 12.0 computer software was used in measuring lateral cephalomatric roentgengrams of cervical vertebrae of 280 children from Beijing aged 9-15. The shape of cervical vertebrae of children with that of adults on X-ray films was compared, and the growth and development of cervical vertebrae of 9-15 years old children from Beijing was observed. We found out that the rapid growth period of cervical vertebrae was 12-14 years old for girls and 14-15 years old for boys. During puberty, the change of vertebrae's shape has no difference between male and female. 42 female and 28 male teenagers from the 280 aged 9-13 years old were taken X-ray films of left handwrist. The comparison between the films and roentgengrams shows that the appearance of sesamoid of hand and the concavity of the second vertebrae body is at the same time, which means that the beginning of rapid growth period can be estimated by the lateral cephalometric roentgengrams of cervical vertebrae.
Schwarz-Wings, Daniela; Meyer, Christian A; Frey, Eberhard; Manz-Steiner, Hans-Rudolf; Schumacher, Ralf
The pre-sacral vertebrae of most sauropod dinosaurs were surrounded by interconnected, air-filled diverticula, penetrating into the bones and creating an intricate internal cavity system within the vertebrae. Computational finite-element models of two sauropod cervical vertebrae now demonstrate the mechanical reason for vertebral pneumaticity. The analyses show that the structure of the cervical vertebrae leads to an even distribution of all occurring stress fields along the vertebrae, concentrated mainly on their external surface and the vertebral laminae. The regions between vertebral laminae and the interior part of the vertebral body including thin bony struts and septa are mostly unloaded and pneumatic structures are positioned in these regions of minimal stress. The morphology of sauropod cervical vertebrae was influenced by strongly segmented axial neck muscles, which require only small attachment areas on each vertebra, and pneumatic epithelia that are able to resorb bone that is not mechanically loaded. The interaction of these soft tissues with the bony tissue of the vertebrae produced lightweight, air-filled vertebrae in which most stresses were borne by the external cortical bone. Cervical pneumaticity was therefore an important prerequisite for neck enlargement in sauropods. Thus, we expect that vertebral pneumaticity in other parts of the body to have a similar role in enabling gigantism.
Schwarz-Wings, Daniela; Meyer, Christian A.; Frey, Eberhard; Manz-Steiner, Hans-Rudolf; Schumacher, Ralf
The pre-sacral vertebrae of most sauropod dinosaurs were surrounded by interconnected, air-filled diverticula, penetrating into the bones and creating an intricate internal cavity system within the vertebrae. Computational finite-element models of two sauropod cervical vertebrae now demonstrate the mechanical reason for vertebral pneumaticity. The analyses show that the structure of the cervical vertebrae leads to an even distribution of all occurring stress fields along the vertebrae, concentrated mainly on their external surface and the vertebral laminae. The regions between vertebral laminae and the interior part of the vertebral body including thin bony struts and septa are mostly unloaded and pneumatic structures are positioned in these regions of minimal stress. The morphology of sauropod cervical vertebrae was influenced by strongly segmented axial neck muscles, which require only small attachment areas on each vertebra, and pneumatic epithelia that are able to resorb bone that is not mechanically loaded. The interaction of these soft tissues with the bony tissue of the vertebrae produced lightweight, air-filled vertebrae in which most stresses were borne by the external cortical bone. Cervical pneumaticity was therefore an important prerequisite for neck enlargement in sauropods. Thus, we expect that vertebral pneumaticity in other parts of the body to have a similar role in enabling gigantism. PMID:19801376
Javadian, Yahya; Akbari, Mohammad; Talebi, Ghoadamali; Taghipour-Darzi, Mohammad; Janmohammadi, Naser
Background: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP). Methods: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test. Results: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (P<0.05), except L3 translation in the control group. At the endpoint, mean translation value of L4 (P=0.04) and L5 (P=0.001) and rotation of the L5 (P=0.01) in the treatment group was significantly lower than the control group. Conclusion: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than
San Román, Paloma; Palma, Juan Carlos; Oteo, M Dolores; Nevado, Esther
The aim of this study was to determine the validity of cervical vertebrae radiographic assessment to predict skeletal maturation. Left hand-wrist and lateral cephalometric radiographs of 958 Spanish children from 5 to 18 years of age were measured. On the left hand-wrist radiographs the classification of Grave and Brown was used to assess skeletal maturation. Cervical vertebrae maturation was evaluated with lateral cephalometric radiographs using the stages described by Lamparski and by Hassel and Farman. A new method to evaluate the cervical maturation by studying the changes in the concavity of the lower border, height, and shape of the vertebral body was created. Correlation coefficients were calculated to establish the relationship between skeletal maturation values obtained by the three classifications of vertebral and skeletal maturation measured at the wrist. All correlation values obtained were statistically significant (P < 0.001). The results suggest that this new method to determine skeletal maturation is very reliable. A simple method based on morphological characteristics of the cervical vertebral bodies to evaluate the maturation stage has been designed. In the population investigated, this method is as accurate as the Hassel and Farman classification and superior to the Lamparski classification. The morphological vertebral parameter best able to estimate the maturation is the concavity of the lower border of the body.
Williams, Scott A; García-Martínez, Daniel; Bastir, Markus; Meyer, Marc R; Nalla, Shahed; Hawks, John; Schmid, Peter; Churchill, Steven E; Berger, Lee R
Hominin evolution featured shifts from a trunk shape suitable for climbing and housing a large gut to a trunk adapted to bipedalism and higher quality diets. Our knowledge regarding the tempo, mode, and context in which these derived traits evolved has been limited, based largely on a small-bodied Australopithecus partial skeleton (A.L. 288-1; "Lucy") and a juvenile Homo erectus skeleton (KNM-WT 15000; "Turkana Boy"). Two recent discoveries, of a large-bodied Australopithecus afarensis (KSD-VP-1/1) and two Australopithecus sediba partial skeletons (MH1 and MH2), have added to our understanding of thorax evolution; however, little is known about thorax morphology in early Homo. Here we describe hominin vertebrae, ribs, and sternal remains from the Dinaledi chamber of the Rising Star cave system attributed to Homo naledi. Although the remains are highly fragmented, the best-preserved specimens-two lower thoracic vertebrae and a lower rib-were found in association and belong to a small-bodied individual. A second lower rib may belong to this individual as well. All four of these individual elements are amongst the smallest known in the hominin fossil record. H. naledi is characterized by robust, relatively uncurved lower ribs and a relatively large spinal canal. We expect that the recovery of additional material from Rising Star Cave will clarify the nature of these traits and shed light on H. naledi functional morphology and phylogeny.
Stieger, James; Burns, Joseph E.; Yao, Jianhua; Summers, Ronald M.
Vertebral cortex removal through cancellous bone reconstruction (CBR) algorithms on CT has been shown to enhance the detection rate of bone metastases by radiologists and reduce average reading time per case. Removal of the cortical bone provides an unobstructed view of the inside of vertebrae without any anomalous distractions. However, these algorithms rely on the assumption that the cortical bone of vertebrae can be removed without the identification of the endosteal cortical margin. We present a method for the identification of the endosteal cortical margin based on vertebral models and CT intensity information. First, triangular mesh models are created using the marching cubes algorithm. A search region is established along the normal of the surface and the image gradient is calculated at every point along the search region. The location with the greatest image gradient is selected as the corresponding point on the endosteal cortical margin. In order to analyze the strength of this method, ground truth and control models were also created. Our method was shown to have a significantly reduce the average error from 0.80 mm +/- 0.14 mm to 0.65 mm +/- 0.17 mm (p <0.0001) when compared to erosion. This method can potentially improve CBR algorithms, which improve visualization of cancellous bone lesions such as metastases, by more accurately identifying the inner wall of the vertebral cortex.
Myronovskyi, Maksym; Rosenkränzer, Birgit; Luzhetskyy, Andriy
The deletions of large genomic DNA fragments and consecutive gene knockouts are prerequisites for the generation of organisms with improved properties. One of the key issues in this context is the removal of antibiotic resistance markers from engineered organisms without leaving an active recombinase recognition site. Here, we report the establishment of an iterative marker excision system (IMES) that solves this problem. Based on the phiC31 integrase and its mutant att sites, IMES can be used for highly effective deletion of DNA fragments between inversely oriented B-CC and P-GG sites. The B-CC and P-GG sites are derived from attB and attP by substitution of the central core TT dinucleotide with CC and GG, respectively. An unnatural RR site that resides in the chromosome following deletion is the joining product of the right shoulders of B-CC and P-GG. We show that the RR sites do not recombine with each other as well as the RR site recombines with B-CC. The recombination efficiencies between RR and P-GG or RR and LL are only 0.1 % and 1 %, respectively. Thus, IMES can be used for multistep genomic engineering without risking unwanted DNA recombination. The fabrication of multi-purpose antibiotic cassettes and examples of the utilisation of IMES are described.
Chatterjee, Somenath; Bodhey, Narendra Kuber Gupta, Arun Kumar; Periakaruppan, Alagappan
The lumbar spine is a less common location for chordoma. Here we describe a 44-year-old woman presenting with pain due to a L4 vertebral expansile lesion that caused significant canal stenosis and neural foraminal compromise. Vertebroplasty was performed and resulted in immediate pain relief. For patients with painful lumbar chordoma who are unwilling to undergo surgery, vertebroplasty can play a palliative role as in patients with other vertebral lesions. Treating pain and stabilizing vertebra by way of vertebroplasty in a case of chordoma has not yet been reported.
Ghannam, Malik; Jumah, Fareed; Mansour, Shaden; Samara, Amjad; Alkhdour, Saja; Alzuabi, Muayad A; Aker, Loai; Adeeb, Nimer; Massengale, Justin; Oskouian, Rod J; Shane Tubbs, R
The intervertebral disc (IVD) is a joint unique in structure and functions. Lying between adjacent vertebrae, it provides both the primary support and the elasticity required for the spine to move stably. Various aspects of the IVD have long been studied by researchers seeking a better understanding of its dynamics, aging, and subsequent disorders. In this article, we review the surgical anatomy, imaging modalities, and molecular biology of the lumbar IVD. Clin. Anat. 30:251-266, 2017. © 2017 Wiley Periodicals, Inc.
Berner, Dagmar; Jülke, Henriette; Hohaus, Christian; Brehm, Walter; Gerlach, Kerstin
The sheep spine is widely used as a model for preclinical research in human medicine to test new spinal implants and surgical procedures. Therefore, precise morphometric data are needed. The present study aimed to provide computed tomographic (CT) morphometry of sheep thoracolumbar spine. Five adult normal Merino sheep were included in this study. Sheep were anaesthetised and positioned in sternal recumbency. Subsequently, transverse and sagittal images were obtained using a multi-detector-row helical CT scanner. Measurements of the vertebral bodies, pedicles, intervertebral disc and transverse processes were performed with dedicated software. Vertebral bodies and the spinal canal were wider than they were deep, most obviously in the lumbar vertebrae. The intervertebral discs were as much as 57.4% thicker in the lumbar than in the thoracic spine. The pedicles were higher and longer than they were wide over the entire thoracolumbar spine. In conclusion, the generated data can serve as a CT reference for the ovine thoracolumbar spine and may be helpful in using sheep spine as a model for human spinal research. PMID:24106508
Doherty, Carolynne M; Forbes, Raeburn B
Diagnostic Lumbar Puncture is one of the most commonly performed invasive tests in clinical medicine. Evaluation of an acute headache and investigation of inflammatory or infectious disease of the nervous system are the most common indications. Serious complications are rare, and correct technique will minimise diagnostic error and maximise patient comfort. We review the technique of diagnostic Lumbar Puncture including anatomy, needle selection, needle insertion, measurement of opening pressure, Cerebrospinal Fluid (CSF) specimen handling and after care. We also make some quality improvement suggestions for those designing services incorporating diagnostic Lumbar Puncture. PMID:25075138
Koyama, Koji; Nakazato, Koichi; Min, Seok-Ki; Gushiken, Koji; Hatakeda, Yoshiaki; Seo, Kyoko; Hiranuma, Kenji
Background: Magnetic resonance imaging (MRI) studies have shown that gymnasts have a high prevalence of radiological abnormalities, such as intervertebral disk degeneration (IDD) and anterior limbus vertebra (ALV). These 2 abnormalities may coexist at the same spinal level. However, the relationship between IDD and ALV remains unclear. Hypothesis: A significant relationship exists between IDD and ALV in Japanese collegiate gymnasts. Study Design: Case-control study. Methods: A total of 104 Japanese collegiate gymnasts (70 men and 34 women; age, 19.7 ± 1.0 years) with 11.8 ± 3.6 years of sporting experience participated. T1- and T2-weighted MRIs were used to evaluate ALV and IDD. Results: The prevalence among the gymnasts of IDD and ALV was 40.4% (42/104) and 20.2% (21/104), respectively. The prevalence of IDD was significantly higher in gymnasts with ALV than those without ALV, as determined using the chi-square test. Logistic regression analysis demonstrated a significant association between IDD and ALV (adjusted odds ratio [OR], 6.60; 95% confidence interval [CI], 2.14-20.35). IDD was further grouped by whether it was present in the upper lumbar region (L1-2, L2-3, and L3-4 disks) or in the lower lumbar region (L4-5 and L5-S1 disks). Upper IDD had a greater association with ALV (adjusted OR, 33.17; 95% CI, 7.09-155.25) than did lower IDD (adjusted OR, 6.71; 95% CI, 1.57-28.73). Conclusion: In Japanese collegiate gymnasts, ALV is a predictor of IDD, especially in the upper lumbar region. Clinical Relevance: Information regarding ALV is important to prevent IDD in Japanese collegiate gymnasts. PMID:26535240
Abe, Tetsuya; Funayama, Toru; Noguchi, Hiroshi; Nakayama, Keita; Miura, Kousei; Nagashima, Katsuya; Kumagai, Hiroshi; Yamazaki, Masashi
When ossification of the yellow ligament (OYL) occurs in the lumbar spine and extends to the lateral wall of the spinal canal, facetectomy is required to remove all of the ossified lesion and achieve decompression. Subsequent posterior fixation with interbody fusion will then be necessary to prevent postoperative progression of the ossification and intervertebral instability. The technique of lateral lumbar interbody fusion (LLIF) has recently been introduced. Using this procedure, surgeons can avoid excess blood loss from the extradural venous plexus and detachment of the ossified lesion and the ventral dura mater is avoidable. We present a 55-year-old male patient with OYL at L3/4 and anterior spondylolisthesis of L4 vertebra, with concomitant ossification of the posterior longitudinal ligament, who presented with a severe gait disturbance. He underwent a 2-stage operation without complications: LLIF for L3/4 and L4/5 was performed at the initial surgery, and posterior decompression fixation using pedicle screws from L3 to L5 was performed at the second surgery. His postoperative progress was favorable, and his interbody fusion was deemed successful. Here, we present the first reported case of LLIF for OYL of the lumbar spine. This procedure can be a good option for OYL of the lumbar spine. PMID:28352485
Hager, Staci M; Udermann, Brian E; Reineke, David M; Gibson, Mark H; Mayer, John M; Murray, Steven R
We evaluated the reliability of static and dynamic lumbar muscle endurance measurements on a BackUP lumbar extension dynamometer. Sixteen healthy participants (8 male; 8 female) volunteered for this investigation. Fifty percent of each participant's body weight was calculated to determine the weight load utilized for the static (holding time) and dynamic (repetitions) lumbar extension endurance tests. Four separate tests (2 static, 2 dynamic) were conducted with at least a 24-hour rest period between tests. Test-retest intraclass correlations were shown to be high (static lumbar endurance, ICC = 0.92 (p < 0.0005); dynamic lumbar endurance, ICC = 0.93 (p < 0.0005) for both of the performed tests. Our results demonstrated that static and dynamic lumbar endurance can be assessed reliably on a BackUP lumbar extension dynamometer. Key PointsReliability studies that test lumbar endurance on machines that effectively stabilize the pelvis and isolate the lumbar extensors are limited.This is the first study to report reliability measures of static and dynamic lumbar endurance on a BackUP lumbar extension dynamometer.Static and dynamic lumbar endurance on a BackUP lumbar extension dynamometer, which uses a variety of pelvic stabilization mechanisms, can be reliably assessed in apparently healthy individuals.Future research is necessary to examine the reliability of lumbar extension endurance on the BackUP dynamometer in patient populations and validity in various settings.
Jia, Pingping; Her, Chengtao; Chai, Weihang
DNA damage is caused by either endogenous cellular metabolic processes such as hydrolysis, oxidation, alkylation, and DNA base mismatches, or exogenous sources including ultraviolet (UV) light, ionizing radiation, and chemical agents. Damaged DNA that is not properly repaired can lead to genomic instability, driving tumorigenesis. To protect genomic stability, mammalian cells have evolved highly conserved DNA repair mechanisms to remove and repair DNA lesions. Telomeres are composed of long tandem TTAGGG repeats located at the ends of chromosomes. Maintenance of functional telomeres is critical for preventing genome instability. The telomeric sequence possesses unique features that predispose telomeres to a variety of DNA damage induced by environmental genotoxins. This review briefly describes the relevance of excision repair pathways in telomere maintenance, with the focus on base excision repair (BER), nucleotide excision repair (NER), and mismatch repair (MMR). By summarizing current knowledge on excision repair of telomere damage and outlining many unanswered questions, it is our hope to stimulate further interest in a better understanding of excision repair processes at telomeres and in how these processes contribute to telomere maintenance.
Kim, Hyeun Sung; Lee, Won Tae
There has been no report of bilateral pedicle stress fractures involving two vertebrae. The authors describe a unique case of spondylolisthesis accompanying a bilateral pedicle stress fracture involving two vertebrae. De novo development of spondylolisthesis at the L5-S1 vertebrae accompanying a bilateral pedicle stress fracture at L4 and L5 was observed in a 70-year-old woman. The patient's medical history was unremarkable and she did not have any predisposing factors except severe osteoporosis. Interbody fusion with bone cement augmented screw fixation was performed. Surgical treatment resulted in good pain management and improved functional recovery. PMID:22949973
... 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 ...
Xiang, Pin; Du, Chengfei; Mo, Zhongjun; Gong, He; Wang, Lizhen; Fan, Yubo
We observed the effect of vibration parameters on lumbar spine under different vibration conditions using finite element analysis method in our laboratory. In this study, the CT-images of L1-L5 segments were obtained. All images were used to develop 3D geometrical model using the Mimics10. 01 (Materialise, Belgium). Then it was modified using Geomagic Studio12. 0 (Raindrop Geomagic Inc. USA). Finite element (FE) mesh model was generated by Hypermesh11. 0 (Altair Engineering, Inc. USA) and Abaqus. Abaqus was used to calculate the stress distribution of L1-L5 under different vibration conditions. It was found that in a vibration cycle, tensile stress was occurred on lumbar vertebra mainly. Stress distributed evenly and stress concentration occurred on the left rear side of the upper endplate. The stress had no obvious changes under different frequencies, but the stress was higher when amplitude was greater. In conclusion, frequency and amplitude parameters have little effect on the stress distribution in vertebra. The stress magnitude is positively correlated with the amplitude.
Lumbar radiculopathy is a common problem. Nerve root compression can occur at different places along a nerve root's course including in the foramina. Minimal invasive approaches allow easier exposure of the lateral foramina and decompression of the nerve root in the foramina. This video demonstrates a minimally invasive approach to decompress the lumbar nerve root in the foramina with a lateral to medial decompression. The video can be found here: http://youtu.be/jqa61HSpzIA.
Alwood, J S; Yumoto, K; Mojarrab, R; Limoli, C L; Almeida, E A C; Searby, N D; Globus, R K
Astronauts are exposed to both musculoskeletal disuse and heavy ion radiation in space. Disuse alters the magnitude and direction of forces placed upon the skeleton causing bone remodeling, while energy deposited by ionizing radiation causes free radical formation and can lead to DNA strand breaks and oxidative damage to tissues. Radiation and disuse each result in a net loss of mineralized tissue in the adult, although the combined effects, subsequent consequences for mechanical properties and potential for recovery may differ. First, we examined how a high dose (2 Gy) of heavy ion radiation ((56)Fe) causes loss of mineralized tissue in the lumbar vertebrae of skeletally mature (4 months old), male, C57BL/6 mice using microcomputed tomography and determined the influence of structural changes on mechanical properties using whole bone compression tests and finite element analyses. Next, we tested if a low dose (0.5 Gy) of heavy particle radiation prevents skeletal recovery from a 14-day period of hindlimb unloading. Irradiation with a high dose of (56)Fe (2 Gy) caused bone loss (-14%) in the cancellous-rich centrum of the fourth lumbar vertebra (L4) 1 month later, increased trabecular stresses (+27%), increased the propensity for trabecular buckling and shifted stresses to the cortex. As expected, hindlimb unloading (14 days) alone adversely affected microarchitectural and mechanical stiffness of lumbar vertebrae, although the reduction in yield force was not statistically significant (-17%). Irradiation with a low dose of (56)Fe (0.5 Gy) did not affect vertebrae in normally loaded mice, but significantly reduced compressive yield force in vertebrae of unloaded mice relative to sham-irradiated controls (-24%). Irradiation did not impair the recovery of trabecular bone volume fraction that occurs after hindlimb unloaded mice are released to ambulate normally, although microarchitectural differences persisted 28 days later (96% increase in ratio of rod- to plate
Common location of teratomas in children are sacrococcygeal, gonadal, mediastinal and retroperitoneal, but teratomas may also occur at very unusual locations. A six-month-old boy presented with a large swelling at his left lumbar region. He presented with gradually increasing lump at his back, involving more on left lumbar region and midline since birth. Clinical examination revealed a solitary, non-tender, soft to firm, irregular mass, occupying more on his left lumbar and midline region and also crossing the midline. Radiological investigations revealed a well defined mass of 9.6 x 7.5cm, with bony elements and spina bifida at L1 and L2 levels. His Computed Tomography (CT) scan finding was consistent with mature teratoma. Complete surgical excision of the tumour was done without any difficulties. Histology of the excised tumour was conclusive of mature teratoma. His post-operative period was excellent, but he lost to follow-up after discharge. PMID:28208935
Santos, Eduardo César Almada; Bertoz, Francisco Antônio; Arantes, Flávia de Moraes; Reis, Patrícia Maria Pizzo; de Bertoz, André Pinheiro Magalhães
The determination of skeletal maturation by morphological evaluation of the cervical vertebrae was evaluated in a 100 cephalograms. The analysis showed that this method was reproducible for assessing the individual's growth curve.
Zheng, Y; Nixon, M S; Allen, R
Low back pain is a significant problem and its cost is enormous to society. However, diagnosis of the underlying causes remains problematic despite extensive study. Reasons for this arise from the deep-rooted situation of the spine and also from its structural complexity. Clinicians have to mentally convert 2-D image information into a 3-D form to gain a better understanding of structural integrity. Therefore, visualisation and animation may be helpful for understanding, diagnosis and for guiding therapy. Some low back pain originates from mechanical disorders, and study of the spine kinematics may provide an insight into the source of the problem. Digital videofluoroscopy was used in this study to provide 2-D image sequences of the spine in motion, but the images often suffer due to noise, exacerbated by the very low radiation dosage. Thus determining vertebrae position within the image sequence presents a considerable challenge. This paper describes a combination of spine kinematic measurements with a solid model of the human lumbar spine for visualisation of spine motion. Since determination of the spine kinematics provides the foundation and vertebral extraction is at the core, this is discussed in detail. Edge detection is a key feature of segmentation and it is shown that phase congruency performs better than most established methods with the rather low-grade image sequences from fluoroscopy. The Hough transform is then applied to determine the positions of vertebrae in each frame of a motion sequence. In the Hough transform, Fourier descriptors are used to represent the vertebral shapes. The results show that the Hough transform is a very promising technique for vertebral extraction from videofluoroscopic images. A dynamic visualisation package has been developed in order to view the moving lumbar spine from any angle and viewpoint. Wire frame models of the vertebrae were built by using CT images from the Visible Human Project and these models are scaled to
Kim, Sung-Soo; Suk, Se-Il
Study Design Retrospective study. Purpose To determine the effect and direction of direct vertebral rotation (DVR) in the lowest instrumented vertebra (LIV) on the uninstrumented lumbar curve depending on the lumbar modifier used for the correction of thoracic adolescent idiopathic scoliosis. Overview of Literature DVR in the LIV should be implemented in a different direction to obtain better spontaneous lumbar correction depending on the preoperative lumbar spine modifier. Methods We retrospectively analyzed 160 patients with thoracic adolescent idiopathic scoliosis treated by pedicle screw instrumentation and rod derotation. Patients who had a distal fusion level between T11 and L1 were divided into two groups: the DVR group versus the No-DVR group. Each group was divided into subgroups depending on the lumbar modifier used: the DVR-A, B, and C groups versus the No-DVR-A, B, and C groups. The DVR-A group was subdivided into two subgroups depending on the direction of screw rotation in the LIV: the DVR-A-O group (opposite direction) and the DVR-A-S group (same direction). Results There were no significant differences in the preoperative curve characteristics between the two groups. The preoperative lumbar curve was corrected in 70% of the patients in the DVR group and in 56% in the No-DVR group. Spontaneous coronal correction of the lumbar curve was better in the DVR-A-S group than that in the No-DVR-A group. However, the DVR-A-O group had the higher incidence of adding-on deformity. The DVR-B and C groups showed better spontaneous correction of lumbar coronal magnitude, apical vertebral translation, and rotation and the LIV tilting. Conclusions In lumbar modifiers B and C, screws in the LIV have to be rotated opposite to the direction of the screw rotation of the main thoracic curve; however, in modifier A, the screws have to be rotated in the same direction. PMID:28243381
Lee, M; Esler, M A; Mildren, J; Herbert, R
The purpose of this study was to examine the responses of normal subjects to the application of cyclical lumbar posteroanterior forces which simulated a manipulative therapy technique known as mobilization. The specific aim was to determine whether increases in spinal extensor muscle activity could modify the stiffness of lumbar posteroanterior movements. The lumbar posteroanterior stiffness was measured in eleven asymptomatic subjects in the prone position, both in the relaxed condition and during maximal voluntary isometric muscle contractions. The electromyographic activity of lumbar extensor muscles was measured in the relaxed and maximal contraction conditions during the application of mobilization. The posteroanterior stiffness was found to be significantly greater during maximum activation of the extensor muscles. The results indicate that muscle activity can significantly alter lumbar posteroanterior stiffness. Clinicians often apply posteroanterior forces over a spinous process of a vertebra to assess the resistance to movement. Information about the degree and nature of perceived resistance to posteroanterior movement is used to help make a diagnosis and select treatment techniques. This study has shown that increased activity of the spinal extensor muscles can increase the stiffness of lumbar posteroanterior movements, compared with the case where the subject is relaxed. When interpreting the posteroanterior responses of patients, clinicians should be aware that spinal extensor mucle activity can influence resistance to posteroanterior movement.
Tague, Robert G
The human sacrum is sexually dimorphic, with males being larger than females in most dimensions. Previous studies, though, suggest that females may have a longer costal process of the first sacral vertebra (S1) than males. However, these studies neither quantified nor tested statistically the costal process of S1. This study compares S1 with the five lumbar vertebrae (L1 to L5) for a number of metric dimensions, including costal process length. Four issues are addressed, the: 1) hypothesis that females have a longer costal process of S1 than males; 2)hypothesis that homologous structures (i.e., costal processes of L1 to S1) differ in their direction of sexual dimorphism; 3) importance of the costal process of S1 to the obstetrical capacity of the pelvis; and 4) evolution of sexual dimorphism in costal process length of S1. One hundred ninety-seven individuals, including males and females of American blacks and whites, from the Hamann-Todd and Terry Collections were studied. Results show that males are significantly larger than females for most vertebral measurements, except that females have a significantly longer costal process of S1 than males. Costal process length of S1 is positively correlated with the transverse diameter and circumference of the pelvic inlet. The magnitude of sexual dimorphism in costal process length of S1 ranks this measure among the most highly dimorphic of the pelvis. Compared with the humans in this study, australopithecines have a relatively long costal process of S1, but their broad sacrum was not associated with obstetrical imperatives.
The demonstration of DNA damage excision and repair replication by Setlow, Howard-Flanders, Hanawalt and their colleagues in the early 1960s, constituted the discovery of the ubiquitous pathway of nucleotide excision repair (NER). The serial steps in NER are similar in organisms from unicellular bacteria to complex mammals and plants, and involve recognition of lesions, adducts or structures that disrupt the DNA double helix, removal of a short oligonucleotide containing the offending lesion, synthesis of a repair patch copying the opposite undamaged strand, and ligation, to restore the DNA to its original form. The transcription-coupled repair (TCR) subpathway of NER, discovered nearly two decades later, is dedicated to the removal of lesions from the template DNA strands of actively transcribed genes. In this review I will outline the essential factors and complexes involved in NER in humans, and will comment on additional factors and metabolic processes that affect the efficiency of this important process.
The demonstration of DNA damage excision and repair replication by Setlow, Howard-Flanders, Hanawalt and their colleagues in the early 1960s, constituted the discovery of the ubiquitous pathway of nucleotide excision repair (NER). The serial steps in NER are similar in organisms from unicellular bacteria to complex mammals and plants, and involve recognition of lesions, adducts or structures that disrupt the DNA double helix, removal of a short oligonucleotide containing the offending lesion, synthesis of a repair patch copying the opposite undamaged strand, and ligation, to restore the DNA to its original form. The transcription-coupled repair (TCR) subpathway of NER, discovered nearly two decades later, is dedicated to the removal of lesions from the template DNA strands of actively transcribed genes. In this review I will outline the essential factors and complexes involved in NER in humans, and will comment on additional factors and metabolic processes that affect the efficiency of this important process. PMID:26388429
Abstract Background: Osteophytes are bony outgrowths commonly found on lumbar vertebrae. They rarely produce complications with the most common complication being nerve entrapment, but rarer complications including aorta or inferior vena cava rupture, superior mesenteric artery syndrome, compression of the iliopsoas muscle, and cerebrospinal fluid leaks have been described. Rare cases affecting the ureter resulting in ureteral colic or extravasation of urine have been described. Case Presentation: We describe a case in which a lumbar osteophyte bridging the L4 and L5 disks was encircling the ureter and minor trauma caused a ureteral injury, resulting in urine extravasation into the L4 and L5 disks space and the retroperitoneum. Owing to the comorbidities of this patient, this case was treated conservatively with stenting and the patient has suffered no further complications. Conclusion: This is a rare complication of a lumbar osteophyte but should be considered as a potential cause of ureter injury. Treatment should be individualized by patient preference and comorbidities, as some patients would elect to pursue more aggressive therapy whereas others would incline for conservative measures. PMID:28078328
Shen, Wei; Yang, Feng; Mu, Wei; Yang, Caiyun; Yang, Xin; Tian, Jie
Localization of the vertebrae is of importance in many medical applications. For example, the vertebrae can serve as the landmarks in image registration. They can also provide a reference coordinate system to facilitate the localization of other organs in the chest. In this paper, we propose a new vertebrae localization method using convolutional neural networks (CNN). The main advantage of the proposed method is the removal of hand-crafted features. We construct two training sets to train two CNNs that share the same architecture. One is used to distinguish the vertebrae from other tissues in the chest, and the other is aimed at detecting the centers of the vertebrae. The architecture contains two convolutional layers, both of which are followed by a max-pooling layer. Then the output feature vector from the maxpooling layer is fed into a multilayer perceptron (MLP) classifier which has one hidden layer. Experiments were performed on ten chest CT images. We used leave-one-out strategy to train and test the proposed method. Quantitative comparison between the predict centers and ground truth shows that our convolutional neural networks can achieve promising localization accuracy without hand-crafted features.
Horan, G S; Wu, K; Wolgemuth, D J; Behringer, R R
Hoxa-4 (previously known as Hox-1.4) is a mouse homeobox-containing gene that is expressed in the presumptive hindbrain and spinal cord, prevertebrae, and other tissues during embryogenesis. To understand the role of Hoxa-4 during development, we generated Hoxa-4 mutant mice. Homozygous mutants were viable and fertile. Analysis of neonatal skeletons revealed the development of ribs on the seventh cervical vertebra at variable penetrance and expressivity. A low frequency of alterations in sternal morphogenesis was also observed. In addition, we analyzed the skeletons of transgenic mice that overexpress Hoxa-4 and found that the formation of the small rib anlagen that often develop on the seventh cervical vertebra was suppressed. Analysis of adult homozygous mutant skeletons revealed that the dorsal process normally associated with the second cervical vertebra was also found on the third cervical vertebra. These results demonstrate that Hoxa-4 plays a role in conferring positional information along the anteroposterior axis to specify the identity of the third and the seventh cervical vertebrae. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 PMID:7809093
Pai, Akshay; Narasimhamurthy, Anand; Rao, V. S. Veeravasarapu; Vaidya, Vivek
The identification of key landmark points in an MR spine image is an important step for tasks such as vertebra counting. In this paper, we propose a template matching based approach for automatic detection of two key landmark points, namely the second cervical vertebra (C2) and the sacrum from sagittal MR images. The approach is comprised of an approximate localization of vertebral column followed by matching with appropriate templates in order to detect/localize the landmarks. A straightforward extension of the work described here is an automated classification of spine section(s). It also serves as a useful building block for further automatic processing such as extraction of regions of interest for subsequent image processing and also in aiding the counting of vertebra.
Głowacki, Maciej; Harasymczuk, Jerzy; Piontek, Tomasz; Strzyzewski, Wojciech
Background. The aim of this paper is to assess the extent of correction of scoliosis after surgery from the anterior approach using the CD Hopf method. Material and methods. We analyzed 20 patients with idiopatic thoracolumbar or lumbar scoliosis (Cobb angle 53 +/- 8 degrees , lordosis angle 56.9 +/- 11.9 degrees , vertebral translation 5.5 +/- 0.9 cm). Results. After surgery with the CD Hopf method, the scoliosis angle was reduced to 21 +/- 8 degrees . The correction rate was 61.7 +/- 12.1 degrees , with spondylodesis limited to 4 vertebrae in 13 patients, and 3 vertebrae in 7 patients. The average lumbar lordosis after surgery was 50.8+/-7.9 degrees , and the average vertebral translation was 2.6 +/- 1.1 cm. In post-surgical follow-up examinations the scoliosis angle increased slightly, not exceeding 3 degrees . Conclusions. Surgical treatment of scoliosis using the CD Hopf technique through the anterior approach allows for major correction in the frontal plane, accompanied by moderate decrease of lumbar lordosis. This method also enables significant improvement of horizontalization of border scoliosis vertebrae despite the short extent of the instrumentation and spondylodesis.
Habib, Maham; Babar, Sumbal; Kundi, Asif K; Assad, Salman; Sheikh, Amjad
Bertolotti’s syndrome (BS) must be considered as a differential diagnosis in a young patient presenting with low back pain (LBP). We present a case of a 26-year-old male complaining of mild chronic LBP for six years, radiating to his left thigh for the past six months. He has been taking non-steroidal anti-inflammatory drugs (NSAIDs) with skeletal muscle relaxants for pain relief. The X-ray and computed tomography (CT) imagings showed congenital enlargement of the left transverse process of the fifth lumbar (L5) vertebra forming pseudo-articulation with the sacrum and unilateral pars interarticularis defect at the L4 level on the left side, respectively. He has managed with gabapentin 100 mg three times a day for his neuropathic left leg pain. On follow-up, the patient reported that his pain has improved with gabapentin and it decreased from 8/10 to 4/10 on the visual analogue scale. PMID:27904817
Tazawa, Toshiharu; Kamiya, Yoshinori; Takamori, Mina; Ogawa, Ken-Ichi; Goto, Takahisa
Ventral disc protrusions have been neglected because they are asymptomatic. Lumbar sympathetic nerve block (LSNB) is one of the clinical choices for refractory low back pain treatment. Leakage of the contrast medium may occur and lead to complications, especially when using a neurolytic agent. In this study, we retrospectively reviewed the magnetic resonance images (MRIs) of 52 consecutive patients with refractory low back pain due to lumbar spinal canal stenosis who underwent LSNB, and graded ventral disc protrusion at the L1/2 to L5/S1 vertebral discs on a three-point scale (grade 0 = no protrusion, grade 1 = protrusion without migration, grade 2 = protrusion with migration). We also determined if there was leakage of contrast medium in LSNB. Ventral disc protrusion was observed in all patients, and 75 % (39/52) had grade 2 protrusion in the L1/2-L3/4 vertebral discs. Moreover, the incidence of contrast medium leakage was significantly higher at the vertebrae that had grade 2 protrusion than at those with less protrusion. We revealed a higher incidence of ventral disc protrusion of the lumbar vertebrae than previously reported, and that the incidence of leakage in LSNB increased when ventral disc protrusion was present. To avoid complications, attention should be paid to ventral disc protrusions before performing LSNB.
Macpherson, J. M.; Fung, J.; Peterson, B. W. (Principal Investigator)
This study examined the role of trunk extensor muscles in the thoracic and lumbar regions during postural adjustments in the freely standing cat. The epaxial extensor muscles participate in the rapid postural responses evoked by horizontal translation of the support surface. The muscles segregate into two regional groups separated by a short transition zone, according to the spatial pattern of the electromyographic (EMG) responses. The upper thoracic muscles (T5-9) respond best to posteriorly directed translations, whereas the lumbar muscles (T13 to L7) respond best to anterior translations. The transition group muscles (T10-12) respond to almost all translations. Muscles group according to vertebral level rather than muscle species. The upper thoracic muscles change little in their response with changes in stance distance (fore-hindpaw separation) and may act to stabilize the intervertebral angles of the thoracic curvature. Activity in the lumbar muscles increases along with upward rotation of the pelvis (iliac crest) as stance distance decreases. Lumbar muscles appear to stabilize the pelvis with respect to the lumbar vertebrae (L7-sacral joint). The transition zone muscles display a change in spatial tuning with stance distance, responding to many directions of translation at short distances and focusing to respond best to contralateral translations at the long stance distance.
Pyon, Jai-Kyong; Park, Bum-Jin; Mun, Goo-Hyun; Cha, Myung-Kyu; Lim, So-Young; Bang, Sa-Ik; Oh, Kap-Sung
Although the removal of forehead and brow benign tumors using an endoscopic technique has proven to be valuable, the efficacy of an endoscopic excision for cheek masses is unclear. A retrospective review was performed on 8 patients with a lipoma (7) and a foreign body granuloma (1) located at the cheek region. There were 7 men and 1 woman with a mean age of 34.8 years (range, 22-54 years). All the excisional procedures were performed with an endoscope through 2 small incisions, one on the hair-bearing sideburns and the other behind the earlobe. The masses varied from 0.7 x 0.7 cm to 4.0 x 3.0 cm in size. There were no intraoperative or postoperative complications, and no recurrence was detected after a 5- to 61-month follow-up. An endoscopically assisted excision of cheek lipomas is an effective procedure and might be a good alternative to the more conventional procedures.
Vialle, Luis Roberto; Vialle, Emiliano Neves; Suárez Henao, Juan Esteban; Giraldo, Gustavo
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
Ciricillo, S F; Weinstein, P R
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
Syrimpeis, Vasileios; Vitsas, Vasileios; Korovessis, Panagiotis
Context Hemangiomas are the commonest benign tumors of the spine. Most occur in the thoracolumbar spine and the majority are asymptomatic. Rarely, hemangiomas cause symptoms through epidural expansion of the involved vertebra, resulting in spinal canal stenosis, spontaneous epidural hemorrhage, and pathological burst fracture. Findings We report a rare case of a 73-year-old woman, who had been treated for two months for degenerative neurogenic claudication. On admission, magnetic resonance imaging and computed tomographic scans revealed a hemangioma of the third lumbar vertebra protruding to the epidural space producing lateral spinal stenosis and ipsilateral nerve root compression. The patient underwent successful right hemilaminectomy for decompression of the nerve root, balloon kyphoplasty with poly-methyl methacrylate (PMMA) and pedicle screw segmental stabilization. Postoperative course was uneventful. Conclusion In the elderly, this rare presentation of spinal stenosis due to hemangiomas may be encountered. Decompression and vertebral augmentation by means balloon kyphoplasty with PMMA plus segmental pedicle screw fixation is recommended.
Firooznia, H.; Benjamin, V.; Kricheff, I.I.; Rafii, M.; Golimbu, C.
Computed tomography (CT) of the lumbar spine was performed with selectively positioned 5-mm-thick axial cross sections to examine each disk level from the top of the neural foramen to the pedicle of the next caudad vertebra. One hundred consecutive patients with 116 surgical disk explorations were reviewed. There was agreement between the CT and surgical findings in 89 patients (104 explorations) in determination of presence or absence of a herniated nucleus pulposus (HNP). Discrepancy occurred in 12 instances (11 patients): two because of incorrect interpretations, five in previously operated patients, three in spondylolisthesis, and two in spinal stenosis. There were 97 true-positives, eight false-negatives, seven true-negatives, and four false-positives. If nine previously operated patients are excluded from the study, then CT was accurate in detection of presence or absence of an HNP in 93% of the disk explorations.
Zhou, Chuan; Chan, Heang-Ping; Dong, Qian; He, Bo; Wei, Jun; Hadjiiski, Lubomir M.; Couriel, Daniel
We are developing an automated method for the identification of the spinal cord and the vertebras on spinal MR images, which is an essential step for computerized analysis of bone marrow diseases. The spinal cord segment was first enhanced by a newly developed hierarchical multiscale tubular (HMT) filter that utilizes the complementary hyper- and hypo- intensities in the T1-weighted (T1W) and STIR MRI sequences. An Expectation-Maximization (EM) analysis method was then applied to the enhanced tubular structures to extract candidates of the spinal cord. The spinal cord was finally identified by a maximum-likelihood registration method by analysis of the features extracted from the candidate objects in the two MRI sequences. Using the identified spinal cord as a reference, the vertebras were localized based on the intervertebral disc locations extracted by another HMT filter applied to the T1W images. In this study, 5 and 30 MRI scans from 35 patients who were diagnosed with multiple myeloma disease were collected retrospectively with IRB approval as training and test set, respectively. The vertebras manually outlined by a radiologist were used as reference standard. A total of 422 vertebras were marked in the 30 test cases. For the 30 test cases, 100% (30/30) of the spinal cords were correctly segmented with 4 false positives (FPs) mistakenly identified on the back muscles in 4 scans. A sensitivity of 95.0% (401/422) was achieved for the identification of vertebras, and 5 FPs were marked in 4 scans with an average FP rate of 0.17 FPs/scan.
Ibarz, Elena; Herrera, Antonio
The knowledge of the lumbar spine biomechanics is essential for clinical applications. Due to the difficulties to experiment on living people and the irregular results published, simulation based on finite elements (FE) has been developed, making it possible to adequately reproduce the biomechanics of the lumbar spine. A 3D FE model of the complete lumbar spine (vertebrae, discs, and ligaments) has been developed. To verify the model, radiological images (X-rays) were taken over a group of 25 healthy, male individuals with average age of 27.4 and average weight of 78.6 kg with the corresponding informed consent. A maximum angle of 34.40° is achieved in flexion and of 35.58° in extension with a flexion-extension angle of 69.98°. The radiological measurements were 33.94 ± 4.91°, 38.73 ± 4.29°, and 72.67°, respectively. In lateral bending, the maximum angles were 19.33° and 23.40 ± 2.39, respectively. In rotation a maximum angle of 9.96° was obtained. The model incorporates a precise geometrical characterization of several elements (vertebrae, discs, and ligaments), respecting anatomical features and being capable of reproducing a wide range of physiological movements. Application to disc degeneration (L5-S1) allows predicting the affection in the mobility of the different lumbar segments, by means of parametric studies for different ranges of degeneration. PMID:23509766
Chong, Hyon Su; Kim, Hak Sun; Ankur, Nanda; Kho, Phillip Anthony; Kim, Sung Jun; Kim, Do Yeon; Park, Jin Oh; Moon, Seong Hwan; Lee, Hwan Mo
Purpose The objectives of this study are to describe the outcome of adolescent idiopathic scoliosis (AIS) patients treated with Video Assisted Thoracoscopic Surgery (VATS) plus supplementary minimal incision in the lumbar region for thoracic and lumbar deformity correction and fusion. Materials and Methods This is a case series of 13 patients treated with VATS plus lumbar mini-open surgery for AIS. A total of 13 patients requiring fusions of both the thoracic and lumbar regions were included in this study: 5 of these patients were classified as Lenke type 1A and 8 as Lenke type 5C. Fusion was performed using VATS up to T12 or L1 vertebral level. Lower levels were accessed via a small mini-incision in the lumbar area to gain access to the lumbar spine via the retroperitoneal space. All patients had a minimum follow-up of 1 year. Results The average number of fused vertebrae was 7.1 levels. A significant correction in the Cobb angle was obtained at the final follow-up (p = 0.001). The instrumented segmental angle in the sagittal plane was relatively well-maintained following surgery, albeit with a slight increase. Scoliosis Research Society-22 (SRS-22) scores were noted have significantly improved at the final follow-up (p < 0.05). Conclusion Indications for the use of VATS may be extended from patients with localized thoracic scoliosis to those with thoracolumbar scoliosis. By utilizing a supplementary minimal incision in the lumbar region, a satisfactory deformity correction may be accomplished with minimal post-operative scarring. PMID:21155045
Song, Deyong; Chen, Zhong; Song, Dewei; Li, Zaixue
Intraosseous schwannomas of the mobile spine are extremely rare. To our knowledge, only 21 cases have been reported in the literature. In this report, we present a case of schwannoma involving the lumbar spine, with a review of the literature and discussion of this rare tumor. A 44 year old male presented with a 3 year history of intermittent low back pain, with radiation into the right lower extremity during the last 2 years. Radiographs revealed an approximately 4 x 4 cm irregular mass with marginal sclerosis located at the L5 vertebra, involving the right pedicle and extruding into the spinal canal. The tumor was resected completely and was confirmed as schwannoma by histological examination. At follow up after 12 months, the patient was free of pain and with no recurrence. Despite its low incidence, intraosseous schwannomas should be considered as the differential diagnosis of an extradural mass involving the vertebrae. Surgery is the preferred treatment method and usually carries a good prognosis.
