90-day Readmission After Lumbar Spinal Fusion Surgery in New York State Between 2005 and 2014: A 10-year Analysis of a Statewide Cohort.

PubMed

Baaj, Ali A; Lang, Gernot; Hsu, Wei-Chun; Avila, Mauricio J; Mao, Jialin; Sedrakyan, Art

2017-11-15

MINI: We assessed 90-day readmission and evaluated risk factors associated with readmission after lumbar spinal fusion surgery in New York State. The overall 90-day readmission rate was 24.8%. Age, sex, race, insurance, procedure, number of operated spinal levels, health service area, and comorbidities are major risk factors for 90-day readmission. Retrospective cohort study. The aim of this study was to assess 90-day readmission and evaluate risk factors associated with readmission after lumbar fusion in New York State. Readmission is becoming an important metric for quality and efficiency of health care. Readmission and its predictors following spine surgery are overall poorly understood and limited evidence is available specifically in lumbar fusion. The New York Statewide Planning and Research Cooperative System (SPARCS) was utilized to capture patients undergoing lumbar fusion from 2005 to 2014. Temporal trend of 90-day readmission was assessed using Cochran-Armitage test. Logistic regression was used to examine predictors associated with 90-day readmission. There were 86,869 patients included in this cohort study. The overall 90-day readmission rate was 24.8%. On a multivariable analysis model, age (odds ratio [OR] comparing ≥75 versus <35 years: 1.24, 95% confidence interval [CI]: 1.13-1.35), sex (OR female to male: 1.19, 95% CI: 1.15-1.23), race (OR African-American to white: 1.60, 95% CI: 1.52-1.69), insurance (OR Medicaid to Medicare: 1.42, 95% CI: 1.33-1.53), procedure (OR comparing thoracolumbar fusion, combined [International Classification of Disease, Ninth Revision, ICD-9: 81.04] to posterior lumbar interbody fusion/transforaminal lumbar spinal fusion [ICD-9: 81.08]: 2.10, 95% CI: 1.49-2.97), number of operated spinal levels (OR comparing four to eight vertebrae to two to three vertebrae: 2.39, 95% CI: 2.07-2.77), health service area ([HSA]; OR comparing Finger Lakes to New York-Pennsylvania border: 0.67, 95% CI: 0.61-0.73), and comorbidity, i.e., coronary artery disease (OR: 1.26, 95% CI: 1.19-1.33) were significantly associated with 90-day readmission. Directions of the odds ratios for these factors were consistent after stratification by procedure type. Age, sex, race, insurance, procedure, number of operated spinal levels, HSA, and comorbidities are major risk factors for 90-day readmission. Our study allows risk calculation to determine high-risk patients before undergoing spinal fusion surgery to prevent early readmission, improve quality of care, and reduce health care expenditures. 3.

Effect of Load Carriage on Lumbar Spine Kinematics

DTIC Science & Technology

2013-01-01

reference frame and lordosis was reduced during all tasks with load. Superior levels became more lordotic, whereas inferior levels became more... lordosis , and IVD compressibility have been measured in both young 17 and adult 13 populations using upright MRI. However, these data cannot be...the kinematic behavior of the overall lumbar spine and func- tional spinal units. We hypothesized that IVD compression and lumbar lordosis increased

Degenerative lumbar spinal stenosis and lumbar spine configuration

PubMed Central

Hamoud, K.; May, H.; Hay, O.; Medlej, B.; Masharawi, Y.; Peled, N.; Hershkovitz, I.

2010-01-01

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

Improvement of spinal alignment and quality of life after corrective surgery for spinal kyphosis in patients with osteoporosis: a comparative study with non-operated patients.

PubMed

Miyakoshi, N; Hongo, M; Kobayashi, T; Abe, T; Abe, E; Shimada, Y

2015-11-01

This study evaluated changes in spinal alignment and quality of life (QOL) after corrective spinal surgery for patients with postmenopausal osteoporosis and spinal kyphosis. Spinal global alignment and QOL were significantly improved after corrective spinal surgery but did not reach the level of non-operated controls. With the increased aging of society, the demand for corrective spinal instrumentation for spinal kyphosis in osteoporotic patients is increasing. However, previous studies have not focused on the improvement of quality of life (QOL) after corrective spinal surgery in patients with osteoporosis, compared to non-operated control patients. The purposes of this study were thus to evaluate changes in spinal alignment and QOL after corrective spinal instrumentation for patients with osteoporosis and spinal kyphosis and to compare these results with non-operated patients. Participants comprised 39 patients with postmenopausal osteoporosis ≥50 years old who underwent corrective spinal surgery using multilevel posterior lumbar interbody fusion (PLIF) for symptomatic thoracolumbar or lumbar kyphosis, and 82 age-matched patients with postmenopausal osteoporosis without prevalent vertebral fractures. Spinopelvic parameters were evaluated with standing lateral spine radiography, and QOL was evaluated with the Japanese Osteoporosis QOL Questionnaire (JOQOL), SF-36, and Roland-Morris Disability Questionnaire (RDQ). Lumbar kyphosis angle, sagittal vertical axis, and pelvic tilt were significantly improved postoperatively. QOL evaluated with all three questionnaires also significantly improved after 6 months postoperatively, particularly in domain and subscale scores for pain and general/mental health. However, these radiographic parameters, total JOQOL score, SF-36 physical component summary score, and RDQ score were significantly inferior compared with non-operated controls. The results indicate that spinal global alignment and QOL were significantly improved after corrective spinal surgery using multilevel PLIF for patients with osteoporosis and spinal kyphosis but did not reach the level of non-operated controls.

Relevant Anatomic and Morphological Measurements of the Rat Spine: Considerations for Rodent Models of Human Spine Trauma.

PubMed

Jaumard, Nicolas V; Leung, Jennifer; Gokhale, Akhilesh J; Guarino, Benjamin B; Welch, William C; Winkelstein, Beth A

2015-10-15

Basic science study measuring anatomical features of the cervical and lumbar spine in rat with normalized comparison with the human. The goal of this study is to comprehensively compare the rat and human cervical and lumbar spines to investigate whether the rat is an appropriate model for spine biomechanics investigations. Animal models have been used for a long time to investigate the effects of trauma, degenerative changes, and mechanical loading on the structure and function of the spine. Comparative studies have reported some mechanical properties and/or anatomical dimensions of the spine to be similar between various species. However, those studies are largely limited to the lumbar spine, and a comprehensive comparison of the rat and human spines is lacking. Spines were harvested from male Holtzman rats (n = 5) and were scanned using micro- computed tomography and digitally rendered in 3 dimensions to quantify the spinal bony anatomy, including the lateral width and anteroposterior depth of the vertebra, vertebral body, and spinal canal, as well as the vertebral body and intervertebral disc heights. Normalized measurements of the vertebra, vertebral body, and spinal canal of the rat were computed and compared with corresponding measurements from the literature for the human in the cervical and lumbar spinal regions. The vertebral dimensions of the rat spine vary more between spinal levels than in humans. Rat vertebrae are more slender than human vertebrae, but the width-to-depth axial aspect ratios are very similar in both species in both the cervical and lumbar regions, especially for the spinal canal. The similar spinal morphology in the axial plane between rats and humans supports using the rat spine as an appropriate surrogate for modeling axial and shear loading of the human spine.

Adjacent segment disease after instrumented fusion for adult lumbar spondylolisthesis: Incidence and risk factors.

PubMed

Zhong, Zhao-Ming; Deviren, Vedat; Tay, Bobby; Burch, Shane; Berven, Sigurd H

2017-05-01

A potential long-term complication of lumbar fusion is the development of adjacent segment disease (ASD), which may necessitate second surgery and adversely affect outcomes. The objective of this is to determine the incidence of ASD following instrumented fusion in adult patients with lumbar spondylolisthesis and to identify the risk factors for this complication. We retrospectively assessed adult patients who had undergone decompression and instrumented fusion for lumbar spondylolisthesis between January 2006 and December 2012. The incidence of ASD was analyzed. Potential risk factors included the patient-related factors, surgery-related factors, and radiographic variables such as sagittal alignment, preexisting disc degeneration and spinal stenosis at the adjacent segment. A total of 154 patients (mean age, 58.4 years) were included. Mean duration of follow-up was 28.6 months. Eighteen patients (11.7%) underwent a reoperation for ASD; 15 patients had reoperation at cranial ASD and 3 at caudal ASD. The simultaneous decompression at adjacent segment (p=0.002) and preexisting spinal stenosis at cranial adjacent segment (p=0.01) were identified as risk factors for ASD. The occurrence of ASD was not affected by patient-related factors, the types, grades and levels of spondylolisthesis, surgical approach, fusion procedures, levels of fusion, number of levels fused, types of bone graft, use of bone morphogenetic proteins, sagittal alignment, preexisting adjacent disc degeneration and preexisting spinal stenosis at caudal adjacent segments. Our findings suggest the overall incidence of ASD is 11.7% in adult patients with lumbar spondylolisthesis after decompression and instrumented fusion at a mean follow-up of 28.6 months, the simultaneous decompression at the adjacent segment and preexisting spinal stenosis at cranial adjacent segment are risk factors for ASD. Copyright © 2017. Published by Elsevier B.V.

Spinal sagittal imbalance in patients with lumbar disc herniation: its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy.

PubMed

Liang, Chen; Sun, Jianmin; Cui, Xingang; Jiang, Zhensong; Zhang, Wen; Li, Tao

2016-07-22

Spinal sagittal imbalance is a widely acknowledged problem, but there is insufficient knowledge regarding its occurrence. In some patients with lumbar disc herniation (LDH), their symptom is similar to spinal sagittal imbalance. The aim of this study is to illustrate the spinopelvic sagittal characteristics and identity the role of spinal musculature in the mechanism of sagittal imbalance in patients with LDH. Twenty-five adults with spinal sagittal imbalance who initially came to our clinic for treatment of LDH, followed by posterior discectomy were reviewed. The horizontal distance between C7 plumb line-sagittal vertical axis (C7PL-SVA) greater than 5 cm anteriorly with forward bending posture is considered as spinal sagittal imbalance. Radiographic parameters including thoracic kyphotic angle (TK), lumbar lordotic angle (LL), pelvic tilting angle (PT), sacral slope angle (SS) and an electromyography(EMG) index 'the largest recruitment order' were recorded and compared. All patients restored coronal and sagittal balance immediately after lumbar discectomy. The mean C7PL-SVA and trunk shift value decreased from (11.6 ± 6.6 cm, and 2.9 ± 6.1 cm) preoperatively to (-0.5 ± 2.6 cm and 0.2 ± 0.5 cm) postoperatively, while preoperative LL and SS increased from (25.3° ± 14.0° and 25.6° ± 9.5°) to (42.4° ± 10.2° and 30.4° ± 8.7°) after surgery (P < 0.05). The preoperative mean TK and PT (24.7° ± 11.3° and 20.7° ± 7.8°) decreased to (22.0° ± 9.8° and 15.8 ± 5.5°) postoperatively (P < 0.05). The largest recruitment order on the level of T7-T8, T12-L1 and the herniated level all improved compared with before and after surgery (P < 0.05). All patients have been followed up for more than 2 years. The mean ODI was 77.8 % before surgery to 4.2 % at the final follow-up. Spinal sagittal imbalance caused by LDH is one type of compensatory sagittal imbalance. Compensatory mechanism of spinal sagittal imbalance mainly includes a loss of lumbar lordosis, an increase of thoracic kyphosis and pelvis tilt. Spinal musculature plays an important role in spinal sagittal imbalance in patients with LDH.

Gastrointestinal symptoms in spinal cord injury: relationships with level of injury and psychologic factors.

PubMed

Ng, Clinton; Prott, Gillian; Rutkowski, Susan; Li, Yueming; Hansen, Ross; Kellow, John; Malcolm, Allison

2005-08-01

Previous surveys of gastrointestinal symptoms after spinal cord injury have not used validated questionnaires and have not focused on the full spectrum of such symptoms and their relationship to factors, such as level of spinal cord injury and psychologic dysfunction. This study was designed to detail the spectrum and prevalence of gastrointestinal symptoms in spinal cord injury and to determine clinical and psychologic factors associated with such symptoms. Established spinal cord injury patients (>12 months) randomly selected from a spinal cord injury database completed the following three questionnaires: 1) Rome II Integrative Questionnaire, 2) Hospital Anxiety and Depression Scale, and 3) Burwood Bowel Dysfunction after spinal cord injury. A total of 110 patients participated. The prevalence of abdominal bloating and constipation were 22 and 46 percent, respectively. Bloating was associated with cervical (odds ratio = 9.5) and lumbar (odds ratio = 12.1) level but not with thoracic level of injury. Constipation was associated with a higher level of injury (cervical odds ratio = 5.6 vs. lumbar) but not with psychologic factors. In contrast, abdominal pain (33 percent) and fecal incontinence (41 percent) were associated with higher levels of anxiety (odds ratio = 6.8, and odds ratio = 2.4) but not with the level of injury. There is a high prevalence and wide spectrum of gastrointestinal symptoms in spinal cord injury. Abdominal bloating and constipation are primarily related to specific spinal cord levels of injury, whereas abdominal pain and fecal incontinence are primarily associated with higher levels of anxiety. Based on our findings, further physiologic and psychologic research studies in spinal cord injury patients should lead to more rational management strategies for the common gastrointestinal symptoms in spinal cord injury.

Quantitative evaluation of the lumbosacral sagittal alignment in degenerative lumbar spinal stenosis

PubMed Central

Makirov, Serik K.; Jahaf, Mohammed T.; Nikulina, Anastasia A.

2015-01-01

Goal of the study This study intends to develop a method of quantitative sagittal balance parameters assessment, based on a geometrical model of lumbar spine and sacrum. Methods One hundred eight patients were divided into 2 groups. In the experimental group have been included 59 patients with lumbar spinal stenosis on L1-5 level. Forty-nine healthy volunteers without history of any lumbar spine pathlogy were included in the control group. All patients have been examined with supine MRI. Lumbar lordosis has been adopted as circular arc and described either anatomical (lumbar lordosis angle), or geometrical (chord length, circle segment height, the central angle, circle radius) parameters. Moreover, 2 sacral parameters have been assessed for all patients: sacral slope and sacral deviation angle. Both parameters characterize sacrum disposition in horizontal and vertical axis respectively. Results Significant correlation was observed between anatomical and geometrical lumbo-sacral parameters. Significant differences between stenosis group and control group were observed in the value of the “central angle” and “sacral deviation” parameters. We propose additional parameters: lumbar coefficient, as ratio of the lordosis angle to the segmental angle (Kl); sacral coefficient, as ratio of the sacral tilt (ST) to the sacral deviation (SD) angle (Ks); and assessment modulus of the mathematical difference between sacral and lumbar coefficients has been used for determining lumbosacral balance (LSB). Statistically significant differences between main and control group have been obtained for all described coefficients (p = 0.006, p = 0.0001, p = 0.0001, accordingly). Median of LSB value of was 0.18 and 0.34 for stenosis and control groups, accordingly. Conclusion Based on these results we believe that that spinal stenosis is associated with an acquired deformity that is measureable by the described parameters. It's possible that spinal stenosis occurs in patients with an LSB of 0.2 or less, so this value can be predictable for its development. It may suggest that spinal stenosis is more likely to occur in patients with the spinal curvature of this type because of abnormal distribution of the spine loads. This fact may have prognostic significance for develop vertebral column disease and evaluation of treatment results. PMID:26767160

Association of walking speed with sagittal spinal alignment, muscle thickness, and echo intensity of lumbar back muscles in middle-aged and elderly women.

PubMed

Masaki, Mitsuhiro; Ikezoe, Tome; Fukumoto, Yoshihiro; Minami, Seigo; Aoyama, Junichi; Ibuki, Satoko; Kimura, Misaka; Ichihashi, Noriaki

2016-06-01

Age-related change of spinal alignment in the standing position is known to be associated with decreases in walking speed, and alteration in muscle quantity (i.e., muscle mass) and muscle quality (i.e., increases in the amount of intramuscular non-contractile tissue) of lumbar back muscles. Additionally, the lumbar lordosis angle in the standing position is associated with walking speed, independent of lower-extremity muscle strength, in elderly individuals. However, it is unclear whether spinal alignment in the standing position is associated with walking speed in the elderly, independent of trunk muscle quantity and quality. The present study investigated the association of usual and maximum walking speed with age, sagittal spinal alignment in the standing position, muscle quantity measured as thickness, and quality measured as echo intensity of lumbar muscles in 35 middle-aged and elderly women. Sagittal spinal alignment in the standing position (thoracic kyphosis, lumbar lordosis, and sacral anterior inclination angle) using a spinal mouse, and muscle thickness and echo intensity of the lumbar muscles (erector spinae, psoas major, and lumbar multifidus) using an ultrasound imaging device were also measured. Stepwise regression analysis showed that only age was a significant determinant of usual walking speed. The thickness of the lumbar erector spinae muscle was a significant, independent determinant of maximal walking speed. The results of this study suggest that a decrease in maximal walking speed is associated with the decrease in lumbar erector spinae muscles thickness rather than spinal alignment in the standing position in middle-aged and elderly women.

Spinal needle force monitoring during lumbar puncture using fiber Bragg grating force device.

PubMed

Ambastha, Shikha; Umesh, Sharath; Dabir, Sundaresh; Asokan, Sundarrajan

2016-11-01

A technique for real-time dynamic monitoring of force experienced by a spinal needle during lumbar puncture using a fiber Bragg grating (FBG) sensor is presented. The proposed FBG force device (FBGFD) evaluates the compressive force on the spinal needle during lumbar puncture, particularly avoiding the bending effect on the needle. The working principle of the FBGFD is based on transduction of force experienced by the spinal needle into strain variations monitored by the FBG sensor. FBGFD facilitates external mounting of a spinal needle for its smooth insertion during lumbar puncture without any intervention. The developed FBGFD assists study and analysis of the force required for the spinal needle to penetrate various tissue layers from skin to the epidural space; this force is indicative of the varied resistance offered by different tissue layers for the spinal needle traversal. Calibration of FBGFD is performed on a micro-universal testing machine for 0 to 20 N range with an obtained resolution of 0.021 N. The experimental trials using spinal needles mounted on FBGFD are carried out on a human cadaver specimen with punctures made in the lumbar region from different directions. Distinct forces are recorded when the needle encounters skin, muscle tissue, and a bone in its traversing path. Real-time spinal needle force monitoring using FBGFD may reduce potentially serious complications during the lumbar puncture, such as overpuncturing of tissue regions, by impeding the spinal needle insertion at epidural space.

Spinal needle force monitoring during lumbar puncture using fiber Bragg grating force device

NASA Astrophysics Data System (ADS)

Ambastha, Shikha; Umesh, Sharath; Dabir, Sundaresh; Asokan, Sundarrajan

2016-11-01

A technique for real-time dynamic monitoring of force experienced by a spinal needle during lumbar puncture using a fiber Bragg grating (FBG) sensor is presented. The proposed FBG force device (FBGFD) evaluates the compressive force on the spinal needle during lumbar puncture, particularly avoiding the bending effect on the needle. The working principle of the FBGFD is based on transduction of force experienced by the spinal needle into strain variations monitored by the FBG sensor. FBGFD facilitates external mounting of a spinal needle for its smooth insertion during lumbar puncture without any intervention. The developed FBGFD assists study and analysis of the force required for the spinal needle to penetrate various tissue layers from skin to the epidural space; this force is indicative of the varied resistance offered by different tissue layers for the spinal needle traversal. Calibration of FBGFD is performed on a micro-universal testing machine for 0 to 20 N range with an obtained resolution of 0.021 N. The experimental trials using spinal needles mounted on FBGFD are carried out on a human cadaver specimen with punctures made in the lumbar region from different directions. Distinct forces are recorded when the needle encounters skin, muscle tissue, and a bone in its traversing path. Real-time spinal needle force monitoring using FBGFD may reduce potentially serious complications during the lumbar puncture, such as overpuncturing of tissue regions, by impeding the spinal needle insertion at epidural space.

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

PubMed

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

2008-10-01

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

Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain

PubMed Central

Christensen, Finn Bjarke; Christiansen, Terkel; Bünger, Cody

2006-01-01

Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient-level, (2) to investigate the correlation between costs and effects, (3) to investigate the influence of selected patient characteristics on cost-effectiveness and, (4) to investigate the incremental cost-effectiveness ratio of (a) posterior instrumentation and (b) intervertebral anterior support in lumbar spinal fusion. We hypothesized a positive correlation between costs and effects, that determinants of effects would also determine cost-effectiveness, and that posterolateral instrumentation and anterior intervertebral support are cost-effective adjuncts in posterolateral lumbar fusion. A cohort of 136 consecutive patients with chronic low back pain, who were surgically treated from January 2001 through January 2003, was followed until 2 years postoperatively. Operations took place at University Hospital of Aarhus and all patients had either (1) non-instrumented posterolateral lumbar spinal fusion, (2) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator’s perspective, by means of Activity-Based-Costing. Clinical effects were measured by means of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted analysis (for non-random allocation of patients) was performed in order to reveal the incremental cost-effectiveness ratios of (a) posterior instrumentation and (b) anterior support. The costs of non-instrumented posterolateral spinal fusion were estimated at DKK 88,285(95% CI 81,369;95,546), instrumented posterolateral spinal fusion at DKK 94,396(95% CI 89,865;99,574) and instrumented posterolateral lumbar spinal fusion + anterior intervertebral support at DKK 120,759(95% CI 111,981;133,738). The net-benefit of the regimens was significantly affected by smoking and functional disability in psychosocial life areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited, whereas the probability of anterior intervertebral support being cost-effective escalates as willingness-to-pay per effect unit increases. This study reveals useful and hitherto unknown information both about cost-patterns at the patient-level and determinants of cost-effectiveness. The overall conclusion of the present investigation is a recommendation to focus further on determinants of cost-effectiveness. For example, patient characteristics that are modifiable at a relatively low expense may have greater influence on cost-effectiveness than the surgical technique itself—at least from an administrator’s perspective. PMID:16871387

Distraction of facets with intraarticular spacers as treatment for lumbar canal stenosis: report on a preliminary experience with 21 cases.

PubMed

Goel, Atul; Shah, Abhidha; Jadhav, Madan; Nama, Santhosh

2013-12-01

The authors report their experience in treating 21 patients by using a novel form of treatment of lumbar degenerative disease that leads to canal stenosis. The surgery involved distraction of the facets using specially designed Goel intraarticular spacers and was aimed at arthrodesis of the spinal segment in a distracted position. The operation is based on the premise that subtle and longstanding facet instability, joint space reduction, and subsequent facet override had a profound and primary influence in the pathogenesis of degenerative lumbar canal stenosis. The surgical technique and the rationale for treatment are discussed. Between April 2006 and January 2011, 21 cases of lumbar degenerative disease resulting in characteristic lumbar canal stenosis were treated in the authors' department with the proposed technique. The patients were prospectively analyzed. There were 15 men and 6 women who ranged in age from 48 to 71 years (mean 58 years). Nine patients underwent 1-level and 12 patients underwent 2-level treatment. Surgery involved wide opening of the articular joint, denuding of the articular capsule/endplate cartilage, distraction of the facets, and forced impaction of Goel intraarticular spacers. Bone graft pieces obtained by sectioning the spinous processes were placed within and over the joint and in the midline over the adequately prepared host area of laminae. The Oswestry Disability Index and visual analog scale were used to clinically assess the patients before and after surgery and at follow-up. The alterations in the physical architecture of spinal canal and intervertebral foramen dimensions were evaluated before and after placement of the intrafacet implant and after at least 6 months of follow-up. All patients had varying degrees of relief from symptoms of local back pain and radiculopathy. Impaction of spacers within the facet joints resulted in an increase in the spinal canal and intervertebral root canal dimensions (mean 2.33 mm), reduction of buckling of the ligamentum flavum, and reduction of the extent of bulge of the disc into the spinal canal. The procedure resulted in firm stabilization and fixation of the spinal segment and provided a ground for arthrodesis. No patient worsened neurologically after treatment. During the follow-up period, all patients had evidence of segmental bone fusion. No patient underwent reexploration or further surgery of the lumbar spine. Impaction of the spacers within the articular cavity after facet distraction resulted in reversal of several effects of spine degeneration that had caused spinal and root canal stenosis. The safe, firm, and secure stabilization at the fulcrum of lumbar spinal movements provided a ground for segmental spinal arthrodesis. The immediate postoperative and lasting recovery from symptoms suggests the validity of the procedure.

Association of decision-making in spinal surgery with specialty and emotional involvement-the Indications in Spinal Surgery (INDIANA) survey.

PubMed

Sollmann, Nico; Morandell, Carmen; Albers, Lucia; Behr, Michael; Preuss, Alexander; Dinkel, Andreas; Meyer, Bernhard; Krieg, Sandro M

2018-03-01

Although recent trials provided level I evidence for the most common degenerative lumbar spinal disorders, treatment still varies widely. Thus, the Indications in Spinal Surgery (INDIANA) survey explores whether decision-making is influenced by specialty or personal emotional involvement of the treating specialist. Nationwide, neurosurgeons and orthopedic surgeons specialized in spine surgery were asked to answer an Internet-based questionnaire with typical clinical patient cases of lumbar disc herniation (DH), lumbar spinal stenosis (SS), and lumbar degenerative spondylolisthesis (SL). The surgeons were assigned to counsel a patient or a close relative, thus creating emotional involvement. This was achieved by randomly allocating the surgeons to a patient group (PG) and relative group (RG). We then compared neurosurgeons to orthopedic surgeons and the PG to the RG regarding treatment decision-making. One hundred twenty-two spine surgeons completed the questionnaire (response rate 78.7%). Regarding DH and SS, more conservative treatment among orthopedic surgeons was shown (DH: odds ratio [OR] 4.1, 95% confidence interval [CI] 1.7-9.7, p = 0.001; SS: OR 3.9, CI 1.8-8.2, p < 0.001). However, emotional involvement (PG vs. RG) did not affect these results for any of the three cases (DH: p = 0.213; SS: p = 0.097; SL: p = 0.924). The high response rate indicates how important the issues raised by this study actually are for dedicated spine surgeons. Moreover, there are considerable variations in decision-making for the most common degenerative lumbar spinal disorders, although there is high-quality data from large multicenter trials available. Emotional involvement, though, did not influence treatment recommendations.

The Effects of Ketorolac Injected via Patient Controlled Analgesia Postoperatively on Spinal Fusion

PubMed Central

Park, Si-Young; Moon, Seong-Hwan; Park, Moon-Soo; Oh, Kyung-Soo

2005-01-01

Lumbar spinal fusions have been performed for spinal stability, pain relief and improved function in spinal stenosis, scoliosis, spinal fractures, infectious conditions and other lumbar spinal problems. The success of lumbar spinal fusion depends on multifactors, such as types of bone graft materials, levels and numbers of fusion, spinal instrumentation, electrical stimulation, smoking and some drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs). From January 2000 to December 2001, 88 consecutive patients, who were diagnosed with spinal stenosis or spondylolisthesis, were retrospectively enrolled in this study. One surgeon performed all 88 posterolateral spinal fusions with instrumentation and autoiliac bone graft. The patients were divided into two groups. The first group (n=30) was infused with ketorolac and fentanyl intravenously via patient controlled analgesia (PCA) postoperatively and the second group (n=58) was infused only with fentanyl. The spinal fusion rates and clinical outcomes of the two groups were compared. The incidence of incomplete union or nonunion was much higher in the ketorolac group, and the relative risk was approximately 6 times higher than control group (odds ratio: 5.64). The clinical outcomes, which were checked at least 1 year after surgery, showed strong correlations with the spinal fusion status. The control group (93.1%) showed significantly better clinical results than the ketorolac group (77.6%). Smoking had no effect on the spinal fusion outcome in this study. Even though the use of ketorolac after spinal fusion can reduce the need for morphine, thereby decreasing morphine related complications, ketorolac used via PCA at the immediate postoperative state inhibits spinal fusion resulting in a poorer clinical outcome. Therefore, NSAIDs such as ketorolac, should be avoided after posterolateral spinal fusion. PMID:15861498

Immunohistochemical study of motoneurons in lumbar spinal cord of c57black/6 mice after 30-days space flight

NASA Astrophysics Data System (ADS)

Tyapkina, Oksana; Islamov, Rustem; Nurullin, Leniz; Petrov, Konstantin.; Rezvyakov, Pavel; Nikolsky, Evgeny

To investigate mechanisms of hypogravity motor syndrome development the immunoexpression of heat shock proteins (Hsp27 and Hsp70), proteins of synaptic transmission (Synaptophysin and PSD95) and neuroprotective proteins (VEGF and Flt-1) in motoneurons of lumbar spinal cord in c57black/6 control mice (n=2) and after 30-days space flight (n=2) was studied. For a quantitative assessment of target proteins level in motoneurons frozen cross sections of lumbar spinal cord were underwent to immunohistochemical staining. Primary antibodies against VEGF, Flt-1, Hsp27 and Hsp70 (SantaCruz Biotechnology, inc. USA), against Synaptophysin and PSD95 (Abcam plc, UK) were visualized by streptavidin-biotin method. Images of spinal cords were received using OlympusBX51WI microscope with AxioCamMRm camera (CarlZeiss, Germany) and the AxioVisionRel. 4.6.3 software (CarlZeiss, Germany). The digitized data were analyzed using ImageJ 1.43 software (NIH, the USA). Quantitively, protein level in motoneurons was estimated by the density of immunoprecipitation. Results of research have not revealed any reliable changes in the immunnoexpression of vascular endothelial growth factor (VEGF) and its Flt-1 receptor in motoneurons of lumbar spinal cord in control and in mice after 30-day space flight. Studying of heat shock proteins, such as Hsp27 and Hsp70, revealed the decrease in level of these proteins immunoexpression in motoneurons of mice from flight group by 15% and 10%, respectively. Some decrease in level of immunnoexpression of presynaptic membrane proteins (synaptophysin, by 21%) and proteins of postsynaptic area (PSD95, by 55%) was observed after space flight. The data obtained testify to possible changes in a functional state (synaptic activity and stress resistance) of motoneurons of lumbar spinal cord in mice after space flight. Thus, we obtained new data on involvement of motoneurons innervating skeletal muscles in development of hypogravity motor syndrome. Research was supported by grants of: BION-M1, program of the President of the Russian Federation (Science School) no. No. 5584.214.4 (NEE), RFFR No.11-04-00602 (NEE), Program No.7 of Presidium of RAS (NEE), RFFR No.13-04-00310 (IRR), RFFR No.12-04-01414 (NLF).

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

PubMed Central

Cox, James M.

2012-01-01

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

Recovery of locomotion in the cat following spinal cord lesions.

PubMed

Rossignol, S; Bouyer, L; Barthélemy, D; Langlet, C; Leblond, H

2002-10-01

In most species, locomotor function beneath the level of a spinal cord lesion can be restored even if the cord is completely transected. This suggests that there is, within the spinal cord, an autonomous network of neurons capable of generating a locomotor pattern independently of supraspinal inputs. Recent studies suggest that several physiological and neurochemical changes have to occur in the neuronal networks located caudally to the lesion to allow the expression of spinal locomotion. Some evidence of this plasticity will be addressed in this review. In addition, original data on the functional organisation of the lumbar spinal cord will also be presented. Recent works in our lab show that segmental responsiveness of the spinal cord of the cat to locally micro-injected drugs in different lumbar segments, in combination with complete lesions at various level of the spinal cord, suggest a rostro-caudal organisation of spinal locomotor control. Moreover, the integrity of midlumbar segments seems to be crucial for the expression of spinal locomotion. These data suggest that the regions of critical importance for locomotion can be confined to a restricted portion of the spinal cord. Later, these midlumbar segments could be targeted by electrical stimulation or grafts to improve recovery of function. Understanding the changes in spinal cord neurophysiology and neurochemistry after a lesion is of critical importance to the improvement of treatments for locomotor rehabilitation in spinal-cord-injured patients.

Focal dysfunction of the proteasome: a pathogenic factor in a mouse model of amyotrophic lateral sclerosis.

PubMed

Kabashi, Edor; Agar, Jeffrey N; Taylor, David M; Minotti, Sandra; Durham, Heather D

2004-06-01

Mutations in the Cu/Zn-superoxide dismutase (SOD-1) gene are responsible for a familial form of amyotrophic lateral sclerosis (fALS). The present study demonstrated impaired proteasomal function in the lumbar spinal cord of transgenic mice expressing human SOD-1 with the ALS-causing mutation G93A (SOD-1(G93A)) compared to non-transgenic littermates (LM) and SOD-1(WT) transgenic mice. Chymotrypsin-like activity was decreased as early as 45 days of age. By 75 days, chymotrypsin-, trypsin-, and caspase-like activities of the proteasome were impaired, at about 50% of control activity in lumbar spinal cord, but unchanged in thoracic spinal cord and liver. Both total and specific activities of the proteasome were reduced to a similar extent, indicating that a change in proteasome function, rather than a decrease in proteasome levels, had occurred. Similar decreases of total and specific activities of the proteasome were observed in NIH 3T3 cell lines expressing fALS mutants SOD-1(G93A) and SOD-1(G41S), but not in SOD-1(WT) controls. Although overall levels of proteasome were maintained in spinal cord of SOD-1(G93A) transgenic mice, the level of 20S proteasome was substantially reduced in lumbar spinal motor neurons relative to the surrounding neuropil. It is concluded that impairment of the proteasome is an early event and contributes to ALS pathogenesis.

Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

PubMed Central

ICHINOSE, Daisuke; TOCHIGI, Satoru; TANAKA, Toshihide; SUZUKI, Tomoya; TAKEI, Jun; HATANO, Keisuke; KAJIWARA, Ikki; MARUYAMA, Fumiaki; SAKAMOTO, Hiroki; HASEGAWA, Yuzuru; TANI, Satoshi; MURAYAMA, Yuichi

2018-01-01

A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy. PMID:29479039

Sacroiliac Joint Fusion Minimally Affects Adjacent Lumbar Segment Motion: A Finite Element Study

PubMed Central

Kiapour, Ali; Yerby, Scott A.; Goel, Vijay K.

2015-01-01

Background Adjacent segment disease is a recognized consequence of fusion in the spinal column. Fusion of the sacroiliac joint is an effective method of pain reduction. Although effective, the consequences of sacroiliac joint fusion and the potential for adjacent segment disease for the adjacent lumbar spinal levels is unknown. The objective of this study was to quantify the change in range of motion of the sacroiliac joint and the adjacent lumbar spinal motion segments due to sacroiliac joint fusion and compare these changes to previous literature to assess the potential for adjacent segment disease in the lumbar spine. Methods An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the sacroiliac joint using three laterally placed triangular implants (iFuse Implant System, SI-BONE, Inc., San Jose, CA). The range of motion of the sacroiliac joint and the adjacent lumbar spinal motion segments were calculated using a hybrid loading protocol and compared with the intact range of motion in flexion, extension, lateral bending, and axial rotation. Results The range of motions of the treated sacroiliac joints were reduced in flexion, extension, lateral bending, and axial rotation, by 56.6%, 59.5%, 27.8%, and 53.3%, respectively when compared with the intact condition. The stiffening of the sacroiliac joint resulted in increases at the adjacent lumbar motion segment (L5-S1) for flexion, extension, lateral bending, and axial rotation, of 3.0%, 3.7%, 1.1%, and 4.6%, respectively. Conclusions Fusion of the sacroiliac joint resulted in substantial (> 50%) reductions in flexion, extension, and axial rotation of the sacroiliac joint with minimal (< 5%) increases in range of motion in the lumbar spine. Although the predicted increases in lumbar range of motion are minimal after sacroiliac joint fusion, the long-term clinical results remain to be investigated. PMID:26767156

Sacroiliac Joint Fusion Minimally Affects Adjacent Lumbar Segment Motion: A Finite Element Study.

PubMed

Lindsey, Derek P; Kiapour, Ali; Yerby, Scott A; Goel, Vijay K

2015-01-01

Adjacent segment disease is a recognized consequence of fusion in the spinal column. Fusion of the sacroiliac joint is an effective method of pain reduction. Although effective, the consequences of sacroiliac joint fusion and the potential for adjacent segment disease for the adjacent lumbar spinal levels is unknown. The objective of this study was to quantify the change in range of motion of the sacroiliac joint and the adjacent lumbar spinal motion segments due to sacroiliac joint fusion and compare these changes to previous literature to assess the potential for adjacent segment disease in the lumbar spine. An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the sacroiliac joint using three laterally placed triangular implants (iFuse Implant System, SI-BONE, Inc., San Jose, CA). The range of motion of the sacroiliac joint and the adjacent lumbar spinal motion segments were calculated using a hybrid loading protocol and compared with the intact range of motion in flexion, extension, lateral bending, and axial rotation. The range of motions of the treated sacroiliac joints were reduced in flexion, extension, lateral bending, and axial rotation, by 56.6%, 59.5%, 27.8%, and 53.3%, respectively when compared with the intact condition. The stiffening of the sacroiliac joint resulted in increases at the adjacent lumbar motion segment (L5-S1) for flexion, extension, lateral bending, and axial rotation, of 3.0%, 3.7%, 1.1%, and 4.6%, respectively. Fusion of the sacroiliac joint resulted in substantial (> 50%) reductions in flexion, extension, and axial rotation of the sacroiliac joint with minimal (< 5%) increases in range of motion in the lumbar spine. Although the predicted increases in lumbar range of motion are minimal after sacroiliac joint fusion, the long-term clinical results remain to be investigated.

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

PubMed

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

2013-03-01

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

Effects of Psoas Muscle Thickness on Outcomes of Lumbar Fusion Surgery.

PubMed

Verla, Terence; Adogwa, Owoicho; Elsamadicy, Aladine; Moreno, Jessica R; Farber, Harrison; Cheng, Joseph; Bagley, Carlos A

2016-03-01

Lumbar arthrodesis is a surgical option for treatment of lumbar pathologies. Stability of the spinal construct partly depends on load-bearing support from back muscles. Despite the role of the psoas muscle in upright spinal stabilization, data describing its clinical significance are scarce. We evaluated the effects of the psoas muscle thickness on outcomes after lumbar fusion surgery. A retrospective review was performed of hospital records (2007-2013) of adult patients undergoing lumbar fusion surgery. Patients ≥ 18 years old who had undergone ≥ 1 level of lumbar fusion with available preoperative magnetic resonance imaging scans and at least 1 year of follow-up were included. Axial psoas muscle thickness was measured at each lumbar intervertebral space. Psoas muscle thickness at each vertebral level was compared between patients with and without the occurrence of specific clinical outcomes. There were 257 patients included. The average age was 58.15 years; about 45% of patients were men. Most of the patients underwent a transforaminal interbody fusion surgery (58.4%). The average psoas muscle thickness ranged from 11.49 mm at L1-2 to 36.51 mm at L4-5. Patients with postoperative hip flexor weakness and increased time to ambulation had significantly smaller psoas muscle thickness. Also, patients with >50% improvement in visual analog scale pain score had significantly greater psoas muscle thickness. This study shows that the psoas muscle can be beneficial in overall postoperative rehabilitation with early ambulation and greater improvement in functional outcomes. Given the role of the psoas muscle in spinal stabilization, the effect of psoas muscle thickness on postoperative functional outcomes warrants further investigation. Copyright © 2016 Elsevier Inc. All rights reserved.

Novel spinal instrumentation to enhance osteogenesis and fusion: a preliminary study.

PubMed

MacEwan, Matthew R; Talcott, Michael R; Moran, Daniel W; Leuthardt, Eric C

2016-09-01

OBJECTIVE Instrumented spinal fusion continues to exhibit high failure rates in patients undergoing multilevel lumbar fusion or pseudarthrosis revision; with Grade II or higher spondylolisthesis; or in those possessing risk factors such as obesity, tobacco use, or metabolic disorders. Direct current (DC) electrical stimulation of bone growth represents a unique surgical adjunct in vertebral fusion procedures, yet existing spinal fusion stimulators are not optimized to enhance interbody fusion. To develop an advanced method of applying DC electrical stimulation to promote interbody fusion, a novel osteogenic spinal system capable of routing DC through rigid instrumentation and into the vertebral bodies was fabricated. A pilot study was designed to assess the feasibility of osteogenic instrumentation and compare the ability of osteogenic instrumentation to promote successful interbody fusion in vivo to standard spinal instrumentation with autograft. METHODS Instrumented, single-level, posterior lumbar interbody fusion (PLIF) with autologous graft was performed at L4-5 in adult Toggenburg/Alpine goats, using both osteogenic spinal instrumentation (plus electrical stimulation) and standard spinal instrumentation (no electrical stimulation). At terminal time points (3 months, 6 months), animals were killed and lumbar spines were explanted for radiographic analysis using a SOMATOM Dual Source Definition CT Scanner and high-resolution Microcat II CT Scanner. Trabecular continuity, radiodensity within the fusion mass, and regional bone formation were examined to determine successful spinal fusion. RESULTS Quantitative analysis of average bone density in pedicle screw beds confirmed that electroactive pedicle screws used in the osteogenic spinal system focally enhanced bone density in instrumented vertebral bodies. Qualitative and quantitative analysis of high-resolution CT scans of explanted lumbar spines further demonstrated that the osteogenic spinal system induced solid bony fusion across the L4-5 disc space as early as 6 weeks postoperatively. In comparison, inactive spinal instrumentation with autograft was unable to promote successful interbody fusion by 6 months postoperatively. CONCLUSIONS Results of this study demonstrate that novel osteogenic spinal instrumentation supports interbody fusion through the focal delivery of DC electrical stimulation. With further technical development and scientific/clinical validation, osteogenic spinal instrumentation may offer a unique alternative to biological scaffolds and pharmaceutical adjuncts used in spinal fusion procedures.

Etiology of lumbar lordosis and its pathophysiology: a review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration.

PubMed

Sparrey, Carolyn J; Bailey, Jeannie F; Safaee, Michael; Clark, Aaron J; Lafage, Virginie; Schwab, Frank; Smith, Justin S; Ames, Christopher P

2014-05-01

The goal of this review is to discuss the mechanisms of postural degeneration, particularly the loss of lumbar lordosis commonly observed in the elderly in the context of evolution, mechanical, and biological studies of the human spine and to synthesize recent research findings to clinical management of postural malalignment. Lumbar lordosis is unique to the human spine and is necessary to facilitate our upright posture. However, decreased lumbar lordosis and increased thoracic kyphosis are hallmarks of an aging human spinal column. The unique upright posture and lordotic lumbar curvature of the human spine suggest that an understanding of the evolution of the human spinal column, and the unique anatomical features that support lumbar lordosis may provide insight into spine health and degeneration. Considering evolution of the skeleton in isolation from other scientific studies provides a limited picture for clinicians. The evolution and development of human lumbar lordosis highlight the interdependence of pelvic structure and lumbar lordosis. Studies of fossils of human lineage demonstrate a convergence on the degree of lumbar lordosis and the number of lumbar vertebrae in modern Homo sapiens. Evolution and spine mechanics research show that lumbar lordosis is dictated by pelvic incidence, spinal musculature, vertebral wedging, and disc health. The evolution, mechanics, and biology research all point to the importance of spinal posture and flexibility in supporting optimal health. However, surgical management of postural deformity has focused on restoring posture at the expense of flexibility. It is possible that the need for complex and costly spinal fixation can be eliminated by developing tools for early identification of patients at risk for postural deformities through patient history (genetics, mechanics, and environmental exposure) and tracking postural changes over time.

Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison

PubMed Central

Satoskar, Savni R.; Goel, Aimee A.; Mehta, Pooja H.; Goel, Atul

2014-01-01

Objective: The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of ‘Goel facet spacer’ in the treatment of degenerative spinal canal stenosis. Materials and Methods: Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint. Results: The spacers achieved distraction of facets that was more pronounced in the vertical perspective. Introduction of spacers on both sides resulted in an increase in the intervertebral foraminal height and a circumferential increase in the spinal canal dimensions. Additionally, there was an increase in the disc space or intervertebral body height. The lumbar facets are more vertically and anteroposteriorly oriented when compared to cervical facets that are obliquely and transversely oriented. Conclusions: Understanding the anatomical peculiarities of the lumbar and cervical facets can lead to an optimum utilization of the potential of Goel facet distraction arthrodesis technique in the treatment of spinal degenerative canal stenosis. PMID:25558146

Lumbar spinal loads and muscle activity during a golf swing.

PubMed

Lim, Young-Tae; Chow, John W; Chae, Woen-Sik

2012-06-01

This study estimated the lumbar spinal loads at the L4-L5 level and evaluated electromyographic (EMG) activity of right and left rectus abdominis, external and internal obliques, erector spinae, and latissimus dorsi muscles during a golf swing. Four super VHS camcorders and two force plates were used to obtain three-dimensional (3D) kinematics and kinetics of golf swings performed by five male collegiate golfers. Average EMG levels for different phases of golf swing were determined. An EMG-assisted optimization model was applied to compute the contact forces acting on the L4-L5. The results revealed a mean peak compressive load of over six times the body weight (BW) during the downswing and mean peak anterior and medial shear loads approaching 1.6 and 0.6 BW during the follow-through phases. The peak compressive load estimated in this study was high, but less than the corresponding value (over 8 BW) reported by a previous study. Average EMG levels of different muscles were the highest in the acceleration and follow-through phases, suggesting a likely link between co-contractions of paraspinal muscles and lumbar spinal loads.

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

PubMed Central

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

2011-01-01

Background When spinal fusion is applied to degenerative lumbar spinal disease with instability, adjacent segment disorder will be an issue in the future. However, decompression alone could cause recurrence of spinal canal stenosis because of increased instability on operated segments and lead to revision surgery. Covering the disadvantages of both procedures, we applied nonfusion stabilization with the Segmental Spinal Correction System (Ulrich Medical, Ulm, Germany) and decompression. Methods The surgical results of 52 patients (35 men and 17 women) with a minimum 2-year follow-up were analyzed: 10 patients with lumbar spinal canal stenosis, 15 with lumbar canal stenosis with disc herniation, 20 with degenerative spondylolisthesis, 6 with disc herniation, and 1 with lumbar discopathy. Results The Japanese Orthopaedic Association score was improved, from 14.4 ± 5.3 to 25.5 ± 2.8. The improvement rate was 76%. Range of motion of the operated segments was significantly decreased, from 9.6° ± 4.2° to 2.0° ± 1.8°. Only 1 patient had adjacent segment disease that required revision surgery. There was only 1 screw breakage, but the patient was asymptomatic. Conclusions Over a minimum 2-year follow-up, the results of nonfusion stabilization with the Segmental Spinal Correction System for unstable degenerative lumbar disease were good. It is necessary to follow up the cases with a focus on adjacent segment disorders in the future. PMID:25802671

Passive lumbar tissue loading during trunk bending at three speeds: An in vivo study.

PubMed

Ning, Xiaopeng; Nussbaum, Maury A

2015-08-01

Low back disorders are closely related with the magnitude of mechanical loading on human spine. However, spinal loading contributed by the lumbar passive tissues is still not well understood. In this study, the effect of motion speed on lumbar passive moment output was investigated. In addition, the increase of lumbar passive moment during trunk bending was modeled. Twelve volunteers performed trunk-bending motions at three different speeds. Trunk kinematics and muscle activities were collected and used to estimate instantaneous spinal loading and the corresponding lumbar passive moment. The lumbar passive moments at different ranges of trunk motion were compared at different speed levels and the relationship between lumbar passive moment lumbar flexion was modeled. A non-linear, two-stage pattern of increase in lumbar passive moment was evident during trunk flexion. However, the effect of motion speed was not significant on lumbar passive moments or any of the model parameters. As reported previously, distinct lumbar ligaments may begin to generate tension at differing extents of trunk flexion, and this could be the cause of the observed two-stage increasing pattern of lumbar passive moment. The current results also suggest that changes in tissue strain rate may not have a significant impact on the total passive moment output at the relatively slow trunk motions examined here. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

PubMed

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

2013-06-01

Spinal deformities reportedly affect postural instability or falls. To prevent falls in clinical settings, the determination of a cut-off angle of spinal sagittal contour associated with increase risk for falls would be useful for screening for high-risk fallers. The purpose of this study was to calculate the spinal sagittal contour angle associated with increased risk for falls during medical checkups in community dwelling elders. The subjects comprised 213 patients (57 men, 156 women) with a mean age of 70.1 years (range, 55-85 years). The upright and flexion/extension thoracic kyphosis and lumbar lordosis angles, and the spinal inclination were evaluated with SpinalMouse(®). Postural instability was evaluated by stabilometry, using the total track length (LNG), enveloped areas (ENV), and track lengths in the lateral and anteroposterior directions (X LNG and Y LNG, respectively). The back extensor strength (BES) was measured using a strain-gauge dynamometer. The relationships among the parameters were analyzed statistically. Age, lumbar lordosis, spinal inclination, LNG, X LNG, Y LNG, and BES were significantly associated with falls (P<0.05). Multivariate logistic regression analyses revealed that lumbar lordosis was the most significant factor (P<0.01). Univariate logistic regression analyses for falls about lumbar lordosis angles revealed that angles of 3° and less were significant for falls. The present findings suggest that increased age, spinal inclination, LNG, X LNG, Y LNG, and decreased BES and lumbar lordosis, are associated with falls. An angle of lumbar lordosis of 3° or less was associated with falls in these community-dwelling elders. Copyright © 2012 Elsevier B.V. All rights reserved.

The influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination during weightlifting.

PubMed

Hu, Boyi; Ning, Xiaopeng

2015-01-01

Lumbar muscle fatigue is a potential risk factor for the development of low back pain. In this study, we investigated the influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination patterns during weightlifting. Each of the 15 male subjects performed five repetitions of weightlifting tasks both before and after a lumbar extensor muscle fatiguing protocol. Lumbar muscle electromyography was collected to assess fatigue. Trunk kinematics was recorded to calculate lumbar-pelvic continuous relative phase (CRP) and CRP variability. Results showed that fatigue significantly reduced the average lumbar-pelvic CRP value (from 0.33 to 0.29 rad) during weightlifting. The average CRP variability reduced from 0.17 to 0.15 rad, yet this change ws statistically not significant. Further analyses also discovered elevated spinal loading during weightlifting after the development of lumbar extensor muscle fatigue. Our results suggest that frequently experienced lumbar extensor muscle fatigue should be avoided in an occupational environment. Lumbar extensor muscle fatigue generates more in-phase lumbar-pelvic coordination patterns and elevated spinal loading during lifting. Such increase in spinal loading may indicate higher risk of back injury. Our results suggest that frequently experienced lumbar muscle fatigue should be avoided to reduce the risk of LBP.

Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles, and sagittal spinal alignment in young and middle-aged medical workers.

PubMed

Masaki, Mitsuhiro; Aoyama, Tomoki; Murakami, Takashi; Yanase, Ko; Ji, Xiang; Tateuchi, Hiroshige; Ichihashi, Noriaki

2017-11-01

Muscle stiffness of the lumbar back muscles in low back pain (LBP) patients has not been clearly elucidated because quantitative assessment of the stiffness of individual muscles was conventionally difficult. This study aimed to examine the association of LBP with muscle stiffness assessed using ultrasonic shear wave elastography (SWE) and muscle mass of the lumbar back muscle, and spinal alignment in young and middle-aged medical workers. The study comprised 23 asymptomatic medical workers [control (CTR) group] and 9 medical workers with LBP (LBP group). Muscle stiffness and mass of the lumbar back muscles (lumbar erector spinae, multifidus, and quadratus lumborum) in the prone position were measured using ultrasonic SWE. Sagittal spinal alignment in the standing and prone positions was measured using a Spinal Mouse. The association with LBP was investigated by multiple logistic regression analysis with a forward selection method. The analysis was conducted using the shear elastic modulus and muscle thickness of the lumbar back muscles, and spinal alignment, age, body height, body weight, and sex as independent variables. Multiple logistic regression analysis showed that muscle stiffness of the lumbar multifidus muscle and body height were significant and independent determinants of LBP, but that muscle mass and spinal alignment were not. Muscle stiffness of the lumbar multifidus muscle in the LBP group was significantly higher than that in the CTR group. The results of this study suggest that LBP is associated with muscle stiffness of the lumbar multifidus muscle in young and middle-aged medical workers. Copyright © 2017 Elsevier Ltd. All rights reserved.

Biomechanical tolerance of whole lumbar spines in straightened posture subjected to axial acceleration.

PubMed

Stemper, Brian D; Chirvi, Sajal; Doan, Ninh; Baisden, Jamie L; Maiman, Dennis J; Curry, William H; Yoganandan, Narayan; Pintar, Frank A; Paskoff, Glenn; Shender, Barry S

2018-06-01

Quantification of biomechanical tolerance is necessary for injury prediction and protection of vehicular occupants. This study experimentally quantified lumbar spine axial tolerance during accelerative environments simulating a variety of military and civilian scenarios. Intact human lumbar spines (T12-L5) were dynamically loaded using a custom-built drop tower. Twenty-three specimens were tested at sub-failure and failure levels consisting of peak axial forces between 2.6 and 7.9 kN and corresponding peak accelerations between 7 and 57 g. Military aircraft ejection and helicopter crashes fall within these high axial acceleration ranges. Testing was stopped following injury detection. Both peak force and acceleration were significant (p < 0.0001) injury predictors. Injury probability curves using parametric survival analysis were created for peak acceleration and peak force. Fifty-percent probability of injury (95%CI) for force and acceleration were 4.5 (3.9-5.2 kN), and 16 (13-19 g). A majority of injuries affected the L1 spinal level. Peak axial forces and accelerations were greater for specimens that sustained multiple injuries or injuries at L2-L5 spinal levels. In general, force-based tolerance was consistent with previous shorter-segment lumbar spine testing (3-5 vertebrae), although studies incorporating isolated vertebral bodies reported higher tolerance attributable to a different injury mechanism involving structural failure of the cortical shell. This study identified novel outcomes with regard to injury patterns, wherein more violent exposures produced more injuries in the caudal lumbar spine. This caudal migration was likely attributable to increased injury tolerance at lower lumbar spinal levels and a faster inertial mass recruitment process for high rate load application. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. J Orthop Res 36:1747-1756, 2018. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Herpes zoster sciatica mimicking lumbar canal stenosis: a case report.

PubMed

Koda, Masao; Mannoji, Chikato; Oikawa, Makiko; Murakami, Masazumi; Okamoto, Yuzuru; Kon, Tamiyo; Okawa, Akihiko; Ikeda, Osamu; Yamazaki, Masashi; Furuya, Takeo

2015-07-29

Symptom of herpes zoster is sometimes difficult to distinguish from sciatica induced by spinal diseases, including lumbar disc herniation and spinal canal stenosis. Here we report a case of sciatica mimicking lumbar canal stenosis. A 74-year-old Chinese male patient visited our hospital for left-sided sciatic pain upon standing or walking for 5 min of approximately 1 month's duration. At the first visit to our hospital, there were no skin lesions. A magnetic resonance imaging showed spinal canal stenosis between the 4th and 5th lumbar spine. Thus, we diagnosed the patient with sciatica induced by spinal canal stenosis. We considered decompression surgery for the stenosis of 4th and 5th lumbar spine because conservative therapy failed to relieve the patient's symptom. At that time, the patient complained of a skin rash involving his left foot for several days. A vesicular rash and erythema were observed on the dorsal and plantar surfaces of the great toe and lateral malleolus. The patient was diagnosed with herpes zoster in the left 5th lumbar spinal nerve area based on clinical findings, including the characteristics of the pain and vesicular rash and erythema in the 5th lumbar spinal dermatome. The patient was treated with famciclovir (1,500 mg/day) and non-steroidal anti-inflammatory drugs. After 1 week of medication, the skin rash resolved and pain relief was obtained. In conclusion, spinal surgeons should keep in mind herpes zoster infection as one of the possible differential diagnoses of sciatica, even if there is no typical skin rash.

Spondylectomy and lateral lumbar interbody fusion for thoracolumbar kyphosis in an adult with achondroplasia: A case report.

PubMed

Miyazaki, Masashi; Kanezaki, Shozo; Notani, Naoki; Ishihara, Toshinobu; Tsumura, Hiroshi

2017-12-01

Fixed thoracolumbar kyphosis with spinal stenosis in adult patients with achondroplasia presents a challenging issue. We describe the first case in which spondylectomy and minimally invasive lateral access interbody arthrodesis were used for the treatment of fixed severe thoracolumbar kyphosis and lumbar spinal canal stenosis in an adult with achondroplasia. A 61-year-old man with a history of achondroplastic dwarfism presented with low back pain and radiculopathy and neurogenic claudication. Plain radiographs revealed a high-grade thoracolumbar kyphotic deformity with diffuse degenerative changes in the lumbar spine. The apex was located at L2, the local kyphotic angle from L1 to L3 was 105°, and the anterior area was fused from the L1 to L3 vertebrae. MRI revealed significant canal and lateral recess stenosis secondary to facet hypertrophy. We planned a front-back correction of the anterior and posterior spinal elements. We first performed anterior release at the fused part from L1 to L3 and XLIF at L3/4 and L4/5. Next, the patient was placed in the prone position. Spondylectomy at the L2 vertebra and posterior fusion from T10 to L5 were performed. Postoperative radiographs revealed L1 to L3 kyphosis of 32°. No complications occurred during or after surgery. Postoperatively, the patient's low back pain and neurological claudication were resolved. No worsening of kyphosis was observed 24 months postoperatively. Circumferential decompression of the spinal cord at the apical vertebral level and decompression of lumbar canal stenosis were necessary. Front-back correction of the anterior and posterior spinal elements via spondylectomy and lateral lumbar interbody fusion is a reasonable surgical option for thoracolumbar kyphosis and developmental canal stenosis in patients with achondroplasia.

Change of Lumbar Ligamentum Flavum after Indirect Decompression Using Anterior Lumbar Interbody Fusion.

PubMed

Ohtori, Seiji; Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Aoki, Yasuchika; Nakamura, Junichi; Miyagi, Masayuki; Suzuki, Miyako; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Fujimoto, Kazuki; Shiga, Yasuhiro; Abe, Koki; Kanamoto, Hiroto; Inoue, Gen; Takahashi, Kazuhisa; Furuya, Takeo; Koda, Masao

2017-02-01

Retrospective case series. The purpose of this study was to examine changes in the ligamentum flavum thickness and remodeling of the spinal canal after anterior fusion during a 10-year follow-up. Extreme lateral interbody fusion provides minimally invasive treatment of the lumbar spine; this anterior fusion without direct posterior decompression, so-called indirect decompression, can achieve pain relief. Anterior fusion may restore disc height, stretch the flexure of the ligamentum flavum, and increase the spinal canal diameter. However, changes in the ligamentum flavum thickness and remodeling of the spinal canal after anterior fusion during a long follow-up have not yet been reported. We evaluated 10 patients with L4 spondylolisthesis who underwent stand-alone anterior interbody fusion using the iliac crest bone. Magnetic resonance imaging was performed 10 years after surgery. The cross-sectional area (CSA) of the dural sac and the ligamentum flavum at L1-2 to L5-S1 was calculated using a Picture Archiving and Communication System. Spinal fusion with correction loss (average, 4.75 mm anterior slip) was achieved in all patients 10 years postsurgery. The average CSAs of the dural sac and the ligamentum flavum at L1-2 to L5-S1 were 150 mm 2 and 78 mm 2 , respectively. The average CSA of the ligamentum flavum at L4-5 (30 mm 2 ) (fusion level) was significantly less than that at L1-2 to L3-4 or L5-S1. Although patients had an average anterior slip of 4.75 mm, the average CSA of the dural sac at L4-5 was significantly larger than at the other levels. Spinal stability induced a lumbar ligamentum flavum change and a sustained remodeling of the spinal canal, which may explain the long-term pain relief after indirect decompression fusion surgery.

Hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level

PubMed Central

Ikeda, Osamu; Minami, Norihiko; Yamazaki, Masashi; Koda, Masao; Morinaga, Tatsuo

2015-01-01

Context We present a rare and interesting case of hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level suggesting a possible mechanism by which spinal subdural hematomas can arise. Findings A 71-year-old man presented with persistent sciatic pain and intermittent claudication. Magnetic resonance imaging demonstrated a multilocular mass lesion that showed high signal intensity in both T1- and T2-weighted images, and was located both inside and outside of the spinal canal. Computed tomographic myelography showed a cap-shaped block of the dural tube at L5 and computed tomography with L5–S facet arthrography demonstrated cystic masses. The patient was diagnosed with lumbar radiculopathy caused by hemorrhagic facet cysts, and then progressed to surgical treatment. Surgery revealed that the cysts contained blood clots, and intraoperative findings that the inside of the dural tube appeared blackish and that the dural tube was tensely ballooned after removal of the cysts led us to explorative durotomy. The durotomy demonstrated concentrated old blood pooling both in the dorsal and ventral subdural space, and these spaces were subsequently drained. After surgery, his sciatic pain and intermittent claudication resolved. There was no evidence of cyst mass recurrence at 2 years of follow-up. Conclusion We propose a newly described mechanism for the formation of spinal subdural hematomas. We recommend surgeons be alert to epidural lesions causing repeated acute compression of the dural tube, which can cause spinal subdural hematoma, and consider the possible coexistence of these lesions in diagnosis and strategic surgical decisions. PMID:24976137

Hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level.

PubMed

Ikeda, Osamu; Minami, Norihiko; Yamazaki, Masashi; Koda, Masao; Morinaga, Tatsuo

2015-03-01

We present a rare and interesting case of hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level suggesting a possible mechanism by which spinal subdural hematomas can arise. A 71-year-old man presented with persistent sciatic pain and intermittent claudication. Magnetic resonance imaging demonstrated a multilocular mass lesion that showed high signal intensity in both T1- and T2-weighted images, and was located both inside and outside of the spinal canal. Computed tomographic myelography showed a cap-shaped block of the dural tube at L5 and computed tomography with L5-S facet arthrography demonstrated cystic masses. The patient was diagnosed with lumbar radiculopathy caused by hemorrhagic facet cysts, and then progressed to surgical treatment. Surgery revealed that the cysts contained blood clots, and intraoperative findings that the inside of the dural tube appeared blackish and that the dural tube was tensely ballooned after removal of the cysts led us to explorative durotomy. The durotomy demonstrated concentrated old blood pooling both in the dorsal and ventral subdural space, and these spaces were subsequently drained. After surgery, his sciatic pain and intermittent claudication resolved. There was no evidence of cyst mass recurrence at 2 years of follow-up. We propose a newly described mechanism for the formation of spinal subdural hematomas. We recommend surgeons be alert to epidural lesions causing repeated acute compression of the dural tube, which can cause spinal subdural hematoma, and consider the possible coexistence of these lesions in diagnosis and strategic surgical decisions.

Lumbar stenosis surgery: Spine surgeons not insurance companies should decide when enough is better than too much.

PubMed

Epstein, Nancy E

2017-01-01

Lumbar surgery for spinal stenosis is the most common spine operation being performed in older patients. Nevertheless, every time we want to schedule surgery, we confront the insurance industry. More often than not they demand patients first undergo epidural steroid injections (ESI); clearly they are not aware of ESI's lack of long-term efficacy. Who put these insurance companies in charge anyway? We did. How? Through performing too many unnecessary or overly extensive spinal operations (e.g., interbody fusions and instrumented fusions) without sufficient clinical and/or radiographic indications. Patients with lumbar spinal stenosis with/without degenerative spondylolisthesis (DS) are being offered decompressions alone and/or unnecessarily extensive interbody and/or instrumented fusions. Furthermore, a cursory review of the literature largely demonstrates comparable outcomes for decompressions alone vs. decompressions/in situ fusions vs. interbody/instrumented fusions. Too many older patients are being subjected to unnecessary lumbar spine surgery, some with additional interbody/non instrumented or instrumented fusions, without adequate clinical/neurodiagnostic indications. The decision to perform spine surgery for lumbar stenosis/DS, including decompression alone, decompression with non instrumented or instrumented fusion should be in the hands of competent spinal surgeons with their patients' best outcomes in mind. Presently, insurance companies have stepped into the "void" left by spinal surgeons' failing to regulate when, what type, and why spinal surgery is being offered to patients with spinal stenosis. Clearly, spine surgeons need to establish guidelines to maximize patient safety and outcomes for lumbar stenosis surgery. We need to remove insurance companies from their present roles as the "spinal police."

Impact of back muscle strength and aging on locomotive syndrome in community living Japanese women.

PubMed

Hirano, Kenichi; Imagama, Shiro; Hasegawa, Yukiharu; Wakao, Norimitsu; Muramoto, Akio; Ishiguro, Naoki

2013-02-01

The Japanese Orthopaedic Association has proposed the term locomotive syndrome (LS) to designate a condition of individuals in high-risk groups with musculoskeletal disease who are highly likely to require nursing care. This study investigates the influence of spinal factors on LS in Japanese females. A total of 187 women > or =50 years old were enrolled in the study. Those answering yes to least one of the 7 categories in the self-assessment checklist for LS were defined as having LS. We evaluated lateral lumbar radiographs, sagittal parameters, sagittal balance using the spinal inclination angle (SIA) as an index, spinal range of motion (ROM) as determined with SpinalMouse, back muscle strength (BMS), and body mass index (BMI). Age, BMI, BMS, SIA, sacral slope angle (SSA), and lumbar spinal ROM showed significant correlations with LS. Multiple logistic regression analysis indicated that an increase in age (OR 1.054, p<0.05) and a decrease in BMS (OR 0.968, p<0.01) were significantly associated with LS. Age had significant negative correlations with BMS, SSA, thoracic and lumbar spinal ROM, and it had positive correlations with BMI, SIA, and lumbar kyphosis. BMS had significant negative correlations with age, SIA, thoracic and lumbar kyphosis, and it had positive correlations with SSA, lumbar and total spinal ROM. An increase in age and a decrease in BMS may be the most important risk factors for LS in Japanese women. Back muscle strengthening and spinal ROM exercises could be useful for improving the status of an individual suffering from LS.

Augmentation of Voluntary Locomotor Activity by Transcutaneous Spinal Cord Stimulation in Motor-Incomplete Spinal Cord-Injured Individuals.

PubMed

Hofstoetter, Ursula S; Krenn, Matthias; Danner, Simon M; Hofer, Christian; Kern, Helmut; McKay, William B; Mayr, Winfried; Minassian, Karen

2015-10-01

The level of sustainable excitability within lumbar spinal cord circuitries is one of the factors determining the functional outcome of locomotor therapy after motor-incomplete spinal cord injury. Here, we present initial data using noninvasive transcutaneous lumbar spinal cord stimulation (tSCS) to modulate this central state of excitability during voluntary treadmill stepping in three motor-incomplete spinal cord-injured individuals. Stimulation was applied at 30 Hz with an intensity that generated tingling sensations in the lower limb dermatomes, yet without producing muscle reflex activity. This stimulation changed muscle activation, gait kinematics, and the amount of manual assistance required from the therapists to maintain stepping with some interindividual differences. The effect on motor outputs during treadmill-stepping was essentially augmentative and step-phase dependent despite the invariant tonic stimulation. The most consistent modification was found in the gait kinematics, with the hip flexion during swing increased by 11.3° ± 5.6° across all subjects. This preliminary work suggests that tSCS provides for a background increase in activation of the lumbar spinal locomotor circuitry that has partially lost its descending drive. Voluntary inputs and step-related feedback build upon the stimulation-induced increased state of excitability in the generation of locomotor activity. Thus, tSCS essentially works as an electrical neuroprosthesis augmenting remaining motor control. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Human Amniotic Tissue-derived Allograft, NuCel, in Posteriolateral Lumbar Fusions for Degenerative Disc Disease

ClinicalTrials.gov

2017-09-14

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

Tail Nerve Electrical Stimulation and Electro-Acupuncture Can Protect Spinal Motor Neurons and Alleviate Muscle Atrophy after Spinal Cord Transection in Rats

PubMed Central

Zhang, Yu-Ting; Jin, Hui; Wang, Jun-Hua; Wen, Lan-Yu; Yang, Yang; Ruan, Jing-Wen; Zhang, Shu-Xin; Ling, Eng-Ang

2017-01-01

Spinal cord injury (SCI) often results in death of spinal neurons and atrophy of muscles which they govern. Thus, following SCI, reorganizing the lumbar spinal sensorimotor pathways is crucial to alleviate muscle atrophy. Tail nerve electrical stimulation (TANES) has been shown to activate the central pattern generator (CPG) and improve the locomotion recovery of spinal contused rats. Electroacupuncture (EA) is a traditional Chinese medical practice which has been proven to have a neural protective effect. Here, we examined the effects of TANES and EA on lumbar motor neurons and hindlimb muscle in spinal transected rats, respectively. From the third day postsurgery, rats in the TANES group were treated 5 times a week and those in the EA group were treated once every other day. Four weeks later, both TANES and EA showed a significant impact in promoting survival of lumbar motor neurons and expression of choline acetyltransferase (ChAT) and ameliorating atrophy of hindlimb muscle after SCI. Meanwhile, the expression of neurotrophin-3 (NT-3) in the same spinal cord segment was significantly increased. These findings suggest that TANES and EA can augment the expression of NT-3 in the lumbar spinal cord that appears to protect the motor neurons as well as alleviate muscle atrophy. PMID:28744378

Transforaminal Lumbar Puncture: An Alternative Technique in Patients with Challenging Access.

PubMed

Nascene, D R; Ozutemiz, C; Estby, H; McKinney, A M; Rykken, J B

2018-05-01

Interlaminar lumbar puncture and cervical puncture may not be ideal in all circumstances. Recently, we have used a transforaminal approach in selected situations. Between May 2016 and December 2017, twenty-six transforaminal lumbar punctures were performed in 9 patients (25 CT-guided, 1 fluoroscopy-guided). Seven had spinal muscular atrophy and were referred for intrathecal nusinersen administration. In 2, CT myelography was performed via transforaminal lumbar puncture. The lumbar posterior elements were completely fused in 8, and there was an overlying abscess in 1. The L1-2 level was used in 2; the L2-3 level, in 10; the L3-4 level, in 12; and the L4-5 level, in 2 procedures. Post-lumbar puncture headache was observed on 4 occasions, which resolved without blood patching. One patient felt heat and pain at the injection site that resolved spontaneously within hours. One patient had radicular pain that resolved with conservative treatment. Transforaminal lumbar puncture may become an effective alternative to classic interlaminar lumbar puncture or cervical puncture. © 2018 by American Journal of Neuroradiology.

Spinal stenosis presenting as "the postpolio syndrome". Review of four cases.

PubMed

LaBan, M M; Sanitate, S S; Taylor, R S

1993-12-01

The diagnosis of postpolio syndrome is based primarily on a thorough history supported by both clinical and laboratory examination. Similarly, the presence of an occult spinal stenosis may be suspected initially by a history of progressive lumbar or cervical radicular pain, as well as concomitant extremity weakness and/or myelopathic signs. Appropriate electrodiagnostic examinations, including somatosensory spinal-evoked potentials and electroneuromyography, as well as imaging studies, computer-assisted tomography scan, magnetic resonance imaging and/or myelography are all useful in confirming the clinical diagnosis of either cervical spinal stenosis or lumbar spinal stenosis in patients who also may have had a history of poliomyelitis. Four patients (three men and one woman) previously diagnosed as having postpolio syndrome were referred with predominate complaints of spinal and extremity pain as well as associated motor weakness. It was subsequently recognized that these patients, ranging in age from 45-65 yr, were actually presenting with symptomatic spinal stenosis. It was discovered that two patients had cervical spinal stenosis; the other two had lumbar spinal stenosis.

Lumbar muscle inflammation alters spinally mediated locomotor recovery induced by training in a mouse model of complete spinal cord injury.

PubMed

Jeffrey-Gauthier, Renaud; Piché, Mathieu; Leblond, Hugues

2017-09-17

Locomotor networks after spinal cord injury (SCI) are shaped by training-activated proprioceptive and cutaneous inputs. Nociception from injured tissues may alter these changes but has largely been overlooked. The objective of the present study was to ascertain whether lumbar muscle inflammation hinders locomotion recovery in a mouse model of complete SCI. Lower limb kinematics during treadmill training was assessed before and after complete SCI at T8 (2, 7, 14, 21 and 28days post-injury). Locomotor recovery was compared in 4 groups of CD1 mice: control spinal mice; spinal mice with daily locomotor training; spinal mice with lumbar muscle inflammation (Complete Freund's Adjuvant (CFA) injection); and spinal mice with locomotor training and CFA. On day 28, H-reflex excitability and its inhibition at high-frequency stimulation (frequency-dependent depression: FDD) were compared between groups, all of which showed locomotor recovery. Recovery was enhanced by training, whereas lumbar muscle inflammation hindered these effects (knee angular excursion and paw drag: p's<0.05). In addition, lumbar muscle inflammation impaired hind limb coupling during locomotion (p<0.05) throughout recovery. Also, H-reflex disinhibition was prevented by training, with or without CFA injection (p's<0.05). Altogether, these results indicate that back muscle inflammation modulates spinally mediated locomotor recovery in mice with complete SCI, in part, by reducing adaptive changes induced by training. Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

Effect of torso flexion on the lumbar torso extensor muscle sagittal plane moment arms.