Lee, H-J; Kim, P-T; Jeon, I-H; Kyung, H-S; Ra, I-H; Kim, T-K
Osteophyte excision is a mainstay of treatment for mucous cyst combined with Heberden's node in a distal interphalangeal joint or in an interphalangeal joint of the thumb. The aim of this study was to evaluate the results of osteophyte excision without cyst excision for the treatment of a mucous cyst combined with Heberden's node. The medical records of 37 patients (42 cases) with a mucous cyst with Heberden's node were retrospectively reviewed. Thirty-eight of 40 cases with available pre-operative simple radiographs showed evidence of joint arthrosis. A T-shaped skin incision of the joint capsule between the extensor tendon and lateral collateral ligament was used. Osteophyte excision without cyst excision was performed. All cysts, except one, regressed without recurrence or a skin complication after osteophyte excision, but eight cases showed post-operative pain and loss of range of motion. Osteophyte excision without cyst excision may be a good treatment choice for mucous cyst of the finger.
Bansil, Rohit; Hirano, Yoshitaka; Sakuma, Hideo; Watanabe, Kazuo
Background: Another rare cause of lower back pain with radiculopathy is the discal cyst. It is believed to arise from degeneration of a herniated disc, although many other theories of its origin have been proposed. Here, we report a patient with lower back pain/radiculopathy attributed originally to a herniated lumbar disc, which transformed within 6 months into a discal cyst. Case Description: A 42-year-old male had a magnetic resonance (MR) documented herniated lumbar disc at the L4-5 level. It was managed conservatively for 6 months, after which symptoms recurred and progressed. The follow-up MR study revealed a discal cyst at the L4-5 without residual herniated disc. Of interest, the cyst communicated with the L4-5 intervertebral disc, which was herniated under the posterior longitudinal ligament and the disc space. During surgery, the cyst was completely removed, and his symptoms/signs resolved. Conclusion: A discal cyst develops as pathological sequelae of a degenerated herniated disc. Although rare, these lesions must be considered among the differential diagnoses in young patients with radicular back pain. MR study clearly documents these lesions, and surgical excision of the cyst is the treatment of choice. PMID:27843689
... 27 Alcohol, Tobacco Products and Firearms 2 2014-04-01 2014-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...
... 27 Alcohol, Tobacco Products and Firearms 2 2012-04-01 2011-04-01 true Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...
... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...
... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...
... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...
... 27 Alcohol, Tobacco Products and Firearms 2 2011-04-01 2011-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...
... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...
... 27 Alcohol, Tobacco Products and Firearms 2 2013-04-01 2013-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...
... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...
... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...
Chow, Carina F K; Kim, Seon Hahn
Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units' routinely performing complete mesocolic excisions have good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. And yet unlike total mesorectal excision, uptake in the West has been relatively slow with many units sceptical of the true benefits gained by taking up a more technically challenging and potentially more morbid procedure when there is a paucity of literature to support these claims. This article reviews complete mesocolic excision for colon cancer, attempting to identify the risks and benefits of the technique and particularly looking at the reasons why its uptake has not been universal. It also discusses the similarities of a complete mesocolic excision to a colon resection with a D3 lymphadenectomy as well as the role of a laparoscopic approach to this technique. Considering a D3 lymphadenectomy has been the standard of care for stage II and III colon cancers in many of our Asian neighbours for over 20 years, combining this data with data on complete mesocolic excision may provide enough evidence to support or refute the need for complete mesocolic excisions. Maybe there might be lessons to be learnt from our colleagues in the east.
Oshima, Masashi; Matsuzaki, Hiromi; Tokuhashi, Yasuaki; Okawa, Akihiro
Vertebroplasty was performed using hydroxyapatite blocks to examine the course of compressive strength and histological features in a dog model. The vertebral fracture model was prepared by punching a hole in the center of the vertebra and at 4 sites around the vertebra (5 holes in total) from the front side of the vertebra using an air drill and hollowing the holes. Measurements were made on healthy vertebrae, vertebrae from the vertebral fracture model, vertebrae removed from animals immediately after vertebroplasty, vertebrae collected 1 and 2 months after vertebroplasty, and vertebrae untreated for 1 month after vertebral fracture. Histological examinations were also performed 1 and 2 weeks and 1 and 2 months after vertebroplasty with hydroxyapatite blocks. The strength of vertebrae in the fracture model immediately after vertebroplasty was significantly higher than that in the untreated fracture, and the strength of vertebrae 1 month after the procedure was equivalent to that of healthy vertebrae. Histologically, new bone formation was found around hydroxyapatite blocks 2 weeks after the procedure, and strong crosslinking between neighboring hydroxyapatite blocks was found after 1 month.These results suggest that hydroxyapatite blocks may be effective as filling material for vertebral fracture from both biomechanical and histological perspectives.
Yu, Bin; Wu, Desheng; Shen, Bin; Zhao, Weidong; Huang, Yufeng; Zhu, Jianguang; Qi, Dongduo
Vertebral hemangiomas are benign lesions and are often asymptomatic. Most vertebral hemangiomas that cause cord compression and neurological symptoms are located in the thoracic spine and involve a single vertebra. The authors report the rare case of lumbar hemangiomas in a 60-year-old woman presenting with severe back pain and rapidly progressive neurological signs attributable to 2 noncontiguous lesions. After embolization of the feeding arteries, no improvement was noted. Thus, the authors performed open surgery using a combination of posterior decompression, intraoperative kyphoplasty, and segmental fixation. The patient experienced relief from back and leg pain immediately after surgery. At 3 months postoperatively, her symptoms and neurological deficits had improved completely. To the authors' knowledge, this is the first description of 2 noncontiguous extensive lumbar hemangiomas presenting with neurological symptoms managed by such combined treatment. The combined management seems to be an effective method for treating symptomatic vertebral hemangiomas.
Cedoz, M E; Larbre, J P; Lequin, C; Fischer, G; Llorca, G
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.
Caltabiano, M; Leonardi, R; Zaborra, G
The relationship among cervical vertebral maturation and skeletal, dental and chronological ages were assessed by the Authors in lateral cephalometric, hand and orthopantomographic x-rays on 72 italian young subjects from 10 to 15 years of age. Statistically significant correlations were found between cervical vertebral maturation and skeletal age both in males and females, while vertebrae age was correlated with dental and chronological ages only in the females.
Gaonkar, Bilwaj; Shu, Liao; Hermosillo, Gerardo; Zhan, Yiqiang
Vertebral segmentation is a critical first step in any quantitative evaluation of vertebral pathology using CT images. This is especially challenging because bone marrow tissue has the same intensity profile as the muscle surrounding the bone. Thus simple methods such as thresholding or adaptive k-means fail to accurately segment vertebrae. While several other algorithms such as level sets may be used for segmentation any algorithm that is clinically deployable has to work in under a few seconds. To address these dual challenges we present here, a new algorithm based on the geodesic distance transform that is capable of segmenting the spinal vertebrae in under one second. To achieve this we extend the theory of the geodesic distance transforms proposed in1 to incorporate high level anatomical knowledge through adaptive weighting of image gradients. Such knowledge may be provided by the user directly or may be automatically generated by another algorithm. We incorporate information 'learnt' using a previously published machine learning algorithm2 to segment the L1 to L5 vertebrae. While we present a particular application here, the adaptive geodesic transform is a generic concept which can be applied to segmentation of other organs as well.
Functional deficits after whiplash injury can be analyzed with a quite novel radiologic method by examination of joint-blocks in C0/1 and C1/2. Thereto the movability of C0, C1 and C2 is determined with three spiral CT-scans of the patient's cervical spine. One series in neutral and one in maximal active lateral right and left rotation each. Previous methods were slice based and time consuming when manually evaluated. We propose a new approach to a computation of these angles in 3D. After a threshold segmentation of bone tissue, a rough 2D classification takes place for C0, C1 and C2 in each rotation series. The center of an axial rotation for each vertebra is gained from the approximation of its center of gravity. The rotation itself is estimated by a cross-correlation of the radial distance functions. From the previous rotation the results are taken to initialize a 3D matching algorithm based on the sum of squared differences in intensity. The optimal match of the vertebrae is computed by means of the multidimensional Powell minimization algorithm. The three translational and three rotational components build a six-dimensional search-space. The vertebrae detection and rotation computation is done fully automatic.
Sakaura, Hironobu; Yamashita, Tomoya; Miwa, Toshitada; Ohzono, Kenji; Ohwada, Tetsuo
The incidence of symptomatic adjacent segment pathology (ASP) after fusion surgery for adult low-grade isthmic spondylolisthesis (IS) has been reported to be relatively low compared with other lumbar disease entities. However, there has been no study of symptomatic ASP incidence using posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation. We investigated the incidence of symptomatic ASP after PLIF with pedicle screw instrumentation for adult low-grade IS and identified significant risk factors for symptomatic ASP. We retrospectively studied records of 40 consecutive patients who underwent PLIF with pedicle screw instrumentation at the Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Japan. The patients were followed for ≥ 4 years. Patients' medical records were retrospectively examined for evidence of symptomatic ASP. Age at time of surgery, sex, fusion level, whole lumbar lordosis, segmental lordosis, preexisting laminar inclination angle, and facet tropism at the cranial fusion segment were analyzed to identify risk factors for symptomatic ASP. Four patients (ASP group) developed symptomatic ASP at the cranial segment adjacent to the fusion. There were no significant differences in age, sex, fusion level, lumbar lordosis, segmental lordosis, or facet tropism at the cranial segment adjacent to the fusion between the ASP and the non-ASP groups. In contrast, laminar inclination angle at the cranial vertebra adjacent to the fusion was significantly higher in the ASP group than in the non-ASP group. Four patients (10%) developed symptomatic ASP after PLIF with transpedicular fixation for adult low-grade IS. Preexisting laminar horizontalization at the cranial vertebra adjacent to the fusion was a significant risk factor for symptomatic ASP. PMID:24436872
Reed, William R.; Pickar, Joel G.; Long, Cynthia R.
Objective: Individuals experiencing low back pain often present clinically with intervertebral joint dysfunction. The purpose of this study was to determine whether relative changes in stiffness at a single spinal joint alters neural responsiveness of lumbar muscle spindles to either vertebral movement or position. Methods: Muscle spindle discharge was recorded in response to 1mm L6 ramp and hold movements (0.5mm/s) in the same animal for lumbar laminectomy-only (n=23), laminectomy & L5/6 facet screw (n=19), laminectomy & L5/6 facetectomy (n=5) conditions. Mean instantaneous frequency (MIF) was calculated for the ramp-up, hold, ramp-down and post-ramp phases during each joint condition. Results: Mean MIFs were not significantly different between the laminectomy-only and the other two types of joint dysfunction for the ramp-up, hold, ramp-down, or post-ramp phases. Conclusion: Stiffness changes caused by single facet joint dysfunction failed to alter spindle responses during slow 1mm ramp and hold movements of the L6 vertebra. PMID:24932020
From the mechanical point of view the spinal system is highly complex, containing a multitude of components, passive and active. In fact, even if the active components (the muscles) were exchanged by passive springs, the total number of elements considerably exceeds the minimum needed to maintain static equilibrium. In other words, the system is statically highly indeterminate. The particular role of the active components at static equilibrium is to enable a virtually arbitrary choice of posture, independent of the distribution and magnitude of the outer load albeit within physiological limits. Simultaneously this implies that ordinary procedures known from the analysis of mechanical systems with passive components cannot be applied. Hence the distribution of the forces over the different elements is not uniquely determined. Consequently nervous control of the force distribution over the muscles is needed, but little is known about how this achieved. This lack of knowledge implies great difficulties at numerical simulation of equilibrium states of the spinal system. These difficulties remain even if considerable reductions are made, such as the assumption that the thoracic cage behaves like a rigid body. A particularly useful point of view about the main principles of the force distributions appears to be the distinction between a local and a global system of muscles engaged in the equilibrium of the lumbar spine. The local system consists of muscles with insertion or origin (or both) at lumbar vertebrae, whereas the global system consists of muscles with origin on the pelvis and insertions on the thoracic cage. Given the posture of the lumbar spine, the force distribution over the local system appears to be essentially independent of the outer load of the body (though the force magnitudes are, of course, dependent on the magnitude of this load). Instead different distributions of the outer load on the body are met by different distributions of the forces in the
Lin, Yu-Li; Lai, Yu-Hsien; Wang, Chih-Hsien; Kuo, Chiu-Huang; Liou, Hung-Hsiang; Hsu, Bang-Gee
Anthropometric measurements, including body mass index (BMI), body weight and total fat mass are associated with the bone mineral density (BMD) in the general population. Compared to that in the general population, BMD was lower in dialysis patients. However, the association between anthropometric measurements and BMD is not well-established among peritoneal dialysis (PD) patients. To study this, we conducted a cross-sectional study in 48 chronic PD patients. Anthropometric parameters, biochemical data, and BMD measured by dual energy X-ray absorptiometry in lumbar vertebrae (L2-L4) were collected. Among these PD patients, eight patients (16.7%) had osteoporosis and 22 patients (45.8%) osteopenia, while 18 patients were normal. Older age, decreased height, lower body weight, BMI, triceps skinfold thickness (TSF), mid-arm fat area (MAFA), and higher adiponectin levels were observed in our patients with lower lumbar T-scores. Height, body weight, waist circumference, BMI, body fat mass, TSF, mid-arm circumference, MAFA, and serum phosphorus levels were positively, while age, adiponectin levels were negatively correlated with lumbar BMD levels. According to our multivariate forward stepwise linear regression analysis, TSF (R(2) change = 0.080, P = 0.017) and body weight (R(2) change = 0.333, P = 0.002) were both correlated with low lumbar BMD. In conclusion, either TSF or body weight in our chronic PD patients was proved to be an independent predictor for osteolytic bone lesions.
Alonso-Bartolomé, P; Canga, A; Vázquez-Barquero, A; García-Valtuille, R; Abascal, F; Cerezal, L
Intradural disc herniation is a rare complication of degenerative disc disease. A correct diagnosis of this process is frequently difficult. If this entity is not preoperatively diagnosed and is omitted at surgery, severe neurologic sequels may be provoked. We report a case of a pathologically proven intradural disc herniation preoperatively diagnosed by MR imaging. Clinically, it was manifested by sudden onset of right leg ciatalgia and progressive right lower extremity weakness. The patient also referred a one-month history of sexual dysfunction. MR imaging revealed interruption of the low signal of the anulus fibrosus and of the posterior longitudinal ligament at L2-L3 level and a voluminous disc fragment migrated in the dural sac that showed rim enhancement with gadolinium.The clinical, neuroradiological, and surgical management of lumbar intradural disc herniation are reviewed.
SKRZYPIEC, Daniel M.; NAGEL, Katrin; SELLENSCHLOH, Kay; KLEIN, Anke; PÜSCHEL, Klaus; MORLOCK, Michael M.; HUBER, Gerd
An in-vitro experiment was designed to investigate the mode of failure following shear fatigue loading of lumbar motion-segments. Human male lumbar motion-segments (age 32–42 years, n=6) were immersed in Ringer solution at 37°C and repeatedly loaded, using a modified materials testing machine. Fatigue loading consisted of a sinusoidal shear load from 0 N to 1,500 N (750 N±750 N) applied to the upper vertebra of the motion-segment, at a frequency of 5 Hz. During fatigue experiments, several failure events were observed in the dynamic creep curves. Post-test x-ray, CT and dissection revealed that all specimens had delamination of the intervertebral disc. Anterior shear fatigue predominantly resulted in fracture of the apophyseal processes of the upper vertebrae (n=4). Exposure to the anterior shear fatigue loading caused motion-segment instability and resulted in vertebral slip corresponding to grade I and ‘mild’ grade II spondylolisthesis, as observed clinically. PMID:26829975
Freyer, G A; Davey, S; Ferrer, J V; Martin, A M; Beach, D; Doetsch, P W
DNA lesions induced by UV light, cyclobutane pyrimidine dimers, and (6-4)pyrimidine pyrimidones are known to be repaired by the process of nucleotide excision repair (NER). However, in the fission yeast Schizosaccharomyces pombe, studies have demonstrated that at least two mechanisms for excising UV photo-products exist; NER and a second, previously unidentified process. Recently we reported that S. pombe contains a DNA endonuclease, SPDE, which recognizes and cleaves at a position immediately adjacent to cyclobutane pyrimidine dimers and (6-4)pyrimidine pyrimidones. Here we report that the UV-sensitive S. pombe rad12-502 mutant lacks SPDE activity. In addition, extracts prepared from the rad12-502 mutant are deficient in DNA excision repair, as demonstrated in an in vitro excision repair assay. DNA repair activity was restored to wild-type levels in extracts prepared from rad12-502 cells by the addition of partially purified SPDE to in vitro repair reaction mixtures. When the rad12-502 mutant was crossed with the NER rad13-A mutant, the resulting double mutant was much more sensitive to UV radiation than either single mutant, demonstrating that the rad12 gene product functions in a DNA repair pathway distinct from NER. These data directly link SPDE to this alternative excision repair process. We propose that the SPDE-dependent DNA repair pathway is the second DNA excision repair process present in S. pombe. PMID:7623848
Vilariño Villaverde, Raquel; Bruguier, Christine; Zerlauth, Jean-Baptiste; De Froidmont, Sébastien; Grabherr, Silke
Lumbar surgery is regularly applied in cases of discal hernia and acquired lumbar stenosis. In this report, we present a case of a laceration in the left common iliac artery and iliac vein during a lumbar surgery and discuss the literature concerning this kind of event. In the present case, the surgical procedure was followed by a sudden decrease in blood pressure, and the surgeon discovered an intra-abdominal haemorrhage that led to the patient's death. Postmortem investigation confirmed the intra-abdominal haemorrhage and revealed a laceration of the proximal portion of the left common iliac artery and left iliac vein. The source of bleeding could be detected especially thanks to multi-phase postmortem CT angiography (MPMCTA), which was performed prior to autopsy. We also found a haemorrhagic path through the intervertebral disc between the L4-L5 vertebrae, caused by the surgeon's instrument (pituitary rongeur). To date, a few cases have been described of iatrogenic death resulting from a tear in the iliac vessels during lumbar surgery, but not from the postmortem perspective. Such investigations have recently been modernized thanks to the introduction of forensic imaging. In particular, MPMCTA offers new possibilities in postmortem investigations and can be considered the new gold standard for investigating deaths related to medical intervention. Here we describe the first case of a death during lumbar surgery using this new method.
Soliman, Hany A.G.; Mac-Thiong, Jean-Marc; Levasseur, Annie; Parent, Stefan
Study Design Cohort study. Purpose The aim of this study is to propose and evaluate a new technique to assess bone mineral density of fractured vertebrae using quantitative computed tomography (QCT). Overview of Literature There is no available technique to estimate bone mineral density (BMD) at the fractured vertebra because of the alterations in bony structures at the fracture site. Methods Forty patients with isolated fracture from T10 to L2 were analyzed from the vertebrae above and below the fracture level. Apparent density (AD) was measured based on the relationship between QCT images attenuation coefficients and the density of calibration objects. AD of 8 independent regions of interest (ROI) within the vertebral body and 2 ROI within the pedicles of vertebrae above and below the fractured vertebra were measured. At the level of the fractured vertebra, AD was measured at the pedicles, which are typically intact. AD of the fractured vertebral body was linearly interpolated, based on the assumption that AD at the fractured vertebra is equivalent to the average AD measured in vertebrae adjacent to the fracture. Estimated and measured AD of the pedicles at the fractured level were compared to verify our assumption of linear interpolation from adjacent vertebrae. Results The difference between the measured and the interpolated density of the pedicles at the fractured vertebra was 0.006 and 0.003 g/cm3 for right and left pedicle respectively. The highest mean AD located at the pedicles and the lowest mean AD was found at the anterior ROI of the vertebral body. Significant negative correlation exist between age and AD of ROI in the vertebral body. Conclusions This study suggests that the proposed technique is adequate to estimate the AD of a fractured vertebra from the density of adjacent vertebrae. PMID:28243370
Benameur, Said; Mignotte, Max; Parent, Stefan; Labelle, Hubert; Skalli, Wafa; de Guise, Jacques
We propose a new 3D/2D registration method for vertebrae of the scoliotic spine, using two conventional radiographic views (postero-anterior and lateral), and a priori global knowledge of the geometric structure of each vertebra. This geometric knowledge is efficiently captured by a statistical deformable template integrating a set of admissible deformations, expressed by the first modes of variation in Karhunen-Loeve expansion, of the pathological deformations observed on a representative scoliotic vertebra population. The proposed registration method consists of fitting the projections of this deformable template with the preliminary segmented contours of the corresponding vertebra on the two radiographic views. The 3D/2D registration problem is stated as the minimization of a cost function for each vertebra and solved with a gradient descent technique. Registration of the spine is then done vertebra by vertebra. The proposed method efficiently provides accurate 3D reconstruction of each scoliotic vertebra and, consequently, it also provides accurate knowledge of the 3D structure of the whole scoliotic spine. This registration method has been successfully tested on several biplanar radiographic images and validated on 57 scoliotic vertebrae. The validation results reported in this paper demonstrate that the proposed statistical scheme performs better than other conventional 3D reconstruction methods.
Kranenbarg, Sander; Waarsing, Jan H; Muller, Mees; Weinans, Harrie; van Leeuwen, Johan L
Lordosis in fish is an abnormal ventral curvature of the vertebral column, accompanied by abnormal calcification of the afflicted vertebrae. Incidences of lordosis are a major problem in aquaculture and often correlate with increased swimming activity. To understand the biomechanical causes and consequences of lordosis, we mapped the morphological changes that occur in the vertebrae of European sea bass during their development from larva to juvenile. Our micro-CT analysis of lordotic and non-lordotic vertebrae revealed significant differences in their micro-architecture. Lordotic vertebrae have a larger bone volume, flattened dorsal zygapophyses and extra lateral ridges. They also have a larger second moment of area (both lateral and dorso-ventral) than non-lordotic vertebrae. This morphology suggests lordotic vertebrae to be adapted to an increased bending moment, caused by the axial musculature during increased swimming activity. We hypothesize the increase in swimming activity to have a two-fold effect in animals that become lordotic. The first effect is buckling failure of the axial skeleton due to an increased compressive load. The second effect is extra bone deposition as an adaptive response of the vertebrae at the cellular level, caused by an increased strain and strain rate in these vertebrae. Lordosis thus comprises both a buckling failure of the vertebral column and a molecular response that adapts the lordotic vertebrae to a new loading regime.
Zander, Thomas; Dreischarf, Marcel; Schmidt, Hendrik
The loads between adjacent vertebrae can be generalised as a single spatial force acting at the intervertebral centre of reaction. The exact position in vivo is unknown. However, in rigid body musculoskeletal models that simulate upright standing, the position is generally assumed to be located at the discs' centres of rotation. The influence of the antero-posterior position of the centre of reaction on muscle activity and joint loads remains unknown. Thus, by using an inverse dynamic model, we varied the position of the centre of reaction at L4/L5 (i), simultaneously at all lumbar levels (ii), and by optimisation at all lumbar levels (iii). Variation of the centres of reaction can considerably influence the activities of lumbar muscles and the joint forces between vertebrae. The optimisation of the position of the centre of reaction reduced the maximum lumbar muscle activity and axial joint forces at L4/L5 from 17.5% to 1.5% of the muscle strength and from 490 N to 390 N, respectively. Thus, when studying individual postures, such as for therapeutic or preventive evaluations, potential differences between the centre of reaction and the centre of rotation might influence the study results. These differences could be taken into account by sensitivity analyses.
Li, Weishi; Wang, Shaobai; Xia, Qun; Passias, Peter; Kozanek, Michal; Wood, Kirkham; Li, Guoan
Study Design Controlled laboratory study. Objective To evaluate the effect of lumbar degenerative disc diseases (DDDs) on motion of the facet joints during functional weight-bearing activities. Summary of Background Data It has been suggested that DDD adversely affects the biomechanical behavior of the facet joints. Altered facet joint motion, in turn, has been thought to associate with various types of lumbar spine pathology including facet degeneration, neural impingement, and DDD progression. However, to date, no data have been reported on the motion patterns of the lumbar facet joint in DDD patients. Methods Ten symptomatic patients of DDD at L4–S1 were studied. Each participant underwent magnetic resonance images to obtain three-dimensional models of the lumbar vertebrae (L2–S1) and dual fluoroscopic imaging during three characteristic trunk motions: left-right torsion, left-right bending, and flexion-extension. In vivo positions of the vertebrae were reproduced by matching the three-dimensional models of the vertebrae to their outlines on the fluoroscopic images. The kinematics of the facet joints and the ranges of motion (ROMs) were compared with a group of healthy participants reported in a previous study. Results In facet joints of the DDD patients, there was no predominant axis of rotation and no difference in ROMs was found between the different levels. During left-right torsion, the ROMs were similar between the DDD patients and the healthy participants. During left-right bending, the rotation around mediolateral axis at L4–L5, in the DDD patients, was significantly larger than that of the healthy participants. During flexion-extension, the rotations around anterioposterior axis at L4–L5 and around craniocaudal axis at the adjacent level (L3–L4), in the DDD patients, were also significantly larger, whereas the rotation around mediolateral axis at both L2–L3 and L3–L4 levels in the DDD patients were significantly smaller than those of the
... 29 Labor 3 2010-07-01 2010-07-01 false Exclusion of excise taxes. 794.121 Section 794.121 Labor... Exclusion of excise taxes. The computation of the annual gross volume of sales of the enterprise for purposes of section 7(b)(3) is made “exclusive of excise taxes.” It will be noted that the excise...
Fernández-Pérez, María José; McNamara, James A.; Velasco-Torres, Miguel; Benavides, Erika; Galindo-Moreno, Pablo; Catena, Andrés
The aim of this study was to determine the relationship between the closure stage of the spheno-occipital synchondrosis and the maturational stage of the cervical vertebrae (CVM) in growing and young adult subjects using cone beam computed tomography (CBCT). CBCT images with an extended field of view obtained from 315 participants (148 females and 167 males; mean age 15.6 ±7.3 years; range 6 to 23 years) were analyzed. The fusion status of the synchondrosis was determined using a five-stage scoring system; the vertebral maturational status was evaluated using a six-stage stratification (CVM method). Ordinal regression was used to study the ability of the synchondrosis stage to predict the vertebral maturation stage. Vertebrae and synchondrosis had a strong significant correlation (r = 0.89) that essential was similar for females (r = 0.88) and males (r = 0.89). CVM stage could be accurately predicted from synchondrosis stage by ordinal regression models. Prediction equations of the vertebral stage using synchondrosis stage, sex and biological age as predictors were developed. Thus this investigation demonstrated that the stage of spheno-occipital synchondrosis, as determined in CBCT images, is a reasonable indicator of growth maturation. PMID:27513752
Venumadhav, Nelluri; KS, Siddaraju
Background: The ligamentum longitudinale anterius is a broad and strong band of fibrous tissue that runs along the anterior surfaces of the bodies of the vertebrae. Aim: The study was undertaken to evaluate the incidence of ossified ligamentum longitudinale anterius in adult dry human vertebra. Materials and Methods: This study was carried out on 95 sets of dry human vertebral columns irrespective of age and sex at Mayo Institute of Medical Sciences- Barabanki,-UP, Melaka Manipal Medical College-Manipal University and Department of Anatomy, KMCT Medical College, Manassery- Calicut, India. All the sets of vertebral columns were macroscopically inspected for the ossified ligamentum longitudinale anterius. Results: It was observed that out of 95 sets of vertebral columns, 27 (28.42%) vertebral columns showed ossification. Out of 27 vertebral columns, 17 (17.89%) vertebral columns showed segmental type of ossification, 2 (2.11%) vertebral columns showed continuous type of ossification and 8 (8.42%) vertebral columns showed mixed type of ossification at different vertebral level. Conclusion: Such type of ossification will affect the biomechanics of the spine and may result in stiff neck, low back pain, dysphagia, odynophagia, compression of the brachial plexus, aphonia, immobility or mucosal thickening of larynx. Hence, knowledge of such abnormalities should be kept in mind to minimise serious complications in any surgical intervention or investigative procedures in the region. PMID:25302180
Chun, Eun Hee
Foraminal or extraforaminal Far Lateral Disc Herniations (FLDH) extending into or beyond the foraminal zone have been recognized as between 7-12% of all lumbosacral disc herniations. Conventional posterior laminectomy may not provide good access to a herniation that lies far lateral to the lateral margin of the pedicle. Use of the endoscopic technique through a percutaneous approach to treat such FLDH patients can decrease the surgical morbidity while achieving better outcomes. We made an effort to utilize the advantages of percutaneous endoscopic lumbar discectomy (PELD) and to determine the appropriate approach for FLDH at the level between the 5th Lumbar and first Sacral vertebrae(L5-S1). The authors present a case of an endoscopically resected lumbar extruded disc of the left extraforaminal zone with superior foraminal migration at the level of L5-S1, which had led to foot drop, while placing the endoscope in the anterior epidural space without facetectomy. PMID:26839673
Vásquez-Ríos, Jorge Rodrigo; Nava-Bringas, Tania Inés
Antecedentes: el ejercicio es la intervención con mayor grado de evidencia de eficacia para el tratamiento del dolor crónico de la espalda baja, con beneficio superior en términos de dolor y funcionalidad, en comparación con cualquiera otra intervención. Existe una amplia variedad de ejercicios diseñados; sin embargo, actualmente los llamados ejercicios de estabilización lumbar adquiririeron una popularidad creciente entre los clínicos que están en contacto con enfermedades de la columna. Sin embargo, existe controversia en cuanto a la prescripción adecuada de los mismos y los múltiples protocolos publicados. Objetivo: analizar la bibliografía científica acerca del uso y prescripción de estos ejercicios para favorecer la mejor toma de decisiones enlos clínicos y diseñar, con base a la evidencia, el programa más adecuado para cada paciente. Conclusión: se encontró que este programa es una herramienta esencial en el tratamiento del dolor de espalda baja, en la etapa terapéutica y en la preventiva.
Kershner, David E; Binhammer, Robert T
A meticulous examination was performed on 56 vertebral columns from cadavers between 64 and 89 years of age. Identification of all contents within the dural sac was completed; however, the main focus was the cauda equina and lumbar region. In addition to scope dissection, radiographs and histological preparations were used to identify structures, tissue types, and any possible pathology. Discrete intrathecal ligamentous bands were observed in all cadavers examined. They were found randomly binding the dorsal nerve roots of the cauda equina to the dura. Occasional binding of the ventral nerve roots to the dorsal roots was observed. Histological examination demonstrated a dense collagen ligament varying between 0.13 and 0.35 microm in thickness and from 3 mm to 3.5 cm in length. The average number of ligaments found per cadaver was 18. These ligaments displayed a broad base attachment to the nerve root or dura of approximately 3 mm. Looping of the nerve roots associated with these ligaments was seen in one cadaver with a burst fracture. Electron microscopic studies of these ligaments demonstrated similarities to denticulate ligaments. It is suggested that the intrathecal ligaments represent remnants from fetal development of the denticulate ligaments.
Engrav, L H; Gottlieb, J R; Millard, S P; Walkinshaw, M D; Heimbach, D M; Marvin, J A
Most burn victims have unattractive residual lesions, which may include hypertrophic donor sites, unsightly skin grafts, hypertrophic scars, and mature scars with altered pigmentation or texture. Some of these lesions can be treated by total excision in one or more stages or they can be reconstructed utilizing grafts, flaps, Z-plasties, or tissue expansion. But frequently these procedures are either not indicated or not elected by the patient. In such a situation, the only surgical option is partial excision, with the goal of making the lesion less conspicuous and more easily concealed by clothing. Whether or not such partial excisions are worthwhile is the obvious question. We could not find an answer in the literature and therefore decided to review our own experience. Between 6/30/81 and 3/12/86, 92 such procedures were performed and followed in 25 patients. Partial excision of hypertrophic donor sites, unsightly skin grafts, and hypertrophic scars did yield improved appearance in most patients. However, partial excision of mature scars, ie, areas of altered pigmentation or texture, did not have the same success. We continue to treat the first three types of lesions in this fashion but no longer include the latter.
Mir-Sanchis, Ignacio; Martínez-Rubio, Roser; Martí, Miguel; Chen, John; Lasa, Íñigo; Novick, Richard P; Tormo-Más, María Ángeles; Penadés, José R
Staphylococcus aureus pathogenicity islands (SaPIs) are a group of related 15-17 kb mobile genetic elements that commonly carry genes for superantigen toxins and other virulence factors. The key feature of their mobility is the induction of SaPI excision and replication by certain phages and their efficient encapsidation into specific small-headed phage-like infectious particles. Previous work demonstrated that chromosomal integration depends on the SaPI-encoded recombinase, Int. However, although involved in the process, Int alone was not sufficient to mediate efficient SaPI excision from chromosomal sites, and we expected that SaPI excision would involve an Xis function, which could be encoded by a helper phage or by the SaPI, itself. Here we report that the latter is the case. In vivo recombination assays with plasmids in Escherichia coli demonstrate that SaPI-coded Xis is absolutely required for recombination between the SaPI att(L) and att(R) sites, and that both sites, as well as their flanking SaPI sequences, are required for SaPI excision. Mutational analysis reveals that Xis is essential for efficient horizontal SaPI transfer to a recipient strain. Finally, we show that the master regulator of the SaPI life cycle, Stl, blocks expression of int and xis by binding to inverted repeats present in the promoter region, thus controlling SaPI excision.
Schuck, Andreas . E-mail: firstname.lastname@example.org; Ahrens, Susanne; Schorlemer, Ines von; Kuhlen, Michaela; Paulussen, Michael; Hunold, Andrea; Gosheger, Georg; Winkelmann, Winfried; Dunst, Juergen; Willich, Normann; Juergens, Heribert
Purpose: Treatment results in patients with Ewing tumors of the vertebrae enrolled in the Cooperative Ewing's Sarcoma Study (CESS) 81, 86, and the European Intergroup Cooperative Ewing's Sarcoma Study (EICESS) 92 trials were analyzed with special emphasis on radiation-associated factors. Patients and Methods: A retrospective analysis was performed on 116 patients with primary tumors of the cervical, thoracic, or lumbar vertebrae treated between 1981 and 1999. Furthermore, a relapse analysis was done on those patients who underwent radiotherapy and subsequently had a local recurrence. Results: A total of 64.6% of the patients received definitive radiotherapy; 27.5% of patients had surgery and radiotherapy. Only 4 patients (3.4%) underwent definitive surgery. Twenty-seven patients presented with metastases at diagnosis. 22.4% of the total group developed a local relapse. Among the subgroup with definitive radiotherapy, local recurrence was seen in 17 of 75 patients (22.6%). Event-free survival and survival at 5 years were 47% and 58%, respectively. Of the 14 evaluable patients with a local relapse after radiotherapy, 13 were in-field. No correlation between radiation dose and local control could be found. Conclusion: Surgery with wide resection margins is rarely possible. The results after definitive radiotherapy in vertebral tumors are comparable to those of other tumor sites when definitive radiotherapy is given. Nearly all local relapses after radiotherapy are in-field.
Jette, Nancy G.; Lim, Yi L.; Lim, Hui L.; Mokhtar, Sabarul A.; Gan, Kok B.; Singh, Devinder K. A.
Objectives This study aimed to examine correlations between lumbar kinematics, functional disability and fear avoidance beliefs among adults with nonspecific chronic low back pain (LBP). Methods This cross-sectional study was conducted between March and December 2014. A total of 32 adults diagnosed with nonspecific chronic LBP were recruited from outpatients attending either an orthopaedic clinic at a university hospital or a private physiotherapy clinic in Malaysia. Lumbar kinematics were measured using sensors attached at the first lumbar (L1) and second sacral (S2) vertebrae levels. The Oswestry Disability Index (ODI) and Fear-Avoidance Beliefs Questionnaire (FABQ) were used to assess degree of functional disability and fear avoidance beliefs, respectively. Results For maximum range of motion, positive correlations were observed between ODI scores and right lateral flexion and right rotation (P = 0.01 each), although there was a negative correlation with left rotation (P = 0.03). With maximum angular velocity, ODI scores were positively correlated with right and left lateral flexion L1 (P = 0.01 and <0.01, respectively) but negatively correlated with left lateral flexion L2 (P = 0.04). Regarding minimum angular velocity, ODI scores were positively correlated with left lateral flexion S2 (P <0.01) but negatively correlated with right and left lateral flexion L1 (P = 0.02 each), right rotation L1 (P = 0.02) and left rotation S2 (P = 0.01). No significant correlations were found between lumbar kinematics and FABQ scores. Conclusion These findings suggest that certain lumbar kinematic parameters are correlated with functional disability, but not with fear avoidance beliefs. PMID:28003888
Ge, Weiqing; Pickar, Joel G.
In the lumbar spine, muscle spindle responsiveness is affected by the duration and direction of a lumbar vertebra’s positional history. The purpose of the present study was to determine the relationship between changes in the magnitude of a lumbar vertebra’s positional history and the responsiveness of lumbar muscle spindles to a subsequent vertebral position and subsequent vertebral movement. Neural activity from multifidus and longissimus muscle spindle afferents in deeply anesthetized cats was recorded while creating positional histories of the L6 vertebra. History was induced using a displacement-controlled feedback motor. It held the L6 vertebra for 4 seconds at an intermediate position (hold-intermediate at 0mm) and at 7 positions from 0.07 to 1.55mm more ventralward and dorsalward which lengthened (hold-long) and shortened (hold-short) the lumbar muscles. Following the conditioning hold positions, L6 was returned to the intermediate position. Muscle spindle discharge at this position and during a lengthening movement was compared between hold-intermediate and hold-short conditionings and between hold-intermediate and hold-short conditionings. We found that regardless of conditioning magnitude, the 7 shortening magnitudes similarly increased muscle spindle responsiveness to both vertebral position and movement. In contrast, the 7 lengthening magnitudes produced a graded decrease in responsiveness to both position and movement. The decrease to position became maximal following conditioning magnitudes of ~0.75 mm. The decrease to movement did not reach a maximum even with conditioning magnitudes of ~1.55 mm. The data suggest that the fidelity of proprioceptive information from muscle spindles in the low back is influenced by small changes in the previous length history of lumbar muscles. PMID:22721784
Sanoussi, Samuila; Rachid, Sani; Sani, Chaibou Maman; Mahamane, Bawa; Addo, Guemou
We present two cases of rachipagus in two male infants and review the literature on this anomaly. These infants were from consanguineous marriages and cases of twins were reported in their families. In the first case it was a limb attached to the lower lumbar region with a rudimentary posterior arch. At the junction there was a lipomeningocele. Anatomical dissection of the limb identified the bones of the lower limb. In the second case, the parasites were joints of the upper limb that were attached to the chest by rudimentary posterior arches. In both cases there was only one spinal canal and a single spinal cord. Except the spina bifida in the first case no other malformation was diagnosed. The parasites were successfully excised. The two patients are well at one year of follow-up. Rachipagus is a rare embryogenic malformation with a good prognosis in the absence of associated congenital anomalies. PMID:22091327
Yao, Qi; Wang, Shaobai; Shin, Jae-Hyuk; Li, Guoan; Wood, Kirkham B.
Study Design Controlled laboratory study. Objective To investigate the in vivo biomechanical effect of degenerative lumbar spondylolisthesis (DLS) on the motion of the facet joint during various functional weight-bearing activities. Summary of Background Data Although the morphological changes of the facet joints in patients with DLS have been reported in a few studies, no data has been reported on the kinematics of these facet joints. Methods Ten patients with DLS at L4–L5 were studied. Each patient underwent a magnetic resonance imaging (MRI) scan to obtain three-dimensional (3D) models of the lumbar vertebrae from L2–L5 as well as a dual fluoroscopic imaging scan in different postures: flexion-extension, left-right bending and left-right torsion. The positions of the vertebrae were reproduced by matching the MRI-based vertebral models to the fluoroscopic images. The kinematics of the facet joint and the ranges of motion (ROMs) were compared with those of healthy subjects and those of patients with degenerative disc diseases (DDD) previously published. Results In DLS patients, the range of rotation of the facet joints was significantly less at the DLS level (L4–L5) than that at the adjacent levels (L2–L3 and L3–L4), while the range of translation was similar at all levels. The range of rotation at the facet joints of the DLS level decreased compared to those of both the DDD patients and healthy subjects at the corresponding vertebral level (L4–L5), while no significant difference was found in the range of translation. The ROM of facet joints in DLS and in DDD patients was similar at the adjacent levels (L2–L3 and L3–L4). Conclusion The range of rotation decreased at the facet joints at the DLS level (L4–L5) in patients compared to those in healthy subjects and DDD patients. This decrease in range of rotation implies that the DLS disease may cause restabilization of the joint. The data may help the selection of conservative treatment or different
Peter, R; Malinsky, M; Ourednicek, P; Jan, J
A method is presented aiming at detecting and classifying bone lesions in 3D CT data of human spine, via Bayesian approach utilizing Markov random fields. A developed algorithm for necessary segmentation of individual possibly heavily distorted vertebrae based on 3D intensity modeling of vertebra types is presented as well.
Berillis, Panagiotis; Panagiotopoulos, Nikolaos; Boursiaki, Vaia; Karapanagiotidis, Ioannis T; Mente, Eleni
Skeletal deformities of gilthead seabream (Sparus aurata) are a major factor affecting the production cost, the external morphology and survival and growth of the fish. Adult individuals of S. aurata were collected from a commercial fish farm in Greece and were divided into two groups: one with the presence of lordosis, a skeletal deformity, and one without any skeletal deformity. Fishes were X-rayed, and cervical, abdominal and caudal vertebrae lengths were measured. Vertebrae were taken from the site of the vertebral column where lordosis occurred. One part was decalcified and prepared for collagen examination with transmission electron microscopy, and the rest were incinerated, and the Ca and P contents were measured. The stoichiometries of the samples were obtained by EDS (Energy Dispersive Spectroscopy). The same procedure was followed for fish without skeletal deformities (vertebrae were taken from the middle region of the vertebral column). The decalcified vertebrae parts were examined with TEM, collagen micrographs were taken and the fibrils' periods and diameters were measured. There were no significant differences for both Ca and P or the collagen fibrils' periods between the two fish groups. The mean lengths of the cervical, abdominal and caudal vertebrae where lordosis occurred were similar to the lengths of the respective regions of the individuals without the skeletal deformity. The TEM examination showed a significantly smaller mean vertebrae collagen fibril diameter from the fishes with lordosis compared with those from the controls, revealing the significance of collagen to bone structure.
Yoshiiwa, Toyomi; Notani, Naoki; Ishihara, Toshinobu; Kawano, Masanori; Tsumura, Hiroshi
Study Design Cross-sectional study. Purpose To investigate the relationship between ligamentum flavum (LF) thickening and lumbar segmental instability and disc degeneration and facet joint osteoarthritis. Overview of Literature Posterior spinal structures, including LF thickness, play a major role in lumbar spinal canal stenosis pathogenesis. The cause of LF thickening is multifactorial and includes activity level, age, and mechanical stress. LF thickening pathogenesis is unknown. Methods We examined 419 patients who underwent computed tomography (CT) myelography and magnetic resonance imaging after complaints of clinical symptoms. To investigate LF hypertrophy, 57 patients whose lumbar vertebra had normal disc heights at L4–5 were selected to exclude LF buckling as a hypertrophy component. LF thickness, disc space widening angulation in flexion, segmental angulation, presence of a vacuum phenomenon, and lumbar lordosis at T12–S1 were investigated. Disc and facet degeneration were also evaluated. Facet joint orientation was measured via an axial CT scan. Results The mean LF thickness in all patients was 4.4±1.0 mm at L4–5. There was a significant correlation between LF thickness and disc degeneration; LF thickness significantly increased with severe disc degeneration and facet joint osteoarthritis. There was a tendency toward increased LF thickness in more sagittalized facet joints than in coronalized facet joints. Logistic regression analysis showed that LF thickening was influenced by segmental angulation and facet joint osteoarthritis. Patient age was associated with LF thickening. Conclusions LF hypertrophy development was associated with segmental instability and severe disc degeneration, severe facet joint osteoarthritis, and a sagittalized facet joint orientation. PMID:27994791
Choi, Seyoung; Lee, Minsun; Kwon, Byongan
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.  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
Xiao, Deng; Luo, Qinglu; He, Chengqi; Yang, Lin; He, Hongchen; Wu, Yuanchao
Previous case-control studies have shown various degrees of inverse correlation between osteoarthritis (OA) and osteoporosis (OP). The aim of this study was to examine the relationship between osteophytes at the cervical , lumbar vertebrae and knee, and the bone mineral density (BMD) of lumbar spine. We analyzed the data on 4091 female patients (aged 13 to 92 years). Osteophyte was defined by X ray examination. BMD of the lumbar spine (LS) was measured by dual energy X-ray absorptiometry (Lunar DPX). The association of osteophytes with BMD and osteophytes at different sites and different degrees were assessed by covariance analysis. Adjustments were made for age and body mass index. The relationship between osteophytes and BMD was analyzed by Binary Logistic Regression. BMD at each site was greater in the female with osteophytes (L4 BMD: P < 0.01, Mean BMD: P < 0.05); the relationship between osteophytes and osteoporosis and that between duration of osteophytes and osteoporosis were inversely correlated (P < 0.01). It confirms the existence of an inverse relationship between osteophytes and OP while a positive relationship is between age, body mass index and osteoporosis.
Oishi, Y; Shimizu, K; Katoh, T; Nakao, H; Yamaura, M; Furuko, T; Narusawa, K; Nakamura, T
Our study was designed to assess the contributions of the physical and constitutional factors to osteophyte formation, disc degeneration, and bone mineral density (BMD) in lumbar vertebrae of elderly postmenopausal women. A total of 126 Japanese women with back pain, aged over 60 years, were invited to participate in the study. Then 80 subjects with a full set of data for physical examinations, radiographs, MRI, and DXA were examined. TaqI polymorphism of vitamin D receptor (VDR) gene was examined in 60 subjects. Prevalence rates of osteophytes (on radiographs) and disc degeneration (on MRI) were 61 and 68%, respectively. Body weight and BMI correlated significantly with anteroposterior (AP) and lateral (LAT) BMD (r = 0.354 for weight, r = 0.347 for BMI) and mean osteophyte area (r = 0.557 for weight, r = 0.486 for BMI), and body weight also correlated with number of discs with osteophytes. However, these did not correlate with the disc area or the number of degenerated discs. Stepwise regression analysis revealed that body weight and LAT-BMD values independently related to the osteophyte area. Disc area (r = 0.386 for AP view) and osteophyte area (r = 0.384 for AP view) significantly correlated with BMD. However, disc area and osteophyte area did not correlate with each other (r = 0.056). The proportion of degenerated discs was higher in the lower lumbar discs, but not the proportion of discs with osteophytes. Frequencies of T and t alleles of VDR did not correlate with disc degeneration, osteophyte formation, or osteoporosis. Our data showed that increases in osteophyte formation and BMD in the lumbar vertebrae are influenced by body weight and BMI, but did not correlate with disc area, which correlated inversely with BMD. Disc degeneration and osteophyte formation seem to represent two different factors that affect lumbar spine in elderly women.