PubMed

Jorgensen, Michael J; Marras, William S; Gupta, Purnendu; Waters, Thomas R

2003-01-01

Accurate anatomical inputs for biomechanical models are necessary for valid estimates of internal loading. The magnitude of the moment arm of the lumbar erector muscle group is known to vary as a function of such variables as gender. Anatomical evidence indicates that the moment arms decrease during torso flexion. However, moment arm estimates in biomechanical models that account for individual variability have been derived from imaging studies from supine postures. Quantify the sagittal plane moment arms of the lumbar erector muscle group as a function of torso flexion, and identify individual characteristics that are associated with the magnitude of the moment arms as a function of torso flexion. Utilization of a 0.3 Tesla Open magnetic resonance image (MRI) to image and quantify the moment arm of the right erector muscle group as a function of gender and torso flexion. Axial MRI images through and parallel to each of the lumbar intervertebral discs at four torso flexion angles were obtained from 12 male and 12 female subjects in a lateral recumbent posture. Multivariate analysis of variance was used to investigate the differences in the moment arms at different torso flexion angles, whereas hierarchical linear regression was used to investigate associations with individual anthropometric characteristics and spinal posture. The largest decrease in the lumbar erector muscle group moment arm from neutral to 45-degree flexion occurred at the L5-S1 level (9.7% and 8.9% for men and women, respectively). Measures of spinal curvature (L1-S1 lordosis), body mass and trunk characteristics (depth or circumference) were associated with the varying moment arm at most lumbar levels. The sagittal plane moment arms of the lumbar erector muscle mass decrease as the torso flexes forward. The change in moment arms as a function of torso flexion may have an impact on prediction of spinal loading in biomechanical models.

Effect of noxious electrical stimulation of the peroneal nerve on stretch reflex activity of the hamstring muscle in rats: possible implications of neuronal mechanisms in the development of tight hamstrings in lumbar disc herniation.

PubMed

Hirayama, Jiro; Yamagata, Masatsune; Takahashi, Kazuhisa; Moriya, Hideshige

2005-05-01

The effect of noxious electrical stimulation of the peroneal nerve on the stretch reflex electromyogram activity of the hamstring muscle (semitendinous) was studied. To verify the following hypothetical mechanisms underlying tight hamstrings in lumbar disc herniation: stretch reflex muscle activity of hamstrings is increased by painful inputs from an injured spinal nerve root and the increased stretch reflex muscle activity is maintained by central sensitization. It is reported that stretch reflex activity of the trunk muscles is induced by noxious stimulation of the sciatic nerve and maintained by central sensitization. In spinalized rats (transected spinal cord), the peroneal nerve was stimulated electrically as a conditioning stimulus. Stretch reflex electromyogram activity of the semitendinous muscle was recorded before and after the conditioning stimulus. Even after electrical stimulation was terminated, an increased stretch reflex activity of the hamstring muscle was observed. It is likely that a central sensitization mechanism at the spinal cord level was involved in the increased reflex activity. Central sensitization may play a part in the neuronal mechanisms of tight hamstrings in lumbar disc herniation.

Influence of Lumbar Lordosis on the Outcome of Decompression Surgery for Lumbar Canal Stenosis.

PubMed

Chang, Han Soo

2018-01-01

Although sagittal spinal balance plays an important role in spinal deformity surgery, its role in decompression surgery for lumbar canal stenosis is not well understood. To investigate the hypothesis that sagittal spinal balance also plays a role in decompression surgery for lumbar canal stenosis, a prospective cohort study analyzing the correlation between preoperative lumbar lordosis and outcome was performed. A cohort of 85 consecutive patients who underwent decompression for lumbar canal stenosis during the period 2007-2011 was analyzed. Standing lumbar x-rays and 36-item short form health survey questionnaires were obtained before and up to 2 years after surgery. Correlations between lumbar lordosis and 2 parameters of the 36-item short form health survey (average physical score and bodily pain score) were statistically analyzed using linear mixed effects models. There was a significant correlation between preoperative lumbar lordosis and the 2 outcome parameters at postoperative, 6-month, 1-year, and 2-year time points. A 10° increase of lumbar lordosis was associated with a 5-point improvement in average physical scores. This correlation was not present in preoperative scores. This study showed that preoperative lumbar lordosis significantly influences the outcome of decompression surgery on lumbar canal stenosis. Copyright © 2017 Elsevier Inc. All rights reserved.

The Role of the Ligamentum Flavum Area as a Morphological Parameter of Lumbar Central Spinal Stenosis.

PubMed

Kim, Young Uk; Park, Jun Young; Kim, Doo Hwan; Karm, Myung-Hwan; Lee, Jae-Young; Yoo, Jee In; Chon, Sung Won; Suh, Jeong Hun

2017-03-01

Hypertrophy of the ligamentum flavum (LF) has been considered as a major cause of lumbar central spinal stenosis (LCSS). Previous studies have found that ligamentum flavum thickness (LFT) is correlated with aging, disc degeneration, and lumbar spinal stenosis. However, hypertrophy is different from thickness. Thus, to evaluate hypertrophy of the whole LF, we devised a new morphological parameter, called the ligamentum flavum area (LFA). We hypothesized that the LFA is a key morphologic parameter in the diagnosis of LCSS. Retrospective observational study. The single center study in Seoul, Republic of Korea. LF samples were collected from 166 patients with LCSS, and from 167 controls who underwent lumbar magnetic resonance imaging (MRI) as part of a routine medical examination. T1-weighted axial MR imageswere acquired at the facet joint level from individual patients. We measured the LFA and LFT at the L4-L5 intervertebral level on MRI using a picture archiving and communications system. The LFA was measured as the cross-sectional area of the whole LF at the L4-L5 stenotic level. The LFT was measured by drawing a line along the side of the ligament facing the spinal canal and along the laminar side of the ligament curve and then measuring the thickest point at the L4-L5 level. The average LFA was 96.56 ± 30.74 mm2 in the control group and 132.69 ± 32.68 mm2 in the LCSS group. The average LFT was 3.61 ± 0.72 mm in the control group and 4.24 ± 0.97 mm in the LCSS group. LCSS patients had significantly higher LFA (P < 0.001) and LFT (P < 0.001). Regarding the validity of both LFA and LFT as predictors of LCSS, Receiver Operator Characteristics (ROC) curve analysis showed that the best cut-off point for the LFA was 105.90 mm2, with 80.1% sensitivity, 76.0% specificity, and area under the curve (AUC) of 0.83 (95% CI, 0.78 - 0.87). The best cut off-point of the LFT was 3.74 mm, with 70.5% sensitivity, 66.5% specificity, and AUC of 0.72 (95% CI, 0.66 - 0.77). The principal methodological limitation was the retrospective observational nature. Anatomically, degenerative lumbar spinal stenosis can involve the central canal, foramina, and lateral recess. However, we focused on LCSS only. Although the LFT and LFA were both significantly associated with LCSS, the LFA was a more sensitive measurement parameter. Thus, to evaluate LCSS patients, the treating doctor should more carefully analyze the LFA than LFT.Institutional Review Board (IRB) approval number: S2015-1328-0001Key words: Ligamentum flavum, ligamentum flavum area, ligamentum flavum thickness, lumbar central spinal stenosis, hypertrophy of the ligamentum flavum, morphological parameter, cross-sectional area, optimal cut-off point.

Can the human lumbar posterior columns be stimulated by transcutaneous spinal cord stimulation? A modeling study

PubMed Central

Danner, Simon M.; Hofstoetter, Ursula S.; Ladenbauer, Josef; Rattay, Frank; Minassian, Karen

2014-01-01

Stimulation of different spinal cord segments in humans is a widely developed clinical practice for modification of pain, altered sensation and movement. The human lumbar cord has become a target for modification of motor control by epidural and more recently by transcutaneous spinal cord stimulation. Posterior columns of the lumbar spinal cord represent a vertical system of axons and when activated can add other inputs to the motor control of the spinal cord than stimulated posterior roots. We used a detailed three-dimensional volume conductor model of the torso and the McIntyre-Richard-Grill axon model to calculate the thresholds of axons within the posterior columns in response to transcutaneous lumbar spinal cord stimulation. Superficially located large diameter posterior column fibers with multiple collaterals have a threshold of 45.4 V, three times higher than posterior root fibers (14.1 V). With the stimulation strength needed to activate posterior column axons, posterior root fibers of large and small diameters as well as anterior root fibers are co-activated. The reported results inform on these threshold differences, when stimulation is applied to the posterior structures of the lumbar cord at intensities above the threshold of large-diameter posterior root fibers. PMID:21401670

Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF

PubMed Central

Phan, Kevin; Malham, Greg; Seex, Kevin; Rao, Prashanth J.

2015-01-01

Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life. Surgical interbody fusion of degenerative levels is an effective treatment option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity. The surgical options for interbody fusion of the lumbar spine include: posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF). The indications may include: discogenic/facetogenic low back pain, neurogenic claudication, radiculopathy due to foraminal stenosis, lumbar degenerative spinal deformity including symptomatic spondylolisthesis and degenerative scoliosis. In general, traditional posterior approaches are frequently used with acceptable fusion rates and low complication rates, however they are limited by thecal sac and nerve root retraction, along with iatrogenic injury to the paraspinal musculature and disruption of the posterior tension band. Minimally invasive (MIS) posterior approaches have evolved in an attempt to reduce approach related complications. Anterior approaches avoid the spinal canal, cauda equina and nerve roots, however have issues with approach related abdominal and vascular complications. In addition, lateral and OLIF techniques have potential risks to the lumbar plexus and psoas muscle. The present study aims firstly to comprehensively review the available literature and evidence for different lumbar interbody fusion (LIF) techniques. Secondly, we propose a set of recommendations and guidelines for the indications for interbody fusion options. Thirdly, this article provides a description of each approach, and illustrates the potential benefits and disadvantages of each technique with reference to indication and spine level performed. PMID:27683674

[Surgical treatment of degenerative lumbar scoliosis with multi-segment lumbar spinal stenosis].

PubMed

Lan, Jiaping; Tang, Xun; Xu, Yongqing; Zhou, Tianhua; Shi, Jian; Cui, Yi; Xiang, Qili; Cai, Zhijun; Zhao, Qingkai; Yang, Xiaoyong; Zhao, Caihua

2014-08-01

To explore the surgical indications, decompression and fusion method, and fusion level selection of degenerative lumbar scoliosis (DLS) and multi-segment lumbar spinal stenosis. Between April 2000 and November 2011, 46 cases of DLS and multi-segment lumbar spinal stenosis were treated with multi-level decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion (5 segments or above). Of 46 cases, 25 were male and 21 were female, with a mean age of 70.2 years (range, 65-81 years) and with a mean disease duration of 6.4 years (range, 4 years and 6 months to 13 years). X-ray films showed that the lumbar Cobb angle was (26.7 ± 10.0) degrees, and the lumbar lordotic angle was (20.3 ± 8.8)degrees. The lumbar CT and MRI images showed three-segment stenosis in 24 cases, four-segment stenosis in 17 cases, and five-segment stenosis in 5 cases. A total of 165 stenosed segments included 12 L1,2, 34 L2,3, 43 L3,4, 45 L4,5, and 31 L5 and S1. Visual analogue scale (VAS) score, Oswestry disability index (ODI), and Japanese Orthopedic Association (JOA) score (29 points) were employed to evaluate effectiveness. Thirteen patients had leakage of cerebrospinal fluid during operation, and no infection was found after corresponding treatment; pulmonary infection and urinary system infection occurred in 4 and 2 patients respectively, who relieved after received antibiotic therapy; 8 patients with poor wound healing received dressing change, adequate drainage, debridement and suture. No death, paralysis, central nervous system infection, or other complication was observed in these patients. Forty-six cases were followed up 12-72 months (mean, 36.2 months). Lumbago and backache and intermittent claudication of lower extremity were obviously improved. During follow-up, no screw incising, loosening and broken screws, or pseudarthrosis was noted under X-ray film and CT scanning. At last follow-up, the lumbar Cobb angle was reduced to (9.8 ± 3.6) degrees, while the lumbar lordotic angle was increased to (34.1 ± 9.4) degrees, which were significantly improved when compared with preoperative ones (t = 16.935, P = 0.000; t = 15.233, P = 0.000). At last follow-up, VAS, ODI, and JOA scores were 3.2 ± 1.2, 35.5% ± 14.0%, and 26.6 ± 5.7 respectively, showing significant differences when compared with preoperative scores (8.0 ± 2.2, 60.8% ± 13.3%, and 12.9 ± 3.4) (t = 19.857, P = 0.000; t = 16.642, P = 0.000; t = 15.922, P = 0.000). Multi-segment decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion is helpful to relieve nerve compression symptoms, rebuild spinal balance, and improve the life quality of the patients. It is a very effective way to treat DLS and multi-segment lumbar spinal stenosis.

Lumbar puncture (image)

MedlinePlus

... is a clear fluid that circulates in the space surrounding the spinal cord and brain. CSF protects the brain and spinal cord from injury by acting like a liquid cushion. CSF is usually obtained through a lumbar ...

[Virtual clinical diagnosis support system of degenerative stenosis of the lumbar spinal canal].

PubMed

Shevelev, I N; Konovalov, N A; Cherkashov, A M; Molodchenkov, A A; Sharamko, T G; Asiutin, D S; Nazarenko, A G

2013-01-01

The aim of the study was to develop a virtual clinical diagnostic support system of degenerative lumbar spinal stenosis on database of spine registry. Choice of criteria's for diagnostic system was made on symptom analysis of 298 patients with lumbar spinal stenosis. Also was analysed a group of patient with disc herniation's for sensitivity and specify assessment of developed diagnostic support system. Represented clinical diagnostic support system allows identifying patients with degenerative lumbar spinal stenosis on stage of patient's primary visit. System sensitivity and specify are 90 and 71% respectively. "Online" mode of diagnostic system in structure of spine registry provides maximal availability for specialists, regardless of their locations. Development of tools "medicine 2.0" is the actual direction for carrying out further researches with which carrying out the centralized baea collection by means of specialized registers helps.

The evaluation of lumbar multifidus muscle function via palpation: reliability and validity of a new clinical test.

PubMed

Hebert, Jeffrey J; Koppenhaver, Shane L; Teyhen, Deydre S; Walker, Bruce F; Fritz, Julie M

2015-06-01

The lumbar multifidus muscle provides an important contribution to lumbar spine stability, and the restoration of lumbar multifidus function is a frequent goal of rehabilitation. Currently, there are no reliable and valid physical examination procedures available to assess lumbar multifidus function among patients with low back pain. To examine the inter-rater reliability and concurrent validity of the multifidus lift test (MLT) to identify lumbar multifidus dysfunction among patients with low back pain. A cross-sectional analysis of reliability and concurrent validity performed in a university outpatient research facility. Thirty-two persons aged 18 to 60 years with current low back pain and a minimum modified Oswestry disability score of 20%. Study participants were excluded if they reported a history of lumbar spine surgery, lumbar radiculopathy, medical red flags, osteoporosis, or had recently been treated with spinal manipulation or trunk stabilization exercises. Concurrent measures of lumbar multifidus muscle function at the L4-L5 and L5-S1 levels were obtained with the MLT (index test) and real-time ultrasound imaging (reference standard). The inter-rater reliability of the MLT was examined by measuring the level of agreement between two blinded examiners. Concurrent validity of the MLT was investigated by comparing clinicians' judgments with real-time ultrasound imaging measures of lumbar multifidus function. Inter-rater reliability of the MLT was substantial to excellent (κ=0.75 to 0.81, p≤.01) and free from errors of bias and prevalence. When performed at L4-L5 or L5-S1, the MLT demonstrated evidence of concurrent validity through its relationship with the reference standard results at L4-L5 (rbis=0.59-0.73, p≤.01). The MLT generally failed to demonstrate a relationship with the reference standard results from the L5-S1 level. Our results provide preliminary evidence supporting the reliability and validity of the MLT to assess lumbar multifidus function at the L4-L5 spinal level. Additional research examining the measurement properties and utility of this test should be undertaken before confident implementation with patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Regional differences in lumbar spinal posture and the influence of low back pain

PubMed Central

Mitchell, Tim; O'Sullivan, Peter B; Burnett, Angus F; Straker, Leon; Smith, Anne

2008-01-01

Background Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP) patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP. Methods One hundred and seventy female undergraduate nursing students, with and without LBP, participated in this cross-sectional study. Lower lumbar (LLx), Upper lumbar (ULx) and total lumbar (TLx) spine angles were measured using an electromagnetic tracking system in static postures and across a range of functional tasks. Results Regional differences in lumbar posture and movement were found. Mean LLx posture did not correlate with ULx posture in sitting (r = 0.036, p = 0.638), but showed a moderate inverse correlation with ULx posture in usual standing (r = -0.505, p < 0.001). Regional differences in range of motion from reference postures in sitting and standing were evident. BMI accounted for regional differences found in all sitting and some standing measures. LBP was not associated with differences in regional lumbar spine angles or range of motion, with the exception of maximal backward bending range of motion (F = 5.18, p = 0.007). Conclusion This study supports the concept of regional differences within the lumbar spine during common postures and movements. Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. BMI influenced regional lumbar posture and movement, possibly representing adaptation due to load. PMID:19014712

Proximal Junctional Failure After Long-Segment Instrumentation for Degenerative Lumbar Kyphosis With Ankylosing Spinal Disorder.

PubMed

Ikegami, Daisuke; Matsuoka, Takashi; Miyoshi, Yuji; Murata, Yoichi; Aoki, Yasuaki

2015-06-15

Case report. We report a case of proximal junctional failure at the ankylosed, but not the mobile, junction after segmental instrumented fusion for degenerative lumbar kyphosis with ankylosing spinal disorder. Proximal junctional failure (PJF) and proximal junctional kyphosis (PJK) are important complications that occur subsequent to long-segment instrumentation for correction of adult spinal deformity. Thus far, most studies have focused on the mobile junction as a site at which PJK/PJF can occur, and little is known about the relationship between PJK/PJF and ankylosing spinal disorders such as diffuse idiopathic skeletal hyperostosis. The patient was an 82-year-old female with degenerative lumbar kyphosis. She had abnormal confluent hyperostosis in the anterior longitudinal ligaments from Th5 to Th10. The patient was treated operatively with spinal instrumented fusion from Th10 to the sacrum. Four weeks subsequent to initial surgery, the patient developed progressive lower extremity paresis caused by the uppermost instrumented vertebrae fracture (Th10) and adjacent subluxation (Th9). Extension of fusion to Th5 with decompression at Th9-Th10 was performed. However, the patient showed no improvement in neurological function. PJF can occur at the ankylosing site above the uppermost instrumented vertebrae after long-segment instrumentation for adult spinal deformity. PJF in the ankylosed spine may cause severe fracture instability and cord deficit. The ankylosed spine should be integrated into the objective determination of materials contributing to the appropriate selection of fusion levels. 3.

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures

PubMed Central

Mannoji, Chikato; Murakami, Masazumi; Kinoshita, Tomoaki; Hirayama, Jiro; Miyashita, Tomohiro; Eguchi, Yawara; Yamazaki, Masashi; Suzuki, Takane; Aramomi, Masaaki; Ota, Mitsutoshi; Maki, Satoshi; Takahashi, Kazuhisa; Furuya, Takeo

2016-01-01

Study Design Retrospective case-control study. Purpose To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. Overview of Literature Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. Methods The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. Results Stepwise logistic regression revealed kissing spine (p=0.024; odds ratio, 3.80) and foraminal stenosis (p<0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. Conclusions When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure. PMID:27994785

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures.

PubMed

Koda, Masao; Mannoji, Chikato; Murakami, Masazumi; Kinoshita, Tomoaki; Hirayama, Jiro; Miyashita, Tomohiro; Eguchi, Yawara; Yamazaki, Masashi; Suzuki, Takane; Aramomi, Masaaki; Ota, Mitsutoshi; Maki, Satoshi; Takahashi, Kazuhisa; Furuya, Takeo

2016-12-01

Retrospective case-control study. To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. Stepwise logistic regression revealed kissing spine ( p =0.024; odds ratio, 3.80) and foraminal stenosis ( p <0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.

Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study

PubMed Central

George, Steven Z; Bishop, Mark D; Bialosky, Joel E; Zeppieri, Giorgio; Robinson, Michael E

2006-01-01

Background The underlying causes of spinal manipulation hypoalgesia are largely unknown. The beneficial clinical effects were originally theorized to be due to biomechanical changes, but recent research has suggested spinal manipulation may have a direct neurophysiological effect on pain perception through dorsal horn inhibition. This study added to this literature by investigating whether spinal manipulation hypoalgesia was: a) local to anatomical areas innervated by the lumbar spine; b) correlated with psychological variables; c) greater than hypoalgesia from physical activity; and d) different for A-delta and C-fiber mediated pain perception. Methods Asymptomatic subjects (n = 60) completed baseline psychological questionnaires and underwent thermal quantitative sensory testing for A-delta and C-fiber mediated pain perception. Subjects were then randomized to ride a stationary bicycle, perform lumbar extension exercise, or receive spinal manipulation. Quantitative sensory testing was repeated 5 minutes after the intervention period. Data were analyzed with repeated measures ANOVA and post-hoc testing was performed with Bonferroni correction, as appropriate. Results Subjects in the three intervention groups did not differ on baseline characteristics. Hypoalgesia from spinal manipulation was observed in lumbar innervated areas, but not control (cervical innervated) areas. Hypoalgesic response was not strongly correlated with psychological variables. Spinal manipulation hypoalgesia for A-delta fiber mediated pain perception did not differ from stationary bicycle and lumbar extension (p > 0.05). Spinal manipulation hypoalgesia for C-fiber mediated pain perception was greater than stationary bicycle riding (p = 0.040), but not for lumbar extension (p = 0.105). Conclusion Local dorsal horn mediated inhibition of C-fiber input is a potential hypoalgesic mechanism of spinal manipulation for asymptomatic subjects, but further study is required to replicate this finding in subjects with low back pain. PMID:16911795

Evaluation of Water Content in Lumbar Intervertebral Discs and Facet Joints Before and After Physiological Loading Using T2 Mapping MRI.

PubMed

Yamabe, Daisuke; Murakami, Hideki; Chokan, Kou; Endo, Hirooki; Oikawa, Ryosuke; Sawamura, Shoitsu; Doita, Minoru

2017-12-15

T2 mapping was used to quantify the water content of lumbar spine intervertebral discs (IVDs) and facet joints before and after physiological loading. The aim of this study was to clarify the interaction between lumbar spine IVD and facet joints as load-bearing structures by measuring the water content of their matrix after physiological loading using T2 mapping magnetic resonance imaging (MRI). To date, few reports have functionally evaluated lumbar spine IVD and facet joints, and their interaction in vivo. T2 mapping may help detect changes in the water content of IVD and articular cartilage of facet joints before and after physiological loading, thereby enabling the evaluation of changes in interacted water retention between IVD and facet joints. Twenty asymptomatic volunteers (10 female and 10 male volunteers; mean age, 19.3 years; age range, 19-20 years) underwent MRI before and after physiological loading such as lumbar flexion, extension, and rotation. Each IVD from L1/2 to L5/S1 was sliced at center of the disc space, and the T2 value was measured at the nucleus pulposus (NP), anterior annulus fibrosus (AF), posterior AF, and bilateral facet joints. In the NP, T2 values significantly decreased after exercise at every lumbar spinal level. In the anterior AF, there were no significant differences in T2 values at any level. In the posterior AF, T2 values significantly increased only at L4/5. In the bilateral facet joints, T2 values significantly decreased after exercise at every level. There was a significant decrease in the water content of facet joints and the NP at every lumbar spinal level after dynamic loading by physical lumbar exercise. These changes appear to play an important and interactional role in the maintenance of the interstitial matrix in the IVD NP and cartilage in the facet joint. 3.

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

PubMed

Daniel, Matej

2011-10-01

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

Decompression Surgery Alone Versus Decompression Plus Fusion in Symptomatic Lumbar Spinal Stenosis: A Swiss Prospective Multicenter Cohort Study With 3 Years of Follow-up.

PubMed

Ulrich, Nils H; Burgstaller, Jakob M; Pichierri, Giuseppe; Wertli, Maria M; Farshad, Mazda; Porchet, François; Steurer, Johann; Held, Ulrike

2017-09-15

Retrospective analysis of a prospective, multicenter cohort study. To estimate the added effect of surgical fusion as compared to decompression surgery alone in symptomatic lumbar spinal stenosis patients with spondylolisthesis. The optimal surgical management of lumbar spinal stenosis patients with spondylolisthesis remains controversial. Patients of the Lumbar Stenosis Outcome Study with confirmed DLSS and spondylolisthesis were enrolled in this study. The outcomes of this study were Spinal Stenosis Measure (SSM) symptoms (score range 1-5, best-worst) and function (1-4) over time, measured at baseline, 6, 12, 24, and 36 months follow-up. In order to quantify the effect of fusion surgery as compared to decompression alone and number of decompressed levels, we used mixed effects models and accounted for the repeated observations in main outcomes (SSM symptoms and SSM function) over time. In addition to individual patients' random effects, we also fitted random slopes for follow-up time points and compared these two approaches with Akaike's Information Criterion and the chi-square test. Confounders were adjusted with fixed effects for age, sex, body mass index, diabetes, Cumulative Illness Rating Scale musculoskeletal disorders, and duration of symptoms. One hundred thirty-one patients undergoing decompression surgery alone (n = 85) or decompression with fusion surgery (n = 46) were included in this study. In the multiple mixed effects model the adjusted effect of fusion compared with decompression alone surgery on SSM symptoms was 0.06 (95% confidence interval: -0.16-0.27) and -0.07 (95% confidence interval: -0.25-0.10) on SSM function, respectively. Among the patients with degenerative lumbar spinal stenosis and spondylolisthesis our study confirms that in the two groups, decompression alone and decompression with fusion, patients distinctively benefited from surgical treatment. When adjusted for confounders, fusion surgery was not associated with a more favorable outcome in both SSM scores as compared to decompression alone surgery. 3.

Spondylectomy and lateral lumbar interbody fusion for thoracolumbar kyphosis in an adult with achondroplasia

PubMed Central

Miyazaki, Masashi; Kanezaki, Shozo; Notani, Naoki; Ishihara, Toshinobu; Tsumura, Hiroshi

2017-01-01

Abstract Rationale: Fixed thoracolumbar kyphosis with spinal stenosis in adult patients with achondroplasia presents a challenging issue. We describe the first case in which spondylectomy and minimally invasive lateral access interbody arthrodesis were used for the treatment of fixed severe thoracolumbar kyphosis and lumbar spinal canal stenosis in an adult with achondroplasia. Patient concerns: A 61-year-old man with a history of achondroplastic dwarfism presented with low back pain and radiculopathy and neurogenic claudication. Diagnoses: Plain radiographs revealed a high-grade thoracolumbar kyphotic deformity with diffuse degenerative changes in the lumbar spine. The apex was located at L2, the local kyphotic angle from L1 to L3 was 105°, and the anterior area was fused from the L1 to L3 vertebrae. MRI revealed significant canal and lateral recess stenosis secondary to facet hypertrophy. Interventions: We planned a front-back correction of the anterior and posterior spinal elements. We first performed anterior release at the fused part from L1 to L3 and XLIF at L3/4 and L4/5. Next, the patient was placed in the prone position. Spondylectomy at the L2 vertebra and posterior fusion from T10 to L5 were performed. Postoperative radiographs revealed L1 to L3 kyphosis of 32°. Outcomes: No complications occurred during or after surgery. Postoperatively, the patient's low back pain and neurological claudication were resolved. No worsening of kyphosis was observed 24 months postoperatively. Lessons: Circumferential decompression of the spinal cord at the apical vertebral level and decompression of lumbar canal stenosis were necessary. Front-back correction of the anterior and posterior spinal elements via spondylectomy and lateral lumbar interbody fusion is a reasonable surgical option for thoracolumbar kyphosis and developmental canal stenosis in patients with achondroplasia. PMID:29245270

Improvement in pain after lumbar surgery in cancer patients with mechanical radiculopathy.

PubMed

Moliterno, Jennifer; Veselis, Clinton A; Hershey, Michael A; Lis, Eric; Laufer, Ilya; Bilsky, Mark H

2014-10-01

Lumbar metastases can result in spinal instability and mechanical radiculopathy, characterized by radicular pain produced by axial loading. This pain pattern represents a definitive symptom of neoplastic instability and may serve as a reliable indication for surgical stabilization. We examined the results of surgical decompression and fixation in the treatment of mechanical radiculopathy. A retrospective clinical study. An internally maintained spine neurosurgery database was queried between February 2002 and April 2010. Patients were identified and deemed eligible for inclusion in this study based on the presence of all the following: metastatic tumor, lumbar surgery, and lumbar radiculopathy. Visual analog scale (VAS) of pain and Eastern Cooperative Oncology Group (ECOG) status. The Memorial Sloan-Kettering Cancer Center Department of Neurosurgery operative database was queried over an 8-year period to identify all patients with spinal metastases who underwent lumbar surgery. Only patients whose operative indication included mechanical radiculopathy were included. Pre- and postoperative pain was assessed with the VAS of pain, whereas pre- and postoperative performance status was evaluated using the ECOG. Fifty-five patients were included in the cohort. L2 and L3 were the most common levels involved, and most patients underwent multilevel posterior decompression and instrumented fusion. After surgery, 98% of patients reported pain relief. A significant difference between average pre- and postoperative pain scores was found (p<.01). Overall, 41.5% of patients experienced improvement in their ECOG score postoperatively. Mechanical radiculopathy in patients with spinal metastases represents a highly reliable surgical indication. Spinal decompression and fixation is an effective treatment for pain palliation in this patient population. Copyright © 2014 Elsevier Inc. All rights reserved.

General anesthesia versus segmental thoracic or conventional lumbar spinal anesthesia for patients undergoing laparoscopic cholecystectomy.

PubMed

Yousef, Gamal T; Lasheen, Ahmed E

2012-01-01

Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction. A total of 90 patients undergoing elective laparoscopic cholecystectomy, between January 2010 and May 2011, were randomized into three equal groups to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under segmental thoracic (TSA group) or conventional lumbar (LSA group) spinal anesthesia or general anesthesia (GA group). To achieve a T3 sensory level we used (hyperbaric bupivacaine 15 mg, and fentanyl 25 mg at L2/L3) for LSAgroup, and (hyperbaric bupivacaine 7.5 mg, and fentanyl 25 mg at T10/T11) for TSAgroup. Propofol, fentanyl, atracurium, sevoflurane, and tracheal intubation were used for GA group. Intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction were compared between the three groups. All procedures were completed laparoscopically by the allocated method of anesthesia with no anesthetic conversions. The time for the blockade to reach T3 level, intraoperative hypotensive and bradycardic events and vasopressor use were significantly lower in (TSA group) than in (LSA group). Postoperative pain scores as assessed throughout any time, postoperative right shoulder pain and hospital stay was lower for both (TSA group) and (LSA group) compared with (GA group). The higher degree of patients satisfaction scores were recorded in patients under segmental TSA. The present study not only confirmed that both segmental TSA and conventional lumber spinal anesthesia (LSA) are safe and good alternatives to general anesthesia (GA) in healthy patients undergoing laparoscopic cholecystectomy but also showed better postoperative pain control of both spinal techniques when compared with general anesthesia. Segmental TSA provides better hemodynamic stability, lesser vasopressor use and early ambulation and discharge with higher degree of patient satisfaction making it excellent for day case surgery compared with conventional lumbar spinal anesthesia.

Correlation of serum levels of fibroblast growth factor 23 and Klotho protein levels with bone mineral density in maintenance hemodialysis patients.

PubMed

Zheng, Shubei; Chen, Yan; Zheng, Yu; Zhou, Zhihong; Li, Zhanyuan

2018-04-17

The correlation of serum fibroblast growth factor 23 (FGF-23) and Klotho protein levels with bone mineral density (BMD) in maintenance hemodialysis (MHD) patients was analyzed. Between January 2015 and November 2015, 125 MHD patients in our hospital were enrolled. Dual-energy X-ray absorptiometry was used to examine the BMD in the femoral neck and lumbar spine of MHD patients. The patients were divided into three groups: a normal bone mass group, an osteopenia group, and an osteoporosis group. An ELISA was performed to measure serum FGF-23, Klotho protein, and 1,25(OH) 2 VitD 3 levels. Other parameters, including calcium (Ca), phosphorus (P), and parathyroid hormone, were also measured. Of the 125 MHD patients, 82.40% of patients had femoral neck osteopenia, and 56.00% of patients had lumbar spinal osteopenia. The serum FGF-23 level was highest in the osteoporosis group. However, there was no significant difference in serum FGF-23 levels among the three groups, depending on femoral neck and lumbar spinal BMD (P > 0.05). Spearman's correlation analysis also pointed to a lack of correlation between serum FGF-23 levels and BMD. Among the three groups, there were significant differences in serum Klotho protein levels and femoral neck BMD (P < 0.05). Serum Klotho protein levels in the osteoporosis group were clearly lower than those in the normal bone mass group and osteopenia group (P < 0.05). Similarly, serum Klotho protein levels were significantly lower in those with lumbar spinal osteopenia as compared with those in the normal group. There was a positive correlation between serum Klotho protein levels and BMD and T values for the femoral neck and lumbar spine. The results of a multiple linear regression analysis revealed that the serum Klotho protein level was one of the main factors affecting BMD in MHD patients. The serum level of FGF-23 was not correlated with a change in BMD of MHD patients, whereas the serum Klotho protein level was associated with the degree of BMD. A high Klotho protein level may decrease the severity of chronic kidney disease and mineral bone disorder (CKD-MBD) in MHD patients with low BMD.

Management of lumbar spinal stenosis.

PubMed

Lurie, Jon; Tomkins-Lane, Christy

2016-01-04

Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality. © BMJ Publishing Group Ltd 2015.

Clinical value of transforaminal epidural steroid injection in lumbar radiculopathy.

PubMed

Leung, S M; Chau, W W; Law, S W; Fung, K Y

2015-10-01

To identify the diagnostic, therapeutic, and prognostic values of transforaminal epidural steroid injection as interventional rehabilitation for lumbar radiculopathy. Regional hospital, Hong Kong. A total of 232 Chinese patients with lumbar radiculopathy attributed to disc herniation or spinal stenosis received transforaminal epidural steroid injection between 1 January 2007 and 31 December 2011. Transforaminal epidural steroid injection. Patients' immediate response, response duration, proportion of patients requiring surgery, and risk factors affecting the responses to transforaminal epidural steroid injection for lumbar radiculopathy. Of the 232 patients, 218 (94.0%) had a single level of radiculopathy and 14 (6.0%) had multiple levels. L5 was the most commonly affected level. The immediate response rate to transforaminal epidural steroid injection was 80.2% in 186 patients with clinically diagnosed lumbar radiculopathy and magnetic resonance imaging of the lumbar spine suggesting nerve root compression. Of patients with single-level radiculopathy and multiple-level radiculopathy, 175 (80.3%) and 11 (78.6%) expressed an immediate response to transforaminal epidural steroid injection, respectively. The analgesic effect lasted for 1 to <3 weeks in 35 (15.1%) patients, for 3 to 12 weeks in 37 (15.9%) patients, and for more than 12 weeks in 92 (39.7%) patients. Of the 232 patients, 106 (45.7%) were offered surgery, with 65 (61.3%) undergoing operation, and with 42 (64.6%) requiring spinal fusion in addition to decompression surgery. Symptom chronicity was associated with poor immediate response to transforaminal epidural steroid injection, but not with duration of pain reduction. Poor response to transforaminal epidural steroid injection was not associated with a preceding industrial injury. The immediate response to transforaminal epidural steroid injection was approximately 80%. Transforaminal epidural steroid injection is a useful diagnostic, prognostic, and short-term therapeutic tool for lumbar radiculopathy. Although transforaminal epidural steroid injection cannot alter the need for surgery in the long term, it is a reasonably safe procedure to provide short-term pain relief and as a preoperative assessment tool.

Lumbar spinal mobility changes among adults with advancing age

PubMed Central

Saidu, Ismaila Adamu; Maduagwu, Stanley Monday; Abbas, Abdullahi Digil; Adetunji, Omotayo O.; Jajere, Abdurahman Mohammed

2011-01-01

Background: Limitations in spinal mobility can interfere with the attainment of important functional skills and activities of daily living and restrictions in spinal mobility are usually the earliest and reliable indicator of diseases. Objective: The aim of this study was to determine the differences of lumbar spinal mobility among healthy adults with advancing age. Materials and Methods: The modified Schober's method was used to measure anterior flexion. The guideline of the American Academy of Orthopaedic Surgeons was adapted to measure lateral flexion and extension. Results: The results of this study indicate that spinal mobility decreases with advancing age. The most significant (P < 0.05) differences occurred between the two youngest and the two oldest age categories. Conclusion: Using these data, we developed normative values of spinal mobility for each sex and age group. This study helps the clinicians to understand and correlate the restrictions of lumbar spinal mobility due to age and differentiate the limitations due to disease. PMID:22408334

Cost Utility Analysis of Percutaneous Adhesiolysis in Managing Pain of Post-lumbar Surgery Syndrome and Lumbar Central Spinal Stenosis.

PubMed

Manchikanti, Laxmaiah; Helm, Standiford; Pampati, Vidyasagar; Racz, Gabor B

2015-06-01

The increase in the number of interventions for the management of chronic pain and associated escalation of healthcare costs has captured the attention of health policymakers, in no small part due to the lack of documentation of efficacy, cost-effectiveness, or cost utility analysis. A recent cost utility analysis of caudal epidural injections in managing chronic low back pain of various pathologies showed a high cost utility with improvement in quality of life years, competitive with various other modalities of treatments. However, there are no analyses derived from high-quality controlled studies related to the cost utility of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome or lumbar central spinal stenosis. This analysis is based on 2 previously published controlled studies. To assess the cost utility of percutaneous adhesiolysis procedures in managing chronic low back and lower extremity pain secondary to post-lumbar surgery syndrome and lumbar central spinal stenosis. A private, specialty referral interventional pain management center in the United States. Two controlled studies were conducted assessing the clinical effectiveness of percutaneous adhesiolysis for post-lumbar surgery syndrome and lumbar central spinal stenosis in an interventional pain management setting utilizing contemporary interventional pain management practices. A cost utility analysis was performed with direct payment data for a total of 130 patients in treatment groups over a 2-year period. Various outcome measures were included with significant improvement, defined as at least 50% improvement with reduction in pain and disability status. The results of 2 controlled studies of low back pain with 60 and 70 patients and a 2-year follow-up with the actual reimbursement data showed cost utility for 1 year of quality-adjusted life year (QALY) of USD $2,652 for post-lumbar surgery syndrome and USD $2,649 for lumbar central spinal stenosis. The results of this assessment show that the cost utility of managing chronic, intractable low back pain with percutaneous adhesiolysis at a QALY that is similar or lower in price than medical therapy only, physical therapy, manipulation, spinal cord stimulation, and surgery. The limitations of this cost utility analysis are that it is a single-center evaluation, with the inclusion of costs of adhesiolysis procedures in an ambulatory surgery center and physician visits, rather than all related costs including drug therapy and costs of disability in multiple settings. This cost utility analysis of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome and lumbar central spinal stenosis shows the clinical effectiveness and cost utility of these procedures at USD $2,650 per one year of QALY when performed in an ambulatory surgery center. © 2014 World Institute of Pain.

The effect of prior lumbar surgeries on the flexion relaxation phenomenon and its responsiveness to rehabilitative treatment.

PubMed

Neblett, Randy; Mayer, Tom G; Brede, Emily; Gatchel, Robert J

2014-06-01

Abnormal pretreatment flexion-relaxation in chronic disabling occupational lumbar spinal disorder patients has been shown to improve with functional restoration rehabilitation. Little is known about the effects of prior lumbar surgeries on flexion-relaxation and its responsiveness to treatment. To quantify the effect of prior lumbar surgeries on the flexion-relaxation phenomenon and its responsiveness to rehabilitative treatment. A prospective cohort study of chronic disabling occupational lumbar spinal disorder patients, including those with and without prior lumbar spinal surgeries. A sample of 126 chronic disabling occupational lumbar spinal disorder patients with prior work-related injuries entered an interdisciplinary functional restoration program and agreed to enroll in this study. Fifty-seven patients had undergone surgical decompression or discectomy (n=32) or lumbar fusion (n=25), and the rest had no history of prior injury-related spine surgery (n=69). At post-treatment, 116 patients were reevaluated, including those with prior decompressions or discectomies (n=30), lumbar fusions (n=21), and no surgery (n=65). A comparison group of 30 pain-free control subjects was tested with an identical assessment protocol, and compared with post-rehabilitation outcomes. Mean surface electromyography (SEMG) at maximum voluntary flexion; subject achievement of flexion-relaxation (SEMG≤3.5 μV); gross lumbar, true lumbar, and pelvic flexion ROM; and a pain visual analog scale self-report during forward bending task. Identical measures were obtained at pretreatment and post-treatment. Patients entered an interdisciplinary functional restoration program, including a quantitatively directed, medically supervised exercise process and a multimodal psychosocial disability management component. The functional restoration program was accompanied by a SEMG-assisted stretching training program, designed to teach relaxation of the lumbar musculature during end-range flexion, thereby improving or normalizing flexion-relaxation and increasing lumbar flexion ROM. At 1 year after discharge from the program, a structured interview was used to obtain socioeconomic outcomes. At pre-rehabilitation, the no surgery group patients demonstrated significantly better performance than both surgery groups on absolute SEMG at maximum voluntary flexion and on true lumbar flexion ROM. Both surgery groups were less likely to achieve flexion-relaxation than the no surgery patients. The fusion patients had reduced gross lumbar flexion ROM and greater pain during bending compared with the no surgery patients, and reduced true lumbar flexion ROM compared with the discectomy patients. At post-rehabilitation, all groups improved substantially on all measures. When post-rehabilitation measures were compared with the pain-free control group, with gross and true lumbar ROM corrected by 8° per spinal segment fused, there were no differences between any of the patient groups and the pain-free control subjects on spinal ROM and only small differences in SEMG. The three groups had comparable socioeconomic outcomes at 1 year post-treatment in work retention, health-care utilization, new injury, and new surgery. Despite the fact that the patients with prior surgery demonstrated greater pretreatment SEMG and ROM deficits, functional restoration treatment, combined with SEMG-assisted stretching training, was successful in improving all these measures by post-treatment. After treatment, both groups demonstrated ROM within anticipated limits, and the majority of patients in all three groups successfully achieved flexion-relaxation. In a chronic disabling occupational lumbar spinal disorder cohort, surgery patients were nearly equal to nonoperated patients in responding to interdisciplinary functional restoration rehabilitation on measures investigated in this study, achieving close to normal performance measures associated with pain-free controls. The responsiveness and final scores shown in this study suggests that flexion-relaxation may be a useful, objective diagnostic tool to measure changes in physical capacity for chronic disabling occupational lumbar spinal disorder patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Spinal postural training: Comparison of the postural and mobility effects of electrotherapy, exercise, biofeedback trainer in addition to postural education in university students.

PubMed

Çelenay, Şeyda Toprak; Kaya, Derya Özer; Özüdoğru, Anıl

2015-01-01

Spinal posture and mobility are significant for protecting spine. The aim was to compare effects of different postural training interventions on spinal posture and mobility. Ninety-six university students (ages: 18–25 years) were allocated into Electrical Stimulation (ES) (n = 24), Exercise (n = 24), Biofeedback Posture Trainer (Backtone) (n = 24), and Postural Education (n = 24, Controls) groups. All the groups got postural education. The interventions were carried out 3 days a week for 8 weeks. Spinal Mouse device (Idiag, Fehraltorf, Switzerland) was used to detect thoracic and lumbar curvatures and mobility (degrees) in standing and sitting positions. Paired Student’s t-test, one-way ANOVA, and pairwise post-hoc tests were used. ES decreased thoracic curvature, the exercise decreased thoracic and lumbar curvature and increased thoracic mobility in standing position between pre-post training (p < 0.05). Exercise and Backtone improved thoracic curvature in sitting (p <0.05). In Exercise Group, thoracic curvature decreased compared to Backtone and Education Groups, and thoracic mobility increased compared to all groups (p < 0.05). The exercise was effective and superior in improving thoracic and lumbar curves, and mobility among university students. ES decreased thoracic curve. Biofeedback posture trainer improved sitting posture. A prospective randomized controlled trial, Level 1.

[Lumbar spondylosis].

PubMed

Seichi, Atsushi

2014-10-01

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

Lumbar lipomeningomyelocele associated with multiple café au lait spots: a case report.

PubMed

Balasubramanian, Pradeep; Srinivas, C R; Arunachalam, Pavai; Thirumurthy, K S; Rajkumar, P R; Manuvidhya, H

2015-01-01

We report on a child with several café au lait spots in association with a lumbar lipomeningomyelocele as an apparently new association. Cutaneous markers, the identification of which plays a crucial role in the early diagnosis and management of spinal malformations, can accompany occult spinal dysraphism. Herein we report a case of lumbar lipomeningomyelocele associated with an overlying café au lait spot that served as a marker of occult spinal dysraphism. The patient also had segmental café au lait spots on the face, making the association unique. © 2015 Wiley Periodicals, Inc.

The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery.

PubMed

Boissière, Louis; Bourghli, Anouar; Vital, Jean-Marc; Gille, Olivier; Obeid, Ibrahim

2013-06-01

Sagittal malalignment is frequently observed in adult scoliosis. C7 plumb line, lumbar lordosis and pelvic tilt are the main factors to evaluate sagittal balance and the need of a vertebral osteotomy to correct it. We described a ratio: the lumbar lordosis index (ratio lumbar lordosis/pelvic incidence) (LLI) and analyzed its relationships with spinal malalignment and vertebral osteotomies. 53 consecutive patients with a surgical adult scoliosis had preoperative and postoperative full spine EOS radiographies to measure spino-pelvic parameters and LLI. The lack of lordosis was calculated after prediction of theoretical lumbar lordosis. Correlation analysis between the different parameters was performed. All parameters were correlated with spinal malalignment but LLI is the most correlated parameter (r = -0.978). It is also the best parameter in this study to predict the need of a spinal osteotomy (r = 1 if LLI <0.5). LLI is a statistically validated parameter for sagittal malalignment analysis. It can be used as a mathematical tool to detect spinal malalignment in adult scoliosis and guides the surgeon decision of realizing a vertebral osteotomy for adult scoliosis sagittal correction. It can be used as well for the interpretation of clinical series in adult scoliosis.

A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice.

PubMed

Daniels, Clinton J; Wakefield, Pamela J; Bub, Glenn A; Toombs, James D

2016-12-01

The purpose of this narrative review was to describe the most common spinal fusion surgical procedures, address the clinical indications for lumbar fusion in degeneration cases, identify potential complications, and discuss their relevance to chiropractic management of patients after surgical fusion. The PubMed database was searched from the beginning of the record through March 31, 2015, for English language articles related to lumbar fusion or arthrodesis or both and their incidence, procedures, complications, and postoperative chiropractic cases. Articles were retrieved and evaluated for relevance. The bibliographies of selected articles were also reviewed. The most typical lumbar fusion procedures are posterior lumbar interbody fusion, anterior lumbar interbody fusion, transforaminal interbody fusion, and lateral lumbar interbody fusion. Fair level evidence supports lumbar fusion procedures for degenerative spondylolisthesis with instability and for intractable low back pain that has failed conservative care. Complications and development of chronic pain after surgery is common, and these patients frequently present to chiropractic physicians. Several reports describe the potential benefit of chiropractic management with spinal manipulation, flexion-distraction manipulation, and manipulation under anesthesia for postfusion low back pain. There are no published experimental studies related specifically to chiropractic care of postfusion low back pain. This article describes the indications for fusion, common surgical practice, potential complications, and relevant published chiropractic literature. This review includes 10 cases that showed positive benefits from chiropractic manipulation, flexion-distraction, and/or manipulation under anesthesia for postfusion lumbar pain. Chiropractic care may have a role in helping patients in pain who have undergone lumbar fusion surgery.

Pneumorrhachis.

PubMed

Eroglu, Umit; Yakar, Fatih; Zaimoglu, Murat; Ozates, Ozgür; Ozgural, Onur; Ugur, Hasan Caglar

2016-01-01

The presence of air in spinal canal is called as "pneumorrhachis." Nontraumatic, noniatrogenic spontaneous spinal air is an uncommon case. Peripheral alveoli burst due to the increased pressure in alveoli in the case of trauma, asthma, pneumothorax, or pneumomediastinum. Air pass to the mediastinum and then to retropharyngeal space and reaches to epidural space. In this paper, a 44-year-old female patient who has a spontaneous pneumorrhachis in the epidural space in the spinal canal L5-S1 lumbar level has been presented.

Effect of spinal monoaminergic neuronal system dysfunction on pain threshold in rats, and the analgesic effect of serotonin and norepinephrine reuptake inhibitors.

PubMed

Tamano, Ryuta; Ishida, Mitsuhiro; Asaki, Toshiyuki; Hasegawa, Minoru; Shinohara, Shunji

2016-02-26

Dysfunction in the central serotonin (5-HT) and norepinephrine (NE) systems cause depression and pain. Descending spinal pain modulatory pathways are important in the analgesic mechanisms of antidepressants, particularly serotonin and norepinephrine reuptake inhibitors (SNRIs). While many non-clinical studies have demonstrated the roles of central monoaminergic systems in pain, there is little evidence to illuminate the direct contribution of spinal descending pain modulatory systems independently of depressive-like behavior. To examine the effects of dysfunction of spinal monoaminergic systems on pain sensitivity, we established a rat chronic pain model by administering lumbar-intrathecal reserpine to minimize its influence on brain. Lumbar-intrathecal reserpine evoked persistent mechanical hypersensitivity and corresponding reductions in spinal 5-HT and NE concentrations (from 767.2 to 241.6ng/g and from 455.9 to 41.7ng/g, respectively after reserpine 30nmol). Lumbar-intrathecal reserpine did not deplete brain monoamines or bring about depressive-like behavior in the forced swim test. Spinal monoamines depletion-induced pain sensitivity was ameliorated by lumbar-intrathecal administration of the SNRIs (duloxetine and milnacipran) in dose-dependent manners. These suggest that increased pain sensitivity could be induced by dysfunction solely of the descending pain modulatory system, regardless of depressive-like behavior, and lumbar-intrathecal administration of SNRIs could ameliorate the pain sensitivity which might be mediated by affecting the descending pain modulatory system in the spinal cord, not via their antidepressant effects. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Initiating or blocking locomotion in spinal cats by applying noradrenergic drugs to restricted lumbar spinal segments.

PubMed

Marcoux, J; Rossignol, S

2000-11-15

After an acute low thoracic spinal transection (T13), cats can be made to walk with the hindlimbs on a treadmill with clonidine, an alpha2-noradrenergic agonist. Because previous studies of neonatal rat spinal cord in vitro suggest that the most important lumbar segments for rhythmogenesis are L1-L2, we investigated the role of various lumbar segments in the initiation of walking movements on a treadmill of adult cats spinalized (T13), 5-6 d earlier. The locomotor activities were evaluated from electromyographic and video recordings. The results show that: (1) localized topical application of clonidine in restricted baths over either the L3-L4 or the L5-L7 segments was sufficient to induce walking movements. Yohimbine, an alpha2-noradrenergic antagonist, could block this locomotion when applied over L3-L4 or L5-L7; (2) microinjections of clonidine in one or two lumbar segments from L3 to L5 could also induce locomotion; (3) after an intravenous injection of clonidine, locomotion was blocked by microinjections of yohimbine in segments L3, L4, or L5 but not if the injection was in L6; (4) locomotion was also blocked in all cases by additional spinal transections at L3 or L4. These results show that it is possible to initiate walking in the adult spinal cat with a pharmacological stimulation of a restricted number of lumbar segments and also that the integrity of the L3-L4 segments is necessary to sustain the locomotor activity.

The Incidence of Adjacent Segment Degeneration after the Use of a Versatile Dynamic Hybrid Stabilization Device in Lumbar Stenosis: Results of a 5–8-Year Follow-up

PubMed Central

Dobran, Mauro; Esposito, Domenico Paolo; Gladi, Maurizio; Scerrati, Massimo; Iacoangeli, Maurizio

2018-01-01

Study Design Retrospective study with long-term follow-up. Purpose To evaluate the long-term incidence of adjacent segment degeneration (ASD) and clinical outcomes in a consecutive series of patients who underwent spinal decompression associated with dynamic or hybrid stabilization with a Flex+TM stabilization system (SpineVision, Antony, France) for lumbar spinal stenosis. Overview of Literature The incidence of ASD and clinical outcomes following dynamic or hybrid stabilization with the Flex+TM system used for lumbar spinal stenosis have not been well investigated. Methods Twenty-one patients with lumbar stenosis and probable post-decompressive spinal instability underwent decompressive laminectomy followed by spinal stabilization using the Flex+TM stabilization system. The indication for a mono-level dynamic stabilization was a preoperative magnetic resonance imaging (MRI) demonstrating evidence of severe disc disease associated with severe spinal stenosis. The hybrid stabilization (rigid-dynamic) system was used for multilevel laminectomies with associated initial degenerative scoliosis, first-grade spondylolisthesis, or rostral pathology. Results The improvement in Visual Analog Scale and Oswestry Disability Index scores at follow-up were statistically significant (p<0.0001 and p<0.0001, respectively). At the 5–8-year follow-up, clinical examination, MRI, and X-ray findings showed an ASD complication with pain and disability in one of 21 patients. The clinical outcomes were similar in patients treated with dynamic or hybrid fixation. Conclusions Patients treated with laminectomy and Flex+TM stabilization presented a satisfactory clinical outcome after 5–8 years of follow-up, and ASD incidence in our series was 4.76% (one patient out of 21). We are aware that this is a small series, but our long-term follow-up may be sufficient to contribute to the expanding body of literature on the development of symptomatic ASD associated with dynamic or hybrid fixation. PMID:29713407

Dural ectasia associated with Mounier-Kuhn syndrome: a novel association in the context of spinal stenosis.

PubMed

Sheridan, Gerard Anthony; Godkin, Owen; Devitt, Aiden

2017-08-30

We present the case of a patient undergoing lumbar spine decompression for stenosis with a history of Mounier-Kuhn syndrome. The patient presented with axial lumbar spine pain over 6 months with progressive radicular pain to the left L3 dermatome. MRI confirmed spinal stenosis at L3/4 level with associated dural ectasia. The patient had an uneventful spinal decompression with resolution of radicular symptoms and axial spine pain. Dural ectasia poses a significant risk when operating on the lumbosacral spine. Larger cerebrospinal fluid volumes and a capacious dural canal can result in anaesthetic and orthopaedic complications such as inadequate spinal anaesthesia, complicated epidural analgesia, intraoperative dural tears and difficult pedicle screw insertion due to narrow pedicles. This is the first case in the literature detailing the association between dural ectasia and Mounier-Kuhn syndrome. We recommend adequate spinal imaging in patients with Mounier-Kuhn syndrome to exclude dural ectasia prior to undergoing lumbosacral spinal procedures. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Correlations of hip mobility with degree of back pain and lumbar spinal mobility in chronic low-back pain patients.

PubMed

Mellin, G

1988-06-01

Mobility of hips and lumbar spine were measured in 301 men and 175 women who were in employment but suffered from chronic or recurrent low-back pain. The degree of low-back pain (LBP) was assessed with a questionnaire. Hip flexion, extension, internal rotation, and hamstring flexibility in the men, and hip flexion and extension in the women had statistically significant negative correlations with LBP. Among the correlations between hip and lumbar spinal mobility, hip flexion and extension with lumbar rotation were strongest.

Limited effect of fly-wheel and spinal mobilization exercise countermeasures on lumbar spine deconditioning during 90 d bed-rest in the Toulouse LTBR study

NASA Astrophysics Data System (ADS)

Belavý, Daniel L.; Ohshima, Hiroshi; Bareille, Marie-Pierre; Rittweger, Jörn; Felsenberg, Dieter

2011-09-01

We examined the effect of high-load fly-wheel (targeting the lower-limb musculature and concurrent loading of the spine via shoulder restraints) and spinal movement countermeasures against lumbar spine muscle atrophy, disc and spinal morphology changes and trunk isokinetic torque loss during prolonged bed-rest. Twenty-four male subjects underwent 90 d head-down tilt bed-rest and performed either fly-wheel (FW) exercises every three days, spinal movement exercises in lying five times daily (SpMob), or no exercise (Ctrl). There was no significant impact of countermeasures on losses of isokinetic trunk flexion/extension ( p≥0.65). Muscle volume change by day-89 of bed-rest in the psoas, iliacus, lumbar erector spinae, lumbar multifidus and quadratus lumborum, as measured via magnetic resonance imaging (MRI), was statistically similar in all three groups ( p≥0.33). No significant effect on MRI-measures of lumbar intervertebral disc volume, spinal length and lordosis ( p≥0.09) were seen either, but there was some impact ( p≤0.048) on axial plane disc dimensions (greater reduction than in Ctrl) and disc height (greater increases than in Ctrl). MRI-data from subjects measured 13 and 90-days after bed-rest showed partial recovery of the spinal extensor musculature by day-13 after bed-rest with this process complete by day-90. Some changes in lumbar spine and disc morphology parameters were still persistent 90-days after bed-rest. The present results indicate that the countermeasures tested were not optimal to maintain integrity of the spine and trunk musculature during bed rest.

Dynamic biomechanical examination of the lumbar spine with implanted total spinal segment replacement (TSSR) utilizing a pendulum testing system.

PubMed

Daniels, Alan H; Paller, David J; Koruprolu, Sarath; Palumbo, Mark A; Crisco, Joseph J

2013-01-01

Biomechanical investigations of spinal motion preserving implants help in the understanding of their in vivo behavior. In this study, we hypothesized that the lumbar spine with implanted total spinal segment replacement (TSSR) would exhibit decreased dynamic stiffness and more rapid energy absorption compared to native functional spinal units under simulated physiologic motion when tested with the pendulum system. Five unembalmed, frozen human lumbar functional spinal units were tested on the pendulum system with axial compressive loads of 181 N, 282 N, 385 N, and 488 N before and after Flexuspine total spinal segment replacement implantation. Testing in flexion, extension, and lateral bending began by rotating the pendulum to 5°; resulting in unconstrained oscillatory motion. The number of rotations to equilibrium was recorded and bending stiffness (N-m/°) was calculated and compared for each testing mode. The total spinal segment replacement reached equilibrium with significantly fewer cycles to equilibrium compared to the intact functional spinal unit at all loads in flexion (p<0.011), and at loads of 385 N and 488 N in lateral bending (p<0.020). Mean bending stiffness in flexion, extension, and lateral bending increased with increasing load for both the intact functional spinal unit and total spinal segment replacement constructs (p<0.001), with no significant differences in stiffness between the intact functional spinal unit and total spinal segment replacement in any of the test modes (p>0.18). Lumbar functional spinal units with implanted total spinal segment replacement were found to have similar dynamic bending stiffness, but absorbed energy at a more rapid rate than intact functional spinal units during cyclic loading with an unconstrained pendulum system. Although the effects on clinical performance of motion preserving devices is not fully known, these results provide further insight into the biomechanical behavior of this device under approximated physiologic loading conditions.

Dynamic Biomechanical Examination of the Lumbar Spine with Implanted Total Spinal Segment Replacement (TSSR) Utilizing a Pendulum Testing System

PubMed Central

Daniels, Alan H.; Paller, David J.; Koruprolu, Sarath; Palumbo, Mark A.; Crisco, Joseph J.

2013-01-01

Background Biomechanical investigations of spinal motion preserving implants help in the understanding of their in vivo behavior. In this study, we hypothesized that the lumbar spine with implanted total spinal segment replacement (TSSR) would exhibit decreased dynamic stiffness and more rapid energy absorption compared to native functional spinal units under simulated physiologic motion when tested with the pendulum system. Methods Five unembalmed, frozen human lumbar functional spinal units were tested on the pendulum system with axial compressive loads of 181 N, 282 N, 385 N, and 488 N before and after Flexuspine total spinal segment replacement implantation. Testing in flexion, extension, and lateral bending began by rotating the pendulum to 5°; resulting in unconstrained oscillatory motion. The number of rotations to equilibrium was recorded and bending stiffness (N-m/°) was calculated and compared for each testing mode. Results The total spinal segment replacement reached equilibrium with significantly fewer cycles to equilibrium compared to the intact functional spinal unit at all loads in flexion (p<0.011), and at loads of 385 N and 488 N in lateral bending (p<0.020). Mean bending stiffness in flexion, extension, and lateral bending increased with increasing load for both the intact functional spinal unit and total spinal segment replacement constructs (p<0.001), with no significant differences in stiffness between the intact functional spinal unit and total spinal segment replacement in any of the test modes (p>0.18). Conclusions Lumbar functional spinal units with implanted total spinal segment replacement were found to have similar dynamic bending stiffness, but absorbed energy at a more rapid rate than intact functional spinal units during cyclic loading with an unconstrained pendulum system. Although the effects on clinical performance of motion preserving devices is not fully known, these results provide further insight into the biomechanical behavior of this device under approximated physiologic loading conditions. PMID:23451222

Assessing the clinical utility of combined movement examination in symptomatic degenerative lumbar spondylosis.

PubMed

Monie, A P; Price, R I; Lind, C R P; Singer, K P

2015-07-01

The aim of this study is to report the development and validation of a low back computer-aided combined movement examination protocol in normal individuals and record treatment outcomes of cases with symptomatic degenerative lumbar spondylosis. Test-retest, following intervention. Self-report assessments and combined movement examination were used to record composite spinal motion, before and following neurosurgical and pain medicine interventions. 151 normal individuals aged from 20 years to 69 years were assessed using combined movement examination between L1 and S1 spinal levels to establish a reference range. Cases with degenerative low back pain and sciatica were assessed before and after therapeutic interventions with combined movement examination and a battery of self-report pain and disability questionnaires. Change scores for combined movement examination and all outcome measures were derived. Computer-aided combined movement examination validation and intraclass correlation coefficient with 95% confidence interval and least significant change scores indicated acceptable reliability of combined movement examination when recording lumbar movement in normal subjects. In both clinical cases lumbar spine movement restrictions corresponded with self-report scores for pain and disability. Post-intervention outcomes all showed significant improvement, particularly in the most restricted combined movement examination direction. This study provides normative reference data for combined movement examination that may inform future clinical studies of the technique as a convenient objective surrogate for important clinical outcomes in lumbar degenerative spondylosis. It can be used with good reliability, may be well tolerated by individuals in pain and appears to change in concert with validated measures of lumbar spinal pain, functional limitation and quality of life. Copyright © 2015 Elsevier Ltd. All rights reserved.

Early or delayed stabilization in severely injured patients with spinal fractures? Current surgical objectivity according to the Trauma Registry of DGU: treatment of spine injuries in polytrauma patients.

PubMed

Bliemel, Christopher; Lefering, Rolf; Buecking, Benjamin; Frink, Michael; Struewer, Johannes; Krueger, Antonio; Ruchholtz, Steffen; Frangen, Thomas Manfred

2014-02-01

Because of a lack of evidence, the appropriate timing of surgical stabilization of thoracic and lumbar spine injuries in severely injured patients is still controversial. Data of a large international trauma register were analyzed to investigate the medical care situation of unstable spinal column fractures in patients with multiple injuries, so as to examine the outcome related to timing of surgical stabilization. Data sets of the Trauma Registry of German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (1993-2010) were analyzed. The Trauma Registry of DGU is a prospective, multicenter register that provides information on severely injured patients. All patients with an Injury Severity Score (ISS) of 16 or greater caused by blunt trauma, subsequent treatment of 7 days or more, 16 years or older, and thoracic or lumbar spine injuries (spine Abbreviated Injury Scale [AIS] score ≥ 2) were included in our analysis. Patients with relevant spine injuries classified as having a spine AIS score of 3 or greater were further analyzed in terms of whether they got early (<72 hours) or late (>72 hours) surgical treatment due to unstable spinal column fractures. Of 24,974 patients, 8,994 (36.0%) had documented spinal injuries (spine AIS score ≥ 2). A total of 1,309 patients who sustained relevant thoracic spine injuries (spine AIS score ≥ 3) and 994 patients who experienced lumbar spine trauma and classified as having spine AIS score of 3 or greater were more precisely analyzed. Of these, 68.2% and 71.0%, respectively, received an early thoracic or lumbar spine fixation. With an increase in spinal injury severity, an increase in early stabilization in the thoracic and lumbar spine was seen. In the group of patients with early surgical stabilization, significantly shorter hospital stays, shorter intensive care unit stays, fewer days on mechanical ventilation, and lower rates of sepsis were seen. In the case that additional body regions were affected, for example, when patients were critically ill, a delayed spinal stabilization was more often performed. A spinal stabilization at an early stage (<72 hours) is presumed to be beneficial. Although some patients may require delay due to necessary medical improvement, every reasonable effort should be made to treat patients with instable spinal column fractures as soon as possible. If an early surgical treatment is feasible, severely injured patients may benefit from a shorter period of hospital treatment and a lower rate of complications. Therapeutic study, level III.

[Lumbar spinal anesthesia with cervical nociceptive blockade. Critical review of a series of 1,330 procedures].

PubMed

Benitez, Percio Ramón Becker; Nogueira, Celso Schmalfuss; Holanda, Ana Cristina Carvalho de; Santos, Jose Caio

2016-01-01

The manufacture of minimally traumatic needles and synthesis of pharmacological adjuncts with safe and effective action on inhibitory and neuromodulatory synapses distributed along the nociceptive pathways were crucial for a new expansion phase of spinal anesthesia. The objectives of this paper are present our clinical experience with 1,330 lumbar spinal anesthesia performed with purposeful nociceptive blockade of the thoracic and cervical spinal nerves corresponding to dermatomes C4 or C3; warn about the method pathophysiological risks, and emphasize preventive standards for the safe application of the technique. Review of the historical background and anatomical spinal anesthesia with cervical levels of analgesia. Description of the technique used in our institution; population anesthetized; and surgery performed with the described method. Critical exposition of the physiological, pathophysiological, and clinical effects occurred and registered during anesthesia-surgery and postoperative period. Spinal anesthesia with nociceptive blockade to dermatome C4, or C3, is an effective option for surgery on somatic structures distal to the metamer of the third cervical spinal nerve, lasting no more than four or five hours. The method safety depends on the unrestricted respect for the essential rules of proper anesthesia. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Lumbar spinal anesthesia with cervical nociceptive blockade. Critical review of a series of 1,330 procedures.

PubMed

Benitez, Percio Ramón Becker; Nogueira, Celso Schmalfuss; de Holanda, Ana Cristina Carvalho; Santos, José Caio

2016-01-01

The manufacture of minimally traumatic needles and synthesis of pharmacological adjuncts with safe and effective action on inhibitory and neuromodulatory synapses distributed along the nociceptive pathways were crucial for a new expansion phase of spinal anesthesia. The objectives of this paper are present our clinical experience with 1330 lumbar spinal anesthesia performed with purposeful nociceptive blockade of the thoracic and cervical spinal nerves corresponding to dermatomes C4 or C3; warn about the method pathophysiological risks, and emphasize preventive standards for the safe application of the technique. Review of the historical background and anatomical spinal anesthesia with cervical levels of analgesia. Description of the technique used in our institution; population anesthetized; and surgery performed with the described method. Critical exposition of the physiological, pathophysiological, and clinical effects occurred and registered during anesthesia-surgery and postoperative period. Spinal anesthesia with nociceptive blockade to dermatome C4, or C3, is an effective option for surgery on somatic structures distal to the metamer of the third cervical spinal nerve, lasting no more than four or five hours. The method safety depends on the unrestricted respect for the essential rules of proper anesthesia. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Adult thoracolumbar and lumbar scoliosis treated with long vertebral fusion to the sacropelvis: a comparison between new hybrid selective spinal fusion versus anterior-posterior spinal instrumentation.

PubMed

Yagi, Mitsuru; Patel, Ravi; Lawhorne, Thomas W; Cunningham, Matthew E; Boachie-Adjei, Oheneba

2014-04-01

Combined anteroposterior spinal fusion with instrumentation has been used for many years to treat adult thoracolumbar/lumbar scoliosis. This surgery remains a technical challenge to spine surgeons, and current literature reports high complication rates. The purpose of this study is to validate a new hybrid technique (a combination of single-rod anterior instrumentation and a shorter posterior instrumentation to the sacrum) to treat adult thoracolumbar/lumbar scoliosis. This study is a retrospective consecutive case series of surgically treated patients with adult lumbar or thoracolumbar scoliosis. This is a retrospective study of 33 matched pairs of patients with adult scoliosis who underwent two different surgical procedures: a new hybrid technique versus a third-generation anteroposterior spinal fusion. Preoperative and postoperative outcome measures include self-report measures, physiological measures, and functional measures. In a retrospective case-control study, 33 patients treated with the hybrid technique were matched with 33 patients treated with traditional anteroposterior fusion based on preoperative radiographic parameters. Mean follow-up in the hybrid group was 5.3 years (range, 2-11 years), compared with 4.6 years (range, 2-10 years) in the control group. Operating room (OR) time, estimated blood loss, and levels fused were collected as surrogates for surgical morbidity. Radiographic parameters were collected preoperatively, postoperatively, and at final follow-up. The Scoliosis Research Society Patient Questionnaire (SRS-22r) and Oswestry Disability Index (ODI) scores were collected for clinical outcomes. Operating room time, EBL, and levels fused were significantly less in the hybrid group compared with the control group (p<.0001). The postoperative thoracic Cobb angle was similar between the hybrid and control techniques (p=.24); however, the hybrid technique showed significant improvement in the thoracolumbar/lumbar curves (p=.004) and the lumbosacral fractional curve (p<.0001). The major complication rate was less in the hybrid group compared with the control group (18% vs. 39%, p=.01). Clinical outcomes at final follow-up were not significantly different based on overall SRS-22r scores and ODI scores. The new hybrid technique demonstrates good long-term results, with less morbidity and fewer complications than traditional anteroposterior surgery select patients with thoracolumbar/lumbar scoliosis. This study received no funding. No potential conflict of interest-associated bias existed. Copyright © 2014 Elsevier Inc. All rights reserved.

Comparing the Use of Dynamic Response Index (DRI) and Lumbar Load as Relevant Spinal Injury Metrics

DTIC Science & Technology

2014-01-09

reproducible results in greater detail under controlled testing conditions • Biofidelic enhancements to the Hybrid III design were made which support...occupants 4) General discussion on continued use of DRI as a design criterion for spinal injuries given the availability of the more direct Lumbar...load from fully encumbered ATDs in underbody blast testing . 15. SUBJECT TERMS DRI, Lumbar Load, Blast, LSDYNA, MADYMO, occupant, injury, pelvic

Neuromodulation of the lumbar spinal locomotor circuit.

PubMed

AuYong, Nicholas; Lu, Daniel C

2014-01-01

The lumbar spinal cord contains the necessary circuitry to independently drive locomotor behaviors. This function is retained following spinal cord injury (SCI) and is amenable to rehabilitation. Although the effectiveness of task-specific training and pharmacologic modulation has been repeatedly demonstrated in animal studies, results from human studies are less striking. Recently, lumbar epidural stimulation (EDS) along with locomotor training was shown to restore weight-bearing function and lower-extremity voluntary control in a chronic, motor-complete human SCI subject. Related animal studies incorporating EDS as part of the therapeutic regiment are also encouraging. EDS is emerging as a promising neuromodulatory tool for SCI. Copyright © 2014 Elsevier Inc. All rights reserved.

Cost Analysis of Spinal Versus General Anesthesia for Lumbar Diskectomy and Laminectomy Spine Surgery.

PubMed

Agarwal, Prateek; Pierce, John; Welch, William C

2016-05-01

Lumbar spine surgery can be performed using various anesthetic modalities, most notably general or spinal anesthesia. Because data comparing the cost of these anesthetic modalities in spine surgery are scarce, this study asks whether spinal anesthesia is less costly than general anesthesia. A total of 542 patients who underwent elective lumbar diskectomy or laminectomy spine surgery between 2007 and 2011 were retrospectively identified, with 364 having received spinal anesthesia and 178 having received general anesthesia. Mean direct operating cost, indirect cost (general support staff, insurance, taxes, floor space, facility, and administrative costs), and total cost were compared among patients who received general and spinal anesthesia. Linear multiple regression analysis was used to identify the effect of anesthesia type on cost and determine the factors underlying this effect, while controlling for patient and procedure characteristics. When controlling for patient and procedure characteristics, use of spinal anesthesia was associated with a 41.1% lower direct operating cost (-$3629 ± $343, P < 0.001), 36.6% lower indirect cost (-$1603 ± $168, P < 0.001), and 39.6% lower total cost (-$5232 ± $482, P < 0.001) compared with general anesthesia. Shorter hospital stay, shorter duration of anesthesia, shorter duration of operation, and lower estimated blood loss contributed to lower costs for spinal anesthesia, but other factors beyond these were also responsible for lower direct operating and total costs. When comparing the benefits of spinal and general anesthesia, spinal anesthesia is less costly when used in patients undergoing lumbar diskectomy and laminectomy spine surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Relationships among spinal mobility and sagittal alignment of spine and lower extremity to quality of life and risk of falls.