Josiah, Darnell T; Boo, SoHyun; Tarabishy, Abdul; Bhatia, Sanjay
OBJECTIVE The objective of this study was to investigate the neurovascular and anatomical differences in patients with lumbosacral transitional vertebrae (LSTV) and the associated risk of neurovascular injury in minimally invasive spine surgery. METHODS The authors performed a retrospective study of CT and MR images of the lumbar spine obtained at their institution between 2010 and 2014. The following characteristics were evaluated: level of the iliac crest in relation to the L4-5 disc space, union level of the iliac veins and arteries in relation to the L4-5 disc space, distribution of the iliac veins and inferior vena cava according to the different Moro zones (A, I, II, III, IV, P) at the L4-5 disc space, and the location of the psoas muscle at the L4-5 disc space. The findings were compared with findings on images obtained in 28 age- and sex-matched patients without LSTV who underwent imaging studies during the same time period. RESULTS Twenty-eight patients (12 male, 16 female) with LSTV and the required imaging studies were identified; 28 age- and sex-matched patients who had undergone CT and MRI studies of the thoracic and lumbar spine imaging but did not have LSTV were selected for comparison (control group). The mean ages of the patients in the LSTV group and the control group were 52 and 49 years, respectively. The iliac crest was located at a mean distance of 12 mm above the L4-5 disc space in the LSTV group and 4 mm below the L4-5 disc space in the controls. The iliac vein union was located at a mean distance of 8 mm above the L4-5 disc space in the LSTV group and 2.7 mm below the L4-5 disc space in the controls. The iliac artery bifurcation was located at a mean distance of 23 mm above the L4-5 disc space in the LSTV group and 11 mm below the L4-5 disc space in controls. In patients with LSTV, the distribution of iliac vein locations was as follows: Zone A, 7.1%; Zone I only, 78.6%; Zone I encroaching into Zone II, 7.1%; and Zone II only, 7.1%. In the
Cornwall, Jon; Deries, Marianne; Duxson, Marilyn
Although the morphology of human lumbar transversospinal (TSP) muscles has been studied, little is known about the structure of these muscles in the mouse (Mus musculus). Such information is relevant given mice are often used as a "normal" phenotype for studies modeling human development. This study describes the gross morphology, muscle fiber arrangement, and innervation pattern of the mouse lumbar TSP muscles. A unique feature of the study is the use of a transgenic mouse line bearing a muscle-specific nuclear marker that allows clear delineation of muscle fiber and connective tissue boundaries. The lumbar TSP muscles of five mice were examined bilaterally; at each spinal level muscles attached to the caudal edge of the spinous process and passed caudally as a single complex unit. Fibers progressively terminated over the four vertebral segments caudad, with multiple points of muscle fiber attachment on each vertebra. Motor endplates, defined with acetylcholinesterase histochemistry, were consistently located half way along each muscle fiber, regardless of length, with all muscle fibers arranged in-parallel rather than in-series. These results provide information relevant to interpretation of developmental and functional studies involving this muscle group in the mouse and show mouse lumbar TSP muscles are different in form to descriptions of equivalent muscles in humans and horses.
... 29 Labor 3 2010-07-01 2010-07-01 false Excise taxes separately stated. 779.264 Section 779.264... Coverage Excise Taxes § 779.264 Excise taxes separately stated. A tax is separately stated where it clearly... was no invoice or sales slip. In the absence of a sales slip or invoice, the amount of the tax...
... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Effect of excise tax. 25.2512-7 Section 25.2512... TAXES GIFT TAX; GIFTS MADE AFTER DECEMBER 31, 1954 Transfers § 25.2512-7 Effect of excise tax. If jewelry, furs or other property, the purchase of which is subject to an excise tax, is purchased at...
... Parts 113 and 191 RIN 1505-AC18 Drawback of Internal Revenue Excise Tax AGENCY: Customs and Border... Regulations to: preclude the filing of a substitution drawback claim for internal revenue excise tax paid on imported merchandise in situations where no excise tax was paid upon the substituted merchandise or...
Kelley, Jeremy; Collins, Ryan; Allam, Christopher
Background: To report the first case of a renal schwannoma excised with robot-assisted laparoscopy. Case Presentation: A 43-year-old Caucasian female patient with vague abdominal symptoms was noted to have incidental right renal mass. Physical examination and laboratory tests were within normal limits. CT revealed a 4.6 cm heterogeneous enhancing right renal mass arising near the hilum. RENAL nephrometry score was 11a. She was treated by right robot-assisted laparoscopic nephrectomy. She recovered well without complications. Pathology analysis revealed a benign renal schwannoma. Conclusion: Renal schwannoma is a rare kidney tumor. We report the first known case of this tumor excised by robot-assisted laparoscopic nephrectomy.
Kelley, Jeremy; Collins, Ryan
Abstract Background: To report the first case of a renal schwannoma excised with robot-assisted laparoscopy. Case Presentation: A 43-year-old Caucasian female patient with vague abdominal symptoms was noted to have incidental right renal mass. Physical examination and laboratory tests were within normal limits. CT revealed a 4.6 cm heterogeneous enhancing right renal mass arising near the hilum. RENAL nephrometry score was 11a. She was treated by right robot-assisted laparoscopic nephrectomy. She recovered well without complications. Pathology analysis revealed a benign renal schwannoma. Conclusion: Renal schwannoma is a rare kidney tumor. We report the first known case of this tumor excised by robot-assisted laparoscopic nephrectomy. PMID:27872900
Read, D R; Sokil, S; Ruiz-Salas, G
Twenty-five patients with invasive rectal cancer treated by transanal excision between 1978-1989 are presented. Two patients had poorly differentiated tumours and were converted to abdominoperineal resection and one patient had extensive liver metastases documented preoperatively. The remaining twenty-two, mean age 64 years, fulfilled the criteria for local treatment. Eighty-two percent of tumours were T1 or T2 stage. There was no operative mortality. Six complications in five patients occurred, none requiring surgical intervention. Five patients died of unrelated causes without evidence of recurrence at 4, 4, 14, 26 and 58 months. The length of follow-up for the surviving group (17 patients) was 16 to 115 months (mean 63 months). Two patients developed local recurrence at 32 and 60 months. Transanal excision can be curative for selected rectal cancers.
Dalal, Krishna; Elanchezhiyan, D; Maran, V B; Das, Raunak Kumar; Kumar, Piyush; Singh, S P; Murali Krishna, C; Chatterjee, Jyotirmoy
Scientific validation of reflexology requires an in-depth and noninvasive evaluation of "reflexology/reflex areas" in health and disease. The present paper reports the differential properties of "normal" and "abnormal" reflexology areas related to the lumbar vertebrae in a subject suffering from low back pain. The pathology is supported by radiological evidence. The reflexology target regions were clinically assessed with respect to colour and tenderness in response to finger pressure. Grey scale luminosity and pain intensity, as assessed by visual analogue scale scores, differentiated "normal" from "abnormal" skin. Skin swept source-optical coherence tomography recorded their structural differences. Infrared thermography revealed temperature variations. A laser Doppler study using a combined microcirculation and transcutaneous oxygen monitoring system indicated alterations in blood flow and oxygen perfusion. Raman spectroscopy showed differences in chemical signatures between these areas. The present findings may indicate a potential correlation between the reflexology areas and subsurface pathological changes, showing an association with the healthy or unhealthy status of the lumbar vertebrae.
Hamoud, K.; May, H.; Hay, O.; Medlej, B.; Masharawi, Y.; Peled, N.; Hershkovitz, I.
As life expectancy increases, degenerative lumbar spinal stenosis (DLSS) becomes a common health problem among the elderly. DLSS is usually caused by degenerative changes in bony and/or soft tissue elements. The poor correlation between radiological manifestations and the clinical picture emphasizes the fact that more studies are required to determine the natural course of this syndrome. Our aim was to reveal the association between lower lumbar spine configuration and DLSS. Two groups were studied: the first included 67 individuals with DLSS (mean age 66 ± 10) and the second 100 individuals (mean age 63.4 ± 13) without DLSS-related symptoms. Both groups underwent CT images (Philips Brilliance 64) and the following measurements were performed: a cross-section area of the dural sac, vertebral body dimensions (height, length and width), AP diameter of the bony spinal canal, lumbar lordosis and sacral slope angles. All measurements were taken at L3 to S1. Vertebral body lengths were significantly greater in the DLSS group at all levels compared to the control, whereas anterior vertebral body heights (L3, L4, L5) and middle vertebral heights (L3, L5) were significantly smaller in the LSS group. Lumbar lordosis, sacral slope and bony spinal canal were significantly smaller in the DLSS compared to the control. We conclude that the size and shape of vertebral bodies and canals significantly differed between the study groups. A tentative model is suggested to explain the association between these characteristics and the development of degenerative spinal stenosis. PMID:20652366
O'Brien, T.M.; Murray, T.E.; Malone, L.A.; Dervan, P.; Walsh, M.; McManus, R.; Ennis, J.T.
The definite diagnosis of osteoid osteoma relies on the demonstration of the nidus, best shown by CT, which also provides precise preoperative localization of the nidus. While bone-block excision to remove the nidus is feasible in the long bones, there may be unacceptable sequelae in the vertebral column and small bones of the hands. By precisely localizing the nidus, radionuclide scintimetry permits excellent therapeutic results, with minimal morbidity.
Shim, Jocelyne J; Heo, Giseon; Lagravère, Manuel O
Diagnosis of skeletal age in adolescents helps orthodontists select and time treatments. Currently this is done using lateral cephalometric radiographs. This study evaluates the application of the conventional method in cone-beam computer tomographic (CBCT) images to bring forth assessment of skeletal maturation in three-dimensions. Ninety-eight lateral cephalometric radiographs and CBCT scans were collected from orthodontic patients between 11 to 17 years of age over an 18-month period. CBCT scans were examined in seven sagittal slices based on cervical vertebral maturation staging (CVMS). Collected CVMS values were compared with those from corresponding lateral cephalometric radiograph. CVMS measured from CBCT and lateral cephalometric radiographs were the same on average. However, they were not consistent with each other and scored interclass correlation coefficient of 0.155 in validity test. Interoperator reliability was weak (0.581). Adaptation of cervical vertebrae maturation staging in CBCT requires further clarifications or modifications to become consistent with lateral cephalometric examinations and to become a reliable method. Alternatively, a completely new method may be developed consisting of maturational indicators or landmarks unique to CBCT imaging.
Van Houten, B
One of the best-studied DNA repair pathways is nucleotide excision repair, a process consisting of DNA damage recognition, incision, excision, repair resynthesis, and DNA ligation. Escherichia coli has served as a model organism for the study of this process. Recently, many of the proteins that mediate E. coli nucleotide excision have been purified to homogeneity; this had led to a molecular description of this repair pathway. One of the key repair enzymes of this pathway is the UvrABC nuclease complex. The individual subunits of this enzyme cooperate in a complex series of partial reactions to bind to and incise the DNA near a damaged nucleotide. The UvrABC complex displays a remarkable substrate diversity. Defining the structural features of DNA lesions that provide the specificity for damage recognition by the UvrABC complex is of great importance, since it represents a unique form of protein-DNA interaction. Using a number of in vitro assays, researchers have been able to elucidate the action mechanism of the UvrABC nuclease complex. Current research is devoted to understanding how these complex events are mediated within the living cell. PMID:2181258
Aggabao, Patricia C.; Poorghasamians, Ervin; Chavez, Thomas A.
Lumbar lordosis (LL) is more prominent in women than in men, but the mechanisms responsible for this discrepancy are poorly defined. A recent study indicates that newborn girls have smaller vertebral cross-sectional area (CSA) when compared to boys—a difference that persists throughout life and is independent of body size. We determined the relations between vertebral cross-sectional area (CSA) and LL angle and whether sex differences in lumbar lordosis are related to sex differences in vertebral CSA. Using multi-planar magnetic resonance imaging (MRI), we measured vertebral cross-sectional area (CSA) and vertebral height of the spine of 40 healthy boys and 40 girls, ages 9–13 years. Measures of the CSA of the lumbar vertebrae significantly differed between sexes (9.38 ± 1.46 vs. 7.93 ± 0.69 in boys and girls, respectively; P < 0.0001), while the degree of LL was significantly greater in girls than in boys (23.7 ± 6.1 vs. 27.6 ± 8.0 in boys and girls, respectively; P = 0.02). When all subjects were analyzed together, values for LL angle were negatively correlated to vertebral CSA (r = -0.47; P < 0.0001); this was also true when boys and girls were analyzed separately. Multivariate regression analysis indicated that vertebral CSA was independently associated with LL, even after accounting for sex, age, height or vertebral height, and weight. Similar negative relations were present when thoracic vertebrae were analyzed (Model P < 0.0001, R2 = 0.37, thoracic vertebral CSA slope P < 0.0001), suggesting that deficient vertebral cross-sectional dimensions are not merely the consequence of the anterior lumbar curvature. We conclude that vertebral CSA is negatively associated with LL, and that the greater degree of LL in females could, at least in part, be due to smaller vertebral cross-sectional dimensions. Studies are needed to examine the potential relations between vertebral CSA and spinal conditions known to be associated with increased LL, such as
Wren, Tishya A L; Aggabao, Patricia C; Poorghasamians, Ervin; Chavez, Thomas A; Ponrartana, Skorn; Gilsanz, Vicente
Lumbar lordosis (LL) is more prominent in women than in men, but the mechanisms responsible for this discrepancy are poorly defined. A recent study indicates that newborn girls have smaller vertebral cross-sectional area (CSA) when compared to boys-a difference that persists throughout life and is independent of body size. We determined the relations between vertebral cross-sectional area (CSA) and LL angle and whether sex differences in lumbar lordosis are related to sex differences in vertebral CSA. Using multi-planar magnetic resonance imaging (MRI), we measured vertebral cross-sectional area (CSA) and vertebral height of the spine of 40 healthy boys and 40 girls, ages 9-13 years. Measures of the CSA of the lumbar vertebrae significantly differed between sexes (9.38 ± 1.46 vs. 7.93 ± 0.69 in boys and girls, respectively; P < 0.0001), while the degree of LL was significantly greater in girls than in boys (23.7 ± 6.1 vs. 27.6 ± 8.0 in boys and girls, respectively; P = 0.02). When all subjects were analyzed together, values for LL angle were negatively correlated to vertebral CSA (r = -0.47; P < 0.0001); this was also true when boys and girls were analyzed separately. Multivariate regression analysis indicated that vertebral CSA was independently associated with LL, even after accounting for sex, age, height or vertebral height, and weight. Similar negative relations were present when thoracic vertebrae were analyzed (Model P < 0.0001, R2 = 0.37, thoracic vertebral CSA slope P < 0.0001), suggesting that deficient vertebral cross-sectional dimensions are not merely the consequence of the anterior lumbar curvature. We conclude that vertebral CSA is negatively associated with LL, and that the greater degree of LL in females could, at least in part, be due to smaller vertebral cross-sectional dimensions. Studies are needed to examine the potential relations between vertebral CSA and spinal conditions known to be associated with increased LL, such as spondylolysis
Müller, F; O'Rahilly, R; Benson, D R
An anomalous (butterfly) eleventh thoracic vertebra in a fetus of 63 mm greatest length is described and graphic reconstructions (together with normal controls) are provided. The cartilaginous hemicentra are separated by disc-like material. Cartilaginous bars to adjacent vertebrae are present. The neural arch is complete. The notochord is not duplicated. Only one comparable case in the embryonic period has been described previously. After a discussion of cleft vertebrae in the human and in experimental animals, a developmental timetable of the appearance of several vertebral anomalies is provided. The sensitive period for butterfly vertebrae, depending on the mode of origin, seems to be 3-6 postovulatory weeks. More severe anomalies, such as the split notochord syndrome, appear earlier. It is concluded that most of the vertebral anomalies discussed arise during the embryonic period proper, although the timing of a few, such as spina bifida occulta, extends into the early fetal period. Images Fig. 1 Fig. 3 Fig. 5 PMID:3693103
Rasoulian, Abtin; Rohling, Robert N.; Abolmaesumi, Purang
Segmentation of the spinal column from CT images is a pre-processing step for a range of image guided interventions. Current techniques focus on identification and separate segmentation of each vertebra. Recently, statistical multi-object shape models have been introduced to extract common statistical characteristics between several anatomies. These models are also used for segmentation purposes and are shown to be robust, accurate, and computationally tractable. In this paper, we reconstruct a statistical multi-vertebrae shape+pose model and propose a novel technique to register such a model to CT images. We validate our technique in terms of accuracy of the multi-vertebrae segmentation of CT images acquired from 16 subjects. The mean distance error achieved for all vertebrae is 1.17 mm with standard deviation of 0.38 mm.
Bogduk, N; Wilson, A S; Tynan, W
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
Mehta, Roma Satish; Dabadghav, Rachana; Rairikar, Savita; Shayam, Ashok; Sancheti, Parag
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
Been, Ella; Gómez-Olivencia, Asier; Kramer, Patricia A
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.
Armond, Mônica Costa; Generoso, Rodrigo; Falci, Saulo Gabriel Moreira; Ramos-Jorge, Maria Letícia; Marques, Leandro Silva
The identification of the skeletal maturation stage of the cervical vertebrae has proven an important reference for orthodontic diagnosis. The aim of the present study was to determine the association between the skeletal maturation stage of the cervical vertebrae and types of malocclusion according to the age and gender of participants. A total of 361 individuals (168 males and 193 females) between 8 and 14 years of age were selected from a convenience sample. Malocclusions were diagnosed through study models using the Angle classification. Maturation stages of the cervical vertebrae were determined using the method proposed by Hassel and Farman. Statistical analysis involved the chi-square test (p £ 0.05) and multiple logistic regression (forward stepwise procedure). Significant differences were observed between the stage of skeletal maturation of the cervical vertebrae and gender at ages 11, 12 and 14 years. Males with Class II malocclusion were twice as likely to be in Stage 1 or 2 of cervical vertebra maturation than individuals with Class I malocclusion (OR = 2.1 [CI 95%, 1.33-3.18]). There were no differences between individuals with Class I and Class III malocclusions. The association between skeletal maturation of the cervical vertebrae and type of malocclusion was significant, suggesting a skeletal component in the determination of Class II malocclusions.
Zhu, Chenxu; Lu, Lining; Zhang, Jun; Yue, Zongwei; Song, Jinghui; Zong, Shuai; Liu, Menghao; Stovicek, Olivia; Gao, Yi Qin; Yi, Chengqi
NEIL1 (Nei-like 1) is a DNA repair glycosylase guarding the mammalian genome against oxidized DNA bases. As the first enzymes in the base-excision repair pathway, glycosylases must recognize the cognate substrates and catalyze their excision. Here we present crystal structures of human NEIL1 bound to a range of duplex DNA. Together with computational and biochemical analyses, our results suggest that NEIL1 promotes tautomerization of thymine glycol (Tg)—a preferred substrate—for optimal binding in its active site. Moreover, this tautomerization event also facilitates NEIL1-catalyzed Tg excision. To our knowledge, the present example represents the first documented case of enzyme-promoted tautomerization for efficient substrate recognition and catalysis in an enzyme-catalyzed reaction. PMID:27354518
Ponrartana, Skorn; Aggabao, Patricia C.; Dharmavaram, Naga L.; Fisher, Carissa L.; Friedlich, Philippe; Epi, MS; Devaskar, Sherin U.; Gilsanz, Vicente
Objective To examine whether the sex-related differences in vertebral cross-sectional area (CSA) found in children and at the timing of peak bone mass – a major determinant of osteoporosis and future fracture risk – are also present at birth. Study design Vertebral CSA, vertebral height, and intervertebral disc height were measured using magnetic resonance imaging (MRI) in 70 healthy full-term newborns (35 male and 35 female). Additionally, measures of the length and CSA of the humerus, musculature, and adiposity were obtained. Results Weight, body length, and head and waist circumferences did not significantly differ between sexes (all P’s ≥ 0.06). Compared with newborn boys, girls had significantly smaller vertebral cross-sectional dimensions; 1.47 ± 0.11 vs. 1.31 ± 0.12; P < 0.0001. Multiple linear regression analysis indicated that sex was a predictor of vertebral CSA independent of gestational age, birth weight, and body length. In contrast, sexes were monomorphic with regard to vertebral height, intervertebral disc height, and spinal length (all P’s ≥ 0.11). There were also no sex differences in the length or cross-sectional dimensions of the humerus or in measures of musculature and adiposity (all P’s ≥ 0.10). Conclusions Factors related to sex influence fetal development of the axial skeleton. The smaller vertebral CSA in females is associated with greater flexibility of the spine that could represent the human adaptation to fetal load. Unfortunately, it also imparts a mechanical disadvantage that increases stress within the vertebrae for all physical activities and the susceptibility for fragility fractures later in life. PMID:26028289
Kamak, Hasan; Yildırım, Eren
Aims: The aims of our study were to investigate the distribution of cervical vertebrae anomalies (CVAs) among dental Angle Class I, II, and III malocclusions in Turkish population and whether a correlation between CVA and dental malocclusion. Materials and Methods: The study was performed on lateral cephalometric radiographs which were taken at the Department of Orthodontics, Faculty of Dentistry, Kirikkale University. The final sample of 318 orthodontic patients was included in the study. Dental malocclusions were performed according to Angle classification. CVAs were categorized: (1) fusion and (2) posterior arch deficiency (PAD). The Chi-square test was used to the analysis of the potential differences among dental malocclusions. Results: The final sample of 318 patients was examined. CVA was observed in 42 individuals (of 26 [8.17%] had fusion and 16 [5.03%] had PAD), with a frequency of 13.2%. Of the 26 fusion defect, 8 (30.7%) had Angle Class I, 8 (30.7%) had Angle Class II, and 10 (38.4%) had Angle Class III malocclusion. Of the 16 PAD, 8 (50%) had Angle Class I, 8 (50%) had Angle Class II but no patients with Angle Class III malocclusion was observed. The distribution of dental malocclusions regarding CVA was not statistically significant (P = 0.076). Of these 42 individuals with CVA, 52.3% (15 fusions and 7 PAD) were females and 47.7% (11 fusions and 9 PAD) were males. Conclusion: In our study, the prevalence of fusion and PAD were found 8.1% and 5.0% in Turkish population, respectively. Besides, no statistically significant correlation between CVA and Angle Class I, II, and III malocclusions were found. Our findings support the studies showing no gender dimorphism. PMID:26692691
Koo, Terry K; Kwok, Wingchi Edmund
Three-dimensional (3D) measurement of the spine can provide important information for functional, developmental, diagnostic, and treatment-effect evaluations. However, existing measurement techniques are either 2-dimensional, highly invasive, or involve a high radiation dose, prohibiting their widespread and repeated use in both research and clinical settings. Non-invasive, non-ionizing, 3D measurement of the spine is still beyond the current state-of-the-art. Towards this goal, we developed an intensity-based hierarchical CT-ultrasound registration approach to quantify the 3D positions and orientations of lumbar vertebrae from 3D freehand ultrasound and one-time computed tomography. The method was validated using a human dry bone specimen (T12-L5) and a porcine cadaver (L2-L6) by comparing the registration results with a gold standard fiducial-based registration. Mean (SD) target registration error and percentage of successful registration were 1.2 (0.6) mm and 100% for the human dry bone specimen, and 2.18 (0.82) mm and 92% for the porcine cadaver, indicating that the method is accurate and robust under clinically realistic conditions. Given that the use of ultrasound eliminates ionizing radiation during pose measurements, we believe that the hierarchical CT-ultrasound registration method is an attractive option for quantifying 3D poses of individual vertebra and motion segment, and thus warrants further investigations.
Campa-Thompson, Molly; Weir, Robert; Calcetera, Natalie; Quirke, Philip; Carmack, Susanne
Total mesorectal excision (TME) is the current optimal surgical treatment for patients with rectal carcinoma. A complete TME is related to lower local recurrence rates and increased patient survival. Many confounding factors in the patient's anatomy and prior therapy can make it difficult to obtain a perfect plane, and thus a complete TME. The resection specimen can be thoroughly evaluated, grossly and microscopically, to identify substandard surgical outcomes and increased risk of local recurrence. Complete and accurate data reporting is critical for patient care and helps surgeons improve their technique. PMID:25733973
Higashino, Kosaku; Kim, Jin Hwan; Horton, William C; Hutton, William C
In reconstruction of the osteoporotic spine, patients often show poor outcome because of pedicle screw failure. This study used osteoporotic and nonosteoporotic vertebrae to determine the difference in fixation strength between pedicle screws inserted straight forward and pedicle screws inserted in an upward trajectory toward the superior end plate (i.e., end-plate screws). There is some evidence to suggest that end-plate screws have a strength advantage. The particular focus was on osteoporotic vertebrae. Thirty-three vertebrae (T10-L2) were harvested. The bone mineral density (BMD) was measured: 15 vertebrae were greater than 0.8 g/cm(2) and designated as nonosteoporotic (average BMD 1.146 ± 0.186 g/cm(2)) and 18 vertebrae were designated as osteoporotic (average BMD 0.643 ± 0.088 g/cm(2)). On one pedicle the screw was inserted straight forward and on the other pedicle the screw was inserted as an end-plate screw. The torque of insertion was measured (Proto 6106 torque screwdriver). Using an MTS Mini Bionix, two types of mechanical testing were carried out on each pedicle: (a) cephalocaudad toggling was first carried out to simulate some physiological type loading: 500 cycles at 0.3 Hz, at ±50 N; and (b) then each pedicle screw was pulled out at a displacement rate of 12.5 cm/min.There was no difference in pullout force between the pedicle screws inserted straight forward and the pedicle screws inserted as end-plate screws. This result applies whether the vertebrae were osteoporotic or nonosteoporotic. For both the straight-forward screws and the end-plate screws, a statistically significant correlation was observed between torque of insertion and pullout force. The results of this experiment indicate that pedicle screws inserted as end-plate screws do not provide a strength advantage over pedicle screws inserted straight forward, whether the vertebrae are osteoporotic or not.
Kranenbarg, Sander; van Cleynenbreugel, Tim; Schipper, Henk; van Leeuwen, Johan
Mammalian bone is an active tissue in which osteoblasts and osteoclasts balance bone mass. This process of adaptive modelling and remodelling is probably regulated by strain-sensing osteocytes. Bone of advanced teleosts is acellular yet, despite the lack of osteocytes, it is capable of an adaptive response to physical stimuli. Strenuous exercise is known to induce lordosis. Lordosis is a ventrad curvature of the vertebral column, and the affected vertebrae show an increase in bone formation. The effects of lordosis on the strain distribution in sea bass (Dicentrarchus labrax L.) vertebrae are assessed using finite element modelling. The response of the local tissue is analyzed spatially and ontogenetically in terms of bone volume. Lordotic vertebrae show a significantly increased strain energy due to the increased load compared with normal vertebrae when loaded in compression. High strain regions are found in the vertebral centrum and parasagittal ridges. The increase in strain energy is attenuated by a change in architecture due to the increased bone formation. The increased bone formation is seen mainly at the articular surfaces of the vertebrae, although some extra bone is formed in the vertebral centrum. Regions in which the highest strains are found do not spatially correlate with regions in which the most extensive bone apposition occurs in lordotic vertebrae of sea bass. Mammalian-like strain-regulated bone modelling is probably not the guiding mechanism in adaptive bone modelling of acellular sea bass vertebrae. Chondroidal ossification is found at the articular surfaces where it mediates a rapid adaptive response, potentially attenuating high stresses on the dorsal zygapophyses.
Sundaramurthy, Sharada; Suresh, H.B.; Anirudh, A.V.; Prakash Rozario, Anthony
Introduction Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. Presentation may be misleading and diagnosis often missed. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option. Presentation of case A 42 year old male presented with history of pain in lower back of 4 years duration and was being treated symptomatically over 4 years with analgesics and physiotherapy. He had noticed a swelling over the left side of his mid-back and consequently on examination was found to have a primary acquired lumbar hernia arising from the deep superior lumbar triangle of Grynfelt. Diagnosis was confirmed by Computed Tomographic imaging. Discussion A lumbar hernia may be primary or secondary with only about 300 cases of primary lumbar hernia reported in literature. Lumbar hernias manifest through two possible defects in the posterior abdominal wall, the superior being more common. Management remains surgical with various techniques emerging over the years. The patient at our center underwent an open sublay mesh repair with excellent outcome. Conclusion A surgeon may encounter a primary lumbar hernia perhaps once in his lifetime making it an interesting surgical challenge. Sound anatomical knowledge and adequate imaging are indispensable. Inspite of advances in minimally invasive surgery, it cannot be universally applied to patients with lumbar hernia and management requires a more tailored approach. PMID:26812667
Quiles, M; Marchisello, P J; Tsairis, P
The etiologic factors and pathologic findings in 38 patients with lumbar arachnoiditis are presented. Lumbar spine surgery and the injection of contrast materials prior to the diagnosis of this condition are considered the most important factors in its genesis. In this series, there was microscopic evidence of arachnoiditis ossificans in 3 patients and arachnoiditis calcificans in 1 patient.
Alen, Jose F.; Ramos, Ana; Lobato, Ramiro D.; Lagares, Alfonso
Lumbar synovial cysts frequently present with back pain, chronic radiculopathy and/or progressive symptoms of spinal canal compromise. These cysts generally appear in the context of degenerative lumbar spinal disease. Few cases of spontaneous hemorrhage into synovial cysts have been reported in the literature. PMID:20174835
Prasad, Kishore Chandra; Kumar, Ashwini; Prasad, Sampath Chandra; Jain, Disha
The purpose of this article is to report a case of esthesioneuroblastoma involving the bilateral paranasal sinuses, which was excised using an endoscopic-assisted transfacial approach. A patient presented with nasal swelling and left-sided nasal obstruction, epistaxis, and diplopia. Examination revealed broadening of the nasal dorsum with a fleshy pink mass in both nasal cavities. Computed tomographic scan showed a mass involving the nasal cavity and paranasal sinuses on both sides. The tumor was diagnosed as group C esthesioneuroblastoma. The mass was excised by bilateral medial maxillectomy and bilateral frontoethmoidectomy. Using a 0 degrees endoscope, the attachment of the tumor to the cribriform plate was identified and resected using a motordrill. On Waroff staining, Hispathology slides suggested esthesioneuroblastoma. The patient was asymptomatic for 1 year, following which he developed infection of the nasal cavity for which he had no form of treatment. He subsequently developed maggots in the nasal cavity after which he died. An endoscopic resection of the cribriform plate from the nasal cavity without a formal craniofacial resection can be safely performed with oncologic safety.
Unnikrishnan, Ginu U.; Gallagher, John A.; Hussein, Amira I.; Barest, Glenn D.; Morgan, Elise F.
Knowledge of the nature of the elastic symmetry of trabecular bone is fundamental to the study of bone adaptation and failure. Previous studies have classified human vertebral trabecular bone as orthotropic or transversely isotropic but have typically obtained samples from only selected regions of the centrum. In this study, the elastic symmetry of human vertebral trabecular bone was characterized using microfinite element (μFE) analyses performed on 1019 cubic regions of side length equal to 5 mm, obtained via thorough sampling of the centrums of 18 human L1 vertebrae (age = 81.17 ± 7.7 yr; eight males and ten females). An optimization procedure was used to find the closest orthotropic representation of the resulting stiffness tensor for each cube. The orthotropic elastic constants and orientation of the principal elastic axes were then recorded for each cube and were compared to the constants predicted from Cowin's fabric-based constitutive model (Cowin, 1985, “The Relationship Between the Elasticity Tensor and the Fabric Tensor,” Mech. Mater., 4(2), pp. 137–147.) and the orientation of the principal axes of the fabric tensor, respectively. Deviations from orthotropy were quantified by the “orthotropic error” (van Rietbergen et al., 1996, “Direct Mechanics Assessment of Elastic Symmetries and Properties of Trabecular Bone Architecture,” J. Biomech., 29(12), pp. 1653–1657), and deviations from transverse isotropy were determined by statistical comparison of the secondary and tertiary elastic moduli. The orthotropic error was greater than 50% for nearly half of the cubes, and the secondary and tertiary moduli differed from one another (p < 0.0001). Both the orthotropic error and the difference between secondary and tertiary moduli decreased with increasing bone volume fraction (BV/TV; p ≤ 0.007). Considering only the cubes with an orthotropic error less than 50%, only moderate correlations were observed between the fabric
In advanced age, lumbar pain is less frequently caused by occupational stress and psychosomatic factors. Unstable segments and spondylo-arthrotic degeneration can lead to muscular strain whenever insufficient secondary stability and missing muscular equilibrium are involved. In the differential diagnosis one must distinguish between osteoporosis and spinal stenosis, which increases in frequency with age. Pain due to internal or gynecological problems must be excluded. From the therapeutic point of view, patients should be instructed in ergonomics and the simple application of physiotherapeutic procedures, e.g. heat and cold. Analgetics become increasingly important with age, consequently resulting in reduced use of antirheumatics. There exists enough evidence to show that muscular training of the lumbar muscles play an important role in the secondary prevention of lumbar pain in elderly people as well. Essentially, it can be stated that physical age is not directly related to possible ailment. The change of occupational obligations, with possibilities to adapt to personal stress levels, as well as the positive attitude towards everyday life in retirement have a major influence in accepting and handling ability of problems, concerning pain. In the department of Physical Medicine, Rehabilitation and Rheumatology of the Clinic Wilhelm Schulthess it was found that among 7806 patients with lower back pain (1990-1995) 43.3% involved the ages of 40 to 60 and 31.3% the ages of 60 to 80. More distinctly than in younger patients, older aged patients tend to show a marked discrepancy between radiological findings and effective pain. Lower back pains of elderly patients are of a different nature from those found in younger or middle-aged people. Ischialgia due to the protrusion of an intervertebral disk or an acute lumbovertebral syndrome caused by muscular instability are found much less frequently.
Elmasry, Moustafa; Steinvall, Ingrid; Thorfinn, Johan; Abdelrahman, Islam; Olofsson, Pia; Sjoberg, Folke
Background: Different surgical techniques have evolved since excision and autografting became the treatment of choice for deep burns in the 1970s. The treatment plan at the Burn Center, Linköping University Hospital, Sweden, has shifted from single-stage excision and immediate autografting to staged excisions and temporary cover with xenografts before autografting. The aim of this study was to find out if the change in policy resulted in extended duration of hospital stay/total body surface area burned (LOS/TBSA%). Methods: Retrospective clinical cohort including surgically-managed patients with burns of 15%-60% TBSA% within each treatment group. The first had early full excisions of deep dermal and full thickness burns and immediate autografts (1997-98), excision and immediate autograft group) and the second had staged excisions before final autografts using xenografts for temporary cover (2010-11, staged excision group). Results: The study included 57 patients with deep dermal and full-thickness burns, 28 of whom had excision and immediate autografting, and 29 of whom had staged excisions with xenografting before final autografting. Adjusted (LOS/TBSA%) was close to 1, and did not differ between groups. Mean operating time for the staged excision group was shorter and the excised area/operation was smaller. The total operating time/TBSA% did not differ between groups. Conclusion: Staged excisions with temporary cover did not affect adjusted LOS/TBSA% or total operating time. Staged excisions may be thought to be more expensive because of the cost of covering the wound between stages, but this needs to be further investigated as do the factors that predict long term outcome. PMID:28123862
Cho, Sung Min; Rhee, Woo Tack; Choi, Soo Jung; Eom, Dae Woon
The lumbar intraspinal epidural ganglion cyst has been a rare cause of the low back pain or leg pain. Ganglion cysts and synovial cysts compose the juxtafacet cysts. Extensive studies have been performed about the synovial cysts, however, very little has been known about the ganglion cyst. Current report is about two ganglion cysts associated with implicative findings in young male patients. We discuss about the underlying pathology of the ganglion cyst based on intraoperative evidences, associated disc herniation at the same location or severe degeneration of the ligament flavum that the cyst originated from in young patients.
Ha, Sang Woo; Kim, Seok Won; Lee, SeungMyung; Kim, Yong Hyun; Kim, Hyeun Sung
Objective Discal cyst is rare and causes indistinguishable symptoms from lumbar disc herniation. The clinical manifestations and pathological features of discal cyst have not yet been completely known. Discal cyst has been treated with surgery or with direct intervention such as computed tomography (CT) guided aspiration and steroid injection. The purpose of this study is to evaluate the safety and efficacy of the percutaneous endoscopic surgery for lumbar discal cyst over at least 6 months follow-up. Methods All 8 cases of discal cyst with radiculopathy were treated by percutaneous endoscopic surgery by transforaminal approach. The involved levels include L5-S1 in 1 patient, L3-4 in 2, and L4-5 in 5. The preoperative magnetic resonance imaging and 3-dimensional CT with discogram images in all cases showed a connection between the cyst and the involved intervertebral disc. Over a 6-months period, self-reported measures were assessed using an outcome questionaire that incorporated total back-related medical resource utilization and improvement of leg pain [visual analogue scale (VAS) and Macnab's criteria]. Results All 8 patients underwent endoscopic excision of the cyst with additional partial discectomy. Seven patients obtained immediate relief of symptoms after removal of the cyst by endoscopic approach. There were no recurrent lesions during follow-up period. The mean preoperative VAS for leg pain was 8.25±0.5. At the last examination followed longer than 6 month, the mean VAS for leg pain was 2.25±2.21. According to MacNab' criteria, 4 patients (50%) had excellent results, 3 patients (37.5%) had good results; thus, satisfactory results were achieved in 7 patients (87.5%). However, one case had unsatisfactory result with persistent leg pain and another paresthesia. Conclusion The radicular symptoms were remarkably improved in most patients immediately after percutaneous endoscopic cystectomy by transforaminal approach. PMID:22737300
Rusina OYu; Mirskaya, E E; Andreeva, I V; Skavronskaya, A G
The ability of 23 chemicals (carcinogens and non-carcinogens) to induce precise excision of Tn10 and point mutations was studied in experiments with a single strain. The mutation assay was shown to detect a wider spectrum of genotoxic agents than the assay of Tn10 precise excision. The latter was induced only by potent SOS mutagens, which is in accordance with data on the SOS dependence of the induction of precise excision of Tn10. The precise excision assay as an additional test contributing to the knowledge of particular features of the action of a tested mutagen is discussed. The induction of precise excision of Tn10 by pyrene (and its failure to induce point mutations in this strain) demonstrates the value of using the transposon excision assay in cases of 'problem' mutagens.
Kamal, M; Goyal, S
A comparative evaluation of hand wrist and cervical vertebrae was done to know the validity of cervical vertebrae as maturity indicators. A sample of 50 subjects (25 females and 25 males) in the age group of 10-12 years were selected on criteria of normal occlusion and the result showed that cervical vertebrae can be used with the same confidence as hand wrist radiographs to evaluate skeletal maturity, thus avoiding the need for an additional radiograph.
Hamrick, Mark W; Pennington, Catherine; Byron, Craig D
GDF-8, also known as myostatin, is a member of the transforming growth factor-beta superfamily of secreted growth and differentiation factors that is expressed in vertebrate skeletal muscle. Myostatin functions as a negative regulator of skeletal muscle growth and myostatin null mice show a doubling of muscle mass compared to normal mice. We describe here morphology of the lumbar spine in myostatin knockout (Mstn(-/-)) mice using histological and densitometric techniques. The Mstn(-/-) mice examined in this study weigh approximately 10% more than controls (p<0.001) but the iliopsoas muscle is over 50% larger in the knockout mice than in wild-type mice (p<0.001). Peripheral quantitative computed tomography (pQCT) data from the fifth lumbar vertebra show that mice lacking myostatin have approximately 50% greater trabecular bone mineral density (p=0.001) and significantly greater cortical bone mineral content than normal mice. Toluidine blue staining of the intervertebral disc between L4-L5 reveals loss of proteoglycan staining in the hyaline end plates and inner annulus fibrosus of the knockout mice. Loss of cartilage staining in the caudal end plate of L4 is due to ossification of the end plate in the myostatin-deficient animals. Results from this study suggest that increased muscle mass in mice lacking myostatin is associated with increased bone mass as well as degenerative changes in the intervertebral disc.
MATSUI, HIROKI; IMAGAMA, SHIRO; ITO, ZENYA; ANDO, KEI; HIRANO, KENICHI; TAUCHI, RYOJI; MURAMOTO, AKIO; MATSUMOTO, TOMOHIRO; ISHIGURO, NAOKI
ABSTRACT Spinal epidural hematoma (SEH) is an uncommon disorder, and chronic SEHs are rarer than acute SEHs. However, there is few reported involving the bone change of the vertebral body in chronic SEHs. We present a case report of lumbar epidural hematoma that required differentiation from extramedullary spinal tumors by a long process because the CT scan revealed scalloping of the vertebral body and review the relevant literature. A 78-year-old man had experienced a gradual onset of low back pain and excruciating pain in both legs. Lumbar MRI on T1-weighted images revealed a space-occupying lesion with a hyperintense signal relative to the spinal cord with no enhancement on gadolinium adminisration. Meanwhile, T2-weighted images revealed a heterogeneous intensity change, accompanying a central area of hyperintense signals with a hypointense peripheral border at the L4 vertebra. Moreover, the CT scan demonstrated scalloping of the posterior wall of the L4 vertebral body which is generally suspected as the CT finding of spainal tumor. During the epidural space exploration, we found a dark red-colored mass surrounded by a capsular layer, which was fibrous and adhered to the flavum and dura mater. Microscopic histological examination of the resected mass revealed a mixture of the relatively new hematoma and the hematoma that was moving into the connective tissue. Accordingly, the hematoma was diagnosed as chronic SEH. The particular MRI findings of chronic SEHs are helpful for making accurate preoperative diagnoses of this pathology. PMID:25130006
Stubbs, M; Harris, M; Solomonow, M; Zhou, B; Lu, Y; Baratta, R V
A ligamento-muscular protective reflex in the lumbar spine was demonstrated in a feline model. Stimulating electrodes were applied to the supraspinous ligament between several lumbar vertebra (L1 to L6) while recording myoelectric discharge from the paraspinal muscles at the L3, L4 and L5, bilaterally. Electromyographic (EMG) activity was present in the paraspinal muscles bilaterally, upon stimulation of the supraspinous ligament, in six preparations. The EMG discharge was strongest in the muscles one level below that of the stimulated ligament, whereas weaker EMG signals were recorded from as far as two levels above and below. The mean time delay between the application of the stimulus to the ligament to the resulting EMG ranged from 2.52 to 2.77 ms at all levels. Stimulation of the supraspinous ligament in the L6 segment resulted in a weak reflex response, and stimulation in the L7 segment did not produce any EMG activity. It was concluded that mechanoreceptors in the supraspinous ligament at the L1/6 levels may initiate sensory signals upon strain of the ligament, during flexion. This, in turn, causes contraction of the paraspinal muscles, bilaterally, to extend the spine and prevent possible damage to the ligament while maintaining stability. The results may add to the understanding of low back pain, and to the formulation of surgical procedures which could spare the neural supply of the ligament, allowing advanced physiotherapeutic modalities to be implemented for post-surgical rehabilitation.
Benjelloun, Mohammed; Mahmoudi, Saïd; Lecron, Fabian
We propose a medical image segmentation approach based on the Active Shape Model theory. We apply this method for cervical vertebra detection. The main advantage of this approach is the application of a statistical model created after a training stage. Thus, the knowledge and interaction of the domain expert intervene in this approach. Our application allows the use of two different models, that is, a global one (with several vertebrae) and a local one (with a single vertebra). Two modes of segmentation are also proposed: manual and semiautomatic. For the manual mode, only two points are selected by the user on a given image. The first point needs to be close to the lower anterior corner of the last vertebra and the second near the upper anterior corner of the first vertebra. These two points are required to initialize the segmentation process. We propose to use the Harris corner detector combined with three successive filters to carry out the semiautomatic process. The results obtained on a large set of X-ray images are very promising.
Oh, Han San; Kim, Hyun Gon; Park, Kwan Ho
Objective Vertebroplasty is an effective treatment for vertebral compression fracture, but may progress gradual vertebral height decrease in spite of vertebroplasty. Gradual vertebral height decrease also may induce aggravation of kyphotic change without severe pain. The purpose of this study was to evaluate risk factors for gradual vertebral height decrease in the absence of recurrent severe back pain. Methods A retrospective analysis was performed on 44 patients who were diagnosed with a first osteoporotic compression fracture at a single level at the thoracolumbar junction. All patients were taken vertebroplasty. Possible risk factors for gradual vertebral height decrease, such as sex, age, bone mineral density, body mass index, level of compression fracture, volume of injected cement, cement leakage into disc space, and air clefts within fractured vertebrae, were analyzed. Results Gradual vertebral height decrease of augmented vertebrae occurred commonly when more than 4 cc of injected cement was used, and when air clefts within fractured vertebrae were seen on admission. In addition, the sagittal Cobb angle more commonly increased during the follow-up period in such cases. Conclusion Injection of more than 4 cc of cement during vertebroplasty and air cleft within fractured vertebrae on admission induced gradual vertebral height decrease in augmented vertebrae. Thus, longer follow-up will be needed in such cases, even when patients do not complain of recurrent severe back pain. PMID:27182497
Bubley, W J; Kneebone, J; Sulikowski, J A; Tsang, P C W
Male and female spiny dogfish Squalus acanthias were collected in the western North Atlantic Ocean in the Gulf of Maine between July 2006 and June 2009. Squalus acanthias ranged from 25 to 102 cm stretch total length and were caught during all months of the year except January. Age estimates derived from banding patterns visible in both the vertebrae and second dorsal-fin spines were compared. Vertebral growth increments were visualized using a modified histological staining technique, which was verified as appropriate for obtaining age estimates. Marginal increment analysis of vertebrae verified the increment periodicity, suggesting annual band deposition. Based on increased precision and accuracy of age estimates, as well as more biologically realistic parameters generated in growth models, the current study found that vertebrae provided a more reliable and accurate means of estimating age in S. acanthias than the second dorsal-fin spine. Age estimates obtained from vertebrae ranged from <1 year-old to 17 years for male and 24 years for female S. acanthias. The two-parameter von Bertalanffy growth model fit to vertebrae-derived age estimates produced parameters of L∞ = 94·23 cm and k = 0·11 for males and L∞ = 100·76 cm and k = 0·12 for females. While these growth parameters differed from those previously reported for S. acanthias in the western North Atlantic Ocean, the causes of such differences were beyond the scope of the current study and remain to be determined.
Vermeulen, Wim; Fousteri, Maria
Transcriptional arrest caused by DNA damage is detrimental for cells and organisms as it impinges on gene expression and thereby on cell growth and survival. To alleviate transcriptional arrest, cells trigger a transcription-dependent genome surveillance pathway, termed transcription-coupled nucleotide excision repair (TC-NER) that ensures rapid removal of such transcription-impeding DNA lesions and prevents persistent stalling of transcription. Defective TC-NER is causatively linked to Cockayne syndrome, a rare severe genetic disorder with multisystem abnormalities that results in patients' death in early adulthood. Here we review recent data on how damage-arrested transcription is actively coupled to TC-NER in mammals and discuss new emerging models concerning the role of TC-NER-specific factors in this process.
García-Flórez, Luis J; Otero-Díez, Jorge L
Transanal endoscopic surgery (TES) consists of a series of anorectal surgical procedures using different devices that are introduced into the anal canal. TES has been developed significantly since it was first used in the 1980s. The key point for the success of these techniques is how accurately patients are selected. The main indication was the resection of endoscopically unresectable adenomas. In recent years, these techniques have become more widespread which has allowed them to be applied in conservative rectal procedures for both benign diseases and selected cases of rectal cancer. For more advanced rectal cancers it should be considered palliative or, in some controlled trials, experimental. The role of newer endoscopic techniques available has not yet been defined. TES may allow for new strategies in the treatment of rectal pathology, like transanal natural orifice transluminal endoscopic surgery or total mesorectal excision. PMID:26309355
Brenerman, Boris M.; Illuzzi, Jennifer L.; Wilson, David M.
Base excision repair (BER) is a frontline defense mechanism for dealing with many common forms of endogenous DNA damage, several of which can drive mutagenic or cell death outcomes. The pathway engages proteins such as glycosylases, abasic endonucleases, polymerases and ligases to remove substrate modifications from DNA and restore the genome back to its original state. Inherited mutations in genes related to BER can give rise to disorders involving cancer, immunodeficiency and neurodegeneration. Studies employing genetically defined heterozygous (haploinsufficient) mouse models indicate that partial reduction in BER capacity can increase vulnerability to both spontaneous and exposure-dependent pathologies. In humans, measurement of BER variation has been imperfect to this point, yet tools to assess BER in epidemiological surveys are steadily evolving. We provide herein an overview of the BER pathway and discuss the current efforts toward defining the relationship of BER defects with disease susceptibility. PMID:25355293
Vawter, D. L.; Fung, Y. C.; West, J. B.
An optical-electromechanical system is used to measure the force-deformation behavior of biaxially loaded rectangular slabs of excised dog lung parenchyma. In the course of the study, the effects of time, the consistency of reference lengths and areas, the presence of hysteresis, the necessity of preconditioning, the repeatability of results, the effects of lateral load, the effect of strain rate, the effect of pH, the influence of temperature, and the variations among specimens are considered. A new finding is that there is a change in elastic behavior when the tissue undergoes a compressive strain. When the tissue is in tension, increasing the lateral load decreases the compliance, whereas the opposite is true when compressive strain is present.
Wilson, David M.; Kim, Daemyung; Berquist, Brian R.; Sigurdson, Alice J.
The major DNA repair pathway for coping with spontaneous forms of DNA damage, such as natural hydrolytic products or oxidative lesions, is base excision repair (BER). In particular, BER processes mutagenic and cytotoxic DNA lesions such as non-bulky base modifications, abasic sites, and a range of chemically distinct single-strand breaks. Defects in BER have been linked to cancer predisposition, neurodegenerative disorders, and immunodeficiency. Recent data indicate a large degree of sequence variability in DNA repair genes and several studies have associated BER gene polymorphisms with disease risk, including cancer of several sites. The intent of this review is to describe the range of BER capacity among individuals and the functional consequences of BER genetic variants. We also discuss studies that associate BER deficiency with disease risk and the current state of BER capacity measurement assays. PMID:21167187
Zakaria, Hesham Mostafa; Schultz, Lonni; Mossa-Basha, Feras; Griffith, Brent; Chang, Victor
OBJECT Improved objective assessments of perioperative risk after spine surgery are necessary to decrease postoperative morbidity and mortality rates. Morphometric analysis has proven utility in predicting postoperative morbidity and mortality in surgical disciplines. The aim of the present study was to evaluate whether morphometrics can be applied to the cases of patients undergoing lumbar spine surgery. METHODS The authors performed a retrospective review of the perioperative course of 395 patients who underwent lumbar surgery at their institution from 2013 to 2014. Preoperative risk factors such as age, diabetes, smoking, coronary artery disease, and body mass index (BMI) were recorded. Preoperative MRI was used to measure the psoas muscle area at the L-4 vertebra and paraspinal muscle area at the T-12 vertebra. Primary outcomes included unplanned return to the operating room, 30- and 90-day readmissions, surgical site infection, wound dehiscence, new neurological deficit, deep vein thrombosis, pulmonary embolism, myocardial infarction, urinary tract infection, urinary retention, hospital-acquired pneumonia, stroke, and prolonged stay in the intensive care unit. RESULTS The overall rate of adverse events was 30%, the most common event being urinary retention (12%). Greater age (p = 0.015) and tobacco usage (p = 0.026) were both significantly associated with complications for all patients, while diabetes, coronary artery disease, and high BMI were not. No surgery-related characteristics were associated with postoperative morbidity, including whether surgery required instrumentation, whether it was a revision, or the number of vertebral levels treated. Using multivariate regression analysis, male and female patients with the lowest psoas tertile had an OR of 1.70 (95% CI 1.04-2.79, p = 0.035) for having postoperative complications. Male patients in the lowest psoas tertile had an OR of 2.42 (95% CI 1.17-5.01, p = 0.016) for having a postoperative complication. The
Lecron, Fabian; Mahmoudi, Sidi Ahmed; Benjelloun, Mohammed; Mahmoudi, Saïd; Manneback, Pierre
The context of this work is related to the vertebra segmentation. The method we propose is based on the active shape model (ASM). An original approach taking advantage of the edge polygonal approximation was developed to locate the vertebra positions in a X-ray image. Despite the fact that segmentation results show good efficiency, the time is a key variable that has always to be optimized in a medical context. Therefore, we present how vertebra extraction can efficiently be performed in exploiting the full computing power of parallel (GPU) and heterogeneous (multi-CPU/multi-GPU) architectures. We propose a parallel hybrid implementation of the most intensive steps enabling to boost performance. Experimentations have been conducted using a set of high-resolution X-ray medical images, showing a global speedup ranging from 3 to 22, by comparison with the CPU implementation. Data transfer times between CPU and GPU memories were included in the execution times of our proposed implementation.
Wang, Naiguo; Wang, Dachuan; Wang, Feng; Tan, Bingyi; Yuan, Zenong
Abstract The objective of this study was to investigate short segment decompression of degenerative lumbar scoliosis (DLS) and the efficiency of fusion treatment. After DLS surgery, the patients were retrospectively reviewed using the VAS (visual analog scale) and ODI (Oswestry Disability Index) to assess clinical outcomes. All patients underwent posterior lumbar decompressive laminectomy, pedicle screw internal fixation, and posterolateral bone graft fusion surgery. Radiographic measurements included the scoliotic Cobb angle, the fused Cobb angle, the anterior intervertebral angle (AIA), the sagittal intervertebral angle (SIA), and lumbar lordosis angle. The relationships between these parameters were examined by bivariate Pearson analysis and linear regression analysis. Preoperatively, the Cobb angle at the scoliotic segment was 15.4°, which decreased to 10.2° immediately following surgery (P < 0.05). The AIA significantly increased by the last follow-up (4.4 ± 3.4) compared with pre- and postoperative values (2.5 ± 2.8 and 2.2 ± 2.4, respectively; P < 0.05). However, the scoliotic Cobb angle and the AIA did not correlate with the VAS or ODI scores. At the final follow-up, no patients had pseudoarthrosis or internal instrumentation-related complications. Short fusion surgical treatment results in limited DLS correction, with correction loss over time. The AIA between the upper adjacent segment and proximal fused vertebra continues to increase postoperatively, which does not exacerbate clinical symptoms, as reflected by the low reoperation rates for repairing degeneration at adjacent levels. PMID:26632679
Pedersen, Mona E; Ytteborg, Elisabeth; Kohler, Achim; Baeverfjord, Grete; Enersen, Grethe; Ruyter, Bente; Takle, Harald; Hannesson, Kirsten O
We analysed the distribution and expression of the small leucine-rich proteoglycans (SLRPs) decorin, biglycan and lumican in vertebral columns of Atlantic salmon Salmo salar L. with and without radiographically detectable deformities. Vertebral deformities are a reoccurring problem in salmon and other intensively farmed species, and an understanding of the components involved in the pathologic development of the vertebrae is important in order to find adequate solutions to this problem. Using immunohistology and light microscopy, we found that in non-deformed vertebrae biglycan, lumican and decorin were all expressed in osteoblasts at the vertebral growth zones and at the ossification front of the chondrocytic arches. Hence, the SLRPs are expressed in regions where intramembranous and endochondral ossification take place. In addition, mRNA expression of biglycan, decorin and lumican was demonstrated in a primary osteoblast culture established from Atlantic salmon, supporting the in vivo findings. Transcription of the SLRPs increased during differentiation of the osteoblasts in vitro and where lumican mRNA expression increased later in the differentiation compared with decorin and biglycan. Intriguingly, in vertebral fusions, biglycan, decorin and lumican protein expression was extended to trans-differentiating cells at the border between arch centra and osteoblast growth zones. In addition, mRNA expression of biglycan, decorin and lumican differed between non-deformed and fused vertebrae, as shown by quantitative PCR (qPCR). Western blotting revealed an additional band of biglycan in fused vertebrae which had a higher molecular weight than in non-deformed vertebrae. Fourier-transform infrared (FTIR) spectroscopy revealed more spectral focality in the endplates of vertebral fusions and significantly more non-reducible collagen crosslinks compared with non-deformed vertebrae, thus identifying differences in bone structure.
Sá, Pedro; Marques, Pedro; Alpoim, Bruno; Rodrigues, Elisa; Félix, António; Silva, Luís; Leal, Miguel
Lumbar stenosis is an increasingly common pathological condition that is becoming more frequent with increasing mean life expectancy, with high costs for society. It has many causes, among which degenerative, neoplastic and traumatic causes stand out. Most of the patients respond well to conservative therapy. Surgical treatment is reserved for patients who present symptoms after implementation of conservative measures. Here, a case of severe stenosis of the lumbar spine at several levels, in a female patient with pathological and surgical antecedents in the lumbar spine, is presented. The patient underwent two different decompression techniques within the same operation. PMID:26229836
Purpose The primary goal of this Policy Statement is to educate patients, physicians, medical providers, reviewers, adjustors, case managers, insurers, and all others involved or affected by insurance coverage decisions regarding lumbar disc replacement surgery. Procedures This Policy Statement was developed by a panel of physicians selected by the Board of Directors of ISASS for their expertise and experience with lumbar TDR. The panel's recommendation was entirely based on the best evidence-based scientific research available regarding the safety and effectiveness of lumbar TDR. PMID:25785243
Reynolds, R.J.; Love, J.D.; Friedberg, E.C.
Cell-free extracts prepared from rad1-19, rad2-2, rad3-1, rad4-3, rad7-1, rad10-1, rad14-1, rad16-1, and cycl-1 (rad7) mutants of Saccharomyces cerevisiae all catalyze the preferential excision of thymine-containing pyrimidine dimers from ultraviolet-irradiated DNA specifically incised with M. luteus ultraviolet deoxyribonucleic acid incising activity.
Özdemir, Tayfun; Öz, Hande Ece
Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation. PMID:27134989
Tuna, Serpil; Özdemir, Tayfun; Öz, Hande Ece
Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation.
Parliament, Hugh A.
The Adaptive Signal Processing Testbed (ASPT) signal excision software is a set of programs that provide real-time processing functions for the excision of interfering tones from a live spread-spectrum signal as well as off-line functions for the analysis of the effectiveness of the excision technique. The processing functions provided by the ASPT signal excision software are real-time adaptive filtering of live data, storage to disk, and file sorting and conversion. The main off-line analysis function is bit error determination. The purpose of the software is to measure the effectiveness of an adaptive filtering algorithm to suppress interfering or jamming signals in a spread spectrum signal environment. A user manual for the software is provided, containing information on the different software components available to perform signal excision experiments: the real-time excision software, excision host program, file processing utilities, and despreading and bit error rate determination software. In addition, information is presented describing the excision algorithm implemented, the real-time processing framework, the steps required to add algorithms to the system, the processing functions used in despreading, and description of command sequences for post-run analysis of the data.
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The frequency of P element excision and the structure of the resulting excision products were determined in three drosophilid species, Drosophila melanogaster, D. virilis, and Chymomyza procnemis. A transient P element mobility assay was conducted in the cells of developing insect embryos, but unlik...
... 26 Internal Revenue 14 2013-04-01 2013-04-01 false Effect of excise tax. 25.2512-7 Section 25.2512-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES GIFT TAX; GIFTS MADE AFTER DECEMBER 31, 1954 Transfers § 25.2512-7 Effect of excise tax....
Mullany, P; Roberts, A P; Wang, H
Translocation of conjugative transposons proceeds via excision of the element to generate a circular molecule that can then integrate into a new site, which can be in the same or a different cell. This review summarises some of the different mechanisms used for excision and integration of conjugative transposons.
Cordero-Carrión, I.; Vasset, N.; Novak, J.; Jaramillo, J. L.
We present a new excision technique used in constrained formulations of Einstein equations to deal with black hole in numerical simulations. We show the applicability of this scheme in several scenarios. In particular, we present the dynamical evolution of the collapse of a neutron star to a black hole, using the CoCoNuT code and this excision technique.
Nabeta, Masaharu; Yoshimoto, Hisashi; Sato, Shigenobu; Hyakumachi, Takahiko; Yanagibashi, Yasushi; Masuda, Takeshi
Discal cysts are rare lesions that can result in refractory sciatica. Because they are so rare, their exact origin and details of the clinical manifestations are still unknown. The authors report on five men treated for discal cysts. The mean age of the patients at the time of the surgery was 32 years (range 25-38 years). All patients suffered from lower-extremity pain and the results of the straight leg-raising test were positive in all cases. Three patients reported motor weakness and four had sensory disturbance-symptoms similar to those found in patients with lumbar disc herniation. Magnetic resonance imaging demonstrated spherically shaped extradural lesions of various sizes with low and high signal intensities on T1- and T2-weighted images, respectively. Discography revealed obvious communication between the cyst and the intervertebral disc with reproducible leg pain in all patients. All patients underwent posterior decompression and excision of the cysts either with or without additional discectomy. The radicular symptoms were remarkably improved in all patients immediately after surgery, and no recurrent lesions were noted during follow up.
The observation that polA1 and recL152 mutations result in both slow pyrimidine dimer excision and large repair patch size leads to the hypothesis that patch size is directly related to the rate of excision. In this study caffeine, a known inhibitor of excision repair, was used to examine the extent of correlation between excision rate and patch size by measuring patch size in the presence of several concentrations of caffeine. Both the rate of excision and the resistance to ultraviolet radiation were reduced with increasing concentrations of caffeine after irradiation. Caffeine also inhibited the rate at which incisions were made and prolonged the time required to rejoin the discontinuities. Patch size, however, was unaffected by caffeine treatment.
Skalpe, I O
Late sequelae (adhesive arachnoiditis) have been reported following myelography with the oily contrast medium (Pantopaque) and with the ionic water-soluble contrast media methiodal sodium (Abrodil, Conturex, Kontrast U) meglumine iothalamate (Conray Meglumine) and meglumine iocarmate (Bis-Conray, Dimer-X). Adhesive arachnoiditis has not yet been reported after the use of the nonionic water-soluble contrast medium metrizamide (Amipaque). Thus, this is considered the contrast medium of choice for lumbar myelography. Using the recommended dose of 10 ml with an iodine concentration of 170 mg/ml for this examination, adhesive arachnoiditis is unlikely to occur. Increased osmolality of spinal fluid after injection of contrast medium is related to increased frequency of arachnoiditis.
Yüksel, Kasım Zafer
Background Low back pain is a frequent condition that results in substantial disability and causes admission of patients to neurosurgery clinics. To evaluate and present the therapeutic outcomes in lumbar disc hernia (LDH) patients treated by means of a conservative approach, consisting of bed rest and medical therapy. Methods This retrospective cohort was carried out in the neurosurgery departments of hospitals in Kahramanmaraş city and 23 patients diagnosed with LDH at the levels of L3−L4, L4−L5 or L5−S1 were enrolled. Results The average age was 38.4 ± 8.0 and the chief complaint was low back pain and sciatica radiating to one or both lower extremities. Conservative treatment was administered. Neurological examination findings, durations of treatment and intervals until symptomatic recovery were recorded. Laségue tests and neurosensory examination revealed that mild neurological deficits existed in 16 of our patients. Previously, 5 patients had received physiotherapy and 7 patients had been on medical treatment. The number of patients with LDH at the level of L3−L4, L4−L5, and L5−S1 were 1, 13, and 9, respectively. All patients reported that they had benefit from medical treatment and bed rest, and radiologic improvement was observed simultaneously on MRI scans. The average duration until symptomatic recovery and/or regression of LDH symptoms was 13.6 ± 5.4 months (range: 5−22). Conclusions It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically. This condition must be taken into account during decision making for surgical intervention in LDH patients devoid of indications for emergent surgery. PMID:28119770
Foda, Hossam M T
A boomerang-shaped alar base excision is described to narrow the nasal base and correct the excessive alar flare. The boomerang excision combined the external alar wedge resection with an internal vestibular floor excision. The internal excision was inclined 30 to 45 degrees laterally to form the inner limb of the boomerang. The study included 46 patients presenting with wide nasal base and excessive alar flaring. All cases were followed for a mean period of 18 months (range, 8 to 36 months). The laterally oriented vestibular floor excision allowed for maximum preservation of the natural curvature of the alar rim where it meets the nostril floor and upon its closure resulted in a considerable medialization of alar lobule, which significantly reduced the amount of alar flare and the amount of external alar excision needed. This external alar excision measured, on average, 3.8 mm (range, 2 to 8 mm), which is significantly less than that needed when a standard vertical internal excision was used ( P < 0.0001). Such conservative external excisions eliminated the risk of obliterating the natural alar-facial crease, which did not occur in any of our cases. No cases of postoperative bleeding, infection, or vestibular stenosis were encountered. Keloid or hypertrophic scar formation was not encountered; however, dermabrasion of the scars was needed in three (6.5%) cases to eliminate apparent suture track marks. The boomerang alar base excision proved to be a safe and effective technique for narrowing the nasal base and elimination of the excessive flaring and resulted in a natural, well-proportioned nasal base with no obvious scarring.
... treatment while waiting for the results of the culture. Risks A lumbar puncture is considered a safe procedure with minimal risks. Most of the time, there are no complications. In some instances, a ...
.org Fractures of the Thoracic and Lumbar Spine Page ( 1 ) Spinal fractures can vary widely in severity. While some fractures are very serious injuries that require emergency treatment, other fractures can ...
Dalal, Krishna; Elanchezhiyan, D.; Maran, V. B.; Das, Raunak Kumar; Kumar, Piyush; Singh, S. P.; Murali Krishna, C.; Chatterjee, Jyotirmoy
Scientific validation of reflexology requires an in-depth and noninvasive evaluation of “reflexology/reflex areas” in health and disease. The present paper reports the differential properties of “normal” and “abnormal” reflexology areas related to the lumbar vertebrae in a subject suffering from low back pain. The pathology is supported by radiological evidence. The reflexology target regions were clinically assessed with respect to colour and tenderness in response to finger pressure. Grey scale luminosity and pain intensity, as assessed by visual analogue scale scores, differentiated “normal” from “abnormal” skin. Skin swept source-optical coherence tomography recorded their structural differences. Infrared thermography revealed temperature variations. A laser Doppler study using a combined microcirculation and transcutaneous oxygen monitoring system indicated alterations in blood flow and oxygen perfusion. Raman spectroscopy showed differences in chemical signatures between these areas. The present findings may indicate a potential correlation between the reflexology areas and subsurface pathological changes, showing an association with the healthy or unhealthy status of the lumbar vertebrae. PMID:23365581
Zhang, Haiping; Niu, Xingbang; Wang, Biao; He, Simin; Hao, Dingjun
Abstract Rationale: Lumbar osteoid osteoma has a low incidence, which could easily lead to scoliosis. Patient concerns: Scoliosis secondary to lumbar osteoid osteoma could be easily misdiagnosed when patients do not complain of obvious symptoms. Diagnoses: We reported a case of a 9-year-old boy with back deformity that was firstly diagnosed with scoliosis at the local hospital. After prescribed with orthosis, the patient experienced aggravating pain that could not be relieved with painkillers. After he admitted to our hospital for further medical advice, he was prescribed to complete radiological examinations. Considering his radiological examination results and his medical history, correct diagnosis of lumbar osteoid osteoma was made. Interventions: Surgical intervention of posterior lesion resection was conducted after diagnosis. Intra-operative frozen pathology indicated features of osteoid osteoma. As the lesion involved inferior articular process of L5, which could cause lumbar instability after lesion resection, internal fixation was conducted at L4-S1 segment, and posterolateral bone fusion was also conducted at L5-S1 segment. Outcomes: Three months after operation, the patient showed marked improvement of scoliosis deformity and great relief of lumbar pain. Lessons subsections: Although spine osteoid osteoma is clinically rare, it shall not be overlooked when young patients present with scoliosis first. Radiological results including computed tomography and magnetic resonance imaging shall be taken carefully as reference when making diagnosis. Surgical intervention of lesion resection could well improve scoliosis and relieve lumbar pain. PMID:27893671
Abuamara, S; Dacher, J N; Lechevallier, J
Fracture of the atlas vertebra is rare in children. We report two paediatric cases of bifocal pedicular fracture of the posterior arch of C1. Evaluation was performed by nonenhanced computed tomography scan, which successively confirmed both diagnosis and healing. In both cases, nonoperative management was successful.
Biesbrouck, Maurits; Vanden Berghe, Alex
Some remarkable statements made by Andreas Vesalius (1514-1564) in his principal work De Humani Corporis Fabrica (1543) about the anatomy and function of the lower thoracic vertebrae are discussed in the light of information from the literature. Their accuracy is evaluated on the basis of several pieces of anatomical evidence and clinical cases.
Background: Formation of the vertebral column is a critical developmental stage in mammals. The strict control of this process has resulted in little variation in number of vertebrae across mammalian species and no variation within most mammalian species. The pig is quite unique as considerable vari...
Arnold, Patrick; Amson, Eli; Fischer, Martin S
Almost all mammals have seven vertebrae in their cervical spines. This consistency represents one of the most prominent examples of morphological stasis in vertebrae evolution. Hence, the requirements associated with evolutionary modifications of neck length have to be met with a fixed number of vertebrae. It has not been clear whether body size influences the overall length of the cervical spine and its inner organization (i.e., if the mammalian neck is subject to allometry). Here, we provide the first large scale analysis of the scaling patterns of the cervical spine and its constituting cervical vertebrae. Our findings reveal that the opposite allometric scaling of C1 and C2-C7 accommodate the increase of neck bending moment with body size. The internal organization of the neck skeleton exhibits surprisingly uniformity in the vast majority of mammals. Deviations from this general pattern only occur under extreme loading regimes associated with particular functional and allometric demands. Our results indicate that the main source of variation in the mammalian neck stems from the disparity of overall cervical spine length. The mammalian neck reveals how evolutionary disparity manifests itself in a structure that is otherwise highly restricted by meristic constraints. This article is protected by copyright. All rights reserved.
Hoffman, Matthew R.; Rieves, Adam L.; Budde, Adam J.; Surender, Ketan; Zhang, Yu; Jiang, Jack J.
Objective Disordered voices are often associated with abnormal changes in aerodynamic parameters of subglottal pressure and airflow. Phonation instability pressure (PIP) has been previously proposed to evaluate subglottal pressure at the onset of chaotic phonation. We propose the concept of and measure phonation instability flow (PIF), the airflow at which phonation becomes chaotic. Phonation flow range (PFR), PIF minus phonation threshold flow (PTF), is proposed to assess the range over which normal vocal fold vibration occurs. Study Design Repeated measures with each ex vivo larynx serving as its own control. Methods Pressure and airflow were measured at phonation onset and chaos onset in seven excised canine larynges under three experimental conditions: 0% elongation with no glottal gap; 20% elongation with no glottal gap; 20% elongation with a 3 mm posterior glottal gap. Paired t-tests were performed to determine if experimental measurements differed between elongations (0% and 20%) or degrees of abduction (20% elongation with and without a 3 mm glottal gap). Results Both PIF and PFR were dependent on abduction but not elongation. PIP was not significantly dependent on either condition. PIF and PFR showed greater differences for abduction than either phonation threshold pressure (PTP) or PTF. Conclusions PIF and PFR may be useful parameters in the experimental or clinical settings, particularly when evaluating disorders characterized by a glottal gap such as vocal fold paralysis and presbylaryngis. PMID:21555205
Ersoy Callıoglu, Elif; Bozdemir, Kazım; Ulusoy, Bulent; Oguzhan, Tolga; Korkmaz, M. Hakan
Ectopic thyroid gland may be detected at any place between foramen caecaum and normal thyroid localization due to inadequacy of the embryological migration of the thyroid gland. It has a prevalence varying between 1/10.000 and 1/100000 in the community. Usually follow-up without treatment is preferred except for obstructive symptoms, bleeding, and suspicion of malignity. Main symptoms are dysphagia, dysphonia, bleeding, dyspnea, and obstructive sleep apnea. In symptomatic cases, the first described method in surgical treatment is open approach since it is a region difficult to have access to. However, this approach has an increased risk of morbidity and postoperative complications. Transoral robotic surgery, which is a minimally invasive surgical procedure, has advantages such as larger three-dimensional point of view and ease of manipulation due to robotic instruments. In this report, a case at the age of 49 who presented to our clinic with obstructive symptoms increasing within the last year and was found to have lingual thyroid and underwent excision of ectopic thyroid tissue by da Vinci surgical system is presented. PMID:26064746
Mathur, Ena; Sareen, Mohit; Dhaka, Payal; Baghla, Pallavi
Introduction: Lasers have made tremendous progress in the field of dentistry and have turned out to be crucial in oral surgery as collateral approach for soft tissue surgery. This rapid progress can be attributed to the fact that lasers allow efficient execution of soft tissue procedures with excellent hemostasis and field visibility. When matched to scalpel, electrocautery or high frequency devices, lasers offer maximum postoperative patient comfort. Methods: Four patients agreed to undergo surgical removal of benign lesions of the oral cavity. 810 nm diode lasers were used in continuous wave mode for excisional biopsy. The specimens were sent for histopathological examination and patients were assessed on intraoperative and postoperative complications. Results: Diode laser surgery was rapid, bloodless and well accepted by patients and led to complete resolution of the lesions. The excised specimen proved adequate for histopathological examination. Hemostasis was achieved immediately after the procedure with minimal postoperative problems, discomfort and scarring. Conclusion: We conclude that diode lasers are rapidly becoming the standard of care in contemporary dental practice and can be employed in procedures requiring excisional biopsy of oral soft tissue lesions with minimal problems in histopathological diagnosis. PMID:26464781
... Excise Tax; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Correcting amendment... qualified subchapter S subsidiaries) and the indoor tanning services excise tax. DATES: This correction is... Employment taxes, Estate taxes, Excise taxes, Gift taxes, Income taxes, Penalties, Reporting...
... Services Excise Tax AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Final and temporary... (including qualified subchapter S subsidiaries) and the indoor tanning services excise tax. These regulations affect disregarded entities responsible for collecting the indoor tanning services excise tax and...
Küchle, M; Holbach, L; Schlötzer-Schrehardt, U; Naumann, G O
A 26-year-old man developed a non-pigmented ciliary body tumour of his right eye. A 7 mm block excision and tectonic corneoscleral graft were performed. The excised tissue was studied using histopathological, immunohistochemical, and electron microscopic techniques. The tumour revealed characteristic features of a Schwann cell neoplasm including Antoni A and B patterns, acid mucopolysaccharides, S-100, and vimentin positivity, and--by electron microscopy--Luse bodies. It was classified as a schwannoma. Although rare, schwannoma should be included in the clinical differential diagnosis of non-pigmented ciliary body tumours. Local excision should be considered to avoid over-treatment by enucleation. Images PMID:8025076
Bajaj, V; Langtry, J A A
Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis that presents clinically as follicular papules and pustules. These can coalesce into firm hypertrophic plaques and nodules on the nape of the neck, most commonly affecting young adult men. Treatment includes topical steroids/antibiotics and oral antibiotics, but often has disappointing results. Surgical approaches include excision with primary closure or skin grafting, and hair-removal lasers. Another surgical approach is excision with secondary intention healing. This can result in good cosmesis with little or no recurrence. We report two men with AKN where treatment by excision with secondary intention was successful.
Kayaalp, Cüneyt; Soyer, Vural; Ersan, Veysel; Aydın, Cemalettin; Karagül, Servet
Congenital choledochal cysts are rare in adults. Due to the risk of developing cholangiocarcinoma, the current standard of care is complete excision of the cyst and reconstruction with hepaticojejunostomy. So far, more than 200 laparoscopic resections have been reported in adults, the majority being from Far Eastern countries over the last five years. Herein, the technique of laparoscopic type I choledochal cyst excision and hepaticojejunostomy is presented in a 37-year-old male with an accompanying video. The advantages of laparoscopic surgery are applicable for choledochal cyst excision as well. We believe that teamwork, expertise on intracorporeal suturing and hepatobiliary surgery are central issues for this operation. PMID:27436941
Vaca, Elbert E.; Mundinger, Gerhard S.; Zelken, Jonathan A.; Erdag, Gulsun
Objective: Penile syringomas are rare lesions usually occurring in isolation. We report the excision and reconstruction of multiple synchronous penile shaft syringomas with local scrotal flaps. Methods: We report a rare case of excision of multiple penile syringomas and reconstruction with scrotal flaps in a 29-year-old man. Results: Penile syringomas were excised and reconstructed with scrotal flaps in a single-stage procedure. Conclusions: In addition to providing wound coverage, this reconstructive option allowed for excellent functional results with regard to shaft alignment and erectile function, and it should be considered in the reconstructive armamentarium for penile shaft lesions. PMID:24966995
Tyagi, Vipin; Dar, Tanveer Iqbal; Durani, Abdul Munan; Chada, Sudhir
Angiomyxoma is a rare tumour found predominantly in pelvis of young females. Less than 150 cases have been reported, more than 90% in females and only few cases in males. Its surgical excision is a big challenge and usually leads to recurrence due to incomplete excision. We report a case of retrovesical Angiomyxoma in an elderly male. The aim of this report is to highlight the rarity of this disease, especially in males, and robotic assisted excision as an evolving option of treatment. PMID:24761083
Wahner, H.W.; Dunn, W.L.; Riggs, B.L.
This study evaluates the effectiveness of DPA to separate patients with osteoporosis (greater than 2 spinal fractures, normal Ca, P, absence of drugs, and metabolic bone disease) from a normal population. Performance criteria for the instrument have been described previously. Data was obtained from a prospective study of 105 normal women, 75 patients with osteoporosis and a retrospective study of 300 patients with osteoporosis seen in 1982/83. The results were as follows: (1) Area density (gm/cm/sup 2/) was found superior to mass (gm) due to the occasional problem to clearly identify the boundaries of L1-4. (2) Separation of the two populations was best when L1-L4,L2-L4, L3 alone or 10 paths over the mid lumbar area were used. One pass was not acceptable. (3) Compression fractures (CF) in the LS showed an increase in area density initially but area density may be undistinguishable from intact vertebrae later. To correct for this loss of bone area a factor predicting the area of lumbar vertebrae and based on patients actual height and weight was introduced and tested. (4) In the retrospective study a negative correlation was found between number of thoracic spine CF and bone mineral values in the LS. (5) A fracture threshold value of BM defined as the level below which 95% of all patients with CF were found was determined to be 0.98 g/cm2. Sixty-five percent of patients with two or more spinal CF could be separated from the normal population (outside 2SD). By using a correction factor for height loss this could be further increased to about 70%. CF in the LS may falsely elevate bone mineral values.
Kaufmann, W.K.; Bodell, W.J.; Cleaver, J.E.
U.v. irradiation of confluent human fibroblasts activated DNA repair, aspects of which were characterized in the cells after they were permeabilized. Incubation of intact cells for 20 min between irradiation and harvesting was necessary to obtain a maximum rate of reparative DNA synthesis. Cells harvested immediately after irradiation before repair was initiated displayed only a small stimulation of DNA synthesis, indicating that permeable cells have a reduced capacity to recognize pyrimidine dimers and activate repair. The distribution of sizes of DNA strands labeled during 10 min of reparative DNA synthesis resembled that of parental DNA. However, during a 60-min incubation of permeable cells at 37 degrees C, parental DNA and DNA labeled by reparative DNA synthesis were both cleaved to smaller sizes. Cleavage also occurred in unirradiated cells, indicating that endogenous nuclease was active during incubation. Repair patches synthesized in permeable cells displayed increased sensitivity to digestion by micrococcal nuclease. However, the change in sensitivity during a chase with unlabeled DNA precursors was small, suggesting that reassembly of nucleosome structure at sites of repair was impaired. To examine whether this deficiency was due to a preponderance of incomplete or unligated repair patches, 3H-labeled (repaired) DNA was purified, then digested with exonuclease III and nuclease S1 to probe for free 3' ends and single-stranded regions. About 85% of the (3H)DNA synthesized during a 10-min pulse resisted digestion, suggesting that a major fraction of the repair patches that were filled were also ligated. U.v. light-activated DNA synthesis in permeable cells, therefore, appears to represent the continuation of reparative gap-filling at sites of excision repair activated within intact cells. Gap-filling and ligation were comparatively efficient processes in permeable cells.
Elmasry, M; Steinvall, I; Thorfinn, J; Olofsson, P; Abbas, A H; Abdelrahman, I; Adly, O A; Sjoberg, F
During the 80s and 90s, early and total excision of full thickness burns followed by immediate autograft was the most common treatment, with repeated excision and grafting, mostly for failed grafts. It was hypothesized, therefore, that delayed coverage with an autograft preceded by a temporary xenograft after early and sequential smaller excisions would lead to a better wound bed with fewer failed grafts, a smaller donor site, and possibly also a shorter duration of stay in hospital. We carried out a case control study with retrospective analysis from our National Burn Centre registry for the period 1997-2011. Patients who had been managed with early total excision and autograft were compared with those who had had sequential smaller excisions covered with temporary xenografts until the burn was ready for the final autograft. The sequential excision and xenograft group (n=42) required one-third fewer autografts than patients in the total excision and autograft group (n=45), who needed more than one operation (p<0.001). We could not detect any differences in duration of stay in hospital / total body surface area burned% (duration of stay/TBSA%) (2.0 and 1.8) (p=0.83). The two groups showed no major differences in terms of adjusted duration of stay, but our findings suggest that doing early, smaller, sequential excisions using a xenograft for temporary cover can result in shorter operating times, saving us the trouble of making big excisions. However, costs tended to be higher when the burns were > 25% TBSA.
Elmasry, M.; Steinvall, I.; Thorfinn, J.; Olofsson, P.; Abbas, A.H.; Abdelrahman, I.; Adly, O.A.; Sjoberg, F.
Summary During the 80s and 90s, early and total excision of full thickness burns followed by immediate autograft was the most common treatment, with repeated excision and grafting, mostly for failed grafts. It was hypothesized, therefore, that delayed coverage with an autograft preceded by a temporary xenograft after early and sequential smaller excisions would lead to a better wound bed with fewer failed grafts, a smaller donor site, and possibly also a shorter duration of stay in hospital. We carried out a case control study with retrospective analysis from our National Burn Centre registry for the period 1997-2011. Patients who had been managed with early total excision and autograft were compared with those who had had sequential smaller excisions covered with temporary xenografts until the burn was ready for the final autograft. The sequential excision and xenograft group (n=42) required one-third fewer autografts than patients in the total excision and autograft group (n=45), who needed more than one operation (p<0.001). We could not detect any differences in duration of stay in hospital / total body surface area burned% (duration of stay/TBSA%) (2.0 and 1.8) (p=0.83). The two groups showed no major differences in terms of adjusted duration of stay, but our findings suggest that doing early, smaller, sequential excisions using a xenograft for temporary cover can result in shorter operating times, saving us the trouble of making big excisions. However, costs tended to be higher when the burns were > 25% TBSA. PMID:28149249
Shin, Chul-ho; Kim, Minjeong; Park, Gi Duck
[Purpose] This study examined spinal shape in professional golfers with chronic back pain, and analyzed the effects of a 4-week regimen of semi-weekly manipulation and corrective core exercises on spinal shape. [Subjects] Two golfers with chronic back pain. [Methods] The pelvis and spinal vertebrae were corrected using the Thompson “drop” technique. Angle and force were adjusted to place the pelvis, lumbar spine, and thoracic vertebrae in neutral position. The technique was applied twice weekly after muscle massage in the back and pelvic areas. The golfers performed corrective, warmup stretching exercises, followed by squats on an unstable surface using the Togu ball. They then used a gym ball for repetitions of hip rotation, upper trunk extension, sit-ups, and pelvic anterior-posterior, pelvic left-right, and trunk flexion-extension exercises. The session ended with cycling as a cool-down exercise. Each session lasted 60 minutes. [Results] The difference in height was measured on the left and right sides of the pelvic bone. The pelvic tilt changed significantly in both participants after the 4-week program. [Conclusion] In golfers, core muscles are critical and are closely related to spinal deformation. Core strengthening and spinal correction play a pivotal role in the correction of spinal deformation. PMID:26504350
Shin, Chul-Ho; Kim, Minjeong; Park, Gi Duck
[Purpose] This study examined spinal shape in professional golfers with chronic back pain, and analyzed the effects of a 4-week regimen of semi-weekly manipulation and corrective core exercises on spinal shape. [Subjects] Two golfers with chronic back pain. [Methods] The pelvis and spinal vertebrae were corrected using the Thompson "drop" technique. Angle and force were adjusted to place the pelvis, lumbar spine, and thoracic vertebrae in neutral position. The technique was applied twice weekly after muscle massage in the back and pelvic areas. The golfers performed corrective, warmup stretching exercises, followed by squats on an unstable surface using the Togu ball. They then used a gym ball for repetitions of hip rotation, upper trunk extension, sit-ups, and pelvic anterior-posterior, pelvic left-right, and trunk flexion-extension exercises. The session ended with cycling as a cool-down exercise. Each session lasted 60 minutes. [Results] The difference in height was measured on the left and right sides of the pelvic bone. The pelvic tilt changed significantly in both participants after the 4-week program. [Conclusion] In golfers, core muscles are critical and are closely related to spinal deformation. Core strengthening and spinal correction play a pivotal role in the correction of spinal deformation.
Porter, Marianne E; Long, John H
In swimming sharks, vertebrae are subjected, in part, to compressive loads as axial muscles contract. We currently have no information about which vertebral elements, centra, arch cartilages, or both, actually bear compressive loads in cartilaginous vertebrae. To address this issue, the goal of this experiment was to determine the load-bearing ability of arch and centrum cartilages in compression, to determine the material properties of shark vertebrae, and to document fracture patterns in the centra with and without the arches. Intact vertebrae and vertebrae with the arch cartilages experimentally removed (centra alone) were subjected to compressive loading to failure at a single strain rate. The maximum compressive forces sustained by the vertebrae and the centra are statistically indistinguishable. Thus we conclude that under these testing conditions the arch does not bear appreciable loads. Independent evidence for this conclusion comes from the fact that vertebrae fail in compression at the centra, and not at the arches. Overall, the results of these mechanical tests suggest that the neural arches are not the primary load-bearing structure during axial compression.
Friedberg, Errol C
This article, taken largely from the book Correcting the Blueprint of Life: An Historical Account of the Discovery of DNA Repair Mechanisms, summarizes the very early history of the discovery of nucleotide excision repair.
... If You Have Questions en español Resonancia magnética: columna lumbar What It Is Magnetic resonance imaging (MRI) ... MORE ON THIS TOPIC Magnetic Resonance Imaging (MRI): Cervical Spine Lumbar Puncture (Spinal Tap) Magnetic Resonance Imaging ( ...
The source code for the ASPT Signal Excision Software Package which is part of the Adaptive Signal Processing Testbed (ASPT) is presented. The source code covers the programs 'excision', 'ab.out', 'd0.out', 'bd1.out', 'develop', 'despread', 'sorting', and 'convert'. These programs are concerned with collecting data, filtering out interference from a spread spectrum signal, analyzing the results, and developing and testing new filtering algorithms.
Ramkumar, Subramaniam; Ramkumar, Lakshmi; Malathi, Narasimhan
Mucoceles are nonneoplastic cystic lesions of major and minor salivary glands which result from the accumulation of mucus. These lesions are most commonly seen in children. Though usually these lesions can be treated by local surgical excision, in our case, to avoid intraoperative surgical complications like bleeding and edema and to enable better healing, excision was done using a diode laser in the wavelength of 940 nm. PMID:28097026
Morningstar, Mark W
Abstract Objective To test the hypothesis that restoring the lumbar lordosis will increase a patient's voluntary muscular strength and decrease back pain symptoms. Clinical Features A patient was diagnosed with mechanical low back pain. The initial radiographic study revealed a loss of the lumbar lordosis. The patient determined his maximum bench press prior to the treatment program. The treatment outcome was based upon post-intervention radiographs, a Borg pain scale, and the patient's post-intervention maximum bench press. Intervention and Outcome The treatment program consisted of warm-up exercises, spinal manipulation, rehabilitative exercises, neuromuscular re-education, and prescribed home care. The treatment period consisted of 12 visits in the first 4 weeks, followed by once weekly for another 12 weeks, for a total of 24 visits in 4 months. In the first month, the Borg scale decreased from 5/10 to 0/10, and after 4 months the lumbar lordosis was increased from 2° to 31°. The sacral base angle (Ferguson's angle) increased from 18° to 31°. The patient's maximum bench press also increased from 245 pounds to 305 pounds. Conclusion Restoration of the lumbar lordosis appears to have a positive effect on muscular strength. This study supports the previous premise that a lumbar lordosis provides an inherent mechanical advantage for strength and stability. PMID:19674610
Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y
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
Wallace, Susan S.
This perspective reviews the many dimensions of base excision repair from a 10,000 foot vantage point and provides one person’s view on where the field is headed. Enzyme function is considered under the lens of X-ray diffraction and single molecule studies. Base excision repair in chromatin and telomeres, regulation of expression and the role of posttranslational modifications are also discussed in the context of enzyme activities, cellular localization and interacting partners. The specialized roles that base excision repair play in transcriptional activation by active demethylation and targeted oxidation as well as how base excision repair functions in the immune processes of somatic hypermutation and class switch recombination and its possible involvement in retroviral infection are also discussed. Finally the complexities of oxidative damage and its repair and its link to neurodegenerative disorders, as well as the role of base excision repair as a tumor suppressor are examined in the context of damage, repair and aging. By outlining the many base excision repair-related mysteries that have yet to be unraveled, hopefully this perspective will stimulate further interest in the field. PMID:24780558
Roentgenographic Measurement of Lumbar Intervertebral Disc Height ." Spine , 6(2):154:158. Andriacchi, T., Schultz, A... measured , enabling coupled motion (Wite and Panjabi, 1978), for example, in lateral bending of the lumbar spine , to be investigated. Two different...to seated position. They describe measured positions of the lumbar spine , sacrum, and inncminate with anatomical landmarks important to
Lins, E; Basedow, H
This is a case of lumbar disc protrusion in a 14 year old girl, with typical symptomatology. Special attention should be called to the rarity of this case. The clinical and myelographic diagnosis showed a lumbar herniation L 4/L5. Treatment was performed by lumbar hemilaminectomie. The post operative controll showed remission of the clinical findings.
Kim, Joon-Sung; Kim, Ji Yeon
Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360
Modi, H N; Srinivasalu, S; Suh, S W; Yang, J H
Spondylolisthesis associated with neurofibromatosis is rare, and only 12 cases have been reported so far. However, only one report of grade 4 spondylolisthesis with neurofibromatosis has been reported in the literature. A 15-year-old boy with neurofibromatosis was admitted for back pain and neurological claudication. Radiograph showed grade 4 spondylolisthesis of the L5 vertebra with scalloping of the L4-L5 vertebrae. L4-L5 laminectomy, reduction, L3-S1 posterior instrumentation and fusion were performed. The reduction of the spondylisthesis was done entirely from the posterior approach using pedicle screws. Radiography at four months showed a broken S1 screw with a loss of reduction. The patient was re-operated on, to provide additional stability with pelvic fixation. He was pain-free with a good fusion at the two-year follow-up. Adequate posterior stabilisation with fusion gives good results in grade 4 spondylolisthesis associated with neurofibromatosis and dural ectasia.
Karargyris, Orestis; Morassi, Lampros-Guiseppe; Stathopoulos, Ioannis P.; Chatziioannou, Sofia N.; Pneumaticos, Spyros G.