PubMed

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

2017-03-01

Spinal deformities can affect quality of life (QOL) and risk of falling, but no studies have explored the relationships of spinal mobility and sagittal alignment of spine and the lower extremities simultaneously. Purpose of this study is to clarify the relationship of those postural parameters to QOL and risk of falling. The study evaluated 110 subjects (41 men, 69 women; mean age, 73 years). Upright and flexion and extension angles for thoracic kyphosis, lumbar lordosis, and spinal inclination were evaluated with SpinalMouse ® . Total-body inclination and hip and knee flexion angles in upright position were measured from lateral photographs. Subjects were divided into Fallers (n=23, 21%) and Non-fallers (n=87, 79%) based on past history of falls. QOL was assessed using the Short Form 36 Health Survey (SF-36 ® ). Age, total-body inclination, spinal inclination upright and in extension, thoracic kyphosis in flexion, lumbar lordosis upright and in extension, and knee flexion correlated significantly with the SF-36. Multiple regression analysis revealed total-body inclination and knee flexion to have the most significant relationships with the SF-36. SF-36, total-body inclination, spinal inclination in extension, thoracic kyphosis in flexion, lumbar lordosis upright and in extension, and hip and knee flexion angles differed significantly between Fallers and Non-fallers (P<0.05 for all). Multivariate logistic regression analyses revealed lumbar lordosis in extension to be a significant predictor of falling (P=0.038). Forward-stooped posture and knee-flexion deformity could be important indicator of lower QOL. Moreover, limited extension in the lumbar spine could be a useful screening examination for fall prevention in the elderly. Copyright © 2017 Elsevier B.V. All rights reserved.

Influence of Alendronate and Endplate Degeneration to Single Level Posterior Lumbar Spinal Interbody Fusion

PubMed Central

Rhee, Wootack; Ha, Seongil; Lim, Jae Hyeon; Jang, Il Tae

2014-01-01

Objective Using alendronate after spinal fusion is a controversial issue due to the inhibition of osteoclast mediated bone resorption. In addition, there are an increasing number of reports that the endplate degeneration influences the lumbar spinal fusion. The object of this retrospective controlled study was to evaluate how the endplate degeneration and the bisphosphonate medication influence the spinal fusion through radiographic evaluation. Methods In this study, 44 patients who underwent single-level posterior lumbar interbody fusion (PLIF) using cage were examined from April 2007 to March 2009. All patients had been diagnosed as osteoporosis and would be recommended for alendronate medication. Endplate degeneration is categorized by the Modic changes. The solid fusion is defined if there was bridging bone between the vertebral bodies, either within or external to the cage on the plain X-ray and if there is less than 5° of angular difference in dynamic X-ray. Results In alendronate group, fusion was achieved in 66.7% compared to 73.9% in control group (no medication). Alendronate did not influence the fusion rate of PLIF. However, there was the statistical difference of fusion rate between the endplate degeneration group and the group without endplate degeneration. A total of 52.4% of fusion rate was seen in the endplate degeneration group compared to 91.3% in the group without endplate degeneration. The endplate degeneration suppresses the fusion process of PLIF. Conclusion Alendronate does not influence the fusion process in osteoporotic patients. The endplate degeneration decreases the fusion rate. PMID:25620981

WISE 2005: Aerobic and resistive countermeasures prevent paraspinal muscle deconditioning during 60-day bed rest in women.

PubMed

Holt, Jacquelyn A; Macias, Brandon R; Schneider, Suzanne M; Watenpaugh, Donald E; Lee, Stuart M C; Chang, Douglas G; Hargens, Alan R

2016-05-15

Microgravity-induced lumbar paraspinal muscle deconditioning may contribute to back pain commonly experienced by astronauts and may increase the risk of postflight injury. We hypothesized that a combined resistive and aerobic exercise countermeasure protocol that included spinal loading would mitigate lumbar paraspinal muscle deconditioning during 60 days of bed rest in women. Sixteen women underwent 60-day, 6° head-down-tilt bed rest (BR) and were randomized into control and exercise groups. During bed rest the control group performed no exercise. The exercise group performed supine treadmill exercise within lower body negative pressure (LBNP) for 3-4 days/wk and flywheel resistive exercise for 2-3 days/wk. Paraspinal muscle cross-sectional area (CSA) was measured using a lumbar spine MRI sequence before and after BR. In addition, isokinetic spinal flexion and extension strengths were measured before and after BR. Data are presented as means ± SD. Total lumbar paraspinal muscle CSA decreased significantly more in controls (10.9 ± 3.4%) than in exercisers (4.3 ± 3.4%; P < 0.05). The erector spinae was the primary contributor (76%) to total lumbar paraspinal muscle loss. Moreover, exercise attenuated isokinetic spinal extension loss (-4.3 ± 4.5%), compared with controls (-16.6 ± 11.2%; P < 0.05). In conclusion, LBNP treadmill and flywheel resistive exercises during simulated microgravity mitigate decrements in lumbar paraspinal muscle structure and spine function. Therefore spaceflight exercise countermeasures that attempt to reproduce spinal loads experienced on Earth may mitigate spinal deconditioning during long-duration space travel.

Considerations in Spinal Fusion Surgery for Chronic Lumbar Pain: Psychosocial Factors, Rating Scales, and Perioperative Patient Education-A Review of the Literature.

PubMed

Gaudin, Daniel; Krafcik, Brianna M; Mansour, Tarek R; Alnemari, Ahmed

2017-02-01

Despite widespread use of lumbar spinal fusion as a treatment for back pain, outcomes remain variable. Optimizing patient selection can help to reduce adverse outcomes. This literature review was conducted to better understand factors associated with optimal postoperative results after lumbar spinal fusion for chronic back pain and current tools used for evaluation. The PubMed database was searched for clinical trials related to psychosocial determinants of outcome after lumbar spinal fusion surgery; evaluation of commonly used patient subjective outcome measures; and perioperative cognitive, behavioral, and educational therapies. Reference lists of included studies were also searched by hand for additional studies meeting inclusion and exclusion criteria. Patients' perception of good health before surgery and low cardiovascular comorbidity predict improved postoperative physical functional capacity and greater patient satisfaction. Depression, tobacco use, and litigation predict poorer outcomes after lumbar fusion. Incorporation of cognitive-behavioral therapy perioperatively can address these psychosocial risk factors and improve outcomes. The 36-Item Short Form Health Survey, European Quality of Life five dimensions questionnaire, visual analog pain scale, brief pain inventory, and Oswestry Disability Index can provide specific feedback to track patient progress and are important to understand when evaluating the current literature. This review summarizes current information and explains commonly used assessment tools to guide clinicians in decision making when caring for patients with lower back pain. When determining a treatment algorithm, physicians must consider predictive psychosocial factors. Use of perioperative cognitive-behavioral therapy and patient education can improve outcomes after lumbar spinal fusion. Copyright © 2016 Elsevier Inc. All rights reserved.

Retrospective exploration of risk factors for L5 radiculopathy following lumbar floating fusion surgery.

PubMed

Orita, Sumihisa; Yamagata, Masatsune; Ikeda, Yoshikazu; Nakajima, Fumitake; Aoki, Yasuchika; Nakamura, Junichi; Takahashi, Kazuhisa; Suzuki, Takane; Ohtori, Seiji

2015-10-17

Lumbar floating fusion occasionally causes postoperative adjacent segment disorder (ASD) at lumbosacral level, causing L5 spinal nerve disorder by L5-S1 foraminal stenosis. The disorder is considered to be one of the major outcomes of L5-S1 ASD, which has not been evaluated yet. The present study aimed to evaluate the incidence and risk factors of postoperative L5 spinal nerve disorder after lumbar interbody fusion extending to the L5 vertebra. We evaluated 125 patients with a diagnosis of spondylolisthesis who underwent floating fusion surgery with transforaminal lumbar interbody fusion with average postoperative period of 25.2 months. The patients were regarded as symptomatic with postoperative L5 spinal nerve disorder such as radicular pain/numbness in the lower limbs and/or motor dysfunction. We estimated and compared the wedging angle (frontal view) and height (lateral view) of the lumbosacral junction in pre- and postoperative plain X-ray images and the foraminal ratio (ratio of the narrower foraminal diameter to the wider diameter in the craniocaudal direction) in the preoperative magnetic resonance image. Risk factors for the incidence of L5 spinal nerve disorder were explored using multivariate logistic regression. Eight of the 125 patients (6.4%) were categorized as symptomatic, an average of 13.3 months after surgery. The wedging angle was significantly higher, and the foraminal ratio was significantly decreased in the symptomatic group (both P < 0.05) compared to the asymptomatic group. Multivariate logistic regression analysis of possible risk factors revealed that the wedging angle, foraminal ratio, and multileveled fusion were statistically significant. Higher wedging angle and lower foraminal ratio in the lumbosacral junction were significantly predictive for the incidence of L5 nerve root disorder as well as multiple-leveled fusion. These findings indicate that lumbosacral fixation should be considered for patients with these risk factors even if they have few symptoms from the L5-S1 junction.

[Anterior lumbar interbody fusion. Indications, technique, advantages and disadvantages].

PubMed

Richter, M; Weidenfeld, M; Uckmann, F P

2015-02-01

Anterior lumbar interbody fusion (ALIF) for lumbar interbody fusion from L2 to the sacrum has been an established technique for decades. The advantages and disadvantages of ALIF compared to posterior interbody fusion techniques are discussed. The operative technique is described in detail. Complications and avoidance strategies are discussed. This article is based on a selective literature search using PubMed and the experience of the authors in this medical field. The advantages of ALIF compared to posterior fusion techniques are the free approach to the anterior disc space without opening of the spinal canal or the neural foramina. This gives the possibility of an extensive anterior release and placement of the largest possible cages without the risk of neural structure damage. The disadvantages of ALIF are the additional anterior approach and the related complications. The most frequent complication is due to damage of vessels. The rate of complications is significantly increased in revision surgery. The ALIF technique meaningfully expands the repertoire of the spinal surgeon especially for the treatment of non-union after interbody fusion, in patients with epidural scar tissue at the index level and spinal infections. Advantages and disadvantages should be considered when evaluating the indications for ALIF.

General anesthesia versus segmental thoracic or conventional lumbar spinal anesthesia for patients undergoing laparoscopic cholecystectomy

PubMed Central

Yousef, Gamal T.; Lasheen, Ahmed E.

2012-01-01

Background: Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. Objective: This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction. Materials and Methods: A total of 90 patients undergoing elective laparoscopic cholecystectomy, between January 2010 and May 2011, were randomized into three equal groups to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under segmental thoracic (TSA group) or conventional lumbar (LSA group) spinal anesthesia or general anesthesia (GA group). To achieve a T3 sensory level we used (hyperbaric bupivacaine 15 mg, and fentanyl 25 mg at L2/L3) for LSAgroup, and (hyperbaric bupivacaine 7.5 mg, and fentanyl 25 mg at T10/T11) for TSAgroup. Propofol, fentanyl, atracurium, sevoflurane, and tracheal intubation were used for GA group. Intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction were compared between the three groups. Results: All procedures were completed laparoscopically by the allocated method of anesthesia with no anesthetic conversions. The time for the blockade to reach T3 level, intraoperative hypotensive and bradycardic events and vasopressor use were significantly lower in (TSA group) than in (LSA group). Postoperative pain scores as assessed throughout any time, postoperative right shoulder pain and hospital stay was lower for both (TSA group) and (LSA group) compared with (GA group). The higher degree of patients satisfaction scores were recorded in patients under segmental TSA. Conclusion: The present study not only confirmed that both segmental TSA and conventional lumber spinal anesthesia (LSA) are safe and good alternatives to general anesthesia (GA) in healthy patients undergoing laparoscopic cholecystectomy but also showed better postoperative pain control of both spinal techniques when compared with general anesthesia. Segmental TSA provides better hemodynamic stability, lesser vasopressor use and early ambulation and discharge with higher degree of patient satisfaction making it excellent for day case surgery compared with conventional lumbar spinal anesthesia. PMID:25885611

Lumbar Muscle Cross-Sectional Areas Do Not Predict Clinical Outcomes in Adults With Spinal Stenosis: A Longitudinal Study.

PubMed

Gellhorn, Alfred C; Suri, Pradeep; Rundell, Sean D; Olafsen, Nathan; Carlson, M Jake; Johnson, Steve; Fry, Adrielle; Annaswamy, Thiru M; Gilligan, Christopher; Comstock, Bryan; Heagerty, Patrick; Friedly, Janna; Jarvik, Jeffrey G

2017-06-01

Minimal longitudinal data exist regarding the role of lumbar musculature in predicting back pain and function. In cross-sectional study designs, there is often atrophy of the segmental multifidus muscle in subjects with low back pain compared with matched controls. However, the cross-sectional design of these studies prevents drawing conclusions regarding whether lumbar muscle characteristics predict or modify future back pain or function. The primary objective of this study is to determine whether the cross-sectional area (CSA) of lumbar muscles predict functional status or back pain at 6- or 12-month follow-up in older adults with spinal degeneration. The secondary objective is to evaluate whether these muscle characteristics improve outcome prediction above and beyond the prognostic information conferred by demographic and psychosocial variables. Secondary analysis of a randomized controlled trial. A total of 209 adults aged 50 years and older with clinical and radiographic spinal stenosis from the Lumbar Epidural steroid injection for Spinal Stenosis (LESS) trial. Using baseline magnetic resonance images, we calculated CSAs of the lumbar multifidus, psoas, and quadratus lumborum muscles using a standardized protocol by manually tracing the borders of each of the muscles. The relationship between lumbar muscle CSAs and baseline measures was assessed with Pearson or Spearman correlation coefficients. The relationship between lumbar muscle characteristics and 6- and 12-month Roland Morris Disability Questionnaire (RDQ) and back pain Numeric Rating Scale (NRS) responses was further evaluated with multivariate linear regression. A hierarchical approach to the regression was performed: a basic model with factors of conceptual importance including age, gender, BMI, and baseline RDQ score formed the first step. The second and third steps evaluated whether psychosocial variables or muscle measures conferred additional prognostic information to the basic model. Function as measured by the RDQ and back pain as measured by the NRS at 6- and 12-month follow-up. Lumbar muscle CSA was not a significant predictor of 6- or 12-month RDQ or pain score in multivariate analyses. Cross-sectional areas of lumbar muscles do not predict function or pain at medium- and long-term follow-up in adults with lumbar spinal stenosis. III. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2016-06-01

Observational study. To correlate lumbar lordosis and lumbar core strength in information technology (IT) professionals. IT professionals have to work for long hours in a sitting position, which can affect lumbar lordosis and lumbar core strength. 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. 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). 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.

Ureter Injury as a Complication of Oblique Lumbar Interbody Fusion.

PubMed

Lee, Hyeong-Jin; Kim, Jin-Sung; Ryu, Kyeong-Sik; Park, Choon Keun

2017-06-01

Oblique lumbar interbody fusion is a commonly used surgical method of achieving lumbar interbody fusion. There have been some reports about complications of oblique lumbar interbody fusion at the L2-L3 level. However, to our knowledge, there have been no reports about ureter injury during oblique lumbar interbody fusion. We report a case of ureter injury during oblique lumbar interbody fusion to share our experience. A 78-year-old male patient presented with a history of lower back pain and neurogenic intermittent claudication. He was diagnosed with spinal stenosis at L2-L3, L4-L5 level and spondylolisthesis at L4-L5 level. Symptoms were not improved after several months of medical treatments. Then, oblique lumbar interbody fusion was performed at L2-L3, L4-L5 level. During the surgery, anesthesiologist noticed hematuria. A retrourethrogram was performed immediately by urologist, and ureter injury was found. Ureteroureterostomy and double-J catheter insertion were performed. The patient was discharged 2 weeks after surgery without urologic or neurologic complications. At 2 months after surgery, an intravenous pyelogram was performed, which showed an intact ureter. Our study shows that a low threshold of suspicion of ureter injury and careful manipulation of retroperitoneal fat can be helpful to prevent ureter injury during oblique lumbar interbody fusion at the upper level. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of spinal internal loads and lumbar curvature under holding static load at different trunk and knee positions.

PubMed

Kahrizi, Sedighe; Parnianpour, Mohammad; Firoozabadi, Seyyed Mohammad; Kasemnejad, Anoshirvan; Karimi, Elham

2007-04-01

A study was performed to investigate how different trunk and knee positions while holding static loads affect the lumbar curvature and internal loads on the lumbar spine at L4-L5. Ten healthy male subjects participated in this study. Two inclinometers were used to evaluate the curvature of lumbar spine, lordosis, while a 3D static biomechanical model was used to predict the spinal compression and shear forces at L4-L5. Eighteen static tasks while holding three level of load (0, 10 and 20 kg), two levels of knee position (45 and 180 degrees of flexion) and three levels of trunk position (neutral, 15 and 30 degree of flexion) were simulated for 10 healthy male subjects. The results of this study revealed that the lordosis of lumbar spine changed to kyphosis with increasing weight of load from 0 to 20 kg in trunk flexion position (p<0.05), but in squatting position (45 degrees knee full flexion) the higher load did not affect the curvature. The results of this study suggested, at a more flexed trunk and standing position with higher loads both external moment and internal loads increased significantly at L4-L5 level but with 45 knee flexion external moment and compression force increased and shear force decreased significantly (p < 0.05). Subjects made more effort to maintain stability of the body in squat position. The highest external moment and compression force were computed at flexed knee and trunk position with highest loads. Hence holding weight in this position must be avoided by implementing ergonomic change to the workplace.

The beneficial effects of treadmill step training on activity-dependent synaptic and cellular plasticity markers after complete spinal cord injury.

PubMed

Ilha, Jocemar; Centenaro, Lígia A; Broetto Cunha, Núbia; de Souza, Daniela F; Jaeger, Mariane; do Nascimento, Patrícia S; Kolling, Janaína; Ben, Juliana; Marcuzzo, Simone; Wyse, Angela T S; Gottfried, Carmem; Achaval, Matilde

2011-06-01

Several studies have shown that treadmill training improves neurological outcomes and promotes plasticity in lumbar spinal cord of spinal animals. The morphological and biochemical mechanisms underlying these phenomena remain unclear. The purpose of this study was to provide evidence of activity-dependent plasticity in spinal cord segment (L5) below a complete spinal cord transection (SCT) at T8-9 in rats in which the lower spinal cord segments have been fully separated from supraspinal control and that subsequently underwent treadmill step training. Five days after SCT, spinal animals started a step-training program on a treadmill with partial body weight support and manual step help. Hindlimb movements were evaluated over time and scored on the basis of the open-field BBB scale and were significantly improved at post-injury weeks 8 and 10 in trained spinal animals. Treadmill training also showed normalization of withdrawal reflex in trained spinal animals, which was significantly different from the untrained animals at post-injury weeks 8 and 10. Additionally, compared to controls, spinal rats had alpha motoneuronal soma size atrophy and reduced synaptophysin protein expression and Na(+), K(+)-ATPase activity in lumbar spinal cord. Step-trained rats had motoneuronal soma size, synaptophysin expression and Na(+), K(+)-ATPase activity similar to control animals. These findings suggest that treadmill step training can promote activity-dependent neural plasticity in lumbar spinal cord, which may lead to neurological improvements without supraspinal descending control after complete spinal cord injury.

Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

PubMed Central

Lee, Su-Keon; Song, Kyung-Sub; Park, Byung-Moon; Lim, Sang-Youn; Jang, Geun; Lee, Beom-Seok; Moon, Seong-Hwan; Lee, Hwan-Mo

2016-01-01

Background To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondylolisthesis on lumbar lordosis after an intraoperative prone position. Methods Sixty-seven patients, who underwent spinal fusion at the Department of Orthopaedic Surgery of Gwangmyeong Sungae Hospital between May 2007 and February 2012, were included in this study. The study compared lumbar lordosis on preoperative upright, intraoperative prone and postoperative upright lateral X-rays between the simple stenosis (SS) group and spondylolisthesis group. The average age of patients was 67.86 years old. The average preoperative lordosis was 43.5° (± 14.9°), average intraoperative lordosis was 48.8° (± 13.2°), average postoperative lordosis was 46.5° (± 16.1°) and the average change on the frame was 5.3° (± 10.6°). Results Among all patients, 24 patients were diagnosed with simple spinal stenosis, 43 patients with spondylolisthesis (29 degenerative spondylolisthesis and 14 isthmic spondylolisthesis). Between the SS group and spondylolisthesis group, preoperative lordosis, intraoperative lordosis and postoperative lordosis were significantly larger in the spondylolisthesis group. The ratio of patients with increased lordosis on the OSI frame compared to preoperative lordosis was significantly higher in the spondylolisthesis group. The risk of increased lordosis on frame was significantly higher in the spondylolisthesis group (odds ratio, 3.325; 95% confidence interval, 1.101 to 10.039; p = 0.033). Conclusions Intraoperative lumbar lordosis on the OSI frame with a prone position was larger in the SS patients than the spondylolisthesis patients, which also produced a larger postoperative lordosis angle after posterior spinal fusion surgery. An increase in lumbar lordosis on the OSI frame should be considered during posterior spinal fusion surgery, especially in spondylolisthesis patients. PMID:26929801

Lumbar foraminal stenosis, the hidden stenosis including at L5/S1.

PubMed

Orita, Sumihisa; Inage, Kazuhide; Eguchi, Yawara; Kubota, Go; Aoki, Yasuchika; Nakamura, Junichi; Matsuura, Yusuke; Furuya, Takeo; Koda, Masao; Ohtori, Seiji

2016-10-01

In patients with lower back and leg pain, lumbar foraminal stenosis (LFS) is one of the most important pathologies, especially for predominant radicular symptoms. LFS pathology can develop as a result of progressing spinal degeneration and is characterized by exacerbation with foraminal narrowing caused by lumbar extension (Kemp's sign). However, there is a lack of critical clinical findings for LFS pathology. Therefore, patients with robust and persistent leg pain, which is exacerbated by lumbar extension, should be suspected of LFS. Radiological diagnosis is performed using multiple radiological modalities, such as magnetic resonance imaging, including plain examination and novel protocols such as diffusion tensor imaging, as well as dynamic X-ray, and computed tomography. Electrophysiological testing can also aid diagnosis. Treatment options include both conservative and surgical approaches. Conservative treatment includes medication, rehabilitation, and spinal nerve block. Surgery should be considered when the pathology is refractory to conservative treatment and requires direct decompression of the exiting nerve root, including the dorsal root ganglia. In cases with decreased intervertebral height and/or instability, fusion surgery should also be considered. Recent advancements in minimally invasive lumbar lateral interbody fusion procedures enable effective and less invasive foraminal enlargement compared with traditional fusion surgeries such as transforaminal lumbar interbody fusion. The lumbosacral junction can cause L5 radiculopathy with greater incidence than other lumbar levels as a result of anatomical and epidemiological factors, which should be better addressed when treating clinical lower back pain.

Biomechanical consequences of running with deep core muscle weakness.

PubMed

Raabe, Margaret E; Chaudhari, Ajit M W

2018-01-23

The deep core muscles are often neglected or improperly trained in athletes. Improper function of this musculature may lead to abnormal spinal loading, muscle strain, or injury to spinal structures, all of which have been associated with increased low back pain (LBP) risk. The purpose of this study was to identify potential strategies used to compensate for weakness of the deep core musculature during running and to identify accompanying changes in compressive and shear spinal loads. Kinematically-driven simulations of overground running were created for eight healthy young adults in OpenSim at increasing levels of deep core muscle weakness. The deep core muscles (multifidus, quadratus lumborum, psoas, and deep fascicles of the erector spinae) were weakened individually and together. The superficial longissimus thoracis was a significant compensator for 4 out of 5 weakness conditions (p < 0.05). The deep erector spinae required the largest compensations when weakened individually (up to a 45 ± 10% increase in compensating muscle force production, p = 0.004), revealing it may contribute most to controlling running kinematics. With complete deep core muscle weakness, peak anterior shear loading increased on all lumbar vertebrae (up to 19%, p = 0.001). Additionally, compressive spinal loading increased on the upper lumbar vertebrae (up to 15%, p = 0.007) and decreased on the lower lumbar vertebrae (up to 8%, p = 0.008). Muscular compensations may increase risk of muscular fatigue or injury and increased spinal loading over numerous gait cycles may result in damage to spinal structures. Therefore, insufficient strength of the deep core musculature may increase a runner's risk of developing LBP. Copyright © 2017 Elsevier Ltd. All rights reserved.

Spinal deformity in patients with Sotos syndrome (cerebral gigantism).

PubMed

Tsirikos, Athanasios I; Demosthenous, Nestor; McMaster, Michael J

2009-04-01

Retrospective review of a case series. To present the clinical characteristics and progression of spinal deformity in patients with Sotos syndrome. There is limited information on the development of spinal deformity and the need for treatment in this condition. The medical records and spinal radiographs of 5 consecutive patients were reviewed. All patients were followed to skeletal maturity (mean follow-up: 6.6 y). The mean age at diagnosis of spinal deformity was 11.9 years (range: 5.8 to 14.5) with 4 patients presenting in adolescence. The type of deformity was not uniform. Two patients presented in adolescence with relatively small and nonprogressive thoracolumbar and lumbar scoliosis, which required observation but no treatment until the end of spinal growth. Three patients underwent spinal deformity correction at a mean age of 11.7 years (range: 6 to 15.4). The first patient developed a double structural thoracic and lumbar scoliosis and underwent a posterior spinal arthrodesis extending from T3 to L4. Five years later, she developed marked degenerative changes at the L4/L5 level causing symptomatic bilateral lateral recess stenosis and affecting the L5 nerve roots. She underwent spinal decompression at L4/L5 and L5/S1 levels followed by extension of the fusion to the sacrum. The second patient developed a severe thoracic kyphosis and underwent a posterior spinal arthrodesis. The remaining patient presented at the age of 5.9 years with a severe thoracic kyphoscoliosis and underwent a 2-stage antero-posterior spinal arthrodesis. The development of spinal deformity is a common finding in children with Sotos syndrome and in our series it occurred in adolescence in 4 out of 5 patients. There is significant variability on the pattern of spine deformity, ranging from a scoliosis through kyphoscoliosis to a pure kyphosis, and also the age at presentation and need for treatment.

Congenital lumbar spinal stenosis: a prospective, control-matched, cohort radiographic analysis.

PubMed

Singh, Kern; Samartzis, Dino; Vaccaro, Alexander R; Nassr, Ahmad; Andersson, Gunnar B; Yoon, S Tim; Phillips, Frank M; Goldberg, Edward J; An, Howard S

2005-01-01

Degenerative lumbar spinal stenosis manifests primarily after the sixth decade of life as a result of facet hypertrophy and degenerative disc disease. Congenital stenosis, on the other hand, presents earlier in age with similar clinical findings but with multilevel involvement and fewer degenerative changes. These patients may have subtle anatomic variations of the lumbar spine that may increase the likelihood of thecal sac compression. However, to the authors' knowledge, no quantitative studies have addressed various radiographic parameters of symptomatic, congenitally stenotic individuals to normal subjects. To radiographically quantify and compare the anatomy of the lumbar spine in symptomatic, congenitally stenotic individuals to age- and sex-matched, asymptomatic, nonstenotic controlled individuals. A prospective, control-matched, cohort radiographic analysis. Axial and sagittal magnetic resonance imaging (MRI) and lateral, lumbar, plain radiographs of 20 surgically treated patients who were given a clinical diagnosis of congenital lumbar stenosis by the senior author were randomized with images of 20, asymptomatic age- and sex-matched subjects. MRIs and lateral, lumbar, plain radiographs were independently quantitatively assessed by two individuals. Measurements obtained from the axial MRIs included: midline anterior-posterior (AP) vertebral body diameter, vertebral body width, midline AP canal diameter, canal width, spinal canal cross-sectional area, pedicle length, and pedicle width. From the sagittal MRIs, the following measurements were calculated: AP vertebral body diameter, vertebral body height, and AP canal diameter at the mid-vertebral level. On the lateral, lumbar, plain radiograph (L3 level), the AP diameters of the vertebral body spinal canal were measured. The images of these 40 individuals were then randomized and distributed in a blinded fashion to five separate spine surgeons who graded the presence and severity of congenital stenosis utilizing a five-tier scale. Images consisting of 15 symptomatic individuals, graded definitely congenitally stenotic (mean age, 51.7 years; range, 43-65 years), and 15 asymptomatic individuals, graded definitely not stenotic (mean age, 50.7 years; range, 41-55 years), were age- and sex-matched and included for further review. From these 30 patients, a lateral, lumbar, plain radiograph and axial and sagittal MRIs (T1/T2 weighted) from L2-L5 were quantitatively analyzed. Rater reliability was assessed by Kappa coefficient testing. The cross-sectional area of the canal was significantly smaller in the congenitally stenotic patients at all lumbar levels measured (L2: 176 mm(2) vs. 259 mm(2), L3: 177 mm(2) vs. 275 mm(2), L4: 183 mm(2) vs. 283 mm(2), L5: 213 mm(2) vs. 323 mm(2), p<.05). Pedicle length was markedly shorter in the stenosis group at each lumbar level (L2: 5.9 mm vs. 8.9 mm, L3: 6.0 mm vs. 8.8 mm, L4: 6.5 mm vs. 9.2 mm, L5: 5.8 mm vs. 9.1 mm, p<.05). Furthermore, midline, axial AP canal diameter, vertebral body width, and sagittal AP canal diameter were all significantly smaller than the control patients (p<.05). A ratio of the AP diameter of the pedicle length to the vertebral body was also noted to be statistically significant on both the lateral plain radiographs (L3: 0.426 vs. 0.704) and sagittal MRI (L2: 0.343 vs. 0.461, L3: 0.361 vs. 0.461, L4: 0.362 vs. 0.481, L5: 0.354 vs. 0.452, p<.05). No difference was noted comparing the AP diameter of the vertebral body (axial and sagittal images), vertebral body height, canal width, and pedicle width. Kappa testing coefficient indicated a strong rater reliability (k=0.81, 95% confidence interval: 0.62-0.94). Congenital lumbar stenosis has not been clearly defined radiographically. Clinically, congenitally stenotic patients present at a younger age with fewer degenerative changes and multiple levels of involvement. Radiographically, these patients have a shorter pedicular length and as a result a smaller cross-sectional spinal canal area (mean critical values of 6.5 mm and 213 mm(2) were observed, respectively). The mean critical ratios were 0.43 (2:1 AP vertebral body: pedicle length) on the lateral lumbar radiograph and 0.36 on the sagittal MRI. The altered canal anatomy resulting from a decreased pedicle length may anatomically predispose these patients to earlier complaints of symptomatic neurogenic claudication. Identification of the presence of congenital stenosis should increase the treating surgeon's awareness of the potential need for multilevel treatment.

[Recalibration via a postero-lateral approach in recent traumatic stenosis of the dorsal and lumbar spine. Modalities and results apropos of 31 cases].

PubMed

Richaud, J; Bousquet, P; Ealet, G; Clamens, J; Beltchika, K; Lazorthes, Y

1990-01-01

The authors present 31 cases of spinal trauma affecting thoraco lumbar level with severe spinal canal stenosis secondary to compressive trauma of the anterior disco-corpereal region. Associated neurological disorders were of varying severity. 23 cases were investigated by computed tomography. In all cases, the surgical procedure involved rectification of spinal deformities, with initially a unilateral postero-lateral approach permitting anterior spinal canal recalibration, either by impaction of protrusive fragments or ablation of free disc fragments. The stabilization was usually achieved by complementary bilateral plates using Roy-Camille or Privat material in 22 cases, associated with postero-lateral arthrodesis by grafting with reconstruction of the articulo-pedicular structure in 19 cases. Emergency operation was done in 14 cases; in 5 cases operation was done on the 2nd or 3rd day and in 11 cases after the 3rd day. The functional spinal result was excellent, and recalibration was verified by tomography in all cases. In those cases showing neurological deficiency, good and early recovery was attributable to the suppression of spinal canal stenosis, and a consequently neurological improvement was always obtained, even for the most serious of lesions except those at the thoracis level superior to T10. The application of this postero-lateral approach for severe spinal trauma seems to represent, in all cases of recent lesions, an alternative to the anterior or combined methods. We do not share the opinion that delay in decompression does not influence the neurological prognosis and emergency operation is advisable.

Lumbar spine disc heights and curvature: upright posture vs. supine compression harness

NASA Technical Reports Server (NTRS)

Lee, Shi-Uk; Hargens, Alan R.; Fredericson, Michael; Lang, Philipp K.

2003-01-01

INTRODUCTION: Spinal lengthening in microgravity is thought to cause back pain in astronauts. A spinal compression harness can compress the spine to eliminate lengthening but the loading condition with harness is different than physiologic conditions. Our purpose was to compare the effect of spine compression with a harness in supine position on disk height and spinal curvature in the lumbar spine to that of upright position as measured using a vertically open magnetic resonance imaging system. METHODS: Fifteen healthy subjects volunteered. On day 1, each subject lay supine for an hour and a baseline scan of the lumbar spine was performed. After applying a load of fifty percent of body weight with the harness for thirty minutes, the lumbar spine was scanned again. On day 2, after a baseline scan, a follow up scan was performed after kneeling for thirty minutes within the gap between two vertically oriented magnetic coils. Anterior and posterior disk heights, posterior disk bulging, and spinal curvature were measured from the baseline and follow up scans. RESULTS: Anterior disk heights increased and posterior disk heights decreased compared with baseline scans both after spinal compression with harness and upright posture. The spinal curvature increased by both loading conditions of the spine. DISCUSSION: The spinal compression with specially designed harness has the same effect as the physiologic loading of the spine in the kneeling upright position. The harness shows some promise as a tool to increase the diagnostic capabilities of a conventional MR system.

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

PubMed

Elster, A D

1989-12-01

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

AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion

PubMed Central

Rapp, Steven M; Miller, Larry E; Block, Jon E

2011-01-01

Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF) system is a minimally invasive fusion device that accesses the lumbar (L4–S1) intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date. PMID:22915939

AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion.

PubMed

Rapp, Steven M; Miller, Larry E; Block, Jon E

2011-01-01

Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF) system is a minimally invasive fusion device that accesses the lumbar (L4-S1) intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date.

Age-related loss of lumbar spinal lordosis and mobility--a study of 323 asymptomatic volunteers.

PubMed

Dreischarf, Marcel; Albiol, Laia; Rohlmann, Antonius; Pries, Esther; Bashkuev, Maxim; Zander, Thomas; Duda, Georg; Druschel, Claudia; Strube, Patrick; Putzier, Michael; Schmidt, Hendrik

2014-01-01

The understanding of the individual shape and mobility of the lumbar spine are key factors for the prevention and treatment of low back pain. The influence of age and sex on the total lumbar lordosis and the range of motion as well as on different lumbar sub-regions (lower, middle and upper lordosis) in asymptomatic subjects still merits discussion, since it is essential for patient-specific treatment and evidence-based distinction between painful degenerative pathologies and asymptomatic aging. A novel non-invasive measuring system was used to assess the total and local lumbar shape and its mobility of 323 asymptomatic volunteers (age: 20-75 yrs; BMI <26.0 kg/m2; males/females: 139/184). The lumbar lordosis for standing and the range of motion for maximal upper body flexion (RoF) and extension (RoE) were determined. The total lordosis was significantly reduced by approximately 20%, the RoF by 12% and the RoE by 31% in the oldest (>50 yrs) compared to the youngest age cohort (20-29 yrs). Locally, these decreases mostly occurred in the middle part of the lordosis and less towards the lumbo-sacral and thoraco-lumbar transitions. The sex only affected the RoE. During aging, the lower lumbar spine retains its lordosis and mobility, whereas the middle part flattens and becomes less mobile. These findings lay the ground for a better understanding of the incidence of level- and age-dependent spinal disorders, and may have important implications for the clinical long-term success of different surgical interventions.

Posterior-only approach for lumbar vertebral column resection and expandable cage reconstruction for spinal metastases.

PubMed

Jandial, Rahul; Kelly, Brandon; Chen, Mike Yue

2013-07-01

The increasing incidence of spinal metastasis, a result of improved systemic therapies for cancer, has spurred a search for an alternative method for the surgical treatment of lumbar metastases. The authors report a single-stage posterior-only approach for resecting any pathological lumbar vertebral segment and reconstructing with a medium to large expandable cage while preserving all neurological structures. The authors conducted a retrospective consecutive case review of 11 patients (5 women, 6 men) with spinal metastases treated at 1 institution with single-stage posterior-only vertebral column resection and reconstruction with an expandable cage and pedicle screw fixation. For all patients, the indications for operative intervention were spinal cord compression, cauda equina compression, and/or spinal instability. Neurological status was classified according to the American Spinal Injury Association impairment scale, and functional outcomes were analyzed by using a visual analog scale for pain. For all patients, a circumferential vertebral column resection was achieved, and full decompression was performed with a posterior-only approach. Each cage was augmented by posterior pedicle screw fixation extending 2 levels above and below the resected level. No patient required a separate anterior procedure. Average estimated blood loss and duration of each surgery were 1618 ml (range 900-4000 ml) and 6.6 hours (range 4.5-9 hours), respectively. The mean follow-up time was 14 months (range 10-24 months). The median survival time after surgery was 17.7 months. Delayed hardware failure occurred for 1 patient. Preoperatively, 2 patients had intractable pain with intact lower-extremity strength and 8 patients had severe intractable pain, lower-extremity paresis, and were unable to walk; 4 of whom regained the ability to walk after surgery. Two patients who were paraplegic before decompression recovered substantial function but remained wheelchair bound, and 2 patients remained paraparetic after the surgery. No patients had lasting intraoperative neuromonitoring changes, and none died. Complications included 2 reoperations, 1 delayed hardware failure (cage subsidence that did not require revision), and 3 incidental durotomies (none of which required reoperation). No postoperative pneumonia, ileus, or deep venous thrombosis developed in any patient. A posterior-only approach for vertebral segment resection with preservation of spinal nerve roots is a viable technique that can be used throughout the entire lumbar spine. Extensive mobilization of the nerve roots is of utmost importance and allows for insertion and expansion of medium-sized, in situ expandable cages in the midline. This approach, although technically challenging, might reduce the morbidity associated with an anterior approach.

Speculum lumbar extraforaminal microdiscectomy.

PubMed

Obenchain, T G

2001-01-01

Public interest, monetary pressures and improving diagnostic techniques have placed an increasing emphasis on minimalism in lumbar disc excision. Current techniques include microlumbar discectomy and minimally invasive spinal surgery. Both are good techniques but may be painful, require a hospital stay and/or are not widely used because of difficulty acquiring the necessary skills. The author therefore developed a less invasive microscopic technique that may be performed on a consistent outpatient basis with easily acquired skills. The purpose of this study was to describe a variant of minimally invasive lumbar disc excision, while assessing the effects on a small group of patients. The treatment protocol was a prospective community hospital-based case study designed to evaluate a less invasive method of excising herniated lumbar discs residing in the canal, foraminal or far lateral space. This study is comprised of 50 patients with all anatomic forms of lumbar disc herniations, inside or outside the canal, at all levels except the lumbosacral joint. Clinical results were measured by return to work time, the criteria of MacNab and by Prolo et al.'s economic and functional criteria. Selection criteria included adult patients with intractable low back and leg pain, plus an imaging study revealing a lumbar disc herniation consistent with the patient's clinical presentation. Mean patient age was 48 years. The male:female ratio was approximately 2:1. All patients failed at least 3 weeks of conservative therapy. Herniations occurred from the L2-3 space through L4-5, with 30 herniations being within and 20 outside the spinal canal. Both contained and extruded/sequestered herniations were treated. Excluded from the study were patients with herniations inside the spinal canal at the L5-S1 level. Surgical approach was by microscopic speculum transforaminal route for discs residing both within and outside the lumbar canal. The initial 50 consecutive patients had successful technical operations performed on an outpatient basis by this less invasive technique. By the criteria of MacNab (Table 3), 84% (42 of 50) had an excellent or good result, returning to work at a mean time of 3.5 weeks. Per Prolo et al.'s economic scale, 72% were disabled at levels I and II before surgery. Postoperatively, 92% had improved to levels IV and V. Similarly, on his functional scale, 94% functioned at levels I and II before surgery, whereas 88% achieved levels IV and V after surgery. Eighty percent required no pain medications 1 week after surgery. The only complication was an L3 minor nerve root injury as it exited the L3-4 foramen. The author has described a minimally invasive technique for excising herniated discs that is applicable to all types of lumbar herniations, except for those residing in the canal at L5-S1. Clinical outcomes are comparable to those of other forms of discectomy.

One-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation in treating lumbosacral spinal tuberculosis.

PubMed

Pang, Xiaoyang; Wu, Ping; Shen, Xiongjie; Li, Dongzhe; Luo, Chenke; Wang, Xiyang

2013-08-01

Retrospective analysis of the clinical study efficacy and feasibility of one-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation in treating lumbosacral spinal tuberculosis. A total of 21 patients with lumbosacral tuberculosis (TB) collected from January 2004 to January 2010, underwent one-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation. In addition, the clinical efficacy was evaluated based on the data on the lumbo-sacral angle, neuro-logical status that was recorded by American Spinal Injury Association (ASIA) Impairment Scale, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which were collected at specific time points. All cases were followed up for 16-36 months (average 24.9 ± 6.44 months). 18 patients suffered from evident neurological deficits preoperatively, of which 16 patients returned to normal at the final follow-up. Two patients with neurological dysfunction aggravated postoperative, experienced significant partial neurological recovery. With an effective and standard anti-TB chemotherapy treated, the values of ESR and CRP returned to normal levels 3-month later postoperative and maintained till the final follow-up. Preoperative lumbosacral angle was 20.89 ± 2.32° and returned 29.62 ± 1.41° postoperative. During long-term follow-up, there was only 1-3° lumbosacral angle loss. There was a significant difference between preoperative and postoperative lumbosacral angles. With effective and standard anti-TB chemotherapy, one-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation for lumbosacral tuberculosis can effectively relieve pain symptoms, improve neurological function, and reconstruct the spinal stability.

Correction of Grade 2 Spondylolisthesis Following a Non-Surgical Structural Spinal Rehabilitation Protocol Using Lumbar Traction: A Case Study and Selective Review of Literature

PubMed Central

Fedorchuk, Curtis; Lightstone, Douglas F; McRae, Christi; Kaczor, Derek

2017-01-01

Objective Discuss the use of non-surgical spinal rehabilitation protocol in the case of a 69-year-old female with a grade 2 spondylolisthesis. A selective literature review and discussion are provided. Clinical Features A 69-year-old female presented with moderate low back pain (7/10 pain) and severe leg cramping (7/10 pain). Initial lateral lumbar x-ray revealed a grade 2 spondylolisthesis at L4-L5 measuring 13.3 mm. Interventions and Outcomes The patient completed 60 sessions of Mirror Image® spinal exercises, adjustments, and traction over 45 weeks. Post-treatment lateral lumbar x-ray showed a decrease in translation of L4-L5 from 13.3 mm to 2.4 mm, within normal limits. Conclusions This case provides the first documented evidence of a non-surgical or chiropractic treatment, specifically Chiropractic BioPhysics®, protocols of lumbar spondylolisthesis where spinal alignment was corrected. Additional research is needed to investigate the clinical implications and treatment methods. PMID:29299090

Traumatic subdural hematoma in the lumbar spine.

PubMed

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

2011-10-01

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

Modeling trans-spinal direct current stimulation for the modulation of the lumbar spinal motor pathways

NASA Astrophysics Data System (ADS)

Kuck, A.; Stegeman, D. F.; van Asseldonk, E. H. F.

2017-10-01

Objective. Trans-spinal direct current stimulation (tsDCS) is a potential new technique for the treatment of spinal cord injury (SCI). TsDCS aims to facilitate plastic changes in the neural pathways of the spinal cord with a positive effect on SCI recovery. To establish tsDCS as a possible treatment option for SCI, it is essential to gain a better understanding of its cause and effects. We seek to understand the acute effect of tsDCS, including the generated electric field (EF) and its polarization effect on the spinal circuits, to determine a cellular target. We further ask how these findings can be interpreted to explain published experimental results. Approach. We use a realistic full body finite element volume conductor model to calculate the EF of a 2.5 mA direct current for three different electrode configurations. We apply the calculated electric field to realistic motoneuron models to investigate static changes in membrane resting potential. The results are combined with existing knowledge about the theoretical effect on a neuronal level and implemented into an existing lumbar spinal network model to simulate the resulting changes on a network level. Main results. Across electrode configurations, the maximum EF inside the spinal cord ranged from 0.47 V m-1 to 0.82 V m-1. Axon terminal polarization was identified to be the dominant cellular target. Also, differences in electrode placement have a large influence on axon terminal polarization. Comparison between the simulated acute effects and the electrophysiological long-term changes observed in human tsDCS studies suggest an inverse relationship between the two. Significance. We provide methods and knowledge for better understanding the effects of tsDCS and serve as a basis for a more targeted and optimized application of tsDCS.

Spinal Anesthesia with Isobaric Tetracaine in Patients with Previous Lumbar Spinal Surgery

PubMed Central

Kim, Soo Hwan; Jeon, Dong-Hyuk; Chang, Chul Ho; Lee, Sung-Jin

2009-01-01

Purpose Previous lumbar spinal surgery (PLSS) is not currently considered as a contraindication for regional anesthesia. However, there are still problems that make spinal anesthesia more difficult with a possibility of worsening the patient's back pain. Spinal anesthesia using combined spinal-epidural anesthesia (CSEA) in elderly patients with or without PLSS was investigated and the anesthetic characteristics, success rates, and possible complications were evaluated. Materials and Methods Fifty patients without PLSS (Control group) and 45 patients with PLSS (PLSS group) who were scheduled for total knee arthroplasty were studied prospectively. A CSEA was performed with patients in the left lateral position, and 10 mg of 0.5% isobaric tetracaine was injected through a 27 G spinal needle. An epidural catheter was then inserted for patient controlled analgesia. Successful spinal anesthesia was defined as adequate sensory block level more than T12. The number of skin punctures and the onset time were recorded, and maximal sensory block level (MSBL), time to 2-segment regression, success rate and complications were observed. Results The success rate of CSEA in Control group and PLSS group was 98.0%, and 93.3%, respectively. The median MSBL in PLSS group was higher than Control group [T4 (T2-L1) vs. T6 (T3-T12)] (p < 0.001). There was a significant difference in the number of patients who required ephedrine for the treatment of hypotension in PLSS group (p = 0.028). Conclusion The success rate of CSEA in patients with PLSS was 93.3%, and patients experienced no significant neurological complications. The MSBL can be higher in PLSS group than Control group. PMID:19430559

Lumbar Disc Replacement for Junctional Decompensation After Fusion Surgery: Clinical and Radiological Outcome at an Average Follow-Up of 33 Months

PubMed Central

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

2007-01-01

Background Failed fusion surgery remains difficult to treat. Few published data on disc replacement surgery after failed fusion procedures exist. Our objective was to evaluate outcomes of junctional lumbar disc replacement after previous fusion surgery and to correlate outcome with radiological changes to parameters of sagittal balance. Methods Out of a single-center prospective registry of 290 patients with 404 lumbar disc replacements, 27 patients had had a previous lumbar fusion operation on 1 to 4 lumbar segments and had completed a mean follow- up of 33 months (range: 18–56). We correlated the clinical outcome measures (patient satisfaction, 10-point pain score, and Oswestry Disability Index [ODI] score) to parameters of spinal sagittal alignment (sacral tilt, pelvic tilt, pelvic incidence, and lumbar lordosis). Results Postoperative hospital stay averaged 3.3 days (range: 2–8). Previously-employed patients went back to their jobs with a mean of 32 days (range: 21–42) after the procedure. At the latest follow-up, 1 of the patients considered the outcome to be poor, 3 fair, 8 good, and 15 excellent. Twenty-four patients “would undergo the operation again.” Average pain score decreased from 9.1 ± 1.0 (SD) to 3.2 ± 2.1 (P < .01). Average ODI decreased from 50.2 ± 9.9 preoperatively to 21.7 ± 14.2 (P ≤ .01). We found the change in pelvic tilt to be an independent predictor of better clinical outcome by multivariate analysis (P < .05). Conclusions In patients with junctional failure adjacent to a previous posterolateral fusion, disc replacement at the junctional level(s), compared with osteotomy and fusion surgery, offers the advantage of maintaining segmental mobility and correcting the flat-back deformity through a single approach with less operative time and blood loss. Early- to intermediate-term results are promising. The influence of changes in spinal sagittal alignment on clinical outcome needs to be addressed in future research. Clinical Relevance This is the first study on “junctional disc replacement patients” correlating clinical outcome to changes in spinal/pelvic alignment. PMID:25802584

Intrathecal volume changes in lumbar spinal canal stenosis following extension and flexion: An experimental cadaver study.

PubMed

Teske, Wolfram; Schwert, Martin; Zirke, Sonja; von Schulze Pellengahr, Christoph; Wiese, Matthias; Lahner, Matthias

2015-01-01

The spinal canal stenosis is a common disease in elderly. The thecal sac narrowing is considered as the anatomical cause for the disease. There is evidence that the anatomical proportions of the lumbar spinal canal are influenced by postural changes. The liquor volume shift during these postural changes is a valuable parameter to estimate the dynamic qualities of this disease. The aim of this human cadaver study was the determination of intrathecal fluid volume changes during the lumbar flexion and the extension. A special measuring device was designed and built for the study to investigate this issue under controlled conditions. The measuring apparatus fixed the lumbar spine firmly and allowed only flexion and extension. The dural sac was closed water tight. The in vitro changes of the intrathecal volumes during the motion cycle were determined according to the principle of communicating vessels. Thirteen human cadaver spines from the Institute of Anatomy were examined in a test setting with a continuous adjustment of motion. The diagnosis of the lumbar spinal stenosis was confirmed by a positive computer tomography prior testing. The volume changes during flexion and extension cycles were measured stepwise in a 2 degree distance between 18° flexion and 18° extension. Three complete series of measurements were performed for each cadaver. Two specimens were excluded because of fluid leaks from further investigation. The flexion of the lumbar spine resulted in an intrathecal volume increase. The maximum volume effects were seen in the early flexion positions of 2° and 4°. The spine reclination resulted in a volume reduction. The maximum extension effect was seen between 14° and 16°. According to our results, remarkable volume effects were seen in the early movements of the lumbar spine especially for the flexion. The results support the concept of the spinal stenosis as a dynamic disease and allow a better understanding of the pathophysiology of this nosological entity. Under clinical aspects our data support the value of a body upright position under avoiding of extended spinal inclination and reclination.

Cost Effectiveness of OMT for Chronic Low Back Pain

ClinicalTrials.gov

2018-06-14

Lumbar Radiculopathy; Lesion of Sciatic Nerve, Left Lower Limb; Lesion of Sciatic Nerve, Right Lower Limb; Lumbar Spinal Stenosis; Lumbar Spondylosis; Lumbago With Sciatica, Left Side; Lumbago With Sciatica, Right Side

Migrating lumbar facet joint cysts.

PubMed

Palmieri, Francesco; Cassar-Pullicino, Victor N; Lalam, Radhesh K; Tins, Bernhard J; Tyrrell, Prudencia N M; McCall, Iain W

2006-04-01

The majority of lumbar facet joint cysts (LFJCs) are located in the spinal canal, on the medial aspect of the facet joint with characteristic diagnostic features. When they migrate away from the joint of origin, they cause diagnostic problems. In a 7-year period we examined by computed tomography (CT) and magnetic resonance (MR) imaging five unusual cases of facet joint cysts which migrated from the facet joint of origin. Three LFJCs were identified in the right S1 foramen, one in the right L5-S1 neural foramen and one in the left erector spinae and multifidus muscles between the levels of L2-L4 spinous process. Awareness that spinal lesions identified at MRI and CT could be due to migrating facet joint cyst requires a high level of suspicion. The identification of the appositional contact of the cyst and the facet joint needs to be actively sought in the presence of degenerative facet joints.

A systematic review to assess comparative effectiveness studies in epidural steroid injections for lumbar spinal stenosis and to estimate reimbursement amounts.

PubMed

Bresnahan, Brian W; Rundell, Sean D; Dagadakis, Marissa C; Sullivan, Sean D; Jarvik, Jeffrey G; Nguyen, Hiep; Friedly, Janna L

2013-08-01

To systematically appraise published comparative effectiveness evidence (clinical and economic) of epidural steroid injections (ESI) for lumbar spinal stenosis and to estimate Medicare reimbursement amounts for ESI procedures. TYPE: Systematic review. PubMed, Embase, and CINAHL were searched through August 2012 for key words that pertain to low back pain, spinal stenosis or sciatica, and epidural steroid injection. We used institutional and Medicare reimbursement amounts for our cost estimation. Articles published in English that assessed ESIs for adults with lumbar spinal stenosis versus a comparison intervention were included. Our search identified 146 unique articles, and 138 were excluded due to noncomparative study design, not having a study population with lumbar spinal stenosis, not having an appropriate outcome, or not being in English. We fully summarized 6 randomized controlled trials and 2 large observational studies. Randomized controlled trial articles were reviewed, and the study population, sample size, treatment groups, ESI dosage, ESI approaches, concomitant interventions, outcomes, and follow-up time were reported. Descriptive resource use estimates for ESIs were calculated with use of data from our institution during 2010 and Medicare-based reimbursement amounts. ESIs or anesthetic injections alone resulted in better short-term improvement in walking distance compared with control injections. However, there were no longer-term differences. No differences between ESIs versus anesthetic in self-reported improvement in pain were reported. Transforaminal approaches had better improvement in pain scores (≤4 months) compared with interlaminar injections. Two observational studies indicated increased rates of lumbar ESI in Medicare beneficiaries. Our sample included 279 patients who received at least 1 ESI during 2010, with an estimated mean total outpatient reimbursement for one ESI procedure "event" to be $637, based on 2010 Medicare reimbursement amounts ($505 technical and $132 professional payments). This systematic review of ESI for treating lumbar spinal stenosis found a limited amount of data that suggest that ESI is effective in some patients for improving select short-term outcomes, but results differed depending on study design, outcome measures used, and comparison groups evaluated. Overall, there are relatively few comparative clinical or economic studies for ESI procedures for lumbar spinal stenosis in adults, which indicated a need for additional evidence. Copyright © 2013. Published by Elsevier Inc.

Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis: A Cross-sectional Study.

PubMed

Théroux, Jean; Le May, Sylvie; Hebert, Jeffrey J; Labelle, Hubert

2017-08-01

A cross-sectional study. The aim of this study was to investigate spinal pain prevalence in adolescents with idiopathic scoliosis (AIS) and to explore associations between pain intensity and pain-related disability with scoliosis site, severity, and spinal bracing. The causal link between spinal pain and AIS remains unclear. Spinal asymmetry has been recognized as a back pain risk factor, which is a known cause of care-seeking in adolescents. Participants were recruited from an outpatient tertiary-care scoliosis clinic. Pain intensity and pain-related disability were measured by the Brief Pain Inventory questionnaire and the Roland-Morris Disability Questionnaire. Scoliosis severity estimation was performed using Cobb angles. Associations were explored using multiple linear regressions and reported with unstandardized beta coefficients (β) adjusted for age and sex. We recruited 500 patients (85% female) with mean (SD) age of 14.2 (1.8) years. Means (SD) of thoracic and lumbar Cobb angle were 24.54(9.77) and 24.13 (12.40), respectively. Spinal pain prevalence was 68% [95% confidence interval (95% CI): 64.5-72.4] with a mean intensity of 1.63 (SD, 1.89). Spinal pain intensity was positively associated with scoliosis severity in the main thoracic (P = 0.003) and lumbar (P = 0.001) regions. The mean (SD) disability score was 1.73 (2.98). Disability was positively associated with scoliosis severity in the proximal thoracic (P = 0.035), main thoracic (P = 0.000), and lumbar (P = 0.000) regions.Spinal bracing was associated with lower spinal pain intensity in the thoracic (P = 0.000) and lumbar regions (P = 0.009). Bracing was also related with lower disability for all spinal areas (P < 0.045). Spinal pain is common among patients with AIS, and greater spinal deformity was associated with higher pain intensity. These findings should inform clinical decision-making when caring for patients with AIS. 3.

A Multicenter Radiographic Evaluation of the Rates of Preoperative and Postoperative Malalignment in Degenerative Spinal Fusions.

PubMed

Leveque, Jean-Christophe A; Segebarth, Bradley; Schroerlucke, Samuel R; Khanna, Nitin; Pollina, John; Youssef, Jim A; Tohmeh, Antoine G; Uribe, Juan S

2018-07-01

Multicenter, retrospective, institutional-review-board -approved study at 18 institutions in the United States with 24 treating investigators. This study was designed to retrospectively assess the prevalence of spinopelvic malalignment in patients who underwent one- or two-level lumbar fusions for degenerative (nondeformity) indications and to assess the incidence of malalignment after fusion surgery as well as the rate of alignment preservation and/or correction in this population. Spinopelvic malalignment after lumbar fusion has been associated with lower postoperative health-related quality of life and elevated risk of adjacent segment failure. The prevalence of spinopelvic malalignment in short-segment degenerative lumbar fusion procedures from a large sample of patients is heretofore unreported and may lead to an under-appreciation of these factors in surgical planning and ultimate preservation or correction of alignment. Lateral preoperative and postoperative lumbar radiographs were retrospectively acquired from 578 one- or two-level lumbar fusion patients and newly measured for lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt. Patients were categorized at preop and postop time points as aligned if PI-LL < 10° or malaligned if PI-LL≥10°. Patients were grouped into categories based on their alignment progression from pre- to postoperative, with preserved (aligned to aligned), restored (malaligned to aligned), not corrected (malaligned to malaligned), and worsened (aligned to malaligned) designations. Preoperatively, 173 (30%) patients exhibited malalignment. Postoperatively, 161 (28%) of patients were malaligned. Alignment was preserved in 63%, restored in 9%, not corrected in 21%, and worsened in 7% of patients. This is the first multicenter study to evaluate the preoperative prevalence and postoperative incidence of spinopelvic malalignment in a large series of short-segment degenerative lumbar fusions, finding over 25% of patients out of alignment at both time points, suggesting that alignment preservation/restoration considerations should be incorporated into the decision-making of even degenerative lumbar spinal fusions. 3.

Spinal stenosis

MedlinePlus

... stenosis; LBP - stenosis Patient Instructions Spine surgery - discharge Images Sciatic nerve Spinal stenosis Spinal stenosis References Försth P, Ólafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J ...

Reliable and fast volumetry of the lumbar spinal cord using cord image analyser (Cordial).

PubMed

Tsagkas, Charidimos; Altermatt, Anna; Bonati, Ulrike; Pezold, Simon; Reinhard, Julia; Amann, Michael; Cattin, Philippe; Wuerfel, Jens; Fischer, Dirk; Parmar, Katrin; Fischmann, Arne

2018-04-30

To validate the precision and accuracy of the semi-automated cord image analyser (Cordial) for lumbar spinal cord (SC) volumetry in 3D T1w MRI data of healthy controls (HC). 40 3D T1w images of 10 HC (w/m: 6/4; age range: 18-41 years) were acquired at one 3T-scanner in two MRI sessions (time interval 14.9±6.1 days). Each subject was scanned twice per session, allowing determination of test-retest reliability both in back-to-back (intra-session) and scan-rescan images (inter-session). Cordial was applied for lumbar cord segmentation twice per image by two raters, allowing for assessment of intra- and inter-rater reliability, and compared to a manual gold standard. While manually segmented volumes were larger (mean: 2028±245 mm 3 vs. Cordial: 1636±300 mm 3 , p<0.001), accuracy assessments between manually and semi-automatically segmented images showed a mean Dice-coefficient of 0.88±0.05. Calculation of within-subject coefficients of variation (COV) demonstrated high intra-session (1.22-1.86%), inter-session (1.26-1.84%), as well as intra-rater (1.73-1.83%) reproducibility. No significant difference was shown between intra- and inter-session reproducibility or between intra-rater reliabilities. Although inter-rater reproducibility (COV: 2.87%) was slightly lower compared to all other reproducibility measures, between rater consistency was very strong (intraclass correlation coefficient: 0.974). While under-estimating the lumbar SCV, Cordial still provides excellent inter- and intra-session reproducibility showing high potential for application in longitudinal trials. • Lumbar spinal cord segmentation using the semi-automated cord image analyser (Cordial) is feasible. • Lumbar spinal cord is 40-mm cord segment 60 mm above conus medullaris. • Cordial provides excellent inter- and intra-session reproducibility in lumbar spinal cord region. • Cordial shows high potential for application in longitudinal trials.

Back pain in space and post-flight spine injury: Mechanisms and countermeasure development

NASA Astrophysics Data System (ADS)

Sayson, Jojo V.; Lotz, Jeffrey; Parazynski, Scott; Hargens, Alan R.

2013-05-01

During spaceflight many astronauts experience moderate to severe lumbar pain and deconditioning of paraspinal muscles. There is also a significant incidence of herniated nucleus pulposus (HNP) in astronauts post-flight being most prevalent in cervical discs. Relief of in-flight lumbar back pain is facilitated by assuming a knee-to-chest position. The pathogenesis of lumbar back pain during spaceflight is most likely discogenic and somatic referred (from the sinuvertebral nerves) due to supra-physiologic swelling of the lumbar intervertebral discs (IVDs) due to removal of gravitational compressive loads in microgravity. The knee-to-chest position may reduce lumbar back pain by redistributing stresses through compressive loading to the IVDs, possibly reducing disc volume by fluid outflow across IVD endplates. IVD stress redistribution may reduce Type IV mechanoreceptor nerve impulse propagation in the annulus fibrosus and vertebral endplate resulting in centrally mediated pain inhibition during spinal flexion. Countermeasures for lumbar back pain may include in-flight use of: (1) an axial compression harness to prevent excessive IVD expansion and spinal column elongation; (2) the use of an adjustable pulley exercise developed to prevent atrophy of spine muscle stabilisers; and (3) other exercises that provide Earth-like annular stress with low-load repetitive active spine rotation movements. The overall objective of these countermeasures is to promote IVD health and to prevent degenerative changes that may lead to HNPs post-flight. In response to "NASA's Critical Path Roadmap Risks and Questions" regarding disc injury and higher incidence of HNPs after space flight (Integrated Research Plan Gap-B4), future studies will incorporate pre- and post-flight imaging of International Space Station long-duration crew members to investigate mechanisms of lumbar back pain as well as degeneration and damage to spinal structures. Quantitative results on morphological, biochemical, metabolic, and kinematic spinal changes in the lumbar spine may aid further development of countermeasures to prevent lumbar back pain in microgravity and reduce the incidence of HNPs post-flight.

Altered spinal motion in low back pain associated with lumbar strain and spondylosis.

PubMed

Cheng, Joseph S; Carr, Christopher B; Wong, Cyrus; Sharma, Adrija; Mahfouz, Mohamed R; Komistek, Richard D

2013-04-01

Study Design We present a patient-specific computer model created to translate two-dimensional (2D) fluoroscopic motion data into three-dimensional (3D) in vivo biomechanical motion data. Objective The aim of this study is to determine the in vivo biomechanical differences in patients with and without acute low back pain. Current dynamic imaging of the lumbar spine consists of flexion-extension static radiographs, which lack sensitivity to out-of-plane motion and provide incomplete information on the overall spinal motion. Using a novel technique, in-plane and coupled out-of-plane rotational motions are quantified in the lumbar spine. Methods A total of 30 participants-10 healthy asymptomatic subjects, 10 patients with low back pain without spondylosis radiologically, and 10 patients with low back pain with radiological spondylosis-underwent dynamic fluoroscopy with a 3D-to-2D image registration technique to create a 3D, patient-specific bone model to analyze in vivo kinematics using the maximal absolute rotational magnitude and the path of rotation. Results Average overall in-plane rotations (L1-L5) in patients with low back pain were less than those asymptomatic, with the dominant loss of motion during extension. Those with low back pain also had significantly greater out-of-plane rotations, with 5.5 degrees (without spondylosis) and 7.1 degrees (with spondylosis) more out-of-plane rotational motion per level compared with asymptomatic subjects. Conclusions Subjects with low back pain exhibited greater out-of-plane intersegmental motion in their lumbar spine than healthy asymptomatic subjects. Conventional flexion-extension radiographs are inadequate for evaluating motion patterns of lumbar strain, and assessment of 3D in vivo spinal motion may elucidate the association of abnormal vertebral motions and clinically significant low back pain.

Validation of spinal motion with the spine reposition sense device

PubMed Central

Petersen, Cheryl M; Rundquist, Peter J

2009-01-01

Background A sagittal plane spine reposition sense device (SRSD) has been developed. Two questions were addressed with this study concerning the new SRSD: 1) whether spine movement was occurring with the methodology, and 2) where movement was taking place. Methods Sixty-five subjects performed seven trials of repositioning to a two-thirds full flexion position in sitting with X and Y displacement measurements taken at the T4 and L3 levels. The thoracolumbar angle between the T4 and the L3 level was computed and compared between the positions tested. A two (vertebral level of thoracic and lumbar) by seven (trials) mixed model repeated measures ANOVA indicated whether significant differences were present between the thoracic (T4) and lumbar (L3) angular measurements. Results Calculated thoracolumbar angles between T4 and L3 were significantly different for all positions tested indicating spinal movement was occurring with testing. No interactions were found between the seven trials and the two vertebral levels. No significant findings were found between the seven trials but significant differences were found between the two vertebral levels. Conclusion This study indicated spine motion was taking place with the SRSD methodology and movement was found specific to the lumbar spine. These findings support utilizing the SRSD to evaluate changes in spine reposition sense during future intervention studies dealing with low back pain. PMID:19386126

Blood patch rates after lumbar puncture with Whitacre versus Quincke 22- and 20-gauge spinal needles.

PubMed

Hatfield, Malcolm K; Handrich, Stephen J; Willis, Jeffrey A; Beres, Robert A; Zaleski, George X

2008-06-01

The objective of our study was to compare the incidence of blood patch as the best objective indicator of postdural puncture headache after elective fluoroscopic lumbar puncture with the use of a 22-gauge Whitacre (pencil point) needle versus standard 22- and 20-gauge Quincke (bevel-tip) needles and to determine the best level of puncture. The records of 724 consecutive patients who were referred to St. Mary's Medical Center department of radiology for fluoroscopic lumbar puncture from January 2003 through April 2007 were retrospectively reviewed. Emergency requests (191) were discarded along with those for patients with clinical signs of pseudotumor cerebri (21), normal pressure hydrocephalus (3), and failed attempts (4). The collective total was 505 elective lumbar punctures. The blood patch rate for the 22-gauge Whitacre needle was 4.2%. The result for the 22-gauge Quincke point needle was 15.1% whereas that for the 20-gauge Quincke point needle was 29.6%. In addition, the level of puncture showed a blood patch rate that increased as the level of lumbar puncture lowered. The highest level of lumbar puncture was L1-L2 with the lowest recorded level being L5-S1. The Whitacre needle is associated with a significantly lower incidence of blood patch rate after lumbar puncture. The highest level of puncture (L1-L2) also provides the lowest level of blood patch rate.

Insect GDNF:TTC fusion protein improves delivery of GDNF to mouse CNS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Jianhong; Chian, Ru-Ju; Ay, Ilknur

2009-12-18

With a view toward improving delivery of exogenous glial cell line-derived neurotrophic factor (GDNF) to CNS motor neurons in vivo, we evaluated the bioavailability and pharmacological activity of a recombinant GDNF:tetanus toxin C-fragment fusion protein in mouse CNS. Following intramuscular injection, GDNF:TTC but not recombinant GDNF (rGDNF) produced strong GDNF immunostaining within ventral horn cells of the spinal cord. Intrathecal infusion of GDNF:TTC resulted in tissue concentrations of GDNF in lumbar spinal cord that were at least 150-fold higher than those in mice treated with rGDNF. While levels of immunoreactive choline acetyltransferase and GFR{alpha}-1 in lumbar cord were not alteredmore » significantly by intrathecal infusion of rGNDF, GDNF:TTC, or TTC, only rGDNF and GDNF:TTC caused significant weight loss following intracerebroventricular infusion. These studies indicate that insect cell-derived GDNF:TTC retains its bi-functional activity in mammalian CNS in vivo and improves delivery of GDNF to spinal cord following intramuscular- or intrathecal administration.« less

Age-Related Loss of Lumbar Spinal Lordosis and Mobility – A Study of 323 Asymptomatic Volunteers

PubMed Central

Dreischarf, Marcel; Albiol, Laia; Rohlmann, Antonius; Pries, Esther; Bashkuev, Maxim; Zander, Thomas; Duda, Georg; Druschel, Claudia; Strube, Patrick; Putzier, Michael; Schmidt, Hendrik

2014-01-01

Background The understanding of the individual shape and mobility of the lumbar spine are key factors for the prevention and treatment of low back pain. The influence of age and sex on the total lumbar lordosis and the range of motion as well as on different lumbar sub-regions (lower, middle and upper lordosis) in asymptomatic subjects still merits discussion, since it is essential for patient-specific treatment and evidence-based distinction between painful degenerative pathologies and asymptomatic aging. Methods and Findings A novel non-invasive measuring system was used to assess the total and local lumbar shape and its mobility of 323 asymptomatic volunteers (age: 20–75 yrs; BMI <26.0 kg/m2; males/females: 139/184). The lumbar lordosis for standing and the range of motion for maximal upper body flexion (RoF) and extension (RoE) were determined. The total lordosis was significantly reduced by approximately 20%, the RoF by 12% and the RoE by 31% in the oldest (>50 yrs) compared to the youngest age cohort (20–29 yrs). Locally, these decreases mostly occurred in the middle part of the lordosis and less towards the lumbo-sacral and thoraco-lumbar transitions. The sex only affected the RoE. Conclusions During aging, the lower lumbar spine retains its lordosis and mobility, whereas the middle part flattens and becomes less mobile. These findings lay the ground for a better understanding of the incidence of level- and age-dependent spinal disorders, and may have important implications for the clinical long-term success of different surgical interventions. PMID:25549085

Cauda Equina Syndrome Due to Vigorous Back Massage With Spinal Manipulation in a Patient With Pre-Existing Lumbar Disc Herniation: A Case Report and Literature Review.

PubMed

Yang, Si-Dong; Chen, Qian; Ding, Wen-Yuan

2018-04-01

Cauda equina syndrome (CES) resulting from acute lumbar disc herniation due to spinal massage is extremely rare. We present a case of CES caused by the acute worsening of a lumbar disc herniation after a vigorous back massage that included spinal manipulation. After vigorous back massage with spinal manipulation performed by a massage therapist, a 38-yr-old male patient experienced CES with severe numbness in both lower limbs, inability to walk due to weakness of bilateral lower limbs, and incontinence of urine and feces. The magnetic resonance imaging and computer tomography scan results showed that the L4-5 disc herniated down into the spinal canal, extensively compressing the ventral dural sac. The patient was successfully treated with an emergency operation including laminectomy, spinal canal decompression, discectomy, interbody fusion, and pedicle screw fixation. The muscle power in both lower limbs of the patient recovered rapidly to support standing only 1 wk later. Moreover, he regained continence of urine and feces. In conclusion, this case brings us novel knowledge that spinal massage or manipulation may worsen pre-existing disc herniation causing CES, and a timely emergency surgery is necessary and effective for treatment of CES-related symptoms.

Lumbar Spine Paraspinal Muscle and Intervertebral Disc Height Changes in Astronauts After Long-Duration Spaceflight on the International Space Station.

PubMed

Chang, Douglas G; Healey, Robert M; Snyder, Alexander J; Sayson, Jojo V; Macias, Brandon R; Coughlin, Dezba G; Bailey, Jeannie F; Parazynski, Scott E; Lotz, Jeffrey C; Hargens, Alan R

2016-12-15

Prospective case series. Evaluate lumbar paraspinal muscle (PSM) cross-sectional area and intervertebral disc (IVD) height changes induced by a 6-month space mission on the International Space Station. The long-term objective of this project is to promote spine health and prevent spinal injury during space missions and here on Earth. National Aeronautics and Space Administration (NASA) crewmembers have a 4.3 times higher risk of herniated IVDs, compared with the general and military aviator populations. The highest risk occurs during the first year after a mission. Microgravity exposure during long-duration spaceflights results in approximately 5 cm lengthening of body height, spinal pain, and skeletal deconditioning. How the PSMs and IVDs respond during spaceflight is not well described. Six NASA crewmembers were imaged supine with a 3 Tesla magnetic resonance imaging. Imaging was conducted preflight, immediately postflight, and then 33 to 67 days after landing. Functional cross-sectional area (FCSA) measurements of the PSMs were performed at the L3-4 level. FCSA was measured by grayscale thresholding within the posterior lumbar extensors to isolate lean muscle on T2-weighted scans. IVD heights were measured at the anterior, middle, and posterior sections of all lumbar levels. Repeated measures analysis of variance was used to determine significance at P < 0.05, followed by post-hoc testing. Paraspinal lean muscle mass, as indicated by the FCSA, decreased from 86% of the total PSM cross-sectional area down to 72%, immediately after the mission. Recovery of 68% of the postflight loss occurred during the next 6 weeks, still leaving a significantly lower lean muscle fractional content compared with preflight values. In contrast, lumbar IVD heights were not appreciably different at any time point. The data reveal lumbar spine PSM atrophy after long-duration spaceflight. Some FCSA recovery was seen with 46 days postflight in a terrestrial environment, but it remained incomplete compared with preflight levels. 4.

Physiotherapy and lumbar facet joint injections as a combination treatment for chronic low back pain. A narrative review of lumbar facet joint injections, lumbar spinal mobilizations, soft tissue massage and lower back mobility exercises.

PubMed

Chambers, Hannah

2013-06-01

The aim of this study was to summarize the available evidence on lumbar facet joint injections and the physiotherapy treatments, land-based lower back mobility exercise, soft tissue massage and lumbar spinal mobilizations for chronic low back pain (CLBP). The plausibility of physiotherapy and lumbar facet joint injections as a combination treatment is discussed. Using a systematic process, an online electronic search was performed using key words utilizing all available databases and hand searching reference lists. Using a critical appraisal tool from the Critical Appraisal Skills Programme (CASP), the literature was screened to include primary research. The main aspects of the research were summarized. The evidence for lumbar facet joint injections suggests an overall short-term positive effect on CLBP. Land-based lower back mobility exercise and soft tissue massage appear to have a positive effect on CLBP in the short term and possibly in the longer term. There is insufficient evidence to draw conclusions for lumbar spinal mobilizations. The review indicates that lumbar facet joint injections create a short period when pain is reduced. Physiotherapy treatments including land-based lower back mobility exercise and soft tissue massage may be of benefit during this time to improve the longer-term outcomes of patients with CLBP. It is not possible to make generalizations or firm conclusions. The current review highlights the need for further research. A randomized controlled trial is recommended to assess the impact of physiotherapy in combination with lumbar facet joint injections on CLBP. Copyright © 2013 John Wiley & Sons, Ltd.

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

PubMed

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

2016-03-21

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

Automatic lumbar spine measurement in CT images

NASA Astrophysics Data System (ADS)

Mao, Yunxiang; Zheng, Dong; Liao, Shu; Peng, Zhigang; Yan, Ruyi; Liu, Junhua; Dong, Zhongxing; Gong, Liyan; Zhou, Xiang Sean; Zhan, Yiqiang; Fei, Jun

2017-03-01

Accurate lumbar spine measurement in CT images provides an essential way for quantitative spinal diseases analysis such as spondylolisthesis and scoliosis. In today's clinical workflow, the measurements are manually performed by radiologists and surgeons, which is time consuming and irreproducible. Therefore, automatic and accurate lumbar spine measurement algorithm becomes highly desirable. In this study, we propose a method to automatically calculate five different lumbar spine measurements in CT images. There are three main stages of the proposed method: First, a learning based spine labeling method, which integrates both the image appearance and spine geometry information, is used to detect lumbar and sacrum vertebrae in CT images. Then, a multiatlases based image segmentation method is used to segment each lumbar vertebra and the sacrum based on the detection result. Finally, measurements are derived from the segmentation result of each vertebra. Our method has been evaluated on 138 spinal CT scans to automatically calculate five widely used clinical spine measurements. Experimental results show that our method can achieve more than 90% success rates across all the measurements. Our method also significantly improves the measurement efficiency compared to manual measurements. Besides benefiting the routine clinical diagnosis of spinal diseases, our method also enables the large scale data analytics for scientific and clinical researches.

Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee.

PubMed

Obeid, Ibrahim; Hauger, Olivier; Aunoble, Stéphane; Bourghli, Anouar; Pellet, Nicolas; Vital, Jean-Marc

2011-09-01

It has become well recognised that sagittal balance of the spine is the result of an interaction between the spine and the pelvis. Knee flexion is considered to be the last compensatory mechanism in case of sagittal imbalance, but only few studies have insisted on the relationship between spino-pelvic parameters and lower extremity parameters. Correlation between the lack of lumbar lordosis and knee flexion has not yet been established. A retrospective study was carried out on 28 patients with major spinal deformities. The EOS system was used to measure spinal and pelvic parameters and the knee flexion angle; the lack of lumbar lordosis was calculated after prediction of lumbar lordosis with two different formulas. Correlation analysis between the different measured parameters was performed. Lumbar lordosis correlated with sacral slope (r = -0.71) and moderately with knee flexion angle (r = 0.42). Pelvic tilt correlated moderately with knee flexion angle (r = 0.55). Lack of lumbar lordosis correlated best with knee flexion angle (r = 0.72 and r = 0.63 using the two formulas, respectively). Knee flexion as a compensatory mechanism to sagittal imbalance was well correlated to the lack of lordosis and, depending on the importance of the former parameter, the best procedure to correct sagittal imbalance could be chosen.

The Lumbar Lordosis in Males and Females, Revisited.

PubMed

Hay, Ori; Dar, Gali; Abbas, Janan; Stein, Dan; May, Hila; Masharawi, Youssef; Peled, Nathan; Hershkovitz, Israel

2015-01-01

Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females. Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height. Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined). Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis). The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing.

Estimation of lumbar spinal loading and trunk muscle forces during asymmetric lifting tasks: application of whole-body musculoskeletal modelling in OpenSim.

PubMed

Kim, Hyun-Kyung; Zhang, Yanxin

2017-04-01

Large spinal compressive force combined with axial torsional shear force during asymmetric lifting tasks is highly associated with lower back injury (LBI). The aim of this study was to estimate lumbar spinal loading and muscle forces during symmetric lifting (SL) and asymmetric lifting (AL) tasks using a whole-body musculoskeletal modelling approach. Thirteen healthy males lifted loads of 7 and 12 kg under two lifting conditions (SL and AL). Kinematic data and ground reaction force data were collected and then processed by a whole-body musculoskeletal model. The results show AL produced a significantly higher peak lateral shear force as well as greater peak force of psoas major, quadratus lumborum, multifidus, iliocostalis lumborum pars lumborum, longissimus thoracis pars lumborum and external oblique than SL. The greater lateral shear forces combined with higher muscle force and asymmetrical muscle contractions may have the biomechanical mechanism responsible for the increased risk of LBI during AL. Practitioner Summary: Estimating lumbar spinal loading and muscle forces during free-dynamic asymmetric lifting tasks with a whole-body musculoskeletal modelling in OpenSim is the core value of this research. The results show that certain muscle groups are fundamentally responsible for asymmetric movement, thereby producing high lumbar spinal loading and muscle forces, which may increase risks of LBI during asymmetric lifting tasks.

Lumbar spinal fusion. Outcome in relation to surgical methods, choice of implant and postoperative rehabilitation.

PubMed

Christensen, Finn Bjarke

2004-10-01

Chronic low back pain (CLBP) has become one of the most common causes of disability in adults under 45 years of age and is consequently one of the most common reasons for early retirement in industrialised societies. Accordingly, CLBP represents an expensive drain on society's resources and is a very challenging area for which a consensus for rational therapy is yet to be established. The spinal fusion procedure was introduced as a treatment option for CLBP more than 70 years ago. However, few areas of spinal surgery have caused so much controversy as spinal fusion. The literature reveals divergent opinions about when fusion is indicated and how it should be performed. Furthermore, the significance of the role of postoperative rehabilitation following spinal fusion may be underestimated. There exists no consensus on the design of a program specific for rehabilitation. Ideally, for any given surgical procedure, it should be possible to identify not only possible complications relative to a surgical procedure, but also what symptoms may be expected, and what pain behaviour may be expected of a particular patient. The overall aims of the current studies were: 1) to introduce patient-based functional outcome evaluation into spinal fusion treatment; 2) to evaluate radiological assessment of different spinal fusion procedures; 3) to investigate the effect of titanium versus stainless steel pedicle screws on mechanical fixation and bone ingrowth in lumbar spinal fusion; 4) to analyse the clinical and radiological outcome of different lumbar spinal fusion techniques; 5) to evaluate complications and re-operation rates following different surgical procedures; and 6) to analyse the effect of different rehabilitation strategies for lumbar spinal fusion patients. The present thesis comprises 9 studies: 2 clinical retrospective studies, 1 clinical prospective case/reference study, 5 clinical randomised prospective studies and 1 animal study (Mini-pigs). In total, 594 patients were included in the investigation from 1979 to 1999. Each had prior to inclusion at least 2 years of CLBP and had therefore been subjected to most of the conservative treatment leg pain, due to localized isthmic spondylolisthesis grades I-II or primary or secondary degeneration. PATIENT-BASED FUNCTIONAL OUTCOME: Patients' self-reported parameters should include the impact of CLBP on daily activity, work and leisure time activities, anxiety/depression, social interests and intensity of back and leg pain. Between 1993 and 2003 approximately 1400 lumbar spinal fusion patients completed the Dallas Pain Questionnaire under prospective design studies. In 1996, the Low Back Pain Rating scale was added to the standard questionnaire packet distributed among spinal fusion patients. In our experience, these tools are valid instruments for clinical assessment of candidates for spinal fusion procedures. It is extremely difficult to interpret radiographs of both lumbar posterolateral fusion and anterior interbody fusion. Plain radiographs are clearly not the perfect media for analysis of spinal fusion, but until new and better diagnostic methods are available for clinical use, radiographs will remain the golden standard. Therefore, the development of a detailed reliable radiographic classification system is highly desirable. The classification used in the present thesis for the evaluation of posteroalteral spinal fusion, both with and without instrumentation, demonstrated good interobserver and intraobserver agreement. The classification showed acceptable reliability and may be one way to improve interstudy and intrastudy correlation of radiologic outcomes after posterolateral spinal fusion. Radiology-based evaluation of anterior lumbar interbody fusion is further complicated when cages are employed. The use of different cage designs and materials makes it almost impossible to establish a standard radiological classification system for anterior fusions. BONE-SCREW INTERFACE: Mechanical binding at the bone-screw interface was significantly greater for titanium pedicle screws than it was for stainless steel. This could be explained by the fact that the titanium screws had superior bone on-growth. There was no correlation between screw removal torques and pull-out strength. Clinically, the use of titanium and titanium-alloy pedicle screws may be preferable for osteoporotic patients and those with decreased osteogenesis. The present series of studies observed significant long-term functional improvement for approximately 70% of patients who had undergone lumbar spinal fusion procedure. Solid fusion as determined from radiographs ranged from 52% to 92% depending on the choice of surgical procedure. The choice of surgical procedure should relate to the diagnosis, as patients with isthmic spondylolisthesis (Grades I and II) are best served with posterolateral fusion without instrumentation, and patients with disc degeneration seem to gain most from instrumented posterolateral fusion or circumferential fusion. The number of perioperative complications increased with the use of pedicle screw systems to support posterolateral fusions and increased further with the use of circumferential fusions. There was no significant association between outcome result and perioperative complications. The risk of reoperation within 2 years after the spinal fusion procedure was, however, significantly lower for those who had received circumferential fusion in comparison to posterolateral fusion with instrumentation. Furthermore, the risk of non-union was found to be significantly lower for patients who had received circumferential fusion as compared to posterolateral fusion with and without instrumentation. The complications of sexual dysfunction and fusion at non-intended levels were found to be significant but without influence on the overall outcome. The patients in the Back-café group performed a succession of many daily tasks significantly better and moreover had less pain compared with both the Video and Training groups 2 years after lumbar spinal fusion. The Video group had significantly greater treatment demands outside the hospital system. This study demonstrates the importance of the inclusion of coping schemes and questions the role of intensive exercises in a rehabilitation program for spinal fusion patients.

Common neural structures activated by epidural and transcutaneous lumbar spinal cord stimulation: Elicitation of posterior root-muscle reflexes

PubMed Central

Freundl, Brigitta; Binder, Heinrich; Minassian, Karen

2018-01-01

Epidural electrical stimulation of the lumbar spinal cord is currently regaining momentum as a neuromodulation intervention in spinal cord injury (SCI) to modify dysregulated sensorimotor functions and augment residual motor capacity. There is ample evidence that it engages spinal circuits through the electrical stimulation of large-to-medium diameter afferent fibers within lumbar and upper sacral posterior roots. Recent pilot studies suggested that the surface electrode-based method of transcutaneous spinal cord stimulation (SCS) may produce similar neuromodulatory effects as caused by epidural SCS. Neurophysiological and computer modeling studies proposed that this noninvasive technique stimulates posterior-root fibers as well, likely activating similar input structures to the spinal cord as epidural stimulation. Here, we add a yet missing piece of evidence substantiating this assumption. We conducted in-depth analyses and direct comparisons of the electromyographic (EMG) characteristics of short-latency responses in multiple leg muscles to both stimulation techniques derived from ten individuals with SCI each. Post-activation depression of responses evoked by paired pulses applied either epidurally or transcutaneously confirmed the reflex nature of the responses. The muscle responses to both techniques had the same latencies, EMG peak-to-peak amplitudes, and waveforms, except for smaller responses with shorter onset latencies in the triceps surae muscle group and shorter offsets of the responses in the biceps femoris muscle during epidural stimulation. Responses obtained in three subjects tested with both methods at different time points had near-identical waveforms per muscle group as well as same onset latencies. The present results strongly corroborate the activation of common neural input structures to the lumbar spinal cord—predominantly primary afferent fibers within multiple posterior roots—by both techniques and add to unraveling the basic mechanisms underlying electrical SCS. PMID:29381748

Three-dimensional lumbar segment movement characteristics during paediatric cerebral palsy gait.

PubMed

Kiernan, D; Malone, A; O'Brien, T; Simms, C K

2017-03-01

Kinematic analysis of the trunk during cerebral palsy (CP) gait has been well described. In contrast, movement of the lumbar spine is generally ignored. This is most likely due to the complex nature of the spine. As an alternative to using complex sensor protocols, this study modelled the lumbar region as a single segment and investigated characteristic patterns of movement during CP gait. In addition, the impact of functional level of impairment and the relationship with lower lumbar spinal loading were examined. Fifty-two children with CP (26 GMFCS I and 26 GMFCS II) and 26 controls were recruited. A full barefoot 3-dimensional kinematic and kinetic analysis were conducted. Lumbar segment movement demonstrated increased forward flexion for CP children. This movement became more pronounced according to GMFCS level with GMFCS II children demonstrating increases of up to 8°. In addition, a moderate correlation was present between lumbar flexion/extension and L5/S1 sagittal moments (r=0.427 in the global frame and r=0.448 with respect to the pelvis, p<0.01). Children with CP demonstrated increased movement of the lumbar region compared to TD, with movement becoming more excessive as GMFCS level increased. Excessive forward flexion and loading at the lumbar spine were linked. However, the moderate correlation suggests other contributors to increased loading were present. In conclusion, this study is a first step at identifying how lumbar segment movement is altered during CP gait. Copyright © 2017 Elsevier B.V. All rights reserved.

The geometric curvature of the lumbar spine during restricted and unrestricted squats.

PubMed

Hebling Campos, Mário; Furtado Alaman, Laizi I; Seffrin-Neto, Aldo A; Vieira, Carlos A; Costa de Paula, Marcelo; Barbosa de Lira, Claudio A

2017-06-01

The main purpose of this study was to analyze the behavior of the geometric curvature of the lumbar spine during restricted and unrestricted squats, using a novel investigative method. The rationale for our hypothesis is that the lumbar curvature has different patterns at different spine levels depending on the squat technique used. Spine motion was collected via stereo-photogrammetric analysis in nineteen participants (11 males, 8 females). The reconstructed spine points at the upright neutral position and at the deepest position of the squat exercise were projected onto the sagittal plane of the trunk, a polynomial was fitted to the data, and were quantified the two-dimensional geometric curvature at lower, central and higher lumbar levels, besides the inclination of trunk and lumbosacral region, the overall geometric curvature and overall angle of the lumbar spine. The mean values for each variable were analysed with paired t-test (P<0.05). The lumbar presents a flexion from upright neutral posture to deepest point of the movement, but for the lower lumbar the flexion is less intense if the knees travel anteriorly past the toes. The trunk and the lumbosacral region lean forward in both squat techniques and these effects are also reduced in unrestricted squats. The data collected in the study are evidence that during barbell squats the lumbar curvature has different patterns at different spinal levels depending on the exercise technique. The lower lumbar spine appears to be less overloaded during unrestricted squats.

Using spinopelvic parameters to estimate residual lumbar lordosis assuming previous lumbosacral fusion-a study of normative values.

PubMed

Hey, Hwee Weng Dennis; Tan, Kimberly-Anne; Kantharajanna, Shashidhar Bangalore; Teo, Alex Quok An; Chan, Chloe Xiaoyun; Liu, Ka-Po Gabriel; Wong, Hee-Kit

2018-03-01

Pelvic incidence (PI)=pelvic tilt (PT)+sacral slope (SS) is an established trigonometric equation which can be expanded from studying the fixed pelvis with the spine to a fixed spinopelvic complex with the remnant spine, in scenarios of spinopelvic fusion or ankylosis. For a fixed spinopelvic complex, we propose the equation termed: lumbar incidence (LI)=lumbar tilt (LT)+lumbar slope (LS). This study aimed to establish reference values for LI, LT, and LS at each lumbar vertebral level, and to show how LI can be used to determine residual lumbar lordosis (rLL). This is a cross-sectional study of prospectively collected data, conducted at a single academic tertiary health-care center. The study included 53 healthy patients aged 19-35 with first episode mechanical low back pain for a period of <3 months. Patients with previous spinal intervention, those with known or suspected spinal pathologies, and those who were pregnant, were excluded. Radiological measurements of LI, LT, LS, and rLL. All patients had full-body lateral standing radiographs obtained via a slot scanner. Basic global and regional radiographic parameters, spinopelvic parameters, and the aforementioned new parameters were measured. LI was correlated with rLL at each level by plotting LI against rLL on scatter plots and drawing lines-of-best-fit through the datapoints. The mean value of L5I was 22.82°, L4I was 6.52°, L3I was -0.92°, L2I was -5.56°, and L1I was -5.95°. LI turns negative at L3, LS turns negative at the L3/L4 apex, and LT remains positive throughout the lumbar spine. We found that the relationship of LI with its corresponding rLL follows a parabolic trend. Thus, rLL can be determined from the linear equations of the tangents to the parabolic lumbar spine. We propose the LI-rLL method for determining rLL as the LI recalibrates via spinopelvic compensation post instrumentation, and thus the predicted rLL will be based on this new equilibrium, promoting restoration of harmonized lordosis. The rLL-to-LI ratio is a simplified, but less accurate, method of deriving rLL from LI. This study demonstrates the extended use of PI=PT+SS proposed as LI=LT+LS. These new spinopelvic reference values help us better understand the position of each vertebra relative to the hip. In situations when lumbar vertebrae are fused or ankylosed to the sacrum to form a single spinopelvic complex, LI can be used to determine rLL, to preserve spinal harmony within the limits of compensated body balance. Copyright © 2017 Elsevier Inc. All rights reserved.

Does the presence of the nerve root sedimentation sign on MRI correlate with the operative level in patients undergoing posterior lumbar decompression for lumbar stenosis?

PubMed

Fazal, Akil; Yoo, Andrew; Bendo, John A

2013-08-01

Recent research describes the use of a nerve root sedimentation sign to diagnose lumbar spinal stenosis (LSS). The lack of sedimentation of the nerve roots (positive sedimentation sign) to the dorsal part of the dural sac is the characteristic feature of this new radiological parameter. To demonstrate how the nerve root sedimentation sign compares with other more traditional radiological parameters in patients who have been operated for LSS. A retrospective chart and image review. Preoperative magnetic resonance images (MRIs) were reviewed from 71 consecutive operative patients who presented with LSS and received spinal decompression surgery from 2006 to 2010. Preoperative T2-weighted MRIs were reviewed for each patient. One hundred thirty-four vertebral levels from L1 to L5 were measured for: sedimentation sign, cross-sectional area (CSA) and anterior/posterior (A/P) diameter of the dural sac, thickness of the ligamentum flavum, and Fujiwara grade of facet hypertrophy. Radiological measurements were made using Surgimap 1.1.2.169 software (Nemaris, Inc., New York, NY, USA). Statistical analyses were performed using the SPSS 17.0 statistical software (SPSS Inc., Chicago, IL, USA). Significance was demonstrated using unpaired t tests and chi-squared tests. Study funding was departmental. There were no study-specific conflicts of interest-associated biases. A positive sedimentation sign was determined in 120 operated levels (89.5%), whereas 14 levels (10.5%) had no sign (negative sedimentation sign). The mean CSA and A/P diameter were 140.62 mm(2) (standard deviation [SD]=53) and 11.76 mm (SD=3), respectively, for the no-sign group; the mean CSA and A/P diameter were 81.87 mm(2) (SD=35) and 8.76 mm (SD=2.2), respectively, for the sedimentation sign group (p<.001). We found that 60% of levels with Fujiwara Grade A facet hypertrophy did not have a sedimentation sign, whereas 86.3% of levels with Grade B, 93.2% of levels with Grade C, and 100.0% of levels with Grade D did have a sedimentation sign (p<.001). The sedimentation sign is a new measurement tool that can enable physicians to objectively assess and quantify spinal stenosis. The sign is most often present in patients who have clinically significant lumbar stenosis and require surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

Abscess or tumour? Lumbar spinal abscess mimicking a filum terminale tumour

PubMed Central

Sajjad, Jahangir; Kaliaperumal, Chandrasekaran; O'Sullivan, Michael

2012-01-01

A 62-year-old woman presented with a 4-month history of central lower backache and a 2-week history of progressive bilateral leg weakness. She also complained of numbness on her left thigh and gluteal region, associated with urinary hesitancy and constipation. On examination, she had bilateral partial foot drop, absent knee and ankle reflexes and a negative Babinski's reflex and associated hyperaesthesia in L3 distribution bilaterally with decreased anal tone. Laboratory results revealed normal inflammatory markers. MRI scan demonstrated a large uniformly enhancing lesion in the filum terminale suggestive of a lumbar spinal tumour. An emergency spinal laminectomy from L3 to S2 was performed. Per operatively, the duramater was thickened and hyperaemic. The histopathology report suggested inflammation with no evidence of malignancy. Tissue specimen of cultured Staphylococcus aureus was sensitive to flucloxacillin. A final diagnosis of lumbar spinal abscess was made and subsequent antibiotic treatment led to good clinical recovery. PMID:22669871

Rehabilitation of low back pain patients. A review.

PubMed

Revel, M

1995-01-01

Numerous methods have been developed for the rehabilitation of low back pain patients, including spinal flexion and extension exercises, lumbar spine locking in an intermediate position, enhancement of spinal and pelvic proprioceptive sensibility, swimming pool therapy, back schools, and functional restoration. Each seeks to achieve a goal assumed to be central to the prevention of a first or recurrent episode of low back pain. Goals include short-term pain relief, an improved ability to achieve self-sedation, abdominal and lumbar muscle strengthening, increased hip and lumbar spine mobility, improved lumbar and pelvic proprioceptive sensibility, intervertebral joint stabilization, lumbar posture modification and improved general fitness. Less than 30 studies meeting widely accepted validity and applicability criteria for therapeutic trials have addressed the clinical efficacy of rehabilitation in low back pain patients. Most studies of the back school approach have found no benefit. Spinal flexion and extension exercise programs have yielded short-lived improvements, with no differences across methods. There is evidence that functional restoration programs based on graded activity may provide long-term benefits including better social and occupational outcomes. We have evaluated the physical therapy methods most commonly taught to and used by physical therapists in France.

Monoamine Release in the Cat Lumbar Spinal Cord during Fictive Locomotion Evoked by the Mesencephalic Locomotor Region

PubMed Central

Noga, Brian R.; Turkson, Riza P.; Xie, Songtao; Taberner, Annette; Pinzon, Alberto; Hentall, Ian D.

2017-01-01

Spinal cord neurons active during locomotion are innervated by descending axons that release the monoamines serotonin (5-HT) and norepinephrine (NE) and these neurons express monoaminergic receptor subtypes implicated in the control of locomotion. The timing, level and spinal locations of release of these two substances during centrally-generated locomotor activity should therefore be critical to this control. These variables were measured in real time by fast-cyclic voltammetry in the decerebrate cat’s lumbar spinal cord during fictive locomotion, which was evoked by electrical stimulation of the mesencephalic locomotor region (MLR) and registered as integrated activity in bilateral peripheral nerves to hindlimb muscles. Monoamine release was observed in dorsal horn (DH), intermediate zone/ventral horn (IZ/VH) and adjacent white matter (WM) during evoked locomotion. Extracellular peak levels (all sites) increased above baseline by 138 ± 232.5 nM and 35.6 ± 94.4 nM (mean ± SD) for NE and 5-HT, respectively. For both substances, release usually began prior to the onset of locomotion typically earliest in the IZ/VH and peaks were positively correlated with net activity in peripheral nerves. Monoamine levels gradually returned to baseline levels or below at the end of stimulation in most trials. Monoamine oxidase and uptake inhibitors increased the release magnitude, time-to-peak (TTP) and decline-to-baseline. These results demonstrate that spinal monoamine release is modulated on a timescale of seconds, in tandem with centrally-generated locomotion and indicate that MLR-evoked locomotor activity involves concurrent activation of descending monoaminergic and reticulospinal pathways. These gradual changes in space and time of monoamine concentrations high enough to strongly activate various receptors subtypes on locomotor activated neurons further suggest that during MLR-evoked locomotion, monoamine action is, in part, mediated by extrasynaptic neurotransmission in the spinal cord. PMID:28912689

Acute myelopathy selectively involving lumbar anterior horns following intranasal insufflation of ecstasy and heroin

PubMed Central

Riva, Nilo; Riva, Nilo; Morana, Paolo; Cerri, Federica; Gerevini, Simonetta; Amadio, Stefano; Formaglio, Fabio; Comi, Giancarlo; Comola, Mauro; Del Carro, Ubaldo

2009-01-01

We report a patient who developed acute myelopathy after intranasal insufflation of amphetamines and heroin. The functional prognosis was very poor; after 4 months, she remained paraplegic. MRI imaging showed selective T2 hyperintensity and intense enhancement confined to the spinal anterior horns and lumbar nerve roots and plexus. This unique MRI pattern, together with neurophysiological data, suggests that the pathological process at the first primary affected spinal anterior horns (SAH), conditioning motoneuron cell death, and then nerve roots and lumbar plexus as a consequence of wallerian degeneration PMID:21686691

Discrete mitochondrial aberrations in the spinal cord of sporadic ALS patients.

PubMed

Delic, Vedad; Kurien, Crupa; Cruz, Josean; Zivkovic, Sandra; Barretta, Jennifer; Thomson, Avery; Hennessey, Daniel; Joseph, Jaheem; Ehrhart, Jared; Willing, Alison E; Bradshaw, Patrick; Garbuzova-Davis, Svitlana

2018-08-01

Amyotrophic lateral sclerosis (ALS) is an adult onset neurodegenerative disease characterized by progressive motor neuron degeneration in the brain and spinal cord leading to muscle atrophy, paralysis, and death. Mitochondrial dysfunction is a major contributor to motor neuron degeneration associated with ALS progression. Mitochondrial abnormalities have been determined in spinal cords of animal disease models and ALS patients. However, molecular mechanisms leading to mitochondrial dysfunction in sporadic ALS (sALS) patients remain unclear. Also, segmental or regional variation in mitochondrial activity in the spinal cord has not been extensively examined in ALS. In our study, the activity of mitochondrial electron transport chain complex IV was examined in post-mortem gray and white matter of the cervical and lumbar spinal cords from male and female sALS patients and controls. Mitochondrial distribution and density in spinal cord motor neurons, lateral funiculus, and capillaries in gray and white matter were analyzed by immunohistochemistry. Results showed that complex IV activity was significantly decreased only in gray matter in both cervical and lumbar spinal cords from ALS patients. In ALS cervical and lumbar spinal cords, significantly increased mitochondrial density and altered distribution were observed in motor neurons, lateral funiculus, and cervical white matter capillaries. Discrete decreased complex IV activity in addition to changes in mitochondria distribution and density determined in the spinal cord in sALS patients are novel findings. These explicit mitochondrial defects in the spinal cord may contribute to ALS pathogenesis and should be considered in development of therapeutic approaches for this disease. © 2018 Wiley Periodicals, Inc.

Spinal Anesthesia in Infant Rats: Development of a Model and Assessment of Neurological Outcomes

PubMed Central

Yahalom, Barak; Athiraman, Umeshkumar; Soriano, Sulpicio G.; Zurakowski, David; Carpino, Elizabeth; Corfas, Gabriel; Berde, Charles B.

2012-01-01

Background Previous studies in infant rats and case-control studies of human infants undergoing surgery have raised concerns about potential neurodevelopmental toxicities of general anesthesia. Spinal anesthesia is an alternative to general anesthesia for some infant surgeries. To test for potential toxicity, we developed a spinal anesthesia model in infant rats. Methods Rats of postnatal ages 7, 14, and 21 days were assigned to: no treatment; 1% isoflurane for either 1 h or 6 h, or lumbar spinal injection of saline or bupivacaine, at doses of 3.75 mg/kg (low dose) or 7.5 mg/kg (high dose). Subgroups of animals underwent neurobehavioral testing and blood gas analysis. Brain and lumbar spinal cord sections were examined for apoptosis using cleaved caspase-3 immunostaining. Lumbar spinal cord was examined histologically. Rats exposed to spinal or general anesthesia as infants underwent Rotarod testing of motor performance as adults. Data were analyzed using analysis of variance (ANOVA) using general linear models, Friedman Tests, and Mann–Whitney U tests, as appropriate. Results Bupivacaine 3.75 mg/kg was effective for spinal anesthesia in all age groups, and produced sensory and motor function recovered in 40 to 60 min. Blood gases were similar among groups. Brain and spinal cord apoptosis increased in rats receiving 6 h of 1% isoflurane, but not among the other treatments. All groups showed intact motor performance at adulthood. Conclusions Spinal anesthesia is technically feasible in infant rats, and appears benign in terms of neuroapoptotic and neuromotor sequelae. PMID:21555934

Acute Effects of Hamstring Stretching on Sagittal Spinal Curvatures and Pelvic Tilt

PubMed Central

López-Miñarro, Pedro A.; Muyor, José M.; Belmonte, Felipe; Alacid, Fernando

2012-01-01

The aim of this study was to determine acute effects of hamstring stretching in thoracic and lumbar spinal curvatures and pelvic tilt. Fifty-five adults (29.24 ± 7.41 years) were recruited for this study. Subjects performed a hamstring stretching protocol consisting of four exercises. The session consisted of 3 sets of each exercise and subjects held the position for 20 seconds with a 30-second rest period between sets and exercises. Thoracic and lumbar spinal angles and pelvic tilt were measured with a SpinalMouse in relaxed standing, sit-and-reach test and Macrae & Wright position. Hamstring extensibility was determined by active straight leg raise test and sit-and-reach score. All measures were performed before and immediately after the hamstring stretching protocol. Active straight leg raise angle and sitand-reach score significantly improved immediately after the stretching protocol (p<0.001). Greater anterior pelvic tilt (p<0.001) and lumbar flexion (p<0.05) and a smaller thoracic kyphosis in the sit-and-reach (p<0.001) were found after the stretching protocol. However, stretching produced no significant change on spinal curvatures or pelvic tilt in standing and maximal trunk flexion with knees flexed. In conclusion, static stretching of the hamstring is associated to an immediate change in the sagittal spinal curvatures and pelvic position when performing trunk flexion with knees extended, so that allowing for greater lumbar flexion and anterior pelvic tilt and lower thoracic kyphosis. Hamstring stretching is recommended prior to sport activities involving trunk flexion with the knees straight. PMID:23486214

Postero-Lateral Disc Prosthesis Combined With a Unilateral Facet Replacement Device Maintains Quantity and Quality of Motion at a Single Lumbar Level

PubMed Central

Nayak, Aniruddh N.; Doarn, Michael C.; Gaskins, Roger B.; James, Chris R.; Cabezas, Andres F.; Castellvi, Antonio E.

2014-01-01

Background Mechanically replacing one or more pain generating articulations in the functional spinal unit (FSU) may be a motion preservation alternative to arthrodesis at the affected level. Baseline biomechanical data elucidating the quantity and quality of motion in such arthroplasty constructs is non-existent. Purpose The purpose of the study was to quantify the motion-preserving effect of a posterior total disc replacement (PDR) combined with a unilateral facet replacement (FR) system at a single lumbar level (L4-L5). We hypothesized that reinforcement of the FSU with unilateral FR to replace the resected, native facet joint following PDR implantation would restore quality and quantity of motion and additionally not change biomechanics at the adjacent levels. Study Design In-vitro study using human cadaveric lumbar spines. Methods Six (n = 6) cadaveric lumbar spines (L1-S1) were evaluated using a pure-moment stability testing protocol (±7.5 Nm) in flexion-extension (F/E), lateral bending (LB) and axial rotation (AR). Each specimen was tested in: (1) intact; (2) unilateral FR; and (3) unilateral FR + PDR conditions. Index and adjacent level ROM (using hybrid protocol) were determined opto-electronically. Interpedicular travel (IPT) and instantaneous center of rotation (ICR) at the index level were radiographically determined for each condition. ROM, ICR, and IPT measurements were compared (repeated measures ANOVA) between the three conditions. Results Compared to the intact spine, no significant changes in F/E, LB or AR ROM were identified as a result of unilateral FR or unilateral FR + PDR. No significant changes in adjacent L3-L4 or L5-S1 ROM were identified in any loading mode. No significant differences in IPT were identified between the three test conditions in F/E, LB or AR at the L4-L5 level. The ICRs qualitatively were similar for the intact and unilateral FR conditions and appeared to follow placement (along the anterior-posterior (AP) direction) of the PDR in the disc space Conclusion Biomechanically, quantity and quality of motion are maintained with combined unilateral FR + PDR at a single lumbar spinal level. PMID:25694929

Identification of the lumbar interspinous spaces by palpation and verified by X-rays.

PubMed

Tanaka, Kei; Irikoma, Shingo; Kokubo, Sotaro

2013-01-01

Palpation has been shown to be rather inaccurate at identifying lumbar interspinous spaces in neuraxial anesthesia. The aim of this study is to assess the accuracy of the determination of the lumbar interspinous spaces by anesthesiologist's palpation using postoperative X-rays in obstetric patients. We reviewed the anesthetic record and the post-operative abdominal X-rays of the cesarean sections. We indwelled the epidural catheter for post-operative one-shot analgesia. We included combined spinal and epidural anesthesia cases and compared the interspinous level which the anesthesiologist recorded and the epidural catheter insertion level confirmed by abdominal X-ray for each case. We also evaluated the factors (age, body weight, height, Body Mass Index, gestational age, and the type of surgery [planned / emergency]) leading to misidentification of interspinous level. Nine hundred and sixty seven cesarean sections were performed and a total of 835 cases were evaluated. The levels of the puncture documented by the anesthesiologists were in agreement with the actual catheter insertion levels in 563 (67%) cases. When the anesthesiologists aimed at L2-3 level, we found the catheter insertion at L1-2 in 5 cases (4.9%), none of which had any post-operative neurological deficits. No variables evaluated were significantly associated with misidentification of interspinous level by the anesthesiologists. There was a discrepancy between the anesthesiologists' estimation by palpation and the actual catheter insertion level shown in X-rays. It seems to be safer to choose the interspinous level L3-4 or lower in spinal anesthesia. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

Comparing parecoxib and ketorolac as preemptive analgesia in patients undergoing posterior lumbar spinal fusion: a prospective randomized double-blinded placebo-controlled trial.

PubMed

Siribumrungwong, Koopong; Cheewakidakarn, Julin; Tangtrakulwanich, Boonsin; Nimmaanrat, Sasikaan

2015-03-18

Poor postoperative pain control is frequently associated with complications and delayed discharge from a hospital. Preemptive analgesia is one of the methods suggested for reducing postoperative pain. Opioids are effective for pain control, but there known addictive properties make physicians cautious about using them. Parecoxib and ketorolac are potent non-opioid NSAIDs that are attractive alternative drugs to opioids to avoid opioid-related side effects. However, there are no good head-to-head comparisons between these two drugs in the aspect of preemptive analgesic effects in lumbar spinal fusion surgery. This study aimed to compare the efficacy in terms of postoperative pain control and safety of parecoxib with ketorolac as preemptive analgesia in posterior lumbar spinal fusion patients. A prospective, double-blinded randomized controlled trial was carried out in patients undergoing posterior lumbar spinal fusion, who were randomized into 3 groups (n = 32). Parecoxib, ketorolac or a placebo was given to each patient via injection around 30 minutes prior to incision. The efficacy of postoperative pain control was assessed by a verbal numerical rating score (0-10). And various postoperative things were monitored for analysis, such as total opioid consumption, complications, and estimated blood loss. Both the ketorolac and parecoxib groups showed significantly better early postoperative pain reduction at the postanesthesia care unit (PACU) than the control group (p < 0.05). There were no differences between the pain scores of ketorolac and parecoxib at any time points. Complications and bleeding were not significantly different between all three groups. Preemptive analgesia using both ketorolac and parecoxib showed a significantly better early postoperative pain control in the PACU than the control group in patients undergoing lumbar spinal fusion. ClinicalTrials.gov NCT01859585. Registered 15 May 2013.

Symptomatic Spinal Epidural Lipomatosis After a Single Local Epidural Steroid Injection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tok, Chung Hong, E-mail: rogertok@gmail.com; Kaur, Shaleen; Gangi, Afshin

Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202-211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202-211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabeticmore » man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection.« less

[Radiological study on the n-HA/PA66 cage used in the transforaminal lumbar interbody fusion].

PubMed

Sang, Pei-ming; Zhang, Ming; Chen, Bin-hui; Cai, Chang; Gu, Shi-rong; Zhou, Min

2014-08-01

To explore the effects of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage on recovering and maintaining lumbar curvature, lumbar heights and fusion rate when used in the transforaminal lumbar interbody fusion. From February to July 2012, 50 patients with degenerative lumbar disease(lumbar disc herniation in 32 cases and lumbar spondylolisthesis in 18 cases) were treated with transforaminal lumbar interbody fusion using the n-HA/PA66 cage, and their preoperative and postoperative clinical outcomes were analyzed. The patients were followed up for 2, 4, 6 and 8 months after operation, during which the CR and CT film of lumbar vertebra were checked to get relative height of vertebral space, Taillard index,index of lumbar spinal curvature,angle of segmental and full lumbar lordosis. The data were analyzed respectively with pair t-test, analysis of variance or LSD-t-test. All the patients were followed up, and the duraion ranged from 8 to 13 months, with a mean of 11.32 months. There were significant differences in relative height of vertebral space, Taillard index, index of lumbar spinal curvature, angle of segmental and full lumbar lordosis after surgery, but there were no significant differences in different periods after operation. The fusion time of lumbar ranged from 4 to 8 months. The n-HA/PA66 cage can recover and maintain lumbar normal stability with higher rate of fusion and less complications.

Spinal injuries in professional rugby union: a prospective cohort study.

PubMed

Fuller, Colin W; Brooks, John H M; Kemp, Simon P T

2007-01-01

To determine the incidence, severity, nature, and causes of cervical, thoracic, and lumbar spine injuries sustained during competition and training in professional rugby union. A 2 season prospective cohort design. Twelve English Premiership rugby union clubs. Five hundred and forty-six male rugby union players of whom 296 were involved in both seasons. Location, diagnosis, severity (number of days unavailable for training and matches), and cause of injury: incidence of match and training injuries (injuries/1000 player-hours). Player age, body mass, stature, playing position, use of headgear, and activity and period of season. The incidences of spinal injuries were 10.90 (9.43 to 12.60) per 1000 player match-hours and 0.37 (0.29 to 0.47) per 1000 player training-hours. No player sustained a catastrophic spinal injury, but 3 players sustained career-ending injuries. Overall, players were more likely to sustain a cervical injury during matches and a lumbar injury during training. Forwards were significantly more likely to sustain a spinal injury than backs during both matches (P < 0.01) and training (P = 0.02). During matches, injuries to the cervical (average: 13 days; P < 0.01) and lumbar (13 days; P < 0.01) spine were more severe than injuries to the thoracic (5 days) spine; during training, injuries to the lumbar spine (26 days) were more severe than injuries to the cervical (13 days; P = 0.10) or thoracic (12 days; P = 0.06) spine. A total of 4037 days were lost to competition and training through spinal injuries with lumbar disc injuries sustained during training accounting for 926 days (23%) and cervical nerve root injuries sustained during matches for 621 days (15%). During matches, more injuries were caused by tackles (37%), and during training more injuries were caused by weight-training (33%). The results showed that rugby union players were exposed to a high risk of noncatastrophic spinal injury during tackling, scrummaging, and weight-training activities; injury prevention strategies, therefore, should be focused on these activities.

"Do Not Follow the Tail": A Practical Approach to Remove a Sheared Lumbar Catheter Fragment Avoiding Its Migration into the Spinal Canal.

PubMed

Oshino, Satoru; Kishima, Haruhiko; Ohnishi, Yu-ichiro; Iwatsuki, Koichi; Saitoh, Youichi

2016-03-01

Catheter shearing is one of the most common complications of various neurosurgical modalities that use an intrathecal lumbar catheter. The sheared catheter fragment often can spontaneously migrate into the spinal canal; however, in some cases, the end of the fragment will remain outside the spinal canal. In this situation, the consulting neurosurgeons may try to retrieve the catheter fragment by approaching it directly through the catheter tract. This simple maneuver, however, can cause the fragment to slip into the spinal canal before it is secured, as we experienced recently in 2 cases. Because the fragment of the sheared catheter slipped while manipulating it within the catheter tract, we suggest that surgeons not approach the fragment along the tract to prevent it from migrating downward. Using the operative findings of an illustrative case, we describe how to avoid downward migration of the catheter fragment when retrieving a sheared lumbar catheter. We found that the sheared catheter of a lumbar-peritoneal shunt was slowly slipping along with the pulsatile movement of cerebrospinal fluid within the catheter tract. We successfully retrieved the fragment by approaching it from outside the catheter tract. We propose that surgeons approach the fragment from outside of the catheter tract. One should keep in mind a simple phrase, 'Do not follow the tail', when retrieving the sheared lumbar catheter fragment. Copyright © 2016 Elsevier Inc. All rights reserved.

[A woman with a postoperative lumbar swelling].

PubMed

Hulshof, Hanna M; Elsenburg, Patric H J M; Frequin, Stephan T F M

2013-01-01

A 65-year-old woman had developed a large lumbar swelling in a period of four weeks following lumbar laminectomy. An MRI-scan revealed a large fluid collection, which had formed from the spinal canal. The diagnosis 'liquorcele', a rare complication of spine surgery, was established.

Laparoscopic cholecystectomy under spinal anesthesia: comparative study between conventional-dose and low-dose hyperbaric bupivacaine

PubMed Central

Imbelloni, Luiz Eduardo; Sant’Anna, Raphael; Fornasari, Marcos; Fialho, José Carlos

2011-01-01

Background Laparoscopic cholecystectomy has the advantages of causing less postoperative pain and requiring a short hospital stay, and therefore is the treatment of choice for cholelithiasis. This study was designed to compare spinal anesthesia using hyperbaric bupivacaine given as a conventional dose by lumbar puncture or as a low-dose by thoracic puncture. Methods A total of 140 patients with symptomatic gallstone disease were randomized to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under spinal anesthesia using either conventional lumbar spinal anesthesia (hyperbaric bupivacaine 15 mg and fentanyl 20 mg) or low-dose thoracic spinal anesthesia (hyperbaric bupivacaine 7.5 mg and fentanyl 20 μg). Intraoperative parameters, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two treatment groups. Results All procedures were completed under spinal anesthesia, with no cases needing conversion to general anesthesia. Values for time for block to reach the T3 dermatomal level, duration of motor and sensory block, and hypotensive events were significantly lower with low-dose bupivacaine. Postoperative pain was higher for low-dose hyperbaric bupivacaine at 6 and 12 hours. All patients were discharged after 24 hours. Follow-up 1 week postoperatively showed all patients to be satisfied and to be keen advocates of spinal anesthesia. Conclusion Laparoscopic cholecystectomy can be performed successfully under spinal anesthesia. A small dose of hyperbaric bupivacaine 7.5 mg and 20 μg fentanyl provides adequate spinal anesthesia for laparoscopy and, in comparison with hyperbaric bupivacaine 15% and fentanyl 20 μg, causes markedly less hypotension. The low-dose strategy may have an advantage in ambulatory patients because of the earlier recovery of motor and sensory function and earlier discharge. PMID:22915892

Thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage.

PubMed

Pang, Xiaoyang; Shen, Xiongjie; Wu, Ping; Luo, Chenke; Xu, Zhengquan; Wang, Xiyang

2013-06-01

Retrospective analysis of the clinical efficacy and feasibility of patients with thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. A total of 18 patients with thoracolumbar tuberculosis (TB), between February 2007 and February 2011, underwent one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. And the clinical efficacy was evaluated based on surgery duration time, the blood loss, the postural drainage of time, neurological status that was recorded by American Spinal Injury Association (ASIA) Impairment Scale, the fate of bone graft fusion, kyphosis angle, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which were collected at certain time. The average follow-up period was 34 months (range 18-48 months). 18 patients suffered from seriously neurological deficits pre-operatively, of which 16 patients returned to normal at final follow-up. The surgery duration time was 197 ± 37.9 min, and the blood loss was 815 ± 348.5 ml. The postural drainage of time was 7.2 ± 2.7 days. The psoas abscesses disappeared in all cases, within the time range of 6-9 months (mean 7.4 ± 1.2 months). All patients of the grafted bones were thoroughly fused, with a fusion time ranging from 4 to 12 months (mean 7.8 months). Kyphosis angle was 44.32 ± 7.26° on average pre-operative and returned to 11.72 ± 2.85° at 6 weeks after operation; kyphosis angle was 13.10 ± 2.39° at final follow-up. The values of ESR and CRP were significant declined at 6 weeks post-operative, and returned to normal levels at final follow-up. With standardized anti-TB chemotherapy, thoracolumbar spinal tuberculosis with psoas abscesses could be effectively treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage.

Ergonomic Challenges in Conventional and Advanced Apparel Manufacturing.

DTIC Science & Technology

1992-10-01

countered by several disadvantages. When standing, the vertebrae in the lumbar region (low back) adopt a forward curved or lordotic posture. This lordosis ...increases (Andersson, 1986). The backrest also promotes lordosis . S 1 FIGURE 1. EFFECTS OF SITING ON SPINAL CURVATURE. ’𔃼, llustrtin from Grandjcan...rotated backwards forcing the lumbar spine to flatten (loss of lordosis ) or become backward curved (kyphotic). 2 To further relieve spinal loading, improve

The Lumbar Lordosis in Males and Females, Revisited

PubMed Central

Hay, Ori; Dar, Gali; Abbas, Janan; Stein, Dan; May, Hila; Masharawi, Youssef; Peled, Nathan; Hershkovitz, Israel

2015-01-01

Background Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females. Methods Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height. Principal Findings Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined). Conclusions Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis). The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing. PMID:26301782

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

PubMed Central

Huang, H.; Nightingale, R. W.

2018-01-01

Objectives Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. Methods A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Results Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t-test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Conclusion Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article: H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28–35. DOI: 10.1302/2046-3758.71.BJR-2017-0100.R1. PMID:29330341

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

PubMed

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

2018-01-01

Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t -test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article : H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28-35. DOI: 10.1302/2046-3758.71.BJR-2017-0100.R1. © 2018 Huang et al.

Pig lumbar spine anatomy and imaging-guided lateral lumbar puncture: a new large animal model for intrathecal drug delivery.

PubMed

Pleticha, Josef; Maus, Timothy P; Jeng-Singh, Christian; Marsh, Michael P; Al-Saiegh, Fadi; Christner, Jodie A; Lee, Kendall H; Beutler, Andreas S

2013-05-30

Intrathecal (IT) administration is an important route of drug delivery, and its modelling in a large animal species is of critical value. Although domestic swine is the preferred species for preclinical pharmacology, no minimally invasive method has been established to deliver agents into the IT space. While a "blind" lumbar puncture (LP) can sample cerebrospinal fluid (CSF), it is unreliable for drug delivery in pigs. Using computed tomography (CT), we determined the underlying anatomical reasons for this irregularity. The pig spinal cord was visualised terminating at the S2-S3 level. The lumbar region contained only small amounts of CSF found in the lateral recess. Additional anatomical constraints included ossification of the midline ligaments, overlapping lamina with small interlaminar spaces, and a large bulk of epidural adipose tissue. Accommodating the the pig CT anatomy, we developed a lateral LP (LLP) injection technique that employs advanced planning of the needle path and monitoring of the IT injection progress. The key features of the LLP procedure involved choosing a vertebral level without overlapping lamina or spinal ligament ossification, a needle trajectory crossing the midline, and entering the IT space in its lateral recess. Effective IT delivery was validated by the injection of contrast media to obtain a CT myelogram. LLP represents a safe and reliable method to deliver agents to the lumbar pig IT space, which can be implemented in a straightforward way by any laboratory with access to CT equipment. Therefore, LLP is an attractive large animal model for preclinical studies of IT therapies. Copyright © 2013 Elsevier B.V. All rights reserved.

Outcome of transforaminal lumbar interbody fusion in spondylolisthesis-A clinico-radiological correlation.

PubMed

Balasubramanian, Vijay Anand; Douraiswami, Balaji; Subramani, Suresh

2018-06-01

Lumbar spondylolisthesis is a common cause of morbidity in middle aged individuals. Spinal fusion with instrumentation has become the gold standard for lumbar segmental instability. Studies which correlate the improvement in radiology postoperatively with functional outcome show contrasting reports. This study is aimed at finding the correlation between clinical and radiological outcomes after surgery with transforaminal lumbar interbody fusion. A retrospective study in 35 patients who underwent transforaminal lumbar interbody fusion in a period of 1 year was done. Preoperative pain (VAS Score), functional ability (ODI), radiological parameters (slip angle, slip grade, disc height, foraminal height, lumbar lordosis) were compared with postoperative recordings at the last followup. Functional improvement (Macnab's criteria) and fusion (Lee's fusion criteria) were assessed. Statistical analysis was done with student's paired t -test and Pearson's correlation coefficient. VAS score, ODI improved from 8 to 2 and 70 to 15 respectively. Slip angle improved from 23°to 5° on an average. 80% patients showed fusion and 85% showed good clinical outcome at 1 year followup. Analyzing with Pearson correlation coefficient showed no significant relation between pain scores and radiological parameters. But there was statistically significant relation between radiological fusion and the final clinical outcome. TLIF produces spinal fusion in most individuals. Strong spinal fusion is essential for good clinical outcome in spondylolisthesis patients who undergo TLIF. Reduction in slip is not necessary for all patients with listhesis.

Lumbar spinal loading during bowling in cricket: a kinetic analysis using a musculoskeletal modelling approach.

PubMed

Zhang, Yanxin; Ma, Ye; Liu, Guangyu

2016-01-01

The objective of the study was to evaluate two types of cricket bowling techniques by comparing the lumbar spinal loading using a musculoskeletal modelling approach. Three-dimensional kinematic data were recorded by a Vicon motion capture system under two cricket bowling conditions: (1) participants bowled at their absolute maximal speeds (max condition), and (2) participants bowled at their absolute maximal speeds while simultaneously forcing their navel down towards their thighs starting just prior to ball release (max-trunk condition). A three-dimensional musculoskeletal model comprised of the pelvis, sacrum, lumbar vertebrae and torso segments, which enabled the motion of the individual lumbar vertebrae in the sagittal, frontal and coronal planes to be actuated by 210 muscle-tendon units, was used to simulate spinal loading based on the recorded kinematic data. The maximal lumbar spine compressive force is 4.89 ± 0.88BW for the max condition and 4.58 ± 0.54BW for the max-trunk condition. Results showed that there was no significant difference between the two techniques in trunk moments and lumbar spine forces. This indicates that the max-trunk technique may not increase lower back injury risks. The method proposed in this study could be served as a tool to evaluate lower back injury risks for cricket bowling as well as other throwing activities.

Sacral epiduroscopic laser decompression for complex regional pain syndrome after lumbar spinal surgery: A case report.

PubMed

Jung, Jae-Wook; Kim, Yong Han; Kim, Hyojoong; Kang, Eunsu; Jo, Hyunji; Ko, Myoung Jin

2018-05-01

CRPS after a lumbar surgery has symptoms that are similar to PSSS. However, standard criteria for distinguishing CRPS from PSSS do not exist. We present a case report of a 31-year-old female with CRPS symptoms after lumbar spinal surgery treated by performing SELD. This patient was referred to our pain clinic for left ankle pain. She received a lumbar discectomy for a herniated lumbar disc (L5/S1) but the pain was aggravated after surgery. The characteristics of the pain were burning, tingling, and cold, and were accompanied by other symptoms such as swelling, color change and mail dystrophy. The patient was diagnosed with CRPS. Medications and interventional therapies were not effective in reducing pain. SELD was performed and severe adhesive inflammation was observed in the L4-S1 epidural space. We performed mechanical adhesiolysis and injected hyalurodinase and dexamethasone near the L5 and S1 root. One month after, a second SELD was performed as same manner. After second SELD, the patient's pain markedly decreased. On the second visit in the outpatient clinic, the patient was absent of pain without any other medications. CRPS like symptoms can appear after lumbar spinal surgery due to adhesion and inflammation in the epidural space. In such cases, SELD can be considered as diagnostic and therapeutic option.

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

PubMed

Schneider, Michael; Ammendolia, Carlo; Murphy, Donald; Glick, Ronald; Piva, Sara; Hile, Elizabeth; Tudorascu, Dana; Morton, Sally C

2014-01-01

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

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

PubMed Central

2014-01-01

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

Radiographic and Clinical Outcome of Silicate-substituted Calcium Phosphate (Si-CaP) Ceramic Bone Graft in Spinal Fusion Procedures.

PubMed

Alimi, Marjan; Navarro-Ramirez, Rodrigo; Parikh, Karishma; Njoku, Innocent; Hofstetter, Christoph P; Tsiouris, Apostolos J; Härtl, Roger

2017-07-01

Retrospective cohort study. To evaluate the radiographic and clinical outcome of silicate-substituted calcium phosphate (Si-CaP), utilized as a graft substance in spinal fusion procedures. Specific properties of Si-CaP provide the graft with negative surface charge that can result in a positive effect on the osteoblast activity and neovascularization of the bone. This study included those patients who underwent spinal fusion procedures between 2007 and 2011 in which Si-CaP was used as the only bone graft substance. Fusion was evaluated on follow-up CT scans. Clinical outcome was assessed using Oswestry Disability Index, Neck Disability Index, and the visual analogue scale (VAS) for back, leg, neck, and arm pain. A total of 234 patients (516 spinal fusion levels) were studied. Surgical procedures consisted of 57 transforaminal lumbar interbody fusion, 49 anterior cervical discectomy and fusion, 44 extreme lateral interbody fusion, 30 posterior cervical fusions, 19 thoracic fusion surgeries, 17 axial lumbar interbody fusions, 16 combined anterior and posterior cervical fusions, and 2 anterior lumbar interbody fusion. At a mean radiographic follow-up of 14.2±4.3 months, fusion was found to be present in 82.9% of patients and 86.8% of levels. The highest fusion rate was observed in the cervical region. At the latest clinical follow-up of 21.7±14.2 months, all clinical outcome parameters showed significant improvement. The Oswestry Disability Index improved from 45.6 to 13.3 points, Neck Disability Index from 40.6 to 29.3, VAS back from 6.1 to 3.5, VAS leg from 5.6 to 2.4, VAS neck from 4.7 to 2.7, and VAS arm from 4.1 to 1.7. Of 7 cases with secondary surgical procedure at the index level, the indication for surgery was nonunion in 3 patients. Si-CaP is an effective bone graft substitute. At the latest follow-up, favorable radiographic and clinical outcome was observed in the majority of patients. Level-III.

Video-assisted removal of metal pellet fragments from the vertebral canal following gunshot injury and long-term outcome in a cat.

PubMed

Matres-Lorenzo, Luis; Bernardé, Antoine; Bernard, Fabrice

2016-09-20

 To describe the surgical management and long-term outcome of a spinal gunshot injury in a cat. A two-year-old, 4.2 kg castrated European Shorthair male cat was referred for evaluation of bilateral acute hindlimb paralysis with loss of deep pain perception in the right hindlimb associated with a perforating gunshot wound in the left side of the flank. Based on the clinical findings, the injury was localized to the fourth lumbar-first sacral spinal cord segment. The orthogonal spinal radiographs and computed tomography examination showed several metal pellet fragments within the vertebral canal of the sixth lumbar vertebra. A left mini-hemilaminectomy of the sixth lumbar vertebra pedicle combined with a mini dorsal laminectomy over the sixth to seventh lumbar vertebrae disc space were performed. A 2.4 mm 30° arthroscope was then introduced within the spinal canal to improve visibility and help with the fragment extraction. The cat was discharged from the hospital five days after surgery and the owners were encouraged to continue passive and active physiotherapy movements. The cat was ambulatory with a plantigrade stance eight weeks following surgery. At the last follow-up examination (24 months postoperatively), the cat was able to jump on chairs, although intermittent urinary and faecal incontinence, proprioceptive deficits, and plantigrade stance were still present.  Decompressive surgery may promote neurological status improvement following spinal gunshot injury.

Do Lordotic Cages Provide Better Segmental Lordosis Versus Nonlordotic Cages in Lateral Lumbar Interbody Fusion (LLIF)?

PubMed

Sembrano, Jonathan N; Horazdovsky, Ryan D; Sharma, Amit K; Yson, Sharon C; Santos, Edward R G; Polly, David W

2017-05-01

A retrospective comparative radiographic review. To evaluate the radiographic changes brought about by lordotic and nonlordotic cages on segmental and regional lumbar sagittal alignment and disk height in lateral lumbar interbody fusion (LLIF). The effects of cage design on operative level segmental lordosis in posterior interbody fusion procedures have been reported. However, there are no studies comparing the effect of sagittal implant geometry in LLIF. This is a comparative radiographic analysis of consecutive LLIF procedures performed with use of lordotic and nonlordotic interbody cages. Forty patients (61 levels) underwent LLIF. Average age was 57 years (range, 30-83 y). Ten-degree lordotic PEEK cages were used at 31 lumbar interbody levels, and nonlordotic cages were used at 30 levels. The following parameters were measured on preoperative and postoperative radiographs: segmental lordosis; anterior and posterior disk heights at operative level; segmental lordosis at supra-level and subjacent level; and overall lumbar (L1-S1) lordosis. Measurement changes for each cage group were compared using paired t test analysis. The use of lordotic cages in LLIF resulted in a significant increase in lordosis at operative levels (2.8 degrees; P=0.01), whereas nonlordotic cages did not (0.6 degrees; P=0.71) when compared with preoperative segmental lordosis. Anterior and posterior disk heights were significantly increased in both groups (P<0.01). Neither cage group showed significant change in overall lumbar lordosis (lordotic P=0.86 vs. nonlordotic P=0.25). Lordotic cages provided significant increase in operative level segmental lordosis compared with nonlordotic cages although overall lumbar lordosis remained unchanged. Anterior and posterior disk heights were significantly increased by both cages, providing basis for indirect spinal decompression.

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

PubMed Central

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

2012-01-01

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

Spinal cord potentials in traumatic paraplegia and quadriplegia.

PubMed Central

Sedgwick, E M; el-Negamy, E; Frankel, H

1980-01-01

Cortical, cervical and lumbar somatosensory evoked potentials were recorded following median and tibial nerve stimulation in patients with traumatic paraplegia and quadriplegia. The isolated cord was able to produce normal potentials even during spinal shock if the vertical extent of the lesion did not involve the generator mechanisms. The cervical potentials showed subtle changes in paraplegia at Th5 levels and below. In high cervical lesions the early cervical potentials may still be present but the later potentials were absent or, in partial lesions, delayed. PMID:7420105

Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache

PubMed Central

Xu, Hong; Liu, Yang; Song, WenYe; Kan, ShunLi; Liu, FeiFei; Zhang, Di; Ning, GuangZhi; Feng, ShiQing

2017-01-01

Abstract Background: Postdural puncture headache (PDPH), mainly resulting from the loss of cerebral spinal fluid (CSF), is a well-known iatrogenic complication of spinal anesthesia and diagnostic lumbar puncture. Spinal needles have been modified to minimize complications. Modifiable risk factors of PDPH mainly included needle size and needle shape. However, whether the incidence of PDPH is significantly different between cutting-point and pencil-point needles was controversial. Then we did a meta-analysis to assess the incidence of PDPH of cutting spinal needle and pencil-point spinal needle. Methods: We included all randomly designed trials, assessing the clinical outcomes in patients given elective spinal anesthesia or diagnostic lumbar puncture with either cutting or pencil-point spinal needle as eligible studies. All selected studies and the risk of bias of them were assessed by 2 investigators. Clinical outcomes including success rates, frequency of PDPH, reported severe PDPH, and the use of epidural blood patch (EBP) were recorded as primary results. Results were evaluated using risk ratio (RR) with 95% confidence interval (CI) for dichotomous variables. Rev Man software (version 5.3) was used to analyze all appropriate data. Results: Twenty-five randomized controlled trials (RCTs) were included in our study. The analysis result revealed that pencil-point spinal needle would result in lower rate of PDPH (RR 2.50; 95% CI [1.96, 3.19]; P < 0.00001) and severe PDPH (RR 3.27; 95% CI [2.15, 4.96]; P < 0.00001). Furthermore, EBP was less used in pencil-point spine needle group (RR 3.69; 95% CI [1.96, 6.95]; P < 0.0001). Conclusions: Current evidences suggest that pencil-point spinal needle was significantly superior compared with cutting spinal needle regarding the frequency of PDPH, PDPH severity, and the use of EBP. In view of this, we recommend the use of pencil-point spinal needle in spinal anesthesia and lumbar puncture. PMID:28383416

Transforaminal Percutaneous Endoscopic Discectomy and Foraminoplasty after Lumbar Spinal Fusion Surgery.

PubMed

Wu, Jian-Jun; Chen, Hui-Zhen; Zheng, Changkun

2017-07-01

The most common causes of pain following lumbar spinal fusions are residual herniation, or foraminal fibrosis and foraminal stenosis that is ignored, untreated, or undertreated. The original surgeon may advise his patient that nothing more can be done in his opinion that the nerve was visually decompressed by the original surgery. Post-operative imaging or electrophysiological assessment may be inadequate to explain all the reasons for residual or recurrent symptoms. Treatment of failed lumbar spinal fusions by repeat traditional open revision surgery usually incorporates more extensive decompression causing increased instability and back pain. The authors, having limited their practice to endoscopic surgery over the last 10 years, report on their experience gained during that period to relieve pain by transforaminal percutaneous endoscopic revision of lumbar spinal fusions. To assess the effectiveness of transforaminal percutaneous endoscopic discectomy and foraminoplasty in patients with pain after lumbar spinal fusion. Retrospective study. Inpatient surgery center. Sixteen consecutive patients with pain after lumbar spinal fusions presenting with back and leg pain that had supporting imaging diagnosis of foraminal stenosis and/or residual/recurrent disc herniation, or whose pain complaint was supported by relief from diagnostic and therapeutic injections, were offered percutaneous transforaminal endoscopic discectomy and foraminoplasty over a repeat open procedure. Each patient sought consultation following a transient successful, partially successful or unsuccessful open lumbar spinal fusions treatment for disc herniation or spinal stenosis. Endoscopic foraminoplasty was also performed to either decompress the bony foramen in the case of foraminal stenosis, or to allow for endoscopic visual examination of the affected traversing and exiting nerve roots in the axilla. The average follow-up time was 30.3 months, minimum 12 months. Outcome data at each visit included MacNab criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI). The average leg VAS improved from 9.1 ± 2.0 to 2.0 ± 0.8 (P < 0.005). Ten patients had excellent outcomes, 5 had good outcomes, one had a fair outcome, and none had poor outcomes, according to the MacNab criteria. Fifteen of 16 patients had excellent or good outcomes, for an overall success rate of 93.7%. No patients required reoperation. There were no incidental durotomies, infections, vascular, or visceral injuries. There was one complication, a case of leg numbness caused by dorsal root ganglion injury. The numbness improved after 2 weeks. After 3 months, physical exam showed that the total area of numbness in the legs had decreased. At last follow-up, the patient had no pain, and only a few areas with numbness remained that did not affect the patient's activities of daily living. The patient was relieved to be able to avoid open decompression. This is a retrospective study. The transforaminal endoscopic approach is effective for patients with back or leg pain after lumbar spinal fusions due to residual/recurrent nucleus pulposus and foraminal stenosis. Failed initial index surgery may involve failure to recognize patho-anatomy in the axilla of the foramen housing the traversing and the exiting nerve. The transforaminal endoscopic approach effectively decompresses the foramen and does not further destabilize the spine needing stabilization. It also avoids going through the previous surgical site. Full-endoscopic, foraminal stenosis, recurrent herniation, surgical treatment, fusion.

Use of a 22-gauge Whitacre needle to reduce the incidence of side effects after lumbar myelography: a prospective randomised study comparing Whitacre and Quincke spinal needles.

PubMed

Pedersen, O N

1996-01-01

In a prospective study lumbar iohexol myelography was performed in 107 consecutive patients, randomised for lumbar puncture with a Quincke or Whitacre spinal needle. All patients answered a questionnaire about possible side effects. Data from 100 patients (58 men, 42 women) were evaluated. In the Quincke group (n = 53), 23 (43%) reported no side effects. In the 30 patients who reported various side effects, post-dural puncture headache (PDPH) occurred in 22 (42%), of whom 9 had mild, 6 moderate and 7 (13%) severe cephalalgia, 18 (34%) reported increased low back pain/sciatica, 5 nausea and 7 dizziness. In the Whitacre group (n = 47), 33 (70%) had no side effects. PDPH was reported by 9 patients (19%), of whom 2 had mild, 6 moderate and only 1 (2%) severe cephalalgia, 4 (9%) reported increased low back pain/sciatica, 5 nausea and 4 dizziness. The conclusion drawn from this study is that lumbar myelography performed with the Whitacre spinal needle reduces postspinal side effects.

Spinal anesthesia for laparoscopic cholecystectomy: Thoracic vs. Lumbar Technique

PubMed Central

Imbelloni, Luiz Eduardo

2014-01-01

Aims: In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a prospective study with all patients undergoing LC under spinal anesthesia in our department since 2007. Settings and Design: Prospective observational. Materials and Methods: From 2007 to 2011, 369 patients with symptoms of colelithiasis, laparoscopic cholecystectomy were operated under spinal anesthesia with pneumoperitoneum and low pressure CO2. We compared 15 mg of hyperbaric bupivacaine and lumbar puncture with 10 or 7.5 mg of hyperbaric bupivacaine thoracic puncture, all with 25 μg fentanyl until the sensory level reached T3. Intraoperative parameters, post-operative pain, complications, recovery, patient satisfaction, and cost were compared between both groups. Statistical Analysis Used: Means were compared by ANOVA or Kruskal-Wallis test, the percentages of the Chi-square test or Fisher's exact test when appropriate. Time of motor and sensory block in spinal anesthesia group was compared by paired t test or Mann-Whitney test. Differences were considered significant when P ≤ 0.05, and for comparisons of mean pain visual scale, we employed the Bonferroni correction applied to be considered significant only with P ≤ 0.0125 Results: All procedures were completed under spinal anesthesia. The use of lidocaine 1% was successful in the prevention of shoulder pain in 329 (89%) patients. There were significant differences in time to reach T3, obtaining 15 mg > 10 mg = 7.5 mg. There is a positive correlation between the dose and the incidence of hypotension. The lowest doses gave a decrease of 52.2% in the incidence of hypotension. There was a positive correlation between the dose and duration of sensory and motor block. Sensory block was almost twice the motor block at all doses. With low doses, 60% of patients went from table to stretcher. Satisfaction occurred in 99% of patients. Conclusions: Laparoscopic cholecystectomy can be performed successfully under spinal anesthesia with low-pressure pneumoperitoneum of CO2. The use of thoracic puncture and low doses of hyperbaric bupivacaine provided better hemodynamic stability, less hypotension, and shorter duration of sensory and motor blockade than lumbar spinal anesthesia with conventional doses. PMID:25422604

Global and segmental kinematic changes following sequential resection of posterior osteoligamentous structures in the lumbar spine: An in vitro biomechanical investigation using pure moment testing protocols.

PubMed

Chamoli, Uphar; Korkusuz, Mert H; Sabnis, Ashutosh B; Manolescu, Andrei R; Tsafnat, Naomi; Diwan, Ashish D

2015-11-01

Lumbar spinal surgeries may compromise the integrity of posterior osteoligamentous structures implicating mechanical stability. Circumstances necessitating a concomitant surgery to achieve restabilisation are not well understood. The main objective of this in vitro study was to quantify global and segmental (index and adjacent levels) kinematic changes in the lumbar spine following sequential resection of the posterior osteoligamentous structures using pure moment testing protocols. Six fresh frozen cadaveric kangaroo lumbar spines (T12-S1) were tested under a bending moment in flexion-extension, bilateral bending, and axial torsion in a 6-degree-of-freedom Kinematic Spine Simulator. Specimens were tested in the following order: intact state (D0), after interspinous and supraspinous ligaments transection between L4 and L5 (D1), further after a total bilateral facetectomy between L4 and L5 (D2). Segmental motions at the cephalad, damaged, and caudal levels were recorded using an infrared-based motion tracking device. Following D1, no significant change in the global range of motion was observed in any of the bending planes. Following D2, a significant increase in the global range of motion from the baseline (D0) was observed in axial torsion (median normalised change +20%). At the damaged level, D2 resulted in a significant increase in the segmental range of motion in flexion-extension (+77%) and axial torsion (+492%). Additionally, a significant decrease in the segmental range of motion in axial torsion (-35%) was observed at the caudal level following D2. These results suggest that a multi-segment lumbar spine acts as a mechanism for transmitting motions, and that a compromised joint may significantly alter motion transfer to adjacent segments. We conclude that the interspinous and supraspinous ligaments play a modest role in restricting global spinal motions within physiologic limits. Following interspinous and supraspinous ligaments transection, a total bilateral facetectomy resulted in a significant increase in axial torsion motion, both at global and damaged levels, accompanied with a compensatory decrease in motion at the caudal level. © IMechE 2015.

Spinal and pontine relay pathways mediating respiratory rhythm entrainment by limb proprioceptive inputs in the neonatal rat.

PubMed

Giraudin, Aurore; Le Bon-Jégo, Morgane; Cabirol, Marie-Jeanne; Simmers, John; Morin, Didier

2012-08-22

The coordination of locomotion and respiration is widespread among mammals, although the underlying neural mechanisms are still only partially understood. It was previously found in neonatal rat that cyclic electrical stimulation of spinal cervical and lumbar dorsal roots (DRs) can fully entrain (1:1 coupling) spontaneous respiratory activity expressed by the isolated brainstem/spinal cord. Here, we used a variety of preparations to determine the type of spinal sensory inputs responsible for this respiratory rhythm entrainment, and to establish the extent to which limb movement-activated feedback influences the medullary respiratory networks via direct or relayed ascending pathways. During in vivo overground locomotion, respiratory rhythm slowed and became coupled 1:1 with locomotion. In hindlimb-attached semi-isolated preparations, passive flexion-extension movements applied to a single hindlimb led to entrainment of fictive respiratory rhythmicity recorded in phrenic motoneurons, indicating that the recruitment of limb proprioceptive afferents could participate in the locomotor-respiratory coupling. Furthermore, in correspondence with the regionalization of spinal locomotor rhythm-generating circuitry, the stimulation of DRs at different segmental levels in isolated preparations revealed that cervical and lumbosacral proprioceptive inputs are more effective in this entraining influence than thoracic afferent pathways. Finally, blocking spinal synaptic transmission and using a combination of electrophysiology, calcium imaging and specific brainstem lesioning indicated that the ascending entraining signals from the cervical or lumbar limb afferents are transmitted across first-order synapses, probably monosynaptic, in the spinal cord. They are then conveyed to the brainstem respiratory centers via a brainstem pontine relay located in the parabrachial/Kölliker-Fuse nuclear complex.