Butterfly vertebra is a rare congenital malformation of the spine, which is usually reported in the literature as an isolated finding. We describe a 40-year-old woman that presented to our emergency department with back pain and sciatica. Initial radiological evaluation revealed an incidental finding of a L4 butterfly vertebra in the anteroposterior and lateral view radiographs. The patient presented with no neurological deficit. This rare congenital anomaly is usually asymptomatic, and awareness of its non-traumatic nature is critical in order to establish a correct diagnosis. Further evaluation of the patient is necessary to exclude pathologic fracture, infection, or associated vertebral anomalies and syndromes, such as Alagille, Jarcho-Levin, Crouzon, and Pfeiffer syndromes. Furthermore, in the emergency setting, awareness of this entity is needed so that a correct diagnosis can be established. PMID:26330967
Erlacher-Reid, Claire D; Nollens, Hendrik H; Schmitt, Todd L; St Leger, Judy; Sunico, Sarena
A female, captive bred, juvenile swell shark ( Cephaloscyllium ventriosum ) was observed swimming in tight circles and rolling. Radiographs and computed tomography of this individual revealed extensive cartilage mineralization of the skull and cranial cervical vertebrae compared with diagnostic images of clinically healthy conspecifics. Gross necropsy and histopathologic examination revealed ossification and fibrosis of the cartilaginous matrix of the skull and cervical vertebrae with deep invasion by a pigmented hyphal fungus. There was no growth on fungal culture, but fungal polymerase chain reaction identified a DNA sequence compatible with Exophiala sp. (99%). Radiographs and computed tomography were helpful to determine a prognosis and course of action for this individual. This case emphasizes the need to include fungal infections as a differential diagnosis when evaluating elasmobranchs with abnormal swimming behaviors and mineralization of the skeletal structures.
Skutschas, Pavel P; Baleeva, Nataly V
The development of spinal cord supports (bony thickenings which extend into the vertebral canal of vertebrae) in primitive (Salamandrella keyserlingii) and derived (Lissotriton vulgaris) salamanders were described. The spinal cord supports develop as the protuberances of periostal bone of the neural arches in the anteroproximal part of the septal collagenous fibers which connect a transverse myoseptum with the notochord and spinal cord, in the septal bundle inside the vertebral canal. Spinal cord supports were also found in some teleostean (Salmo salar, Oncorhynchus mykiss) and dipnoan (Protopterus sp.) fishes. The absence of the spinal cord supports in vertebrates with cartilaginous vertebrae (lampreys, chondrichthyan, and chondrostean fishes) corresponds to the fact that the spinal cord supports are bone structures. The absence of the spinal cord supports in frogs correlates with the lack of the well developed septal bundles inside the vertebral canal. The spinal cord supports are, presumably, a synapomorphic character for salamanders which originated independently of those observed in teleostean and dipnoan fishes.
Ryabykh, S. О.; Gubin, A. V.; Prudnikova, О. G.; Kobyzev, А. Е.
We report staged treatment of severe combined spinal deformity in an 11-year-old patient with Ollier disease and abnormal cervical vertebra. Combined scoliosis with systemic pathology and abnormal vertebrae is a rare condition and features atypical deformity location and rapid progression rate and frequently involves the rib cage and pelvis, disturbing the function of chest organs and skeleton. Progressive deformity resulted in cachexia and acute respiratory failure. A halo-pelvic distraction device assembled of Ilizarov components was employed for a staged surgical treatment performed for lifesaving indications. After vital functions stabilized, the scoliosis curve of the cervical spine was corrected and fixed with a hybrid system of transpedicular supporting points, connecting rods, and connectors that provided staged distraction during growth. The treatment showed good functional and cosmetic result. PMID:24436859
Ugburo, Andrew O; Olajide, Thomas O; Fadeyibi, Idowu O; Mofikoya, Bolaji O; Lawal, Abdulrazzaq O; Osinowo, Adedapo O
Giant fibroadenoma (GFA) may present with breast asymmetry and can be excised with an inframammary incision (IFI) or reduction mammoplasty incision (RMI). This study investigated the clinical presentation and compared excision with the IFI and RMI. All patients with benign breast tumours greater than 5 cm underwent core needle biopsy and a histopathological diagnosis. All confirmed GFA had their clinical details documented and randomised into two groups for excision with an IFI or RMI. Twenty-two patients were studied. The age range was 12-46 years, mean 21.18 ± 2.22 years. The patients were divided into two groups: a juvenile group (n = 16) (73%) aged 12-18 years, mean age 14.06 ± 0.42 years, and a perimenopausal group (n = 5) aged 28-46 years. The juvenile group showed cyclic increases in breast size monthly with menstruation while the perimenopausal showed an initial slow growth of 6-24 months followed by a rapid growth. Fifteen patients (68%) had excision biopsy with IMI and seven patients with RMI. Seven of the patients treated with IFI had minimal preoperative asymmetry and satisfactory aesthetic outcome. Among the patients with severe preoperative asymmetry treated with IFI (n = 8) and RMI (n = 7), those treated with IFI had persistent postoperative skin redundancy and asymmetry, which was not found in those treated with RMI. In conclusion, for patients with significant asymmetry, excision with the IFI was associated with persistent asymmetry while excision with RMI was associated with restoration of symmetry.
Yeni, Yener N; Poisson, Laila M; Flynn, Michael J
There is increasing interest in using the heterogeneity of tissue properties in a bone for predicting its fracture risk. Heterogeneity of volumetric bone mineral density (BMD) as measured from quantitative computed tomography (QCT) is of particular interest as these measurements are clinically feasible. Previous examinations of the relationship between the BMD heterogeneity and the mechanical behavior of human vertebrae only considered quasistatic strength and were with limited number of samples. McCubbrey et al. (1995) studied the value of regional BMDs for predicting vertebral fatigue life, determined from short-cycle tests at force levels scaled with the estimated strength of the vertebra, but the focus of that work was in best predictor subsets without a specific focus on the heterogeneity of BMD or the positive vs negative direction of the relationships. The previous analysis also did not take into account the censored nature of the fatigue life data. As such, whether BMD heterogeneity is positively or negatively associated with fatigue life and whether this is independent of the average or minimum BMD are not clear. In the present work, we revisited the McCubbrey data for a preliminary examination of the relationship between BMD heterogeneity and fatigue life using survival analysis. The analysis suggests that BMD heterogeneity measured as the intra-vertebral standard deviation of BMDs in a vertebra is negatively associated with short cycle (high-amplitude) fatigue life independent of the average BMD. The results motivate further studies on the role of BMD heterogeneity in fatigue failure and clinical fracture risk of human vertebrae.
Li, Xiaohe; En, He; Zhang, Yunfeng; Gao, Shang; Li, Guimin; Guo, Yu; Wang, Xin; Wang, Haiyan; Cai, Yongqiang; Wang, Zhiqiang; Li, Zhijun; Li, Cunbao; Zhao, Feifei
Background The key to its successful application is to determine the best entry point for the vertebral screw(s). This study aimed to provide a reference for clinical anterolateral fixation through digital measurement of computed tomography (CT) data to identify relevant anatomical positions in the middle and lower thoracic vertebrae (T4–T12) of 30 adults. Material/Methods We performed digital measurement of anatomical positions in the middle and lower thoracic vertebrae (T4–T12) of 30 adults. Abbreviations: Left height of vertebral body, LHV; Right height of vertebral body, RHV; Anterior height of vertebral body, AHV; Middle height of vertebral body, MHV; Posterior height of vertebral body, PHV; Superior sagittal diameter of vertebral body, SSDV; Superior transverse diameter of vertebral body, STDV; inferior sagittal diameter of vertebral body, ISDV; Inferior transverse diameter of vertebral body, ITDV; (1) Left (right) height of vertebral body, [L(R)HV]; Anterior (middle, posterior) height of vertebral body [A(M,P)HV]; Superior (inferior) sagittal diameter of vertebral body, [S(I)SDV]; Superior (inferior) transverse diameter of vertebral body, [S(I)TDV]. Results The transverse diameters of vertebral bodies were always larger than the sagittal diameter for 3~4 mm. The distance between 2 vertebrae (interval of 1 vertebra) range were (52–56) mm for T4–T7 and (44–48) mm for T8–T12, and the surgeons could collate these data to choose a suitable stick length. Conclusions Bone graft should prune into laterigrade cuboid, it can recover A-P and bilateral physiological functions load, and the height of the vertebral body increased from T4 to T12. PMID:27997524
CASTELLANA, C.; KÓSA, F.
The gross anatomical features of human cervical vertebrae during the fetal-neonatal period were investigated in order to develop morphological standards for the individual ossification centres for use in forensic and anthropological osteology. It was found that the morphology of the cervical vertebral arches and the centra cannot be used for the determination of fetal age although the dens of the axis displays some developmental differences which may be useful for the determination of fetal maturity. PMID:10227677
Archer, Rebecca; Sissener, Thomas; Connery, Neil; Spotswood, Tim
A 10-year-old cocker spaniel bitch presented with severe lumbosacral pain and acute onset left pelvic limb lameness. A diagnosis of asymmetric lumbosacral transitional vertebra with disc protrusion at L6-L7 was made by computed tomography. The cauda equina and left L6 nerve root were surgically decompressed with a dorsal laminectomy and lateral foraminotomy, which led to rapid resolution of the clinical signs.
Kuta, Anna; Mao, Yaopan; Martin, Tina; Ferreira de Sousa, Catia; Whiting, Danielle; Zakaria, Sana; Crespo-Enriquez, Ivan; Evans, Philippa; Balczerski, Bartosz; Mankoo, Baljinder; Irvine, Kenneth D.
The protocadherins Fat4 and Dchs1 act as a receptor-ligand pair to regulate many developmental processes in mice and humans, including development of the vertebrae. Based on conservation of function between Drosophila and mammals, Fat4-Dchs1 signalling has been proposed to regulate planar cell polarity (PCP) and activity of the Hippo effectors Yap and Taz, which regulate cell proliferation, survival and differentiation. There is strong evidence for Fat regulation of PCP in mammals but the link with the Hippo pathway is unclear. In Fat4−/− and Dchs1−/− mice, many vertebrae are split along the midline and fused across the anterior-posterior axis, suggesting that these defects might arise due to altered cell polarity and/or changes in cell proliferation/differentiation. We show that the somite and sclerotome are specified appropriately, the transcriptional network that drives early chondrogenesis is intact, and that cell polarity within the sclerotome is unperturbed. We find that the key defect in Fat4 and Dchs1 mutant mice is decreased proliferation in the early sclerotome. This results in fewer chondrogenic cells within the developing vertebral body, which fail to condense appropriately along the midline. Analysis of Fat4;Yap and Fat4;Taz double mutants, and expression of their transcriptional target Ctgf, indicates that Fat4-Dchs1 regulates vertebral development independently of Yap and Taz. Thus, we have identified a new pathway crucial for the development of the vertebrae and our data indicate that novel mechanisms of Fat4-Dchs1 signalling have evolved to control cell proliferation within the developing vertebrae. PMID:27381226
Teplick, J.G.; Haskin, M.E.
In the postoperative patient ordinary radiographs of the spine generally add very little information, revealing the usual postoperative bone changes and often postoperative narrowing of the intervertebral space. Myelography may sometimes be informative, showing evidence of focal arachnoiditis or a focal defect at the surgical site. However, the latter finding is difficult to interpret. As experience with high-resolution CT scanning of the lumbar spine has been increasing, it is becoming apparent that this noninvasive and easily performed study can give considerably more information about the postoperative spine than any of the other current imaging methods. About 750 patients with previous lumbar laminectomies had CT scanning within a 28 month period.
Zylbersztejn, Sérgio; Spinelli, Leandro de Freitas; Rodrigues, Nilson Rodinei; Werlang, Pablo Mariotti; Kisaki, Yorito; Rios, Aldemar Roberto Mieres; Bello, Cesar Dall
This paper presents an update on degenerative stenosis of the lumbar spine, which is a common pathological condition among patients over the age of 65 years. The anamnesis and physical examination need to be precise, since radiography often only provides indirect signs. Magnetic resonance imaging is necessary if the symptoms persist. The treatment for lumbar stenosis is a matter of controversy. However, there seems to be some benefit from surgical treatment rather than conservative treatment, such that surgery brings improvements in symptoms and functions for a period of up to two years. PMID:27042635
Gandhoke, Gurpreet S; Ricks, Christian; Tempel, Zachary; Zuckerbraun, Brian; Hamilton, D Kojo; Okonkwo, David O; Kanter, Adam S
In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure. The video can be found here: https://youtu.be/r3bC4_vu1hQ .
Kelly, Marie; Jacobs, Dee; Wooten, Mary E.; Edeer, Ayse Ozcan
[Purpose] The purposes of this study were: 1) describe a hierarchy of electromyographic activity production, using percentage maximum voluntary contraction of lumbar iliocostalis and lumbar multifidus muscles during prone, quadruped and sitting exercises; and 2) identify optimal recruitment exercises for both lumbar iliocostalis as a global multi-segmental stabilizer and lumbar multifidus as a segmental stabilizer. [Subjects] Twelve healthy volunteers (six male and six female) aged 24 to 45 participated. [Methods] Surface electromyographic activity data were collected bilaterally from lumbar iliocostalis and lumbar multifidus muscles during exercises. [Results] Two-way ANOVA showed that prone extension, and prone alternate arm and leg lifting exercises produce a statistically significant difference in percent maximum voluntary contraction of lumbar iliocostalis and lumbar multifidus bilaterally compared to other exercises. Quadruped alternate arm and leg lifting exercises produce greater activity in lumbar multifidus muscle than sitting exercises [Conclusion] Prone exercises generate the greatest electromyographic activity and may be the most effective exercises for strengthening both lumbar iliocostalis and lumbar multifidus muscles. Quadruped alternate arm and leg lifting produces electromyographic activity at the recommended percent maximum voluntary contraction for training the lumbar multifidus in its role as a segmental stabilizer and is an effective training exercise for this goal. PMID:27821968
Kibii, Job M; Pan, Rualing; Tobias, Phillip V
The 7th cervical vertebrae of 240 cadavers of South African Zulu, White, and Colored population groups were examined to determine morphometric variation. White and Colored females had statistically significant narrower cervical anteroposterior diameters than their male counterparts, whereas no statistically significant difference between sexes of the Zulu population group was observed in this variable. In addition, although Zulu and Colored females had statistically significant narrower cervical transverse diameters than their male counterparts, there was no statistically significant variation between South African white males and females in this respect. The findings indicate that sexual dimorphism is more apparent in the vertebral centrum, across the three population groups, where males had significantly larger dimensions in centrum anteroposterior diameter, height, and width than their female counterparts. The study further reveals that sexual dimorphism is more apparent when one compares aspects of the 7th cervical vertebra between sexes within the same population group. Overall, the dimensions of the various variates of the vertebra are substantially smaller in women than in men. The smaller dimensions, particularly of the centrum, may be the result of lower skeletal mass in women and render them more vulnerable to fractures resulting from compression forces.
Kaneta, Tomohiro; Ogawa, Matsuyoshi; Daisaki, Hiromitsu; Nawata, Shintaro; Yoshida, Keisuke; Inoue, Tomio
The purpose of this study is to perform quantitative measurement based on the standardized uptake value (SUV) of the uptake of Tc-99m methylene diphosphonate (MDP) in the normal vertebrae using a single photon emission tomography (SPECT)/computed tomography (CT) scanner. A retrospective study of patients with cancer or joint disorders was performed. We acquired data for a group of 29 patients (8 women and 21 men; mean age, 68.2 ± 6.7 years; age range, 44-87 years) undergoing bone SPECT/CT scans with Tc-99m MDP between September and October 2015. Various SUVs were calculated based on body-weight, lean-body-weight (lbw), Japanese lean-body-weight (jlbw) and Japanese bone-mineral-content (jbmc). SUVs of normal vertebrae showed a wide range of values. Among these, the maximum body-weight based SUV showed the lowest coefficient of variation. The SUVs also showed relatively small intra-subject variability. In addition, all SUVs showed moderate and significant correlation with height. Moreover, lbw-, jlbw-, and jbmc-based SUVs of men were significantly higher than those of women. In conclusions, SUVs of normal vertebrae showed a relatively large inter-individual variability and small intra-individual variability. As a quantitative imaging biomarker, SUVs might require standardization with adequate reference data for the same subject to minimize variability. PMID:27766184
Alba, David M; Colombero, Simone; Delfino, Massimo; Martínez-Navarro, Bienvenido; Pavia, Marco; Rook, Lorenzo
The past geographic distribution of the genus Theropithecus (Primates: Cercopithecidae) is mainly restricted to Africa. Outside that continent, the earliest reported records of this genus consist of a calcaneus of cf. Theropithecus sp. from 'Ubeidiya (Israel, 1.6-1.2 Ma [millions of years ago]), as well as three associated cervical vertebrae from Pirro Nord (Italy, 1.7-1.3 Ma) attributed to Theropithecus sp. The attribution of the Pirro Nord vertebrae to this genus has been disputed on morphometric grounds, although their assignment to a large-bodied cercopithecid has remained undisputed. Here we report unpublished cervical vertebral specimens with a similar morphology and, given their significance for the paleobiogeography of Theropithecus (purportedly representing its earliest European record), we re-evaluate their taxonomic attribution. In particular, we reconsider the possibility that they belong to another non-primate mammal recorded at this site. Based on both qualitative and metric morphological comparisons, we strongly favor an alternative attribution of the cervical vertebrae from Pirro Nord to the large porcupine Hystrix refossa, which is widely documented at the site by both dentognathic and other postcranial remains. We therefore conclude that the dispersal of Theropithecus out of Africa before ca. 1 Ma (when it is recorded by dental remains from Cueva Victoria, Spain) is currently based only on the calcaneus from 'Ubeidiya tentatively attributed to this genus.
Huber, Daniel R; Neveu, Danielle E; Stinson, Charlotte M; Anderson, Paul A; Berzins, Ilze K
Approximately 35% of sand tiger sharks (Carcharias taurus) in public aquaria exhibit spinal deformities ranging from compressed vertebrae and loss of intervertebral space to dislocated spines with vertebral degeneration and massive spondylosis caused by excessive mineralization both within vertebrae and outside the notochordal sheath. To identify the mechanical basis of these deformities, vertebral centra from affected (N=12) and non-affected (N=9) C. taurus were subjected to axial compression tests on an MTS 858 Bionix material testing system, after which mineral content was determined. Vertebral centra from affected sharks had significantly lower mineral content and material behavior in nearly all variables characterizing elasticity, plasticity and failure. These mechanical deficiencies are correlated with size at capture, capture method, vitamin C and zinc deficiency, aquarium size and swimming behavior in public aquaria. Non-affected C. taurus had greater stiffness and toughness even though these properties are generally incompatible in mineralized structures, suggesting that the biphasic (mineralized, unmineralized phases) nature of chondrichthyan vertebrae yields material behavior not otherwise observed in vertebrate skeletons. However, vertebral centra from non-affected sharks had lower mineral content (33%), stiffness (167 MPa), yield strain (14%) and ultimate strength (16 MPa) than other species of sharks and bony vertebrates, indicating that biomechanical precautions must be taken in the husbandry of this species.
Tan, Sovira; Yao, Jianhua; Ward, Michael M.; Yao, Lawrence; Summers, Ronald M.
Ankylosing Spondylitis is a disease of the vertebra where abnormal bone structures (syndesmophytes) grow at intervertebral disk spaces. Because this growth is so slow as to be undetectable on plain radiographs taken over years, it is necessary to resort to computerized techniques to complement qualitative human judgment with precise quantitative measures on 3-D CT images. Very fine segmentation of the vertebral body is required to capture the small structures caused by the pathology. We propose a segmentation algorithm based on a cascade of three level set stages and requiring no training or prior knowledge. First, the noise inside the vertebral body that often blocks the proper evolution of level set surfaces is attenuated by a sigmoid function whose parameters are determined automatically. The 1st level set (geodesic active contour) is designed to roughly segment the interior of the vertebra despite often highly inhomogeneous and even discontinuous boundaries. The result is used as an initial contour for the 2nd level set (Laplacian level set) that closely captures the inner boundary of the cortical bone. The last level set (reversed Laplacian level set) segments the outer boundary of the cortical bone and also corrects small flaws of the previous stage. We carried out extensive tests on 30 vertebrae (5 from each of 6 patients). Two medical experts scored the results at intervertebral disk spaces focusing on end plates and syndesmophytes. Only two minor segmentation errors at vertebral end plates were reported and two syndesmophytes were considered slightly under-segmented.
Wood, Margaret M.; Gardner, Jeffrey F.
Bacteroides species are one of the most prevalent groups of bacteria present in the human colon. Many strains carry large, integrated elements including integrative and conjugative elements (ICEs). One such ICE is CTnDOT, which is 65 kb in size and encodes resistances to tetracycline and erythromycin. CTnDOT has been increasing in prevalence in Bacteroides spp., and is now found in greater than 80% of natural isolates. In recent years, CTnDOT has been implicated in the spread of antibiotic resistance among gut microbiota. Interestingly, the excision and transfer of CTnDOT is stimulated in the presence of tetracycline. The tyrosine recombinase IntDOT catalyzes the integration and excision reactions of CTnDOT. Unlike the well-characterized lambda Int, IntDOT tolerates heterology in the overlap region between the sites of cleavage and strand exchange. IntDOT also appears to have a different arrangement of active site catalytic residues. It is missing one of the arginine residues that is conserved in other tyrosine recombinases. The excision reaction of CTnDOT is complex, involving excision proteins Xis2c, Xis2d, and Exc, as well as IntDOT and a Bacteroides host factor. Xis2c and Xis2d are small, basic proteins like other recombination directionality factors (RDFs). Exc is a topoisomerase; however, the topoisomerase function is not required for the excision reaction. Exc has been shown to stimulate excision frequencies when there are mismatches in the overlap regions, suggesting that it may play a role in resolving Holliday junctions containing heterology. Work is currently under way to elucidate the complex interactions involved with the formation of the CTnDOT excisive intasomes. PMID:26104696
Zeng, Zhenshun; Liu, Xiaoxiao; Yao, Jianyun; Guo, Yunxue; Li, Baiyuan; Li, Yangmei; Jiao, Nianzhi; Wang, Xiaoxue
Among the environmental stresses experienced by bacteria, temperature shifts are one of the most important. In this study, we discovered a novel cold adaptation mechanism in Shewanella oneidensis that occurs at the DNA level and is regulated by cryptic prophage excision. Previous studies on bacterial cold tolerance mainly focus on the structural change of cell membrane and changes at the RNA and protein levels. Whether or not genomic change can also contribute to this process has not been explored. Here we employed a whole-genome deep-sequencing method to probe the changes at DNA level in a model psychrotrophic bacteria strain. We found that temperature downshift induced a 10 000-fold increase of the excision of a novel P4-like cryptic prophage. Importantly, although prophage excision only occurred in a relatively small population of bacteria, it was able to facilitate biofilm formation and promote the survival of the entire population. This prophage excision affected cell physiology by disrupting a critical gene encoding transfer-messenger RNA (tmRNA). In addition, we found that the histone-like nucleoid-structuring protein (H-NS) could silence prophage excision via binding to the promoter of the putative excisionase gene at warm temperatures. H-NS level was reduced at cold temperatures, leading to de-repression of prophage excision. Collectively, our results reveal that cryptic prophage excision acts as a regulatory switch to enable the survival of the host at low temperature by controlling the activity of tmRNA and biofilm formation.
Case series Patient: — Final Diagnosis: Routine use of hemocoagulase for injection for the prevention of late-onset bleeding is not recommended for patients who have undergone excision of colon polyps. Hemocoagulase following excision of colon polyps can cause hypofibrinogenemia and even l Symptoms: Hematochezia Medication: — Clinical Procedure: Three patients also had lower gastrointestinal bleeding Specialty: Gastroenterology and Hepatology Objective: Unusual or unexpected effect of treatment Background: In patients with large colon polyps, late-onset bleeding may be more likely to occur because of the larger cutting surface. In these patients, hemostatic agents may be applied to prevent the late-onset bleeding. A total of 7 patients developed hypofibrinogenemia caused by hemocoagulase following excision of colon polyps in our center from November to December 2015. Case Report: Seven patients underwent excision of colon polyps in our center from November to December 2015. The cutting face was large in these patients after surgery; therefore, hemocoagulase was used to prevent potential late-onset bleeding. Evaluation of clotting function showed that the fibrinogen level was normal before surgery in all 7 patients. Hemocoagulase was intravenously administered twice daily beginning from postoperative day 1. Hypofibrinogenemia of varying severity occurred 2–4 d later. Three patients also had lower-gastrointestinal bleeding. After drug withdrawal and infusion of fibrinogen, blood fibrinogen level gradually returned to normal. In contrast, among 13 patients who had not received hemocoagulase treatment for preventing hemorrhage following excision of colon polyps, detection of blood fibrinogen before surgery and 2–4 d after showed normal results. Conclusions: Routine use of Hemocoagulase For Injection for the prevention of late-onset bleeding is not recommended for patients who have undergone excision of colon polyps. Hemocoagulase following excision of colon
Zeng, Zhenshun; Liu, Xiaoxiao; Yao, Jianyun; Guo, Yunxue; Li, Baiyuan; Li, Yangmei; Jiao, Nianzhi; Wang, Xiaoxue
Among the environmental stresses experienced by bacteria, temperature shifts are one of the most important. In this study, we discovered a novel cold adaptation mechanism in Shewanella oneidensis that occurs at the DNA level and is regulated by cryptic prophage excision. Previous studies on bacterial cold tolerance mainly focus on the structural change of cell membrane and changes at the RNA and protein levels. Whether or not genomic change can also contribute to this process has not been explored. Here we employed a whole-genome deep-sequencing method to probe the changes at DNA level in a model psychrotrophic bacteria strain. We found that temperature downshift induced a 10 000-fold increase of the excision of a novel P4-like cryptic prophage. Importantly, although prophage excision only occurred in a relatively small population of bacteria, it was able to facilitate biofilm formation and promote the survival of the entire population. This prophage excision affected cell physiology by disrupting a critical gene encoding transfer-messenger RNA (tmRNA). In addition, we found that the histone-like nucleoid-structuring protein (H-NS) could silence prophage excision via binding to the promoter of the putative excisionase gene at warm temperatures. H-NS level was reduced at cold temperatures, leading to de-repression of prophage excision. Collectively, our results reveal that cryptic prophage excision acts as a regulatory switch to enable the survival of the host at low temperature by controlling the activity of tmRNA and biofilm formation. PMID:27482926
... 29 Labor 3 2010-07-01 2010-07-01 false Excise taxes at the retail level. 779.262 Section 779.262... Coverage Excise Taxes § 779.262 Excise taxes at the retail level. (a) Federal excise taxes are imposed at the retail level on highway vehicle fuels other than gasoline under the provisions of 26 U.S.C....
Korez, Robert; Å tern, Darko; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž
Degenerative changes of the intervertebral disc are among the most common causes of low back pain, where for individuals with significant symptoms surgery may be needed. One of the interventions is the total disc replacement surgery, where the degenerated disc is replaced by an artificial implant. For designing implants with good bone contact and continuous force distribution, the morphology of the intervertebral disc space and vertebral body endplates is of considerable importance. In this study we propose a method for the determination of the intervertebral disc space from three-dimensional (3D) computed tomography (CT) images of the lumbar spine. The first step of the proposed method is the construction of a model of vertebral bodies in the lumbar spine. For this purpose, a chain of five elliptical cylinders is initialized in the 3D image and then deformed to resemble vertebral bodies by introducing 25 shape parameters. The parameters are obtained by aligning the chain to the vertebral bodies in the CT image according to image intensity and appearance information. The determination of the intervertebral disc space is finally achieved by finding the planes that fit the endplates of the obtained parametric 3D models, and placing points in the space between the planes of adjacent vertebrae that enable surface reconstruction of the intervertebral disc space. The morphometric analysis of images from 20 subjects yielded 11:3 +/- 2:6, 12:1 +/- 2:4, 12:8 +/- 2:0 and 12:9 +/- 2:7 cm3 in terms of L1-L2, L2-L3, L3-L4 and L4-L5 intervertebral disc space volume, respectively.
An, Ji Won; Koh, Jae Chul; Sun, Jong Min; Park, Ju Yeon; Choi, Jong Bum; Shin, Myung Ju
Background The location and the number of lumbar sympathetic ganglia (LSG) vary between individuals. The aim of this study was to determine the appropriate level for a lumbar sympathetic ganglion block (LSGB), corresponding to the level at which the LSG principally aggregate. Methods Seventy-four consecutive subjects, including 31 women and 31 men, underwent LSGB either on the left (n = 31) or the right side (n = 43). The primary site of needle entry was randomly selected at the L3 or L4 vertebra. A total of less than 1 ml of radio opaque dye with 4% lidocaine was injected, taking caution not to traverse beyond the level of one vertebral body. The procedure was considered responsive when the skin temperature increased by more than 1℃ within 5 minutes. Results The median responsive level was significantly different between the left (lower third of the L4 body) and right (lower margin of the L3 body) sides (P = 0.021). However, there was no significant difference in the values between men and women. The overall median responsive level was the upper third of the L4 body. The mean responsive level did not correlate with height or BMI. There were no complications on short-term follow-up. Conclusions Selection of the primary target in the left lower third of the L4 vertebral body and the right lower margin of the L3 vertebral body may reduce the number of needle insertions and the volume of agents used in conventional or neurolytic LSGB and radiofrequency thermocoagulation. PMID:27103965
Datana, Sanjeev; Kumar, Prasanna; Kumar Roy, Supriya; Londhe, Sanjay
ABSTRACT% Purpose: The patients with cleft lip and palate have a higher risk of cervical vertebrae anomalies than do patients in general population. The aim of present study was to determine the prevalence of various upper cervical spine anomalies in different type of clefts. Procedures: Lateral cephalograms of 128 patients (66 males, 62 females) with cleft lip and palate, and 125 (60 males, 65 females) non syndromic patients without cleft lip and palate were selected at random from archive. Cephalograms of the patients were traced and the diagnosis of any cervical vertebrae anomaly was noted. Anomalies were categorized as either: posterior arch deficiency or fusions. Main findings: Prevalence of cervical vertebrae anomalies in the c lef t group was 20. 3% while it was 6.4% in the control group. Further cervical vertebrae anomalies were 16.6% in the CPO group, 19.1% in the BCLP group, and 22.2% in the UCLP group. Conclusion: A higher prevalence of cervical vertebrae anomalies was observed in cleft lip and palate patients. The prevalenc e obser ved is 3 times more in clef t group than c ontrol group. How to cite this article: Datana S, Bhalla A, Kumar P, Roy SK, Londhe S. Comparative Evaluation of Prevalence of Upper Cervical Vertebrae Anomalies in Cleft Lip/Palate Patients: A Retrospective Study. Int J Clin Pediatr Dent 2014;7(3):168-171. PMID:25709295
Jeon, Yongmoon; Kim, Daehyung; Martín-López, Juana V; Lee, Ryanggeun; Oh, Jungsic; Hanne, Jeungphill; Fishel, Richard; Lee, Jong-Bong
Mismatch repair (MMR) is activated by evolutionarily conserved MutS homologs (MSH) and MutL homologs (MLH/PMS). MSH recognizes mismatched nucleotides and form extremely stable sliding clamps that may be bound by MLH/PMS to ultimately authorize strand-specific excision starting at a distant 3'- or 5'-DNA scission. The mechanical processes associated with a complete MMR reaction remain enigmatic. The purified human (Homo sapien or Hs) 5'-MMR excision reaction requires the HsMSH2-HsMSH6 heterodimer, the 5' → 3' exonuclease HsEXOI, and the single-stranded binding heterotrimer HsRPA. The HsMLH1-HsPMS2 heterodimer substantially influences 5'-MMR excision in cell extracts but is not required in the purified system. Using real-time single-molecule imaging, we show that HsRPA or Escherichia coli EcSSB restricts HsEXOI excision activity on nicked or gapped DNA. HsMSH2-HsMSH6 activates HsEXOI by overcoming HsRPA/EcSSB inhibition and exploits multiple dynamic sliding clamps to increase tract length. Conversely, HsMLH1-HsPMS2 regulates tract length by controlling the number of excision complexes, providing a link to 5' MMR.
McLucas, B; McGill, J
Clear margins are critical to the identification of complete excision of premalignant lesions on the cervix. Large loop excision of the transformation zone aids the pathologic evaluation of the excised specimen while it causes minimal thermal damage. Prior studies of loop excision were performed with a cutting current blended with a coagulating waveform to aid hemostasis. Blended current has higher voltage, which may cause tissue to stick to the electrode and produce thermal damage to the cervix. In this series, pure cutting current was used to excise the cervical transformation zone in 20 patients. The depth of thermal damage was studied in 6 patients; the average endocervical zone of damage was 0.47 mm and that of the exocervical zone, 0.43 mm. The base of the cervix could be examined with the colposcope for the presence of glands. None of our procedures was complicated by intraoperative or delayed bleeding. The preoperative injection of a vasoconstrictor into the cervical stroma is thought to aid the surgery by its hemostatic properties.
TAKAHASHI, Toshiyuki; HANAKITA, Junya; OHTAKE, Yasufumi; FUNAKOSHI, Yusuke; OICHI, Yuki; KAWAOKA, Taigo; WATANABE, Mizuki
Instrumented lumbar fusion can provide immediate stability and assist in satisfactory arthrodesis in patients who have pain or instability of the lumbar spine. Lumbar adjunctive fusion with decompression is often a good procedure for surgical management of degenerative spondylolisthesis (DS). Among various lumbar fusion techniques, lumbar interbody fusion (LIF) has an advantage in that it maintains favorable lumbar alignment and provides successful fusion with the added effect of indirect decompression. This technique has been widely used and represents an advancement in spinal instrumentation, although the rationale and optimal type of LIF for DS remains controversial. We evaluated the current status and role of LIF in DS treatment, mainly as a means to augment instrumentation. We addressed the basic concept of LIF, its indications, and various types including minimally invasive techniques. It also has acceptable biomechanical features, and offers reconstruction with ideal lumbar alignment. Postsurgical adverse events related to each LIF technique are also addressed. PMID:27169496
Beguiristain, J L; Arriola, F J; Leyes, M
We report a case of pycnodysostosis in which several clefts in the laminas, interarticular parts, and pedicles of the whole lumbar spine were revealed for the first time on CT. We review similar findings in the literature, and discuss their pathogenesis.
Pappalardo, S; Cassarino, A; Braidotti, P
Arachnoid cysts are a rare cause of compression of the contents of the lumbar spinal canal; in the literature only about 100 cases are reported. The various methods of diagnosis are discussed in the light of a recent case observed by the authors.
García, Elena; Sánchez, Raquel; Martínez, Guillermo; Bernal, Carmen; Calatayud, M; Partida, M; Hawkins, Federico
Many problems may arise when defining whether adrenal lesions are primary to the adrenal glands or represent other tissue, whether they are benign or malignant and whether they are functioning or nonfunctioning. Adrenal imaging complements the clinical and hormonal evaluation of these patients. We present a patient with lumbar pain and bilateral adrenal masses.
Campbell, J Q; Coombs, D J; Rao, M; Rullkoetter, P J; Petrella, A J
The purpose of this study was to seek broad verification and validation of human lumbar spine finite element models created using a previously published automated algorithm. The automated algorithm takes segmented CT scans of lumbar vertebrae, automatically identifies important landmarks and contact surfaces, and creates a finite element model. Mesh convergence was evaluated by examining changes in key output variables in response to mesh density. Semi-direct validation was performed by comparing experimental results for a single specimen to the automated finite element model results for that specimen with calibrated material properties from a prior study. Indirect validation was based on a comparison of results from automated finite element models of 18 individual specimens, all using one set of generalized material properties, to a range of data from the literature. A total of 216 simulations were run and compared to 186 experimental data ranges in all six primary bending modes up to 7.8Nm with follower loads up to 1000N. Mesh convergence results showed less than a 5% difference in key variables when the original mesh density was doubled. The semi-direct validation results showed that the automated method produced results comparable to manual finite element modeling methods. The indirect validation results showed a wide range of outcomes due to variations in the geometry alone. The studies showed that the automated models can be used to reliably evaluate lumbar spine biomechanics, specifically within our intended context of use: in pure bending modes, under relatively low non-injurious simulated in vivo loads, to predict torque rotation response, disc pressures, and facet forces.
Gagnon, Dany H; Longtin, Christian; Berbiche, Djamal; Gaudreault, Nathaly
This study aims to quantify the force applied during posterior-to-anterior lumbar vertebrae mobilizations of different grades (I to IV) and compare that force between experienced physiotherapists and final year physiotherapy students. Four experienced physiotherapists and four final year physiotherapy students participated in this study along with five healthy asymptomatic individuals. A manual therapy table positioned over three force plates allowed for measurements of the force oscillation frequency and intensity applied during grade I, II, III and IV posterior-to-anterior (PA) mobilizations at two lumbar vertebral levels (L2 and L4). Mixed model ANOVAs were used to compare the force applied between the experienced physiotherapists and students, and between the various grades. The results showed that the mean oscillation frequency was similar between the groups for all grades. Grade I and grade IV PA mobilizations showed similar mean oscillation frequency as did grade II and III PA mobilizations. The minimum and maximum force applied was higher for the physiotherapists than for the students for all mobilization grades (p values < 0.05). Similar mean maximum force values were recorded for PA mobilizations between grade I and II and between grade III and grade IV. Grade III and IV PA mobilizations yielded higher mean maximum force values than those recorded during grade I and grade II PA mobilizations. The method used in this study allowed for quantification of the force applied during lumbar PA mobilizations. Experienced physiotherapists apply greater force than physiotherapy students across all grades, despite similar oscillation frequency.
Sheshaberidze, E; Merabishvili, I; Loria, M
The goal of the paper is to substantiate the essence of ridetherapy biomechanics as the pathogenetic therapeutic and prophylactic method at lumbar dysplastic (the I and II degrees) and static (short-legged induced) scoliosis. Uneven lower extremities caused by any reason and asymmetric support induce the change in the arrangement of trochantin to the vertebra and correspondingly the uneven loading of lumbar muscles. The asymmetric strength of lumbar muscles evoked by the change in rotator condition becomes the cause of the formation of scoliosis primary arc which, in its turn, causes a compensatory spinal curvature. In case of dysplastic scoliosis a leading role belongs to the beginning of dystrophic changes in intervertebral discs and its further decentration. At riding position the lower extremities are completely disengaged from the antigravity redistribution, the child is in direct contact with vibrations and jolts coming from the horseback; the antigravity loading is distributed on the muscles of the torso and thus, it creates an opportunity to purposefully affect the correction of the spine. During scoliosis the pathogenic essence of ridetherapy is due to the comprehensiveness of its procedures, expressed in the fact that during one procedure several factors are influenced simultaneously: nucleus pulpous, the torso and iliopsoas muscles, the antigravity system, etc. According to the clinical-functional and radiographic studies carried out in the dynamics on 11-16 years old adolescents it has been established that in those groups where the rehabilitation was conducted in a complex with ridetherapy the authentically higher results were obtained as compared to the groups where the rehabilitation was held using therapeutic exercises and massage.
Gupta, Ridhima; Bozzay, Joseph D.; Williams, David L.; DePond, Robert T.; Gantt, Pickens A.
Background. A transverse vaginal septum (TVS) is a rare obstructing anomaly, caused due to improper fusion of Müllerian ducts and urogenital sinus during embryogenesis. Case. A 15-year-old girl presented with primary amenorrhea. She had multiple congenital anomalies. Initial examination and imaging investigation revealed the presence of a unicornuate uterus and a TVS. The TVS was excised; however the patient was unable to perform vaginal dilation postoperatively leading to recurrent stricture formation. She underwent multiple surgeries for excision of the stricture. The patient was eventually evaluated every day in the clinic until she was able to demonstrate successful vaginal dilatation in the presence of a clinician. Summary and Conclusion. Properly guided regular and intensive vaginal dilation after TVS excision may decrease the need of reoperations due to recurrent stricture formation. PMID:26078895
Yang, Yue; Xu, Huirong; Shang, Zhenhua; Chen, Shouzhen; Chen, Fan; Deng, Qiming; Luo, Li; Zhu, Liang; Shi, Benkang
Objective: A meta-analysis was undertaken to provide an evidence-based basis of clinical trials comparing extralevator abdominoperineal excision with conventional abdominoperineal excision for low rectal tumor. Methods: We searched through the major medical databases such as PubMed, EMBASE, Medline, Science Citation Index, Web of Science for all published studies without any limit on language from January 2009 until January 2015. The following search terms were used: extralevator abdominoperineal excision or cylindrical abdominoperineal resection or conventional abdominoperineal excision or abdominoperineal excision or rectal cancer. Furthermore, Additional related studies were manually searched in the reference lists of all published reviews and retrieved articles. Results: In this meta-analysis, there are a total number of 1797 patients included: 1099 patients in the ELAPE group and 698 in the APE group, and there are not statistically differences between groups in CRM [RR=0.65, 95% CI (0.41, 1.04), P=0.07] and wound complications [RR=1.14, 95% CI (1.09, 1.66), P=0.45] between ELAPE and APE. However, ELAPE has a lower rate of intraoperation perforation [RR=0.44; 95% CI (0.33, 0.60); P<0.00001] and local recurrence [RR=0.45, 95% CI (0.27, 0.77), P=0.003] than APE in terms of short follow-up time. PMID:26628967
Robbins, William J.; Hervey, Annette
Exogenous auxin (α-naphthalene acetic acid, indole acetic acid, or 2,4-dichlorophenoxyacetic acid) was essential for the growth of single excised root tips of Bryophyllum calycinum in 50 ml of a mineral salt-sucrose medium supplemented with vitamins. Large inocula with a dry weight of 2.0 mg or more grew with no auxin added to the medium. Evidence for the synthesis of auxin by the excised roots grown from the larger inocula is presented. Leaching of auxin from single root tips cultivated in 15 or 50 ml of basal medium is considered to account for their failure to grow. Images PMID:16591793
Robbins, W J; Hervey, A
Exogenous auxin (alpha-naphthalene acetic acid, indole acetic acid, or 2,4-dichlorophenoxyacetic acid) was essential for the growth of single excised root tips of Bryophyllum calycinum in 50 ml of a mineral salt-sucrose medium supplemented with vitamins. Large inocula with a dry weight of 2.0 mg or more grew with no auxin added to the medium. Evidence for the synthesis of auxin by the excised roots grown from the larger inocula is presented. Leaching of auxin from single root tips cultivated in 15 or 50 ml of basal medium is considered to account for their failure to grow.
Drager, R G; Hallick, R B
Twintrons are introns-within-introns excised by sequential splicing reactions. A new type of complex twintron comprised of four individual group III introns has been characterized. The external intron is interrupted by an internal intron containing two additional introns. This 434 nt complex twintron within a Euglena gracilis chloroplast ribosomal protein gene is excised by four sequential splicing reactions. Two of the splicing reactions utilize multiple 5'- and/or 3'-splice sites. These findings are evidence that introns with multiple active splice sites can be formed by the repeated insertion of introns into existing introns. Images PMID:7685079
Borsuk, G. M.; Dewitt, R. N.
The theoretical and some experimental results of a study aimed at applying CCD filter and transform techniques to the problem of interference excision within communications channels were presented. Adaptive noise (interference) suppression was achieved by the modification of received signals such that they were orthogonal to the recently measured noise field. CCD techniques were examined to develop real-time noise excision processing. They were recursive filters, circulating filter banks, transversal filter banks, an optical implementation of the chirp Z transform, and a CCD analog FFT.