Identification of the visceral pain pathway activated by noxious colorectal distension in mice.

PubMed

Kyloh, Melinda; Nicholas, Sarah; Zagorodnyuk, Vladimir P; Brookes, Simon J; Spencer, Nick J

2011-01-01

In patients with irritable bowel syndrome, visceral pain is evoked more readily following distension of the colorectum. However, the identity of extrinsic afferent nerve pathway that detects and transmits visceral pain from the colorectum to the spinal cord is unclear. In this study, we identified which extrinsic nerve pathway(s) underlies nociception from the colorectum to the spinal cord of rodents. Electromyogram recordings were made from the transverse oblique abdominal muscles in anesthetized wild type (C57BL/6) mice and acute noxious intraluminal distension stimuli (100-120 mmHg) were applied to the terminal 15 mm of colorectum to activate visceromotor responses (VMRs). Lesioning the lumbar colonic nerves in vivo had no detectable effect on the VMRs evoked by colorectal distension. Also, lesions applied to the right or left hypogastric nerves failed to reduce VMRs. However, lesions applied to both left and right branches of the rectal nerves abolished VMRs, regardless of whether the lumbar colonic or hypogastric nerves were severed. Electrical stimulation applied to either the lumbar colonic or hypogastric nerves in vivo, failed to elicit a VMR. In contrast, electrical stimulation (2-5 Hz, 0.4 ms, 60 V) applied to the rectum reliably elicited VMRs, which were abolished by selective lesioning of the rectal nerves. DiI retrograde labeling from the colorectum (injection sites 9-15 mm from the anus, measured in unstretched preparations) labeled sensory neurons primarily in dorsal root ganglia (DRG) of the lumbosacral region of the spinal cord (L6-S1). In contrast, injection of DiI into the mid to proximal colon (injection sites 30-75 mm from the anus, measured in unstretched preparations) labeled sensory neurons in DRG primarily of the lower thoracic level (T6-L2) of the spinal cord. The visceral pain pathway activated by acute noxious distension of the terminal 15 mm of mouse colorectum is transmitted predominantly, if not solely, through rectal/pelvic afferent nerve fibers to the spinal cord. The sensory neurons of this spinal afferent pathway lie primarily in the lumbosacral region of the spinal cord, between L6 and S1.

Percutaneous Pedicle-Lengthening Osteotomy in Minimal Invasive Spinal Surgery to Treat Degenerative Lumbar Spinal Stenosis: A Single-Center Preliminary Experience.

PubMed

Maugeri, Rosario; Basile, Luigi; Gulì, Carlo; Banco, Aurelia; Giordano, Giovanna; Giugno, Antonella; Graziano, Francesca; Giammalva, Roberto Giuseppe; Iacopino, Domenico Gerardo

2018-06-14

 Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal due to spinal degeneration, and its main clinical symptom is neurogenic claudication. Surgical treatment is pursued for patients who do not improve with conservative care. Patients with symptomatic LSS who also have significant medical comorbidities, although clearly in need of intervention, are unattractive candidates for traditional open lumbar decompressive procedures. Thus it is important to explore minimally invasive surgical techniques to treat select patients with LSS.  This retrospective case series evaluated the clinical and radiographic outcomes of a new minimally invasive procedure to treat LSS: pedicle-lengthening osteotomy using the ALTUM system ((Innovative Surgical Designs, Inc., Bloomington, Indiana, United States). Peri- and postoperative demographic and radiographic data were collected from a clinical series of seven patients with moderate LSS who were > 60 years of age. Clinical outcome was evaluated using visual analog scale (VAS) scores and the spinal canal area on computed tomography scans.  Twelve months after the procedure, scoring revealed a median improvement of 3.7 on the VAS for the back and 6.3 on the VAS for the leg, compared with the preoperative baseline ( p  < 0.05). The postoperative central area of the lumbar canal was significantly increased, by 0.39 cm 2 ; the right and left neural foramina were enlarged by 0.29 cm 2 and 0.47 cm 2 , respectively ( p  < 0.05).  In this preliminary study, the ALTUM system showed a good clinical and radiologic outcome 1 year after surgery. In an older or high-risk population, a short minimally invasive procedure may be beneficial for treating LSS. Georg Thieme Verlag KG Stuttgart · New York.

Validation of Patient Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Tests (CATs) in the Surgical Treatment of Lumbar Spinal Stenosis.

PubMed

Patel, Alpesh A; Dodwad, Shah-Nawaz M; Boody, Barrett S; Bhatt, Surabhi; Savage, Jason W; Hsu, Wellington K; Rothrock, Nan E

2018-03-19

Prospective, cohort study. Demonstrate validity of PROMIS physical function, pain interference, and pain behavior computer adaptive tests (CATs) in surgically treated lumbar stenosis patients. There has been increasing attention given to patient reported outcomes associated with spinal interventions. Historical patient outcome measures have inadequate validation, demonstrate floor/ceiling effects, and infrequently used due to time constraints. PROMIS is an adaptive, responsive NIH assessment tool that measures patient-reported health status. 98 consecutive patients were surgically treated for lumbar spinal stenosis and were assessed using PROMIS CATs, ODI, ZCQ and SF-12. Prior lumbar surgery, history of scoliosis, cancer, trauma, or infection were excluded. Completion time, preoperative assessment, 6 week and 3 month postoperative scores were collected. At baseline, 49%, 79%, and 81% of patients had PROMIS PB, PI, and PF scores greater than 1 SD worse than the general population. 50.6% were categorized as severely disabled, crippled, or bed bound by ODI. PROMIS CATs demonstrated convergent validity through moderate to high correlations with legacy measures (r = 0.35-0.73). PROMIS CATs demonstrated known groups validity when stratified by ODI levels of disability. ODI improvements of at least 10 points on average had changes in PROMIS scores in the expected direction (PI = -12.98, PB = -9.74, PF = 7.53). PROMIS CATs demonstrated comparable responsiveness to change when evaluated against legacy measures. PROMIS PB and PI decreased 6.66 and 9.62 and PROMIS PF increased 6.8 points between baseline and 3-months post-op (p < 0.001). Completion time for the PROMIS CATs (2.6 minutes) compares favorably to ODI, ZCQ, and SF-12 scores (3.1, 3.6, and 3.0 minutes). PROMIS CATs demonstrate convergent validity, known groups validity, and responsiveness for surgically treated patients with lumbar stenosis to detect change over time and are more efficient than legacy instruments. 2.

Comprehensive review of neurophysiologic basis and diagnostic interventions in managing chronic spinal pain.

PubMed

Manchikanti, Laxmaiah; Boswell, Mark V; Singh, Vijay; Derby, Richard; Fellows, Bert; Falco, Frank J E; Datta, Sukdeb; Smith, Howard S; Hirsch, Joshua A

2009-01-01

Understanding the neurophysiological basis of chronic spinal pain and diagnostic interventional techniques is crucial in the proper diagnosis and management of chronic spinal pain. Central to the understanding of the structural basis of chronic spinal pain is the provision of physical diagnosis and validation of patient symptomatology. It has been shown that history, physical examination, imaging, and nerve conduction studies in non-radicular or discogenic pain are unable to diagnose the precise cause in 85% of the patients. In contrast, controlled diagnostic blocks have been shown to determine the cause of pain in as many as 85% of the patients. To provide evidence-based clinical practice guidelines for diagnostic interventional techniques. Best evidence synthesis. Strength of evidence was assessed by the U.S. Preventive Services Task Force (USPSTF) criteria utilizing 5 levels of evidence ranging from Level I to III with 3 subcategories in Level II. Diagnostic criteria established by systematic reviews were utilized with controlled diagnostic blocks. Diagnostic criteria included at least 80% pain relief with controlled local anesthetic blocks with the ability to perform multiple maneuvers which were painful prior to the diagnostic blocks for facet joint and sacroiliac joint blocks, whereas for provocation discography, the criteria included concordant pain upon stimulation of the target disc with 2 adjacent discs producing no pain at all. The indicated level of evidence for diagnostic lumbar, cervical, and thoracic facet joint nerve blocks is Level I or II-1. The indicated evidence is Level II-2 for lumbar and cervical discography, whereas it is Level II-3 for thoracic provocation discography. The evidence for diagnostic sacroiliac joint nerve blocks is Level II-2. Level of evidence for selective nerve root blocks for diagnostic purposes is Level II-3. Limitations of this guideline preparation include a continued paucity of literature and conflicts in preparation of systematic reviews and guidelines. These guidelines include the evaluation of evidence for diagnostic interventional procedures in managing chronic spinal pain and recommendations. However, these guidelines do not constitute inflexible treatment recommendations. These guidelines also do not represent a "standard of care."

Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF

PubMed Central

Hey, Hwee Weng Dennis; Hee, Hwan Tak

2010-01-01

Degenerative disease of the lumbar spine is common in ageing populations. It causes disturbing back pain, radicular symptoms and lowers the quality of life. We will focus our discussion on the surgical options of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar degenerative spinal deformities, which include symptomatic spondylolisthesis and degenerative scoliosis. Through a description of each procedure, we hope to illustrate the potential benefits of TLIF over PLIF. In a retrospective study of 53 ALIF/PLIF patients and 111 TLIF patients we found reduced risk of vessel and nerve injury in TLIF patients due to less exposure of these structures, shortened operative time and reduced intra-operative bleeding. These advantages could be translated to shortened hospital stay, faster recovery period and earlier return to work. The disadvantages of TLIF such as incomplete intervertebral disc and vertebral end-plate removal and potential occult injury to exiting nerve root when under experienced hands are rare. Hence TLIF remains the mainstay of treatment in degenerative deformities of the lumbar spine. However, TLIF being a unilateral transforaminal approach, is unable to decompress the opposite nerve root. This may require contralateral laminotomy, which is a fairly simple procedure. The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to treat degenerative lumbar spinal deformity is still in its early stages. Although the initial results appear promising, it remains a difficult operative procedure to master with a steep learning curve. In a recent study comparing 29 MI-TLIF patients and 29 open TLIF, MI-TLIF was associated with longer operative time, less blood loss, shorter hospital stay, with no difference in SF-36 scores at six months and two years. Whether it can replace traditional TLIF as the surgery of choice for degenerative lumbar deformity remains unknown and more studies are required to validate the safety and efficiency. PMID:20419002

Lumbar subcutaneous edema and degenerative spinal disease in patients with low back pain: a retrospective MRI study.

PubMed

Quattrocchi, C C; Giona, A; Di Martino, A; Gaudino, F; Mallio, C A; Errante, Y; Occhicone, F; Vitali, M A; Zobel, B B; Denaro, V

2015-08-01

This study was designed to determine the association between LSE, spondylolisthesis, facet arthropathy, lumbar canal stenosis, BMI, radiculopathy and bone marrow edema at conventional lumbar spine MR imaging. This is a retrospective radiological study; 441 consecutive patients with low back pain (224 men and 217 women; mean age 57.3 years; mean BMI 26) underwent conventional lumbar MRI using a 1.5-T magnet (Avanto, Siemens). Lumbar MR images were reviewed by consensus for the presence of LSE, spondylolisthesis, facet arthropathy, lumbar canal stenosis, radiculopathy and bone marrow edema. Descriptive statistics and association studies were conducted using STATA software 11.0. Association studies have been performed using linear univariate regression analysis and multivariate regression analysis, considering LSE as response variable. The overall prevalence of LSE was 40%; spondylolisthesis (p = 0.01), facet arthropathy (p < 0.001), BMI (p = 0.008) and lumbar canal stenosis (p < 0.001) were included in the multivariate regression model, whereas bone marrow edema, radiculopathy and age were not. LSE is highly associated with spondylolisthesis, facet arthropathy and BMI, suggesting underestimation of its clinical impact as an integral component in chronic lumbar back pain. Longitudinal simultaneous X-ray/MRI studies should be conducted to test the relationship of LSE with lumbar spinal instability and low back pain.

Percutaneous full endoscopic lumbar foraminoplasty for adjacent level foraminal stenosis following vertebral intersegmental fusion in an awake and aware patient under local anesthesia: A case report.

PubMed

Yamashita, Kazuta; Higashino, Kosaku; Sakai, Toshinori; Takata, Yoichiro; Hayashi, Fumio; Tezuka, Fumitake; Morimoto, Masatoshi; Chikawa, Takashi; Nagamachi, Akihiro; Sairyo, Koichi

2017-01-01

Percutaneous endoscopic surgery for the lumbar spine has become established in the last decade. It requires only an 8 mm skin incision, causes minimal damage to the paravertebral muscles, and can be performed under local anesthesia. With the advent of improved equipment, in particular the high-speed surgical drill, the indications for percutaneous endoscopic surgery have expanded to include lumbar spinal canal stenosis. Transforaminal percutaneous endoscopic discectomy has been used to treat intervertebral stenosis. However, it has been reported that adjacent level disc degeneration and foraminal stenosis can occur following intervertebral segmental fusion. When this adjacent level pathology becomes symptomatic, additional fusion surgery is often needed. We performed minimally invasive percutaneous full endoscopic lumbar foraminoplasty in an awake and aware 50-year-old woman under local anesthesia. The procedure was successful with no complications. Her radiculopathy, including muscle weakness and leg pain due to impingement of the exiting nerve, improved after the surgery. J. Med. Invest. 64: 291-295, August, 2017.

Immune function, pain, and psychological stress in patients undergoing spinal surgery.

PubMed

Starkweather, Angela R; Witek-Janusek, Linda; Nockels, Russ P; Peterson, Jonna; Mathews, Herbert L

2006-08-15

This study was an exploratory repeated measures design comparing patients undergoing two magnitudes of surgery in the lumbar spine: lumbar herniated disc repair and posterior lumbar fusion. The present study evaluated and compared the effect of perceived pain, perceived stress, anxiety, and mood on natural killer cell activity (NKCA) and IL-6 production among adult patients undergoing lumbar surgery. Presurgical stress and anxiety can lead to detrimental patient outcomes after surgery, such as increased infection rates. It has been hypothesized that such outcomes are due to stress-immune alterations, which may be further exacerbated by the extent of surgery. However, psychologic stress, anxiety, and mood have not been previously characterized in patients undergoing spinal surgery. Pain, stress, anxiety, and mood were measured using self-report instruments at T1 (1 week before surgery), T2 (the day of surgery), T3 (the day after surgery), and T4 (6 weeks after surgery). Blood (30 mL) was collected for immune assessments at each time point. Pain, stress, anxiety, and mood state were elevated at baseline in both surgical groups and were associated with significant reduction in NKCA compared with the nonsurgical control group. A further decrease in NKCA was observed 24 hours after surgery in both surgical groups with a significant rise in stimulated IL-6 production, regardless of the magnitude of surgery. In the recovery period, NKCA increased to or above baseline values, which correlated with decreased levels of reported pain, perceived stress, anxiety, and mood state. This study demonstrated that patients undergoing elective spinal surgery are highly stressed and anxious, regardless of the magnitude of surgery and that such psychologic factors may mediate a reduction in NKCA.

Acute Communicating Hydrocephalus as Spinal Cord Surgery Complication in Patient with Lumbar Lipomyelocele.

PubMed

Prior, Alessandro; Severino, Mariasavina; Rossi, Andrea; Pavanello, Marco; Piatelli, Gianluca; Consales, Alessandro

2018-04-17

A lumbar lipomyelocele is a closed spinal dysraphism that can cause tethered cord syndrome. Between 5% and 15% of spinal dysraphism surgery cases are burdened with complications, the most common being wound infections or dehiscence and cerebrospinal fluid leak. Acute communicating hydrocephalus has never been described as a complication of this type of surgery. A 6-year-old girl who had undergone several surgeries in another institution for lumbar lipomyeloschisis came to our attention for a second opinion about the management of her spinal dysraphism. During the visit, she experienced sudden loss of consciousness. An emergent computed tomography scan revealed an acute communicating hydrocephalus. External ventricular drainage was performed with quick recovery of consciousness. Further craniospinal magnetic resonance imaging revealed small droplets of fat in the intracranial subarachnoid spaces and ventricular system, suggestive of rupture of the lipoma with consequent aseptic meningitis. This is the first description of acute communicating hydrocephalus as a complication of lipomyelocele surgery. We discuss the possible pathophysiologic mechanisms leading to cerebrospinal fluid dynamics alteration. Copyright © 2018 Elsevier Inc. All rights reserved.

Is dibotermin alfa a cost-effective substitute for autologous iliac crest bone graft in single level lumbar interbody spine fusion?

PubMed

Svedbom, Axel; Paech, Daniel; Leonard, Catherine; Donnell, David; Song, Fujian; Boszcyk, Bronek; Rothenfluh, Dominique A; Lloyd, Andrew; Borgman, Benny

2015-11-01

To evaluate the cost-effectiveness of dibotermin alfa compared with autologous iliac crest bone graft (ICBG) for patients undergoing single level lumbar interbody spinal fusion in a UK hospital setting. An individual patient data (IPD) meta-analysis of six randomized controlled clinical trials and two single arm trials compared dibotermin alfa on an absorbable collagen implantation matrix (ACIM) (n = 456) and ICBG (n = 244) on resource use, re-operation rates, and SF-6D (Short form 6-dimension) health utility (total N = 700). Failure-related second surgery, operating time, post-operative hospital stay, and quality-adjusted life years (QALYs) derived from the IPD meta-analysis were included as inputs in an economic evaluation undertaken to assess the cost-effectiveness of dibotermin alfa/ACIM versus ICBG for patients undergoing single level lumbar interbody spinal fusion. A four year time horizon and the United Kingdom (UK) National Health Service (NHS) and Personal Social Services (PSS) perspective was adopted in the base case, with sensitivity analyses performed to gauge parameter uncertainty. In the base case analysis, patients treated using dibotermin alfa/ACIM (12 mg pack) accrued 0.055 incremental QALYs at an incremental cost of £ 737, compared with patients treated with ICBG. This resulted in an incremental cost-effectiveness ratio (ICER) of £ 13,523, indicating that at a willingness-to-pay threshold of £ 20,000, dibotermin alfa/ACIM is a cost-effective intervention relative to ICBG from the NHS and PSS perspective. In a UK hospital setting, dibotermin alfa/ACIM is a cost-effective substitute for ICBG for patients who require lumbar interbody arthrodesis.

Human spinal locomotor control is based on flexibly organized burst generators.

PubMed

Danner, Simon M; Hofstoetter, Ursula S; Freundl, Brigitta; Binder, Heinrich; Mayr, Winfried; Rattay, Frank; Minassian, Karen

2015-03-01

Constant drive provided to the human lumbar spinal cord by epidural electrical stimulation can cause local neural circuits to generate rhythmic motor outputs to lower limb muscles in people paralysed by spinal cord injury. Epidural spinal cord stimulation thus allows the study of spinal rhythm and pattern generating circuits without their configuration by volitional motor tasks or task-specific peripheral feedback. To reveal spinal locomotor control principles, we studied the repertoire of rhythmic patterns that can be generated by the functionally isolated human lumbar spinal cord, detected as electromyographic activity from the legs, and investigated basic temporal components shared across these patterns. Ten subjects with chronic, motor-complete spinal cord injury were studied. Surface electromyographic responses to lumbar spinal cord stimulation were collected from quadriceps, hamstrings, tibialis anterior, and triceps surae in the supine position. From these data, 10-s segments of rhythmic activity present in the four muscle groups of one limb were extracted. Such samples were found in seven subjects. Physiologically adequate cycle durations and relative extension- and flexion-phase durations similar to those needed for locomotion were generated. The multi-muscle activation patterns exhibited a variety of coactivation, mixed-synergy and locomotor-like configurations. Statistical decomposition of the electromyographic data across subjects, muscles and samples of rhythmic patterns identified three common temporal components, i.e. basic or shared activation patterns. Two of these basic patterns controlled muscles to contract either synchronously or alternatingly during extension- and flexion-like phases. The third basic pattern contributed to the observed muscle activities independently from these extensor- and flexor-related basic patterns. Each bifunctional muscle group was able to express both extensor- and flexor-patterns, with variable ratios across the samples of rhythmic patterns. The basic activation patterns can be interpreted as central drives implemented by spinal burst generators that impose specific spatiotemporally organized activation on the lumbosacral motor neuron pools. Our data thus imply that the human lumbar spinal cord circuits can form burst-generating elements that flexibly combine to obtain a wide range of locomotor outputs from a constant, repetitive input. It may be possible to use this flexibility to incorporate specific adaptations to gait and stance to improve locomotor control, even after severe central nervous system damage. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Human spinal locomotor control is based on flexibly organized burst generators

PubMed Central

Danner, Simon M.; Hofstoetter, Ursula S.; Freundl, Brigitta; Binder, Heinrich; Mayr, Winfried; Rattay, Frank

2015-01-01

Constant drive provided to the human lumbar spinal cord by epidural electrical stimulation can cause local neural circuits to generate rhythmic motor outputs to lower limb muscles in people paralysed by spinal cord injury. Epidural spinal cord stimulation thus allows the study of spinal rhythm and pattern generating circuits without their configuration by volitional motor tasks or task-specific peripheral feedback. To reveal spinal locomotor control principles, we studied the repertoire of rhythmic patterns that can be generated by the functionally isolated human lumbar spinal cord, detected as electromyographic activity from the legs, and investigated basic temporal components shared across these patterns. Ten subjects with chronic, motor-complete spinal cord injury were studied. Surface electromyographic responses to lumbar spinal cord stimulation were collected from quadriceps, hamstrings, tibialis anterior, and triceps surae in the supine position. From these data, 10-s segments of rhythmic activity present in the four muscle groups of one limb were extracted. Such samples were found in seven subjects. Physiologically adequate cycle durations and relative extension- and flexion-phase durations similar to those needed for locomotion were generated. The multi-muscle activation patterns exhibited a variety of coactivation, mixed-synergy and locomotor-like configurations. Statistical decomposition of the electromyographic data across subjects, muscles and samples of rhythmic patterns identified three common temporal components, i.e. basic or shared activation patterns. Two of these basic patterns controlled muscles to contract either synchronously or alternatingly during extension- and flexion-like phases. The third basic pattern contributed to the observed muscle activities independently from these extensor- and flexor-related basic patterns. Each bifunctional muscle group was able to express both extensor- and flexor-patterns, with variable ratios across the samples of rhythmic patterns. The basic activation patterns can be interpreted as central drives implemented by spinal burst generators that impose specific spatiotemporally organized activation on the lumbosacral motor neuron pools. Our data thus imply that the human lumbar spinal cord circuits can form burst-generating elements that flexibly combine to obtain a wide range of locomotor outputs from a constant, repetitive input. It may be possible to use this flexibility to incorporate specific adaptations to gait and stance to improve locomotor control, even after severe central nervous system damage. PMID:25582580

The effect of the X-Stop implantation on intervertebral foramen, segmental spinal canal length and disc space in elderly patients with lumbar spinal stenosis.

PubMed

Wan, Zongmiao; Wang, Shaobai; Kozanek, Michal; Xia, Qun; Mansfield, Frederick L; Lü, Guohua; Wood, Kirkham B; Li, Guoan

2012-03-01

To evaluate the biomechanical effect of the X-Stop device on the intervertebral foramen (IVF) and segmental spinal canal length (SSCL), as well as the intervertebral disc space at the implanted and the adjacent segments in patients with lumbar spinal stenosis (LSS). Eight elderly patients with LSS, scheduled for X-stop implantation, were CT or MRI scanned to construct 3D vertebral models (L2-S1). Before and after the surgery, each patient was also imaged using a dual-fluoroscopic image system during weight-bearing standing and maximum extension-flexion. The positions of the vertebrae were then determined using an established 2D-3D model matching method. The data revealed that the postoperative IVF area was significantly increased by 32.9% (or 32 mm2) (p<0.05) and the IVF width was increased by 24.4% (or 1.1 mm, p=0.06) during extension, but with minimal change in standing and flexion. The IVF heights were significantly (p<0.05) increased at standing by 1.2 mm and extension by 1.8 mm, but not at flexion. The SSCL were significantly (p<0.05) increased at extension by 1.2 mm, but not at standing and flexion. Anterior disc space of the implanted level was significantly decreased from 8.0 to 6.6 mm during standing. The X-Stop implantation efficiently enlarged the IVF area in the elderly patients with LSS at the operated level with little biomechanical effect immediately on the superior and inferior adjacent levels. However, it reduced the anterior disc space at the implanted level.

Changes in Level of the Conus after Corrective Surgery for Scoliosis: MRI-Based Preliminary Study in 31 Patients

PubMed Central

Hong, Jae-Young; Park, Jung-Ho; Hur, Chang-Yong; Hong, Suk-Joo; Modi, Hitesh N

2011-01-01

Background Detection of postoperative spinal cord level change can provide basic information about the spinal cord status, and electrophysiological studies regarding this point should be conducted in the future. Methods To determine the changes in the spinal cord level postoperatively and the possible associated factors, we prospectively studied 31 patients with scoliosis. All the patients underwent correction and posterior fusion using pedicle screws and rods between January 2008 and March 2009. The pre- and postoperative conus medullaris levels were determined by matching the axial magnetic resonance image to the sagittal scout image. The patients were divided according to the change in the postoperative conus medullaris level. The change group was defined as the patients who showed a change of more than one divided section in the vertebral column postoperatively, and the parameters of the change and non-change groups were compared. Results The mean pre- and postoperative Cobb's angle of the coronal curve was 76.80° ± 17.19° and 33.23° ± 14.39°, respectively. Eleven of 31 patients showed a lower conus medullaris level postoperatively. There were no differences in the pre- and postoperative magnitude of the coronal curve, lordosis and kyphosis between the groups. However, the postoperative degrees of correction of the coronal curve and lumbar lordosis were higher in the change group. There were also differences in the disease entities between the groups. A higher percentage of patients with Duchene muscular dystrophy had a change in level compared to that of the patients with cerebral palsy (83.3% vs. 45.5%, respectively). Conclusions The conus medullaris level changed postoperatively in the patients with severe scoliosis. Overall, the postoperative degree of correction of the coronal curve was higher in the change group than that in the non-change group. The degrees of correction of the coronal curve and lumbar lordosis were related to the spinal cord level change after scoliosis correction. PMID:21369475

The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis.

PubMed

Yagi, Mitsuru; Hosogane, Naobumi; Watanabe, Kota; Asazuma, Takashi; Matsumoto, Morio

2016-04-01

Various factors are reported to affect the spinal alignment in degenerative lumbar scoliosis (DLS). Although trunk muscles also appear to affect spinal alignment, the role of the trunk muscles is not yet clear. The aim was to elucidate the role of the multifidus (MF) and psoas (PS) in maintaining global spinal alignment in patients with DLS. This was a multicenter retrospective matched cohort study. Surgically treated 60 paired DLS and lumbar spinal stenosis (LSS) female (120 patients), matched for age and body mass index (BMI; DLS age 68.0±6.8 vs. LSS 67.1±8.9 years; BMI 21.6±3.3 vs. 23.2±3.8 kg/m(2)), were included and were followed for at least 2 years. Spinal alignment, muscle area, and volume were measured from radiographs, magnetic resonance images (MRIs), and whole-body dual-energy X-ray absorptiometry (DXA) scans. Muscle strength was measured by grip power and peak expiratory flow (PEF). As a surrogate of muscle area, we obtained the cross-sectional area (CSA) at the L5-S level from preoperative MRIs. The MF and PS CSAs were significantly smaller in the DLS group than in the LSS group (MF 477.7±192.5 vs. 779.8±248.6 mm(2), p<.01; PS 692.3±201.2 vs. 943.4±272.4 mm(2), p=.002), whereas percentage of difference between the right and left sides was significantly larger in the DLS group (MF 18.4±30.6 vs. 2.4±3.3%, p<.01; PS 14.4±15.8 vs. 2.1±2.2%, p<.01). In the extremities, there were no significant differences in the left- or right-side lean composition and grip strength or PEF tests between the groups. Correlation coefficient tests showed moderate correlations between the MF average CSA (avCSA) and global spinal alignment and spinopelvic alignment (pelvic incidence-lumbar lordosis; R=-0.37, -0.38) in the DLS group. The MF avCSA was correlated with the postoperative progression of kyphosis at the unfused thoracic vertebrae in the DLS group (R=0.34). The CSAs of the MF and PS were significantly smaller in the DLS group. Whole-body DXA showed no significant difference in the lean composition between the groups. There were significant correlations in the DLS patients between the MF CSA and sagittal spinal alignment. These findings suggest the causal relationship between muscles and global spine alignment. Copyright © 2016 Elsevier Inc. All rights reserved.

Spinal Subdural Abscess Following Laminectomy for Symptomatic Stenosis: A Report of 2 Cases and Review of the Literature.

PubMed

Ramos, Alexander D; Rolston, John D; Gauger, Grant E; Larson, Paul S

2016-07-12

BACKGROUND Spinal subdural abscesses, also known as empyemas, are rare infectious lesions, the exact incidence of which is unknown. Presentation is typically dramatic, with back pain, fever, motor, and sensory deficits. Rapid identification and surgical intervention with laminectomy, durotomy, and washout provides the best outcomes. While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery. CASE REPORT Here we present 2 cases: 1) an 87-year-old man with type 2 diabetes, schizophrenia, mild cognitive impairment, and symptomatic lumbar spinal stenosis and 2) a 62-year-old man with a prior L3-4 spinal fusion with symptomatic lumbar spinal stenosis. In both cases, patients underwent laminectomy for spinal stenosis and developed epidural abscess. Following successful drainage of the epidural abscess, they continued to be symptomatic, and repeat imaging revealed the presence of a subdural abscess that was subsequently evacuated. Case 1 had significant improvement with residual lower-extremity weakness, while Case 2 made a complete neurological recovery. CONCLUSIONS These cases illustrate patients at increased risk for developing this rare spinal infection, and demonstrate that rapid recognition and surgical treatment is key to cure and recovery. Review of the literature highlights pertinent risk factors and demonstrates nearly one-third of reported cases have an iatrogenic etiology. The cases presented here demonstrate that a subdural process should be suspected in any patient with intractable pain following treatment of an epidural abscess.

MRI of the lumbar spine: comparison of 3D isotropic turbo spin-echo SPACE sequence versus conventional 2D sequences at 3.0 T.

PubMed

Lee, Sungwon; Jee, Won-Hee; Jung, Joon-Yong; Lee, So-Yeon; Ryu, Kyeung-Sik; Ha, Kee-Yong

2015-02-01

Three-dimensional (3D) fast spin-echo sequence with variable flip-angle refocusing pulse allows retrospective alignments of magnetic resonance imaging (MRI) in any desired plane. To compare isotropic 3D T2-weighted (T2W) turbo spin-echo sequence (TSE-SPACE) with standard two-dimensional (2D) T2W TSE imaging for evaluating lumbar spine pathology at 3.0 T MRI. Forty-two patients who had spine surgery for disk herniation and had 3.0 T spine MRI were included in this study. In addition to standard 2D T2W TSE imaging, sagittal 3D T2W TSE-SPACE was obtained to produce multiplanar (MPR) images. Each set of MR images from 3D T2W TSE and 2D TSE-SPACE were independently scored for the degree of lumbar neural foraminal stenosis, central spinal stenosis, and nerve compression by two reviewers. These scores were compared with operative findings and the sensitivities were evaluated by McNemar test. Inter-observer agreements and the correlation with symptoms laterality were assessed with kappa statistics. The 3D T2W TSE and 2D TSE-SPACE had similar sensitivity in detecting foraminal stenosis (78.9% versus 78.9% in 32 foramen levels), spinal stenosis (100% versus 100% in 42 spinal levels), and nerve compression (92.9% versus 81.8% in 59 spinal nerves). The inter-observer agreements (κ = 0.849 vs. 0.451 for foraminal stenosis, κ = 0.809 vs. 0.503 for spinal stenosis, and κ = 0.681 vs. 0.429 for nerve compression) and symptoms correlation (κ = 0.449 vs. κ = 0.242) were better in 3D TSE-SPACE compared to 2D TSE. 3D TSE-SPACE with oblique coronal MPR images demonstrated better inter-observer agreements compared to 3D TSE-SPACE without oblique coronal MPR images (κ = 0.930 vs. κ = 0.681). Isotropic 3D T2W TSE-SPACE at 3.0 T was comparable to 2D T2W TSE for detecting foraminal stenosis, central spinal stenosis, and nerve compression with better inter-observer agreements and symptom correlation. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Meningitis

MedlinePlus

... and spinal cord. This covering is called the meninges. Causes The most common causes of meningitis are ... Kernig's sign of meningitis Lumbar puncture (spinal tap) Meninges of the brain Meninges of the spine Haemophilus ...

Lumbar spine paraspinal muscle and intervertebral disc height changes in astronauts after long-duration spaceflight on the International Space Station

PubMed Central

Chang, DG; Healey, RM; Snyder, AJ; Sayson, JV; Macias, BR; Coughlin, DG; Bailey, JF; Parazynski, SE; Lotz, JC; Hargens, AR

2017-01-01

Study Design Prospective case series Objective Evaluate lumbar paraspinal muscle (PSM) cross-sectional area and intervertebral disc (IVD) height changes induced by a 6-month space mission on the International Space Station (ISS). The long-term objective of this project is to promote spine health and prevent spinal injury during space missions as well as here on Earth. Summary of Background NASA crewmembers have a 4.3 times higher risk of herniated IVDs, compared to the general and military aviator populations. The highest risk occurs during the first year after a mission. Microgravity exposure during long-duration spaceflights results in ~5cm lengthening of body height, spinal pain, and skeletal deconditioning. How the PSMs and IVDs respond during spaceflight is not well described. Methods Six NASA crewmembers were imaged supine with a 3T MRI. Imaging was conducted pre-flight, immediately post-flight and then 33 to 67 days after landing. Functional cross-sectional area (FCSA) measurements of the PSMs were performed at the L3-4 level. FCSA was measured by grayscale thresholding within the posterior lumbar extensors to isolate lean muscle on T2-weighted scans. IVD heights were measured at the anterior, middle and posterior sections of all lumbar levels. Repeated measures ANOVA was used to determine significance at p<0.05, followed by post-hoc testing. Results Paraspinal lean muscle mass, as indicated by the FCSA, decreased from 86% of the total PSM cross-sectional area down to 72%, immediately after the mission. Recovery of 68% of the post-flight loss occurred over the next 6 weeks, still leaving a significantly lower lean muscle fractional content compared to pre-flight values. In contrast, lumbar IVD heights were not appreciably different at any time point. Conclusions The data reveal lumbar spine PSM atrophy after long-duration spaceflight. Some FCSA recovery was seen with 46 days post-flight in a terrestrial environment, but it remained incomplete compared to pre-flight levels. PMID:27779600

Lumbar Puncture (Spinal Tap) (For Parents)

MedlinePlus

... specific bacteria growing in the sample, a bacterial culture is sent to the lab and these results ... treatment while waiting for the results of the culture. Risks A lumbar puncture is considered a safe ...

Workshop: The Technical Requirements for Image-Guided Therapy (Focus: Spinal Cord and Spinal Column)

DTIC Science & Technology

2000-02-01

degenerative disease, spondylosis , ligamental ossification, fractures, tumors, and other causes. Compression is a painful condition that may require...series of 7000 patients who underwent lumbar disk surgery, Long indicates three reasons for failed surgery: 1. Failure of the patient to meet the...validated outcomes measures in the lumbar area, is used for a 70-year-old patient with osteoarthritis of the knees and low back pain as well as problems

Sitting biomechanics, part II: optimal car driver's seat and optimal driver's spinal model.

PubMed

Harrison, D D; Harrison, S O; Croft, A C; Harrison, D E; Troyanovich, S J

2000-01-01

Driving has been associated with signs and symptoms caused by vibrations. Sitting causes the pelvis to rotate backwards and the lumbar lordosis to reduce. Lumbar support and armrests reduce disc pressure and electromyographically recorded values. However, the ideal driver's seat and an optimal seated spinal model have not been described. To determine an optimal automobile seat and an ideal spinal model of a driver. Information was obtained from peer-reviewed scientific journals and texts, automotive engineering reports, and the National Library of Medicine. Driving predisposes vehicle operators to low-back pain and degeneration. The optimal seat would have an adjustable seat back incline of 100 degrees from horizontal, a changeable depth of seat back to front edge of seat bottom, adjustable height, an adjustable seat bottom incline, firm (dense) foam in the seat bottom cushion, horizontally and vertically adjustable lumbar support, adjustable bilateral arm rests, adjustable head restraint with lordosis pad, seat shock absorbers to dampen frequencies in the 1 to 20 Hz range, and linear front-back travel of the seat enabling drivers of all sizes to reach the pedals. The lumbar support should be pulsating in depth to reduce static load. The seat back should be damped to reduce rebounding of the torso in rear-end impacts. The optimal driver's spinal model would be the average Harrison model in a 10 degrees posterior inclining seat back angle.

Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion.

PubMed

Willems, Paul

2013-02-01

Chronic low back pain (CLBP) is one of the main causes of disability in the western world with a huge economic burden to society. As yet, no specific underlying anatomic cause has been identified for CLBP. Imaging often reveals degenerative findings of the disc or facet joints of one or more lumbar motion segments. These findings, however, can also be observed in asymptomatic people. It has been suggested that pain in degenerated discs may be caused by the ingrowth of nerve fibers into tears or clefts of the annulus fibrosus or nucleus pulposus, and by reported high levels of pro-inflammatory mediators. As this so-called discogenic pain is often exacerbated by mechanical loading, the concept of relieving pain by spinal fusion to stabilise a painful spinal segment, has been developed. For some patients lumbar spinal fusion indeed is beneficial, but its results are highly variable and hard to predict for the individual patient. To identify those CLBP patients who will benefit from fusion, many surgeons rely on tests that are assumed to predict the outcome of spinal fusion. The three most commonly used prognostic tests in daily practice are immobilization in a lumbosacral orthosis, provocative discography and trial immobilization by temporary external transpedicular fixation. Aiming for consensus on the indications for lumbar fusion and in order to improve its results by better patient selection, it is essential to know the role and value of these prognostic tests for CLBP patients in clinical practice. The overall aims of the present thesis were: 1) to evaluate whether there is consensus among spine surgeons regarding the use and appreciation of prognostic tests for lumbar spinal fusion; 2) to verify whether a thoracolumbosacral orthosisis (TLSO) truly minimises lumbosacral motion; 3) to verify whether a TLSO can predict the clinical outcome of fusion for CLBP; 4) to assess whether provocative discography of adjacent segments actually predicts the long-term clinical outcome fusion; 5) to determine the incidence of postdiscography discitis, and whether there is a need for routine antibiotic prophylaxis; 6) to assess whether temporary external transpedicular fixation (TETF) can help to predict the outcome of spinal fusion; 7) to determine the prognostic accuracy of the most commonly used tests in clinical practice to predict the outcome of fusion for CLBP. The results of a national survey among spine surgeons in the Netherlands were presented in Study I. The surgeons were questioned about their opinion on prognostic factors and about the use of predictive tests for lumbar fusion in CLBP patients. The comments were compared with findings from the prevailing literature. The survey revealed a considerable lack of uniformity in the use and appreciation of predictive tests. Prognostic factors known from the literature were not consistently incorporated in the surgeons' decision making process either. This heterogeneity in strategy is most probably caused by the lack of sound scientific evidence for current predictive tests and it was concluded that currently there is not enough consensus among spine surgeons in the Netherlands to create national guidelines for surgical decision making in CLBP. In Study II, the hypothesized working mechanism of a pantaloon cast (i.e., minimisation of lumbosacral joint mobility) was studied. In patients who were admitted for a temporary external transpedicular fixation test (TETF), infrared light markers were rigidly attached to the protruding ends of Steinman pins that were fixed in two spinal levels. In this way three-dimensional motion between these levels could be analysed opto-electronically. During dynamic test conditions such as walking, a plaster cast, either with or without unilateral hip fixation, did not significantly decrease lumbosacral joint motion. Although not substantiated by sound scientific support, lumbosacral orthoses or pantaloon casts are often used in everyday practice as a predictor for the outcome of fusion. A systematic review of the literature supplemented with a prospective cohort study was performed (Study III) in order to assess the value of a pantaloon cast in surgical decision-making. It appeared that only in CLBP patients with no prior spine surgery, a pantaloon cast test with substantial pain relief suggests a favorable outcome of lumbar fusion compared to conservative treatment. In patients with prior spine surgery the test is of no value. It is believed by many spine surgeons that provocative discography, unlike plain radiographs or magnetic resonance imaging, is a physiologic test that can truly determine whether a disc is painful and relevant in a patient's pain syndrome, irrespective of the morphology of the disc. It has been suggested that in order to achieve a successful clinical outcome of lumbar fusion, suspect discs should be painful and adjacent control discs should elicit no pain on provocative discography. For this reason, a cohort of patients in whom the decision to perform lumbar fusion was based on an external fixation (TETF) trial, was analysed retrospectively in Study IV. The results of preoperative discography of solely the levels adjacent to the fusion were compared with the clinical results after spinal fusion. It appeared that in this select group of patients the discographic status of discs adjacent to a lumbar fusion did not have any effect on the clinical outcome. The most feared complication of lumbar discography is discitis. Although low in incidence, this is a serious complication for a diagnostic procedure and prevention by the use of prophylactic antibiotics has been advocated. In search for clinical guidelines, the risk of postdiscography discitis was assessed in Study V by means of a systematic literature review and a cohort of 200 consecutive patients. Without the use of prophylactic antibiotics, an overall incidence of postdiscography discitis of 0.25% was found. To prove that antibiotics would actually prevent discitis, a randomised trial of 9,000 patients would be needed to reach significance. Given the possible adverse effects of antibiotics, it was concluded that the routine use of prophylactic antibiotics in lumbar discography is not indicated. In Study VI, the middle- and long-term results of external fixation (TETF) as a test to predict the clinical outcome of lumbar fusion were studied in a group of back pain patients for whom there was doubt about the indication for surgery. The test included a placebo trial, in which the patients were unaware whether the lumbar segmental levels were fixed or dynamised. Using strict and objective criteria of pain reduction on a visual analogue scale, the TETF test failed to predict clinical outcome of fusion in this select group of patients. Pin track infection and nerve root irritation were registered as complications of this invasive test. It was concluded that in chronic low back pain patients with a doubtful indication for fusion, TETF is not recommended as a supplemental tool for surgical decision-making. In Study VII, a systematic literature review was performed regarding the prognostic accuracy of tests that are currently used in clinical practice and that are presumed to predict the outcome of lumbar spinal fusion for CLBP. The tests of interest were magnetic resonance imaging (MRI), TLSO immobilisation, TETF, provocative discography and facet joint infiltration. Only 10 studies reporting on three different index tests (discography, TLSO immobilisation and TETF) that truly reported on test qualifiers, such as sensitivity, specificity and likelihood ratios, could be selected. It appeared that the accuracy of all prognostic tests was low, which confirmed that in many clinical practices patients are scheduled for fusion on the basis of tests, of which the accuracy is insufficient or at best unknown. As the overall methodological quality of included studies was poor, higher quality trials that include negatively tested as well as positively tested patients for fusion, will be needed. It was concluded that at present, best evidence does not support the use of any prognostic test in clinical practice. No subset of patients with low back pain could be identified, for whom spinal fusion is a reliable and effective treatment. In literature, several studies have reported that cognitive behavioural therapy or intensive exercise programs have treatment results similar to those of spinal fusion, but with considerably less complications, morbidity and costs. As the findings of the present thesis show that the currently used tests do not improve the results of fusion by better patient selection, these tests should not be recommended for surgical decision making in standard care. Moreover, spinal fusion should not be proposed as a standard treatment for chronic low back pain. Causality of nonspecific spinal pain is complex and CLBP should not be regarded as a diagnosis, but rather as a symptom in patients with different stages of impairment and disability. Patients should be evaluated in a multidisciplinary setting or Spine Centre according to the so-called biopsychosocial model, which aims to identify underlying psychosocial factors as well as biological factors. Treatment should occur in a stepwise fashion starting with the least invasive treatment. The current approach of CLBP, in which emphasis is laid on self-management and empowerment of patients to take an active course of treatment in order to prevent long-term disability and chronicity, is recommended.

Transcutaneous spinal direct current stimulation of the lumbar and sacral spinal cord: a modelling study

NASA Astrophysics Data System (ADS)

Fernandes, Sofia R.; Salvador, Ricardo; Wenger, Cornelia; de Carvalho, Mamede; Miranda, Pedro C.

2018-06-01

Objective. Our aim was to perform a computational study of the electric field (E-field) generated by transcutaneous spinal direct current stimulation (tsDCS) applied over the thoracic, lumbar and sacral spinal cord, in order to assess possible neuromodulatory effects on spinal cord circuitry related with lower limb functions. Approach. A realistic volume conductor model of the human body consisting of 14 tissues was obtained from available databases. Rubber pad electrodes with a metallic connector and a conductive gel layer were modelled. The finite element (FE) method was used to calculate the E-field when a current of 2.5 mA was passed between two electrodes. The main characteristics of the E-field distributions in the spinal grey matter (spinal-GM) and spinal white matter (spinal-WM) were compared for seven montages, with the anode placed either over T10, T8 or L2 spinous processes (s.p.), and the cathode placed over right deltoid (rD), umbilicus (U) and right iliac crest (rIC) areas or T8 s.p. Anisotropic conductivity of spinal-WM and of a group of dorsal muscles near the vertebral column was considered. Main results. The average E-field magnitude was predicted to be above 0.15 V m-1 in spinal cord regions located between the electrodes. L2-T8 and T8-rIC montages resulted in the highest E-field magnitudes in lumbar and sacral spinal segments (>0.30 V m-1). E-field longitudinal component is 3 to 6 times higher than the ventral-dorsal and right-left components in both the spinal-GM and WM. Anatomical features such as CSF narrowing due to vertebrae bony edges or disks intrusions in the spinal canal correlate with local maxima positions. Significance. Computational modelling studies can provide detailed information regarding the electric field in the spinal cord during tsDCS. They are important to guide the design of clinical tsDCS protocols that optimize stimulation of application-specific spinal targets.

Percutaneous Decompression of Lumbar Spinal Stenosis with a New Interspinous Device

DOE Office of Scientific and Technical Information (OSTI.GOV)

Masala, Salvatore; Fiori, Roberto; Bartolucci, Dario Alberto, E-mail: bartolucci.md@gmail.com

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

Early Outcomes of Primary Total Hip Arthroplasty After Prior Lumbar Spinal Fusion.

PubMed

Barry, Jeffrey J; Sing, David C; Vail, Thomas P; Hansen, Erik N

2017-02-01

The coexistence of degenerative hip disease and spinal pathology is not uncommon with the number of surgical treatments performed for each condition increasing annually. The limited research available suggests spinal pathology portends less pain relief and worse outcomes after total hip arthroplasty (THA). We hypothesize that primary THA patients with preexisting lumbar spinal fusions (LSF) experience worse early postoperative outcomes. This study is a retrospective matched cohort study. Primary THA patients at 1 institution who had undergone prior LSF (spine arthrodesis-hip arthroplasty [SAHA]) were identified and matched to controls of primary THA without LSF. Early outcomes (<90 days) were compared. From 2012 to 2014, 35 SAHA patients were compared to 70 matched controls. Patients were similar in age, sex, American Society of Anesthesiologist score, body mass index, and Charlson Comorbidity Index. SAHA patients had higher rates of complications (31.4% vs 8.6%, P = .008), reoperation (14.3% vs 2.9%, P = .040), and general anesthesia (54.3% vs 5.7%, P = .0001). Bivariate analysis demonstrated SAHA to predict reoperation (odds ratio, 5.67; P = .045) and complications (odds ratio, 4.89; P = .005). With the numbers available, dislocations (0% vs 2.8%), infections (0% vs 8.6%), readmissions, postoperative walking distance, and disposition only trended to favor controls (P > .05). Comparing controls to SAHA patients with <3 or ≥3 levels fused, longer fusions had increased cumulative postoperative narcotic consumption (mean morphine equivalents, 44.3 vs 46.9 vs 169.4; P = .001). Patients with preexisting LSF experience worse early outcomes after primary THA including higher rates of complications and reoperation. Lower rates of neuraxial anesthesia and increased narcotic usage represent potential contributors. The complex interplay between the lumbar spine and hip warrants attention and further investigation. Copyright © 2016 Elsevier Inc. All rights reserved.

Transforaminal endoscopic treatment of lumbar radiculopathy after instrumented lumbar spine fusion.

PubMed

Telfeian, Albert E; Jasper, Gabriele P; Francisco, Gina M

2015-01-01

Transforaminal endoscopic discectomy and foraminotomy is a well-described minimally invasive technique for surgically treating lumbar radiculopathy caused by a herniated disc and foraminal narrowing. To describe the technique and feasibility of transforaminal foraminoplasty for the treatment of lumbar radiculopathy in patients who have already undergone instrumented spinal fusion. Retrospective study. Hospital and ambulatory surgery center After Institutional Review Board approval, charts from 18 consecutive patients with lumbar radiculopathy and instrumented spinal fusions who underwent endoscopic procedures between 2008 and 2013 were reviewed. The average pain relief one year postoperatively was reported to be 67.0%, good results as defined by MacNab. The average preoperative VAS score was 9.14, indicated in our questionnaire as severe and constant pain. The average one year postoperative VAS score was 3.00, indicated in our questionnaire as mild and intermittent pain. This is a retrospective study and only offers one year follow-up data for patients with instrumented fusions who have undergone endoscopic spine surgery. Transforaminal endoscopic discectomy and foraminotomy could be used as a safe, yet, minimally invasive and innovative technique for the treatment of lumbar radiculopathy in the setting of previous instrumented lumbar fusion. IRB approval: Meridian Health: IRB Study # 201206071J

Repetitive lifting tasks fatigue the back muscles and increase the bending moment acting on the lumbar spine.

PubMed

Dolan, P; Adams, M A

1998-08-01

During manual handling, the back muscles protect the spine from excessive flexion, but in doing so impose a high compressive force on it. Epidemiological links between back pain and repetitive lifting suggest that fatigued muscles may adversely affect the balance between bending and compression. Fifteen volunteers lifted and lowered a 10 kg weight from floor to waist height 100 times. Throughout this task, the bending moment acting on the osteoligamentous lumbar spine was estimated from continuous measurements of lumbar flexion, obtained using the 3-Space Isotrak. Spinal compression was estimated from the electromyographic (EMG) activity of the erector spinae muscles, recorded from skin-surface electrodes at the levels of T10 and L3. EMG signals were calibrated against force when subjects pulled up on a load cell, and correction factors were applied to account for changes in muscle length and contraction velocity. Fatigue in the erector spinae muscles was quantified by comparing the frequency content of their EMG signal during static contractions performed before, and immediately after, the 100 lifts. Results showed that peak lumbar flexion increased during the 100 lifts from 83.3 +/- 14.8% to 90.4 +/- 14.3%, resulting in a 36% increase in estimated peak bending moment acting on the lumbar spine (P = 0.008). Peak spinal compression fell by 11% (p = 0.007). The median frequency of the EMG signal at L3 decreased by 5.5% following the 100 lifts (p = 0.042) confirming that the erector spinae were fatigued, but measures of fatigue showed no significant correlation with increased bending. We conclude that repetitive lifting induces measurable fatigue in the erector spinae muscles, and substantially increases the bending moment acting on the lumbar spine.

Effect of Lumbar Lordosis on the Adjacent Segment in Transforaminal Lumbar Interbody Fusion: A Finite Element Analysis.

PubMed

Zhao, Xin; Du, Lin; Xie, Youzhuan; Zhao, Jie

2018-06-01

We used a finite element (FE) analysis to investigate the biomechanical changes caused by transforaminal lumbar interbody fusion (TLIF) at the L4-L5 level by lumbar lordosis (LL) degree. A lumbar FE model (L1-S5) was constructed based on computed tomography scans of a 30-year-old healthy male volunteer (pelvic incidence,= 50°; LL, 52°). We investigated the influence of LL on the biomechanical behavior of the lumbar spine after TLIF in L4-L5 fusion models with 57°, 52°, 47°, and 40° LL. The LL was defined as the angle between the superior end plate of L1 and the superior end plate of S1. A 150-N vertical axial preload was imposed on the superior surface of L3. A 10-N/m moment was simultaneously applied on the L3 superior surface along the radial direction to simulate the 4 basic physiologic motions of flexion, extension, lateral bending, and torsion in the numeric simulations. The range of motion (ROM) and intradiscal pressure (IDP) of L3-L4 were evaluated and compared in the simulated cases. In all motion patterns, the ROM and IDP were both increased after TLIF. In addition, the decrease in lordosis generally increased the ROM and IDP in all motion patterns. This FE analysis indicated that decreased spinal lordosis may evoke overstress of the adjacent segment and increase the risk of the pathologic development of adjacent segment degeneration; thus, adjacent segment degeneration should be considered when planning a spinal fusion procedure. Copyright © 2018. Published by Elsevier Inc.

Acute intermittent hypoxia and rehabilitative training following cervical spinal injury alters neuronal hypoxia- and plasticity-associated protein expression.

PubMed

Hassan, Atiq; Arnold, Breanna M; Caine, Sally; Toosi, Behzad M; Verge, Valerie M K; Muir, Gillian D

2018-01-01

One of the most promising approaches to improve recovery after spinal cord injury (SCI) is the augmentation of spontaneously occurring plasticity in uninjured neural pathways. Acute intermittent hypoxia (AIH, brief exposures to reduced O2 levels alternating with normal O2 levels) initiates plasticity in respiratory systems and has been shown to improve recovery in respiratory and non-respiratory spinal systems after SCI in experimental animals and humans. Although the mechanism by which AIH elicits its effects after SCI are not well understood, AIH is known to alter protein expression in spinal neurons in uninjured animals. Here, we examine hypoxia- and plasticity-related protein expression using immunofluorescence in spinal neurons in SCI rats that were treated with AIH combined with motor training, a protocol which has been demonstrated to improve recovery of forelimb function in this lesion model. Specifically, we assessed protein expression in spinal neurons from animals with incomplete cervical SCI which were exposed to AIH treatment + motor training either for 1 or 7 days. AIH treatment consisted of 10 episodes of AIH: (5 min 11% O2: 5 min 21% O2) for 7 days beginning at 4 weeks post-SCI. Both 1 or 7 days of AIH treatment + motor training resulted in significantly increased expression of the transcription factor hypoxia-inducible factor-1α (HIF-1α) relative to normoxia-treated controls, in neurons both proximal (cervical) and remote (lumbar) to the SCI. All other markers examined were significantly elevated in the 7 day AIH + motor training group only, at both cervical and lumbar levels. These markers included vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), and phosphorylated and nonphosphorylated forms of the BDNF receptor tropomyosin-related kinase B (TrkB). In summary, AIH induces plasticity at the cellular level after SCI by altering the expression of major plasticity- and hypoxia-related proteins at spinal regions proximal and remote to the SCI. These changes occur under the same AIH protocol which resulted in recovery of limb function in this animal model. Thus AIH, which induces plasticity in spinal circuitry, could also be an effective therapy to restore motor function after nervous system injury.

Differential expression of ryanodine receptor isoforms after spinal cord injury.

PubMed

Pelisch, Nicolas; Gomes, Cynthia; Nally, Jacqueline M; Petruska, Jeffrey C; Stirling, David P

2017-11-01

Ryanodine receptors (RyRs) are highly conductive intracellular Ca 2+ release channels and are widely expressed in many tissues, including the central nervous system. RyRs have been implicated in intracellular Ca 2+ overload which can drive secondary damage following traumatic injury to the spinal cord (SCI), but the spatiotemporal expression of the three isoforms of RyRs (RyR1-3) after SCI remains unknown. Here, we analyzed the gene and protein expression of RyR isoforms in the murine lumbar dorsal root ganglion (DRG) and the spinal cord lesion site at 1, 2 and 7 d after a mild contusion SCI. Quantitative RT PCR analysis revealed that RyR3 was significantly increased in lumbar DRGs and at the lesion site at 1 and 2 d post contusion compared to sham (laminectomy only) controls. Additionally, RyR2 expression was increased at 1 d post injury within the lesion site. RyR2 and -3 protein expression was localized to lumbar DRG neurons and their spinal projections within the lesion site acutely after SCI. In contrast, RyR1 expression within the DRG and lesion site remained unaltered following trauma. Our study shows that SCI initiates acute differential expression of RyR isoforms in DRG and spinal cord. Copyright © 2017 Elsevier B.V. All rights reserved.

Echodense spinal subarachnoid space in neonates with progressive ventricular dilatation: a marker of noncommunicating hydrocephalus.

PubMed

Rudas, G; Almássy, Z; Papp, B; Varga, E; Méder, U; Taylor, G A

1998-10-01

Our purpose was to evaluate the frequency and clinical significance of echogenic debris in the spinal subarachnoid space of neonates at risk for progressive ventricular dilatation. Spinal sonography was performed on 15 neonates with severe intracranial hemorrhage (n = 10) or bacterial meningitis (n = 5). Spinal sonography also was performed on 16 control neonates. Images were analyzed for the presence and location of echogeric debris within the thoracolumbar subarachnoid space. Lumbar punctures were performed on all 31 neonates, and CSF was analyzed for cell count and protein content. Ten of 15 neonates required ventricular drainage procedures. Progressive ventricular dilatation occurred in 11 of 15 neonates with intracranial hemorrhage or meningitis. Echogenic debris was present in the thoracolumbar subarachnoid space on spinal sonography in every neonate with progressive ventricular dilatation compared with none of the 16 control neonates (p < .0001 by chi-square analysis). In addition, the 11 neonates with echogenic subarachnoid space had significantly higher protein and RBC contents in the lumbar CSF (p < .04). Echogenic subarachnoid space revealed by sonography is associated with progressive ventricular dilatation after severe intracranial hemorrhage or bacterial meningitis and is caused by high protein and RBC contents in the subarachnoid space. This finding may be helpful in identifying neonates who will not benefit from serial lumbar punctures for treatment of hydrocephalus.

[Sacroiliac joint dysfunction with groin pain after an operation for lumbar spinal disorder. A case report].

PubMed

Shimoda, Yusuke; Morimoto, Daijiro; Isu, Toyohiko; Motegi, Hiroaki; Imai, Tetsuaki; Matsumoto, Ryouji; Isobe, Masanori; Kim, Kyongsong; Sugawara, Atsushi

2010-11-01

A 75-year-old male presented with groin pain after an operation to treat lumbar spondylolisthesis (L5). Groin tenderness was localized to the medial border of the anterior superior iliac spine (ASIS). Radiographical and physical examination raised the suspicion of sacroiliac joint (SIJ) dysfunction. Injection of a painkiller into the SIJ relieved symptoms, including groin tenderness. Symptoms improved gradually, and finally disappeared after five SIJ injections. Groin pain has been reported as a referred symptom of SIJ dysfunction in 9.3-23% of patients. Prior to the patient undergoing surgery to treat lumbar spondylolisthesis, SIJ dysfunction had not been noted on physical examination. Long periods spent in the abnormal posture due to lumbar spondylolisthesis induced SIJ stress. After the operation, an improvement in daily activity actually increased stress on the SIJ, resulting in SIJ dysfunction. Certain pathologies, including SIJ dysfunction, should be considered as residual symptoms after operations for lumbar spinal diseases.

One-stage posterior debridement, transforaminal lumbar interbody fusion and instrumentation in treatment of lumbar spinal tuberculosis: a retrospective case series.

PubMed

Zhang, Hong-qi; Lin, Min-zhong; Li, Jin-song; Tang, Ming-xing; Guo, Chao-feng; Wu, Jian-huang; Liu, Jin-yang

2013-03-01

The purpose of this study is to compare the clinical outcomes of surgical management by one-stage posterior debridement, transforaminal lumbar interbody fusion (TLIF) and instrumentation and combined posterior and anterior approaches for lumbar spinal tuberculosis, and determine the clinical effectiveness of the posterior only surgical treatment for lumbar spinal TB at the same time. Thirty-seven patients who suffered lumbar tuberculosis were treated by two different surgical procedures in our center from May 2004 to June 2012. All the cases were divided into two groups: 19 cases in Group A underwent one-stage posterior debridement, TLIF and instrumentation, and 18 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single-stage procedure. The operation time, blood loss, lumbar kyphotic angle, recovery of neurological function and fusion time were, respectively, compared between Group A and Group B. The average follow-up period for Group A was 46.6 ± 16.7 months, and for Group B, 47.5 ± 15.0 months. It was obvious that the average operative duration and blood loss of Group A was less than those of Group B. Lumbar tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. The average pretreatment ESR was 60.7 ± 22.5 mm/h, which became normal (9.0 ± 2.8 mm/h) within 3 months in all patients. Surgical management by one-stage posterior debridement, TLIF and instrumentation for lumbar tuberculosis is feasible and effective. This approach obtained better clinical outcomes than combined posterior and anterior surgeries.

Injury-Dependent and Disability-Specific Lumbar Spinal Gene Regulation following Sciatic Nerve Injury in the Rat

PubMed Central

Denyer, Gareth S.; Keay, Kevin A.

2015-01-01

Allodynia, hyperalgesia and spontaneous pain are cardinal sensory signs of neuropathic pain. Clinically, many neuropathic pain patients experience affective-motivational state changes, including reduced familial and social interactions, decreased motivation, anhedonia and depression which are severely debilitating. In earlier studies we have shown that sciatic nerve chronic constriction injury (CCI) disrupts social interactions, sleep-wake-cycle and endocrine function in one third of rats, a subgroup reliably identified six days after injury. CCI consistently produces allodynia and hyperalgesia, the intensity of which was unrelated either to the altered social interactions, sleep-wake-cycle or endocrine changes. This decoupling of the sensory consequences of nerve injury from the affective-motivational changes is reported in both animal experiments and human clinical data. The sensory changes triggered by CCI are mediated primarily by functional changes in the lumbar dorsal horn, however, whether lumbar spinal changes may drive different affective-motivational states has never been considered. In these studies, we used microarrays to identify the unique transcriptomes of rats with altered social behaviours following sciatic CCI to determine whether specific patterns of lumbar spinal adaptations characterised this subgroup. Rats underwent CCI and on the basis of reductions in dominance behaviour in resident-intruder social interactions were categorised as having Pain & Disability, Pain & Transient Disability or Pain alone. We examined the lumbar spinal transcriptomes two and six days after CCI. Fifty-four ‘disability-specific’ genes were identified. Sixty-five percent were unique to Pain & Disability rats, two-thirds of which were associated with neurotransmission, inflammation and/or cellular stress. In contrast, 40% of genes differentially regulated in rats without disabilities were involved with more general homeostatic processes (cellular structure, transcription or translation). We suggest that these patterns of gene expression lead to either the expression of disability, or to resilience and recovery, by modifying local spinal circuitry at the origin of ascending supraspinal pathways. PMID:25905723

Injury-Dependent and Disability-Specific Lumbar Spinal Gene Regulation following Sciatic Nerve Injury in the Rat.

PubMed

Austin, Paul J; Bembrick, Alison L; Denyer, Gareth S; Keay, Kevin A

2015-01-01

Allodynia, hyperalgesia and spontaneous pain are cardinal sensory signs of neuropathic pain. Clinically, many neuropathic pain patients experience affective-motivational state changes, including reduced familial and social interactions, decreased motivation, anhedonia and depression which are severely debilitating. In earlier studies we have shown that sciatic nerve chronic constriction injury (CCI) disrupts social interactions, sleep-wake-cycle and endocrine function in one third of rats, a subgroup reliably identified six days after injury. CCI consistently produces allodynia and hyperalgesia, the intensity of which was unrelated either to the altered social interactions, sleep-wake-cycle or endocrine changes. This decoupling of the sensory consequences of nerve injury from the affective-motivational changes is reported in both animal experiments and human clinical data. The sensory changes triggered by CCI are mediated primarily by functional changes in the lumbar dorsal horn, however, whether lumbar spinal changes may drive different affective-motivational states has never been considered. In these studies, we used microarrays to identify the unique transcriptomes of rats with altered social behaviours following sciatic CCI to determine whether specific patterns of lumbar spinal adaptations characterised this subgroup. Rats underwent CCI and on the basis of reductions in dominance behaviour in resident-intruder social interactions were categorised as having Pain & Disability, Pain & Transient Disability or Pain alone. We examined the lumbar spinal transcriptomes two and six days after CCI. Fifty-four 'disability-specific' genes were identified. Sixty-five percent were unique to Pain & Disability rats, two-thirds of which were associated with neurotransmission, inflammation and/or cellular stress. In contrast, 40% of genes differentially regulated in rats without disabilities were involved with more general homeostatic processes (cellular structure, transcription or translation). We suggest that these patterns of gene expression lead to either the expression of disability, or to resilience and recovery, by modifying local spinal circuitry at the origin of ascending supraspinal pathways.

Subpial Adeno-associated Virus 9 (AAV9) Vector Delivery in Adult Mice.

PubMed

Tadokoro, Takahiro; Miyanohara, Atsushi; Navarro, Michael; Kamizato, Kota; Juhas, Stefan; Juhasova, Jana; Marsala, Silvia; Platoshyn, Oleksandr; Curtis, Erik; Gabel, Brandon; Ciacci, Joseph; Lukacova, Nada; Bimbova, Katarina; Marsala, Martin

2017-07-13

The successful development of a subpial adeno-associated virus 9 (AAV9) vector delivery technique in adult rats and pigs has been reported on previously. Using subpially-placed polyethylene catheters (PE-10 or PE-5) for AAV9 delivery, potent transgene expression through the spinal parenchyma (white and gray matter) in subpially-injected spinal segments has been demonstrated. Because of the wide range of transgenic mouse models of neurodegenerative diseases, there is a strong desire for the development of a potent central nervous system (CNS)-targeted vector delivery technique in adult mice. Accordingly, the present study describes the development of a spinal subpial vector delivery device and technique to permit safe and effective spinal AAV9 delivery in adult C57BL/6J mice. In spinally immobilized and anesthetized mice, the pia mater (cervical 1 and lumbar 1-2 spinal segmental level) was incised with a sharp 34 G needle using an XYZ manipulator. A second XYZ manipulator was then used to advance a blunt 36G needle into the lumbar and/or cervical subpial space. The AAV9 vector (3-5 µL; 1.2 x 10 13 genome copies (gc)) encoding green fluorescent protein (GFP) was then injected subpially. After injections, neurological function (motor and sensory) was assessed periodically, and animals were perfusion-fixed 14 days after AAV9 delivery with 4% paraformaldehyde. Analysis of horizontal or transverse spinal cord sections showed transgene expression throughout the entire spinal cord, in both gray and white matter. In addition, intense retrogradely-mediated GFP expression was seen in the descending motor axons and neurons in the motor cortex, nucleus ruber, and formatio reticularis. No neurological dysfunction was noted in any animals. These data show that the subpial vector delivery technique can successfully be used in adult mice, without causing procedure-related spinal cord injury, and is associated with highly potent transgene expression throughout the spinal neuraxis.

The distribution and origin of a novel brain peptide, neuropeptide Y, in the spinal cord of several mammals.

PubMed

Gibson, S J; Polak, J M; Allen, J M; Adrian, T E; Kelly, J S; Bloom, S R

1984-07-20

The distribution of neuropeptide Y [NPY]-immunoreactive material was examined in the spinal cord and dorsal root ganglia of rat, guinea-pig, cat, marmoset, and horse. Considerable concentrations of NPY and similar distribution patterns of immunoreactive nerve fibres were found in the spinal cord of all species investigated. The dorsal root ganglia of the cat and the horse contained numerous immunoreactive nerve fibres, but in these species, as in the other three studied [rat, guinea-pig, marmoset], no positively stained cell bodies were found. Neuropeptide Y-immunoreactive nerves were observed at all levels of the spinal cord, being most concentrated in the dorsal horn. In the rat, guinea-pig, and marmoset, there was a marked increase of NPY-immunoreactive fibres in the lumbosacral regions of the spinal cord, and this was reflected by a considerable increase of extractable NPY. Estimations of NPY-immunoreactive material in the various regions of the rat spinal cord were as follows: cervical, 13.8 +/- 1.0; thoracic, 21.1 +/- 2.5; lumbar, 16.3 +/- 2.9; sacral, 92.4 +/- 8.5 pmol/gm wet weight of tissue +/- SEM. In the ventral portion of the guinea-pig spinal cord they were as follows: cervical, 7.1 +/- 1.2; thoracic, 8.2 +/- 3.6; lumbar, 22.6 +/- 7.0; sacral, 36.7 +/- 9.5 pmol/gm wet weight of tissue +/- SEM. Analysis of spinal cord extracts by reverse phase high performance liquid chromatography [HPLC] demonstrated that NPY-immunoreactive material elutes in the position of pure NPY standard. No changes in the concentration and distribution of the NPY-like material in the rat spinal cord were observed following a variety of surgical and pharmacological manipulations, including cervical rhizotomy, sciatic nerve section and ligation, and local application of capsaicin [50 mM] to one sciatic nerve. It is therefore suggested that most of the NPY-immunoreactive material in the spinal cord is derived either from intrinsic nerve cell bodies or from supraspinal tracts.

Epidemiology, Treatment, and Prevention of Lumbar Spine Injuries in Major League Baseball Players.

PubMed

Camp, Christopher L; Conti, Matthew S; Sgroi, Terrance; Cammisa, Frank P; Dines, Joshua S

2016-01-01

In recent years, increased attention has been paid to injuries occurring in Major League Baseball (MLB) players. Although most of the current orthopedic literature regarding baseball injuries pertains to the shoulder and elbow, lumbar spine injuries are another common reason for time out of play. Back and core injuries may represent as many as 12% of all injuries that result in time out of play from MLB. This high rate of injury is likely related to the critical role that the spine plays in every major baseball-related movement. Linking the upper extremities to the hips and lower extremities, a healthy, strong, and stable spine and core is a prerequisite for performance in all levels of baseball. It has been well documented that baseball players with poor spinal control and stabilization are at increased risk for future injury. Common etiologies of lumbar injuries include stress fractures, muscle injury, annular tears with or without disc herniation, facet joint pain, sacroiliac joint pain, and stenosis. This review discusses the epidemiology of spinal injuries in baseball. Special attention is paid to the role of the spine in baseball-related activities, common injuries, tips for making the correct diagnosis, treatment options, outcomes, rehabilitation, and injury prevention.

Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgery.

PubMed

Oliveira, Marcio Aparecido; Vidotto, Milena Carlos; Nascimento, Oliver Augusto; Almeida, Renato; Santoro, Ilka Lopes; Sperandio, Evandro Fornias; Jardim, José Roberto; Gazzotti, Mariana Rodrigues

2015-01-01

Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. Prospective study in a tertiary-level university hospital. Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.

Quadratus lumborum asymmetry and lumbar spine injury in cricket fast bowlers.

PubMed

Kountouris, Alex; Portus, Marc; Cook, Jill

2012-09-01

Previous studies have demonstrated quadratus lumborum asymmetry in cricket fast bowlers, but there has been conflicting evidence regarding the relationship to lumbar spine injury, particularly vertebral bone stress injuries. This study investigated the relationship between quadratus lumborum asymmetry and lumbar spine injury in adolescent cricket fast bowlers. The study was a prospective cohort design. Magnetic resonance imaging of 38 adolescent cricket fast bowlers was completed prior to a cricket season, and the cross sectional area of the quadratus lumborum muscle was measured at each lumbar spinal level. The bowlers were followed through the cricket season and those that reported lumbar spine injuries were investigated and classified as either having a soft tissue injury or a bone stress injury. The pre-season cross sectional area of quadratus lumborum was associated with injury status at the conclusion of the cricket season. Twenty-one percent of the cohort developed lumbar bone stress injuries during the cricket season. There was no significant relationship between lumbar spine injury and quadratus lumborum cross sectional area. A high incidence of lumbar bone stress injuries was demonstrated in adolescent fast bowlers. Unlike previous research that demonstrated a link between lumbar spine bone stress injuries and quadratus lumborum cross-sectional area, no such relationship was found. Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Determination of the Chronic Mammalian Toxicological Effects of TNT (twenty-Four Month Chronic Toxicity/Carcinogenicity Study of Trinitrotoluene (TNT) in the Fischer 344 Rat). Volume 1

DTIC Science & Technology

1984-12-01

the study were also analyzed for nitrate, nitrite and mercury content by TEl. 200 Fischer 344 rats, obtained from Harlan Sprague-Dawley, Madison , WI...Iles Pancreas Pituitary gland Prostate Rectum Salivary gland Sciatic nerve Seminal vesicles Skin, abdominal Spinal cord (cervical, thoracic, lumbar ...Skin, abdominal Spinal cord (cervical, thoracic and lumbar ) Sp I een Sternum Including bone marrow Stomach TIssue masses Thyroids (parathyrolds

Effect of spinal manipulation on the development of history-dependent responsiveness of lumbar paraspinal muscle spindles in the cat

PubMed Central

Cao, Dong-Yuan; Pickar, Joel G.