Goodwin, Brandon; Wagner, Richard F.; Resto, Vicente; Kelly, Brent
Dermatofibrosarcoma protuberans (DFSP) is an unusual spindle cell tumor with a high rate of local recurrence with traditional excision. Fortunately, Mohs micrographic surgery yields excellent cure rates for this neoplasm due to contiguous tumor spread and meticulous tumor mapping and margin analysis. We present the unique case of a patient treated with a modified Mohs technique with an analysis of the final margin with permanent sections, who developed a spindle cell neoplasm in the margins of her second stage excision consistent with nodular fasciitis. Distinguishing residual DFSP from a benign reactive process was an essential and challenging component of this patient's management. PMID:28018683
Berner, Dagmar; Jülke, Henriette; Hohaus, Christian; Brehm, Walter; Gerlach, Kerstin
Sheep are commonly used as a model for human spinal orthopaedic research due to their similarity in morphological and biomechanical features. This study aimed to document the volumes of vertebral bodies and compare the generated results as well as morphometry of the sheep lumbar spine to human published data. For this purpose, computed tomography scans were carried out on five adult Merino sheep under general anaesthesia. Transverse 5 mm thick images were acquired from L1 to L6 using a multi-detector-row helical CT scanner. Volume measurements were performed with dedicated software. Four spinal indices and Pavlov's ratio were calculated. Thereafter, the generated data were compared to published literature on humans. The mean vertebral body volume showed an increase towards the caudal vertebrae, but there were no significant differences between the vertebral levels (P>0.05). Compared to humans, sheep vertebral body volumes were 48.6% smaller. The comparison of absolute values between both species revealed that sheep had smaller, longer and narrower vertebral bodies, thinner intervertebral discs, narrower spinal canal, longer transverse processes, shorter dorsal spinous processes and narrower, higher pedicles with more lateral angulations. The comparison of the spinal indices showed a good similarity to human in terms of the vertebral endplates and spinal canal. The results of this study may be helpful for using the sheep as a model for human orthopaedic spinal research if anatomical differences are taken into account. PMID:24396382
Chatham, Lillian S; Patel, Vikas V; Yakacki, Christopher M; Dana Carpenter, R
There is a need to better understand the effects of intervertebral spacer material and design on the stress distribution in vertebral bodies and endplates to help reduce complications such as subsidence and improve outcomes following lumbar interbody fusion. The main objective of this study was to investigate the effects of spacer material on the stress and strain in the lumbar spine after interbody fusion with posterior instrumentation. A standard spacer was also compared with a custom-fit spacer, which conformed to the vertebral endplates, to determine if a custom fit would reduce stress on the endplates. A finite element (FE) model of the L4-L5 motion segment was developed from computed tomography (CT) images of a cadaveric lumbar spine. An interbody spacer, pedicle screws, and posterior rods were incorporated into the image-based model. The model was loaded in axial compression, and strain and stress were determined in the vertebra, spacer, and rods. Polyetheretherketone (PEEK), titanium, poly(para-phenylene) (PPP), and porous PPP (70% by volume) were used as the spacer material to quantify the effects on stress and strain in the system. Experimental testing of a cadaveric specimen was used to validate the model's results. There were no large differences in stress levels (<3%) at the bone-spacer interfaces and the rods when PEEK was used instead of titanium. Use of the porous PPP spacer produced an 8-15% decrease of stress at the bone-spacer interfaces and posterior rods. The custom-shaped spacer significantly decreased (>37%) the stress at the bone-spacer interfaces for all materials tested. A 28% decrease in stress was found in the posterior rods with the custom spacer. Of all the spacer materials tested with the custom spacer design, 70% porous PPP resulted in the lowest stress at the bone-spacer interfaces. The results show the potential for more compliant materials to reduce stress on the vertebral endplates postsurgery. The custom spacer provided a
Bonfim, Marco A E; Costa, André L F; Ximenez, Michel E L; Cotrim-Ferreira, Flávio A; Ferreira-Santos, Rívea I
Objectives: The aim of this study was to evaluate the performance of CBCT three-dimensional (3D) reconstructions and sagittal sections for estimates of cervical vertebrae maturation index (CVMI). Methods: The sample consisted of 72 CBCT examinations from patients aged 8–16 years (45 females and 27 males) selected from the archives of two private clinics. Two calibrated observers (kappa scores: ≥0.901) interpreted the CBCT settings twice. Intra- and interobserver agreement for both imaging exhibition modes was analyzed by kappa statistics, which was also used to analyze the agreement between 3D reconstructions and sagittal sections. Correlations between cervical vertebrae maturation estimates and chronological age, as well as between the assessments by 3D reconstructions and sagittal sections, were analyzed using gamma Goodman–Kruskal coefficients (α = 0.05). Results: The kappa scores evidenced almost perfect agreement between the first and second assessments of the cervical vertebrae by 3D reconstructions (0.933–0.983) and sagittal sections (0.983–1.000). Similarly, the agreement between 3D reconstructions and sagittal sections was almost perfect (kappa index: 0.983). In most divergent cases, the difference between 3D reconstructions and sagittal sections was one stage of CVMI. Strongly positive correlations (>0.8, p < 0.001) were found not only between chronological age and CVMI but also between the estimates by 3D reconstructions and sagittal sections (p < 0.001). Conclusions: Although CBCT imaging must not be used exclusively for this purpose, it may be suitable for skeletal maturity assessments. PMID:26509559
Altan, Müge; Nebioğlu Dalci, Öykü; İseri, Haluk
An important criterion of orthodontic diagnosis is the determination of the skeletal maturation stage. The cervical vertebral maturation (CVM) method is presented as an alternative to skeletal maturation determination. However, studies published to date concerning CVM have generally been cross-sectional. The aim of this investigation was to longitudinally evaluate growth and development with the CVM method. Lateral cephalometric radiographs of 41 girls, aged 9-16 years, collected between 1978 and 1984 were used to evaluate changes in C2, C3, and C4 dimensions. The mean values, standard deviations, maximum and minimum values of cervical vertebrae growth, and growth rate were calculated for every age and age interval. Cumulative growth increment was determined by summing annual mean values for each parameter. CVM stages were initially evaluated according to the method of Lamparski. The time differences between the following CVM stages were evaluated with a paired t-test. The total length increment was distinct for C2 but similar for C1, C3, and C4. Total length increments reached their maximum between CVM stages 2 and 3, except for C3. The total length increment of C3 reached its peak 1 year earlier. The height increments of the spinose processes of C2, C3, and C4 were similar. The results showed that height increments were greater than length increments, which was due to changes in the anatomical pattern. Vertical growth displayed a decreasing trend from the upper to the lower cervical vertebrae. Determination of skeletal maturation from dimensional measurements and anatomical changes of the cervical vertebrae will facilitate orthodontic evaluation by eliminating the need for hand-wrist films and, therefore, decrease the patient's exposure to radiation.
Kromik, Andreas; Ulrich, Reiner; Kusenda, Marian; Tipold, Andrea; Stein, Veronika M; Hellige, Maren; Dziallas, Peter; Hadlich, Frieder; Widmann, Philipp; Goldammer, Tom; Baumgärtner, Wolfgang; Rehage, Jürgen; Segelke, Dierck; Weikard, Rosemarie; Kühn, Christa
A key common feature all but three known mammalian genera is the strict seven cervical vertebrae blueprint, suggesting the involvement of strong conserving selection forces during mammalian radiation. This is further supported by reports indicating that children with cervical ribs die before they reach reproductive age. Hypotheses were put up, associating cervical ribs (homeotic transformations) to embryonal cancer (e.g., neuroblastoma) or ascribing the constraint in cervical vertebral count to the development of the mammalian diaphragm. Here, we describe a spontaneous mutation c.196A > G in the Bos taurus T gene (also known as brachyury) associated with a cervical vertebral homeotic transformation that violates the fundamental mammalian cervical blueprint, but does not preclude reproduction of the affected individual. Genome-wide mapping, haplotype tracking within a large pedigree, resequencing of target genome regions, and bioinformatic analyses unambiguously confirmed the mutant c.196G allele as causal for this previously unknown defect termed vertebral and spinal dysplasia (VSD) by providing evidence for the mutation event. The nonsynonymous VSD mutation is located within the highly conserved T box of the T gene, which plays a fundamental role in eumetazoan body organization and vertebral development. To our knowledge, VSD is the first unequivocally approved spontaneous mutation decreasing cervical vertebrae number in a large mammal. The spontaneous VSD mutation in the bovine T gene is the first in vivo evidence for the hypothesis that the T protein is directly involved in the maintenance of the mammalian seven-cervical vertebra blueprint. It therefore furthers our knowledge of the T-protein function and early mammalian notochord development.
Kromik, Andreas; Ulrich, Reiner; Kusenda, Marian; Tipold, Andrea; Stein, Veronika M.; Hellige, Maren; Dziallas, Peter; Hadlich, Frieder; Widmann, Philipp; Goldammer, Tom; Baumgärtner, Wolfgang; Rehage, Jürgen; Segelke, Dierck; Weikard, Rosemarie; Kühn, Christa
A key common feature of all but three known mammalian genera is the strict seven cervical vertebrae blueprint, suggesting the involvement of strong conserving selection forces during mammalian radiation. This is further supported by reports indicating that children with cervical ribs die before they reach reproductive age. Hypotheses were put up, associating cervical ribs (homeotic transformations) to embryonal cancer (e.g., neuroblastoma) or ascribing the constraint in cervical vertebral count to the development of the mammalian diaphragm. Here, we describe a spontaneous mutation c.196A > G in the Bos taurus T gene (also known as brachyury) associated with a cervical vertebral homeotic transformation that violates the fundamental mammalian cervical blueprint, but does not preclude reproduction of the affected individual. Genome-wide mapping, haplotype tracking within a large pedigree, resequencing of target genome regions, and bioinformatic analyses unambiguously confirmed the mutant c.196G allele as causal for this previously unknown defect termed vertebral and spinal dysplasia (VSD) by providing evidence for the mutation event. The nonsynonymous VSD mutation is located within the highly conserved T box of the T gene, which plays a fundamental role in eumetazoan body organization and vertebral development. To our knowledge, VSD is the first unequivocally approved spontaneous mutation decreasing cervical vertebrae number in a large mammal. The spontaneous VSD mutation in the bovine T gene is the first in vivo evidence for the hypothesis that the T protein is directly involved in the maintenance of the mammalian seven-cervical vertebra blueprint. It therefore furthers our knowledge of the T-protein function and early mammalian notochord development. PMID:25614605
Mundorff, Amy Z; Vidoli, Giovanna; Melinek, Judy
This case study demonstrates the importance of involving an anthropologist in forensic situations with decomposed remains. Anthropological consultation was used in conjunction with the comparison of antemortem and postmortem radiographs to establish positive identification of unknown, decomposed remains. The remains had no traditional identifying features such as fingerprints or dental. Through anthropological analysis, it was determined the decedent was male, between 20 and 23 years at time of death and c. 5'2'' tall. This information allowed for a presumptive identification and a request for antemortem radiographs. The missing person was identified comparing the spinous processes of the cervical and thoracic vertebrae between ante- and postmortem radiographs.
Yang, Zechuan; Li, Chunde; Sun, Haolin
Three-dimensional (3D) printing technology is characterized by "inside-out" stack manufacturing. Compared with conventional technologies, 3D printing has the advantage of personalization and precision. Therefore, the shape and internal structure of the scaffolds made by 3D printing technology are highly biomimetic. Besides, 3D bioprinting can precisely deposit the biomaterials, seeding cells and cytokines at the same time, which is a breakthrough in printing technique and material science. With the development of 3D printing, it will make great contributions to the reconstruction of vertebrae and intervertebral disc in the future.
Examination of congenitally fused (blocked) vertebrae in this study suggests that non-development of the joint between articular facets results in fusion of the vertebral arches which in turn leads to secondary fusion of the bodies and hypoplasia of the intervertebral discs. The presence of independent pedicles and transverse processes do not favour the concept that such an abnormality is the result of non-segmentation of the sclerotome. The condition is probably linked to a defect of an inductor substance which influences normal morphogenesis of the vertebral arch in the embryonic period. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 PMID:3429327
Hon, Kam Lun; Chu, Winnie C; Sung, John K K
Foreign body ingestion was immediately suspected at the emergency department when a 14-month-old boy presented with fever, refusal to eat, and history of choking after consumption of congee with minced fish meat the day before. Two eel vertebrae were subsequently retrieved from the piriform fossa. This case is reported to discuss the importance of obtaining the relevant history of foreign body ingestion and high index of suspicion in very young children. Parents must be educated about the risk of feeding infant and young children with bone-containing foods.
Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.
Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic…
Tu, Xiongying; Das, Kalyan; Han, Qianwei; Bauman, Joseph D.; Clark, Jr., Arthur D.; Hou, Xiaorong; Frenkel, Yulia V.; Gaffney, Barbara L.; Jones, Roger A.; Boyer, Paul L.; Hughes, Stephen H.; Sarafianos, Stefan G.; Arnold, Eddy
Human immunodeficiency virus (HIV-1) develops resistance to 3'-azido-2',3'-deoxythymidine (AZT, zidovudine) by acquiring mutations in reverse transcriptase that enhance the ATP-mediated excision of AZT monophosphate from the 3' end of the primer. The excision reaction occurs at the dNTP-binding site, uses ATP as a pyrophosphate donor, unblocks the primer terminus and allows reverse transcriptase to continue viral DNA synthesis. The excision product is AZT adenosine dinucleoside tetraphosphate (AZTppppA). We determined five crystal structures: wild-type reverse transcriptase-double-stranded DNA (RT-dsDNA)-AZTppppA; AZT-resistant (AZTr; M41L D67N K70R T215Y K219Q) RT-dsDNA-AZTppppA; AZTr RT-dsDNA terminated with AZT at dNTP- and primer-binding sites; and AZTr apo reverse transcriptase. The AMP part of AZTppppA bound differently to wild-type and AZTr reverse transcriptases, whereas the AZT triphosphate part bound the two enzymes similarly. Thus, the resistance mutations create a high-affinity ATP-binding site. The structure of the site provides an opportunity to design inhibitors of AZT-monophosphate excision.
Gamble, Ralph C., Jr.
Points out that, although the analysis of the imposition of an excise tax is widely used in economics courses, the consequences of a change in the tax rate are different and ignored. This article presents an effective way to teach about such a change. (GG)
Barron, John M.; Blanchard, Kelly Hunt; Umbeck, John R.
The authors present an example of the effect a change in the excise tax can have on retail gasoline prices. The findings provide support for standard economic theory, as well as provide a vehicle for illustrating some of the subtleties of the analysis, including the implicit assumptions regarding the implications for the buying and selling prices…
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 40 and 49 RIN 1545-BJ40 Indoor Tanning Services; Cosmetic Services Excise Taxes AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of public hearing...
... 29 Labor 3 2012-07-01 2012-07-01 false Excise taxes separately stated. 779.264 Section 779.264 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS THE FAIR LABOR STANDARDS...
... 29 Labor 3 2014-07-01 2014-07-01 false Excise taxes separately stated. 779.264 Section 779.264 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS THE FAIR LABOR STANDARDS...
Cho, Igsoo; Jeon, Chunbae; Lee, Sangyong; Lee, Daehee; Hwangbo, Gak
[Purpose] This study examined the effects of lumbar stabilization exercises on the functional disability and lumbar lordosis angles in patients with chronic low back pain. [Subjects] The subjects were 30 patients with chronic low back pain divided into a lumbar stabilization exercise group (n = 15) and a conservative treatment group (n = 15). [Methods] The lumbar stabilization exercise and conservative treatment groups performed an exercise program and conservative physical treatment, respectively. Both programs were performed 3 times a week for 6 weeks. The degree of functional disability was assessed by the Oswestry disability index, and lumbar lordosis angles were measured by plain radiography. [Results] The Oswestry disability index decreased significantly in the both groups; however, it was significantly lower in the lumbar stabilization exercise group. The lumbar lordosis angle increased significantly in the lumbar stabilization exercise group after treatment and was also significantly greater than that in the conservative treatment group. [Conclusion] Lumbar stabilization exercise is more effective than conservative treatment for improving functional disability and lumbar lordosis angles. PMID:26180363
Castro-Mateos, Isaac; Pozo, Jose M.; Lazary, Aron; Frangi, Alejandro F.
Computational medicine aims at developing patient-specific models to help physicians in the diagnosis and treatment selection for patients. The spine, and other skeletal structures, is an articulated object, composed of rigid bones (vertebrae) and non-rigid parts (intervertebral discs (IVD), ligaments and muscles). These components are usually extracted from different image modalities, involving patient repositioning. In the case of the spine, these models require the segmentation of IVDs from MR and vertebrae from CT. In the literature, there exists a vast selection of segmentations methods, but there is a lack of approaches to align the vertebrae and IVDs. This paper presents a method to create patient-specific finite element meshes for biomechanical simulations, integrating rigid and non-rigid parts of articulated objects. First, the different parts are aligned in a complete surface model. Vertebrae extracted from CT are rigidly repositioned in between the IVDs, initially using the IVDs location and then refining the alignment using the MR image with a rigid active shape model algorithm. Finally, a mesh morphing algorithm, based on B-splines, is employed to map a template finite-element (volumetric) mesh to the patient-specific surface mesh. This morphing reduces possible misalignments and guarantees the convexity of the model elements. Results show that the accuracy of the method to align vertebrae into MR, together with IVDs, is similar to that of the human observers. Thus, this method is a step forward towards the automation of patient-specific finite element models for biomechanical simulations.
Sundararajan, Srini; Prasad, Priya; Rouhana, Stephen W; Demetropoulos, Constantine K; Yang, King H; King, Albert I; Nolte, Lutz P
The purpose of this study was to determine the characteristics of eighteen lumbar spine motion segments subjected to lateral shear forces under quasi-static (0.5 mm/s) and dynamic (500 mm/s) test conditions. The quasi-static test was also performed on the lumbar spine of a side impact anthropomorphic test device, the EuroSID-2 (ES-2). In the quasi-static tests, the maximum force before disc-endplate separation in the PMHS lumbar motion segments was 1850 +/- 612 N, while the average linear stiffness of PMHS lumbar motion segments was 323 +/- 126 N/mm. There was a statistically significant difference between the quasi-static (1850 +/- 612 N) and dynamic (2616 +/- 1151 N) maximum shear forces. The ES-2 lumbar spine (149 N/mm) was more compliant than the PMHS lumbar segments under the quasi-static test condition.
Bagwell, C E
Treatment of life-threatening pediatric airway lesions has been greatly enhanced by development of the CO2 laser. Using this modality, endoscopic access and precise tissue destruction are possible with minimal local inflammation and subsequent edema of the narrow airway. From October 1986 through October 1988, 26 patients underwent 96 laser procedures for excision of airway lesions, in 23 patients via bronchoscopy and in three patients via microlaryngoscopy. Ages ranged from 1 day to 20 years, with most patients under 2 years of age. Diagnoses included: laryngeal cysts (1); cystic hygroma (3); tumor (neurofibroma, 1) subglottic hemangioma (1); excision of airway granulation tissue (8); and tracheal stenosis (13, including subglottic stenosis in 9). Therapy of the offending lesion required from one to eight laser procedures (mean, 2.8), excluding one patient with congenital long-segment tracheal stenosis who required 24 laser treatments for repeated excision of tracheal granulation tissue. Most lesions responded to only one or two laser treatments. No bleeding or perforation occurred secondary to laser use. Use of the laser was responsible for salvaging the airway or simplifying management of the airway in 21 of the 26 patients. In three patients with cystic hygroma affecting the laryngeal structures as well as soft tissues of the neck, laser excision was performed to maintain upper airway patency with a tracheostomy for airway control. Two patients with critical subglottic stenosis initially responded to laser excision, but moved away from the area and developed recurrence of their subglottic stenosis requiring tracheostomy, because further laser treatment was either unavailable or was deferred in their new locale.(ABSTRACT TRUNCATED AT 250 WORDS)
Sims, I M; Cairns, A J; Furneaux, R H
The accumulation of total water-soluble carbohydrate, and specifically sucrose and fructan, by excised leaves of Phormium tenax and P. cookianum (family Phormiaceae J. G. Agardh, order Asparagales) was investigated. Total water-soluble carbohydrate content of excised leaves of P. tenax and P. cookianum increased during 48 h of continuous illumination at an average rate of 1.3 and 0.9 mg g(-1) fresh weight leaf per hour, respectively. The sucrose content of excised leaves increased throughout the experimental period. The fructan content of excised leaves of P. tenax increased slightly throughout the experimental period, whilst that of P. cookianum was variable and showed no overall change. Chemical and spectroscopic analysis of the fructans obtained from the two Phormium species showed that they were similar to each other and contained mostly 1-linked and terminal fructofuranosyl (Fruf) residues, together with smaller amounts of 6-linked Fruf, 1,6-branched Fruf, terminal and 6-linked glucopyranosyl residues. Separation of the fructans by thin-layer and high-performance anion-exchange chromatography revealed the presence of a complex mixture of fructo-oligosaccharides and higher molecular weight fructan. The branched structure of the fructans isolated from excised leaves of Phormium resembles that of fructans and fructo-oligosaccharides isolated from some related species within the order Asparagales (Agave vera cruz, Cordyline australis and Urginea maritima), but is distinct from the linear structure of fructans from others (Allium cepa and Asparagus officinalis). The structural heterogeniety of fructans within both the order Asparagales and superorder Liliiflorae may be a useful chemotaxonomic aid.
Riedemann-Wistuba, M; Alonso-Pérez, M; Llaneza-Coto, J M
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.
Radło, Paweł; Smetkowski, Andrzej; Tesiorowski, Maciej
Lumbar disc herniation is one of the most common damage of musculoskeletal system. The incidence of pain of lumbosacral spine is estimated approximately on 60-90% in general population, whereas the incidence of disc herniation in patients experiencing low back pain is about 91%. Despite the high incidence and uncomplicated pathogenesis of disc disease there is a problem with the nomenclature. In the vast majority of cases, the naming confusion stems from ignorance of the etiology of low back pain. Different terminologies: morphological, topographical, Radiological and Clinical are used interchangeably. In addition, diagnosis is presented in a variety of languages: Polish, English and Latin. Moreover, the medical and traditional language are used alternately. The authors found in Polish literature more, than 20 terms to describe lumbar disc herniation. All of these terms in the meaning of the authors are used to determine one pathology--mechanical damage to the intervertebral disc and moving the disc material beyond the anatomical area.
Kawaguchi, Masahiko; Ishikawa, Norihiko; Shimizu, Satsuki; Shin, Hisato; Matsunoki, Aika; Watanabe, Go
Single Incision Endoscopic Surgery (SIES) has emerged as a less invasive surgery among laparoscopic surgeries, and this approach for incisional hernia was reported recently. This is the first report of SIES for an incisional lumbar hernia. A 66-year-old Japanese woman was referred to our institution because of a left flank hernia that developed after left iliac crest bone harvesting. A 20-mm incision was created on the left side of the umbilicus and all three trocars (12, 5, and 5 mm) were inserted into the incision. The hernial defect was 14 × 9 cm and was repaired with intraperitoneal onlay mesh and a prosthetic graft. The postoperative course was uneventful. SIES for lumbar hernia offers a safe and effective outcome equivalent compared to laparoscopic surgery. In addition, SIES is less invasive and has a cosmetic benefit.
Siambanes, David; Kposowa, Augustine J; Michelsen, Steven
The results of lumbar diskography at post-diskectomy and nonoperative disk levels in postoperative patients and patients without prior back surgery were reviewed over 3 years. Other possible predictive factors, including disk degeneration (per the Adam's classification), end-point resistance, gender, and age, also were reviewed. The results revealed that no statistically significant association was noted between the presence of a prior diskectomy and the outcome of diskography. However, disk degeneration classified as ruptured and fissured correlated statistically with positive diskography. Additionally, age between 30 and 39 years and male gender were statistically associated with a positive diskogram. Disk levels displaying a poor end point during diskography injection (not amendable to pressurization) were statistically related to ruptured or fissured disk levels and thus positive diskography. Based on these results, the assumption that disabling low-back pain presenting after lumbar procedure is due to diskogenic disease arising from the surgical level is not supported.
Chafetz, N.I.; Genant, H.K.; Moon, K.L.; Helms, C.A.; Morris, J.M.
Fifteen nuclear magnetic resonance (NMR) studies of 14 patients with herniated lumbar intervertebral disks were performed on the UCSF NMR imager. Computed tomographic (CT) scans done on a GE CT/T 8800 or comparable scanner were available at the time of NMR scan interpretation. Of the 16 posterior disk ruptures seen at CT, 12 were recognized on NMR. Diminished nucleus pulposus signal intensity was present in all ruptured disks. In one patient, NMR scans before and after chymopapain injection showed retraction of the protruding part of the disk and loss of signal intensity after chemonucleolysis. Postoperative fibrosis demonstrated by CT in one patient and at surgery in another showed intermediate to high signal intensity on NMR, easily distinguishing it from nearby thecal sac and disk. While CT remains the method of choice for evaluation of the patient with suspected lumbar disk rupture, the results of this study suggest that NMR may play a role in evaluating this common clinical problem.
Singleton, Alex; Agarwal, Vikas; Casagranda, Bethany; Hughes, Marion A; Rothfus, William E
Our patient, a 22-year-old starting wide receiver for an NCAA Division I football team, presented with low back pain and sciatica. A lumbar-spine MRI without contrast demonstrated findings suspicious for discal cyst. The patient was referred for surgery, and the lesion was resected. The rarity of discal cyst makes it difficult to diagnose because most radiologists are not aware of the entity. An organized approach to diagnosis can facilitate appropriate management.
Wortzman, G.; Steinhardt, M.I.
Three patients who had a diagnosis of congenitally absent lumbar pedicle underwent CT examination. Findings showed that each patient had an aberrant hypoplastic pedicle plus a retroisthmic defect in their ipsilateral lamina rather than an absent pedicle. Axial CT was the diagnostic modality of choice; reformated images were of little value. The differential diagnosis to be considered from the findings of plain film radiography includes pediculate thinning, neoplastic disease, neurofibroma, mesodermal dysplasia associated with neurofibromatosis, and vascular anomalies.
Man's quest for recognition has not escaped the physician, whose contributions to medicine perpetuate his name in print. It is a final grasp for professional immortality, which for men like Imhotep and Hippocrates, has prevailed for millennia. This fervor was particularly evident in the latter 19th century, which created a flurry of eponyms, often two or more physicians publishing the same clinical observation. This article reviews the eponym epidemic as it relates to lumbar radiculopathy.
Gatti, P; Valat, J P; Videgrain, M
From a series of 400 cases of lumbar spine phlebography by selective catheterisation, 4 serious thrombo-embolic episodes were observed, including 2 cases of severe pulmonary embolism which responded favourably to medical treatment. In 3 cases, risk factors were found (prolonged immobilisation in bed, past history of phlebitis). One case developed severe phlebitis of the lower limbs despite prophylactic treatment with low dose calcium heparin. In the other cases, no anti-coagulant therapy was prescribed before or during the examination.
markers 14 – 16 , 18 and ground force plates 7 , 18 , 19 to measure body positioning and ground reac- tion forces . These methods approach...data obtained in this setting do not refl ect the state of the lumbar spine in the upright position due to alterations in bone- muscle interactions...lumbar spine might be related to the greater forces acting on inferior levels through the lumbar spine 38 and that IVDs of inferior levels undergo
... excise tax on distilled spirits, wine, beer, tobacco products, and cigarette papers and tubes, and... (IRC). These provisions of the IRC concern the taxation of distilled spirits, wine, beer, tobacco... taxes. See 26 U.S.C. 5061 pertaining to distilled spirits, wine, and beer and 26 U.S.C. 5703...
... regulations pertaining to the semimonthly payments of excise tax on distilled spirits, wine, beer, tobacco.../regulations_laws/all_rulemaking.shtml . You also may view copies of these documents by appointment at the TTB... spirits, wine, beer, tobacco products, and cigarette papers and tubes. The temporary rule also...
Bu, Wenbo; Zhang, Mengli; Zhang, Qian; Yuan, Chunyu; Chen, Xu; Fang, Fang
Some basal cell carcinomas (BCCs) are indistinguishable from nevi based on clinical manifestations. Therefore, it is often difficult for the excision margins of the initial surgical treatment to achieve radical removal of the malignancy. This study was a comparative analysis of the clinical results of aminolevulinic acid (ALA)-photodynamic therapy (PDT) or secondary surgery after the primary excision. In total, 20 patients with preoperative clinical diagnoses of nevi underwent in situ resection. The postoperative pathological diagnoses confirmed all cases were BCC. Ten patients received PDT twice after the primary excision, and 10 cases received extended resection after the primary excision. Patients were followed up for 8 months at least, and the 2 groups did not show statistically significant differences in the recurrence rate, while the PDT group had better results in terms of economic burden, healing period, and cosmetic satisfaction than the group with secondary surgery. Our study demonstrates that ALA-PDT can sever as a considerable remedial treatment for the BCC patients who have not accepted radical resection due to primary clinical misdiagnosis.
Yucel, Ergun; Tezcan, Levent; Yilmaz, O Cem; Akin, Mehmet Levhi
Pilonidal sinus surgery has evolved with the novel flap techniques, and off-midline closure became a preferred surgical procedure due to shorter recovery time and low recurrence rates. To obtain a better off-midline closure without maceration and a possible wound problem, we modified a novel excision technique. We aimed to present this novel flag modification of rhomboid excision and flap reconstruction experience. From December 2007 to June 2009, 100 patients were treated with flag excision and flap reconstruction under regional anesthesia and followed with a mean of 42 (range 35-55) months. Competent closure results were obtained successfully in all patients without an overlap between incision line and midline. None of the patients had seroma. Two patients (2 %) had partial wound detachment superiorly. None of the patients had recurrence during follow-up. The flag excision and flap reconstruction procedure is an effective and comfortable technique both for the surgeon and the patient with a quick healing period and low complication rates without maceration.
Bellini, Chiara M.; Zweig, Thomas; Ferguson, Stephen; Raimondi, Manuela T.; Lamartina, Claudio; Brayda-Bruno, Marco; Fornari, Maurizio
The implantation of lumbar disc prostheses based on different design concepts is widely accepted. This paper reviews currently available literature studies on the biomechanics of TDA in the lumbar spine, and is targeted at the evaluation of possible relationships between the aims of TDA and the geometrical, mechanical and material properties of the various available disc prostheses. Both theoretical and experimental studies were analyzed, by a PUBMED search (performed in February 2007, revised in January 2008), focusing on single level TDA. Both semi-constrained and unconstrained lumbar discs seem to be able to restore nearly physiological IAR locations and ROM values. However, both increased and decreased ROM was stated in some papers, unrelated to the clinical outcome. Segmental lordosis alterations after TDA were reported in most cases, for both constrained and unconstrained disc prostheses. An increase in the load through the facet joints was documented, for both semi-constrained and unconstrained artificial discs, but with some contrasting results. Semi-constrained devices may be able to share a greater part of the load, thus protecting the surrounding biological structure from overloading and possible early degeneration, but may be more susceptible to wear. The next level of development will be the biomechanical integration of compression across the motion segment. All these findings need to be supported by long-term clinical outcome studies. PMID:18946684
Caralopoulos, Ilias N.; Bui, Cuong J.
Background Degenerative lumbar stenosis associated with spondylolisthesis is common in elderly patients. The most common symptoms are those of neurogenic claudication with leg pain. Surgery is indicated for those who fail conservative management. The generally accepted recommendation is to perform a laminectomy and a fusion at the involved level. Methods We reviewed our results for minimally invasive single-level decompression without fusion performed by the senior author in patients with symptomatic lumbar stenosis with spondylolisthesis with no dynamic instability from 2008 to 2011 at a single institution. Outcomes were measured using the visual analog scale (VAS), Prolo Economic Functional Rating Scale, and revised Oswestry Disability Index (ODI) at initial presentation and at 3-month, 6-month, and 1-year follow-up time points. Results Records for 28 patients (19 males, 9 females) were reviewed. The success rate, defined as improvement in pain and functional outcome without the need for surgical fusion, was 86%. VAS scores decreased by 6.3 points, Prolo scores increased by 3.5 points, and the ODI decreased by 31% at 1 year. All changes were statistically significant. Conclusion Minimally invasive decompression alone can be a reasonable alternative to decompression and fusion for patients with spondylolisthetic lumbar stenosis and neurogenic claudication with leg pain. Decompression without fusion should be considered for older patients and for patients who are not ideal fusion candidates. PMID:24688331
Tschen, Jaime A.
Background: The absence or loss of elastic fibers in the skin is referred to as dermal elastolysis. Purpose: This paper describes a woman with a distinctive clinical presentation of mid-dermal elastolysis characterized morphologically by multiple horizontal raised bands on the lower back. Methods: A 20-year-old Filipino woman presented with multiple asymptomatic, flesh-colored, raised, firm, linear, cord-like bands on the lumbar area of her back. There were neither similar lesions elsewhere nor a family member with this condition. Results: Microscopic examination of the raised band showed nearly complete absence of elastic fibers in the mid dermis. In contrast, a biopsy of symmetrically located normal-appearing skin showed a uniform distribution of elastic fibers throughout the dermis. Linear lumbar localized elastolysis is a descriptive designation that accurately reflects a correlation of the clinical and pathological changes of this condition. Conclusion: The clinical differential of raised horizontal cord-like bands on the lower back (without a family history of an inherited elastic fiber disorder, a prior history of trauma, or a significant change in weight or exercise habit) includes linear focal elastosis and linear lumbar localized elastolysis. Microscopic evaluation of a Verhoeff-van Gieson stained lesion specimen (which may be accompanied by a biopsy of normal-appearing skin for comparison) will readily differentiate these conditions. The former is usually characterized by increased elastic fibers, whereas the latter, as in this patient, shows a paucity or absence of elastic fibers in the mid dermis. PMID:23882313
Guppy, Kern H; Silverthorn, James W; Akins, Paul T
Intrathecal spinal catheters (lumbar drains) are indicated for several medical and surgical conditions. In neurosurgical procedures, they are used to reduce intracranial and intrathecal pressures by diverting CSF. They have also been placed for therapeutic access to administer drugs, and more recently, vascular surgeons have used them to improve spinal cord perfusion during the treatment of thoracic aortic aneurysms. Insertion of these lumbar drains is not without attendant complications. One complication is the shearing of the distal end of the catheter with a resultant retained fragment. The authors report the case of a 65-year-old man who presented with a subarachnoid hemorrhage due to the migration of a retained lumbar drain that sheared off during its removal. To the best of the authors' knowledge, this is the first case of rostral migration of a retained intrathecal catheter causing subarachnoid hemorrhage. The authors review the literature on retained intrathecal spinal catheters, and their findings support either early removal of easily accessible catheters or close monitoring with serial imaging.
The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future. PMID:24761206
Houssaye, Alexandra; Boistel, Renaud; Böhme, Wolfgang; Herrel, Anthony
Snakes are a very speciose group of squamates that adapted to various habitats and ecological niches. Their ecological diversity is of particular interest and functional demands associated with their various styles of locomotion are expected to result in anatomical specializations. In order to explore the potential adaptation of snakes to their environment we here analyze variation in vertebral structure at the microanatomical level in species with different locomotor adaptations. Vertebrae, being a major element of the snake body, are expected to display adaptations to the physical constraints associated with the different locomotor modes and environments. Our results revealed a rather homogenous vertebral microanatomy in contrast to what has been observed for other squamates and amniotes more generally. We here suggest that the near-absence of microanatomical specializations in snake vertebrae might be correlated to their rather homogeneous overall morphology and reduced range of morphological diversity, as compared to lizards. Thus, snakes appear to retain a generalist inner morphology that allows them to move efficiently in different environments. Only a few ecologically highly specialized taxa appear to display some microanatomical specializations that remain to be studied in greater detail.
Li, Siwei; Niu, Guodong; Dong, Neil X.; Wang, Xiaodu; Liu, Zhongjun; Song, Chunli; Leng, Huijie
Estrogen withdrawal in postmenopausal women increases bone loss and bone fragility in the vertebra. Bone loss with osteoporosis not only reduces bone mineral density (BMD), but actually alters bone quality, which can be comprehensively represented by bone post-yield behaviors. This study aimed to provide some information as to how osteoporosis induced by estrogen depletion could influence the evolution of post-yield microdamage accumulation and plastic deformation in vertebral bodies. This study also tried to reveal the part of the mechanisms of how estrogen deficiency-induced osteoporosis would increase the bone fracture risk. A rat bilateral ovariectomy (OVX) model was used to induce osteoporosis. Progressive cyclic compression loading was developed for vertebra testing to elucidate the post-yield behaviors. BMD, bone volume fraction, stiffness degradation, and plastic deformation evolution were compared among rats raised for 5 weeks (ovx5w and sham5w groups) and 35 weeks (ovx35w and sham35w groups) after sham surgery and OVX. The results showed that a higher bone loss in vertebral bodies corresponded to lower stiffness and higher plastic deformation. Thus, osteoporosis could increase the vertebral fracture risk probably through microdamage accumulation and plastic deforming degradation.
Banić, Tihomir; Banić, Morana; Cvjetko, Ivan; Somun, Nenad; Bilić, Vide; Vidjak, Vinko; Pavić, Vladimir; Coc, Ivan; Kokić, Tomislav; Kejlal, Zvonko
Vertebral artery injuries due to cervical spine trauma, although rarely described in the literature, are relatively common. While most of them will remain asymptomatic, a small percentage of patients may suffer life threatening complications. We report a case of the right vertebral artery injury in a patient with fracture of C4 vertebra, successfully treated with endovascular approach. A 78-year-old male patient was hospitalized for cervical spine injury caused by falling off the tractor. Radiological assessment revealed fracture of C4 vertebra with proximal two-thirds of C4 body dislocated five millimeters dorsally. Significant swelling of soft prevertebral tissues distally of C2 segment was also present. During emergency surgery using standard anterior approach for cervical spine, excessive bleeding started from the injured right vertebral artery. Bleeding was stopped by tamponade with oxidized regenerated cellulose sheet and C4-C5 anterior fixation; then partial reduction of displacement was done. Fifteen days later, after angiography, endovascular repair of the right vertebral artery was performed using percutaneous stent graft. Follow up computed tomography scan angiography showed valid stent patency without contrast extravasation. In cases of cervical spine trauma, surgeon should always be prepared to manage injury of vertebral artery. Bleeding can primarily be stopped by hemostatic packing, and definitive repair can be successfully achieved by endovascular approach using percutaneous stent graft.
Marlow, Emily J; Pastor, Robert F
Sex is one of the critical questions addressed when unidentified skeletal remains are discovered in forensic or archeological contexts. Continuous testing and re-evaluation of existing techniques is essential to improve accuracy and precision. The Wescott (J Forensic Sci 2000;45(2):462-6) method of sex determination from dimensions of the second cervical vertebra was blind-tested on 153 adult individuals from the Spitalfields documented collection of human skeletal remains held at the Natural History Museum, London. Significant sex differences were determined for all dimensions measured (independent two-sample t-test, p<0.05-0.001). The discriminant functions developed by Wescott were shown to have an overall accuracy of classification of 76.99%. Using stepwise discriminant analysis, a discriminant function based on the Spitalfields data correctly classified sex in 83.3% of individuals and was able to classify males and females with equal accuracy. Additional discriminant functions are presented for use in instances where preservation of the second cervical vertebra is poor.
Verna, Emeline; Piercecchi-Marti, Marie-Dominique; Chaumoitre, Kathia; Adalian, Pascal
In forensic anthropology, identification begins by determining the sex, age, ancestry and stature of the individuals. Asymptomatic variations present on the skeleton, known as discrete traits, can be useful to identify individuals, or at least contribute to complete their biological profile. We decided to focus our work on the upper part of the skeleton, from the first vertebra to the pelvic girdle, and we chose to present 8 discrete traits (spina bifida occulta, butterfly vertebra, supraclavicular nerve foramen, coracoclavicular joint, os acromiale, suprascapular foramen, manubrium foramen and pubic spine), because they show a frequency lower than 10%. We examined 502 anonymous CT scans from polytraumatized individuals, aged 15 to 65 years, in order to detect the selected discrete traits. Age and sex were known for each subject. Thin sections in the axial, coronal and sagittal planes and 3D volume rendering images were created and examined for the visualization of the selected discrete traits. Supraclavicular foramina were found only in males and only on the left clavicle. Coracoclavicular joints were observed only in males. The majority of individuals with a suprascapular foramen were older than 50 years of age. Pubic spines were observed mostly in females. Other traits did not present significant association with sex, age and laterality. No association between traits was highlighted. Better knowledge of human skeletal variations will help anthropologists come closer to a positive identification, especially if these variations are rare, therefore making them more discriminant.
Roy, Prabir K; Lall, Santosh P
Vitamin K has been known to regulate bone formation through osteocalcin synthesis by osteoblasts, which is important for mineralization and bone structure. The mechanism underlying the relationship of vitamin K with the changes of microanatomy is not fully understood, and our goal is to test whether bone deformities develop in association with vitamin K deficiency. Fish were fed a semi-purified diet containing either devoid (0.00 mg/kg diet) or adequate (40.0 mg/kg diet supplemented but 20.8 mg/kg analyzed) levels of vitamin K (menadione sodium bisulphite) for 20 weeks. At the end of 8 and 20 weeks, fish were subjected to gross examination and X-ray, and mineral content of the vertebrae was measured. The vertebrae were also subjected to histological, histomorphometric and enzyme histochemical examinations to determine the bone formation and resorption. Vitamin K deficiency primarily decreased bone mineralization and subsequently a decrease in bone mass thus resulted in an increased susceptibility to bone deformity. The occurrence of bone deformities coincided with an increased amount of osteoid tissue and decreased bone mineral content. Number of osteoblasts and osteoclasts were not affected by dietary vitamin K. In conclusion, vitamin K deficiency can impair bone mineralization and enhances bone deformities.
Sankaramanivel, S; Jeyapriya, R; Hemalatha, D; Djody, S; Arunakaran, J; Srinivasan, N
Alloys of chromium have a long history of success in the surgical treatment of many orthopaedic defects. Nonetheless, prostheses loosening are commonly found around arthoplasties due to corrosion of metals. On this basis, it is hypothesized that chromium accumulation interferes with remodeling of bone. The present study aims to analyse the toxic effects of chromium on bone phosphatases in various regions of the bone in rats. Rats were treated with chromium intraperitoneally (0.5 mg/kg) in the form of potassium dichromate for 5 days. The accumulation of chromium is approximately 5.2-fold in the vertebrae, 8.9-fold in the femur and 8.7-fold in the calvaria, when compared to control. Chromium administration significantly reduced the activity of enzymes, eg, alkaline phosphatase (ALP) and tartrate-resistant acid phosphatase (TRAP). The study revealed a significant increase in the concentration of calcium, altered bone formation rate and bone morphology in the femur, vertebrae and calvaria. The interesting findings of the current study suggest altered bone turnover.
Silva, Patrícia; Rosa, Rodrigo César; Shimano, Antonio Carlos; de Paula, Francisco José Albuquerque; Volpon, José Batista; Defino, Helton Luiz Aparecido
Objective: To determine the effect of pilot hole tapping, together with other variables such as pilot hole diameter, in relation to inner screw diameter and preparation method, on the insertion torque and pullout resistance of the screws used for anterior fixation of the cervical spine. Method: Twenty polyurethane test bodies and 30 thoracic vertebrae (T1-T5) were tested. Four holes were drilled into each test body: two of them with a diameter of 2.0 mm and two with a diameter of 2.5 mm. The holes were drilled using a bit or probe, according to the experimental group. Each experimental group was divided into two equal subgroups, with and without pilot hole tapping. In all, there were eight experimental groups: four using polyurethane specimens and four using sheep vertebrae. Cortical screws of 3.5 mm in outer diameter and 14 mm in length were inserted into the pilot holes. The insertion torque was measured during screw implantation and mechanical pullout tests were then performed using an Emic® universal testing machine, with the Tesc 3.13 software, load cells of 1000 N, force application rate of 0.2 mm/min, preloading of 5 N and accommodation time of 10 seconds. The property evaluated in the mechanical tests was the maximum pullout force. Results and Conclusion: Pilot hole tapping significantly decreased the insertion torque and pullout force of the screws in all the experimental groups. PMID:27022555
Feik, S A; Storey, E
Changes in the rate of growth, shape and structure of the 8th, 16th and 22nd caudal vertebrae of 4 and 24-27 days old Sprague-Dawley rats were studied in situ and in three different non-functional transplantation sites for 12 weeks. With increasing size, maturity and age the three vertebrae showed progressively decreasing growth, changes in shape and structural abnormalities. The smallest anlages grew faster and matured sooner than normal, so that their length equalled that of controls. Central endochondral necrosis in older bones was associated with decreased longitudinal growth but in some younger ones, despite a perforation of the cartilage and herniation of the nucleus pulposus into the marrow cavity of the shaft, growth proceeded at near normal rates. The free ends of older, larger transplants grew faster than the abutting ends joined by joint connective tissue, indicating that central necrosis of cartilage resulted from impaired nutrient diffusion. The results suggest that the cartilage model may possess an inherent capacity to produce a certain limited amount of bone tissue which may be distributed either in the form of long and thin or short and inwaisted bones, depending on the balance of forces between interstitial cartilage expansion and the restraining ensheathing periosteal-perichondrial tissues. This basic form may be modified further by functional forces. Images Fig. 2 Fig. 4 Fig. 6 Fig. 7 Fig. 8 Fig. 10 Fig. 11 Fig. 12 Fig. 9 PMID:6339456
Maroufi, Nader; Behtash, Hamid; Zekavat, Hajar; Parnianpour, Mohamad
The study design is a prospective, case–control. The aim of this study was to develop a reliable measurement technique for the assessment of lumbar spine kinematics using digital video fluoroscopy in a group of patients with low back pain (LBP) and a control group. Lumbar segmental instability (LSI) is one subgroup of nonspecific LBP the diagnosis of which has not been clarified. The diagnosis of LSI has traditionally relied on the use of lateral functional (flexion–extension) radiographs but use of this method has proven unsatisfactory. Fifteen patients with chronic low back pain suspected to have LSI and 15 matched healthy subjects were recruited. Pulsed digital videofluoroscopy was used to investigate kinematics of lumbar motion segments during flexion and extension movements in vivo. Intersegmental linear translation and angular displacement, and pathway of instantaneous center of rotation (PICR) were calculated for each lumbar motion segment. Movement pattern of lumbar spine between two groups and during the full sagittal plane range of motion were analyzed using ANOVA with repeated measures design. Intersegmental linear translation was significantly higher in patients during both flexion and extension movements at L5–S1 segment (p < 0.05). Arc length of PICR was significantly higher in patients for L1–L2 and L5–S1 motion segments during extension movement (p < 0.05). This study determined some kinematic differences between two groups during the full range of lumbar spine. Devices, such as digital videofluoroscopy can assist in identifying better criteria for diagnosis of LSI in otherwise nonspecific low back pain patients in hope of providing more specific treatment. PMID:19727854
Wen, Bingtao; Zhang, Xifeng; Zhang, Lin; Huang, Peng; Zheng, Guoquan
Abstract This study aimed to evaluate the safety and curative effect of percutaneous endoscopic transforaminal lumbar spinal canal decompression in the treatment of lumbar spinal stenosis. This retrospective study recruited 64 patients with lumbar spinal stenosis who underwent percutaneous endoscopic lumbar spinal canal decompression via surgical approach of posterolateral intervertebral foramen. The postoperation neurological function and pain status were evaluated by the visual analog scale (VAS) score of pain and the Oswestry disability index (ODI), and the patient satisfaction was evaluated according to the MacNab outcome criteria. The data, including preoperative comorbidities, operation time, the quantity of bleeding, bed rest time, and intraoperative and postoperative complications, were recorded. The mean operation time was 78 min, the mean quantity of bleeding was 20 mL and bed rest time was 6 h to 3 days. All patients were followed-up for 4 months to 5 years. The mean preoperative VAS score was 7.7 ± 1.2, while postoperative 3 months, 6 months, and final follow-up VAS scores were 2.8 ± 0.7, 2.1 ± 0.6, and 0.8 ± 0.6, respectively (P < 0.001). The mean preoperative ODI score was 72.4 ± 1.2, while postoperative 3 months, 6 months, and final follow-up ODI scores were 29.7 ± 4.9, 23.9 ± 4.0, and 12.5 ± 3.9, respectively (P < 0.001). The excellent and good rate reached 73.4% at the final follow-up. The percutaneous endoscopic transforaminal lumbar spinal canal decompression is an easy, safe, and effective minimally invasive surgery for patients with lumbar spinal stenosis. PMID:27977571
Yang, Hae-sun; Yoo, Won-gyu
[Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4–5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4–5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4–5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale scores for stretching with lumbar traction in lumbar 4–5 HIVD patients, from 18±1.29 to 2.1±1.35. The Oswestry scale scores also decreased significantly, from 20.35±2.01 to 3.5±2.84, after stretching with lumbar traction. [Conclusion] Thus, we suggest stretching with lumbar traction for lumbar 4–5 HIVD patients. PMID:25140094
Hosseini, Mostafa; Heidari, Afshin; Jafarnejad, Babak
This study is a comparison between three methods that are frequently used for the surgical treatment of pilonidal disease all over the world: modified excision and repair, wide excision and secondary repair, and wide excision and flap. The first technique is done by our group for the first time, and has not been described previously in the literature. This is an interventional study performed at Omid, Sadr, and Rasoul Akram hospitals on patients who had undergone operation because of pilonidal sinus disease and met the inclusion criteria between 2004 and 2007. Exclusion criteria were (1) acute pilonidal sinus diseases, (2) history of pilonidal sinus surgery, (3) history of systemic diseases (DM, malignancy, etc.), and (4) pilonidal abscess. Essential information was extracted from complete medical archives. Any data not available in files or during follow-up visits (all patients supposed to be followed at least for 1 year) were gathered by a telephone interview. A total of 194 patients met the criteria and had complete archived files. Longer duration of hospital stay was found in the "wide excision and closing with flap" method comparing with two other methods (P < 0.05). Length of incapacity for work was not different between the "wide excision and modified repair" and "wide excision" (P > 0.5) methods, but longer for "wide excision and flap" in comparison with two others (P < 0.05). Healing time was significantly longer in the "wide excision" method in comparison with two other methods (P < 0.05). However, "wide excision and modified repair" method had the least healing time between all above techniques, except for length of leaving the office. All the three recurrences (1.5 %) occurred in the wide excision and flap method (P < 0.05). The frequency of postoperative complications was 2 (3.3 %) in wide excision and modified repair, 15 (18.5 %) in wide excision, and 17 (32.7 %) in wide excision and flap closure; these differences in
Takeshima, Yasuhiro; Takahashi, Toshiyuki; Hanakita, Junya; Watanabe, Mizuki; Kitahama, Yoshihiro; Kuraishi, Keita; Uesaka, Toshio; Minami, Manabu; Nakase, Hiroyuki
A 39-year-old man presented with an extremely rare discal cyst at the L3-4 level manifesting as a left L4 radiculopathy. Two months after onset, he suffered right L4 radiculopathy with new lumbar disc protrusion. Five months after medical treatment, the patient's symptoms improved, and the discal cyst showed complete regression on magnetic resonance imaging. Most cases of discal cyst are surgically treated, with only two previous cases of spontaneous regression. The present case suggests clinical and radiological recovery of symptomatic lumbar discal cyst can be obtained by only conservative therapy.
Yu, Weibo; Liang, De; Yao, Zhensong; Qiu, Ting; Ye, Linqiang; Huang, Xuecheng; Jiang, Xiaobing
Abstract To determine risk factors related to recollapse of the augmented vertebrae after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral vacuum cleft (IVC). Fifty-two patients treated with PVP for single OVCFs with the IVC were retrospectively reviewed. The follow-up period was at least 2 years. Vertebral height loss ≥15% or kyphotic angle ≥10° at the final follow-up in relation to the immediately postoperative values were adopted as a definition of recollapse of the augmented vertebrae. Correlation analysis and multiple logistic regression analyses were performed to elucidate the related clinical or radiological factors for recollapse of the augmented vertebrae including age, gender, bone mineral density, preoperative fracture severity, locations of IVC sign, distribution patterns of polymethylmethacrylate (PMMA), reduction rate, and reduction angle. Assuming the increase of height loss more than 15% as a criterion of recollapse, only cleft filling pattern of PMMA in the IVC area was a significant risk factor for recollapse of the augmented vertebrae (P < 0.01). Assuming ≥10° progression of kyphotic angle as a criterion, cleft filling pattern of PMMA and higher values of reduction angle was as 2 significant risk factors for recollapse of the augmented vertebrae (P < 0.01). No significant difference was found in other clinical and radiological factors (P > 0.05). Cleft filling pattern of PMMA and higher values of reduction angle may play an important role in inducing recollapse of the augmented vertebrae after PVP for OVCFs with the IVC. Careful observation of patients with these conditions is necessary to prevent deterioration of their clinical course. PMID:28079799
Otake, Y.; Schafer, S.; Stayman, J. W.; Zbijewski, W.; Kleinszig, G.; Graumann, R.; Khanna, A. J.; Siewerdsen, J. H.
Localization of target vertebrae is an essential step in minimally invasive spine surgery, with conventional methods relying on "level counting" - i.e., manual counting of vertebrae under fluoroscopy starting from readily identifiable anatomy (e.g., the sacrum). The approach requires an undesirable level of radiation, time, and is prone to counting errors due to the similar appearance of vertebrae in projection images; wrong-level surgery occurs in 1 of every ~3000 cases. This paper proposes a method to automatically localize target vertebrae in x-ray projections using 3D-2D registration between preoperative CT (in which vertebrae are preoperatively labeled) and intraoperative fluoroscopy. The registration uses an intensity-based approach with a gradient-based similarity metric and the CMA-ES algorithm for optimization. Digitally reconstructed radiographs (DRRs) and a robust similarity metric are computed on GPU to accelerate the process. Evaluation in clinical CT data included 5,000 PA and LAT projections randomly perturbed to simulate human variability in setup of mobile intraoperative C-arm. The method demonstrated 100% success for PA view (projection error: 0.42mm) and 99.8% success for LAT view (projection error: 0.37mm). Initial implementation on GPU provided automatic target localization within about 3 sec, with further improvement underway via multi-GPU. The ability to automatically label vertebrae in fluoroscopy promises to streamline surgical workflow, improve patient safety, and reduce wrong-site surgeries, especially in large patients for whom manual methods are time consuming and error prone.
Yu, Weibo; Liang, De; Yao, Zhensong; Qiu, Ting; Ye, Linqiang; Huang, Xuecheng; Jiang, Xiaobing
To determine risk factors related to recollapse of the augmented vertebrae after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral vacuum cleft (IVC).Fifty-two patients treated with PVP for single OVCFs with the IVC were retrospectively reviewed. The follow-up period was at least 2 years. Vertebral height loss ≥15% or kyphotic angle ≥10° at the final follow-up in relation to the immediately postoperative values were adopted as a definition of recollapse of the augmented vertebrae. Correlation analysis and multiple logistic regression analyses were performed to elucidate the related clinical or radiological factors for recollapse of the augmented vertebrae including age, gender, bone mineral density, preoperative fracture severity, locations of IVC sign, distribution patterns of polymethylmethacrylate (PMMA), reduction rate, and reduction angle.Assuming the increase of height loss more than 15% as a criterion of recollapse, only cleft filling pattern of PMMA in the IVC area was a significant risk factor for recollapse of the augmented vertebrae (P < 0.01). Assuming ≥10° progression of kyphotic angle as a criterion, cleft filling pattern of PMMA and higher values of reduction angle was as 2 significant risk factors for recollapse of the augmented vertebrae (P < 0.01). No significant difference was found in other clinical and radiological factors (P > 0.05).Cleft filling pattern of PMMA and higher values of reduction angle may play an important role in inducing recollapse of the augmented vertebrae after PVP for OVCFs with the IVC. Careful observation of patients with these conditions is necessary to prevent deterioration of their clinical course.
Wang, Kai; Wang, Zhi; Huang, Weiqing
Halo congenital melanocytic nevus (CMN) associated with vitiligo is rare, especially with regard to CMN excision. Only two reports of excision of halo CMN following repigmentation of vitiligo are found in the literature. We present a case of a girl with halo CMN and periorbital vitiligo. The halo CMN was excised and followed by spontaneous improvement of vitiligo. The result suggests excision of the inciting lesion may be a promising way to control vitiligo.
Galiová, M; Kaiser, J; Novotný, K; Ivanov, M; Nývltová Fisáková, M; Mancini, L; Tromba, G; Vaculovic, T; Liska, M; Kanický, V
Double-pulse laser-induced breakdown spectroscopy (DP-LIBS) was optimized for microspatial analyses of fossil and recent snake vertebrae. As complimentary techniques, solution analysis by inductively coupled plasma mass spectrometry and synchrotron radiation X-ray microtomography was utilized in order to determine the overall concentration of the selected elements in the samples and to visualize nondestructively the fossil sample microstructure, respectively. Elemental mapping of pathological bony tissue by DP-LIBS has been proven as a powerful tool for considering the osteitis deformans phases in fossil vertebrae.
López, E; Ibarz, E; Herrera, A; Puértolas, S; Gabarre, S; Más, Y; Mateo, J; Gil-Albarova, J; Gracia, L
Osteoporotic vertebral fractures represent a major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture from bone mineral density (BMD) measurements. A previously developed model, based on the Damage and Fracture Mechanics, was applied for the evaluation of the mechanical magnitudes involved in the fracture process from clinical BMD measurements. BMD evolution in untreated patients and in patients with seven different treatments was analyzed from clinical studies in order to compare the variation in the risk of fracture. The predictive model was applied in a finite element simulation of the whole lumbar spine, obtaining detailed maps of damage and fracture probability, identifying high-risk local zones at vertebral body. For every vertebra, strontium ranelate exhibits the highest decrease, whereas minimum decrease is achieved with oral ibandronate. All the treatments manifest similar trends for every vertebra. Conversely, for the natural BMD evolution, as bone stiffness decreases, the mechanical damage and fracture probability show a significant increase (as it occurs in the natural history of BMD). Vertebral walls and external areas of vertebral end plates are the zones at greatest risk, in coincidence with the typical locations of osteoporotic fractures, characterized by a vertebral crushing due to the collapse of vertebral walls. This methodology could be applied for an individual patient, in order to obtain the trends corresponding to different treatments, in identifying at-risk individuals in early stages of osteoporosis and might be helpful for treatment decisions.
Borrell, Jordan A.; Frost, Shawn B.; Peterson, Jeremy; Nudo, Randolph J.
Objective. Spinal cord injury (SCI) is a devastating neurological trauma with a prevalence of about 282 000 people living with an SCI in the United States in 2016. Advances in neuromodulatory devices hold promise for restoring function by incorporating the delivery of electrical current directly into the spinal cord grey matter via intraspinal microstimulation (ISMS). In such designs, detailed topographic maps of spinal cord outputs are needed to determine ISMS locations for eliciting hindlimb movements. The primary goal of the present study was to derive a topographic map of functional motor outputs in the lumbar spinal cord to hindlimb skeletal muscles as defined by ISMS in a rat model. Approach. Experiments were carried out in nine healthy, adult, male, Sprague Dawley rats. After a laminectomy of the T13-L1 vertebrae and removal of the dura mater, a four-shank, 16-channel microelectrode array was inserted along a 3D (200 µm) stimulation grid. Trains of three biphasic current pulses were used to determine evoked movements and electromyographic (EMG) activity. Via fine wire EMG electrodes, stimulus-triggered averaging (StTA) was used on rectified EMG data to determine response latency. Main results. Hindlimb movements were elicited at a median current intensity of 6 µA, and thresholds were significantly lower in ventrolateral sites. Movements typically consisted of whole leg, hip, knee, ankle, toe, and trunk movements. Hip movements dominated rostral to the T13 vertebral segment, knee movements were evoked at the T13-L1 vertebral junction, while ankle and digit movements were found near the rostral L1 vertebra. Whole leg movements spanned the entire rostrocaudal region explored, while trunk movements dominated medially. StTAs of EMG activity demonstrated a latency of ~4 ms. Significance. The derived motor map provides insight into the parameters needed for future neuromodulatory devices.
... Services Excise Tax AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed rulemaking... (including qualified subchapter S subsidiaries) and the indoor tanning services excise tax. These regulations affect disregarded entities responsible for collecting the indoor tanning services excise tax and...
... 29 Labor 3 2010-07-01 2010-07-01 false Excise taxes not at the retail level. 779.263 Section 779... Coverage Excise Taxes § 779.263 Excise taxes not at the retail level. There are also a wide variety of taxes levied at the manufacturer's or distributor's level and not at the retail level. It should...
... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Federal Excise Tax-DC....229-71 Federal Excise Tax—DC Government. As prescribed in 529.401-71, insert the following clause: Federal Excise Tax—DC Government (SEP 1999) If the District of Columbia cites an Internal Revenue...
... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Federal Excise Tax-DC....229-71 Federal Excise Tax—DC Government. As prescribed in 529.401-71, insert the following clause: Federal Excise Tax—DC Government (SEP 1999) If the District of Columbia cites an Internal Revenue...
... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Federal Excise Tax-DC....229-71 Federal Excise Tax—DC Government. As prescribed in 529.401-71, insert the following clause: Federal Excise Tax—DC Government (SEP 1999) If the District of Columbia cites an Internal Revenue...
... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Federal Excise Tax-DC....229-71 Federal Excise Tax—DC Government. As prescribed in 529.401-71, insert the following clause: Federal Excise Tax—DC Government (SEP 1999) If the District of Columbia cites an Internal Revenue...
... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Federal Excise Tax-DC....229-71 Federal Excise Tax—DC Government. As prescribed in 529.401-71, insert the following clause: Federal Excise Tax—DC Government (SEP 1999) If the District of Columbia cites an Internal Revenue...
Wadhwa, Rishi; Theodore, Pierre; Mummaneni, Praveen
Chondrosarcomas are cartilage-matrix-forming tumors that make up 20-27% of primary malignant bone tumors and are the third most common primary bone malignancy after multiple myelomas and osteosarcomas. Radiographic assessment of this condition includes plain radiography, computed tomography, and magnetic resonance imaging for tumor characterization and delineation of intraosseous and extraosseous involvement. Most chondrosarcomas are refractory to chemotherapy and radiation therapy; therefore, wide en bloc surgical excision offers the best chance for cure. Chondrosarcomas frequently affect the pelvis and upper and lower extremities. In rare instances, the chest wall can be involved, with chondrosarcomas occurring in the ribs, sternum, anterior costosternal junction, and posterior costotransverse junction. In this article, we present a patient with thoracic chondrosarcoma centered at the left T7 costotransverse joint with effacement of the left T7-T8 neuroforamen. We also detail our operative technique of wide en bloc chondrosarcoma excision and review current literature on this topic. PMID:27588229
Fagbemi, Adebanke F.; Orelli, Barbara; Schärer, Orlando D.
Nucleotide excision repair (NER) is a DNA repair pathway that is responsible for removing a variety of lesions caused by harmful UV light, chemical carcinogens, and environmental mutagens from DNA. NER involves the concerted action of over 30 proteins that sequentially recognize a lesion, excise it in the form of an oligonucleotide, and fill in the resulting gap by repair synthesis. ERCC1-XPF and XPG are structure-specific endonucleases responsible for carrying out the incisions 5′ and 3′ to the damage respectively, culminating in the release of the damaged oligonucleotide. This review focuses on the recent work that led to a greater understanding of how the activities of ERCC1-XPF and XPG are regulated in NER to prevent unwanted cuts in DNA or the persistence of gaps after incision that could result in harmful, cytotoxic DNA structures. PMID:21592868
Daniltchenko, Dmitri I.; Kastein, Albrecht; Koenig, Frank; Sachs, Markus; Schnorr, Dietmar; Al-Shukri, Salman; Loening, Stefan A.
To evaluate the potential of reflectance confocal scanning laser microscopy (CM) for rapid imaging of non-processed freshly excised human bladder biopsies and cystectomy specimens. Freshly excised bladder tumors from three cystectomy specimens and random biopsies from twenty patients with a history of superficial bladder tumors were imaged with CM. Additional acetic acid washing prior to CM imaging was performed in some of the samples. Confocal images were compared to corresponding routine histologic sections. CM allows imaging of unprocessed bladder tissue at a subcellular resolution. Urothelial cell layers, collagen, vessels and muscle fibers can be rapidly visualized, in native state. In this regard, umbrella cells, basement membrane elucidated. Besides obvious limitations partly due to non-use of exogenous dyes, CM imaging offers several advantages: rapid imaging of the tissue in its native state like the basement membrane, normally seen only by using immunohistopathology. Reflectance CM opens a new avenue for imaging bladder cancer.
DeCicca, Philip; Kenkel, Donald; Liu, Feng
We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower-tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20 percent smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes. PMID:24140760
Straatsma, TP; McCammon, J A; Miller, John H; Smith, Paul E; Vorpagel, Erich R; Wong, Chung F; Zacharias, Martin W
The goal of the Biomolecular Simulation of Base Excision Repair and Protein Signaling project is to enhance our understanding of the mechanism of human polymerase-β, one of the key enzymes in base excision repair (BER) and the cell-signaling enzymes cyclic-AMP-dependent protein kinase. This work used molecular modeling and simulation studies to specifically focus on the • dynamics of DNA and damaged DNA • dynamics and energetics of base flipping in DNA • mechanism and fidelity of nucleotide insertion by BER enzyme human polymerase-β • mechanism and inhibitor design for cyclic-AMP-dependent protein kinase. Molecular dynamics simulations and electronic structure calculations have been performed using the computer resources at the Molecular Science Computing Facility at the Environmental Molecular Sciences Laboratory.
Al-Qattan, M M; Arafah, M M
Nodular fasciitis is an extremely rare benign fibrous tumour of the hand. Although benign, the tumour is frequently adherent to tendons/nerves and joints of the hand. However, the tumour may spontaneously regress and does not tend to recur following excision with histologically positive margins. For the last 20 years, the author has adopted a specific management approach for these and other benign fibrous tumours of the hand. Following the clinical/radiological diagnosis, tumour excision is done preserving 'vital' structures within the hand. The diagnosis is confirmed histologically and by immune stains, and the patient is then followed up for local recurrence. Over a 20-year period, the author has treated four cases of nodular fasciitis of the hand using this management approach. Despite the positive margins in all cases, there were no recurrences at a minimum follow-up interval of 3 years.
Zhen, Chen; Xia, Zhang; Long, Li; Lishuang, Ma; Pu, Yu; Wenjuan, Zheng; Xiaofan, Li
In 1723, Vater first described choledochal cyst and in 1977, Todani et al classified this disease. For many years, open excision (OP) as the standard procedure made a great impact in the treatment of choledochal cyst. Since 1995, when Farello et al first reported laparoscopic choledochal cyst excision, laparoscopic excision (LA) has been used worldwide. However, its safety remains a major concern. The aim of this meta-analysis was to compare OP with LA in treating choledochal cyst and then to determine whether LA is safe and valid. The design of this study involved systematic review and meta-analysis. Data sources were Medline, Ovid, Elsevier, Google Scholar, Embase, and Cochrane library. The study selection entailed comparative cohort studies. For data extraction, 2 investigators independently assessed selected studies and extracted the following information: study characteristics, quality, outcomes data, etc. For the results, 7 comparative cohort studies about the effectiveness of LA compared with OP were performed meta-analysis. The results showed that although the LA group had a longer operative time (MD = 56.57; 95% CI = 32.20-80.93; P < 0.00001), LA had a shorter duration of hospital stay (MD = -1.93; 95% CI = -2.51 to -1.36; P < 0.00001), and recovery of bowel function (MD = -0.94; 95% CI = -1.33 to -0.55; P < 0.00001). Meta-analysis found no significant difference between most of the 2 groups: bile leak (RR = 0.60; 95% CI = 0.29-1.24; P = 0.17), abdominal bleeding (RR = 0.33; 95% CI = 0.01-8.98; P = 0.51), pancreatitis (RR = 0.26, 95% CI = 0.06-1.03; P = 0.06), total postoperative complications (RR = 1.04; 95% CI = 0.66-1.62; P = 0.88). The LA group had significant lower rates in intraoperative blood transfusion (RR = 0.20; 95% CI = 0.11-0.38; P < 0.00001), and adhesive intestinal obstruction (RR = 0.17, 95% CI = 0.04-0.77; P = 0.02). In conclusion, compared with open excision, laparoscopic excision is a safe, valid, and feasible alternative to open
Thapar, Upasna; Demple, Bruce
Since the discovery of the base excision repair (BER) system for DNA more than 40 years ago, new branches of the pathway have been revealed at the biochemical level by in vitro studies. Largely for technical reasons, however, the confirmation of these subpathways in vivo has been elusive. We review methods that have been used to explore BER in mammalian cells, indicate where there are important knowledge gaps to fill, and suggest a way to address them. PMID:28357058
Parikh, S S; Mol, C D; Hosfield, D J; Tainer, J A
Recent breakthroughs integrate individual DNA repair enzyme structures, biochemistry and biology to outline the structural cell biology of the DNA base excision repair pathways that are essential to genome integrity. Thus, we are starting to envision how the actions, movements, steps, partners and timing of DNA repair enzymes, which together define their molecular choreography, are elegantly controlled by both the nature of the DNA damage and the structural chemistry of the participating enzymes and the DNA double helix.
vanMeter, James R.; Fiske, David R.; Misner, Charles W.
We study the numerical propagation of waves through future null infinity in a conformally compactified spacetime. We introduce an artificial cosmological constant, which allows us some control over the causal structure near null infinity. We exploit this freedom to ensure that all light cones are tilted outward in a region near null infinity, which allows us to impose excision-style boundary conditions in our finite difference code. In this preliminary study we consider electromagnetic waves propagating in a static, conformally compactified spacetime.
Thapar, Upasna; Demple, Bruce
Since the discovery of the base excision repair (BER) system for DNA more than 40 years ago, new branches of the pathway have been revealed at the biochemical level by in vitro studies. Largely for technical reasons, however, the confirmation of these subpathways in vivo has been elusive. We review methods that have been used to explore BER in mammalian cells, indicate where there are important knowledge gaps to fill, and suggest a way to address them.
Shen, Yi; Cheng, Lixin; Tang, Ming
Laryngeal interarytenoid neurilemmomas (LIN) is a benign encapsulated tumor originating from the schwann cells lining nerve fibers. Even though LINs are extremely rare in incidence, they could present with potential threat to the airway and thus requiring prompt diagnosis and treatment. Here, we report two cases of LINs. Both patients underwent excision of the tumor via microlaryngeal endoscopic procedures and recovered well postoperatively without complications. No recurrence was observed postoperatively on routine follow-up after 14 months.
Qiang, Lei; Zhao, Baozhong; Shah, Palak; Sample, Ashley; Yang, Seungwon; He, Yu-Ying
Macroautophagy (hereafter autophagy) is a cellular catabolic process that is essential for maintaining tissue homeostasis and regulating various normal and pathologic processes in human diseases including cancer. One cancer-driving process is accumulation of genetic mutations due to impaired DNA damage repair, including nucleotide excision repair. Here we show that autophagy positively regulates nucleotide excision repair through enhancing DNA damage recognition by the DNA damage sensor proteins XPC and DDB2 via 2 pathways. First, autophagy deficiency downregulates the transcription of XPC through TWIST1-dependent activation of the transcription repressor complex E2F4-RBL2. Second, autophagy deficiency impairs the recruitment of DDB2 to ultraviolet radiation (UV)-induced DNA damage sites through TWIST1-mediated inhibition of EP300. In mice, the pharmacological autophagy inhibitor Spautin-1 promotes UVB-induced tumorigenesis, whereas the autophagy inducer rapamycin reduces UVB-induced tumorigenesis. These findings demonstrate the crucial role of autophagy in maintaining proper nucleotide excision repair in mammalian cells and suggest a previously unrecognized tumor-suppressive mechanism of autophagy in cancer.
A method for measuring DNA excision repair in response to ultraviolet radiation (UV)-induced DNA damage has been developed, validated, and field-tested in cultured human lymphocytes. The methodology is amenable to population-based screening and should facilitate future epidemiologic studies seeking to investigate associations between excision repair proficiency and cancer susceptibility. The impetus for such endeavors derives from the belief that the high incidence of skin cancer in the genetic disorder xeroderma pigmentosum (XP) primarily is a result of the reduced capacity of patients cells to repair UV-induced DNA damage. For assay, UV-irradiated non-replicating recombinant plasmid DNA harboring a chloramphenicol acetyltransferase (CAT) indicator gene is introduced into lymphocytes using DEAE-dextran short-term transfection conditions. Exposure to UV induces transcriptionally-inactivating DNA photoproducts in the plasmid DNA which inactivate CAT gene expression. Excision repair of the damaged CAT gene is monitored indirectly as a function of reactivated CAT enzyme activity following a 40 hour repair/expression incubation period.
Evdokimov, Alexey; Petruseva, Irina; Tsidulko, Aleksandra; Koroleva, Ludmila; Serpokrylova, Inna; Silnikov, Vladimir; Lavrik, Olga
DNA probes for the studies of damaged strand excision during the nucleotide excision repair (NER) have been designed using the novel non-nucleosidic phosphoramidite reagents that contain N-[6-(9-antracenylcarbamoyl)hexanoyl]-3-amino-1,2-propandiol (nAnt) and N-[6-(5(6)-fluoresceinylcarbamoyl)hexanoyl]-3-amino-1,2-propandiol (nFlu) moieties. New lesion-imitating adducts being inserted into DNA show good substrate properties in NER process. Modified extended linear nFlu– and nAntr–DNA are suitable for estimation of specific excision activity catalysed with mammalian whole-cell extracts. The following substrate activity range was revealed for the model 137-bp linear double-stranded DNA: nAnt–DNA ≈ nFlu–DNA > Chol–DNA (Chol–DNA—legitimate NER substrate that contains non-nucleoside fragment bearing cholesterol residue). In vitro assay shows that modified DNA can be a useful tool to study NER activity in whole-cell extracts. The developed approach should be of general use for the incorporation of NER-sensitive distortions into model DNAs. The new synthetic extended linear DNA containing bulky non-nucleoside modifications will be useful for NER mechanism study and for applications. PMID:23609543
Felbaum, Daniel R; Stewart, Jeffrey J; Sandhu, Faheem A
Objective: Tandem cervical and lumbar spinal stenosis (TSS) is classically described as intermittent claudication, gait disturbance, and clinical findings of mixed myelopathy and polyradiculopathy. Rarely, patients can present with TSS manifesting in isolated lumbar pain. Several reports have demonstrated improved lumbar back pain and radiculopathy after decompressive cervical spine procedures. We present six patients with dramatic resolution of lumbar spine related symptoms after decompression of the cervical spinal cord despite presenting solely with lower back complaints. Methods: Clinical records of the senior author (F.A.S.) gathered from April 2006 to March 2013 were retrospectively reviewed identifying six patients presenting solely with lumbar symptoms and diagnosed with TSS based on history and physical examination. Results: Six patients with a mean age of 55 (range 39 to 60) presented with solely lower back symptoms and clinical findings suspicious for TSS. Mean follow-up time for all patients was 12 months (range three to 27 months, median 11.5 months). Three patients underwent a cervical procedure as the principal operation, while the remainder had the lumbar spine decompressed initially. All patients that underwent a cervical procedure initially experienced a dramatic decrease or complete resolution of their preoperative lower back pain and radiculopathy (mean preoperative VAS of 6.7 vs. 3.7 postoperative). The remainder of patients with persistent lumbar symptoms resolved after a subsequent cervical operation. Conclusion: Patients presenting with lumbar symptoms out of proportion to imaging require further investigation. We highlight the resolution of lumbar symptoms after a cervical procedure in a select group of patients presenting with lone lower back complaints. In patients presenting with symptoms disproportionate to lumbar imaging, treatment of cervical pathology may provide robust long-term relief of the initial lumbar-related presentation
Kasahara, Satoshi; Miyamoto, Kenji; Takahashi, Mitsuhiko; Yamanaka, Masanori; Takeda, Naoki
This study assessed the relationship of each movement direction on the lumbar spine and on the pelvis in regards to lumbar-pelvic coordination in the sitting position. Lumbar and pelvic motions were recorded using a flexible electrogoniometer in 12 healthy subjects during two different tasks in the sitting position. The coordination of the lumbar spine and pelvis was evaluated using the ratio of lumbar and pelvic angles (L/P ratio hereafter) in three motion phases. There were significant differences in the L/P ratio values between during the "forward bending" and "rising from a forward flexed position" phases (P<0.01). The L/P ratio value ( approximately -0.7) was consistent during the movement from an erect to a slumped sitting position as the lumbar spine and pelvis moved in opposing directions. This study shows that lumbar-pelvic coordination occurs in the sitting position. Lumbar-pelvic coordination is confirmed even if the movement tasks are different in the sitting position, and these findings show that aspects of a particular movement are dependent on the given movement task. These findings may provide greater insight into the kinematic changes involved in lumber-pelvic coordination, and help clinicians implement sitting exercises conducive to the independence of the patient.
... 49 Transportation 7 2010-10-01 2010-10-01 false Lumbar spine and pelvis. 572.115 Section 572.115... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) ANTHROPOMORPHIC TEST DEVICES Side Impact Hybrid Dummy 50th Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for...
Cho, Newton; Keith, Julia; Pirouzmand, Fahard
Lumbar discal cysts are rare entities causing radicular pain with unknown etiologies. We report a case of a 42-year-old man who developed radiculopathy secondary to a lumbar discal cyst. Our case sheds some light on anatomy, possible etiological association and clinical course which can help management.
... Lumbar spine flexure. (a) When subjected to continuously applied force in accordance with paragraph (b... degrees at a force level of not less than 18 pounds and not more than 22 pounds, and straighten upon removal of the force to within 5 degrees of its initial position. (b) Test procedure. (1) The lumbar...
... Lumbar spine flexure. (a) When subjected to continuously applied force in accordance with paragraph (b... degrees at a force level of not less than 18 pounds and not more than 22 pounds, and straighten upon removal of the force to within 5 degrees of its initial position. (b) Test procedure. (1) The lumbar...
Gabrielsen, T.O.; Gebarski, S.S.; Knake, J.E.; Latack, J.T.; Yang, P.J.; Hoff, J.T.
Lumbar myelography was performed in 50 patients; 25 received iohexol and 25 received metrizamide. The two media produced radiographs of equal quality. However, iohexol is stable in solution, while metrizamide is not. Further, markedly less morbidity resulted from iohexol. These features indicate that iohexol may be superior to metrizamide as a contrast agent for lumbar myelography.
Papadokostakis, Georgios; Stergiopoulos, Konstantinos; Kampanis, Nikos; Katonis, Pavlos
The curvature of the lumbar spine and the risk of developing either osteoporosis (OP) or osteoarthritis (OA) are influenced by many common factors. The aim of this study is to determine whether lumbar lordosis is different between patients with either disease and healthy persons. A cross-sectional, blinded, controlled design was implemented. One hundred and twelve postmenopausal women were evaluated for bone mineral density as well as undergoing spinal radiography. Lordosis measurement was performed with Cobb’s method. The sample was divided in four groups: patients with OP (n = 34, L1–L5 = 40.7°, L1–S1 = 54.1°), patients with OA (n = 29, L1–L5 = 38°, L1–S1 = 52.3°), patients with both diseases (n = 20, L1–L5 = 41.8°, L1–S1 = 52.3°) and controls (n = 29, L1–L5 = 38.6°, L1–S1 = 51.8°). For all participants age, height, weight, body mass index, physical activity level and basal metabolic rate were measured and recorded. The results revealed that although the four groups have significant constitutional differences, lumbar lordosis was comparable between them. The reasons for the lack of association are discussed. PMID:19089464
Estrada, James A; Rice, Aaron N; Natanson, Lisa J; Skomal, Gregory B
We conducted stable 13C and 15N analysis on white shark vertebrae and demonstrated that incremental analysis of isotopes along the radius of a vertebral centrum produces a chronological record of dietary information, allowing for reconstruction of an individual's trophic history. Isotopic data showed significant enrichments in 15N with increasing sampling distance from the centrum center, indicating a correlation between body size and trophic level. Additionally, isotopic values verified two distinct ontogenetic trophic shifts in the white shark: one following parturition, marking a dietary switch from yolk to fish; and one at a total length of >341 cm, representing a known diet shift from fish to marine mammals. Retrospective trophic-level reconstruction using vertebral tissue will have broad applications in future studies on the ecology of threatened, endangered, or extinct species to determine life-long feeding patterns, which would be impossible through other methods.
KURAMOCHI, Mizuki; IZAWA, Takeshi; HORI, Mayuka; KUSUDA, Kayo; SHIMIZU, Junichiro; ISERI, Toshie; AKIYOSHI, Hideo; OHASHI, Fumihito; KUWAMURA, Mitsuru; YAMATE, Jyoji
A 19-year-old female Bengal tiger (Panthera tigris tigris) was presented with hind limb weakness, ataxia and respiratory distress. Computed tomography revealed a mass between the left side of the T7 vertebra and the base of the left 7th rib. The tiger then died, and necropsy was performed. Grossly, the vertebral mass was 6 × 5.7 × 3 cm, and invaded the adjacent vertebral bone and compressed the T7 spinal cord. Histologically, the mass was composed of large, clear, vacuolated and polygonal cells with osteochondral matrix. Cellular and nuclear atypia were moderate. The vacuolated cells stained positively for cytokeratin and vimentin and negatively for S-100. Based on these findings, the present case was diagnosed as a vertebral chordoma; the first report in a tiger. PMID:25766770
Kuramochi, Mizuki; Izawa, Takeshi; Hori, Mayuka; Kusuda, Kayo; Shimizu, Junichiro; Iseri, Toshie; Akiyoshi, Hideo; Ohashi, Fumihito; Kuwamura, Mitsuru; Yamate, Jyoji
A 19-year-old female Bengal tiger (Panthera tigris tigris) was presented with hind limb weakness, ataxia and respiratory distress. Computed tomography revealed a mass between the left side of the T7 vertebra and the base of the left 7th rib. The tiger then died, and necropsy was performed. Grossly, the vertebral mass was 6 × 5.7 × 3 cm, and invaded the adjacent vertebral bone and compressed the T7 spinal cord. Histologically, the mass was composed of large, clear, vacuolated and polygonal cells with osteochondral matrix. Cellular and nuclear atypia were moderate. The vacuolated cells stained positively for cytokeratin and vimentin and negatively for S-100. Based on these findings, the present case was diagnosed as a vertebral chordoma; the first report in a tiger.
Siegel, Michael; Grundman, Jody; DeJong, William; Naimi, Timothy S; King, Charles; Albers, Alison B; Williams, Rebecca S; Jernigan, David H
The authors investigated the relationship between state excise taxes and liquor prices in 8 states, using 2012 data for 45 brands. The authors made 6042 price observations among 177 liquor stores with online prices. Using a hierarchical model, the authors examined the relationship between excise taxes and product prices. State excise taxes were significantly related to liquor prices, with an estimated pass-through rate of 0.93. The proportion of price accounted for by excise taxes averaged 7.0%. The authors find that excise taxes do increase the price of alcohol, but states are not taking advantage of this opportunity to reduce alcohol-related morbidity and mortality.
Petty, P G; Hudgson, P; Hare, W S
It is generally accepted that chronic adhesive lumbar arachnoiditis is a cause of symptoms, notably back pain and/or pain (of almost any type, not necessarily 'anatomical') in the lower limbs, although there is no clearly defined clinical pattern which is clearly associated with this syndrome. There is no doubt that arachnoiditis occurs as a pathological and radiological entity due to a number of causes. In the view of the present authors, the nexus between the pathology and radiology on the one hand, and the patients' symptoms on the other hand, has not been demonstrated with any degree of scientific rigor.
Mendez, Jorge S; Huete, Isidro L; Tagle, Patricio M
We evaluated the fractures of the lumbar and sacral vertebral limbus by disc impingement at the peripheral ring apophysis in 23 adults associated with trauma in 16 of them. Lumbalgia, radicular pain and narrow canal symptoms are the presenting forms of this underdiagnosed pathology. CT is the best method of examination, while plain roentgenograms and MR are usually negative. Accurate diagnosis and surgical technique with larger exposure are needed to resect the fractured fragments and protruded disc material for decompressing the roots and the dural sac. Our results were very good on the majority of cases.
Thomsen, Thomas Laden; Roeder, Ole
Avoiding exposure of extremities to cold combined with pharmacologic treatment usually suffice in the attempt to suppress the related symptoms of Raynaud's syndrome. This case report describes a severe case of Raynaud's syndrome affecting the lower extremities of a 16-year-old female. She was referred to a centre of vascular surgery with severe vasospasms of the feet. After failed attempts of pharmacologic treatment, a laparoscopic lumbar sympathectomy was performed with no complications and a slight reduction of symptoms three years post-surgically.
Cugati, Goutham; Pande, Anil; Jain, Pradeep K; Symss, Nigel Peter; Ramamurthi, Ravi; Vasudevan, Chakravarthy M
An aneurysmal bone cyst (ABC) is a benign, locally proliferative vascular disorder of non-neoplastic osseous lesions in children and young adults. Seventy-five percent of ABCs occur before the age of 20 years. They comprise 1.4% of all primary bone tumors, and commonly occur in the long bones. Spinal ABCs are much rarer. We present to you one such rare case of ABC involving the lumbar spine which was successfully treated with surgery. The clinical pathological and radiological features are described. The treatment options available are discussed.
Ahmadnia, Hassan; Kamalati, Ali; Younesi Rostami, Mehdi; Imani, Mohammad Mehdi; Asadpour, Amir Abbas; Hariri, Mohammad Kazem
BACKGROUND Current surgical treatments in Peyronie’s disease are accompanied by complications such as penile shortening, loss of sensation, erectile dysfunction and recurrence of disease. The aim of this study was the evaluation of clinical results of intracavernosal plaque excision in Peyronie’s disease. METHODS The operation was performed on 35 men. It was consisted of incising the tunica albuginea parallel to the plaque and through this incision, and the plaque was removed from the inside surface without excision or replacing the underlying tunica albuginea by grafts. All patients were evaluated before and periodically within 12 months after the surgery with measurement of penile length, curvature angle in the rigidity phase, and sexual satisfaction. RESULTS The mean age of patients was 51.4±5.3 years (range 42-59 years). The angle of penile curvature was 25-45° (mean=35°). Thirty patients (86%) obtained a nearly complete straightening of penis. All patients restored their previous penile length without any disorder of sensation within the glans penis and expressed improvement of sexual activity. CONCLUSION Intracavernosal plaque excision is a simple, easy and minimal invasive method that does not result in penile shortening, loss of sensation or erectile dysfunction. In properly selected patients, this technique can lead to acceptable elimination of penile curvature and sexual satisfaction. PMID:27308243
Kurata, Kosaku; Higaki, Hidehiko; Miura, Hiromasa; Mawatari, Taro; Murakami, Teruo; Iwamoto, Yukihide
Bone tissue stresses in mechanically loaded vertebrae were computationally investigated in order to reveal the influences of adaptive remodeling/modeling on stress distribution. Morphological alteration of the rat fifth caudal vertebrae was periodically and non-invasively measured with a microcomputed tomography (micro-CT). Von Mises stresses were calculated by using a finite element analysis (FEA) together with rigid-body spring models based on the consecutive micro-CT images. Median cross-sectional area periodically increased in the loaded rats depending on the duration of stimuli, which was caused by periosteal woven bone formation. FEA including the newly formed bone demonstrated that the loaded vertebrae showed the lower stress levels compared with non-loaded one. Averaged stress of the offset-loaded rat was markedly symmetry between ventral and dorsal sides under offset loading condition, while that of the non-loaded rat indicated asymmetry. Stress analyses suggested that the loaded vertebrae would adapt to the daily mechanical loading by depositing and calcifying woven bone over periosteum.
Scharer, Rachel M; Patterson, William F; Carlson, John K; Poulakis, Gregg R
Endangered smalltooth sawfish (Pristis pectinata) were opportunistically sampled in south Florida and aged by counting opaque bands in sectioned vertebrae (n=15). Small sample size precluded traditional age verification, but fish collected in spring and summer had translucent vertebrae margins, while fish collected in winter had opaque margins. Trends in Sr:Ca measured across vertebrae with laser ablation-inductively coupled plasma-mass spectrometry corresponded well to annual salinity trends observed in sawfish estuarine nursery habitats in south Florida, thus serve as a chemical marker verifying annual formation of opaque bands. Based on that finding and assumptions about mean birth date and timing of opaque band formation, estimated age ranged from 0.4 y for a 0.60 m total length (TL) male to 14.0 y for a 4.35 m TL female. Von Bertalanffy growth parameters computed from size at age data were 4.48 m for L(∞), 0.219 y(-1)for k, and -0.81 y for t(0). Results of this study have important implications for sawfish conservation as well as for inferring habitat residency of euryhaline elasmobranchs via chemical analysis of vertebrae.
Scharer, Rachel M.; Patterson III, William F.; Carlson, John K.; Poulakis, Gregg R.
Endangered smalltooth sawfish (Pristis pectinata) were opportunistically sampled in south Florida and aged by counting opaque bands in sectioned vertebrae (n = 15). Small sample size precluded traditional age verification, but fish collected in spring and summer had translucent vertebrae margins, while fish collected in winter had opaque margins. Trends in Sr:Ca measured across vertebrae with laser ablation-inductively coupled plasma-mass spectrometry corresponded well to annual salinity trends observed in sawfish estuarine nursery habitats in south Florida, thus serve as a chemical marker verifying annual formation of opaque bands. Based on that finding and assumptions about mean birth date and timing of opaque band formation, estimated age ranged from 0.4 y for a 0.60 m total length (TL) male to 14.0 y for a 4.35 m TL female. Von Bertalanffy growth parameters computed from size at age data were 4.48 m for L∞, 0.219 y−1for k, and −0.81 y for t0. Results of this study have important implications for sawfish conservation as well as for inferring habitat residency of euryhaline elasmobranchs via chemical analysis of vertebrae. PMID:23082225
Dzukaev, D N; Dreval', O N; Sidorenko, V V; Siviakov, A A; Khoreva, N E
The paper describes a case of successful treatment in a patient with third-grade fracture of the dens of the second cervical vertebra with transdental posterior subluxation. According to the treatment policy chosen, posterior upper cervical spine stabilization and anterior upper spinal cord decompression that was supplemented by anterior cervical spondylodesis were performed in the early period.
Kim, Han Myun; Kim, Hyo-Cheol Woo, Sungmin; Son, Kyu Ri; Cho, Seong Whi; Chung, Jin Wook
PurposeTo describe the radiologic findings and imaging response of hepatocellular carcinoma (HCC) supplied by the lumbar artery.MethodsBetween April 2004 and December 2012, we encountered HCC supplied by a lumbar artery in 21 patients. Two investigators retrospectively reviewed clinical and radiological findings of HCC supplied by the lumbar artery using computed tomography (CT) scans and digital subtraction angiograms.ResultsPatients had received 1–27 sessions of previous chemoembolization procedures (mean 7.7 sessions, median 4 sessions). Mean tumor size was 5.3 cm. The locations of HCC supplied by lumbar artery were the bare area (n = 14, 67 %) and segment VI (n = 7, 33 %). Tumor-feeding arteries arose from the main lumbar artery (n = 7), proximal anterior division (n = 4), and distal anterior division (n = 14). In 20 patients, selective chemoembolization through the tumor-feeding arteries of the lumbar artery was achieved. In 1 patient, nonselective embolization at the main lumbar artery was performed. There was no complication such as skin necrosis or paralysis. On the first follow-up enhanced CT scan, target tumors fed by the lumbar artery showed complete response (n = 6), partial response (n = 4), stable disease (n = 3), and progressive disease (n = 8), but overall tumor response was partial response (n = 1) and progressive disease (n = 20).ConclusionWhen HCC is located in the inferior tip or bare area of the liver, a lumbar artery may supply the tumor. Although selective chemoembolization via the tumor-feeding vessel of the lumbar artery can be achieved in most cases, overall tumor response is commonly unfavorable.