2014-01-01

We determined whether spinal manipulation could prevent and/or reverse the decrease and increase in paraspinal muscle spindle responsiveness caused respectively by lengthening and shortening histories of the lumbar muscles. Single unit spindle activity from multifidus and longissimus muscles was recorded in the L6 dorsal root in anesthetized cats. Muscle history was created and spinal manipulation delivered (thrust amplitude: 1.0mm, duration: 100ms) using a feedback-controlled motor attached to the L6 spinous process. Muscle spindle discharge to a fixed vertebral position (static test) and to vertebral movement (dynamic test) was evaluated following the lengthening and shortening histories. For the static test, changes in muscle spindle responsiveness were significantly less when spinal manipulation followed muscle history (p<0.01), but not when spinal manipulation preceded it (p>0.05). For the dynamic test, spinal manipulation did not significantly affect the history-induced change in muscle spindle responsiveness. Spinal manipulation may partially reverse the effects of muscle history on muscle spindle signaling of vertebral position. PMID:24932019

The association of spinal osteoarthritis with lumbar lordosis

PubMed Central

2010-01-01

Background Careful review of published evidence has led to the postulate that the degree of lumbar lordosis may possibly influence the development and progression of spinal osteoarthritis, just as misalignment does in other joints. Spinal degeneration can ensue from the asymmetrical distribution of loads. The resultant lesions lead to a domino- like breakdown of the normal morphology, degenerative instability and deviation from the correct configuration. The aim of this study is to investigate whether a relationship exists between the sagittal alignment of the lumbar spine, as it is expressed by lordosis, and the presence of radiographic osteoarthritis. Methods 112 female subjects, aged 40-72 years, were examined in the Outpatients Department of the Orthopedics' Clinic, University Hospital of Heraklion, Crete. Lumbar radiographs were examined on two separate occasions, independently, by two of the authors for the presence of osteoarthritis. Lordosis was measured from the top of L1 to the bottom of L5 as well as from the top of L1 to the top of S1. Furthermore, the angle between the bottom of L5 to the top of S1was also measured. Results and discussion 49 women were diagnosed with radiographic osteoarthritis of the lumbar spine, while 63 women had no evidence of osteoarthritis and served as controls. The two groups were matched for age and body build, as it is expressed by BMI. No statistically significant differences were found in the lordotic angles between the two groups Conclusions There is no difference in lordosis between those affected with lumbar spine osteoarthritis and those who are disease free. It appears that osteoarthritis is not associated with the degree of lumbar lordosis. PMID:20044932

Hybrid Rigid-Deformable Model for Prediction of Neighboring Intervertebral Disk Loads During Flexion Movement After Lumbar Interbody Fusion at L3-4 Level.

PubMed

Tuan Dao, Tien

2017-03-01

Knowledge of spinal loads in neighboring disks after interbody fusion plays an important role in the clinical decision of this treatment as well as in the elucidation of its effect. However, controversial findings are still noted in the literature. Moreover, there are no existing models for efficient prediction of intervertebral disk stresses within annulus fibrosus (AF) and nucleus pulposus (NP) regions. In this present study, a new hybrid rigid-deformable modeling workflow was established to quantify the mechanical stress behaviors within AF and NP regions of the L1-2, L2-3, and L4-5 disks after interbody fusion at L3-4 level. The changes in spinal loads were compared with results of the intact model without interbody fusion. The fusion outcomes revealed maximal stress changes (10%) in AF region of L1-2 disk and in NP region of L2-3 disk. The minimal stress change (1%) is noted at the NP region of the L1-2 disk. The validation of simulation outcomes of fused and intact lumbar spine models against those of other computational models and in vivo measurements showed good agreements. Thus, this present study may be used as a novel design guideline for a specific implant and surgical scenario of the lumbar spine disorders.

Geometric Structure of 3D Spinal Curves: Plane Regions and Connecting Zones

PubMed Central

Berthonnaud, E.; Hilmi, R.; Dimnet, J.

2012-01-01

This paper presents a new study of the geometric structure of 3D spinal curves. The spine is considered as an heterogeneous beam, compound of vertebrae and intervertebral discs. The spine is modeled as a deformable wire along which vertebrae are beads rotating about the wire. 3D spinal curves are compound of plane regions connected together by zones of transition. The 3D spinal curve is uniquely flexed along the plane regions. The angular offsets between adjacent regions are concentrated at level of the middle zones of transition, so illustrating the heterogeneity of the spinal geometric structure. The plane regions along the 3D spinal curve must satisfy two criteria: (i) a criterion of minimum distance between the curve and the regional plane and (ii) a criterion controlling that the curve is continuously plane at the level of the region. The geometric structure of each 3D spinal curve is characterized by the sizes and orientations of regional planes, by the parameters representing flexed regions and by the sizes and functions of zones of transition. Spinal curves of asymptomatic subjects show three plane regions corresponding to spinal curvatures: lumbar, thoracic and cervical curvatures. In some scoliotic spines, four plane regions may be detected. PMID:25031873

Procedure Selection and Patient Positioning Influence Spine Kinematics During High-Velocity, Low-Amplitude Spinal Manipulation Applied to the Low Back.

PubMed

Bell, Spencer; D'Angelo, Kevin; Kawchuk, Gregory N; Triano, John J; Howarth, Samuel J

This investigation compared indirect 3-dimensional angular kinematics (position, velocity, and acceleration) of the lumbar spine for 2 different high-velocity, low-amplitude (HVLA) spinal manipulation procedures (lumbar spinous pull or push), and altered initial patient lower limb posture. Twenty-four participants underwent 6 HVLA procedures directed toward the presumed L4 vertebra, reflecting each combination of 2 variants of a spinal manipulation application technique (spinous pull and push) and 3 initial hip flexion angles (0°, 45°, and 90°) applied using a right lateral recumbent patient position. All contact forces and moments between the patient and the external environment, as well as 3-dimensional kinematics of the patient's pelvis and thorax, were recorded. Lumbar spine angular positions, velocities, and accelerations were analyzed within the preload and impulse stages of each HVLA trial. Lumbar spine left axial rotation was greater for the pull HVLA. The pull HVLA also generated a greater maximum (leftward) and lower minimum (rightward) axial rotation velocity and deceleration and greater leftward and rightward lateral bend velocities, acceleration, and deceleration components. Not flexing the hip produced the greatest amount of extension, as well as the lowest axial rotation and maximum axial rotation acceleration during the impulse. This investigation provides basic kinematic information for clinicians to understand the similarities and differences between 2 HVLA side-lying manipulations in the lumbar spine. Use of these findings and novel technology can drive future research initiatives that can both affect clinical decision making and influence teaching environments surrounding spinal manipulative therapy skill acquisition. Copyright © 2017. Published by Elsevier Inc.

Postoperative dysesthesia in lumbar three-column resection osteotomies.

PubMed

Zhang, Zhengfeng; Wang, Honggang; Zheng, Wenjie

2016-08-01

Three-column lumbar spinal resection osteotomies including pedicle subtraction osteotomy (PSO), vertebral column resection (VCR), and total en bloc spondylectomy (TES) can potentially lead to dorsal root ganglion (DRG) injury which may cause postoperative dysesthesia (POD). The purpose of retrospective study was to describe the uncommon complication of POD in lumbar spinal resection osteotomies. Between January 2009 and December 2013, 64 patients were treated with lumbar three-column spinal resection osteotomies (PSO, n = 31; VCR, n = 29; TES, n = 4) in investigator group. POD was defined as dysesthetic pain or burning dysesthesia at a proper DRG innervated region, whether spontaneous or evoked. Non-steroidal antiinflammatory drugs, central none-opioid analgesic agent, neuropathic pain drugs and/or intervertebral foramen block were selectively used to treat POD. There were 5 cases of POD (5/64, 7.8 %), which consisted of 1 patient in PSO (1/31, 3.2 %), 3 patients in PVCR (3/29, 10.3 %), and 1 patient in TES (1/4, 25 %). After the treatment by drugs administration plus DRG block, all patients presented pain relief with duration from 8 to 38 days. A gradual pain moving to distal end of a proper DRG innervated region was found as the beginning of end. Although POD is a unique and rare complication and maybe misdiagnosed as nerve root injury in lumbar spinal resection osteotomies, combination drug therapy and DRG block have an effective result of pain relief. The appearance of a gradual pain moving to distal end of a proper DRG innervated region during recovering may be used as a sign for the good prognosis.

Characterization of spinal injuries sustained by American service members killed in Iraq and Afghanistan: a study of 2,089 instances of spine trauma.

PubMed

Schoenfeld, Andrew J; Newcomb, Ronald L; Pallis, Mark P; Cleveland, Andrew W; Serrano, Jose A; Bader, Julia O; Waterman, Brian R; Belmont, Philip J

2013-04-01

This study sought to characterize spine injuries among soldiers killed in Iraq or Afghanistan whose autopsy results were stored by the Armed Forces Medical Examiner System. The Armed Forces Medical Examiner System data set was queried to identify American military personnel who sustained a spine injury in conjunction with wounds that resulted in death during deployment in Iraq or Afghanistan from 2003 to 2011. Demographic and injury-specific characteristics were abstracted for each individual identified. The raw incidence of spinal injuries was calculated and correlations were drawn between the presence of spinal trauma and military specialty, mechanism and manner of injury, and wounds in other body regions. Significant associations were also sought for specific injury patterns, including spinal cord injury, atlantooccipital injury, low lumbar vertebral fractures, and lumbosacral dissociation. Statistical calculations were performed using χ statistic, z test, t test with Satterthwaite correction, and multivariate logistic regression. Among 5,424 deceased service members, 2,089 (38.5%) were found to have sustained at least one spinal injury. Sixty-seven percent of all fatalities with spinal injury were caused by explosion, while 15% occurred by gunshot. Spinal fracture was the most common type of injury (n = 2,328), while spinal dislocations occurred in 378, and vertebral column transection occurred in 223. Fifty-two percent sustained at least one cervical spine injury, and spinal cord injury occurred in 40%. Spinal cord injuries were more likely to occur as a result of gunshot (p < 0.001), while atlantooccipital injuries (p < 0.001) and low lumbar fractures (p = 0.01) were significantly higher among combat specialty soldiers. No significant association was identified between spinal injury risk and the periods 2003 to 2007 and 2008 to 2011, although atlantooccipital injuries and spinal cord injury were significantly reduced beginning in 2008 (p < 0.001). The results of this study indicate that the incidence of spinal trauma in modern warfare seems to be higher than previously reported. Epidemiologic study, level III.

[Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 2: treatment of the thoracic disc hernia, spinal deformities, spinal tumors, infections and miscellaneous].

PubMed

Verdú-López, Francisco; Beisse, Rudolf

2014-01-01

Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has evolved greatly since it appeared less than 20 years ago. It is currently used in a large number of processes and injuries. The aim of this article, in its two parts, is to review the current status of VATS of the thoracic and lumbar spine in its entire spectrum. After reviewing the current literature, we developed each of the large groups of indications where VATS takes place, one by one. This second part reviews and discusses the management, treatment and specific thoracoscopic technique in thoracic disc herniation, spinal deformities, tumour pathology, infections of the spine and other possible indications for VATS. Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of spinal deformities, spinal tumours, infections and other pathological processes, as well as the reconstruction of injured spinal segments and decompression of the spinal canal if lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in regard to morbidity of the approach and subsequent patient recovery. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

Axotomy increases NADPH-diaphorase activity in the dorsal root ganglia and lumbar spinal cord of the turtle Trachemys dorbigni.

PubMed

Partata, W A; Krepsky, A M; Marques, M; Achaval, M

1999-04-01

Seven days after transection of the sciatic nerve NADPH-diaphorase activity increased in the small and medium neurons of the dorsal root ganglia of the turtle. However, this increase was observed only in medium neurons for up to 90 days. At this time a bilateral increase of NADPH-diaphorase staining was observed in all areas and neuronal types of the dorsal horn, and in positive motoneurons in the lumbar spinal cord, ipsilateral to the lesion. A similar increase was also demonstrable in spinal glial and endothelial cells. These findings are discussed in relation to the role of nitric oxide in hyperalgesia and neuronal regeneration or degeneration.

A bandpass filter for the enhancement of an X-ray reconstruction of the tissue in the spinal canal

NASA Technical Reports Server (NTRS)

Reed, I. S.; Glenn, W. V.; Kwoh, Y. S.; Truong, T. K.

1980-01-01

In this communication, a new bandpass reconstruction filter is developed to partially remove the low spatial frequencies of the bone and the soft tissue in an X-ray reconstruction of a lumbar spine. This partial removal of the low frequencies suppresses the bony vertebral body and the soft tissue components within the projections of actual clinical data. It also has the effect of enhancing the sharp edges of the fatty tissue surrounding the spinal cord region. The intent of this effort is to directly visualize the spinal cord without the need for water-soluble contrast (e.g., metrizamide) to be installed through lumbar punctures.

Targeting Lumbar Spinal Neural Circuitry by Epidural Stimulation to Restore Motor Function After Spinal Cord Injury.

PubMed

Minassian, Karen; McKay, W Barry; Binder, Heinrich; Hofstoetter, Ursula S

2016-04-01

Epidural spinal cord stimulation has a long history of application for improving motor control in spinal cord injury. This review focuses on its resurgence following the progress made in understanding the underlying neurophysiological mechanisms and on recent reports of its augmentative effects upon otherwise subfunctional volitional motor control. Early work revealed that the spinal circuitry involved in lower-limb motor control can be accessed by stimulating through electrodes placed epidurally over the posterior aspect of the lumbar spinal cord below a paralyzing injury. Current understanding is that such stimulation activates large-to-medium-diameter sensory fibers within the posterior roots. Those fibers then trans-synaptically activate various spinal reflex circuits and plurisegmentally organized interneuronal networks that control more complex contraction and relaxation patterns involving multiple muscles. The induced change in responsiveness of this spinal motor circuitry to any residual supraspinal input via clinically silent translesional neural connections that have survived the injury may be a likely explanation for rudimentary volitional control enabled by epidural stimulation in otherwise paralyzed muscles. Technological developments that allow dynamic control of stimulation parameters and the potential for activity-dependent beneficial plasticity may further unveil the remarkable capacity of spinal motor processing that remains even after severe spinal cord injuries.

Demographic and clinical characteristics of persons with spinal cord injury in Turkey: One-year experience of a primary referral rehabilitation center.

PubMed

Taşoğlu, Özlem; Koyuncu, Engin; Daylak, Rabia; Karacif, Derya Yumuşak; İnce, Zerrin; Yenigün, Didem; Özgirgin, Neşe

2018-03-01

To define the demographic and clinical characteristics of persons with spinal cord injury, rehabilitated in a primary referral rehabilitation center in Turkey. Retrospective study. Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey. Medical records of all patients with spinal cord injury (acute-subacute-chronic) at a single academic referral center over the course of one year were reviewed. Variables of each patient were recorded, including: age, sex, etiology, length of rehabilitation stay, neurological level of injury, level of neurological impairment and severity of injury. Among 262 persons with spinal cord injury, 69.8% were male (male:female ratio is 2.31 : 1). Mean age was 38.3 ± 17.6 years. Falls were the most common cause of injury. The majority of falls were falls from a height (93.3%). More than 20% of falls from a height were related to occupational injury. The most common neurological level of injury was L1. Of all persons 46.2% had thoracic, 27.5% had lumbar and 26.3% had cervical lesions. The mean length of rehabilitation stay was 52.1 ± 25.5 days. Persons with motor complete injury and with a shorter (<12 months) time since injury had longer length of rehabilitation stay. The mean age of SCI population is increasing. Falls constitute the majority of etiologic factors and are more common in persons >60 years old. More than 20% of falls from a height are related to occupational injury. Male-female ratio is decreasing. Thoraco-lumbar injures are more common than cervical injuries.

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

PubMed Central

Hasankhani, Ebrahim Ghayem; Ashjazadeh, Amir

2014-01-01

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

Spinal lordosis optimizes the requirements for a stable erect posture.

PubMed

Wagner, Heiko; Liebetrau, Anne; Schinowski, David; Wulf, Thomas; de Lussanet, Marc H E

2012-04-16

Lordosis is the bending of the lumbar spine that gives the vertebral column of humans its characteristic ventrally convex curvature. Infants develop lordosis around the time when they acquire bipedal locomotion. Even macaques develop a lordosis when they are trained to walk bipedally. The aim of this study was to investigate why humans and some animals develop a lumbar lordosis while learning to walk bipedally. We developed a musculoskeletal model of the lumbar spine, that includes an asymmetric, dorsally shifted location of the spinal column in the body, realistic moment arms, and physiological cross-sectional areas (PCSA) of the muscles as well as realistic force-length and force-velocity relationships. The model was used to analyze the stability of an upright body posture. According to our results, lordosis reduces the local joint torques necessary for an equilibrium of the vertebral column during an erect posture. At the same time lordosis increases the demands on the global muscles to provide stability. We conclude that the development of a spinal lordosis is a compromise between the stability requirements of an erect posture and the necessity of torque equilibria at each spinal segment.

Spinal lordosis optimizes the requirements for a stable erect posture

PubMed Central

2012-01-01

Background Lordosis is the bending of the lumbar spine that gives the vertebral column of humans its characteristic ventrally convex curvature. Infants develop lordosis around the time when they acquire bipedal locomotion. Even macaques develop a lordosis when they are trained to walk bipedally. The aim of this study was to investigate why humans and some animals develop a lumbar lordosis while learning to walk bipedally. Results We developed a musculoskeletal model of the lumbar spine, that includes an asymmetric, dorsally shifted location of the spinal column in the body, realistic moment arms, and physiological cross-sectional areas (PCSA) of the muscles as well as realistic force-length and force-velocity relationships. The model was used to analyze the stability of an upright body posture. According to our results, lordosis reduces the local joint torques necessary for an equilibrium of the vertebral column during an erect posture. At the same time lordosis increases the demands on the global muscles to provide stability. Conclusions We conclude that the development of a spinal lordosis is a compromise between the stability requirements of an erect posture and the necessity of torque equilibria at each spinal segment. PMID:22507595

CSF smear (image)

MedlinePlus

... is a clear fluid that circulates in the space surrounding the spinal cord and brain. CSF protects the brain and spinal cord from injury by acting like a liquid cushion. CSF is usually obtained through a lumbar ...

CSF chemistry (image)

MedlinePlus

... is a clear fluid that circulates in the space surrounding the spinal cord and brain. CSF protects the brain and spinal cord from injury by acting like a liquid cushion. CSF is usually obtained through a lumbar ...

The transient receptor potential ankyrin-1 mediates mechanical hyperalgesia induced by the activation of B1 receptor in mice.

PubMed

Meotti, Flavia Carla; Figueiredo, Cláudia Pinto; Manjavachi, Marianne; Calixto, João B

2017-02-01

The kinin receptor B 1 and the transient receptor potential ankyrin 1 (TRPA1) work as initiators and gatekeepers of nociception and inflammation. This study reports that the nociceptive transmission induced by activation of B 1 receptor is dependent on TRPA1 ion channel. The mechanical hyperalgesia was induced by intrathecal (i.t.) injection of B 1 agonist des-Arginine 9 -bradykinin (DABK) or TRPA1 agonist cinnamaldehyde and was evaluated by the withdrawal response after von Frey Hair application in the hind paw. After behavioral experiments, lumbar spinal cord and dorsal root ganglia (DRG) were harvested to assess protein expression and mRNA by immunohistochemistry and real time-PCR, respectively. The pharmacological antagonism (HC030031) or the down-regulation of TRPA1 greatly inhibited the mechanical hyperalgesia induced by DABK. Intrathecal injection of DABK up regulated the ionized calcium binding adaptor molecule (Iba-1) in lumbar spinal cord (L5-L6); TRPA1 protein and mRNA in lumbar spinal cord; and B 1 receptor mRNA in both lumbar spinal cord and DRG. The knockdown of TRPA1 prevented microglia activation induced by DABK. Furthermore, the mechanical hyperalgesia induced by either DABK or by cinnamaldehyde was significantly reduced by inhibition of cyclooxygenase (COX), protein kinase C (PKC) or phospholipase C (PLC). In summary, this study revealed that TRPA1 positively modulates the mechanical hyperalgesia induced by B 1 receptor activation in the spinal cord and that the classical GPCR downstream molecules PLC, diacylglycerol (DAG), 3,4,5-inositide phosphate (IP 3 ) and PKC are involved in the nociceptive transmission triggered by these two receptors. Copyright © 2016 Elsevier Inc. All rights reserved.

Variations in Practice Patterns among Neurosurgeons and Orthopaedic Surgeons in the Management of Spinal Disorders.

PubMed

Hussain, Manzar; Nasir, Sadaf; Moed, Amber; Murtaza, Ghulam

2011-12-01

This is a case series. We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders. Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders. A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. The surgeons were working either in private practice or in academic institutions. The details of the questionnaire included demographic details and the specialty (orthopedic/neurosurgeon). The surgeons were classified according to the level of experience as up to 5 years, 6-10 years and > 10 years. Questions were asked about the approach to lumbar discectomy (fragmentectomy or aggressive disc removal), using steroids for treating discitis, the fusion preference for spondylolisthesis, the role of an orthosis after fusion, the preferred surgical approach for spinal stenosis, the operative approach for spinal trauma (early within 72 hours or late > 72 hours) and the role of surgery in complete spinal cord injury. The data was analyzed using SPSS ver 16. p-values < 0.05 were considered to be significant. Of the 30 surgeons who completed the questionnaire, 20 were neurosurgeons and 10 were orthopedic surgeons. Statistically significant differences were observed for the management of spinal stenosis, spondylolisthesis, using an orthosis after fusion, the type of lumbar discectomy and the value of surgical intervention after complete spinal cord injury. Our results suggest that there continues to exist a statistically significant lack of consensus among neurosurgeons and orthopedic spine surgeons when considering using an orthosis after fusion, the type of discectomy and the value of intervention after complete spinal injury.

Variations in Practice Patterns among Neurosurgeons and Orthopaedic Surgeons in the Management of Spinal Disorders

PubMed Central

Nasir, Sadaf; Moed, Amber; Murtaza, Ghulam

2011-01-01

Study Design This is a case series. Purpose We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders. Overview of Literature Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders. Methods A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. The surgeons were working either in private practice or in academic institutions. The details of the questionnaire included demographic details and the specialty (orthopedic/neurosurgeon). The surgeons were classified according to the level of experience as up to 5 years, 6-10 years and > 10 years. Questions were asked about the approach to lumbar discectomy (fragmentectomy or aggressive disc removal), using steroids for treating discitis, the fusion preference for spondylolisthesis, the role of an orthosis after fusion, the preferred surgical approach for spinal stenosis, the operative approach for spinal trauma (early within 72 hours or late > 72 hours) and the role of surgery in complete spinal cord injury. The data was analyzed using SPSS ver 16. p-values < 0.05 were considered to be significant. Results Of the 30 surgeons who completed the questionnaire, 20 were neurosurgeons and 10 were orthopedic surgeons. Statistically significant differences were observed for the management of spinal stenosis, spondylolisthesis, using an orthosis after fusion, the type of lumbar discectomy and the value of surgical intervention after complete spinal cord injury. Conclusions Our results suggest that there continues to exist a statistically significant lack of consensus among neurosurgeons and orthopedic spine surgeons when considering using an orthosis after fusion, the type of discectomy and the value of intervention after complete spinal injury. PMID:22164314

Posterior epidural disc fragment masquerading as spinal tumor: Review of the literature.

PubMed

Park, Taejune; Lee, Ho Jun; Kim, Jae Seong; Nam, Kiyeun

2018-03-09

Posterior epidural lumbar disc fragment is infrequent because of anatomical barriers, and it is difficult to diagnose posterior epidural lumbar disc fragment because of its rare incidence and the ambiguity of radiologic evaluations. And it is difficult to differentiate it from other diseases such as spinal tumors. Differential diagnosis of posterior epidural lumbar disc fragment is clinically important because its diagnosis can affect treatment and prognosis. To investigate the incidence, anatomical concern, etiology, symptom, diagnostic tool, management and prognosis of posterior epidural lumbar disc fragment, we reviewed articles including case report. We performed a search of all clinical studies of posterior epidural lumbar disc fragment published to date. The following keywords were searched: Posterior epidural lumbar disc fragment, disc migration, posterior epidural disc, extradural migration, dorsal epidural migration, sequestrated disc, and disc fragment. We identified 40 patients of posterior epidural lumbar disc fragment from 28 studies. The most common presentation of posterior epidural lumbar disc fragment was sudden onset radiculopathy (70.0%), followed by cauda equina syndrome (27.5%). The most frequently used diagnostic modality was magnetic resonance imaging (MRI), conducted in 36 cases (90.0%), and followed by computed tomography in 14 cases (35.0%). After the imaging studies, the preoperative diagnoses were 45.0% masses, 20.0% lesions, and 12.5% tumors. Characteristic MRI findings in posterior epidural lumbar disc fragment are helpful for diagnosis; it typically displays low signals on T1-weighted images and high signals on T2-weighted images with respect to the parent disc. In addition, most of the disc fragments show peripheral rim enhancement on MRI with gadolinium administration. Electrodiagnostic testing is useful for verifying nerve damage. Surgical treatment was performed in all cases, and neurologic complications were observed in 12.5%. As posterior epidural lumbar disc fragment could be masqueraded as spinal tumor, if rim enhancement is observed in MRI scans with sudden symptoms of radiculopathy or cauda equina syndrome, it should be taken into consideration. Early diagnosis can lead to early surgery, which can reduce complications.

Comparing cost-effectiveness of X-Stop with minimally invasive decompression in lumbar spinal stenosis: a randomized controlled trial.

PubMed

Lønne, Greger; Johnsen, Lars Gunnar; Aas, Eline; Lydersen, Stian; Andresen, Hege; Rønning, Roar; Nygaard, Øystein P

2015-04-15

Randomized clinical trial with 2-year follow-up. To compare the cost-effectiveness of X-stop to minimally invasive decompression in patients with symptomatic lumbar spinal stenosis. Lumbar spinal stenosis is the most common indication for operative treatment in elderly. Although surgery is more costly than nonoperative treatment, health outcomes for more than 2 years were shown to be significantly better. Surgical treatment with minimally invasive decompression is widely used. X-stop is introduced as another minimally invasive technique showing good results compared with nonoperative treatment. We enrolled 96 patients aged 50 to 85 years, with symptoms of neurogenic intermittent claudication within 250-m walking distance and 1- or 2-level lumbar spinal stenosis, randomized to either minimally invasive decompression or X-stop. Quality-adjusted life-years were based on EuroQol EQ-5D. The hospital unit costs were estimated by means of the top-down approach. Each cost unit was converted into a monetary value by dividing the overall cost by the amount of cost units produced. The analysis of costs and health outcomes is presented by the incremental cost-effectiveness ratio. The study was terminated after a midway interim analysis because of significantly higher reoperation rate in the X-stop group (33%). The incremental cost for X-stop compared with minimally invasive decompression was &OV0556;2832 (95% confidence interval: 1886-3778), whereas the incremental health gain was 0.11 quality-adjusted life-year (95% confidence interval: -0.01 to 0.23). Based on the incremental cost and effect, the incremental cost-effectiveness ratio was &OV0556;25,700. The majority of the bootstrap samples displayed in the northeast corner of the cost-effectiveness plane, giving a 50% likelihood that X-stop is cost-effective at the extra cost of &OV0556;25,700 (incremental cost-effectiveness ratio) for a quality-adjusted life-year. The significantly higher cost of X-stop is mainly due to implant cost and the significantly higher reoperation rate. 2.

Ankylosing Spondylitis: Patterns of Radiographic Involvement—A Re-examination of Accepted Principles in a Cohort of 769 Patients1

PubMed Central

Jang, Jennifer H.; Ward, Michael M.; Rucker, Adam N.; Reveille, John D.; Davis, John C.; Learch, Thomas J.

2011-01-01

Purpose: To re-examine the patterns of radiographic involvement in ankylosing spondylitis (AS). Materials and Methods: This prospective study had institutional review board approval, and 769 patients with AS (556 men, 213 women; mean age, 47.1 years; age range, 18–87 years) provided written informed consent. Radiographs of the cervical spine, lumbar spine, pelvis, and hips were scored by using the Bath Ankylosing Spondylitis Radiology Index (BASRI) by an experienced radiologist. Differences in sacroiliitis grade between right and left sacroiliac joints, frequency of cervical- and lumbar-predominant involvement by sex, frequency of progression to complete spinal fusion, and association between hip arthritis and spinal involvement were computed for the cohort overall and for subgroups defined according to duration of AS in 10-year increments. Results: Symmetric sacroiliitis was seen in 86.1% of patients. Lumbar predominance was more common during the first 20 years of the disease, after which the cervical spine and lumbar spine were equally involved. Men and women were equally likely to have cervical-predominant involvement. Complete spinal fusion was observed in 27.9% of patients with AS for more than 30 years and in 42.6% of patients with AS for more than 40 years. Patients with BASRI hip scores of 2 or greater had significantly higher BASRI spine scores. Conclusion: There were no sex differences in cervical-predominant involvement in AS. Hip arthritis was strongly associated with worse spinal involvement. © RSNA, 2010 PMID:20971774

Autonomic dysreflexia triggered by an unstable lumbar spine in a quadriplegic patient.

PubMed

Wu, Katie P; Lai, Po-Liang; Lee, Li-Fang; Hsu, Chih-Chin

2005-07-01

A 40 year-old man with C5 complete quadriplegia, had L2-L3 pyogenic spondylitis treated with debridement and fusion of the lumbar spine with left iliac bone graft. Three months later he developed symptoms of autonomic dysreflexia, including headache, cold sweating, and hypertension whenever he was in an upright position. These symptoms resolved after lying down. Roentgenograms of the lumbar spine revealed absorption of the bone graft at the L2-L3 level. A spinal stabilization procedure was done after eight weeks of antibiotic therapy under the impression of unstable spine caused by pyogenic spondylitis. Symptoms were relieved immediately following the surgery. This report may be helpful for physicians caring for quadriplegic patients with autonomic dysreflexia induced by an unstable spine.

Ten Important Tips in Treating a Patient with Lumbar Disc Herniation

PubMed Central

Hejrati, Hamid; Ariamanesh, Shahrara

2016-01-01

Lumbar disc herniation is a common spinal disorder that usually responds favorably to conservative treatment. In a small percentage of the patients, surgical decompression is necessary. Even though lumbar discectomy constitutes the most common and easiest spine surgery globally, adverse or even catastrophic events can occur. Appropriate patient selection and effective neural decompression constitute the most important points for better surgical outcomes and avoidance of unpleasant complications. Other important tips include timely performance of magnetic resonance imaging, correct interpretation of scan data, preoperative detection of underlying instability, exclusion of non-discogenic sciatica, determination of the main cause of clinical pathology, avoidance of the wrong side or level, and being sure that the more detailed procedure does not necessarily mean the more effective procedure. PMID:27790328

Spinal cord stimulation modulates intraspinal colorectal visceroreceptive transmission in rats

PubMed Central

Qin, C.; Lehew, R.T.; Khan, K.A.; Wienecke, G.M.; Foreman, R.D.

2007-01-01

Previous studies have shown that spinal cord stimulation (SCS) of upper lumbar segments decreases visceromotor responses to mechanical stimuli in a sensitized rat colon and reduces symptoms of irritable bowel syndrome in patients. SCS applied to the upper cervical spinal dorsal column reduces pain of chronic refractory angina. Further, chemical stimulation of C1-C2 propriospinal neurons in rats modulates the responses of lumbosacral spinal neurons to colorectal distension. The present study was designed to compare the effects of upper cervical and lumbar SCS on activity of lumbosacral neurons receiving noxious colorectal input. Extracellular potentials of L6-S2 spinal neurons were recorded in pentobarbital anesthetized, paralyzed and ventilated male rats. SCS (50 Hz, 0.2 ms) at low intensity (90% of motor threshold) was applied to the dorsal column of upper cervical (C1-C2) or upper lumbar (L2-L3) ipsilateral spinal segments. Colorectal distension (CRD, 20, 40, 60 mmHg, 20 s) was produced by air inflation of a latex balloon. Results showed that SCS applied to L2-L3 and C1-C2 segments significantly reduced the excitatory responses to noxious CRD from 417.6±68.0 imp to 296.3±53.6 imp (P<0.05, n=24) and from 336.2±64.5 imp to 225.0±73.3 imp (P<0.05, n= 18), respectively. Effects of L2-L3 and C1-C2 SCS lasted 10.2±1.9 min and 8.0±0.9 min after offset of CRD. Effects of SCS were observed on spinal neurons with either high or low threshold excitatory responses to CRD. However, L2-L3 or C1-C2 SCS did not significantly affect inhibitory neuronal responses to CRD. C1-C2 SCS-induced effects were abolished by cutting the C7-C8 dorsal column but not by spinal transection at cervicomedullary junction. These data demonstrated that upper cervical or lumbar SCS modulated responses of lumbosacral spinal neurons to noxious mechanical stimulation of the colon, thereby, proved two loci for a potential therapeutic effect of SCS in patients with irritable bowel syndrome and other colonic disorders. PMID:17324482

Impact of spinal pain on daily living activities in postmenopausal women working in agriculture.

PubMed

Raczkiewicz, Dorota; Owoc, Alfred; Sarecka-Hujar, Beata; Saran, Tomasz; Bojar, Iwona

2017-03-22

Postmenopausal women working in agriculture suffer from spinal pain for two overlapping reasons, the first is related to the menopause and the second to the specificity of rural work, which includes lifting heavy objects and changing weather conditions. Spinal pain affects the daily life of women as well as their ability to work. The objective of the study was to analyse the impact of spinal pain on activities of daily life in Polish postmenopausal women performing agricultural work. The study was conducted in 2016 in Poland and included 1,119 post-menopausal women living in rural areas and working in agriculture. The women assessed the severity of spinal pain in 3 sections: neck, thorax and lumbar. Neck Disability Index (NDI) and Oswestry Low Back Disability Index (ODI) questionnaires were used to assess the impact of spinal pain on daily life activities. Generalized linear models were estimated in statistical analyses. Postmenopausal women working in agriculture suffered most often from pain in the lumbar spine, less frequently in the neck, and the least in the thoracic. The most common was an isolated pain in only one section of the spine. Spinal pain disturbed the most the women's rest, standing, lifting objects, while sleep, concentration, and walking the least. The impact of spinal pain on the activities of daily life, on average, was moderate, and increased with greater pain severity, the earlier the age the pain started, the higher the body weight, the lower education level and if there was a co-existing pain in any of the other spine sections. The impact of spinal pain on daily life activities did not depend on age between 45-65, WHR, age at last menstruation, parity, and number and types of births. The impact of spinal pain on daily life activities in postmenopausal women working in agriculture was assessed as moderate, on average, and depended mainly on spinal pain-related characteristics, such as severity, age at onset and co-existence of pain in any other spinal sections.

Delayed Posttraumatic Subacute Lumbar Subarachnoid Hematoma: Case Report and Review of the Literature.

PubMed

Picart, Thiébaud; Jacquesson, Timothée; Jouanneau, Emmanuel; Berhouma, Moncef

2018-05-01

Traumatic spinal subarachnoid hematoma, associated or not with a concurrent subdural hematoma, has rarely been described. The evolution of such hematomas is heterogeneous. This study aims at defining the most accurate management, which is currently not standardized. A 20-year-old man, victim of a high-kinetic road accident 5 days before and with several nonneurologic nonsurgical vertebral fractures, experienced a sudden dorsolumbar pain radiating to his lower limbs. A rapidly progressive asymmetric paraparesis with loss of reflexes was noticed, associated with bilateral global hypoesthesia of the lower limbs and with acute urinary retention, whereas the anal tonicity was preserved (American Spinal Injury Association C). Magnetic resonance imaging scan revealed a conus medullaris compression at the level of the L1-L2 vertebrae by an intradural expansive mass. Immediate surgical decompression revealed a strictly subarachnoid hematoma. Venous bleeding was seen at the level of the conus medullaris and controlled. Pathologic examination of the clot excluded an underlying tumor or vascular abnormality. The complete coagulation profile was normal. Six weeks after surgery, the neurologic examination revealed only a slight tactile hypoesthesia of the left thigh. With only 4 reported cases, purely subarachnoid spinal hematomas remain widely rarer than epidural hematomas. The reported case possesses a certain number of peculiarities: young age, pure subarachnoid location, lumbar location, occurrence after a car accident, subacute onset, and excellent neurologic recovery. In our opinion, a symptomatic subarachnoid spinal hematoma should be surgically evacuated at the early phase so neurologic recovery can be expected. Copyright © 2018 Elsevier Inc. All rights reserved.

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

PubMed Central

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

2013-01-01

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

Transplantation of Embryonic Spinal Cord Derived Cells Helps to Prevent Muscle Atrophy after Peripheral Nerve Injury

PubMed Central

Ruven, Carolin; Li, Wen; Li, Heng; Wong, Wai-Man; Wu, Wutian

2017-01-01

Injuries to peripheral nerves are frequent in serious traumas and spinal cord injuries. In addition to surgical approaches, other interventions, such as cell transplantation, should be considered to keep the muscles in good condition until the axons regenerate. In this study, E14.5 rat embryonic spinal cord fetal cells and cultured neural progenitor cells from different spinal cord segments were injected into transected musculocutaneous nerve of 200–300 g female Sprague Dawley (SD) rats, and atrophy in biceps brachii was assessed. Both kinds of cells were able to survive, extend their axons towards the muscle and form neuromuscular junctions that were functional in electromyographic studies. As a result, muscle endplates were preserved and atrophy was reduced. Furthermore, we observed that the fetal cells had a better effect in reducing the muscle atrophy compared to the pure neural progenitor cells, whereas lumbar cells were more beneficial compared to thoracic and cervical cells. In addition, fetal lumbar cells were used to supplement six weeks delayed surgical repair after the nerve transection. Cell transplantation helped to preserve the muscle endplates, which in turn lead to earlier functional recovery seen in behavioral test and electromyography. In conclusion, we were able to show that embryonic spinal cord derived cells, especially the lumbar fetal cells, are beneficial in the treatment of peripheral nerve injuries due to their ability to prevent the muscle atrophy. PMID:28264437

Radiculopathy in the setting of lumbar nerve root compression due to an extradural intraforaminal lipoma: a report of 3 cases.

PubMed

Loriaux, Daniel B; Adogwa, Owoicho; Gottfried, Oren N

2015-07-01

A true adult spinal lipoma is an exceedingly rare cause of lumbar compression neuropathy. Only 5 cases of true extradural intraforaminal lipomas have been documented in the medical literature. The diagnostic criteria and treatment guidelines for this specific lipoma have yet to be established. This report features 3 histologically confirmed cases of extradural intraforaminal spinal lipomas that recently presented to the authors' practice. In addition, the literature was surveyed to include the 5 previously reported cases of true adult extradural intraforaminal spinal lipomas. The consistency in presentation, response to surgical intervention, and postoperative recovery in these 8 cases supports surgical intervention at the time of diagnosis. The authors' findings support elevated clinical suspicion, efficient diagnosis based on MRI, and early surgical intervention for this rare pathological entity. All cases presented in this report were symptomatic and occurred in the absence of other significant pathologies such as general spinal epidural lipomatosis, intradural lesions, tethering, or severe degenerative stenosis or herniated discs. The clinical, neuroradiological, and histological findings characteristic of a true adult extradural intraforaminal lipoma are emphasized to differentiate this lesion from the more common etiologies for lumbar compression neuropathy. Heightened awareness and clinical suspicion for the focal, foraminal spinal lipoma as a cause of radiculopathy symptoms will enable more efficient diagnosis and treatment.

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2018: dynamic imaging of degenerative spondylolisthesis reveals mid-range dynamic lumbar instability not evident on static clinical radiographs.

PubMed

Dombrowski, Malcolm E; Rynearson, Bryan; LeVasseur, Clarissa; Adgate, Zach; Donaldson, William F; Lee, Joon Y; Aiyangar, Ameet; Anderst, William J

2018-04-01

Degenerative spondylolisthesis (DS) in the setting of symptomatic lumbar spinal stenosis is commonly treated with spinal fusion in addition to decompression with laminectomy. However, recent studies have shown similar clinical outcomes after decompression alone, suggesting that a subset of DS patients may not require spinal fusion. Identification of dynamic instability could prove useful for predicting which patients are at higher risk of post-laminectomy destabilization necessitating fusion. The goal of this study was to determine if static clinical radiographs adequately characterize dynamic instability in patients with lumbar degenerative spondylolisthesis (DS) and to compare the rotational and translational kinematics in vivo during continuous dynamic flexion activity in DS versus asymptomatic age-matched controls. Seven patients with symptomatic single level lumbar DS (6 M, 1 F; 66 ± 5.0 years) and seven age-matched asymptomatic controls (5 M, 2 F age 63.9 ± 6.4 years) underwent biplane radiographic imaging during continuous torso flexion. A volumetric model-based tracking system was used to track each vertebra in the radiographic images using subject-specific 3D bone models from high-resolution computed tomography (CT). In vivo continuous dynamic sagittal rotation (flexion/extension) and AP translation (slip) were calculated and compared to clinical measures of intervertebral flexion/extension and AP translation obtained from standard lateral flexion/extension radiographs. Static clinical radiographs underestimate the degree of AP translation seen on dynamic in vivo imaging (1.0 vs 3.1 mm; p = 0.03). DS patients demonstrated three primary motion patterns compared to a single kinematic pattern in asymptomatic controls when analyzing continuous dynamic in vivo imaging. 3/7 (42%) of patients with DS demonstrated aberrant mid-range motion. Continuous in vivo dynamic imaging in DS reveals a spectrum of aberrant motion with significantly greater kinematic heterogeneity than previously realized that is not readily seen on current clinical imaging. Level V data These slides can be retrieved under Electronic Supplementary Material.

Anaplastic astrocytoma in the spinal cord of an African pygmy hedgehog (Atelerix albiventris).

PubMed

Gibson, C J; Parry, N M A; Jakowski, R M; Eshar, D

2008-11-01

A 2-year-old, female hedgehog presented with an 8-month history of progressive, ascending paresis/paralysis and was tentatively diagnosed with wobbly hedgehog syndrome. She died awaiting further diagnostic tests, and the owners consented to postmortem examination. Grossly, the bladder was large and flaccid and the cervical and lumbar spinal cord were regionally enlarged, light grey, and friable with multifocal hemorrhages. The thoracic spinal cord was grossly normal. Microscopically all regions of the spinal cord had similar changes, although the cervical and lumbar sections were most severely affected. These regions were completely effaced by a moderately cellular infiltration of highly pleomorphic polygonal to spindle shaped cells, mineralization, and necrosis, which were most consistent with anaplastic astrocytoma. The thoracic spinal cord white matter was similarly infiltrated by the neoplastic cells, with perivascular extension into the otherwise normal grey matter. A diagnosis of anaplastic astrocytoma was confirmed using immunohistochemical stains that were positive for glial fibrillary acidic protein and S100.

Avoidance of Wrong-level Thoracic Spine Surgery Using Sterile Spinal Needles: A Technical Report.

PubMed

Chin, Kingsley R; Seale, Jason; Cumming, Vanessa

2017-02-01

A technical report. The aim of the present study was to present an improvement on localization techniques employed for use in the thoracic spine using sterile spinal needles docked on the transverse process of each vertebra, which can be performed in both percutaneous and open spinal procedures. Wrong-level surgery may have momentous clinical and emotional implications for a patient and surgeon. It is reported that one in every 2 spine surgeons will operate on the wrong level during his or her career. Correctly localizing the specific thoracic level remains a significant challenge during spine surgery. Fluoroscopic anteroposterior and lateral views were obtained starting in the lower lumbar spine, and an 18-G spinal needle was placed in the transverse process of L3 counting up from the sacrum and also at T12. The fluoroscopy was then moved cephalad and counting from the spinal needle at T12, the other spinal needles were placed at the targeted operating thoracic vertebrae. Once this was done, we were able to accurately determine the thoracic levels for surgical intervention. Using this technique, the markers were kept in place even after the incisions were made. This prevented us from losing our location in the thoracic spine. Correctly placed instrumentation was made evident with postoperative imaging. We have described the successful use of a new technique using spinal needles docked against transverse processes to correctly and reliably identify thoracic levels before instrumentation. The technique was reproducible in both open surgeries and for a percutaneous procedure. This technique maintains the correct spinal level during an open procedure. We posit that wrong-level thoracic spine surgery may be preventable.

Thoracolumbar spinal ligaments exhibit negative and transverse pre-strain.

PubMed

Robertson, Daniel J; Von Forell, Gregory A; Alsup, Jeremy; Bowden, Anton E

2013-07-01

The present work represents the first reported bi-axial spinal ligament pre-strain data for the thoracic and lumbar spine. Ligament pre-strain (in-situ strain) is known to significantly alter joint biomechanics. However, there is currently a lack of comprehensive data with regards to spinal ligament pre-strain. The current work determined the pre-strain of 71 spinal ligaments (30 anterior longitudinal ligaments, 27 supraspinous ligaments and 14 interspinous ligaments). The interspinous ligament and the anterior longitudinal ligament exhibited bi-axial pre-strain distributions, demonstrating they are not uniaxial structures. The supraspinous ligament frequently exhibited large amounts of negative pre-strain or laxity suggesting it makes no mechanical contribution to spinal stability near the neutral posture. Upon implementing multi-axial pre-strain results into a finite element model of the lumbar spine, large differences in spinal biomechanics were observed. These results demonstrate the necessity of accounting for ligament pre-strain in biomechanical models. In addition, the authors present a unique experimental method for obtaining ligament pre-strain that presents a number of advantages when compared to standard techniques. Copyright © 2013 Elsevier Ltd. All rights reserved.

Determination of the Chronic Mammalian Toxicological Effects of RDX: (Twenty-Four Month Chronic Toxicity/Carcinogenicity Study of Hexahydro-1,3,5- Trinitro-1,3,5-Triazine (RDX) in the Fischer 344 Rat). Volume 1.

DTIC Science & Technology

1983-11-01

content. C . An J ma Is *a Fischer 344 (F344) rats, obtained from Harlan Sprague-Dawley, Madison , WI, were used for this study. Four hundred and thirty...Seminal vesicles "Skin, abdominal Spinal cord (cervical, thoracic, lumbar ) *Spleen Sternum, Including bone marrow Stomach *Testes Thymus Thyroids...abdominal * Spinal cord (cervical, thoracic and lumbar ) Spleen Sternum Including bone marrow Stomach Tissue masses Thyroids (parathyroids) Trachea

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

PubMed

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

2015-07-01

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

21 CFR 888.3070 - Pedicle screw spinal system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar, and... spondylolisthesis with objective evidence of neurologic impairment; fracture; dislocation; scoliosis; kyphosis... with objective evidence of neurologic impairment, fracture, dislocation, scoliosis, kyphosis, spinal...

21 CFR 888.3070 - Pedicle screw spinal system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar, and... spondylolisthesis with objective evidence of neurologic impairment; fracture; dislocation; scoliosis; kyphosis... with objective evidence of neurologic impairment, fracture, dislocation, scoliosis, kyphosis, spinal...

[HEART RHYTHM VARIABILITY ANALYSIS AND ASSESSMENT OF THE SPINAL PAIN SYNDROME DURING DRY IMMERSION].

PubMed

Sun, I; Voronkov, Yu I; Ardashev, V N; Glukhova, S I

2015-01-01

The spinal pain syndrome appears in cosmonauts on both short and long-duration missions. This untoward factor may affect body systems functioning and complicate the successful accomplishment of space mission. Purpose of the investigation was to examine the lumbar spine and to elucidate whether its condition relates to the spinal pain development and changes in heart rate variability (HRV) in the microgravity environment. The experiment was conducted in dry immersion as a method of microgravity effects simulation. It was shown that in dry immersion locomotion reproduces the patterns peculiar for significant gravitational unloading. Spinal pain intensity, angles and heights of the lumbar intervertebral discs and HRV were measured in 19 selected volunteers. During the experiment, all the volunteers developed pains in the back that abated gradually. Pain dependence on the height of intervertebral discs and cardiac regulatory mechanisms were investigated.

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

PubMed

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

2017-12-01

The objective of this study was to determine how simulated manual wheelchair pushing influences biomechanical loading to the lumbar spine and shoulders. Sixty-two subjects performed simulated wheelchair pushing and turning in a laboratory. An electromyography-assisted biomechanical model was used to estimate spinal loads. Moments at the shoulder joint, external hand forces and net turning torque were also assessed. Multiple linear regression techniques were employed to develop biomechanically based wheelchair pushing guidelines relating resultant hand force or net torque to spinal load. Male subjects experienced significantly greater spinal loading (p < 0.01), and spine loads were also increased for wheelchair turning compared to straight wheelchair pushing (p < 0.001). Biomechanically determined maximum acceptable resultant hand forces were 17-18% lower than psychophysically determined limits. We conclude that manual wheelchair pushing and turning can pose biomechanical risk to the lumbar spine and shoulders. Psychophysically determined maximum acceptable push forces do not appear to be protective enough of this biomechanical risk. Practitioner Summary: This laboratory study investigated biomechanical risk to the low back and shoulders during simulated wheelchair pushing. Manual wheelchair pushing posed biomechanical risk to the lumbar spine (in compression and A/P shear) and to the shoulders. Biomechanically determined wheelchair pushing thresholds are presented and are more protective than the closest psychophysically determined equivalents.

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

PubMed Central

2013-01-01

Background Several risk factors exist for the development of low back pain, including prolonged sitting and flexed spinal curvature. Several investigators have studied lumbar support devices and spinal curvatures in sitting, however few have investigated a pain population and reported a quantitative measure of comfort. The purpose of the current project was to determine whether a lumbar support pillow, outfitted with a cut-out to accommodate the bulk of posterior pelvic soft tissue volume, is more effective than a standard chair in promoting a neutral spinal posture and improving subjective and objective measures of comfort in healthy individuals and patients with low back pain. Methods Twenty eight male participants with and without a history of low back pain sat in a standard office chair and in a chair with the lumbar support pillow for 30 minutes. Lumbar and thoracolumbar postures were measured through electromagnetic markers. Comfort was determined based on the least squares radius of centre of pressure shifting, measured at the buttock-chair interface as well as reported discomfort through visual analog scales. Chair support effects were assessed through ANOVA methods. The study was approved by the Canadian Memorial Chiropractic College research ethics board. Results There was a main effect of condition on lumbar posture (p = 0.006) and thoracolumbar posture (p = 0.014). In the lumbar region, the support and standard chair differed by 2.88° (95% CI; 1.01-4.75), with the lumbar support being closer to neutral than the standard chair. In the thoracolumbar region, the support and standard chair differed by -2.42° (95% CI; -4.22 to -0.62), with the standard chair being closer to neutral than the support device. The centre of pressure measure was significantly improved with the pillow (p = 0.017), however there were no subjective changes in comfort. Conclusions A lumbar support pillow with a cut-out for the posterior pelvic tissues improved an objective measure of comfort in healthy individuals and patients with low back pain. Lumbar flattening was decreased and thoracolumbar curvature was increased. However, angular changes were small and future work is required to determine clinical relevance over the long term. Trial registration ClinicalTrials.gov, NCT00754585 PMID:23826832

Atlanto-occipital catheterization of young rats for long-term drug delivery into the lumbar subarachnoid space combined with in vivo testing and electrophysiology in situ.

PubMed

Kopach, Olga; Krotov, Volodymyr; Voitenko, Nana

2017-10-01

Catheterization has been widely used in neuroscience and pain research for local drug delivery. Though different modifications were developed, the use of young animals for spinal catheterization remains limited because of a little success rate. A reliable technique is needed to catheterize young animals aimed for in vivo testing combined with spinal cord electrophysiology, often limited by animal age, to facilitate pain research. We describe intrathecal catheterization of young rats (3-week-old) through atlanto-occipical approach for long-lasting drug delivery into the lumbar subarachnoid space. The technique represents a surgical approach of minimized invasiveness that requires PE-10 catheter and few equipment of standard laboratory use. Behavioral assessments revealed that spinal catheterization does not change peripheral sensitivity of different modalities (thermal and mechanical) and gives no rise to locomotive deficit or anxiety-like behavior in young rats. The long-term administration of genetic material (oligodeoxynucleotides given up to 4days), examined both in vivo and in situ, produced no adverse effects on basal peripheral sensitivity, but changed the AMPA receptor-mediated currents in sensory interneurons of the spinal cord. Dissimilar to already described methods, the method is designed for the use of young rats for behavioral testing in vivo and/or spinal cord electrophysiology in situ. A practical method for spinal catheterization of young animals designed for studies in vivo and in situ is proposed. The method is rapid and effective and should facilitate investigation of therapeutic effects on both systemic and subcellular levels, as an advantage over the existing methods. Copyright © 2017 Elsevier B.V. All rights reserved.

How to interpret computed tomography of the lumbar spine

PubMed Central

Mobasheri, R; Das, T; Vaidya, S; Mallik, S; El-Hussainy, M; Casey, A

2014-01-01

Computed tomography (CT) of the spine has remained an important tool in the investigation of spinal pathology. This article helps to explain the basics of CT of the lumbar spine to allow the clinician better use of this diagnostic tool. PMID:25245727

Effect of zoledronic acid on lumbar spinal fusion in osteoporotic patients.

PubMed

Ding, Qirui; Chen, Jian; Fan, Jin; Li, Qingqing; Yin, Guoyong; Yu, Lipeng

2017-11-01

To investigate the effect of zoledronic acid (ZA) on lumbar spinal fusion in patients with osteoporosis. This retrospective study includes 94 osteoporotic patients suffering from lumbar degenerative diseases or lumbar fracture who underwent lumbar spinal fusion in our institution from January 2013 to August 2014. They were divided into ZA group and control group according to whether the patient received ZA infusion or not. The patients in ZA group were given 5 mg intravenous ZA at the 3rd-5th days after operation. All patients took daily oral supplement of 600 mg calcium carbonate and 800 IU vitamin D during the follow-up after operation. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Short Form 36 (SF-36) scores were recorded preoperatively and post-operatively to evaluate the clinic outcomes; the spinal fusion was assessed by X-ray or CT Scan. 64 patients finished the final follow-up, including 30 patients in ZA group and 34 patients in control group. No significant difference was observed in gender, age, and preoperative BMI VAS, ODI, and SF-36 scores between the two groups (P > 0.05). The post-operative VAS and ODI scores decreased rapidly at 3 and 6 months, but rose back slightly at 12 and 24 months in both groups. On the contrary, post-operative SF-36 scores increased rapidly at 3 and 6 months, while fell back slightly at 12 and 24 months, with a statistically significant difference between the two groups at 12 months, but not at 3 and 6 month post-operation. The spinal fusion rate in ZA group was 90% at 6 months, 92% at 12 months, while it was 75% at 6 months, 92.86% at 12 months in control group, significantly different between the two groups at 12 months, but not at 6 months. In the whole follow-up period, adjacent vertebral compressing fracture occurred in five patients in control group, none in ZA group. No pedicle screw loosening was observed in ZA group, with six in control group. Zoledronic acid accelerates spinal fusion, shortens the time of fusion without changing fusion rate, and also decreases the risk of adjacent vertebral compressing fracture and the rate of pedicle screw loosening, resulting in the improvement of clinical outcomes and quality of life.

Comparison of segmental spinal movement control in adolescents with and without idiopathic scoliosis using modified pressure biofeedback unit.

PubMed

Luo, Hong-Ji; Lin, Shi-Xiang; Wu, Shyi-Kuen; Tsai, Mei-Wun; Lee, Shwn-Jen

2017-01-01

Postural rehabilitation emphasizing on motor control training of segmental spinal movements has been proposed to effectively reduce the scoliotic spinal deformities in adolescent idiopathic scoliosis (AIS). However, information regarding the impairments of segmental spinal movement control involving segmental spinal stabilizers in adolescent idiopathic scoliosis remains limited. Examination of segmental spinal movement control may provide a window for investigating the features of impaired movement control specific to spinal segments that may assist in the development of physiotherapeutic management of AIS. To compare segmental spinal movement control in adolescents with and without idiopathic scoliosis using modified pressure biofeedback unit. Segmental spinal movement control was assessed in twenty adolescents with idiopathic scoliosis (AISG) and twenty healthy adolescents (CG) using a modified pressure biofeedback unit. Participants performed segmental spinal movements that primarily involved segmental spinal stabilizing muscles with graded and sustained muscle contraction against/off a pressure cuff from baseline to target pressures and then maintained for 1 min. Pressure data during the 1-minute maintenance phase were collected for further analysis. Pressure deviation were calculated and compared between groups. The AISG had significantly greater pressure deviations for all segmental spinal movements of cervical, thoracic, and lumbar spine than the CG. Pressure biofeedback unit was feasible for assessing segmental spinal movement control in AIS. AISG exhibited poorer ability to grade and sustain muscle activities for local movements of cervical, thoracic, and lumbar spine, suggesting motor control training of segmental spinal movements involving segmental spinal stabilizing muscles on frontal, sagittal, and transverse planes were required.

Mechanical hypersensitivity, sympathetic sprouting, and glial activation are attenuated by local injection of corticosteroid near the lumbar ganglion in a rat model of neuropathic pain.

PubMed

Li, Jing-Yi; Xie, Wenrui; Strong, Judith A; Guo, Qu-Lian; Zhang, Jun-Ming

2011-01-01

Inflammatory responses in the lumbar dorsal root ganglion (DRG) play a key role in pathologic pain states. Systemic administration of a common anti-inflammatory corticosteroid, triamcinolone acetonide (TA), reduces sympathetic sprouting, mechanical pain behavior, spontaneous bursting activity, and cytokine and nerve growth factor production in the DRG. We hypothesized that systemic TA effects are primarily due to local effects on the DRG. Male Sprague-Dawley rats were divided into 4 groups: SNL (tight ligation and transection of spinal nerves) and normal with and without a single dose of TA injectable suspension slowly injected onto the surface of DRG and surrounding region at the time of SNL or sham surgery. Mechanical threshold was tested on postoperative days 1, 3, 5, and 7. Immunohistochemical staining examined tyrosine hydroxylase and glial fibrillary acidic protein in DRG and CD11B antibody (OX-42) in spinal cord. Local TA treatment attenuated mechanical sensitivity, reduced sympathetic sprouting in the DRG, and decreased satellite glia activation in the DRG and microglia activation in the spinal cord after SNL. A single injection of corticosteroid in the vicinity of the axotomized DRG can mimic many effects of systemic TA, mitigating behavioral and cellular abnormalities induced by spinal nerve ligation. This provides a further rationale for the use of localized steroid injections clinically and provides further support for the idea that localized inflammation at the level of the DRG is an important component of the spinal nerve ligation model, commonly classified as neuropathic pain model.

(18)F-FDG uptake of the spinal cord was decreased after conventional dose radiotherapy in esophageal cancer patients.

PubMed

Harata, Naoki; Yoshida, Katsuya; Oota, Sayako; Fujii, Hayahiko; Isogai, Jun; Yoshimura, Ryoichi

2016-01-01

We retrospectively investigated changes of (18)F-fluorodeocyglucose ((18)F-FDG) uptake in the spinal cord, inside and outside the radiation fields, in patients with esophageal cancer before and after conventional dose radiotherapy. A total of 17 consecutive patients with esophageal cancer (16 males, one female; age 50-83 years, mean 67.0 years), who underwent conventional dose radiotherapy and (18)F-FDG PET/CT before and 5.1 months (range 1.6-8.6 months) after the radiotherapy, were retrospectively evaluated. Sixteen patients had esophageal cancer and one patient had esophageal metastasis from thyroid cancer. Mean standardized uptake values (SUVmean) of the cervical, thoracic (inside and outside the radiation fields) and lumbar spinal cord were measured. SUVmean of the thoracic spinal cord inside the radiation field was decreased significantly after radiotherapy compared to those before radiotherapy (p < 0.001). SUVmean of the cervical spinal cord showed the same trend but it was not statistically significant (p = 0.051). SUVmean of the thoracic spinal cord outside the radiation field and the lumbar spinal cord did not differ significantly before and after the radiotherapy (p = 0.146 and p = 0.701, respectively). The results suggest that glucose metabolism of the spinal cord is decreased in esophageal cancer patients after conventional dose radiotherapy.

Psychological Predictors of Outcomes with Lumbar Spinal Fusion: A Systematic Literature Review.

PubMed

Wilhelm, Mark; Reiman, Michael; Goode, Adam; Richardson, William; Brown, Christopher; Vaughn, Daniel; Cook, Chad

2017-04-01

To review the predictive/risk psychological factors at baseline that are associated with a favourable (or non-favourable) outcome following lumbar spinal fusion (LSF). A computer-assisted literature search of PubMed, CINAHL complete and EMBASE for studies published between January 1, 1990 and October 1, 2014 with controlled vocabulary and key words related to LSF, degenerative lumbar spine diagnoses and appropriate terms for predictive variables. Each study was required to be a retrospective or prospective design that involved LSF (all forms). Quality assessment was conducted with the Quality In Prognosis Studies tool. A study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO# CRD42014008728). The majority of the eight accepted studies were observational, prospective cohorts (n = 6). High levels of baseline depression and lower SF-36 Mental Component Scores (MCS) lower quality of life were associated with non-favourable outcomes. Two studies were rated as high quality, five were moderate and one study had low quality. At present, there are a number of psychological variables that are associated with a poorer outcome with LSF. Higher levels of depression and lower scores on the SF-36 MCS are the most commonly implicated. However, based on the results of the studies using single arm designs there is not enough evidence to determine which psychological variables are influential in predicting outcomes for LSF. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Demographics of acute admissions to a National Spinal Injuries Unit.

PubMed

Lenehan, B; Boran, S; Street, J; Higgins, T; McCormack, D; Poynton, A R

2009-07-01

This prospective demographic study was undertaken to review the epidemiology and demographics of all acute admissions to the National Spinal Injuries Unit in Ireland for the 5 years to 2003. The study was conducted at the National Spinal Injuries Unit, Mater Miscericordiae University Hospital, Dublin, Ireland. Records of all patients admitted to our unit from 1999 to 2003 were compiled from a prospective computerized spinal database. In this 5-year period, 942 patients were acutely hospitalized at the National Spinal Injuries Unit. There were 686 (73%) males and 256 (27%) females, with an average age of 32 years (range 16-84 years). The leading cause of admission with a spinal injury was road traffic accidents (42%), followed by falls (35%), sport (11%), neoplasia (7.5%) and miscellaneous (4.5%). The cervical spine was most commonly affected (51%), followed by lumbar (28%) and thoracic (21%). On admission 38% of patients were ASIA D or worse, of which one-third were AISA A. Understanding of the demographics of spinal column injuries in unique populations can help us to develop preventative and treatment strategies at both national and international levels.

Serum leptin, bone mineral density and the healing of long bone fractures in men with spinal cord injury.

PubMed

Wang, Lei; Liu, Linjuan; Pan, Zhanpeng; Zeng, Yanjun

2015-11-16

Previously reported fracture rates in patients with spinal cord injury range from 1% to 20%. However, the exact role of spinal cord injury in bone metabolism has not yet been clarified. In order to investigate the effects of serum leptin and bone mineral density on the healing of long bone fractures in men with spinal cord injury, 15 male SCI patients and 15 matched controls were involved in our study. The outcome indicated that at 4 and 8 weeks after bone fracture, callus production in patients with spinal cord injury was lower than that in controls. Besides, bone mineral density was significantly reduced at 2, 4 and 8 weeks. In addition, it was found that at each time point, patients with spinal cord injury had significantly higher serum leptin levels than controls and no association was found between serum leptin level and bone mineral density of lumbar vertebrae. Moreover, bone mineral density was positively correlated with bone formation in both of the groups. These findings suggest that in early phases i.e. week 4 and 8, fracture healing was impaired in patients with spinal cord injury and that various factors participated in the complicated healing process, such as hormonal and mechanical factors.

Adaptability of the oxidative capacity of motoneurons

NASA Technical Reports Server (NTRS)

Chalmers, G. R.; Roy, R. R.; Edgerton, V. R.

1992-01-01

Previous studies have demonstrated that a chronic change in neuronal activation can produce a change in soma oxidative capacity, suggesting that: (i) these 2 variables are directly related in neurons and (ii) ion pumping is an important energy requiring activity of a neuron. Most of these studies, however, have focused on reduced activation levels of sensory systems. In the present study the effect of a chronic increase or decrease in motoneuronal activity on motoneuron oxidative capacity and soma size was studied. In addition, the effect of chronic axotomy was studied as an indicator of whether cytoplasmic volume may also be related to the oxidative capacity of motoneurons. A quantitative histochemical assay for succinate dehydrogenase activity was used as a measure of motoneuron oxidative capacity in experimental models in which chronic electromyography has been used to verify neuronal activity levels. Spinal transection reduced, and spinal isolation virtually eliminated lumbar motoneuron electrical activity. Functional overload of the plantaris by removal of its major synergists was used to chronically increase neural activity of the plantaris motor pool. No change in oxidative capacity or soma size resulted from either a chronic increase or decrease in neuronal activity level. These data indicate that the chronic modulation of ionic transport and neurotransmitter turnover associated with action potentials do not induce compensatory metabolic responses in the metabolic capacity of the soma of lumbar motoneurons. Soma oxidative capacity was reduced in the axotomized motoneurons, suggesting that a combination of axoplasmic transport, intracellular biosynthesis and perhaps neurotransmitter turnover represent the major energy demands on a motoneuron. While soma oxidative capacity may be closely related to neural activity in some neural systems, e.g. visual and auditory, lumbar motoneurons appear to be much less sensitive to modulations in chronic activity levels.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Masala, Salvatore, E-mail: salva.masala@tiscali.it; Tarantino, Umberto; Nano, Giovanni, E-mail: gionano@gmail.com

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

Lumbar Aspergillus osteomyelitis mimicking pyogenic osteomyelitis in an immunocompetent adult.

PubMed

Yoon, Kyeong-Wook; Kim, Young-Jin

2015-04-01

Spinal Aspergillus osteomyelitis is rare and occurs mostly in immunocompromised patients, but especially very rare in immunocompetent adult. This report presents a case of lumbar vertebral osteomyelitis in immunocompetent adult. A 53-year-old male who had no significant medical history was admitted due to complaints of back pain radiating to the flank for the last 3 months, followed by a progressive motor weakness of both lower limbs. Lumbar magnetic resonance imaging (MRI) demonstrated osteomyelitis and diskitis, suspected to be a pyogenic condition rather than a tuberculosis infection. Despite antibiotic treatment for several weeks, the symptoms worsened, and finally, open surgery was performed. Surgical biopsy revealed an Aspergillus infection and medical treatment with amphotericin B was started. It can be diagnosed early through an MRI; biopsy is very important but difficult, and making the correct differential diagnosis is essential for avoiding unexpected complications. The authors report a case of lumbar Aspergillus osteomyelitis in an immunocompetent adult and reviewed previously described cases of spinal aspergillosis.

Effects of lumbar drainage on CSF dynamics in subarachnoid hemorrhage condition: A computational study.

PubMed

Abolfazli, Ehsan; Fatouraee, Nasser; Seddighi, Amir Saeed

2016-10-01

Lumbar drainage is considered a therapeutic measure in treatment of subarachnoid hemorrhage. However, the evidence on the effectiveness of this method is still inconclusive. In this study, a subject-specific three dimensional model of the cerebrospinal fluid (CSF) pathways and compartments was developed. The ventricular and the cranial and spinal subarachnoid spaces were reconstructed using magnetic resonance images. Occurrence of subarachnoid hemorrhage was modeled. Since the presence of blood in the CSF spaces is known to be the cause of complications such as cerebral vasospasm, concentration of blood in these spaces was investigated. Two cases of lumbar drains that were different in the drainage rate were studied. Temporal variations of concentration of blood in CSF spaces were calculated. It was observed that lumbar drainage accelerates the clearance of blood and, thereby, the spasmogens present in the cranial and spinal subarachnoid space. Higher clearance rates were observed at higher drainage rates. Copyright © 2016 Elsevier Ltd. All rights reserved.

Lumbar interspinous bursitis in active polymyalgia rheumatica.

PubMed

Salvarani, Carlo; Barozzi, Libero; Boiardi, Luigi; Pipitone, Nicolò; Bajocchi, Gian Luigi; Macchioni, Pier Luigi; Catanoso, Mariagrazia; Pazzola, Giulia; Valentino, Massimo; De Luca, Carlo; Hunder, Gene G

2013-01-01

To evaluate the inflammatory involvement of lumbar interspinous bursae in patients with polymyalgia rheumatica (PMR) using magnetic resonance imaging (MRI). Ten consecutive, untreated new patients with PMR and pain in the shoulder and pelvic girdles were investigated. Seven patients with spondyloarthritis (4 with psoriatic spondyloarthrits, one with entheropatic spondyloarthritis, and 2 with ankylosing spondylitis) as well as 2 patients with spinal osteoarthritis and 2 patients with rheumatoid arthritis with lumbar pain served as controls. MRI of lumbar spine was performed in all PMR patients and controls. Nine patients (5 PMR patients and 4 controls) also had MRI of the thoracic spine. MRI evidence of interspinous lumbar bursitis was found in 9/10 patients with PMR and in 5/11 controls. A moderate to marked (grade ≥2 on a semiquantitative 0-3 scale) lumbar bursitis occurred significantly more frequently in patients with PMR than in control patients (60% vs. 9%, p=0.020). In most of the patients and controls lumbar bursitis was found at the L3-L5 interspaces. Only 2 patients had bursitis at a different level (one patient had widespread lumbar bursitis, and one control at L2-L4). No interspinous bursitis was demonstrated by MRI of the thoracic spine in patients and controls. Inflammation of lumbar bursae may be responsible for the low back pain reported by patients with PMR. The prominent inflammatory involvement of bursae including those of the lumbar spine supports the hypothesis that PMR may be a disorder affecting predominantly extra-articular synovial structures.

Current strategies for the restoration of adequate lordosis during lumbar fusion

PubMed Central

Barrey, Cédric; Darnis, Alice

2015-01-01

Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

Evaluation of electrical nerve stimulation for epidural catheter positioning in the dog.

PubMed

Garcia-Pereira, Fernando L; Sanders, Robert; Shih, Andre C; Sonea, Ioana M; Hauptman, Joseph G

2013-09-01

To evaluate the accuracy of epidural catheter placement at different levels of the spinal cord guided solely by electrical nerve stimulation and resultant segmental muscle contraction. Prospective, experiment. Six male and two female Beagles, age (1 ± 0.17 years) and weight (12.9 ± 1.1 kg). Animals were anesthetized with propofol and maintained with isoflurane. An insulated epidural needle was used to reach the lumbosacral epidural space. A Tsui epidural catheter was inserted and connected to a nerve stimulator (1.0 mA, 0.1 ms, 2 Hz) to assess positioning of the tip at specific spinal cord segments. The catheter was advanced to three different levels of the spinal cord: lumbar (L2-L5), thoracic (T5-T10) and cervical (C4-C6). Subcutaneous needles were previously placed at these spinal levels and the catheter was advanced to match the needle location, guided only by corresponding muscle contractions. Catheter position was verified by fluoroscopy. If catheter tip and needle were at the same vertebral body a score of zero was assigned. When catheter tip was cranial or caudal to the needle, positive or negative numbers, respectively, corresponding to the number of vertebrae between them, were assigned. The mean and standard deviation of the number of vertebrae between catheter tip and needle were calculated to assess accuracy. Results are given as mean ± SD. The catheter position in relation to the needle was within 0.3 ± 2.0 vertebral bodies. Positive predictive values (PPV) were 57%, 83% and 71% for lumbar, thoracic and cervical regions respectively. Overall PPV was 70%. No significant difference in PPV among regions was found. Placement of an epidural catheter at specific spinal levels using electrical nerve stimulation was feasible without radiographic assistance in dogs. Two vertebral bodies difference from the target site may be clinically acceptable when performing segmental epidural regional anesthesia. © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Perforation and bacterial contamination of microscope covers in lumbar spinal decompressive surgery.

PubMed

Osterhoff, Georg; Spirig, José; Klasen, Jürgen; Kuster, Stefan P; Zinkernagel, Annelies S; Sax, Hugo; Min, Kan

2014-01-01

To determine the integrity of microscope covers and bacterial contamination at the end of lumbar spinal decompressive surgery. A prospective study of 25 consecutive lumbar spinal decompressions with the use of a surgical microscope was performed. For detection of perforations, the microscope covers were filled with water at the end of surgery and the presence of water leakage in 3 zones (objective, ocular and control panel) was examined. For detection of bacterial contamination, swabs were taken from the covers at the same locations before and after surgery. Among the 25 covers, 1 (4%) perforation was observed and no association between perforation and bacterial contamination was seen; 3 (4%) of 75 smears from the 25 covers showed post-operative bacterial contamination, i.e. 2 in the ocular zone and 1 in the optical zone, without a cover perforation. The incidence of microscope cover perforation was very low and was not shown to be associated with bacterial contamination. External sources of bacterial contamination seem to outweigh the problem of contamination due to failure of cover integrity. © 2014 S. Karger AG, Basel.

Perforation and Bacterial Contamination of Microscope Covers in Lumbar Spinal Decompressive Surgery

PubMed Central

Osterhoff, Georg; Spirig, José; Klasen, Jürgen; Kuster, Stefan P.; Zinkernagel, Annelies S.; Sax, Hugo; Min, Kan

2014-01-01

Objective To determine the integrity of microscope covers and bacterial contamination at the end of lumbar spinal decompressive surgery. Materials and Methods A prospective study of 25 consecutive lumbar spinal decompressions with the use of a surgical microscope was performed. For detection of perforations, the microscope covers were filled with water at the end of surgery and the presence of water leakage in 3 zones (objective, ocular and control panel) was examined. For detection of bacterial contamination, swabs were taken from the covers at the same locations before and after surgery. Results Among the 25 covers, 1 (4%) perforation was observed and no association between perforation and bacterial contamination was seen; 3 (4%) of 75 smears from the 25 covers showed post-operative bacterial contamination, i.e. 2 in the ocular zone and 1 in the optical zone, without a cover perforation. Conclusions The incidence of microscope cover perforation was very low and was not shown to be associated with bacterial contamination. External sources of bacterial contamination seem to outweigh the problem of contamination due to failure of cover integrity. PMID:24903448

Pedicle distraction increases intervertebral and spinal canal area in a cadaver and bone model

PubMed Central

Hughes, Matthew; Papadakos, Nikolaos; Bishop, Tim; Bernard, Jason

2018-01-01

Introduction: Lumbar spinal stenosis is degenerative narrowing of the spinal canal and/or intervertebral foramen causing compression of the spinal cord and nerve roots. Traditional decompression techniques can often cause significant trauma and vertebral instability. This paper evaluates a method of increasing pedicle length to decompress the spinal and intervertebral foramen, which could be done minimally invasive. Methods: Three Sawbone (Sawbones Europe, Sweden) and 1 cadaveric lumbar spine underwent bilateral pedicle distraction at L4. A pedicle channel was drilled between the superior articular process and transverse process into the vertebral body. The pedicles underwent osteotomy at the midpoint. Screws were inserted bilaterally and fixated distraction of 0 mm, 2 mm, 4 mm and 6 mm. CT images were taken at each level of distraction. Foramen area was measured in the sagittal plane at L3/4. Spinal canal area was measured at L4 in the axial images. The cadaver was used to evaluate safety of osteotomy and soft tissue interactions preventing distraction. Statistical analysis was by student paired t-test and Pearson rank test. Results: Increasing distraction led to greater Spinal canal area. From 4.27 cm2 to 5.72 cm2 (p = 0.002) with 6 mm distraction. A Maximal increase of 34.1%. Vertebral foramen area also increased with increasing pedicle distraction. From 2.43 cm2 to 3.22 cm2 (p = 0.022) with 6 mm distraction. A maximal increase of 32.3%. The cadaver spinal canal increased in area by 21.7%. The vertebral foramen increased in area by 36.2% (left) and 22.6% (right). Discussion: For each increase in pedicle distraction the area of the spinal and vertebral foramen increases. Pedicle distraction could potentially be used to alleviate spinal stenosis and root impingement. A potential osteotomy plane could be at the midpoint of the pedicle with minimal risk to nerve roots and soft tissue restrictions to prevent distraction. PMID:29727270

Pedicle distraction increases intervertebral and spinal canal area in a cadaver and bone model.

PubMed

Hughes, Matthew; Papadakos, Nikolaos; Bishop, Tim; Bernard, Jason

2018-01-01

Lumbar spinal stenosis is degenerative narrowing of the spinal canal and/or intervertebral foramen causing compression of the spinal cord and nerve roots. Traditional decompression techniques can often cause significant trauma and vertebral instability. This paper evaluates a method of increasing pedicle length to decompress the spinal and intervertebral foramen, which could be done minimally invasive. Three Sawbone (Sawbones Europe, Sweden) and 1 cadaveric lumbar spine underwent bilateral pedicle distraction at L4. A pedicle channel was drilled between the superior articular process and transverse process into the vertebral body. The pedicles underwent osteotomy at the midpoint. Screws were inserted bilaterally and fixated distraction of 0 mm, 2 mm, 4 mm and 6 mm. CT images were taken at each level of distraction. Foramen area was measured in the sagittal plane at L3/4. Spinal canal area was measured at L4 in the axial images. The cadaver was used to evaluate safety of osteotomy and soft tissue interactions preventing distraction. Statistical analysis was by student paired t-test and Pearson rank test. Increasing distraction led to greater Spinal canal area. From 4.27 cm 2 to 5.72 cm 2 (p = 0.002) with 6 mm distraction. A Maximal increase of 34.1%. Vertebral foramen area also increased with increasing pedicle distraction. From 2.43 cm 2 to 3.22 cm 2 (p = 0.022) with 6 mm distraction. A maximal increase of 32.3%. The cadaver spinal canal increased in area by 21.7%. The vertebral foramen increased in area by 36.2% (left) and 22.6% (right). For each increase in pedicle distraction the area of the spinal and vertebral foramen increases. Pedicle distraction could potentially be used to alleviate spinal stenosis and root impingement. A potential osteotomy plane could be at the midpoint of the pedicle with minimal risk to nerve roots and soft tissue restrictions to prevent distraction. © The Authors, published by EDP Sciences, 2018.

Comparison of Clinical and Radiologic Results of Mini-Open Transforaminal Lumbar Interbody Fusion and Extreme Lateral Interbody Fusion Indirect Decompression for Degenerative Lumbar Spondylolisthesis

PubMed Central

Gen, Hogaku; Sakuma, Yoshio; Koshika, Yasuhide

2018-01-01

Study Design Retrospective study. Purpose In this study, we compared the postoperative outcomes of extreme lateral interbody fusion (XLIF) indirect decompression with that of mini-open transforaminal lumbar interbody fusion (TLIF) in patients with lumbar degenerative spondylolisthesis. Overview of Literature There are very few reports examining postoperative results of XLIF and minimally invasive TLIF for degenerative lumbar spondylolisthesis, and no reports comparing XLIF and mini-open TLIF. Methods Forty patients who underwent 1-level spinal fusion, either by XLIF indirect decompression (X group, 20 patients) or by mini-open TLIF (T group, 20 patients), for treatment of lumbar degenerative spondylolisthesis were included in this study. Invasiveness of surgery was evaluated on the basis of surgery time, blood loss, hospitalization period, and perioperative complications. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), disc angle (DA), disc height (DH), and slipping length (SL) were evaluated before surgery, immediately after surgery, and at 12 months after surgery. Cross-sectional spinal canal area (CSA) was also measured before surgery and at 1 month after surgery. Results There was no significant difference between the groups in terms of surgery time or hospitalization period; however, X group showed a significant decrease in blood loss (p<0.001). Serious complications were not observed in either group. In clinical assessment, no significant differences were observed between the groups with regard to the JOABPEQ results. The change in DH at 12 months after surgery increased significantly in the X group (p<0.05), and the changes in DA and SL were not significantly different between the two groups. The change in CSA was significantly greater in the T group (p<0.001). Conclusions Postoperative clinical results were equally favorable for both procedures; however, in comparison with mini-open TLIF, less blood loss and greater correction of DH were observed in XLIF. PMID:29713419

Comparison of Clinical and Radiologic Results of Mini-Open Transforaminal Lumbar Interbody Fusion and Extreme Lateral Interbody Fusion Indirect Decompression for Degenerative Lumbar Spondylolisthesis.

PubMed

Kono, Yutaka; Gen, Hogaku; Sakuma, Yoshio; Koshika, Yasuhide

2018-04-01

Retrospective study. In this study, we compared the postoperative outcomes of extreme lateral interbody fusion (XLIF) indirect decompression with that of mini-open transforaminal lumbar interbody fusion (TLIF) in patients with lumbar degenerative spondylolisthesis. There are very few reports examining postoperative results of XLIF and minimally invasive TLIF for degenerative lumbar spondylolisthesis, and no reports comparing XLIF and mini-open TLIF. Forty patients who underwent 1-level spinal fusion, either by XLIF indirect decompression (X group, 20 patients) or by mini-open TLIF (T group, 20 patients), for treatment of lumbar degenerative spondylolisthesis were included in this study. Invasiveness of surgery was evaluated on the basis of surgery time, blood loss, hospitalization period, and perioperative complications. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), disc angle (DA), disc height (DH), and slipping length (SL) were evaluated before surgery, immediately after surgery, and at 12 months after surgery. Cross-sectional spinal canal area (CSA) was also measured before surgery and at 1 month after surgery. There was no significant difference between the groups in terms of surgery time or hospitalization period; however, X group showed a significant decrease in blood loss ( p <0.001). Serious complications were not observed in either group. In clinical assessment, no significant differences were observed between the groups with regard to the JOABPEQ results. The change in DH at 12 months after surgery increased significantly in the X group ( p <0.05), and the changes in DA and SL were not significantly different between the two groups. The change in CSA was significantly greater in the T group ( p <0.001). Postoperative clinical results were equally favorable for both procedures; however, in comparison with mini-open TLIF, less blood loss and greater correction of DH were observed in XLIF.

Footwear affects the behavior of low back muscles when jogging.

PubMed

Ogon, M; Aleksiev, A R; Spratt, K F; Pope, M H; Saltzman, C L

2001-08-01

Use of modified shoes and insole materials has been widely advocated to treat low back symptoms from running impacts, although considerable uncertainty remains regarding the effects of these devices on the rate of shock transmission to the spine. This study investigated the effects of shoes and insole materials on a) the rate of shock transmission to the spine, b) the temporal response of spinal musculature to impact loading, and c) the time interval between peak lumbar acceleration and peak lumbar muscle response. It was hypothesised that shoes and inserts a) decrease the rate of shock transmission, b) decrease the low back muscle response time, and c) shorten the time interval between peak lumbar acceleration and peak lumbar muscle response. Twelve healthy subjects were tested while jogging barefoot (unshod) or wearing identical athletic shoes (shod). Either no material, semi-rigid (34 Shore A), or soft (9.5 Shore A) insole material covered the force plate in the barefoot conditions and was placed as insole when running shod. Ground reaction forces, acceleration at the third lumbar level, and erector spinae myoelectric activity were recorded simultaneously. The rate of shock transmission to the spine was greater (p < 0.0003) unshod (acceleration rate: Means +/- SD 127.35 +/- 87.23 g/s) than shod (49.84 +/- 33.98 g/s). The temporal response of spinal musculature following heel strike was significantly shorter (p < 0.023) unshod (0.038 +/- 0.021 s) than shod (0.047 +/- 0.036 s). The latency between acceleration peak (maximal external force) and muscle response peak (maximal internal force) was significantly (p < 0.021) longer unshod (0.0137 +/- 0.022s) than shod (0.004 +/- 0.040 s). These results suggest that one of the benefits of running shoes and insoles is improved temporal synchronization between potentially destabilizing external forces and stabilizing internal forces around the lumbar spine.

Do people with recurrent back pain constrain spinal motion during seated horizontal and downward reaching?

PubMed

Crosbie, Jack; Nascimento, Dafne Port; Filho, Ruben de Faria Negrão; Ferreira, Paulo

2013-10-01

Although the effect of symptomatic back pain on functional movement has been investigated, changes to spinal movement patterns in essentially pain-free people with a history of recurrent back pain are largely unreported. Reaching activities, important for everyday and occupational function, often present problems to such people, but have not been considered in this population. The purpose of this study was to compare the amplitude and timing of spinal and hip motions during two, seated reaching activities in people with and without a history of recurrent low back pain (RLBP). Spinal and hip motions during reaching downward and across the body, in both directions, were tracked using electromagnetic sensors. Analyses were conducted to explore the amplitudes, velocities and timings of 3D segmental movements and to compare controls with subjects with recurrent, but asymptomatic lumbar or lumbosacral pain. We detected significant differences in the amplitude and timing of movement in the lower thoracic region, with the RLBP group restricting movement and demonstrating compensatory increased motion at the hip. The lumbar region displayed no significant between-group differences. The order in which the spinal segments achieved peak velocity in cross-reaching was reversed in RLBP compared to controls, with lumbar motion leading in controls and lagging in RLBP. Subjects with a history of RLBP show a number of altered kinematic features during reaching activities which are not related to the presence or intensity of pain, but which suggest adaptive changes to movement control. © 2013.

Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain.

PubMed

Hildebrandt, Markus; Fankhauser, Gabriela; Meichtry, André; Luomajoki, Hannu

2017-01-10

Lumbar multifidus muscles (LMM) are important for spinal motion and stability. Low back pain (LBP) is often associated with fat infiltration in LMM. An increasing fat infiltration of LMM may lead to lumbar dysfunction. The purpose of this study was to investigate whether there is a correlation between the severity of lumbar dysfunction and the severity of fat infiltration of LMM. In a cross-sectional study, 42 patients with acute or chronic LBP were recruited. Their MRI findings were visually rated and graded using three criteria for fat accumulation in LMM: Grade 0 (0-10%), Grade 1 (10-50%) and Grade 2 (>50%). Lumbar sagittal range of motion, dynamic upright and seated posture control, sagittal movement control, body awareness and self-assessed functional disability were measured to determine the patients' low back dysfunction. The main result of this study was that increased severity of fat infiltration in the lumbar multifidus muscles correlated significantly with decreased range of motion of lumbar flexion (p = 0.032). No significant correlation was found between the severity of fat infiltration in LMM and impaired movement control, posture control, body awareness or self-assessed functional disability. This is the first study investigating the relationship between the severity of fat infiltration in LMM and the severity of lumbar dysfunction. The results of this study will contribute to the understanding of the mechanisms leading to fat infiltration of LMM and its relation to spinal function. Further studies should investigate whether specific treatment strategies are effective in reducing or preventing fat infiltration of LMM.

Clinical and radiological outcomes of endoscopic partial facetectomy for degenerative lumbar foraminal stenosis.

PubMed

Youn, Myung Soo; Shin, Jong Ki; Goh, Tae Sik; Lee, Jung Sub

2017-06-01

Several different techniques exist to treat degenerative lumbar foraminal stenosis. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, wide decompression often causes spinal instabilities or may require an additional fusion surgery. The aim of this study was to report the outcomes of endoscopic partial facetectomy (EPF) performed on patients with degenerative lumbar foraminal stenosis. Between 2012 and 2014, 25 consecutive patients (12 women and 13 men) who underwent EPF were included in the study. The patients were assessed before surgery and followed-up regularly during outpatient visits (preoperatively and 1, 3, 6, 12, and 24 months postoperatively). The clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) outcome questionnaire. The radiological outcome was measured using the lumbar Cobb angle, disc wedging angle, lumbar lordosis (LL), slip percentage, and disc height index (DHI) in plain standing radiographs. The VAS, ODI, and SF-36 scores significantly improved at 1 month of follow-up compared with the baseline mean values and were maintained within the 2-year follow-up period. There was no radiologic progression in the lumbar Cobb's angle, disc wedging angle, LL, slip percentage, and DHI between preoperatively and 2 years postoperatively. In addition, the EPF with discectomy group and the EPF group were not significantly different in terms of clinical and radiological outcomes. EPF is an effective option in decompressing the lumbar exiting nerve root without causing spinal instabilities for the treatment of patients with lumbar foraminal stenosis.

Spinal injury

MedlinePlus

... Lack of alertness (unconsciousness) Stiff neck, headache, or neck pain First Aid Never move anyone who you think may have a spinal injury, unless it is absolutely necessary. For example, if you need to get the person out ... cervical (neck) Vertebra, lumbar (low back) Vertebra, thoracic (mid ...

Mechanisms of spinal motoneurons survival in rats under simulated hypogravity on earth

NASA Astrophysics Data System (ADS)

Islamov, R. R.; Mishagina, E. A.; Tyapkina, O. V.; Shajmardanova, G. F.; Eremeev, A. A.; Kozlovskaya, I. B.; Nikolskij, E. E.; Grigorjev, A. I.

2011-05-01

It was previously shown that different cell types in vivo and in vitro may die via apoptosis under weightlessness conditions in space as well as in simulated hypogravity on the Earth. We assessed survivability of spinal motoneurons of rats after 35-day antiorthostatic hind limb suspension. Following weight bearing, unloading the total protein content in lumbar spinal cord is dropped by 21%. The electrophysiological studies of m. gastrocnemius revealed an elevated motoneurons' reflex excitability and conduction disturbances in the sciatic nerve axons. The number of myelinated fibers in the ventral root of experimental animals was insignificantly increased by 35-day of antiorthostatic hind limb suspension, although the retrograde axonal transport was significantly decreased during the first week of simulated hypogravity. The results of the immunohistochemical assay with antibodies against proapoptotic protein caspase 9 and cytotoxicity marker neuron specific nitric oxide synthase (nNOS) and the TUNEL staining did not reveal any signs of apoptosis in motoneurons of suspended and control animals. To examine the possible adaptation mechanisms activated in motoneurons in response to simulated hypogravity we investigated immunoexpression of Hsp25 and Hsp70 in lumbar spinal cord of the rats after 35-day antiorthostatic hind limb suspension. Comparative analysis of the immunohistochemical reaction with anti-Hsp25 antibodies revealed differential staining of motoneurons in intact and experimental animals. The density of immunoprecipitate with anti-Hsp25 antibodies was substantially higher in motoneurons of the 35-day suspended than control rats and the more intensive precipitate in this reaction was observed in motoneuron neuritis. Quantitative analysis of Hsp25 expression demonstrated an increase in the Hsp25 level by 95% in experimental rats compared to the control. The immunoexpression of Hsp70 found no qualitative and quantitative differences in control and experimental lumbar spinal cords. Taken together our results show that (1) rat motoneurons survived after 35-day antiorthostatic hind limb suspension and the changes in neurons had a mostly functional character, and (2) the increased immunoexpression of Hsp25 can be considered as the anti-apoptotic factor.

Electrical stimulation and motor recovery.

PubMed

Young, Wise

2015-01-01

In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory.

Finite Element Analysis of the Effect of Epidural Adhesions.

PubMed

Lee, Nam; Ji, Gyu Yeul; Yi, Seong; Yoon, Do Heum; Shin, Dong Ah; Kim, Keung Nyun; Ha, Yoon; Oh, Chang Hyun

2016-07-01

It is well documented that epidural adhesion is associated with spinal pain. However, the underlying mechanism of spinal pain generation by epidural adhesion has not yet been elucidated. To elucidate the underlying mechanism of spinal pain generation by epidural adhesion using a two-dimensional (2D) non-linear finite element (FE) analysis. A finite element analysis. A two-dimensional nonlinear FE model of the herniated lumbar disc on L4/5 with epidural adhesion. A two-dimensional nonlinear FE model of the lumbar spine was developed, consisting of intervertebral discs, dura, spinal nerve, and lamina. The annulus fibrosus and nucleus pulpous were modeled as hyperelastic using the Mooney-Rivlin equation. The FE mesh was generated and analyzed using Abaqus (ABAQUS 6.13.; Hibbitt, Karlsson & Sorenson, Inc., Providence, RI, USA). Epidural adhesion was simulated as rough contact, in which no slip occurred once two surfaces were in contact, between the dura mater and posterior annulus fibrosus. The FE model of adhesion showed significant stress concentration in the spinal nerves, especially on the dorsal root ganglion (DRG). The stress concentration was caused by the lack of adaptive displacement between the dura mater and posterior annulus fibrosus. The peak von Mises stress was higher in the epidural adhesion model (Adhesion, 0.67 vs. Control, 0.46). In the control model, adaptive displacement was observed with decreased stress in the spinal nerve and DRG (with adhesion, 2.59 vs. without adhesion, 3.58, P < 0.00). This study used a 2D non-linear FE model, which simplifies the 3D nature of the human intervertebral disc. In addition, this 2D non-linear FE model has not yet been validated. The current study clearly demonstrated that epidural adhesion causes significantly increased stress in the spinal nerves, especially at the DRG. We believe that the increased stress on the spinal nerve might elicit more pain under similar magnitudes of lumbar disc protrusion.

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

PubMed

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

2017-08-01

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

Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report

PubMed Central

Timbó, Luciana Sátiro; Rosemberg, Laercio Alberto; Brandt, Reynaldo André; Peres, Ricardo Botticini; Nakamura, Olavo Kyosen; Guimarães, Juliana Frota

2014-01-01

Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection. PMID:25628207

Return to Golf After Lumbar Fusion.

PubMed

Shifflett, Grant D; Hellman, Michael D; Louie, Philip K; Mikhail, Christopher; Park, Kevin U; Phillips, Frank M

Spinal fusion surgery is being increasingly performed, yet few studies have focused on return to recreational sports after lumbar fusion and none have specifically analyzed return to golf. Most golfers successfully return to sport after lumbar fusion surgery. Case series. Level 4. All patients who underwent 1- or 2-level primary lumbar fusion surgery for degenerative pathologies performed by a single surgeon between January 2008 and October 2012 and had at least 1-year follow-up were included. Patients completed a specifically designed golf survey. Surveys were mailed, given during follow-up clinic, or answered during telephone contact. A total of 353 patients met the inclusion and exclusion criteria, with 200 responses (57%) to the questionnaire producing 34 golfers. The average age of golfers was 57 years (range, 32-79 years). In 79% of golfers, preoperative back and/or leg pain significantly affected their ability to play golf. Within 1 year from surgery, 65% of patients returned to practice and 52% returned to course play. Only 29% of patients stated that continued back/leg pain limited their play. Twenty-five patients (77%) were able to play the same amount of golf or more than before fusion surgery. Of those providing handicaps, 12 (80%) reported the same or an improved handicap. More than 50% of golfers return to on-course play within 1 year of lumbar fusion surgery. The majority of golfers can return to preoperative levels in terms of performance (handicap) and frequency of play. This investigation offers insight into when golfers return to sport after lumbar fusion surgery and provides surgeons with information to set realistic expectations postoperatively.

Usefulness of Chest Radiographs for Scoliosis Screening: A Comparison with Thoraco-Lumbar Standing Radiographs

PubMed Central

Oh, Chang Hyun; Kim, Chan Gyu; Lee, Myoung Seok; Park, Hyeong-Chun; Park, Chong Oon

2012-01-01

Purpose The purposes of this study were to evaluate the usefulness and limitations of chest radiographs in scoliosis screening and to compare these results with those of thoraco-lumbar standing radiographs (TLSR). Materials and Methods During Korean conscription, 419 males were retrospectively examined using both chest radiographs and TLSR to confirm the scoliosis and Cobb angle at the Regional Military Manpower. We compared the types of spinal curves and Cobb angles as measured from different radiographs. Results In the pattern of spinal curves, the overall matching rate of chest radiographs using TLSR was about 58.2% (244 of 419 cases). Cobb angle differences between chest radiographs and TLSR with meaningful difference was observed in 156 cases (37.2%); a relatively high proportion (9.5%) of Cobb angle differences more than 10 degrees was also observed. The matching rate of both spinal curve types and Cobb angle accuracy between chest radiographs and TLSR was 27.9% (117 among 419 cases). Chest radiographs for scoliosis screening were observed with 93.94% of sensitivity and 61.67% of specificity in thoracic curves; however, less than 40% of sensitivity (38.27%, 20.00%, and 25.80%) and more than 95% of specificity (97.34%, 99.69%, and 98.45%) were observed in thoraco-lumbar, lumbar, and double major curves, respectively. Conclusion The accuracy of chest radiographs for scoliosis screening was low. The incidence of thoracic curve scoliosis was overestimated and lumbar curve scoliosis was easily missed by chest radiography. Scoliosis screening using chest radiography has limited values, nevertheless, it is useful method for detecting thoracic curve scoliosis. PMID:23074120

Dose-response study of spinal hyperbaric ropivacaine for cesarean section

PubMed Central

Chen, Xin-zhong; Chen, Hong; Lou, Ai-fei; Lü, Chang-cheng

2006-01-01

Background: Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind, randomized, dose-response study determined the ED50 (50% effective dose) and ED95 (95% effective dose) of spinal hyperbaric ropivacaine for cesarean section anesthesia. Methods: Sixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1~L2 vertebral interspace, then lumbar puncture was performed at the L3~L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels (pinprick) were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective if an upper sensory level to pin prick of T7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model. Results: ED50 (95% confidence interval) of spinal hyperbaric ropivacaine was determined to be 10.37 (5.23~11.59) mg and ED95 (95% confidence interval) to be 15.39 (13.81~23.59) mg. The maximum sensory block levels and the duration of motor block and the rate of hypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose. Conclusion: The ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery. PMID:17111469

Preoperative anxiety about spinal surgery under general anesthesia.

PubMed

Lee, Jun-Seok; Park, Yong-Moon; Ha, Kee-Yong; Cho, Sung-Wook; Bak, Geun-Hyeong; Kim, Ki-Won

2016-03-01

No study has investigated preoperative anxiety about spinal surgery under general anesthesia. The purposes of this study were (1) to determine how many patients have preoperative anxiety about spinal surgery and general anesthesia, (2) to evaluate the level of anxiety, (3) to identify patient factors potentially associated with the level of anxiety, and (4) to describe the characteristics of the anxiety that patients experience during the perioperative period. This study was performed in 175 consecutive patients undergoing laminectomy for lumbar stenosis or discectomy for herniated nucleus pulposus under general anesthesia. Demographic data, information related to surgery, and characteristics of anxiety were obtained using a questionnaire. The level of anxiety was assessed using a visual analog scale of anxiety (VAS-anxiety). Patient factors potentially associated with the level of anxiety were investigated using multiple stepwise regression analysis. Of 157 patients finally included in this study, 137 (87%) had preoperative anxiety (VAS-anxiety > 0). The mean VAS-anxiety score for spinal surgery was significantly higher than that for general anesthesia (4.6 ± 3.0 vs. 3.2 ± 2.7; P < 0.001). Sex and age were significant patient factors related to the level of anxiety about spinal surgery (P = 0.009) and general anesthesia (P = 0.018); female patients had a higher level of anxiety about spinal surgery, and elderly patients had a higher level of anxiety about general anesthesia. The most helpful factors in overcoming anxiety before surgery and in reducing anxiety after surgery were faith in the medical staff (48.9 %) and surgeon's explanation of the surgery performed (72.3%), respectively. Patients awaiting laminectomy or discectomy feared spinal surgery more than general anesthesia. This study also found that medical staff and surgeons play important roles in overcoming and reducing patient anxiety during the perioperative period.

Cost utility analysis of caudal epidural injections in the treatment of lumbar disc herniation, axial or discogenic low back pain, central spinal stenosis, and post lumbar surgery syndrome.

PubMed

Manchikanti, Laxmaiah; Falco, Frank J E; Pampati, Vidyasagar; Cash, Kimberly A; Benyamin, Ramsin M; Hirsch, Joshua A

2013-01-01

In this era of escalating health care costs and the questionable effectiveness of multiple interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine, and has an influence coverage decisions. Even though multiple cost effectiveness analysis studies have been performed over the years, extensive literature is lacking for interventional techniques. Cost utility analysis studies of epidural injections for managing chronic low back pain demonstrated highly variable results including a lack of cost utility in randomized trials and contrasting results in observational studies. There has not been any cost utility analysis studies of epidural injections in large randomized trials performed in interventional pain management settings. To assess the cost utility of caudal epidural injections in managing chronic low back pain secondary to lumbar disc herniation, axial or discogenic low back pain, lumbar central spinal stenosis, and lumbar post surgery syndrome. This analysis is based on 4 previously published randomized trials. A private, specialty referral interventional pain management center in the United States. Four randomized trials were conducted assessing the clinical effectiveness of caudal epidural injections with or without steroids for lumbar disc herniation, lumbar discogenic or axial low back pain, lumbar central spinal stenosis, and post surgery syndrome. A cost utility analysis was performed with direct payment data for a total of 480 patients over a period of 2 years from these 4 trials. Outcome included various measures with significant improvement defined as at least a 50% improvement in pain reduction and disability status. The results of 4 randomized controlled trials of low back pain with 480 patients with a 2 year follow-up with the actual reimbursement data showed cost utility for one year of quality-adjusted life year (QALY) of $2,206 for disc herniation, $2,136 for axial or discogenic pain without disc herniation, $2,155 for central spinal stenosis, and $2,191 for post surgery syndrome. All patients showed significant improvement clinically and showed positive results in the cost utility analysis with an average cost per one year QALY of $2,172.50 for all patients and $1,966.03 for patients judged to be successful. The results of this assessment show a better cost utility or lower cost of managing chronic, intractable low back pain with caudal epidural injections at a QALY that is similar or lower in price than medical therapy only, physical therapy, manipulation, and surgery in most cases. The limitations of this cost utility analysis include that it is a single center evaluation, even though 480 patients were included in the analysis. Further, only the costs of interventional procedures and physician visits were included. The benefits of returning to work were not assessed.   This cost utility analysis of caudal epidural injections in the treatment of disc herniation, axial or discogenic low back pain, central spinal stenosis, and post surgery syndrome in the lumbar spine shows the clinical effectiveness and cost utility of these injections at less than $2,200 per one year of QALY.

Systemic Inflammatory and Th17 Immune Activation among Patients Treated for Lumbar Radiculopathy Exceeds that of Patients Treated for Persistent Postoperative Neuropathic Pain.

PubMed

Shamji, Mohammed F; Guha, Daipayan; Paul, Darcia; Shcharinsky, Alina

2017-09-01

The pathophysiology of lumbar radiculopathy includes both mechanical compression and biochemical irritation of apposed neural elements. Inflammatory and immune cytokines have been implicated, induced by systemic exposure of immune-privileged intervertebral disc tissue. Surgical intervention provides improved symptoms and quality of life, but persistent postoperative neuropathic pain (PPNP) afflicts a significant fraction of patients. To compare the inflammatory and immune phenotypes among patients undergoing structural surgery for lumbar radiculopathy and spinal cord stimulation for neuropathic pain. Consecutive patients undergoing surgical intervention for lumbar radiculopathy or neuropathic pain were studied. Demographic data included age, gender, and VAS and neuropathic pain scores. Serum was evaluated for cytokine levels (IL-6, Il-17, TNF-α) and cellular content [white blood cell (WBC)/differential, lymphocyte subtypes]. The primary analysis differentiated molecular and cellular profiles between radiculopathy and neuropathic pain patients. Subgroup analysis within the surgical radiculopathy population compared those patients achieving relief of symptoms and those with PPNP. Heightened IL-6, Il-17, and TNF-α levels were observed for the lumbar radiculopathy group compared with the neuropathic pain group. This was complemented by higher WBC count and a greater fraction of Th17 lymphocytes among radiculopathy patients. In the lumbar discectomy subgroup, pain relief was seen among patients with preoperatively elevated IL-17 levels. Those patients with PPNP refractory to surgical discectomy exhibited normal cytokine levels. Differences in Th17 immune activation are seen among radiculopathy and neuropathic pain patients. These cellular and molecular profiles may be translated into biomarkers to improve patient selection for structural spine surgery. Copyright © 2017 by the Congress of Neurological Surgeons

Return to Golf After Lumbar Fusion

PubMed Central

Shifflett, Grant D.; Hellman, Michael D.; Louie, Philip K.; Mikhail, Christopher; Park, Kevin U.; Phillips, Frank M.

2016-01-01

Background: Spinal fusion surgery is being increasingly performed, yet few studies have focused on return to recreational sports after lumbar fusion and none have specifically analyzed return to golf. Hypothesis: Most golfers successfully return to sport after lumbar fusion surgery. Study Design: Case series. Level of Evidence: Level 4. Methods: All patients who underwent 1- or 2-level primary lumbar fusion surgery for degenerative pathologies performed by a single surgeon between January 2008 and October 2012 and had at least 1-year follow-up were included. Patients completed a specifically designed golf survey. Surveys were mailed, given during follow-up clinic, or answered during telephone contact. Results: A total of 353 patients met the inclusion and exclusion criteria, with 200 responses (57%) to the questionnaire producing 34 golfers. The average age of golfers was 57 years (range, 32-79 years). In 79% of golfers, preoperative back and/or leg pain significantly affected their ability to play golf. Within 1 year from surgery, 65% of patients returned to practice and 52% returned to course play. Only 29% of patients stated that continued back/leg pain limited their play. Twenty-five patients (77%) were able to play the same amount of golf or more than before fusion surgery. Of those providing handicaps, 12 (80%) reported the same or an improved handicap. Conclusion: More than 50% of golfers return to on-course play within 1 year of lumbar fusion surgery. The majority of golfers can return to preoperative levels in terms of performance (handicap) and frequency of play. Clinical Relevance: This investigation offers insight into when golfers return to sport after lumbar fusion surgery and provides surgeons with information to set realistic expectations postoperatively. PMID:27879299

Use of liposomal bupivacaine in the postoperative management of posterior spinal decompression.

PubMed

Grieff, Anthony N; Ghobrial, George M; Jallo, Jack

2016-07-01

OBJECTIVE The aim in this paper was to evaluate the efficacy of long-acting liposomal bupivacaine in comparison with bupivacaine hydrochloride for lowering postoperative analgesic usage in the management of posterior cervical and lumbar decompression and fusion. METHODS A retrospective cohort-matched chart review of 531 consecutive cases over 17 months (October 2013 to February 2015) for posterior cervical and lumbar spinal surgery procedures performed by a single surgeon (J.J.) was performed. Inclusion criteria for the analysis were limited to those patients who received posterior approach decompression and fusion for cervical or lumbar spondylolisthesis and/or stenosis. Patients from October 1, 2013, through December 31, 2013, received periincisional injections of bupivacaine hydrochloride, whereas after January 1, 2014, liposomal bupivacaine was solely administered to all patients undergoing posterior approach cervical and lumbar spinal surgery through the duration of treatment. Patients were separated into 2 groups for further analysis: posterior cervical and posterior lumbar spinal surgery. RESULTS One hundred sixteen patients were identified: 52 in the cervical cohort and 64 in the lumbar cohort. For both cervical and lumbar cases, patients who received bupivacaine hydrochloride required approximately twice the adjusted morphine milligram equivalent (MME) per day in comparison with the liposomal bupivacaine groups (5.7 vs 2.7 MME, p = 0.27 [cervical] and 17.3 vs 7.1 MME, p = 0.30 [lumbar]). The amounts of intravenous rescue analgesic requirements were greater for bupivacaine hydrochloride in comparison with liposomal bupivacaine in both the cervical (1.0 vs 0.39 MME, p = 0.31) and lumbar (1.0 vs 0.37 MME, p = 0.08) cohorts as well. None of these differences was found to be statistically significant. There were also no significant differences in lengths of stay, complication rates, or infection rates. A subgroup analysis of both cohorts of opiate-naive versus opiate-dependent patients found that those patients who were naive had no difference in opiate requirements. In chronic opiate users, there was a trend toward higher opiate requirements for the bupivacaine hydrochloride group than for the liposomal bupivacaine group; however, this trend did not achieve statistical significance. CONCLUSIONS Liposomal bupivacaine did not appear to significantly decrease perioperative narcotic use or length of hospitalization, although there was a trend toward decreased narcotic use in comparison with bupivacaine hydrochloride. While the results of this study do not support the routine use of liposomal bupivacaine, there may be a benefit in the subgroup of patients who are chronic opiate users. Future prospective randomized controlled trials, ideally with dose-response parameters, must be performed to fully explore the efficacy of liposomal bupivacaine, as the prior literature suggests that clinically relevant effects require a minimum tissue concentration.

Analysis of the spinal nerve roots in relation to the adjacent vertebral bodies with respect to a posterolateral vertebral body replacement procedure.

PubMed

Awwad, Waleed; Bourget-Murray, Jonathan; Zeiadin, Nadil; Mejia, Juan P; Steffen, Thomas; Algarni, Abdulrahman D; Alsaleh, Khalid; Ouellet, Jean; Weber, Michael; Jarzem, Peter F

2017-01-01

This study aims to improve the understanding of the anatomic variations along the thoracic and lumbar spine encountered during an all-posterior vertebrectomy, and reconstruction procedure. This information will help improve our understanding of human spine anatomy and will allow better planning for a vertebral body replacement (VBR) through either a transpedicular or costotransversectomy approach. The major challenge to a total posterior approach vertebrectomy and VBR in the thoracolumbar spine lies in the preservation of important neural structures. This was a retrospective analysis. Hundred normal magnetic resonance imaging (MRI) spinal studies (T1-L5) on sagittal T2-weighted MRI images were studied to quantify: (1) mid-sagittal vertebral body (VB) dimensions (anterior, midline, and posterior VB height), (2) midline VB and associated intervertebral discs height, (3) mean distance between adjacent spinal nerve roots (DNN) and mean distance between the inferior endplate of the superior vertebrae to its respective spinal nerve root (DNE), and (4) posterior approach expansion ratio (PAER). (1) The mean anterior VB height gradually increased craniocaudally from T1 to L5. The mean midline and posterior VB height showed a similar pattern up to L2. Mean posterior VB height was larger than the mean anterior VB height from T1 to L2, consistent with anterior wedging, and then measured less than the mean anterior VB height, indicating posterior wedging. (2) Midline VB and intervertebral disc height gradually increased from T1 to L4. (3) DNN and DNE were similar, whereby they gradually increased from T1 to L3. (5) Mean PAER varied between 1.69 (T12) and 2.27 (L5) depending on anatomic level. The dimensions of the thoracic and lumbar vertebrae and discs vary greatly. Thus, any attempt at carrying out a VBR from a posterior approach should take into account the specifications at each spinal level.

Diabetes-induced microvascular complications at the level of the spinal cord; a contributing factor in diabetic neuropathic pain.

PubMed

Ved, N; Da Vitoria Lobo, M E; Bestall, S M; L Vidueira, C; Beazley-Long, N; Ballmer-Hofer, K; Hirashima, M; Bates, D O; Donaldson, L F; Hulse, R P

2018-05-17

Abnormalities of neurovascular interactions within the central nervous system of diabetic patients is associated with the onset of many neurological disease states. However, to date, the link between the neurovascular network within the spinal cord and regulation of nociception has not been investigated despite neuropathic pain being common in diabetes. We hypothesised that hyperglycaemia-induced endothelial degeneration in the spinal cord, due to suppression of VEGF-A/VEGFR2 signalling, induces diabetic neuropathic pain. Nociceptive pain behaviour was investigated in a chemically induced model of type 1 diabetes (streptozotocin induced, insulin supplemented; either vehicle or VEGF-A 165 b treated) and an inducible endothelial knockdown of VEGFR2 (tamoxifen induced). Diabetic animals developed mechanical allodynia and heat hyperalgesia. This was associated with a reduction in the number of blood vessels and reduction in Evans blue extravasation in the lumbar spinal cord of diabetic animals versus age-matched controls. Endothelial markers occludin, CD31 and VE-cadherin were downregulated in the spinal cord of the diabetic group versus controls, as well as a concurrent reduction of VEGF-A 165 b expression. In diabetic animals, VEGF-A 165 b treatment (biweekly intraperitoneal, 20 ng g -1 ) restored normal Evans blue extravasation and prevented vascular degeneration, diabetes-induced central neuron activation and neuropathic pain. Inducible knockdown of VEGFR2 (tamoxifen treated Tie2CreER T2 -vegfr2 flfl mice) led to a reduction in blood vessel network volume in the lumbar spinal cord and development of heat hyperalgesia. These findings indicate that hyperglycaemia leads to a reduction in the VEGF-A/VEGFR2 signalling cascade resulting in endothelial dysfunction in the spinal cord, which could be an undiscovered contributing factor to diabetic neuropathic pain. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Effects of a wearable type lumbosacral support for low back pain among hospital workers: A randomized controlled trial.

PubMed

Hagiwara, Yoshihiro; Yabe, Yutaka; Yamada, Hiroyuki; Watanabe, Takashi; Kanazawa, Kenji; Koide, Masashi; Sekiguchi, Takuya; Hatano, Hirokazu; Itoi, Eiji

2017-03-28

To examine the effects of a new wearable type of lumbosacral support on low back pain. A total of 121 healthcare workers participated in this study. They were randomly allocated into the experimental and control groups and the former wore the support with signals of compression on the back by poor posture for the first 3 months. The control group remained on a waiting list for the first 3 months. Medical history, musculoskeletal symptoms, feeling in good posture, sleep habits, psychological distress, Roland-Morris Disability Questionnaire, and Somatosensory Amplification Scale (SSAS) were evaluated. The range of motion (ROM) in the shoulder and hip joints as well as spinal alignment were evaluated. Our primary concern was the difference in the change of low back pain measured by visual analog scale (VAS) between the two groups. A total of 54 participants in the experimental and 53 participants in the control groups were analyzed. VAS and SSAS scores as well as lumbar spinal ROM in the experimental group significantly decreased. Low back pain (OR=0.401, 95% CI=0.168-0.954) and neck pain in the experimental group (OR=0.198, 95% CI=0.052-0.748) significantly decreased. The new lumbar support reduced VAS and SSAS scores, lumbar spinal ROM, low back pain, and neck pain. This new type of lumbar support reduced low back pain among healthcare workers.

Impact of post-manipulation corrective core exercises on the spinal deformation and lumbar strength in golfers: a case study

PubMed Central

Shin, Chul-ho; Kim, Minjeong; Park, Gi Duck

2015-01-01

[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

Reliability and validity of simplified Chinese version of Swiss Spinal Stenosis Questionnaire for patients with degenerative lumbar spinal stenosis.

PubMed

Yi, Honglei; Wei, Xianzhao; Zhang, Wei; Chen, Ziqiang; Wang, Xinhui; Ji, Xinran; Zhu, Xiaodong; Wang, Fei; Xu, Ximing; Li, Zhikun; Fan, Jianping; Wang, Chuanfeng; Chen, Kai; Zhang, Guoyou; Zhao, Yinchuan; Li, Ming

2014-05-01

This was a prospective clinical validation study. To evaluate the reliability and validity of the adapted simplified Chinese version of Swiss Spinal Stenosis (SC-SSS) Questionnaire. The SSS Questionnaire is a reliable and valid instrument to assess the perception of function and pain for patients with degenerative lumbar spinal stenosis. However, there is no culturally adapted SSS Questionnaire for use in mainland China. This was a prospective clinical validation study. The adaption was conducted according to International Quality of Life Assessment Project guidelines. To examine the psychometric properties of the adapted SC-SSS Questionnaire, a sample of 105 patients with lumbar spinal stenosis were included. Thirty-two patients were randomly selected to evaluate the test-retest reliability. Reliability assessment of the SC-SSS Questionnaire was determined by calculating Cronbach α and intraclass coefficient values. Concurrent validity was assessed by correlating SC-SSS Questionnaire scores with relevant domains of the 36-Item Short Form Health Survey. Cronbach α of the symptom severity scale, physical function scale, patients, and satisfaction scale of SC-SSS Questionnaire are 0.89, 0.86, 0.91, respectively, which revealed very good internal consistency. The test-retest reproducibility was found to be excellent with the intraclass correlation coefficient of 0.93, 0.91, and 0.95. In terms of concurrent validity, SC-SSS Questionnaire had good correlation with physical functioning and bodily pain of 36-Item Short Form Health Survey (r = 0.663, 0.653) and low correlation with mental health (r = 0.289). The physical function scale had good correlation with physical functioning of 36-Item Short Form Health Survey (r = 0.637), whereas the rest had moderate correlation. The satisfaction scale score was highly correlated with the change in the symptom severity (r = 0.71) and physical function (r = 0.68) scale score. The SC-SSS Questionnaire showed satisfactory reliability and validity in the evaluation of functionality in patients with lumbar spinal stenosis who are experiencing neurogenic claudication. It is simple and easy to use and can be recommended in clinical and research practice in mainland China. 3.

TRANSCRIPT EXPRESSION OF VESICULAR GLUTAMATE TRANSPORTERS IN LUMBAR DORSAL ROOT GANGLIA AND THE SPINAL CORD OF MICE – EFFECTS OF PERIPHERAL AXOTOMY OR HINDPAW INFLAMMATION

PubMed Central

MALET, M.; VIEYTES, C. A.; LUNDGREN, K. H.; SEAL, R. P.; TOMASELLA, E.; SEROOGY, K. B.; HÖKFELT, T.; GEBHART, G.F.; BRUMOVSKY, P. R.

2013-01-01

Using specific riboprobes, we characterized the expression of VGLUT1-VGLUT3 transcripts in lumbar 4-5 (L4-5) DRGs and the thoracolumbar to lumbosacral spinal cord in male BALB/C mice after a 1- or 3-day hindpaw inflammation, or a 7-day sciatic nerve axotomy. Sham animals were also included. In sham and contralateral L4-5 DRGs of injured mice, VGLUT1-, VGLUT2- and VGLUT3 mRNAs were expressed in ~45%, ~69% or ~17% of neuron profiles (NPs), respectively. VGLUT1 was expressed in large and medium-sized NPs, VGLUT2 in NPs of all sizes, and VGLUT3 in small and medium-sized NPs. In the spinal cord, VGLUT1 was restricted to a number of NPs at thoracolumbar and lumbar segments, in what appears to be the dorsal nucleus of Clarke, and in mid laminae III-IV. In contrast, VGLUT2 was present in numerous NPs at all analyzed spinal segments, except the lateral aspects of the ventral horns, especially at the lumbar enlargement, where it was virtually absent. VGLUT3 was detected in a discrete number of NPs in laminae III-IV of the dorsal horn. Axotomy resulted in a moderate decrease in the number of DRG NPs expressing VGLUT3, whereas VGLUT1 and VGLUT2 were unaffected. Likewise, the percentage of NPs expressing VGLUT transcripts remained unaltered after hindpaw inflammation, both in DRGs and the spinal cord. Altogether, these results confirm previous descriptions on VGLUTs expression in adult mice DRGs, with the exception of VGLUT1, whose protein expression was detected in a lower percentage of mouse DRG NPs. A detailed account on the location of neurons expressing VGLUTs transcripts in the adult mouse spinal cord is also presented. Finally, the lack of change in the number of neurons expressing VGLUT1 and VGLUT2 transcripts after axotomy, as compared to data on protein expression, suggests translational rather than transcriptional regulation of VGLUTs after injury. PMID:23727452

A Baseline Historical Analysis of Neck and Back-Related Morbidity in the U.S. Army: Occupational Risks Potentially Related to Head-Supported Mass

DTIC Science & Technology

2005-09-01

disorder with myelopathy, unspecified region 722.73 Intervertebral disc disorder w/ myelopathy, lumbar region 721.3 Lumbosacral spondylosis without...Disc disorder, lumbar region 721.42 Spondylosis with myelopathy, lumbar region 724.6 Disorders of sacrum 738.4 Acquired spondylolisthesis...particular, increases risk for spondylosis and accentuates age-related decreases in spinal lordosis(20). In addition to the ballistic protection

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

PubMed Central

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

2015-01-01

Abstract Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs. PMID:26200620

Validation, repeatability and reproducibility of a noninvasive instrument for measuring thoracic and lumbar curvature of the spine in the sagittal plane.

PubMed

Chaise, Fabiana O; Candotti, Cláudia T; Torre, Marcelo L; Furlanetto, Tássia S; Pelinson, Patricia P T; Loss, Jefferson F

2011-01-01

The need for early identification of postural abnormalities without exposing patients to constant radiation has stimulated the development of instruments aiming to measure the spinal curvatures. To verify the validity, repeatability and reproducibility of angular measures of sagittal curvatures of the spine obtained using an adapted arcometer, by comparing them with Cobb angles of the respective curvatures obtained by using X-rays. 52 participants were submitted to two procedures designed to evaluate the thoracic and lumbar curvatures: (1) X-ray examination from which the Cobb angles (CA) of both curvatures were obtained, and (2) measuring the angles with the arcometer (AA). Two evaluators collected the data using the arcometer, with the rods placed at T1, T12, L1 and L5 spinous processes levels in a way as to permit linear measurements which, with aid of trigonometry, supplied the AA. There was a very strong and significant correlation between AA and CA (r=0.94; p<0.01), with no-significant difference (p=0.32), for the thoracic curvature. There was a strong and significant correlation for the lumbar curvature (r=0.71; p<0.01) between AA and CA, with no-significant difference (p=0.30). There is a very strong correlation between intra-evaluator and inter-evaluator AA. It was possible to quantify reliably the thoracic and lumbar curvatures with the arcometer and it can thus be considered valid and reliable and for use in evaluating spinal curvatures in the sagittal plane.

Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation?

PubMed

Kokubo, Rinko; Kim, Kyongsong; Mishina, Masahiro; Isu, Toyohiko; Kobayashi, Shiro; Yoshida, Daizo; Morita, Akio

2014-02-01

Spinal subdural hematomas (SDHs) are rare and some are concomitant with intracranial SDH. Their pathogenesis and etiology remain to be elucidated although their migration from the intracranial space has been suggested. The authors postulated that if migration plays a major role, patients with intracranial SDH may harbor asymptomatic lumbar SDH. The authors performed a prospective study on the incidence of spinal SDH in patients with intracranial SDH to determine whether migration is a key factor in their concomitance. The authors evaluated lumbar MR images obtained in 168 patients (125 males, 43 females, mean age 75.6 years) with intracranial chronic SDH to identify cases of concomitant lumbar SDH. In all cases, the lumbar MRI studies were performed within the 1st week after surgical irrigation of the intracranial SDH. Of the 168 patients, 2 (1.2%) harbored a concomitant lumbar SDH; both had a history of trauma to both the head and the hip and/or lumbar area. One was an 83-year-old man with prostate cancer and myelodysplastic syndrome who suffered trauma to his head and lumbar area in a fall from his bed. The other was a 70-year-old man who had hit his head and lumbar area in a fall. Neither patient manifested neurological deficits and their hematomas disappeared under observation. None of the patients with concomitant lumbar SDH had sustained head trauma only, indicating that trauma to the hip or lumbar region is significantly related to the concomitance of SDH (p < 0.05). As the incidence of concomitant lumbar and intracranial chronic SDH is rare and both patients in this study had sustained a direct impact to the head and hips, the authors suggest that the major mechanism underlying their concomitant SDH was double trauma. Another possible explanation is hemorrhagic diathesis and low CSF syndrome.

Preoperative Assessment of Neural Elements in Lumbar Spinal Stenosis by Upright Magnetic Resonance Imaging: An Implication for Routine Practice?

PubMed

Lang, Gernot; Vicari, Marco; Siller, Alexander; Kubosch, Eva J; Hennig, Juergen; Südkamp, Norbert P; Izadpanah, Kaywan; Kubosch, David

2018-04-06

Introduction Lumbar spinal stenosis (LSS) is a kinetic-dependent disease typically aggravating during spinal loading. To date, assessment of LSS is usually performed with magnetic resonance imaging (MRI). However, conventional supine MRI is associated with significant drawbacks as it does not truly reflect physiological loads, experienced by discoligamentous structures during erect posture. Consequently, supine MRI often fails to reveal the source of pain and/or disability caused by LSS. The present study sought to assess neural dimensions via MRI in supine, upright, and upright-hyperlordotic position in order to evaluate the impact of patient positioning on neural narrowing. Therefore, radiological measures such as neuroforaminal dimensions, central canal volume, sagittal listhesis, and lumbar lordosis at spinal level L4/5 were extracted and stratified according to patient posture. Materials and methods Overall, 10 subjects were enclosed in this experimental study. MRI was performed in three different positions: (1) 0° supine (SP), (2) 80° upright (UP), and (3) 80° upright + hyperlordotic (HY) posture. Upright MRI was conducted utilizing a 0.25T open-configuration scanner equipped with a rotatable examination bed allowing for true standing MRI. Radiographic outcome of upright MRI imaging was extracted and evaluated according to patient positioning. Results Upright MRI-based assessment of neural dimensions was successfully accomplished in all subjects. Overall, radiographic parameters revealed a significant decrease of neural dimensions from supine to upright position: Specifically, mean foraminal area decreased from SP to UP by 13.3% (P ≤ 0.05) as well as from SP to HY position by 21% (P ≤ 0.05). Supplementation of hyperlordosis did not result in additional narrowing of neural elements (P ≥ 0.05). Furthermore, central canal volume revealed a decrease of 7% at HY and 8% at UP compared to SP position (P ≥ 0.05). Assessment of lumbar lordosis yielded in a significant increase when assessed at HY (+22.1%) or UP (+8.7%) compared to SP (P ≤ 0.05). Conclusions Our data suggest that neuroforaminal dimensions assessed by conventional supine MRI are potentially overestimated in patients with LSS. Especially, in patients having occult disease not visualized on conventional imaging modalities, upright MRI allows for a precise, clinically relevant, and at the same time non-invasive evaluation of neural elements in LSS when neural decompression is considered.

Comparison of post-dural puncture headache and low back pain between 23 and 25 gauge Quincke spinal needles in patients over 60 years: randomized, double-blind controlled trial.

PubMed

Kim, Meehyoung; Yoon, Haesang

2011-11-01

Even though the use of a 25 gauge or smaller Quincke needle is recommended for spinal anesthesia to reduce post-dural puncture headache in Korea, lumbar puncture in older patients using a 25 gauge or smaller Quincke needle can be difficult. However, most previous studies concerning post-dural puncture headache have chosen children, parturients, and young adults as study participants. The study compared post-dural puncture headache, post-operative back pain, and the number of lumbar puncture attempts using a 23 or 25 gauge Quincke needle for spinal anesthesia of Korean patients >60-years-of-age. Randomized, double-blinded controlled trial. The 53 participants who underwent orthopedic surgery under spinal anesthesia were recruited by informed notices from December 2006 through August 2007 at a 200-bed general hospital located in Kyunggido. Inclusion criteria were an age >60 years, ASA I-II, and administration of patient controlled analgesia for the first 48 h post-operatively. The 53 patients were randomly allocated to either the experimental (23 gauge Quincke needle) or control group (25 gauge Quincke needle). All patients had 24 h bed rest post-operatively. Post-dural puncture headache was assessed by the Dittmann Scale and post-operative back pain was assessed by a visual analogue scale at 24, 48, and 72 h post-operatively. The statistical methods included the Mann-Whitney U-test and Spearman correlation. There were no differences in post-dural puncture headache, and post-operative back pain at 24, 48, and 72 h post-operatively, and no differences in the number of lumbar punctures, with the 23 and 25 gauge Quincke needle. Forty-eight hour post-operative back pain was positively associated with the number of lumbar punctures (p=.036) and age (p=.040). There were no statistically significant associations among post-dural puncture headache, the number of lumbar punctures, and 48 h post-operative back pain. Pre-operative back pain was positively associated with 48 h post-operative back pain (p<.001). The choice of a 23 or 25 gauge Quincke needle for spinal anesthesia has no significant influence on post-dural puncture headache and post-operative back pain for Korean patients greater than 60-years-of-age. The 23 gauge Quincke needle is an option for lumbar punctures in this patient population. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Rehabilitation programme using neuromuscular electrical stimulation in spinal cord: epidemiological aspects].

PubMed

Bittar, Cíntia Kelly; Cliquet, Alberto

2011-01-01

To assess epidemiological profile of spinal cord injury outpatients which have been participating of rehabilitation programme using neuromuscular electrical stimulation, in order to implement campaigns for preventing spinal cord trauma. From January to April 2009, 30 patients at the spinal cord injury ambulatory clinic at Hospital das Clínicas of Unicamp were analysed by some epidemiologic characteristics: age, profession, type and level of their paralysis, origin and time of injury. All patients had complete spinal cord injury (ASIA); 24 patients were men and six were women, the mean age was 34.6 years (range, 10-64 years), two patients were children. Twenty-one patients were paraplegic and nine were tetraplegic; causes included automobile accident (12), run over (three), diving (four), bicycle accident (one), motorcycle accident (three), gunshot wound (six), thoracic tuberculosis (one), and lumbar surgery (one). The mean lesion time was 8.2 years (range, 1-15 years). Two patients were retired. The results suggested that spinal cord injury affects mainly young active men. It is necessary to develop incisive actions to prevent accidents, specially directed to traffic security.

Multilevel lumbar fusion and postoperative physiotherapy rehabilitation in a patient with persistent pain.

PubMed

Pons, Tracey; Shipton, Edward A

2011-04-01

There are no comparative randomised controlled trials of physiotherapy modalities for chronic low back and radicular pain associated with multilevel fusion. Physiotherapy-based rehabilitation to control pain and improve activation levels for persistent pain following multilevel fusion can be challenging. This is a case report of a 68-year-old man who was referred for physiotherapy intervention 10 months after a multilevel spinal fusion for spinal stenosis. He reported high levels of persistent postoperative pain with minimal activity as a consequence of his pain following the surgery. The physiotherapy interventions consisted of three phases of rehabilitation starting with pool exercise that progressed to land-based walking. These were all combined with transcutaneous electrical nerve stimulation (TENS) that was used consistently for up to 8 hours per day. As outcome measures, daily pain levels and walking distances were charted once the pool programme was completed (in the third phase). Phase progression was determined by shuttle test results. The pain level was correlated with the distance walked using linear regression over a 5-day average. Over a 5-day moving average, the pain level reduced and walking distance increased. The chart of recorded pain level and walking distance showed a trend toward decreased pain with the increased distance walked. In a patient undergoing multilevel lumbar fusion, the combined use of TENS and a progressive walking programme (from pool to land) reduced pain and increased walking distance. This improvement was despite poor medication compliance and a reported high level of postsurgical pain.

The NMatrix, a new method of presenting statistics, displays the characteristics of medicines with similar effects used in the treatment of lumbar spinal stenosis concisely and clearly, facilitating the selection of appropriate medications.

PubMed

Nakamura, Masao

2015-07-01

It is often difficult to compare the characteristics of a medicine with those of others based on common standards, whereas the application of rational standards would be expected to facilitate the comparison of medicines with similar effects. The present study was conducted to clarify the characteristics of individual medicines and to examine whether rational standards allow the most appropriate medicines to be chosen. Participants diagnosed with lumbar spinal stenosis (LSS) were assessed for QOL and ADL based on the Roland-Morris Disability Questionnaire, JOA score, VAS, and the presence of intermittent claudication (IC). Four medicines--beraprost sodium, ethyl icosapentate (EPA), sarpogrelate hydrochloride, and limaprost alfadex (PGE1)--were prescribed in a random manner. These four medicines were assessed independently in four studies using the same study design and size in each case. Using the NMatrix, the characteristics of the four medicines and the results of mutual comparisons could be displayed concisely and clearly in one matrix based on significance levels. This work involved analyzing pooled data from the four studies. All four medicines improved IC--one of the characteristic symptoms of LSS--by 12 weeks after administration. PGE1 required more time than the other medicines to affect IC. EPA appeared to almost significantly ameliorate some items at every point, though the evidence was insufficient. The NMatrix concisely and clearly displays the characteristics of "medicines with similar effects" for the treatment of lumbar spinal stenosis, and can help physicians to choose the optimal medicine based on rational criteria for individual patients, according to their symptoms and progress.

One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of lumbar spinal tuberculosis with kyphosis in children.

PubMed

Hu, Xiongke; Zhang, Hongqi; Yin, Xinhua; Chen, Yong; Yu, Honggui; Zhou, Zhenhai

2016-03-01

The purpose of this study is to investigate the clinical efficacy and feasibility of one-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of lumbar spinal tuberculosis with kyphosis in children. From December 2007 to May 2012, 13 patients (six males and seven females) suffering from lumbar spinal tuberculosis with kyphosis were admitted. All patients were treated with one-stage posterior focus debridement, fusion, and instrumentation. Then, the clinical efficacy was estimated by statistical analysis based on the data about Frankel grade, the Cobb angle of kyphosis, and erythrocyte sedimentation rate (ESR), which were collected at certain time. The age of all patients ranged from 5 to 13 years (average, 8.8 years). Operation time ranged from 120 to 190 min (average, 165 min). Intraoperative blood loss ranged from 200 to 800 ml (average, 460 ml). All patients were followed up for 24 to 57 months postoperatively (average, 33.5 months). The Cobb angle was changed significantly between preoperation and postoperation (P < 0.05), and there was no significant loss at the last follow-up. The preoperation ESR (62.5 ± 15.7) returned to normal (16.6 ± 8.1) within 3 months postoperatively in all patients (P < 0.05). Bone fusion was achieved within 3-5 months (average, 3.5 months). In the 13 cases, no postoperative severe complications occurred and neurologic function improved in various degrees. The outcomes of follow-up showed that one-stage posterior focus debridement, fusion, and instrumentation can be an effective treatment method for the lumbar spinal tuberculosis with kyphosis in children.

Interdisciplinary Cognitive-Behavioral Therapy as Part of Lumbar Spinal Fusion Surgery Rehabilitation: Experience of Patients With Chronic Low Back Pain.

PubMed

Lindgreen, Pil; Rolving, Nanna; Nielsen, Claus Vinther; Lomborg, Kirsten

2016-01-01

Patients receiving lumbar spinal fusion surgery often have persisting postoperative pain negatively affecting their daily life. These patients may be helped by interdisciplinary cognitive-behavioral therapy which is recognized as an effective intervention for improving beneficial pain coping behavior, thereby facilitating the rehabilitation process of patients with chronic pain. The purpose of this study was to describe the lived experience of patients recovering from lumbar spinal fusion surgery and to explore potential similarities and disparities in pain coping behavior between receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. We conducted semistructured interviews with 10 patients; 5 receiving cognitive-behavioral therapy in connection with their lumbar spinal fusion surgery and 5 receiving usual care. We conducted a phenomenological analysis to reach our first aim and then conducted a comparative content analysis to reach our second aim. Patients' postoperative experience was characterized by the need to adapt to the limitations imposed by back discomfort (coexisting with the back), need for recognition and support from others regarding their pain, a relatively long rehabilitation period during which they "awaited the result of surgery", and ambivalence toward analgesics. The patients in both groups had similar negative perception of analgesics and tended to abstain from them to avoid addiction. Coping behavior apparently differed among receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. Receivers prevented or minimized pain by resting before pain onset, whereas nonreceivers awaited pain onset before resting. The postoperative experience entailed ambivalence, causing uncertainty, worry and insecurity. This ambivalence was relieved when others recognized the patient's pain and offered support. Cognitive-behavioral therapy as part of rehabilitation may have encouraged beneficial pain coping behavior by altering patients' pain perception and coping behavior, thereby reducing adverse effects of pain.

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

PubMed

Syrimpeis, Vasileios; Vitsas, Vasileios; Korovessis, Panagiotis

2014-03-01

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

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

PubMed Central

Syrimpeis, Vasileios; Vitsas, Vasileios; Korovessis, Panagiotis

2014-01-01

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

Dual lumbar bronchogenic and arachnoid cyst presenting with sciatica and left foot drop.

PubMed

Candy, Nicholas; Young, Adam; Devadass, Abel; Dean, Andrew; McMillen, Jason; Trivedi, Rikin

2017-10-01

Spinal bronchogenic cysts are rare findings, with only four cases of lumbar bronchogenic cysts reported in the literature. All of these bronchogenic cysts involved the conus medullaris. We present the first case of a lumbar bronchogenic cyst and arachnoid cyst arising from the cauda equina in a 68-year-old male. Uniquely, this bronchogenic cyst also contained components of an arachnoid cyst. Magnetic resonance imaging (MRI) demonstrated a compressive cystic lesion at the level of the L3 vertebra splaying the cauda equina. An L3/L4 laminectomy was performed with marsupialisation of the cyst. Histological examination revealed pseudostratified ciliated columnar epithelium confirming the diagnosis of a bronchogenic cyst, as well as a pleated fibrovascular tissue lined by sparsely spaced small monomorphic arachnoidal cells, indicating an arachnoid cyst. We demonstrate that bronchogenic cysts can be successfully treated with marsupialisation.

Lumbar Osteophyte Avid on 68Ga-Prostate-Specific Membrane Antigen PET/CT.

PubMed

Jochumsen, Mads Ryø; Madsen, Michael Alle; Gammelgaard, Lise; Bouchelouche, Kirsten

2018-06-01

A 75-year-old man with recently diagnosed high-risk prostate cancer was referred for primary staging with Ga-prostate-specific membrane antigen (PSMA) PET/CT. The scan revealed intense Ga-PSMA uptake in a lumbar osteophyte on the right side of level L2/L3, whereas several other spinal osteophytes showed no Ga-PSMA uptake. MRI findings in the L3 vertebra was consistent with a benign Modic type 1 lesion, but MRI showed no signs of malignancy in the osteophyte with high Ga-PMSA uptake. This case presents an osteophyte as an addition to the list of potential benign pitfalls to be aware of when interpreting Ga-PSMA PET/CT.

Accumulation of methylglyoxal increases the advanced glycation end-product levels in DRG and contributes to lumbar disk herniation-induced persistent pain.

PubMed

Liu, Cui-Cui; Zhang, Xin-Sheng; Ruan, Yu-Ting; Huang, Zhu-Xi; Zhang, Su-Bo; Liu, Meng; Luo, Hai-Jie; Wu, Shao-Ling; Ma, Chao

2017-08-01

Lumbar disk herniation (LDH) with discogenic low back pain and sciatica is a common and complicated musculoskeletal disorder. The underlying mechanisms are poorly understood, and there are no effective therapies for LDH-induced pain. In the present study, we found that the patients who suffered from LDH-induced pain had elevated plasma methylglyoxal (MG) levels. In rats, implantation of autologous nucleus pulposus (NP) to the left lumbar 5 spinal nerve root, which mimicked LDH, induced mechanical allodynia, increased MG level in plasma and dorsal root ganglion (DRG), and enhanced the excitability of small DRG neurons (<30 μm in diameter). Intrathecal injection of MG also induced mechanical allodynia, and its application to DRG neurons ex vivo increased the number of action potentials evoked by depolarizing current pulses. Furthermore, inhibition of MG accumulation by aminoguanidine attenuated the enhanced excitability of small DRG neurons and the mechanical allodynia induced by NP implantation. In addition, NP implantation increased levels of advanced glycation end products (AGEs) in DRG, and intrathecal injection of MG-derived AGEs induced the mechanical allodynia and DRG neuronal hyperactivity. Intrathecal injection of MG also significantly increased the expression of AGEs in DRG. Importantly, scavenging of MG by aminoguanidine also attenuated the increase in AGEs induced by NP implantation. These results suggested that LDH-induced MG accumulation contributed to persistent pain by increasing AGE levels. Thus generation of AGEs from MG may represent a target for treatment of LDH-induced pain. NEW & NOTEWORTHY Our study demonstrates that methylglyoxal accumulation via increasing advanced glycation end-product levels in dorsal root ganglion contributes to the persistent pain induced by lumbar disk herniation, which proposed potential targets for the treatment of lumbar disk herniation-induced persistent pain. Copyright © 2017 the American Physiological Society.

Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part VI: Lumbar Spinal Stenosis.

PubMed

Fritz, Julie M; Rundell, Sean D; Dougherty, Paul; Gentili, Angela; Kochersberger, Gary; Morone, Natalia E; Naga Raja, Srinivasa; Rodriguez, Eric; Rossi, Michelle I; Shega, Joseph; Sowa, Gwendolyn; Weiner, Debra K

2016-03-01

. To present the sixth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on the evaluation and management of lumbar spinal stenosis (LSS), the most common condition for which older adults undergo spinal surgery. . The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a five-member content expert panel and a nine-member primary care panel were involved in the iterative development of these materials. The illustrative clinical case was taken from the clinical practice of a contributor's colleague (SR). . We present an algorithm and supportive materials to help guide the care of older adults with LSS, a condition that occurs not uncommonly in those with CLBP. The case illustrates the importance of function-focused management and a rational approach to conservative care. . Lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery. Treatment should address all conditions in addition to LSS contributing to pain and disability. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Human and bovine spinal disc mechanics subsequent to trypsin injection.

PubMed

Alsup, Jeremy; Bishop, Timothy; Eggett, Dennis; Bowden, Anton E

2017-10-01

To investigate the biomechanical effects of injections of a protease on the characteristics of bovine coccygeal and human lumbar disc motion segments. Mechanics of treated tissues were measured immediately after injection and 3 h after injection. Motion segments underwent axial rotation and flexion-extension loading. Stiffness and neutral zone parameters experienced significant changes over time, with bovine tissues more strongly affected than human cadaver tissues. This was true in both axial rotation and flexion-extension. The treatment type significantly affected the neutral zone measurements in axial rotation. Hysteresis parameters were impacted by control injections. The extrapolation of bovine coccygeal motion testing results to human lumbar disc mechanics is not yet practical. The injected treatment may have a smaller impact on disc mechanics than time in testing. Viscoelasticity of human lumbar discs may be impacted by any damage to the annulus fibrosis induced by needlestick. Preclinical testing of novel spinal devices is essential to the design validation and regulatory processes, but current testing techniques rely on cadaveric testing of primarily older spines with essentially random amounts of disc degeneration. The present work investigates the viability of using trypsin injections to create a more uniform preclinical model of disc degeneration from a mechanics perspective, for the purpose of testing spinal devices. Such a model would facilitate translation of new spinal technologies to clinical practice.

Efficacy of different bone volume expanders for augmenting lumbar fusions.

PubMed

Epstein, Nancy E

2008-01-01

A wide variety of bone volume expanders are being used in performing posterolateral lumbar noninstrumented and instrumented lumbar fusions. This article presents a review of their efficacy based on fusion rates, complications, and outcomes. Lumbar noninstrumented and instrumented fusions frequently use laminar autografts and different bone graft expanders. This review presents the utility of multiple forms/ratios of DBMs containing allografts. It also discusses the efficacy of artificial bone graft substitutes, including HA and B-TCP. Dynamic x-ray and/or CT examinations were used to document fusion in most series. Outcomes were variously assessed using Odom's criteria or different outcome questionnaires (Oswestry Questionnaire, SF-36, Dallas Pain Questionnaire, and/or Low Back Pain Rating Scale). Performing noninstrumented and instrumented lumbar posterolateral fusions resulted in comparable fusion rates in many series. Similar outcomes were also documented based on Odom's criteria or the multiple patient-based questionnaires. However, in some studies, the addition of spinal instrumentation increased the reoperation rate, operative time, blood loss, and cost. Various forms of DBMs, applied in different ratios to autografts, effectively supplemented spinal fusions in animal models and patient series. beta-Tricalcium phosphate, which is used to augment autograft fusions addressing idiopathic scoliosis or lumbar disease, also proved to be effective. Different types of bone volume expanders, including various forms of allograft-based DBMs, and artificial bone graft substitutes (HA and B-TCP) effectively promote posterolateral lumbar noninstrumented and instrumented fusions when added to autografts.

NORADRENERGIC INNERVATION OF THE RAT SPINAL CORD CAUDAL TO A COMPLETE SPINAL CORD TRANSECTION: EFFECTS OF OLFACTORY ENSHEATHING GLIA

PubMed Central

Takeoka, Aya; Kubasak, Marc D.; Zhong, Hui; Kaplan, Jennifer; Roy, Roland R.; Phelps, Patricia E.

2010-01-01

Transplantation of olfactory bulb-derived olfactory ensheathing glia (OEG) combined with step training improves hindlimb locomotion in adult rats with a complete spinal cord transection. Spinal cord injury studies use the presence of noradrenergic (NA) axons caudal to the injury site as evidence of axonal regeneration and we previously found more NA axons just caudal to the transection in OEG- than media-injected spinal rats. We therefore hypothesized that OEG transplantation promotes descending coeruleospinal regeneration that contributes to the recovery of hindlimb locomotion. Now we report that NA axons are present throughout the caudal stump of both media- and OEG-injected spinal rats and they enter the spinal cord from the periphery via dorsal and ventral roots and along large penetrating blood vessels. These results indicate that the presence of NA fibers in the caudal spinal cord is not a reliable indicator of coeruleospinal regeneration. We then asked if NA axons appose cholinergic neurons associated with motor functions, i.e., central canal cluster and partition cells (active during fictive locomotion) and somatic motor neurons (SMNs). We found more NA varicosities adjacent to central canal cluster cells, partition cells, and SMNs in the lumbar enlargement of OEG- than media-injected rats. As non-synaptic release of NA is common in the spinal cord, more associations between NA varicosities and motor-associated cholinergic neurons in the lumbar spinal cord may contribute to the improved treadmill stepping observed in OEG-injected spinal rats. This effect could be mediated through direct association with SMNs and/or indirectly via cholinergic interneurons. PMID:20025875

Importance of the back-café concept to rehabilitation after lumbar spinal fusion: a randomized clinical study with a 2-year follow-up.