Alkan, Özer; Aydoğan, Cihan; Akkaya, Sevil
Introduction: Cervical vertebral maturation (CVM) methods have gained popularity to assess growth and development status for orthodontic patients. Although craniofacial and craniocervical structures are known to be associated, there is no evidence in the literature if this relation might negatively affect the accuracy of CVM assessments. Therefore, this study aimed to comparatively investigate the sizes of the 2nd, 3rd, and 4th cervical vertebrae in adult females (radius union stage of skeletal maturity) who have different sagittal skeletal patterns. Materials and Methods: A cross-sectional study was conducted, and 151 lateral cephalometric radiographs of adult female patients were assessed in the study. Patients were assigned to three groups according to ANB angle. Parameters including concavity depth at the lower border of the 2nd, 3rd, and 4th cervical vertebrae and base length, upper border length, body length, posterior height, anterior height, and body height of the 3rd and 4th cervical vertebrae bodies were measured. One-way analysis of variance was used for between-group comparisons. Results: No statistically significant differences were found between groups in terms of concavity depth at the lower borders of the 2nd, 3rd, and 4th cervical vertebrae (P > 0.05). Base length, upper border length, body length, posterior height, anterior height, and body height of the 3rd and 4th cervical vertebrae were also similar between groups (P > 0.05). Conclusions: The results of this study supports that sagittal craniofacial pattern has no effect on the accuracy of using the methods assessing CVM and calculating cervical vertebral age. PMID:27630474
Witten, P Eckhard; Gil-Martens, Laura; Hall, Brian K; Huysseune, Ann; Obach, Alex
Anterior/posterior (a/p) compression of the vertebral column, referred to as 'short tails', is a recurring event in farmed Atlantic salmon. Like other skeletal deformities, the problem usually becomes evident in a late life phase, too late for preventive measures, making it difficult to understand the aetiology of the disease. We use structural, radiological, histological, and mineral analyses to study 'short tail' adult salmon and to demonstrate that the study of adult fish can provide important insights into earlier developmental processes. 'Short tails' display a/p compressed vertebrae throughout the spine, except for the first post-cranial vertebrae. The vertebral number is unaltered, but the intervertebral space is reduced and the vertebrae are shorter. Compressed vertebrae are characterized by an unchanged central part, altered vertebral end plates (straight instead of funnel-shaped), an atypical inward bending of the vertebral edges, and structural alterations in the intervertebral tissue. The spongiosa is unaffected. The growth zones of adjacent vertebrae fuse and blend towards the intervertebral space into chondrogenic tissue. This tissue produces different types of cartilage, replacing the notochord. The correspondence in location of intervertebral cartilage and deformed vertebral end plates, and the clearly delimited, unaltered, central vertebral parts suggest that the a/p compression of vertebral bodies is a late developmental disorder that may be related to a metaplastic shift of osteogenic tissue into chondrogenic tissue in the vertebral growth zone. Given the lack of evidence for infections, metabolic disorders and/or genetic disorders, we propose that an altered mechanical load could have caused the transformation of the bone growth zones and the concomitant replacement of the intervertebral (notochord) tissue by cartilaginous tissues in the 'short tails' studied here. This hypothesis is supported by the role that notochord cells are known to play
Study Design. Descriptive study, stratified sampling. Objective. Using dynamic computed tomographic perfusion (CTP) to explore the age-related distribution patterns of the microcirculation perfusion in the vertebral marrow, the vertebral bone mineral density (BMD), and the intervertebral discal degeneration (IDD) further to discuss the possible causation between them. Summary of Background Data. A latest viewpoint deemed that reduced blood supply of the vertebral marrow was correlated with an increased incidence of IDD and loss of BMD. However, the causative relationship between them needs more investigation. Methods. One hundred eighty-six general people were randomly enrolled by stratified sampling and grouped by age: 15 years or less, 16 to 25 years, 26 to 35 years, 36 to 45 years, 46 to 55 years, 56 to 65 years, 66 to 75 years, and 76 years or more. Both CTP and BMD of the third and fourth lumbar vertebral marrow were measured, and the IDD incidence of the third-fourth vertebrae was assessed. The temporal-spatial distribution patterns of the age-related changes of CTP, BMD, and IDD were described, and the correlations between them were calculated. Results. Microcirculatory perfusion of the vertebral marrow developed to maturate by 25 years, maintained stable at 35 years, and then declined by age after 35 years. BMD grew to a peak phase in 26 to 45 years and then dropped by years. However, IDD presented a sudden increase after 45 years of age. CTP (blood flow [r = 0.806], blood volume [r = 0.685], and permeability [r = 0.619]) showed strong positive correlations and CTP (time to peak [r = −0.211], mean transit time [r = −0.598]) showed negative correlations with BMD. Meanwhile, CTP (blood flow [r = −0.815], blood volume [r = −0.753], and permeability [r = −0.690]) had strong negative correlations and CTP (time to peak [r = 0.323] and mean transit time [r = 0.628]) had positive correlations with the incidence of IDD. Conclusion. Aging-related decrease
Bader, R J; Steinhauser, E; Rechl, H; Mittelmeier, W; Bertagnoli, R; Gradinger, R
In addition to autogenous or allogeneic bone grafts, fusion cages composed of metal or plastic are being used increasingly as spacers for interbody fusion of spinal segments. The goal of this study was the mechanical testing of carbon fiber reinforced plastic (CFRP) fusion cages used for anterior lumbar interbody fusion. With a special testing device according to American Society for Testing and Materials (ASTM) standards, the mechanical properties of the implants were determined under four different loading conditions. The implants (UNION cages, Medtronic Sofamor Danek) provide sufficient axial compression, shear, and torsional strength of the implant body. Ultimate axial compression load of the fins is less than the physiological compression loads at the lumbar spine. Therefore by means of an appropriate surgical technique parallel grooves have to be reamed into the endplates of the vertebral bodies according to the fin geometry. Thereby axial compression forces affect the implants body and the fins are protected from damaging loading. Using a supplementary anterior or posterior instrumentation, in vivo failure of the fins as a result of physiological shear and torsional spinal loads is unlikely. Due to specific complications related to autogenous or allogeneic bone grafts, fusion cages made of metal or carbon fiber reinforced plastic are an important alternative implant in interbody fusion.
Lee, Yu Chao; Osti, Orso Lorenzo
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
Madigan, Luke; Vaccaro, Alexander R; Spector, Leo R; Milam, R Alden
Symptomatic lumbar degenerative disk disease, or discogenic back pain, is difficult to treat. Patients often report transverse low back pain that radiates into the sacroiliac joints. Radicular or claudicatory symptoms are generally absent unless there is concomitant nerve compression. Physical examination findings are often unremarkable. Radiographic examination may reveal disk space narrowing, end-plate sclerosis, or vacuum phenomenon in the disk; magnetic resonance imaging is useful for revealing hydration of the disk, annular bulging, or lumbar spine end-plate (Modic) changes in the adjacent vertebral bodies. The use of diskography as a confirmatory study remains controversial. Recent prospective, randomized trials and meta-analyses of the literature have helped expand what is known about degenerative disk disease. In most patients with low back pain, symptoms resolve without surgical intervention; physical therapy and nonsteroidal anti-inflammatory drugs are the cornerstones of nonsurgical treatment. Intradiskal electrothermal treatment has not been shown to be effective, and arthrodesis remains controversial for the treatment of discogenic back pain. Nucleus replacement and motion-sparing technology are too new to have demonstrated long-term data regarding their efficacy.
McNamara, Elizabeth A; Kilim, Holly P; Malabanan, Alan O; Whittaker, LaTarsha G; Rosen, Harold N
The International Society for Clinical Densitometry guidelines recommend using locally derived precision data for spine bone mineral densities (BMDs), but do not specify whether data derived from L1-L4 spines correctly reflect the precision for spines reporting fewer than 4 vertebrae. Our experience suggested that the decrease in precision with successively fewer vertebrae is progressive as more vertebrae are excluded and that the precision for the newer Horizon Hologic model might be better than that for the previous model, and we sought to quantify. Precision studies were performed on Hologic densitometers by acquiring spine BMD in fast array mode twice on 30 patients, according to International Society for Clinical Densitometry guidelines. This was done 10 different times on various Discovery densitometers, and once on a Horizon densitometer. When 1 vertebral body was excluded from analysis, there was no significant deterioration in precision. When 2 vertebrae were excluded, there was a nonsignificant trend to poorer precision, and when 3 vertebrae were excluded, there was significantly worse precision. When 3 or 4 vertebrae were reported, the precision of the spine BMD measurement was significantly better on the Hologic Horizon than on the Discovery, but the difference in precision between densitometers narrowed and was no longer significant when 1 or 2 vertebrae were reported. The results suggest that (1) the measurement of in vivo spine BMD on the new Hologic Horizon densitometer is significantly more precise than on the older Discovery model; (2) the difference in precision between the Horizon and Discovery models decreases as fewer vertebrae are included; (3) the measurement of spine BMD is less precise as more vertebrae are excluded, but still quite reasonable even when only 1 vertebral body is included; and (4) when 3 vertebrae are reported, L1-L4 precision data can reasonably be used to report significance of changes in BMD. When 1 or 2 vertebrae are
Guo, Song; Yan, Meijun; Han, Yingchao; Xia, Dongdong; Sun, Guixin; Li, Lijun; Tan, Jun
Background Transforaminal lumbar interbody fusion (TLIF) is an effective surgery for lumbar degenerative disease. However, this fusion technique requires resection of inferior facet joint to provide access for superior facet joint resection, which results in reduced lumbar spinal stability and unnecessary trauma. We have previously developed extraforaminal lumbar interbody fusion (ELIF) that can avoid back muscle injury with direct nerve root decompression. This study aims to show that ELIF enhances lumbar spinal stability in comparison to TLIF by comparing lumbar spinal stability of L4–L5 range of motion (ROM) on 12 cadaveric spine specimens after performing TLIF or ELIF. Methods 12 cadaveric spine specimens were randomly divided and treated in accordance with the different internal fixations, including ELIF with a unilateral pedicle screw (ELIF+UPS), TLIF with a unilateral pedicle screw (TLIF+UPS), TLIF with a bilateral pedicle screw (TLIF+BPS), ELIF with a unilateral pedicle screw and translaminar facet screw (ELIF+UPS+TLFS) and ELIF with a bilateral pedicle screw (ELIF+BPS). The treatment groups were exposed to a 400-N load and 6 N·m movement force to calculate the angular displacement of L4-L5 during anterior flexion, posterior extension, lateral flexion and rotation operation conditions. Results The ROM in ELIF+UPS group was smaller than that of TLIF+UPS group under all operating conditions, with the significant differences in left lateral flexion and right rotation by 36.15% and 25.97% respectively. The ROM in ELIF+UPS group was higher than that in TLIF+BPS group. The ROM in the ELIF+UPS+TLFS group was much smaller than that in the ELIF+UPS group, but was not significantly different than that in the TLIF+BPS group. Conclusions Despite that TLIF+BPS has great stability, which can be comparable by that of ELIF+UPS. Additionally, ELIF stability can be further improved by using translaminar facet screws without causing more tissue damage to patient. PMID
Tam, Michael S.; Abbass, Mohammad
Background and Objectives: Robotic surgery has been advocated for the radical excision of rectal cancer. Most data supporting its use have been reported from European and Asian centers, with a paucity of data from the United States documenting clear advantages of the robotic technique. This study compares the short-term outcome of robotic versus laparoscopic surgery. Methods: Consecutive patients who underwent laparoscopic (group 1) or robotic (group 2) rectal cancer excision at a single institution over a 2-year period were retrospectively reviewed. The main outcome measures were operative time, blood loss, conversion rates, number of lymph nodes, margin positivity, length of hospital stay, complications, and readmission rates. Results: Forty-two patients were analyzed. The median operative time was shorter in group 1 than that in group 2 (240 minutes vs 260 minutes, P = .04). No difference was noted in blood loss, transfusion rates, intraoperative complications, or conversion rates. There was no difference in circumferential or distal margin positivity. The median length of stay was shorter in group 1 (5 days vs 6 days, P = .05). The 90-day complication rate was similar in both groups (33% vs 43%, P = .75), but there was a trend toward more anastomotic leaks in group 1 (14% vs 0%, P = .23). Similarly, a non–statistically significant trend toward a higher readmission rate was noted in group 1 (24% vs 5%, P = .18). Conclusion: Robotic rectal cancer excision yielded a longer operative time and hospital length of stay, although immediate oncologic results were comparable. The need for randomized data is critical to determine whether the added resource utilization in robotic surgery is justifiable. PMID:25392653
Yu, Ching-Hsiao; Wang, Chen-Ti
It is unclear whether using artificial cages increases fusion rates compared with use of bone chips alone in posterior lumbar interbody fusion for patients with lumbar spondylolisthesis. We hypothesized artificial cages for posterior lumbar interbody fusion would provide better clinical and radiographic outcomes than bone chips alone. We assumed solid fusion would provide good clinical outcomes. We clinically and radiographically followed 34 patients with spondylolisthesis having posterior lumbar interbody fusion with mixed autogenous and allogeneic bone chips alone and 42 patients having posterior lumbar interbody fusion with implantation of artificial cages packed with morselized bone graft. Patients with the artificial cage had better functional improvement in the Oswestry disability index than those with bone chips alone, whereas pain score, patient satisfaction, and fusion rate were similar in the two groups. Postoperative disc height ratio, slip ratio, and segmental lordosis all decreased at final followup in the patients with bone chips alone but remained unchanged in the artificial cage group. The functional outcome correlated with radiographic fusion status. We conclude artificial cages provide better functional outcomes and radiographic improvement than bone chips alone in posterior lumbar interbody fusion for lumbar spondylolisthesis, although both techniques achieved comparable fusion rates. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18846411
Kertmen, Hayri; Gürer, Bora; Yilmaz, Erdal Resit; Sekerci, Zeki
Endoscopic surgery for lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic lumbar discectomy is a well-known, safe, and effective method used for the treatment of the lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic lumbar discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic lumbar discectomy is an extremely rare complication. A 20-year-old patient applied at our department who had undergone transforaminal percutaneous endoscopic lumbar. During the procedure, while performing the discography, non-ionic contrast media was administered into the thecal sac inadvertently. Two hours after surgery, the patient developed generalized tonic-clonic seizure of 5-min duration. Diagnosis of iohexol-induced seizure was made and the patient was treated supportively without anti-epileptics. Here we present the first case of seizure after transforaminal percutaneous endoscopic lumbar discectomy, which was caused by inadvertent administration of the contrast media into the thecal sac. PMID:27695562
Robbins, W J; Hervey, A
Excised roots of Bryophyllum calycinum require for growth both auxin and cytokinin. This is demonstrated by the poor growth of 2-mm root tips in a basal medium of mineral salts, sucrose, and vitamins supplemented with either an auxin or a cytokinin, and much better growth when the basal medium is supplemented with both auxin and cytokinin. However, both substances are synthesized by the root, as is demonstrated by the growth of large inocula (dry wt 6-7 mg) through many successive passages in a medium limited to mineral salts, sugar, and vitamins.
Robbins, William J.; Hervery, Annette
Excised roots of Bryophyllum calycinum require for growth both auxin and cytokinin. This is demonstrated by the poor growth of 2-mm root tips in a basal medium of mineral salts, sucrose, and vitamins supplemented with either an auxin or a cytokinin, and much better growth when the basal medium is supplemented with both auxin and cytokinin. However, both substances are synthesized by the root, as is demonstrated by the growth of large inocula (dry wt 6-7 mg) through many successive passages in a medium limited to mineral salts, sugar, and vitamins. Images PMID:5277083
MacCoy, D M
Coxofemoral luxation, although not a common injury, can cause considerable pelvic limb dysfunction in pet birds. Luxation usually is craniodorsal, as it is in dogs. Previously recommended treatments have not always been effective in managing the injury. Sequelae can include dorsolateral deviation of the pelvic limb, with loss of function and bumblefoot in the nonluxated limb, owing to abnormal weight-bearing. Excision arthroplasty combined with a muscular sling constructed from a segment of the iliofibularis muscle was used to treat coxofemoral luxation in a hyacinth macaw, a moluccan cockatoo, and an African gray parrot. The outcome was excellent in 2 of the 3 birds.
Pinsk, Ilia; Phang, P Terry
Treatment of rectal cancer over the last two decades has evolved with changes in techniques of surgery and radiation based on national and international trials. Preoperative adjuvant radiation is now preferred over postoperative adjuvant radiation, and total mesorectal excision with preservation of pelvic nerves is the gold standard for surgical treatment of rectal cancer. Preservation of the anal sphincter without compromising oncological outcome is an additional benefit for patients with carcinoma in the distal rectum. Further progress in imaging and a multidisciplinary team approach will facilitate individualization of treatment strategy with more focus on quality of life.
Marking excision margins of surgical specimens by silver impregnation has several advantages over commonly used Indian ink: during the slicing the tissue preserves its natural color, the staining is permanent, and the pigment does not smudge over cutting surfaces. The pigment is clearly visible in tissue sections. The tissue specimen is shortly dipped into a 10% water solution of argent nitrate (AgNO3 with HNO3). After slicing, the tissue specimens are developed in common black & white developer for several seconds and paraffin processed as usual. The method is suitable for formaldehyde fixed as well as fresh tissue specimens.
Zemba, M; Stamate, Alina-Cristina; Avram, Corina Ioana; Sîrbu, Laura Nicoleta Urucu; Camburu, Raluca Lăcrămioara; Ochinciuc, Uliana; Burcea, M
Surgical treatment for conjunctival neoplasms, with wide local excision, with or without supplemental cryotherapy to the surgical margins represents the treatment of choice for this pathology. In some cases, these neoplasms can be diffuse or multifocal, with borders that are difficult to detect clinically, such that topical therapies offer a more efficient method for treating the entire ocular surface, delivering high drug concentrations at this level, with negligible systemic side effects. Beginning from the clinical case of a patient diagnosed with conjunctival intraepithelial neoplasia, we try to present other therapeutical alternatives, although in this case the therapeutical approach was the classic one.
Zhuang, Xinming; Fu, Changfeng; Liu, Wanguo; Wang, Yuanyi; Xu, Feng; Zhang, Qi; Liu, Yadong; Liu, Yi
The aim of this study was to determine the skeletal effect of total ethanolic extract from the stem-bark of Ulmus davidiana (UDE) in a rat model of postmenopausal bone loss. Effective dose of UDE was determined in adult female Sprague-Dawley (SD) rats by measuring bone regeneration at fracture site. UDE (250 mg/kg p.o.) was administered to ovariectomized (OVX) osteopenic SD rats for 12 weeks. OVX rats treated with vehicle or 17β-estradiol, and sham-operated rats treated with vehicle served as various controls. Bone mineral density (BMD), microarchitecture, biomechanical strength, turnover markers, and uterotrophic effect were studied. Bioactive markers in UDE were analyzed by HPLC. Human osteoblasts was used to study the effect of compounds on differentiation by alkaline phosphase assay. One-way ANOVA was used to test significance of effects. OVX+UDE group showed BMD, microarchitectural parameters and compressive strength at lumbar vertebra (L5) comparable to sham. At proximal femur, OVX+UDE group exhibited significantly higher BMD, better microarchitecture and compressive strength compared with OVX+vehicle. OVX-induced decrease in Ca/P ratio was completely restored at both skeletal sites by UDE treatment. Serum procollagen N-terminal propeptide and carboxy-terminal collagen crosslinks were respectively higher and lower in OVX+UDE group compared with OVX+vehicle group. Osteogenic genes were upregulated in L5 and anti-resorptive genes were suppressed in proximal femur of OVX+UDE group compared with OVX+vehicle. UDE had no uterine estrogenicity. Analysis of markers yielded two osteogenic isoforms of catechin. In conclusion, UDE completely restored vertebral trabecular bones and strength in osteopenic rats by an osteogenic mechanism and prevented bone loss at proximal femur. PMID:27158327
Bracht, Marcelo Anderson; Celestino, Jardel; Schwertner, Debora Soccal; França, Leandro Cardoso; de Noronha, Marcos
ABSTRACT Purpose: To investigate inter- and intra-observer agreement in the assessment of lumbar vertebral rotational (VR) asymmetry by a motion palpation test. Methods: For this prospective and descriptive test–retest study, 51 asymptomatic participants (40 women, 11 men; mean age 23.3 [SD 5.6] years) were recruited from the community. Each participant was assessed in two sessions by the same three observers, who assessed VR by means of a palpatory test for movement asymmetry. This test is performed by applying posteroanterior pressure in an alternating manner to the left and right transverse processes of a vertebra to determine motion asymmetry in the transverse plane and thus the vertebral position. Observers classified the vertebral position as neutral, rotation to the right, and rotation to the left; they were blinded to which participant was being assessed and to any previous results. Results: Intra- and inter-observer agreement was verified by the kappa coefficient (κ) and the weighted kappa coefficient (κw). Values of κ and κw varied from 0.07 (95% CI, −0.10 to 0.245) to 0.37 (95% CI, 0.11–0.63) for intra-observer agreement and from 0.12 (95% CI, −0.06 to 0.29) to 0.30 (95% CI, 0.08–0.52) for inter-observer agreement. Conclusion: The motion palpation test used to assess VR asymmetry has low agreement levels; therefore, its clinical significance for measuring vertebral position is questionable. PMID:25931669
Pooswamy, Shanmugasundaram; Muralidharagopalan, Niranjanan Raghavn; Subbaiah, Sivasubramaniam
Background: Spondylolisthesis refers to slippage of one vertebra over the other, which may be caused by a variety of reasons such as degenerative, trauma, and isthmic. Surgical management forms the mainstay of treatment to prevent further slip and worsening. However, there is no consensus regarding the best surgical option to treat these patients. This study compares TLIF and instrumented PLF in patients with Grade I and II spondylolisthesis and analysis the outcome with respect to functional outcome, pain, fusion rate, adequacy of medial facetectomy for decompression, and complications. Materials and Methods: Forty patients operated for spondylolisthesis by instrumented posterolateral or transforaminal fusion between January 1, 2010, and June 30, 2012 were included in this retrospective study. They were followed up for 3 years. Twenty one cases were of instrumented posterolateral fusion (PLF) and 19 cases were of transforaminal lumbar interbody fusion (TLIF). The patients were asked to fill up the Oswestry disability index (ODI), Dallas Pain Questionnaire (DPQ), and low back pain rating scale (LBPRS) preoperatively, at 1-month postoperatively, and at 6, 12, 24, and 36 months postoperatively. Radiological parameters were assessed using radiographs. Results: No significant differences were found in DPQ, LBPRS, or ODI scores preoperative, 1-month postoperative, and at 6, 12, 24 and 36 months followup. No significant difference was found between the two groups in blood loss. The only significant difference between the two groups was in the operative time, in which the instrumented PLF group had a mean of 50 min lesser than the TLIF group (P = 0.02). Conclusions: TLIF and instrumented PLF are equally efficacious options in the treatment of Grade I and II spondylolisthesis, except lytic type.
Kaliya-Perumal, Arun-Kumar; Lu, Meng-Ling; Luo, Chi-An; Tsai, Tsung-Ting; Lai, Po-Liang; Chen, Lih-Huei; Chen, Wen-Jer; Niu, Chi-Chien
Abstract Elderly patients with chronic nonresolving symptoms due to degenerative spine pathologies are prone to have poor surgical outcomes and hardware-related complications, especially following multilevel instrumented lumbar fusion surgeries. With intention of analyzing if teriparatide can be an effective adjunct therapy to surgical management, radiological outcomes are studied. Sixty-two elderly patients were divided into 2 similar groups. Group 1 (n = 30; mean age = 69.83 years; fusion levels = 137; screws = 269) had taken teriparatide (20 mcg SC injection, once daily) for a duration of 7.4 ± 2.4 months following surgery and Group 2 (n = 32; mean age = 70.38 years; fusion levels = 144; screws = 283) did not take teriparatide. Radiological evaluation was done to determine the state of postero lateral fusion mass and to investigate the incidence of pedicle screw loosening at 1-year follow-up. Unilateral or bilateral bridging bone formation across the transverse process of adjacent vertebras showing continuous trabeculation suggestive of solid fusion was obtained in 66.7% patients in the teriparatide group and 50% patients in the control group (P = 0.20). 13.4% of the total no. of screws showed signs of loosening in the teriparatide group, compared to 24.4% in the control group (P = 0.001). Percentage of patients achieving solid fusion following teriparatide use was found to be more than that of the control group. This difference may have clinical importance but was not statistically significant. However, teriparatide use was more significantly influential in reducing the incidence of subsequent pedicle screw loosening. PMID:28151894
Roberts, Simon B; Tsirikos, Athanasios I
Surgical correction for kyphoscoliosis is increasingly being performed for patients with mucopolysaccharidosis (MPS). Reported case series have predominantly included patients with Type I (Hurler) and Type IV (Morquio) MPS. To their knowledge, the authors describe the first case report of surgical management of thoracolumbar kyphoscoliosis in Hunter syndrome (MPS Type II) and the rare occurrence of lumbar spondylolisthesis following surgical stabilization. A 12-year-old boy with Hunter syndrome presented with severe thoracolumbar kyphoscoliosis and no associated symptoms. Spinal radiographs demonstrated kyphosis of 48° (T11-L3) and scoliosis of 22° (T11-L3) with an anteriorly hypoplastic L-1 vertebra. The deformity progressed to kyphosis of 60° and scoliosis of 42° prior to surgical intervention. Spinal CT scans identified left T12-L1 facet subluxation, causing anterior rotatory displacement of the spine proximal to L-1 and bilateral L-5 isthmic spondylolysis with no spondylolisthesis. A combined single-stage anterior and posterior instrumented spinal arthrodesis from T-9 to L-4 was performed. Kyphosis and scoliosis were corrected to 4° and 0°, respectively. Prolonged ventilator support and nasogastric feedings were required for 3 months postoperatively. At 2.5 years following surgery, the patient was asymptomatic, mobilizing independently, and had achieved a solid spinal fusion. However, he had also developed a Grade II spondylolisthesis at L4-5; this was managed nonoperatively in the absence of symptoms or further deterioration of the spondylolisthesis to the 3.5-year postoperative follow-up visit. Satisfactory correction of thoracolumbar kyphoscoliosis in Hunter syndrome can be achieved by combined anterior/posterior instrumented arthrodesis. The risk of developing deformity or instability in motion segments adjacent to an instrumented fusion may be greater in patients with MPS related to the underlying connective tissue disorder.
Krupski, Witold; Tatara, Marcin R.; Bury, Pawel; Szabelska, Anna; Charuta, Anna; Maciejewski, Ryszard; Wallner, Grzegorz; Dabrowski, Andrzej
Abstract Gastrectomy induces severe osteoporosis in humans but its quantitative scale within trabecular and cortical compartments was not estimated. The aim of the study was to determine changes of volumetric bone mineral density (vBMD) in lumbar vertebrae (L1–L4) and biochemical bone metabolism markers in serum of patients 1 year after total gastrectomy. The control group consisted of patients (N = 8) subjected to abdominal surgery due to cardiospasmus. Total gastrectomy was performed in the experimental group (N = 6). Volumetric bone mineral density of trabecular and cortical bone of lumbar spine was measured before (baseline) and 1 year after the gastric surgery using the quantitative computed tomography method. Serum concentrations of insulin, insulin-like growth factor-1, tyroxine, interleukin-6, C-terminal telopeptides of type II collagen and bone formation, and resorption markers were determined at baseline and 1 year later, using ELISA, EIA, and IEMA methods. Total gastrectomy induced significant decrease of vBMD values, up to 16.8% and 10.0%, within the trabecular and cortical bone compartments of lumbar spine (P < 0.05). These negative changes of vBMD were associated with significantly increased serum concentration of bone resorption markers such as deoxypyridinoline, pyridinoline, and C-terminal telopeptides of type I collagen, by 13.5%, 32.2%, and 121.5%, respectively (P < 0.05). Neither vBMD nor biochemical bone turnover markers and hormone concentrations were influenced in the control patients. Dramatic bone loss during the first year in gastrectomized patients has proven dynamic osteoporosis progress indicating an importance of treatment interventions in these patients with emphasis on inhibition of intensive bone resorption processes. PMID:26886633
... certain undistributed income of real estate investment trusts; calendar years beginning after December 31... (CONTINUED) MISCELLANEOUS EXCISE TAXES (CONTINUED) EXCISE TAX ON REAL ESTATE INVESTMENT TRUSTS AND REGULATED INVESTMENT COMPANIES Excise Tax on Real Estate Investment Trusts § 55.4981-2 Imposition of excise tax...
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Cristante, Alexandre Fogaça; Rocha, Ivan Diasda; Marcon, Raphael Martus; de Barros Filho, Tarcísio Eloy Pessoa
OBJECTIVES: Hydrodiscectomy is a new technique used for percutaneous spinal discectomy that employs a high-intensity stream of water for herniated disc ablation and tissue aspiration. No previous clinical study has examined the effects of percutaneous hydrodiscectomy. The aim of this study is to evaluate the outcomes of hydrodiscectomy compared to open microdiscectomy regarding pain, function, satisfaction, complications and recurrence rates. METHODS: In this randomized clinical trial, patients referred to our tertiary hospital for lumbar back pain were recruited and included in the study if they had disc protrusion or small herniation in only one level, without neurological deficits and with no resolution after six weeks of conservative treatment. One group underwent open microdiscectomy, and the other group underwent percutaneous microdiscectomy via hydrosurgery. Function was evaluated using the Oswestry Disability Index and pain was assessed using a visual analog scale. Evaluations were performed preoperatively, and then during the first week and at one, three, six and twelve months postoperatively. Personal satisfaction was verified. Clinicaltrials.gov: NCT01367860. RESULTS: During the study period, 20 patients were included in each arm and 39 completed one-year of follow-up (one patient died of unrelated causes). Both groups exhibited equal improvement on the visual analog scale and Oswestry evaluations after treatment, without any significant differences. The improvement in the lumbar visual analog scale score was not significant in the hydrodiscectomy group (p=0.138). The rates of infection, pain, recurrence and satisfaction were similar between the two groups. CONCLUSION: Percutaneous hydrodiscectomy was demonstrated to be as effective as open microdiscectomy for reducing pain. The rates of complications and recurrence of herniation were similar between groups. Patient satisfaction with the treatment was also similar between groups. PMID:27276397
Săftescu-Jescu, C.; Bereteu, L.
Determining the center of pressure trajectories, as an indicator of postural stability or lumbar pathology, has been a challenging issue for researchers during the last decades. The paper advances an investigational method in order to determine a correlation between lumbar spine movements and feet center of pressure distribution. Five young healthy volunteers were simultaneously tested using an ultrasound based motion analyzing system and a force platform, while performing imposed tasks. Results showed specific patterns described by the center of pressure trajectories and a good coordination of angular amplitudes during lumbar spine movement.
Gower, D J; Baker, A L; Bell, W O; Ball, M R
Papilloedema is not always an adequate predictor of potential complications from lumbar puncture, and many clinicians are using computed tomography (CT) before lumbar puncture in an effort to identify more accurately the "at risk" patient. This paper identifies the following anatomical criteria defined by CT scanning that correlate with unequal pressures between intracranial compartments and predispose a patient to herniation following decompression of the spinal compartment: lateral shift of midline structures, loss of the suprachiasmatic and basilar cisterns, obliteration of the fourth ventricle, or obliteration of the superior cerebellar and quadrigeminal plate cisterns with sparing of the ambient cisterns. These criteria should be considered to be contraindications to lumbar puncture. Images PMID:3655817
Yang, H; Schaffer, K; Liu, L; Mahesh, M; Yousem, D M
We sought to establish a guide for identifying fellowship competency in performing fluoroscopically guided lumbar punctures. With a linear mixed-effects model, we compared the fluoroscopy time between the first and last 3 months of neuroradiology training. During 7 years, 55 fellows performed 1142 and 861 lumbar punctures in the first and last quarters of training. A target fluoroscopy time of 0.26 minutes, the upper 95% confidence interval, can serve as a fellowship benchmark for successfully achieving competence in fluoroscopically guided lumbar punctures.
Zhang, Yang; Shan, Jian-Lin; Liu, Xiu-Mei; Li, Fang; Guan, Kai; Sun, Tian-Sheng
Background There have been few studies comparing the clinical and radiographic outcomes between the Dynesys dynamic stabilization system and posterior lumbar interbody fusion (PLIF). The objective of this study is to compare the clinical and radiographic outcomes of Dynesys and PLIF for lumbar degenerative disease. Methods Of 96 patients with lumbar degenerative disease included in this retrospectively analysis, 46 were treated with the Dynesys system and 50 underwent PLIF from July 2008 to March 2011. Clinical and radiographic outcomes were evaluated. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD). Results The mean follow-up time in the Dynesys group was 53.6 ± 5.3 months, while that in the PLIF group was 55.2 ± 6.8 months. At the final follow-up, the Oswestry disability index and visual analogue scale score were significantly improved in both groups. The range of motion (ROM) of stabilized segments in Dynesys group decreased from 7.1 ± 2.2° to 4.9 ± 2.2° (P < 0.05), while that of in PLIF group decreased from 7.3 ± 2.3° to 0° (P < 0.05). The ROM of the upper segments increased significantly in both groups at the final follow-up, the ROM was higher in the PLIF group. There were significantly more radiographic ASDs in the PLIF group than in the Dynesys group. The incidence of complications was comparable between groups. Conclusions Both Dynesys and PLIF can improve the clinical outcomes for lumbar degenerative disease. Compared to PLIF, Dynesys stabilization partially preserves the ROM of the stabilized segments, limits hypermobility in the upper adjacent segment, and may prevent the occurrence of ASD. PMID:26824851
Liao, Wensheng; Guo, Liangbing; Bao, Heng; Wang, Limin
Background: Anatomy of the pedicles of the seventh cervical vertebra (C7) at the cervicothoracic junction is different from other cervical vertebrae. Fixation of C7 is required during cervical vertebra and upper thoracic injuries in clinical practice. However, the typical pedicle screw insertion methods may have problems in clinical practice based on the anatomical features of C7. This study is to explore a new pedicle screw insertion technique for C7 and to provide anatomical and radiographic basis for clinical application. Materials and Methods: C7 vertebral specimens from six human cadavers were observed for the relative position between the posterior bony landmark and the pedicle projection. Computed tomography (CT) was performed for 30 patients with cervical spondylosis (26–61 years old, mean age was 42.3 years old). The CT scan data were processed by Mimics 8.1 software for associated parameter measurement. Appropriate screw entry points (Eps) and insertion angles were selected. A total of 12 pedicle screws were inserted and then observed. The six specimens were observed after inserting the screw using this method. The junction site of the middle 1/3 and outer 1/3 segment of line G [The junction between point A (the intersection point of the superior margin of the lamina of C7 and the medial margin of the superior articular process) and point B (the intersection point of the lateral margin of the inferior articular process and the transverse process)] was taken as the Ep. The screw insertion direction parallel horizontally to the upper terminal lamina of C7 and the sagittal angle was between 35° and 45°. Results: Gross and imaging observations revealed that pedicle projection was on the line (line G) between point A (the intersection point of the superior margin of the lamina of C7 and the medial margin of the superior articular process) and point B (the intersection point of the lateral margin of the inferior articular process and the transverse process
Eun, Jong-Pil; Oh, Young-Min
Recently, we observed a case of lumbar artery injury after trauma, which was treated by endovascular embolization. A 67-year-old woman who was injured in a traffic accident was brought to the emergency room. She was conscious and her hemodynamic condition was stable, but she had paraplegia below L1 dermatome. Contrast-enhanced computed tomography scan of abdomen and pelvis revealed fracture dislocation of L3/4 along with retroperitoneal hematomas. However, there was no evidence of traumatic injury in both thoracic and abdominal cavity. At that time, her blood pressure suddenly decreased to 60/40 mmHg and her mental status deteriorated. Also, her hemoglobin level was 5.4 g/dl. While her hemodynamic condition stabilized with massive fluid resuscitation including blood transfusion, an angiography was immediately performed to look for and embolize site of retroperitoneal hemorrhage. On the angiographic images, there was an active extravasation from ruptured left 3rd lumbar artery, and we performed complete embolization with GELFOAM and coil. Lumbar artery injury after trauma is rare and endovascular treatment is useful in case of hemodynamic instability.
Wang, Ya-peng; Zhang, Wei; Li, Bao-li; Sun, Ya-peng; Ding, Wen-yuan; Shen, Yong
Background To discuss the strategy of suprapedicular foraminal endoscopic approach to lumbar lateral recess decompression and evaluate the safety and effectiveness of this strategy. Material/Methods Complete clinical information of 52 cases of lumbar lateral recess decompression with therapy of suprapedicular foraminal endoscopic approach were analyzed during the period from February 2010 to April 2014 in the Third Hospital of Hebei. All patients were followed up for 24 months, and VAS, JOA, ODI, and LRD were compared between preoperative and postoperative therapy and changes of FA. Intraoperative and postoperative complications were recorded and the safety of the surgery was evaluated. The surgical “excellent” and “good” rates were evaluated using MacNab score. Results VAS scores for lumbago and leg pain at 3, 6, 12, and 24 months after surgery were significantly lower than before surgery (p<0.05). JOA scores at 12 and 24 months after surgery were significantly higher than before surgery (p<0.05). ODI at 12 and 24 months after surgery were significantly lower than before surgery (p<0.05). LRD after surgery was higher (p<0.05), and FA was lower than before surgery. Conclusions Use of the suprapedicular foraminal endoscopic approach to lumbar lateral recess decompression is safe and effective, and this minimally invasive treatment can achieve satisfactory results, especially for elderly patients with complicated underlying diseases. PMID:27890911
Matsuhashi, Tomoya; Iwasaki, Norimasa; Kato, Hiroyuki; Minami, Michio; Minami, Akio
We have carried out a replacement of the lunate in 12 patients with advanced Kienböck's disease, with excision of the lunate and insertion of an iliac bone flap wrapped into palmaris longus. The aims of this study were to determine the effect of this procedure for advanced Kienböck's disease. At a mean follow-up period of 45.3 months, the mean clinical score was excellent in all cases. Radiographically, progression of osteoarthritis (OA) in the radiocarpal joint was found in two patients. At follow-up, the X-ray findings indicated a reduced of osseous core in four patients. On the other hand, carpal height ratio showed no significant change at follow-up. Excision arthroplasty using a tendon ball with osseous core for advanced Kienböck's disease leads to OA progression in some cases. However, clinical results were excellent in all cases. Therefore, this current study provides effective therapeutic procedure for advanced Kienböck's disease.
Zatoński, Mateusz; Hawkins, Benjamin; McKee, Martin
Industry lobbying remains an obstacle to effective health-oriented alcohol policy. In 2013, an increase in excise tax on spirits was announced by the Polish government. This article presents a qualitative analysis of the public debate that ensued on the potential economic, health and social effects of the policy. It focuses on how competing groups, including industry actors, framed their position and sought to dominate the debate. Online archives of five Polish national newspapers, two spirits trade associations, and parliamentary and ministerial archives were searched. A thematic content analysis of the identified sources was conducted. The overall findings were compared with existing research on the framing of the Minimum Unit Pricing (MUP) debate in the UK. A total of 155 sources were analysed. Two main frames were identified: health, and economic The spirits industry successfully promoted the economic frame in their own publications and in the media. The debate was dominated by arguments about potential growth of the grey market and losses in tax revenue that might result from the excise tax increase. The framing of the debate in Poland differed from the framing of the MUP debate in the United Kingdom. The Polish public health community was unsuccessful in making health considerations a significant element of the alcohol policy debate. The strategies pursued by UK health advocates offer lessons for how to make a more substantial impact on media coverage and promote health-oriented legislation.
Allan, B D; Short, P; Crawford, G J; Barrett, G D; Constable, I J
The optimum mode of treatment for symptomatic pterygia would combine efficacy (a low recurrence rate) with safety (freedom from sight threatening complications), and would not affect visual acuity adversely. The efficacy of pterygium excision with conjunctival autografting in a sun exposed population in which pterygia are prevalent has previously been questioned. A cross sectional review of 93 eyes of 85 patients was carried out by slit-lamp examination a minimum of 6 months (range 6-76 months) after pterygium excision and free conjunctival autografting. Case notes were reviewed to obtain details of complications and visual acuity changes related to surgery. Of six recurrences (6.5%) four of these were asymptomatic with minor recurrences. Two patterns of recurrence were identified: cross graft recurrence (three cases) and outflanking (three cases). Complications (wound dehiscence, three cases; Tenon's granuloma one case; conjunctival cyst, one case) were all corrected by minor surgical revision without sequelae. Unaided acuities were unchanged or improved 3 months after surgery in 86 cases, with a minor diminution (1 Snellen line) in seven cases. This study demonstrates a low recurrence rate for a safe technique in an area in which ongoing ultraviolet light exposure levels are high and pterygia are prevalent. Images PMID:8280682
Prabhu, Vijendra; Rao, Satish B. S.; Kumar, Pramod; Rao, Lakshmi; Mahato, Krishna K.
Presently, great importance has been given to Low Level Laser Therapy (LLLT) with the intent of promoting wound healing process. The present study was aimed to investigate the promotive effect of LLLT on full thickness excision wounds in Swiss albino mice using optical fiber probe based light device. Circular wounds of diameter 15 mm were illuminated with single exposure of various laser doses 1, 2, 3, 4, 6, 8 and 10 J/cm2 along with appropriate controls. Further, an optimal dose of 2 J/cm2 was applied to excision wounds at different post-wounding treatment schedules (0, 24 h and 48 h) to explicate the relations between treatment schedule and its tissue regeneration potential. Wound area, mean wound healing time along with hydroxyproline and glucosamine levels from wound ground tissue was assessed to evaluate the resultant photobiostimulatory outcome. Histological analysis was performed on day 10 of post-wounding. A significant increase in hydroxyproline (P< 0.001) and glucosamine levels (P< 0.01) were observed in 2 J/cm2 irradiation group, which was also substantiated by histological findings. In conclusion, the present study demonstrated that the immediate irradiation of 2 J/cm2 dose following wounding hasten the healing process compared to the unilluminated control.
Jeong, Ui-Cheol; Sim, Jae-Heon; Kim, Cheol-Yong; Hwang-Bo, Gak; Nam, Chan-Woo
[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
Majeed, Shiju A; Seshadrinath, N Arun Kumar; Binoy, Kavitha Ravi; Raji, Laila
Background: Although validated radiological scoring systems and histological scoring system of surgically removed degenerated disc are used in assessment of progression of intervertebral disc degeneration, there have not been many studies that integrate these two aspects of assessments. The data available in this respect are very limited. This clinical study was designed to find the correlation between quantitative radiological score (Pfirmann grading system and Modic changes [MC]) and quantitative histological degeneration score (HDS). Materials and Methods: A cohort of 77 patients (45 males, 32 females; mean age of 38 years [range 18–58 years]) who presented with complaints of discogenic pain or radiculopathy at single level were assessed radiologically. They were graded according to the radiological pattern. The surgically excised disc specimen was graded according to HDS. The degree of radiological changes were correlated with the degree of histological changes. Results: Though the overall HDS (0–15) did not show statistically significant correlation with Pfirmann grading system, there were positive association found between mucoid degeneration, chondrocyte proliferation with the Pfirmann grading and mucoid degeneration, which were statistically significant. Female sex also had a higher association with instability pattern. Conclusion: The study shows that the Pfirmann grading system, MCs and HDS can reliably be used as scoring systems for assessing lumbar disc degeneration. The radiological assessment can be used as a noninvasive tool to assess the probable change in content rather than the microstructure of a disc undergoing degeneration. PMID:27293282
Study Design A review of clinical and radiological outcomes of lumbar laminoplasty (LL) for the treatment of isthmic spondylolisthesis (ISL). Purpose The single session performance of posterior lumbar interbody fusion with allograft in the anterior column and providing the realignment of the vertebrae was presented as a preliminary report earlier. Overview of Literature Long-term surgical outcome of cervical laminoplasty in patients has been reported. But, outcome of LL in patients is unclear. Methods The long-term (5 years) year follow-up results of the LL technique are reported in this retrospective study. All patients underwent preoperative and postoperative direct X-ray, computed tomography, and magnetic resonance imaging. The patients that did not respond to conservative treatment were operated. Twenty-one (52.5%) female and 19 (47.5%) male patients were included. Results Mean age was 43,5 years (ranges, 22–57 years). The most common symptoms were low back pain (89%), pelvic and leg pain (69%) and reduction in walking distance (65%). A total of 180 pedicle screws were inserted in 40 patients; posterior lumbar interbody fusion and laminoplasty with reduction was performed in 20 patients for L4–L5, 12 patients for L5–S1, 4 patients for L3–L4–L5 and 4 patients for L4–L5-S1. Ten (25%) patients with ILL had accompanying spinal stenosis. The difference between preoperative and postoperative sagittal plane rotation and dislocation degrees and disc space heights were statistically significant in all patients (p<0.05). Solid grade 4 fusion was observed in 38 patients; in only 2 patients grade 2 pseudoarthrosis developed (5%), but these patients were asymptomatic. Visual analog scale, Prolo economical and functional scale was examined with an average follow-up 5.5 years. Conclusions LL technique has the advantages of shorter duration of operation, lack of graft donor site complications, protection of posterior column osseoligamentous structures and
Johnston, J D; Matheny, J B
The results of a long-term study of 28 patients operated on for adhesive lumbar arachnoiditis are presented. The technique involved was microscopic lysis of adhesions. The first case of surgery was performed in 1966 and the last, in 1970, with followup through 1976. Numerous observations are made regarding the clinical picture and the appearance of arachnoiditis at the time of surgery. Some conclusions are drawn regarding the causes of this condition with some emphasis on the role of Pantopaque, multiple surgeries, and other trauma. The conclusion is that surgical attack on arachnoiditis is a straightforward surgical exercise that, when carried out with appropriate caution, produces no further neurologic deficits and some short-term improvement. However, the authors feel that this procedure should not be performed at the present time because there does not appear to be a method for preventing the reaccumulation of the scar tissue and subsequent recurrence of the symptoms.
Fleury, Gregory; Nissen, Michael J; Genevay, Stéphane
Lumbar radicular pain is a frequent medical pathology and represents a significant burden on society. The diagnosis of sciatica is largely clinical, in the setting of a combination of radicular pain and neurologic deficits (motor, reflexes, and/or sensation) or a positive straight leg raise test. Imaging is generally not necessary for sciatica, except in the presence of warning signs or in the setting of persisting or worsening pain. The recommended first-line treatment has not yet been clearly established. The choice of a conservative treatment approach combined with simple analgesics in the initial stages seems to be reasonable. A detailed discussion with the patient is important to explain the fact that surgery may only be necessary in the event of pain persisting in excess of 3 months or because of the development or worsening of a neurologic deficit. More high quality studies are clearly required to assist the medical practitioner in knowing how best to treat this group of patients.
Robinson, J. S.
Though the lumbar disc syndrome is a costly and ubiquitous affliction, effective evaluation of the disease process has been confounded by major unaddressed methodological short falls. Prominent difficulties include: inattention to the clinical boundaries of the syndrome, neglected co-morbid disease processes, comparison of unequal treatment groups and premature clinical data extrapolation, inadequate diagnostic validation, variability in surgical observation, and reliance upon follow-up techniques faulted by unaddressed distorting factors. Proposals for improvement include: formulation of suitable stratification subgroups emphasizing age and sign-symptom intensity and duration, techniques for improved diagnostic return from surgical exploration, suggestions toward improved quantitation of clinical testing procedures, and implantation of a quality of life scale. PMID:6454306
Andersson, G B; Schultz, A; Nathan, A; Irstam, L
The influences of differences in both intervertebral motion segment orientations and in reader judgments on measurements of the apparent intervertebral disc heights in lateral roentgenographs of the lumbar spine were examined. Forty-nine roentgenographs were obtained of nine discs that were titled laterally up to +/- 10 degrees, and rotated longitudinally up to +/- 20 degrees. Three orthopaedic surgeons and three radiologists measured disc heights from five of these roentgenographs, all using the same measurement method. The differences in apparent height that resulted from the orientation changes and differences in judgments among the six readers were considerable, usually of the order of one half of the nominal disc height. The results show that, while roentgenographic measurements can be used to estimate disc height, accurate measurements cannot readily be made from routine roentgenographs, and the interpretation should always be cautious.
Song, Jenn-Yeu; Chen, Yu-Hao; Hung, Kuang-Chen; Chang, Ti-Sheng
Traumatic spinal subdural hematoma is rare and its mechanism remains unclear. This intervention describes a patient with mental retardation who was suffering from back pain and progressive weakness of the lower limbs following a traffic accident. Magnetic resonance imaging of the spine revealed a lumbar subdural lesion. Hematoma was identified in the spinal subdural space during an operation. The muscle power of both lower limbs recovered to normal after surgery. The isolated traumatic spinal subdural hematoma was not associated with intracranial subdural hemorrhage. A spinal subdural hematoma should be considered in the differential diagnosis of spinal cord compression, especially for patients who have sustained spinal trauma. Emergency surgical decompression is usually the optimal treatment for a spinal subdural hematoma with acute deterioration and severe neurological deficits.