PubMed

Christensen, Finn B; Laurberg, Ida; Bünger, Cody E

2003-12-01

A prospective, randomized, clinical study with a 2-year follow-up. To analyze the effect of three different rehabilitation strategies for lumbar spinal fusion patients. Fifteen percent to 40% of lumbar spinal fusion patients are not expected to improve significantly over a 2-year period. Optimization of present forms of rehabilitation could possibly further improve the outcome. Between 1996 and 1999, 90 patients who had undergone lumbar spinal fusion were 3 months after surgery randomized to one of three different rehabilitation groups. Video group participants watched a video of exercises for training and were subsequently and only once provided instruction regarding their use. The back-café group was provided the same program as the video group, but as a supplement met with a back-café with other fusion-operated patients three times over an 8-week period. The training group was provided physical therapy training twice weekly for 8 weeks. Functional outcome was evaluated at 6, 12, and 24 months after surgery by use of the low back pain rating scale and a questionnaire covering daily functions, work status, and a patient's contact with the primary sector. By 2-year follow-up, the back-café and video groups had less pain compared with the training group (P < 0.03). The back-café group was better at performing daily functions such as carrying bags of market items (P < 0.01), getting up from a chair (P < 0.01), and ascending staircases (P < 0.01) compared with the video and training groups. More in the back-café group resumed working after surgery compared with the two other groups (P < 0.04). The video group had significantly more contacts with general practitioners, physical therapists, and so on compared with the back-café and training groups (P < 0.001). The patients in the back-café group were significantly better at accomplishing a succession of daily tasks compared with the video and training groups 2 years after lumbar spinal fusion. At the 2-year follow-up the training group had a significant pain problem compared with the video and back-café groups. The video group had significantly more treatment demands outside the hospital system. This study demonstrates the relevance of the inclusion of coping schemes and questions the role of intensive exercises in a rehabilitation program for spinal fusion patients.

Spinal Implant Density and Postoperative Lumbar Lordosis as Predictors for the Development of Proximal Junctional Kyphosis in Adult Spinal Deformity.

PubMed

McClendon, Jamal; Smith, Timothy R; Sugrue, Patrick A; Thompson, Sara E; O'Shaughnessy, Brian A; Koski, Tyler R

2016-11-01

To evaluate spinal implant density and proximal junctional kyphosis (PJK) in adult spinal deformity (ASD). Consecutive patients with ASD receiving ≥5 level fusions were retrospectively analyzed between 2007 and 2010. ASD, elective fusions, minimum 2-year follow-up. age <18 years, neuromuscular or congenital scoliosis, cervical or cervicothoracic fusions, nonelective conditions (infection, tumor, trauma). Instrumented fusions were classified by the Scoliosis Research Society-Schwab ASD classification. Statistical analysis consisted of descriptives (measures of central tendency, dispersion, frequencies), independent Student t tests, χ 2 , analysis of variance, and logistic regression to determine association of implant density [(number of screws + number of hooks)/surgical levels of fusion] and PJK. Mean and median follow-up was 2.8 and 2.7 years, respectively. Eighty-three patients (17 male, 66 female) with a mean age of 59.7 years (standard deviation, 10.3) were analyzed. Mean body mass index (BMI) was 29.5 kg/m 2 (range, 18-56 kg/m 2 ) with mean preoperative Oswestry Disability Index of 48.67 (range, 6-86) and mean preoperative sagittal vertical axis of 8.42. The mean levels fused were 9.95 where 54 surgeries had interbody fusion. PJK prevalence was 21.7%, and pseudoarthrosis was 19.3%. Mean postoperative Oswestry Disability Index was 27.4 (range, 0-74). Independent Student t tests showed that PJK was not significant for age, gender, BMI, rod type, mean postoperative sagittal vertical axis, or Scoliosis Research Society-Schwab ASD classification; but iliac fixation approached significance (P = 0.077). Implant density and postoperative lumbar lordosis (LL) were predictors for PJK (P = 0.018 and 0.045, respectively). Controlling for age, BMI, and gender, postoperative LL (not implant density) continued to show significance in multivariate logistic regression model. PJK, although influenced by a multitude of factors, may be statistically related to implant density and LL. Copyright © 2016. Published by Elsevier Inc.

The spinal cord: a review of functional neuroanatomy.

PubMed

Bican, Orhan; Minagar, Alireza; Pruitt, Amy A

2013-02-01

The spinal cord controls the voluntary muscles of the trunk and limbs and receives sensory input from these areas. It extends from the medulla oblongata to the lower border of the first lumbar vertebra. A basic knowledge of spinal cord anatomy is essential for interpretation of clinical signs and symptoms and for understanding of pathologic processes involving the spinal cord. In this article, anatomic structures are correlated with relevant clinical signs and symptoms and a step-wise approach to spinal cord diagnosis is outlined. Copyright © 2013 Elsevier Inc. All rights reserved.

Cross-sectional area of human trunk paraspinal muscles before and after posterior lumbar surgery using magnetic resonance imaging.

PubMed

Ghiasi, Mohammad S; Arjmand, Navid; Shirazi-Adl, Aboulfazl; Farahmand, Farzam; Hashemi, Hassan; Bagheri, Sahar; Valizadeh, Mahsa

2016-03-01

Iatrogenic injuries to paraspinal muscles during the posterior lumbar surgery (PLS) cause a reduction in their cross-sectional areas (CSAs) and contractile densities over time post-surgery. This study aims to quantify such alterations. Pre- and postoperative CSAs (~6 months interval) of all paraspinal muscles were measured in six patients undergoing PLS using a 3-T magnetic resonance (MR) scanner to quantify the alterations in geometrical and tissue effective contractile (non-fatty) CSAs of these muscles at all lumbar levels. To examine the presence of any confounding effects on recorded changes within ~7-month period, measurements were also carried out on ten healthy volunteers. In the healthy population, an important (~22%) portion of CSA of the erector spinae (ES) was noncontractile at the lower lumbar levels. Negligible variations over time in both the total geometrical (<1.7% in average) and contractile (<1.2%) CSAs of muscles were observed in the healthy group (i.e., no confounding effect). Following PLS, significant reductions were observed in the geometrical CSA of only multifidus (MF) muscle by ~14 and 11% as well as in its contractile CSA by ~26 and 14% at the L5-S1 and L4-L5 levels, respectively. The total CSA of ES at lower lumbar levels shows substantial noncontractile contents in both healthy and patient populations. Biomechanical models of the spine should hence account for the noncontractile contents using only the effective contractile muscle CSAs. Postoperative variations in CSAs of paraspinal muscles may have profound effects on patterns of muscle activities, spinal loading, and stability.

Lumbar scoliosis associated with spinal stenosis in idiopathic and degenerative cases.

PubMed

Le Huec, J C; Cogniet, A; Mazas, S; Faundez, A

2016-10-01

Degenerative de novo scoliosis is commonly present in older adult patients. The degenerative process including disc bulging, facet arthritis, and ligamentum flavum hypertrophy contributes to the appearance of symptoms of spinal stenosis. Idiopathic scoliosis has also degenerative changes that can lead to spinal stenosis. The aetiology, prevalence, biomechanics, classification, symptomatology, and treatment of idiopathic and degenerative lumbar scoliosis in association with spinal stenosis are reviewed. Review study is based on a review of pertinent but non-exhaustive literature of the last 20 years in PubMed in English language. Retrospective analysis of studies focused on all parameters concerning scoliosis associated with stenosis. Very few publications have focused specifically on idiopathic scoliosis and stenosis, and this was before the advent of modern segmental instrumentation. On the other hand, many papers were found for degenerative scoliosis and stenosis with treatment methods based on aetiology of spinal canal stenosis and analysis of global sagittal and frontal parameters. Satisfactory clinical results after operative treatment range from 83 to 96 % but with increased percentage of complications. Recent literature analysed the importance of stabilizing or not the spine after decompression in such situation knowing the increasing risk of instability after facet resection. No prospective randomized studies were found to support short instrumentation. Long instrumentation and fusion to prevent distabilization after decompression were always associated with higher complication rates. Imbalance patients with unsatisfactory compensation capacities were at risk of complications. Operative treatment using newly proposed classification system of lumbar scoliosis with associated canal stenosis is useful. Sagittal balance and rotatory dislocation are the main parameters to analyse to determine the length of fusion.

Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials.

PubMed

Meng, T; Zhong, Z; Meng, L

2017-03-01

Lumbar spinal surgery is most commonly performed under general anaesthesia. However, spinal anaesthesia has also been used. We aimed to systematically review the comparative evidence. We only included randomised, controlled trials in this meta-analysis and calculated the risk ratio or standardised mean difference for haemodynamics, blood loss, surgical time, analgesic requirement, nausea and/or vomiting, and length of hospital stay. Eight studies with a total of 625 patients were included. These were considered to be at high risk of bias. Compared with general anaesthesia, the risk ratio (95% CI) with spinal anaesthesia for intra-operative hypertension was 0.31 (0.15-0.64), I 2 = 0% (p = 0.002); for intra-operative tachycardia 0.51 (0.30-0.84), I 2 = 0% (p = 0.009); for analgesic requirement in the postanaesthesia care unit 0.32 (0.24-0.43), I 2 = 0% (p < 0.0001); and for nausea/vomiting within 24 h postoperatively 0.29 (0.18-0.46), I 2 = 12% (p < 0.00001). The standardised mean difference (95% CI) for hospital stay was -1.15 (-1.98 to -0.31), I 2 = 89% (p = 0.007). There was no evidence of a difference in intra-operative hypotension and bradycardia, blood loss, surgical time, analgesic requirement within 24 h postoperatively, and nausea/vomiting in the postanaesthesia care unit. We conclude that spinal anaesthesia appears to offer advantages over general anaesthesia for lumbar spine surgery. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

Device-Training for Individuals with Thoracic and Lumbar Spinal Cord Injury Using a Powered Exoskeleton for Technically Assisted Mobility: Achievements and User Satisfaction

PubMed Central

Gillner, Annett; Borgwaldt, Nicole; Kroll, Sylvia; Roschka, Sybille

2016-01-01

Objective. Results of a device-training for nonambulatory individuals with thoracic and lumbar spinal cord injury (SCI) using a powered exoskeleton for technically assisted mobility with regard to the achieved level of control of the system after training, user satisfaction, and effects on quality of life (QoL). Methods. Observational single centre study with a 4-week to 5-week intensive inpatient device-training using a powered exoskeleton (ReWalk™). Results. All 7 individuals with SCI who commenced the device-training completed the course of training and achieved basic competences to use the system, that is, the ability to stand up, sit down, keep balance while standing, and walk indoors, at least with a close contact guard. User satisfaction with the system and device-training was documented for several aspects. The quality of life evaluation (SF-12v2™) indicated that the use of the powered exoskeleton can have positive effects on the perception of individuals with SCI regarding what they can achieve physically. Few adverse events were observed: minor skin lesions and irritations were observed; no falls occurred. Conclusions. The device-training for individuals with thoracic and lumbar SCI was effective and safe. All trained individuals achieved technically assisted mobility with the exoskeleton while still needing a close contact guard. PMID:27610382

The Effect of Anxiety, Depression, and Optimism on Postoperative Satisfaction and Clinical Outcomes in Lumbar Spinal Stenosis and Degenerative Spondylolisthesis Patients: Cohort Study.

PubMed

Lee, Jaewon; Kim, Hong-Sik; Shim, Kyu-Dong; Park, Ye-Soo

2017-06-01

The aim of this study is to evaluate the effect of depression, anxiety, and optimism on postoperative satisfaction and clinical outcomes in patients who underwent less than two-level posterior instrumented fusions for lumbar spinal stenosis and degenerative spondylolisthesis. Preoperative psychological status of subjects, such as depression, anxiety, and optimism, was evaluated using the Hospital Anxiety and Depression Scale (HADS) and the Revised Life Orientation Test (LOT-R). Clinical evaluation was determined by measuring changes in a visual analogue scale (VAS) and the Oswestry Disability Index (ODI) before and after surgery. Postoperative satisfaction of subjects assessed using the North American Spine Society lumbar spine questionnaire was comparatively analyzed against the preoperative psychological status. The correlation between patient's preoperative psychological status (depression, anxiety, and optimism) and clinical outcomes (VAS and ODI) was evaluated. VAS and ODI scores significantly decreased after surgery ( p < 0.001), suggesting clinically favorable outcomes. Preoperative psychological status of patients (anxiety, depression, and optimism) was not related to the degree of improvement in clinical outcomes (VAS and ODI) after surgery. However, postoperative satisfaction was moderately correlated with optimism. Anxiety and optimism were more correlated with patient satisfaction than clinical outcomes. Accordingly, the surgeon can predict postoperative satisfaction of patients based on careful evaluation of psychological status before surgery.

Rapamycin suppresses microglial activation and reduces the development of neuropathic pain after spinal cord injury.

PubMed

Tateda, Satoshi; Kanno, Haruo; Ozawa, Hiroshi; Sekiguchi, Akira; Yahata, Kenichiro; Yamaya, Seiji; Itoi, Eiji

2017-01-01

Rapamycin is an inhibitor of the mammalian target of rapamycin (mTOR) signaling pathway, plays an important role in multiple cellular functions. Our previous study showed rapamycin treatment in acute phase reduced the neural tissue damage and locomotor impairment after spinal cord injury (SCI). However, there has been no study to investigate the therapeutic effect of rapamycin on neuropathic pain after SCI. In this study, we examined whether rapamycin reduces neuropathic pain following SCI in mice. We used a mouse model of thoracic spinal cord contusion injury, and divided the mice into the rapamycin-treated and the vehicle-treated groups. The rapamycin-treated mice were intraperitoneally injected with rapamycin (1 mg/kg) 4 h after SCI. The rapamycin treatment suppressed phosphorylated-p70S6K in the injured spinal cord that indicated inhibition of mTOR. The rapamycin treatment significantly improved not only locomotor function, but also mechanical and thermal hypersensitivity in the hindpaws after SCI. In an immunohistochemical analysis, Iba-1-stained microglia in the lumbar spinal cord was significantly decreased in the rapamycin-treated mice. In addition, the activity of p38 MAPK in the lumbar spinal cord was significantly attenuated by rapamycin treatment. Furthermore, phosphorylated-p38 MAPK-positive microglia was relatively decreased in the rapamycin-treated mice. These results indicated rapamycin administration in acute phase to reduce secondary neural tissue damage can contribute to the suppression of the microglial activation in the lumbar spinal cord and attenuate the development of neuropathic pain after SCI. The present study first demonstrated that rapamycin has significant therapeutic potential to reduce the development of neuropathic pain following SCI. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:93-103, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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

PubMed

Cher, Daniel Joseph; Reckling, W Carlton

2015-01-01

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

Examination of a lumbar spine biomechanical model for assessing axial compression, shear, and bending moment using selected Olympic lifts.

PubMed

Eltoukhy, Moataz; Travascio, Francesco; Asfour, Shihab; Elmasry, Shady; Heredia-Vargas, Hector; Signorile, Joseph

2016-09-01

Loading during concurrent bending and compression associated with deadlift, hang clean and hang snatch lifts carries the potential for injury to the intervertebral discs, muscles and ligaments. This study examined the capacity of a newly developed spinal model to compute shear and compressive forces, and bending moments in lumbar spine for each lift. Five male subjects participated in the study. The spine was modeled as a chain of rigid bodies (vertebrae) connected via the intervertebral discs. Each vertebral reference frame was centered in the center of mass of the vertebral body, and its principal directions were axial, anterior-posterior, and medial-lateral. The results demonstrated the capacity of this spinal model to assess forces and bending moments at and about the lumbar vertebrae by showing the variations among these variables with different lifting techniques. These results show the model's potential as a diagnostic tool.

Lumbar vertebral hemangioma with extradural extension, causing neurogenic claudication: a case report.

PubMed

Jouibari, Morteza Faghih; Khoshnevisan, Alireza; Ghodsi, Seyed Mohammad; Nejat, Farideh; Naderi, Soheil; Abdollahzadeh, Sina

2011-01-01

The authors present a rare case of lumbar vertebral hemangioma extending to the epidural space with a bisected appearance and impinging on thecal sac. This 52-year-old lady presented with one year history of low back pain and bilateral leg radiation. Plain radiography showed vertical linear streaks at L2 vertebral body and axial computed tomography (CT) scan revealed small "polka dot" appearance within the vertebral body. Magnetic resonance imaging (MRI) showed low signal intensity on T1-weighted images in L2 vertebral body which was not characteristic for hemangioma. The patient underwent an L2 laminectomy, spinal canal decompression and posterior spinal instrumentation. This study indicates that lumbar vertebral hemangioma can extend to the epidural space and cause neurologic symptoms. Magnetic resonance imaging may not show diagnostic features, especially in active lesions and plain radiography and CT scan may be helpful.

Determining clinical practice of expert physiotherapy for patients undergoing lumbar spinal fusion: a cross-sectional survey study.

PubMed

Janssen, Esther R C; Scheijen, Elle E M; van Meeteren, Nico L U; de Bie, Rob A; Lenssen, Anton F; Willems, Paul C; Hoogeboom, Thomas J

2016-05-01

To determine the content of current Dutch expert hospital physiotherapy practice for patients undergoing lumbar spinal fusion (LSF), to gain insight into expert-based clinical practice. At each hospital where LSF is performed, one expert physiotherapist received an e-mailed questionnaire, about pre- and postoperative physiotherapy and discharge after LSF. The level of uniformity in goals and interventions was graded on a scale from no uniformity (50-60 %) to very strong uniformity (91-100 %). LSF was performed at 34 of the 67 contacted hospitals. From those 34 hospitals, 28 (82 %) expert physiotherapists completed the survey. Twenty-one percent of the respondents saw patients preoperatively, generally to provide information. Stated postoperative goals and administered interventions focused mainly on performing transfers safely and keeping the patient informed. Outcome measures were scarcely used. There was no uniformity regarding advice on the activities of daily living. Dutch perioperative expert physiotherapy for patients undergoing LSF is variable and lacks structural outcome assessment. Studies evaluating the effectiveness of best-practice physiotherapy are warranted.

Preservation or Restoration of Segmental and Regional Spinal Lordosis Using Minimally Invasive Interbody Fusion Techniques in Degenerative Lumbar Conditions: A Literature Review.

PubMed

Uribe, Juan S; Myhre, Sue Lynn; Youssef, Jim A

2016-04-01

A literature review. The purpose of this study was to review lumbar segmental and regional alignment changes following treatment with a variety of minimally invasive surgery (MIS) interbody fusion procedures for short-segment, degenerative conditions. An increasing number of lumbar fusions are being performed with minimally invasive exposures, despite a perception that minimally invasive lumbar interbody fusion procedures are unable to affect segmental and regional lordosis. Through a MEDLINE and Google Scholar search, a total of 23 articles were identified that reported alignment following minimally invasive lumbar fusion for degenerative (nondeformity) lumbar spinal conditions to examine aggregate changes in postoperative alignment. Of the 23 studies identified, 28 study cohorts were included in the analysis. Procedural cohorts included MIS ALIF (two), extreme lateral interbody fusion (XLIF) (16), and MIS posterior/transforaminal lumbar interbody fusion (P/TLIF) (11). Across 19 study cohorts and 720 patients, weighted average of lumbar lordosis preoperatively for all procedures was 43.5° (range 28.4°-52.5°) and increased 3.4° (9%) (range -2° to 7.4°) postoperatively (P < 0.001). Segmental lordosis increased, on average, by 4° from a weighted average of 8.3° preoperatively (range -0.8° to 15.8°) to 11.2° at postoperative time points (range -0.2° to 22.8°) (P < 0.001) in 1182 patient from 24 study cohorts. Simple linear regression revealed a significant relationship between preoperative lumbar lordosis and change in lumbar lordosis (r = 0.413; P = 0.003), wherein lower preoperative lumbar lordosis predicted a greater increase in postoperative lumbar lordosis. Significant gains in both weighted average lumbar lordosis and segmental lordosis were seen following MIS interbody fusion. None of the segmental lordosis cohorts and only two of the 19 lumbar lordosis cohorts showed decreases in lordosis postoperatively. These results suggest that MIS approaches are able to impact regional and local segmental alignment and that preoperative patient factors can impact the extent of correction gained (preserving vs. restoring alignment). 4.

Association between history and physical examination factors and change in lumbar multifidus muscle thickness after spinal manipulation in patients with low back pain.

PubMed

Koppenhaver, Shane L; Fritz, Julie M; Hebert, Jeffrey J; Kawchuk, Greg N; Parent, Eric C; Gill, Norman W; Childs, John D; Teyhen, Deydre S

2012-10-01

Understanding the clinical characteristics of patients with low back pain (LBP) who display improved lumbar multifidus (LM) muscle function after spinal manipulative therapy (SMT) may provide insight into a potentially synergistic interaction between SMT and exercise. Therefore, the purpose of this study was to identify the baseline historical and physical examination factors associated with increased contracted LM muscle thickness one week after SMT. Eighty-one participants with LBP underwent a baseline physical examination and ultrasound imaging assessment of the LM muscle during submaximal contraction before and one week after SMT. The relationship between baseline examination variables and 1-week change in contracted LM thickness was assessed using correlation analysis and hierarchical multiple linear regression. Four variables best predicted the magnitude of increases in contracted LM muscle thickness after SMT. When combined, these variables suggest that patients with LBP, (1) that are fairly acute, (2) have at least a moderately good prognosis without focal and irritable symptoms, and (3) exhibit signs of spinal instability, may be the best candidates for a combined SMT and lumbar stabilization exercise (LSE) treatment approach. Published by Elsevier Ltd.

Post-surgical functional recovery, lumbar lordosis, and range of motion associated with MR-detectable redundant nerve roots in lumbar spinal stenosis.

PubMed

Chen, Jinshui; Wang, Juying; Wang, Benhai; Xu, Hao; Lin, Songqing; Zhang, Huihao

2016-01-01

T1- and T2-weighted magnetic resonance images (MRI) can reveal lumbar redundant nerve roots (RNRs), a result of chronic compression and nerve elongation associated with pathogenesis of cauda equina claudication (CEC) in degenerative lumbar canal stenosis (DLCS). The study investigated effects of lumbar lordosis angle and range of motion on functional recovery in lumbar stenosis patents with and without RNRs. A retrospective study was conducted of 93 lumbar spinal stenosis patients who underwent decompressive surgery. Eligible records were assessed by 3 independent blinded radiologists for presence or absence of RNRs on sagittal T2-weighted MR (RNR and non-RNR groups), pre- and post-operative JOA score, lumbar lordosis angle, and range of motion. Of 93 total patients, the RNR group (n=37, 21/37 female) and non-RNR group (n=56; 31/56 female) had similar preoperative conditions (JOA score) and were not significantly different in age (mean 64.19 ± 8.25 vs. 62.8 ± 9.41 years), symptom duration (30.92 ± 22.43 vs. 28.64 ± 17.40 months), or follow-up periods (17.35 ± 4.02 vs. 17.75 ± 4.29 mo) (all p>0.4). The non-RNR group exhibited significantly better final JOA score (p=0.015) and recovery rate (p=0.002). RNR group patients exhibited larger lumbar lordosis angles in the neutral position (p=0.009) and extension (p=0.021) and larger range of motion (p=0.008). Poorer surgical outcomes in patients with RNRs indicated that elevated lumbar lordosis angle and range of motion increased risks of RNR formation, which in turn may cause poorer post-surgical recovery, this information is possibly useful in prognostic assessment of lumbar stenosis complicated by RNRs. Copyright © 2015 Elsevier B.V. All rights reserved.

Melorheostosis causing lumbar radiculopathy: a case report and a review of the literature.

PubMed

Saxena, Ankur; Neelakantan, Asha; Jampana, Ravi; Sangra, Meharpal

2013-08-01

Melorheostosis is a rare sclerosing bone disorder with a predilection for the appendicular skeleton. Involvement of the spine is infrequent and largely asymptomatic. Surgical treatment for spinal involvement is therefore uncommon with only one reported case of lumbar fusion for painful lumbosacral melorheostosis. We report a case of lumbar melorheostosis causing disabling radiculopathy treated with nerve root decompression. Melorheostosis of the lumbar spine causing radicular symptoms has not been reported before. Our message from the management of this particular patient is to consider surgical option in symptomatic individuals. Copyright © 2013 Elsevier Inc. All rights reserved.

The respective contribution of lumbar segments to the generation of locomotion in the isolated spinal cord of newborn rat.

PubMed

Bertrand, S; Cazalets, Jean-René

2002-11-01

Various studies on isolated neonatal rat spinal cord have pointed to the predominant role played by the rostral lumbar area in the generation of locomotor activity. In the present study, the role of the various regions of the lumbar spinal cord in locomotor genesis was further examined using compartmentalization and transections of the cord. We report that the synaptic drive received by caudal motoneurons following N-methyl-d-l-aspartate (NMA)/5-HT superfusion on the entire lumbar cord is different from that triggered by the same compounds specifically applied on the rostral segments. These differences appear to be due to the direct action of NMA/5-HT on motoneuron membrane potential, rather than on premotoneuronal input activation. In order to assess the possible participation of the caudal lumbar segments in locomotor rhythm generation, the segments were over-stimulated with high concentrations of NMA or K+. We find that significant variations in motor cycle period occurred during the over-activation of the rostral segments. Over-activation of caudal segments only si+gnificantly increased the caudal ventral roots burst amplitude. We find that low 5-HT concentrations were unable to induce fictive locomotion under our experimental conditions. When a hemi-transection of the cord was performed between the L2-L3 segments, rhythmic bursting in the ipsilateral L5 disappeared while rhythmicity persisted on the contralateral side. Sectioning of the remaining L2-L3 side totally suppressed rhythmic activity in both L5 ventral roots. These results show that the thoracolumbar part of the cord constitutes the key area for locomotor pattern generation.

Changes in regional activity of the psoas major and quadratus lumborum with voluntary trunk and hip tasks and different spinal curvatures in sitting.

PubMed

Park, Rachel J; Tsao, Henry; Claus, Andrew; Cresswell, Andrew G; Hodges, Paul W

2013-02-01

Cross-sectional controlled laboratory study. To investigate the function of discrete regions of psoas major (PM) and quadratus lumborum (QL) with changes in spinal curvature and hip position. Anatomically discrete regions of PM and QL may have differential function on the lumbar spine, based on anatomical and biomechanical differences in their moment arms between fascicles within each muscle. Fine-wire electrodes were inserted with ultrasound guidance into PM fascicles arising from the transverse process (PM-t) and vertebral body (PM-v) and anterior (QL-a) and posterior (QL-p) layers of QL. Recordings were made on 9 healthy participants, who performed 7 tasks with maximal voluntary efforts and adopted 3 sitting postures that involved different spinal curvatures and hip angles. Activity of PM-t was greater during trunk extension than flexion, whereas activity of PM-v was greater during hip flexion than trunk efforts. Activity of QL-p was greater during trunk extension and lateral flexion, whereas QL-a showed greater activity during lateral flexion. During sitting tasks, PM-t was more active when sitting with a short lordosis than a flat (less extended) lumbar spine posture, whereas PM-v was similarly active in both sitting postures. Activity of PM-t was more affected by changes in position of the lumbar spine than the hip, whereas PM-v was more actively involved in the movement of the hip rather than that of the lumbar spine. Moreover, from its anatomy, PM-t has a combined potential to extend/lordose the lumbar spine and flex the hip, at least in a flexed-hip position.

Interspinous bursitis is common in polymyalgia rheumatica, but is not associated with spinal pain.

PubMed

Camellino, Dario; Paparo, Francesco; Morbelli, Silvia; Cutolo, Maurizio; Sambuceti, Gianmario; Cimmino, Marco A

2014-12-01

Polymyalgia rheumatica (PMR) is a common inflammatory disease in older people characterized by shoulder and/or pelvic girdle, and cervical and, occasionally, lumbar pain. Interspinous bursitis has been suggested as a potential cause of spinal symptoms. We evaluated, by 18 F-fluorodeoxyglucose (FDG) positron emission tomography integrated with computed tomography (PET/CT), the vertebral structures involved in PMR in a cohort of consecutive, untreated patients. Sixty-five consecutive patients with PMR were studied. After a standardized physical examination, which included evaluation of pain and tenderness in the vertebral column, they underwent FDG-PET/CT. Sites of increased uptake and their correlation with spontaneous and provoked pain were recorded. For comparison, FDG-PET/CT was performed also in 65 age- and sex-matched controls and in 10 rheumatoid arthritis (RA) patients. The most frequent site of spontaneous and provoked pain was the cervical portion. FDG uptake was more frequent in the lumbar portion than at any other location, and in the cervical rather than in the thoracic portion (P <0.0001). No correlation was found between uptake and spontaneous or provoked pain. There was an association between presence of cervical and lumbar bursitis (r = 0.34, P = 0.007). None of the control patients and one out of ten RA patients showed interspinous bursitis. Interspinous bursitis is a frequent finding in the lumbar spine of patients with PMR. However, it is not associated with clinical symptoms and can hardly explain the spinal pain reported by the patients. Cervical pain is more frequent than lumbar pain in PMR patients and may be caused by shoulder girdle involvement.

Joint capsule treatment with enkephalin-encoding HSV-1 recombinant vector reduces inflammatory damage and behavioural sequelae in rat CFA monoarthritis.

PubMed

Lu, Ying; McNearney, Terry A; Wilson, Steven P; Yeomans, David C; Westlund, Karin N

2008-03-01

This study assessed enkephalin expression induced by intra-articular application of recombinant, enkephalin-encoding herpes virus (HSV-1) and the impact of expression on nociceptive behaviours and synovial lining inflammation in arthritic rats. Replication-conditional HSV-1 recombinant vectors with cDNA encoding preproenkephalin (HSV-ENK), or control transgene beta-galactosidase cDNA (HSV-beta-gal; control) were injected into knee joints with complete Freund's adjuvant (CFA). Joint temperatures, circumferences and nociceptive behaviours were monitored on days 0, 7, 14 and 21 post CFA and vector treatments. Lumbar (L4-6) dorsal root ganglia (DRG) and spinal cords were immunostained for met-enkephalin (met-ENK), beta-gal, HSV-1 proteins and Fos. Joint tissues were immunostained for met-ENK, HSV-1 proteins, and inflammatory mediators Regulated on Activation, Normal T-cell Expressed and Secreted (RANTES) and cyclo-oxygenase-2, or stained with haematoxylin and eosin for histopathology. Compared to exuberant synovial hypertrophy and inflammatory cell infiltration seen in arthritic rats treated with CFA only or CFA and HSV-beta-gal, the CFA- and HSV-ENK-treated arthritic rats had: (i) striking preservation of synovial membrane cytoarchitecture with minimal inflammatory cell infiltrates; (ii) significantly improved nociceptive behavioural responses to mechanical and thermal stimuli; (iii) normalized Fos staining in lumbar dorsal horn; and (iv) significantly increased met-ENK staining in ipsilateral synovial tissue, lumbar DRG and spinal cord. The HSV-1 and transgene product expression were confined to ipsilateral lumbar DRG (HSV-1, met-ENK, beta-gal). Only transgene product (met-ENK and beta-gal) was seen in lumbar spinal cord sections. Targeted delivery of enkephalin-encoding HSV-1 vector generated safe, sustained opioid-induced analgesia with protective anti-inflammatory blunting in rat inflammatory arthritis.

Differences in 3D vs. 2D analysis in lumbar spinal fusion simulations.

PubMed

Hsu, Hung-Wei; Bashkuev, Maxim; Pumberger, Matthias; Schmidt, Hendrik

2018-04-27

Lumbar interbody fusion is currently the gold standard in treating patients with disc degeneration or segmental instability. Despite it having been used for several decades, the non-union rate remains high. A failed fusion is frequently attributed to an inadequate mechanical environment after instrumentation. Finite element (FE) models can provide insights into the mechanics of the fusion process. Previous fusion simulations using FE models showed that the geometries and material of the cage can greatly influence the fusion outcome. However, these studies used axisymmetric models which lacked realistic spinal geometries. Therefore, different modeling approaches were evaluated to understand the bone-formation process. Three FE models of the lumbar motion segment (L4-L5) were developed: 2D, Sym-3D and Nonsym-3D. The fusion process based on existing mechano-regulation algorithms using the FE simulations to evaluate the mechanical environment was then integrated into these models. In addition, the influence of different lordotic angles (5, 10 and 15°) was investigated. The volume of newly formed bone, the axial stiffness of the whole segment and bone distribution inside and surrounding the cage were evaluated. In contrast to the Nonsym-3D, the 2D and Sym-3D models predicted excessive bone formation prior to bridging (peak values with 36 and 9% higher than in equilibrium, respectively). The 3D models predicted a more uniform bone distribution compared to the 2D model. The current results demonstrate the crucial role of the realistic 3D geometry of the lumbar motion segment in predicting bone formation after lumbar spinal fusion. Copyright © 2018 Elsevier Ltd. All rights reserved.

The effects of doxorubicin (adriamycin) on spinal fusion: an experimental model of posterolateral lumbar spinal arthrodesis.

PubMed

Tortolani, P Justin; Park, Andrew E; Louis-Ugbo, John; Attallah-Wasef, Emad S; Kraiwattanapong, Chaiwat; Heller, John G; Boden, Scott D; Yoon, S Tim

2004-01-01

Malignant spinal lesions may require surgical excision and segmental stabilization. The decision to perform a concomitant fusion procedure is influenced in part by the need for adjunctive chemotherapy as well as the patient's anticipated survival. Although some evidence exists that suggests that chemotherapy may inhibit bony healing, no information exists regarding the effect of chemotherapy on spinal fusion healing. To determine the effect of a frequently used chemotherapeutic agent, doxorubicin, on posterolateral spinal fusion rates. Prospective animal model of posterolateral lumbar fusion. Determination of spinal fusion by manual palpation of excised spines. Plain radiographic evaluation of denuded spines to evaluate intertransverse bone formation. Thirty-two New Zealand White rabbits underwent posterior intertransverse process fusion at L5-L6 with the use of iliac autograft bone. Rabbits randomly received either intravenous doxorubicin (2.5 mg/kg) by means of the central vein of the ear at the time of surgery (16 animals) or no treatment (16 animals; the control group). The animals were euthanized at 5 weeks, and the lumbar spines were excised. Spine fusion was assessed by manually palpating (by observers blinded to the treatment group) at the level of arthrodesis, and at the adjacent levels proximal and distal. This provided similar information to surgical fusion assessment by palpation in humans. Fusion was defined as the absence of palpable motion. Posteroanterior radiographs of the excised spines were graded in a blinded fashion using a five-point scoring system (0 to 4) devised to describe the amount of bone observed between the L5-L6 transverse processes. Power analysis conducted before initiation of the study indicated that an allocation of 16 animals to each group would permit detection of at least a 20% difference in fusion rates with statistical significance at p=.05. Eleven of the 16 spines (69%) in the control group and 6 of the 16 spines (38%) in the doxorubicin group fused. This difference was statistically significant (=.038). There was no significant correlation (p>.05) between the radiographic grade of bone formation (0 to 4) and fusion as determined by palpation. There were four wound infections in the control group and four in the doxorubicin group. However, solid fusions were palpated in three of these four spines in both the control and treatment groups. No significant differences in wound complications were noted with doxorubicin administration. A single dose of doxorubicin administered intravenously at the time of surgery appears to play a significant inhibitory role in the process of spinal fusion. If similar effects occur in humans, these data suggest that doxorubicin may be harmful to bone healing in a spine fusion if given during the perioperative period. Further investigation will be necessary to determine the effect of time to aid at determining whether doxorubicin administered several weeks pre- or postoperatively results in improved fusion rate, and whether bone morphogenetic proteins can overcome these inhibitory effects.

The Role of Posterior Screw Fixation in Single-Level Transforaminal Lumbar Interbody Fusion During Whole Body Vibration: A Finite Element Study.

PubMed

Fan, Wei; Guo, Li-Xin

2018-06-01

Few studies have evaluated the need for supplementary instrumentation after lumbar interbody fusion under the condition of whole body vibration (WBV) that is typically present in vehicles. This study aimed to determine the effect of posterior pedicle screw fixation on dynamic response of the whole lumbar spine to vertical WBV after transforaminal lumbar interbody fusion (TLIF). A previously validated nonlinear, osteoligamentous finite element (FE) model of the intact L1-sacrum human lumbar spine was modified to simulate single-level (L4-L5) TLIF without and with bilateral pedicle screw fixation (BPSF). Transit dynamic analysis was performed on the 2 developed models under a sinusoidal vertical vibration load of ±40 N and a compressive follower preload of 400 N. The resulting dynamic response results for the 2 models in terms of stresses and deformations were recorded and compared. When compared with no fixation, BPSF decreased dynamic responses of the spinal levels to the vertical vibration after TLIF. At the fused level (L4-L5), vibration amplitudes of the von-Mises stresses in L4 inferior endplate and L5 superior endplate decreased after BPSF by 48.0% and 46.4%, respectively. At other disc levels (L1-L2, L2-L3, L3-L4, and L5-S1), vibration amplitudes of the disc bulge, von-Mises stress in annulus ground substance and intradiscal pressure also produced 4.2%-9.0%, 2.3%-8.9%, and 3.4%-8.8% deceases, respectively, after BPSF. After TLIF, application of BPSF can be helpful in the prevention of spine injury during vertical WBV. Copyright © 2018 Elsevier Inc. All rights reserved.

The effects of local insulin application to lumbar spinal fusions in a rat model.

PubMed

Koerner, John D; Yalamanchili, Praveen; Munoz, William; Uko, Linda; Chaudhary, Saad B; Lin, Sheldon S; Vives, Michael J

2013-01-01

The rates of pseudoarthrosis after a single-level spinal fusion have been reported up to 35%, and the agents that increase the rate of fusion have an important role in decreasing pseudoarthrosis after spinal fusion. Previous studies have analyzed the effects of local insulin application to an autograft in a rat segmental defect model. Defects treated with a time-released insulin implant had significantly more new bone formation and greater quality of bone compared with controls based on histology and histomorphometry. A time-released insulin implant may have similar effects when applied in a lumbar spinal fusion model. This study analyzes the effects of a local time-released insulin implant applied to the fusion bed in a rat posterolateral lumbar spinal fusion model. Our hypothesis was twofold: first, a time-released insulin implant applied to the autograft bed in a rat posterolateral lumbar fusion will increase the rate of successful fusion and second, will alter the local environment of the fusion site by increasing the levels of local growth factors. Animal model (Institutional Animal Care and Use Committee approved) using 40 adult male Sprague-Dawley rats. Forty skeletally mature Sprague-Dawley rats weighing approximately 500 g each underwent posterolateral intertransverse lumbar fusions with iliac crest autograft from L4 to L5 using a Wiltse-type approach. After exposure of the transverse processes and high-speed burr decortication, a Linplant (Linshin Canada, Inc., ON, Canada) consisting of 95% microrecrystalized palmitic acid and 5% bovine insulin (experimental group) or a sham implant consisting of only palmitic acid (control group) was implanted on the fusion bed with iliac crest autograft. As per the manufacturer, the Linplant has a release rate of 2 U/day for a minimum of 40 days. The transverse processes and autograft beds of 10 animals from the experimental and 10 from the control group were harvested at Day 4 and analyzed for growth factors. The remaining 20 spines were harvested at 8 weeks and underwent a radiographic examination, manual palpation, and microcomputed tomographic (micro-CT) examination. One of the 8-week control animals died on postoperative Day 1, likely due to anesthesia. In the groups sacrificed at Day 4, there was a significant increase in insulinlike growth factor-I (IGF-I) in the insulin treatment group compared with the controls (0.185 vs. 0.129; p=.001). No significant differences were demonstrated in the levels of transforming growth factor beta-1, platelet-derived growth factor-AB, and vascular endothelial growth factor between the groups (p=.461, .452, and .767 respectively). Based on the radiographs, 1 of 9 controls had a solid bilateral fusion mass, 2 of 9 had unilateral fusion mass, 3 of 9 had small fusion mass bilaterally, and 3 of 9 had graft resorption. The treatment group had solid bilateral fusion mass in 6 of 10 and unilateral fusion mass in 4 of 10, whereas a small bilateral fusion mass and graft resorption were not observed. The difference between the groups was significant (p=.0067). Based on manual palpation, only 1 of 9 controls was considered fused, 4 of 9 were partially fused, and 4 of 9 were not fused. In the treatment group, there were 6 of 10 fusions, 3 of 10 partial fusions, and 1 of 10 were not fused. The difference between the groups was significant (p=.0084). Based on the micro-CT, the mean bone volume of the control group was 126.7 mm(3) and 203.8 mm(3) in the insulin treatment group. The difference between the groups was significant (p=.0007). This study demonstrates the potential role of a time-released insulin implant as a bone graft enhancer using a rat posterolateral intertransverse lumbar fusion model. The insulin-treatment group had significantly higher fusion rates based on the radiographs and manual palpation and had significantly higher levels of IGF-I and significantly more bone volume on micro-CT. Copyright © 2013 Elsevier Inc. All rights reserved.

Symptomatic lumbosacral transitional vertebra: a review of the current literature and clinical outcomes following steroid injection or surgical intervention.

PubMed

Holm, Emil Kongsted; Bünger, Cody; Foldager, Casper Bindzus

2017-01-01

Bertolotti's syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I-V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II). The remainders were case series (level IV). Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient's symptoms, especially patients diagnosed with "far out syndrome" treated with laminectomy. Clinical outcomes were more heterogenetic for patient's treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections) and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient's clinical outcome over time, whereas steroid injection only improves the patient's symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS. © The Authors, published by EDP Sciences, 2017.

Symptomatic lumbosacral transitional vertebra: a review of the current literature and clinical outcomes following steroid injection or surgical intervention

PubMed Central

Holm, Emil Kongsted; Bünger, Cody; Foldager, Casper Bindzus

2017-01-01

Bertolotti’s syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I–V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II). The remainders were case series (level IV). Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient’s symptoms, especially patients diagnosed with “far out syndrome” treated with laminectomy. Clinical outcomes were more heterogenetic for patient’s treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections) and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient’s clinical outcome over time, whereas steroid injection only improves the patient’s symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS. PMID:29243586

Prevalence of spinal disorders and their relationships with age and gender

PubMed Central

Alshami, Ali M.

2015-01-01

Objectives: To establish the period prevalence of spinal disorders referred to physical therapy in a university hospital over a 3-year period, and to determine the relationships of common spinal disorders with patients’ age and gender. Methods: This retrospective study was conducted in the Physical Therapy Department, King Fahd Hospital of the University, Dammam, Saudi Arabia. Computer data of all new electronic referrals from January 2011 to December 2013 were retrieved and reviewed. The computer data included demographic information, referring facility, and diagnosis/disorder. Results: One thousand six hundred and sixty-nine (28.1%) of all referred patients (5929) had spinal disorders. The most common disorders affected the lumbar spine (53.1%) and cervical spine (27.1%), and pain was the most common disorder. Neck pain (60.5%) was more common in patients <30 years old (p<0.001). Cervical spondylosis was common (~30%) in the >30 age groups. Spondylosis and low back pain were more prevalent in women (7.8% and 76.2%) than in men (73.9% and 3.3%). Conclusion: Spinal disorders were common compared with other disorders. Low back pain and neck pain were the most common spinal disorders. Age and gender were weakly related to some of the disorders that affected the lumbar and cervical spine. PMID:25987116

Midbrain stimulation-evoked lumbar spinal activity in the adult decerebrate mouse.

PubMed

Stecina, Katinka

2017-08-15

Genetic techniques rendering murine models a popular choice for neuroscience research has led to important insights on neural networks controlling locomotor function. Using genetically altered mouse models for in vivo, electrophysiological studies in the adult state could validate key principles of locomotor network organization that have been described in neonatal, in vitro preparations. The experimental model presented here describes a decerebrate, in vivo adult mouse preparation in which focal, electrical midbrain stimulation was combined with monitoring lumbar neural activity and motor output after pre-collicular decerebration and neuromuscular blockade. Lumbar cord dorsum potentials (in 9/10 animals) and motoneuron output (in 3/5 animals) including fictive locomotion, was achieved by focal midbrain stimulation. The stimulation electrode locations could be reconstructed (in 6/7 animals) thereby allowing anatomical identification of the stimulated supraspinal regions. This preparation allows for concomitant recording or stimulation in the spinal cord and in the mid/hindbrain of adult mice. It differs from other methods used in the past with adult mice as it does not require pharmacological manipulation of neural excitability in order to generate motor output. Midbrain stimulation can consistently be used for inducing lumbar neural activity in adult mice under neuromuscular blockade. This model is suited for examination of brain-spinal connectivity and it may benefit a wide range of fields depending on the features of the genetically modified mouse models used in combination with the presented methods. Copyright © 2017 Elsevier B.V. All rights reserved.

Countermeasures against lumbar spine deconditioning in prolonged bed rest: resistive exercise with and without whole body vibration.

PubMed

Belavý, Daniel L; Armbrecht, Gabriele; Gast, Ulf; Richardson, Carolyn A; Hides, Julie A; Felsenberg, Dieter

2010-12-01

To evaluate the effect of short-duration, high-load resistive exercise, with and without whole body vibration on lumbar muscle size, intervertebral disk and spinal morphology changes, and low back pain (LBP) incidence during prolonged bed rest, 24 subjects underwent 60 days of head-down tilt bed rest and performed either resistive vibration exercise (n = 7), resistive exercise only (n = 8), or no exercise (n = 9; 2nd Berlin Bed-Rest Study). Discal and spinal shape was measured from sagittal plane magnetic resonance images. Cross-sectional areas (CSAs) of the multifidus, erector spinae, quadratus lumborum, and psoas were measured on para-axial magnetic resonance images. LBP incidence was assessed with questionnaires at regular intervals. The countermeasures reduced CSA loss in the multifidus, lumbar erector spinae and quadratus lumborum muscles, with greater increases in psoas muscle CSA seen in the countermeasure groups (P ≤ 0.004). There was little statistical evidence for an additional effect of whole body vibration above resistive exercise alone on these muscle changes. Exercise subjects reported LBP more frequently in the first week of bed rest, but this was only significant in resistive exercise only (P = 0.011 vs. control, resistive vibration exercise vs. control: P = 0.56). No effect of the countermeasures on changes in spinal morphology was seen (P ≥ 0.22). The results suggest that high-load resistive exercise, with or without whole body vibration, performed 3 days/wk can reduce lumbar muscle atrophy, but further countermeasure optimization is required.

Differential effects of left and right neuropathy on opioid gene expression in lumbar spinal cord.

PubMed

Kononenko, Olga; Mityakina, Irina; Galatenko, Vladimir; Watanabe, Hiroyuki; Bazov, Igor; Gerashchenko, Anna; Sarkisyan, Daniil; Iatsyshyna, Anna; Yakovleva, Tatiana; Tonevitsky, Alex; Marklund, Niklas; Ossipov, Michael H; Bakalkin, Georgy

2018-05-28

The endogenous opioid system (EOS) controls the processing of nociceptive stimuli and is a pharmacological target for opioids. Alterations in expression of the EOS genes under neuropathic pain condition may account for low efficacy of opioid drugs. We here examined whether EOS expression patterns are altered in the lumbar spinal cord of the rats with spinal nerve ligation (SNL) as a neuropathic pain model. Effects of the left- and right-side SNL on expression of EOS genes in the ipsi- and contralateral spinal domains were analysed. The SNL-induced changes were complex and different between the genes; between the dorsal and ventral spinal domains; and between the left and right sides of the spinal cord. Prodynorphin (Pdyn) expression was upregulated in the ipsilateral dorsal domains by each the left and right-side SNL, while changes in expression of μ-opioid receptor (Oprm1) and proenkephalin (Penk) genes were dependent on the SNL side. Changes in expression of the Pdyn and κ-opioid receptor (Oprk1) genes were coordinated between the ipsi- and contralateral sides. Withdrawal response thresholds, indicators of mechanical allodynia correlated negatively with Pdyn expression in the right ventral domain after right side SNL. These findings suggest multiple roles of the EOS gene products in spinal sensitization and changes in motor reflexes, which may differ between the left and right sides. Copyright © 2018. Published by Elsevier B.V.

Cost-utility analysis of minimally invasive versus open multilevel hemilaminectomy for lumbar stenosis.

PubMed

Parker, Scott L; Adogwa, Owoicho; Davis, Brandon J; Fulchiero, Erin; Aaronson, Oran; Cheng, Joseph; Devin, Clinton J; McGirt, Matthew J

2013-02-01

Two-year cost-utility study comparing minimally invasive (MIS) versus open multilevel hemilaminectomy in patients with degenerative lumbar spinal stenosis. The objective of the study was to determine whether MIS versus open multilevel hemilaminectomy for degenerative lumbar spinal stenosis is a cost-effective advancement in lumbar decompression surgery. MIS-multilevel hemilaminectomy for degenerative lumbar spinal stenosis allows for effective treatment of back and leg pain while theoretically minimizing blood loss, tissue injury, and postoperative recovery. No studies have evaluated comprehensive healthcare costs associated with multilevel hemilaminectomy procedures, nor assessed cost-effectiveness of MIS versus open multilevel hemilaminectomy. Fifty-four consecutive patients with lumbar stenosis undergoing multilevel hemilaminectomy through an MIS paramedian tubular approach (n=27) versus midline open approach (n=27) were included. Total back-related medical resource utilization, missed work, and health state values [quality adjusted life years (QALYs), calculated from EuroQuol-5D with US valuation] were assessed after 2-year follow-up. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS versus open hemilaminectomy was assessed as incremental cost-effectiveness ratio (ICER: COST(MIS)-COST(OPEN)/QALY(MIS)-QALY(OPEN)). MIS versus open cohorts were similar at baseline. MIS and open hemilaminectomy were associated with an equivalent cumulative gain of 0.72 QALYs 2 years after surgery. Mean direct medical costs, indirect societal costs, and total 2-year cost ($23,109 vs. $25,420; P=0.21) were similar between MIS and open hemilaminectomy. MIS versus open approach was associated with similar total costs and utility, making it a cost equivalent technology compared with the traditional open approach. MIS versus open multilevel hemilaminectomy was associated with similar cost over 2 years while providing equivalent improvement in QALYs. In our experience, MIS versus open multilevel hemilaminectomy is a cost equivalent technology for patients with lumbar stenosis-associated radicular pain.

A protocol of a randomized controlled multicenter trial for surgical treatment of lumbar spondylolisthesis: the Lumbar Interbody Fusion Trial (LIFT).

PubMed

de Kunder, Suzanne L; Rijkers, Kim; van Kuijk, Sander M J; Evers, Silvia M A A; de Bie, Rob A; van Santbrink, Henk

2016-10-06

With a steep increase in the number of instrumented spinal fusion procedures, there is a need for comparative data to develop evidence based treatment recommendations. Currently, the available data on cost and clinical effectiveness of the two most frequently performed surgeries for lumbar spondylolisthesis, transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF), are not sufficient. Therefore, current guidelines do not advise which is the most appropriate surgical treatment strategy for these patients. Non-randomized studies comparing TLIF and PLIF moreover suggest that TLIF is associated with fewer complications, less blood loss, shorter surgical time and hospital duration. TLIF may therefore be more cost-effective. The results of this study will provide knowledge on short- and long-term clinical and economical effects of TLIF and PLIF procedures, which will lead to recommendations for treating patients with lumbar spondylolisthesis. Multicenter blinded Randomized Controlled Trial (RCT; blinding for the patient and statistician, not for the clinician and researcher). A total of 144 patients over 18 years old with symptomatic single level lumbar degenerative, isthmic or iatrogenic spondylolisthesis whom are candidates for LIF (lumbar interbody fusion) surgery through a posterior approach will be randomly allocated to TLIF or PLIF. The study will consist of three parts: 1) a clinical effectiveness study, 2) a cost-effectiveness study, and 3) a process evaluation. The primary clinical outcome measures are: change in disability measured with Oswestry Disability Index (ODI) and change in quality adjusted life years (QALY) measured with EQ-5D-5L. Secondary clinical outcome measures are: Short Form (36) Health Survey (SF-36), VAS back pain, VAS leg pain, Hospital Anxiety Depression Scale (HADS), complications, productivity related costs (iPCQ) and medical costs (iMCQ). Measurements will be carried out at five fixed time points (pre-operatively and at 3, 6, 12 and 24 months). It is hypothesized that TLIF, compared to PLIF, has similar clinical outcome or is possibly better in reducing disability. Moreover, direct medical costs are expected to be lower due to less surgical morbidity, shorter hospital stay and shorter surgical time. Indirect costs are assumed to be lower for TLIF as well, because we suspect less working days are lost. Currently, prospective data comparing clinical and cost-effectiveness of both techniques are not available. Therefore, in clinical practice both techniques are used and the choice for technique is greatly based on surgeon's preference. The demand for spinal fusion surgery has risen steeply over the last 10 years and is expected to increase even further in the near future. As a result, the burden on society (and the working population) will increase. In case our hypothesis is confirmed, treatment guidelines will be adapted, and TLIF will be recommended as first choice surgical treatment of lumbar spondylolisthesis. Ultimately this will lead to reduction of (direct and indirect) costs and better clinical outcome for spondylolisthesis patients eligible for instrumented spinal surgery. Netherlands Trial Registry, number 5722 (registration date March 30, 2016).

CT and MRI in the evaluation of extraspinal sciatica

PubMed Central

Ergun, T; Lakadamyali, H

2010-01-01

Sciatica is the most frequently encountered symptom in neurosurgical practice and is observed in 40% of adults at some point in their lives. It is described as pain of the hip and the lower extremity secondary to pathologies affecting the sciatic nerve within its intraspinal or extraspinal course. The most frequent cause is a herniating lumbar disc pressing on the neural roots. Extraspinal causes of sciatic pain are usually overlooked because they are extremely rare and due to intraspinal causes (lumbar spinal stenosis, facet joint osteoarthritis, fracture, and tumors of the spinal cord and spinal column) being the main consideration. Early diagnosis of sciatica significantly improves the likelihood of relieving symptoms, as well as avoiding any additional neurologic injury and unnecessary surgery. We evaluate histolopathologically confirmed extraspinal causes of sciatica cases, accompanied by their presented computed tomography and/or magnetic resonance imaging findings. PMID:20647515

Herpes zoster with dysfunction of bladder and anus.

PubMed

Jellinek, E H; Tulloch, W S

1976-12-04

Herpes zoster may give rise to dysfunction of bladder and anus. Mucosal lesions have been reported, and 7 cases are described with retention, loss of sensation, or incontinence. Sacral shingles is associated with sensory loss and flaccid detrusor paralysis. Lumbar shingles may cause retention, and zoster at higher levels can also damage the spinal cord. Recovery is usually complete. The implication for schemes of bladder innervation is discussed.

Early CALP2 expression and microglial activation are potential inducers of spinal IL-6 up-regulation and bilateral pain following motor nerve injury.

PubMed

Chen, Shao-Xia; Wang, Shao-Kun; Yao, Pei-Wen; Liao, Guang-Jie; Na, Xiao-Dong; Li, Yong-Yong; Zeng, Wei-An; Liu, Xian-Guo; Zang, Ying

2018-04-01

Previous work from our laboratory showed that motor nerve injury by lumbar 5 ventral root transection (L5-VRT) led to interleukin-6 (IL-6) over-expression in bilateral spinal cord, and that intrathecal administration of IL-6 neutralizing antibody delayed the induction of mechanical allodynia in bilateral hind paws. However, early events and upstream mechanisms underlying spinal IL-6 expression following L5-VRT require elucidation. The model of L5-VRT was used to induce neuropathic pain, which was assessed with von Frey hairs and the plantar tester in adult male Sprague-Dawley rats. Calpain-2 (CALP2, a calcium-dependent protease) knockdown or over-expression and microglia depletion were conducted intrathecally. Western blots and immunohistochemistry were performed to explore the possible mechanisms. Here, we provide the first evidence that both IL-6 and CALP2 levels are increased in lumbar spinal cord within 30 min following L5-VRT. IL-6 and CALP2 co-localized in both spinal dorsal horn (SDH) and spinal ventral horn. Post-operative (PO) increase in CALP2 in ipsilateral SDH was evident at 10 min PO, preceding increased IL-6 at 20 min PO. Knockdown of spinal CALP2 by intrathecal CALP2-shRNA administration prevented VRT-induced IL-6 overproduction in ipsilateral spinal cord and alleviated bilateral mechanical allodynia. Spinal microglia activation also played a role in early IL-6 up-regulation. Macrophage/microglia markers ED1/Iba1 were increased at 30 min PO, while glial fibrillary acidic protein (astrocyte) and CNPase (oligodendrocyte) markers were not. Increased Iba1 was detected as early as 20 min PO and peaked at 3 days. Morphology changed from a small soma with fine processes in resting cells to an activated ameboid shape. Depletion of microglia using Mac-1-saporin partially prevented IL-6 up-regulation and attenuated VRT-induced bilateral mechanical allodynia. Taken together, our findings provide evidence that increased spinal cord CALP2 and microglia cell activation may have early causative roles in IL-6 over-expression following motor nerve injury. Agents that inhibit CALP2 and/or microglia activation may therefore prove valuable for treating neuropathic pain. © 2018 International Society for Neurochemistry.

THE RELIABILITY AND CONCURRENT VALIDITY OF MEASUREMENTS USED TO QUANTIFY LUMBAR SPINE MOBILITY: AN ANALYSIS OF AN IPHONE® APPLICATION AND GRAVITY BASED INCLINOMETRY

PubMed Central

Pizzini, Matias; Robinson, Ashley; Yanez, Dania; Hanney, William J.

2013-01-01

Purpose/Aim: This purpose of this study was to investigate the reliability, minimal detectable change (MDC), and concurrent validity of active spinal mobility measurements using a gravity‐based bubble inclinometer and iPhone® application. Materials/Methods: Two investigators each used a bubble inclinometer and an iPhone® with inclinometer application to measure total thoracolumbo‐pelvic flexion, isolated lumbar flexion, total thoracolumbo‐pelvic extension, and thoracolumbar lateral flexion in 30 asymptomatic participants using a blinded repeated measures design. Results: The procedures used in this investigation for measuring spinal mobility yielded good intrarater and interrater reliability with Intraclass Correlation Coefficients (ICC) for bubble inclinometry ≥ 0.81 and the iPhone® ≥ 0.80. The MDC90 for the interrater analysis ranged from 4° to 9°. The concurrent validity between bubble inclinometry and the iPhone® application was good with ICC values of ≥ 0.86. The 95% level of agreement indicates that although these measuring instruments are equivalent individual differences of up to 18° may exist when using these devices interchangeably. Conclusions: The bubble inclinometer and iPhone® possess good intrarater and interrater reliability as well as concurrent validity when strict measurement procedures are adhered to. This study provides preliminary evidence to suggest that smart phone applications may offer clinical utility comparable to inclinometry for quantifying spinal mobility. Clinicians should be aware of the potential disagreement when using these devices interchangeably. Level of Evidence: 2b (Observational study of reliability) PMID:23593551

Hepatocellular Carcinoma Supplied by the Right Lumbar Artery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miyayama, Shiro, E-mail: s-miyayama@fukui.saiseikai.or.jp; Yamashiro, Masashi; Okuda, Miho

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

Noradrenergic innervation of the rat spinal cord caudal to a complete spinal cord transection: effects of olfactory ensheathing glia.

PubMed

Takeoka, Aya; Kubasak, Marc D; Zhong, Hui; Kaplan, Jennifer; Roy, Roland R; Phelps, Patricia E

2010-03-01

Transplantation of olfactory bulb-derived olfactory ensheathing glia (OEG) combined with step training improves hindlimb locomotion in adult rats with a complete spinal cord transection. Spinal cord injury studies use the presence of noradrenergic (NA) axons caudal to the injury site as evidence of axonal regeneration and we previously found more NA axons just caudal to the transection in OEG- than media-injected spinal rats. We therefore hypothesized that OEG transplantation promotes descending coeruleospinal regeneration that contributes to the recovery of hindlimb locomotion. Now we report that NA axons are present throughout the caudal stump of both media- and OEG-injected spinal rats and they enter the spinal cord from the periphery via dorsal and ventral roots and along large penetrating blood vessels. These results indicate that the presence of NA fibers in the caudal spinal cord is not a reliable indicator of coeruleospinal regeneration. We then asked if NA axons appose cholinergic neurons associated with motor functions, i.e., central canal cluster and partition cells (active during fictive locomotion) and somatic motor neurons (SMNs). We found more NA varicosities adjacent to central canal cluster cells, partition cells, and SMNs in the lumbar enlargement of OEG- than media-injected rats. As non-synaptic release of NA is common in the spinal cord, more associations between NA varicosities and motor-associated cholinergic neurons in the lumbar spinal cord may contribute to the improved treadmill stepping observed in OEG-injected spinal rats. This effect could be mediated through direct association with SMNs and/or indirectly via cholinergic interneurons. Copyright 2009 Elsevier Inc. All rights reserved.

Relationship between spinal morphology and function and adolescent non-specific back pain: A cross-sectional study.

PubMed

Feng, Qiang; Jiang, Chongmin; Zhou, Yu; Huang, Yun; Zhang, Ming

2017-01-01

Non-specific back pain has become a public health problem affecting adolescent health. To examine the relationships between abnormalities in spinal morphology and non-specific back pain among adolescents. Cross-sectional study. Junior and senior high schools. Participants were screened using a questionnaire regarding back pain. Students in the pain group (n= 273, 121 boys and 152 girls) reported experiencing upper and/or lower back pain within the previous month, and those who did not report pain were assigned to the group without pain (n= 127, 63 boys and 64 girls). Participants who had experienced acute upper and/or lower back injuries within the previous month or received a definitive diagnose of disease were excluded. The SpinalMouse® was used to measure the thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sacrum/hip angle (SA), and incline angle (INA) in both the standing position and sitting position. The SpinalMouse® also was used to measure the sacral, thoracic, and lumbar range of motion (ROM) in the fully flexed position and fully extended position in the sagittal plane. The thoracic and lumbar ROM in left/right lateral flexion was recorded. The Matthiass test was used to assess changes in the measured angles upon loading. Among junior high school students, 47.0% of boys and 53% of girls had an abnormal TKA. Among senior high school students, 52.6% of boys and 46.99% of girls had an abnormal TKA. The incidence of LLA abnormality was significantly higher among junior high boys than girls (p< 0.05), as was the incidence of hypolordosis (p< 0.05). Significantly fewer senior high boys than girls had a normal LLA value (p< 0.05). An excessive TKA (p< 0.05, odds ratio = 1.236) and limited lumbar ROM (p< 0.01, odds ratio = 0.975) were correlated with back pain in adolescents. The incidences of TKA and LLA abnormality are high among Chinese adolescents, and an excessive TKA and insufficient total lumbar ROM may be risk factors for non-specific back pain in adolescents.

Lumbosacral stenosis in Labrador retriever military working dogs - an exomic exploratory study.

PubMed

Mukherjee, Meenakshi; Jones, Jeryl C; Yao, Jianbo

2017-01-01

Canine lumbosacral stenosis is defined as narrowing of the caudal lumbar and/or sacral vertebral canal. A risk factor for neurologic problems in many large sized breeds, lumbosacral stenosis can also cause early retirement in Labrador retriever military working dogs. Though vital for conservative management of the condition, early detection is complicated by the ambiguous nature of clinical signs of lumbosacral stenosis in stoic and high-drive Labrador retriever military working dogs. Though clinical diagnoses of lumbosacral stenosis using CT imaging are standard, they are usually not performed unless dogs present with clinical symptoms. Understanding the underlying genomic mechanisms would be beneficial in developing early detection methods for lumbosacral stenosis, which could prevent premature retirement in working dogs. The exomes of 8 young Labrador retriever military working dogs (4 affected and 4 unaffected by lumbosacral stenosis, phenotypically selected by CT image analyses from 40 dogs with no reported clinical signs of the condition) were sequenced to identify and annotate exonic variants between dogs negative and positive for lumbosacral stenosis. Two-hundred and fifty-two variants were detected to be homozygous for the wild allele and either homozygous or heterozygous for the variant allele. Seventeen non-disruptive variants were detected that could affect protein effectiveness in 7 annotated (SCN1B, RGS9BP, ASXL3, TTR, LRRC16B, PTPRO, ZBBX) and 3 predicted genes (EEF1A1, DNAJA1, ZFX). No exonic variants were detected in any of the canine orthologues for human lumbar spinal stenosis candidate genes. TTR (transthyretin) gene could be a possible candidate for lumbosacral stenosis in Labrador retrievers based on previous human studies that have reported an association between human lumbar spinal stenosis and transthyretin protein amyloidosis. Other genes identified with exonic variants in this study but with no known published association with lumbosacral stenosis and/or lumbar spinal stenosis could also be candidate genes for future canine lumbosacral stenosis studies but their roles remain currently unknown. Human lumbar spinal stenosis candidate genes also cannot be ruled out as lumbosacral stenosis candidate genes. More definitive genetic investigations of this condition are needed before any genetic test for lumbosacral stenosis in Labrador retriever can be developed.

Neuropeptide Y in human spinal cord.

PubMed

Allen, J M; Gibson, S J; Adrian, T E; Polak, J M; Bloom, S R

1984-08-06

The distribution of a newly described peptide, neuropeptide Y (NPY) within the human spinal cord has been determined using radioimmunoassay and immunocytochemistry. Higher concentrations were found in the lumbar (49.9 +/- 6.8 pmol/g) and sacral (47.0 +/- 10.6 pmol/g) regions than in the cervical (27.6 +/- 2.7 pmol/g) and thoracic spinal cord (33.8 +/- 5.3 pmol/g). Immunocytochemistry revealed numerous nerve fibers containing NPY in the spinal cord; these were particularly concentrated in the substantia gelatinosa of the dorsal horn. In the ventral spinal cord NPY-containing nerves were sparse becoming more abundant in lumbosacral segments.

Does unilateral hip flexion increase the spinal anaesthetic level during combined spinal–epidural technique?

PubMed Central

Mohta, Medha; Agarwal, Deepti; Sethi, AK

2011-01-01

Needle-through-needle combined spinal–epidural (CSE) may cause significant delay in patient positioning resulting in settling down of spinal anaesthetic and unacceptably low block level. Bilateral hip flexion has been shown to extend the spinal block by flattening lumbar lordosis. However, patients with lower limb fractures cannot flex their injured limb. This study was conducted to find out if unilateral hip flexion could extend the level of spinal anaesthesia following a prolonged CSE technique. Fifty American Society of Anesthesiologists (ASA) I/II males with unilateral femur fracture were randomly allocated to Control or Flexion groups. Needle-through-needle CSE was performed in the sitting position at L2-3 interspace and 2.6 ml 0.5% hyperbaric bupivacaine injected intrathecally. Patients were made supine 4 min after the spinal injection or later if epidural placement took longer. The Control group patients (n=25) lay supine with legs straight, whereas the Flexion group patients (n=25) had their uninjured hip and knee flexed for 5 min. Levels of sensory and motor blocks and time to epidural drug requirement were recorded. There was no significant difference in sensory levels at different time-points; maximum sensory and motor blocks; times to achieve maximum blocks; and time to epidural drug requirement in two groups. However, four patients in the Control group in contrast to none in the Flexion group required epidural drug before start of surgery. Moreover, in the Control group four patients took longer than 30 min to achieve maximum sensory block. To conclude, unilateral hip flexion did not extend the spinal anaesthetic level; however, further studies are required to explore the potential benefits of this technique. PMID:21808396

Chronic spontaneous lumbar epidural hematoma simulating extradural spinal tumor: a case report.

PubMed

Matsui, Hiroki; Imagama, Shiro; Ito, Zenya; Ando, Kei; Hirano, Kenichi; Tauchi, Ryoji; Muramoto, Akio; Matsumoto, Tomohiro; Ishiguro, Naoki

2014-02-01

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.

Late effects of radiation on the lumbar spinal cord of guinea pigs: Re-treatment tolerance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mason, K.A.; Withers, H.R.; Chiang, Chi-Shiun

Using a guinea pig model of lumbar myelopathy, various factors affecting the tolerance of spinal cord to irradiation were assessed: (a) extent of initial injury; (b) time interval between priming and test doses; and (c) animal age at the time of initial radiation treatment. A 3 cm section of lumbar spinal cord of guinea pigs was irradiated with fractionated doses of 4.5 Gy gamma rays given as 9 fractions per week. Guinea pigs were primed with 9 x 4.5 Gy in 7 days which is 60% of the ED[sub 50] for a continuous course of treatment. After 28 or 40more » weeks, animal were retreated with 6-14 fractions of 4.5 Gy. Animals were observed for 2 years following the priming dose and both the incidence and latency of myelopathy recorded. Young adult guinea pigs (8 wk old) showed both a decreased radiation tolerance and latency compared to old individuals (40 wk old). At 28 or 40 wk after 9 x 4.5 Gy, only about 8% of the initial injury was remembered in young adult guinea pigs. The amount of residual injury was dependent on the initial damage as a proportion of the tolerance dose. The spinal cord shows a greater capacity for long-term recovery than generally appreciated and re-treatment doses clinically prescribed may be lower than necessary. 8 refs., 3 figs., 2 tabs.« less

Transient Receptor Potential Channel and Interleukin-17A Involvement in LTTL Gel Inhibition of Bone Cancer Pain in a Rat Model.

PubMed

Wang, Juyong; Zhang, Ruixin; Dong, Changsheng; Jiao, Lijing; Xu, Ling; Liu, Jiyong; Wang, Zhengtao; Lao, Lixing

2015-07-01

Cancer pain management is a challenge for which Chinese herbal medicine might be useful. To study the spinal mechanisms of the Chinese medicated gel Long-Teng-Tong-Luo (LTTL), a 7-herb compound, on bone cancer pain, a bone cancer pain model was made by inoculating the tibias of female rats with Walker 256 cells. LTTL gel or inert gel, 0.5 g/cm(2)/d, was applied to the skin of tumor-bearing tibias for 21 days beginning a day after the inoculation. Mechanical threshold and paw withdrawal latency to thermal stimulation was measured. Transient receptor potential (TRP) cation channels in lumbar dorsal root ganglia (DRG) were immunostained and counted, and lumbar spinal cord interleukin-17A (IL-17A) was measured with real-time polymerase chain reaction and enzyme-linked immunosorbent assay. TRP antagonists and interleukin (IL)-17A antibodies were intrathecally administered to determine their effects on bone cancer pain. The gel significantly (P < .05) alleviated cancer-induced mechanical allodynia and thermal hyperalgesia and inhibited cancer-enhanced expression of IL-17A in spinal astrocytes and the TRP subfamily members V1, A1, and V4 in lumbar DRG. Intrathecal TRP antagonists at 10 µg significantly (P < .05) attenuated mechanical allodynia, thermal hyperalgesia, and IL-17A expression, indicating that TRP channels facilitate spinal IL-17 expression and cancer pain. IL-17A antibodies inhibited cancer pain, suggesting that IL-17A promotes such pain. The data show that LTTL gel inhibits cancer pain, and this might be accounted for by the decrease in expression of DRG TRP channels and spinal astrocyte IL-17A. © The Author(s) 2015.

Effects of inter-individual lumbar spine geometry variation on load-sharing: Geometrically personalized Finite Element study.

PubMed

Naserkhaki, Sadegh; Jaremko, Jacob L; El-Rich, Marwan

2016-09-06

There is a large, at times contradictory, body of research relating spinal curvature to Low Back Pain (LBP). Mechanical load is considered as important factor in LBP etiology. Geometry of the spinal structures and sagittal curvature of the lumbar spine govern its mechanical behavior. Thus, understanding how inter-individual geometry particularly sagittal curvature variation affects the spinal load-sharing becomes of high importance in LBP assessment. This study calculated and compared kinematics and load-sharing in three ligamentous lumbosacral spines: one hypo-lordotic (Hypo-L) with low lordosis, one normal-lordotic (Norm-L) with normal lordosis, and one hyper-lordotic (Hyper-L) with high lordosis in flexed and extended postures using 3D nonlinear Finite Element (FE) modeling. These postures were simulated by applying Follower Load (FL) combined with flexion or extension moment. The Hypo-L spine demonstrated stiffer behavior in flexion but more flexible response to extension compared to the Norm-L spine. The excessive lordosis stiffened response of the Hyper-L spine to extension but did not affect its resistance to flexion compared to the Norm-L spine. Despite the different resisting actions of the posterior ligaments to flexion moment, the increase of disc compression was similar in all the spines leading to similar load-sharing. However, resistance of the facet joints to extension was more important in the Norm- and Hyper-L spines which reduced the disc compression. The spinal curvature strongly influenced the magnitude and location of load on the spinal components and also altered the kinematics and load-sharing particularly in extension. Consideration of the subject-specific geometry and sagittal curvature should be an integral part of mechanical analysis of the lumbar spine. Copyright © 2016 Elsevier Ltd. All rights reserved.

Quality of data regarding diagnoses of spinal disorders in administrative databases. A multicenter study.

PubMed

Faciszewski, T; Broste, S K; Fardon, D

1997-10-01

The purpose of the present study was to evaluate the accuracy of data regarding diagnoses of spinal disorders in administrative databases at eight different institutions. The records of 189 patients who had been managed for a disorder of the lumbar spine were independently reviewed by a physician who assigned the appropriate diagnostic codes according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The age range of the 189 patients was seventeen to eighty-four years. The six major diagnostic categories studied were herniation of a lumbar disc, a previous operation on the lumbar spine, spinal stenosis, cauda equina syndrome, acquired spondylolisthesis, and congenital spondylolisthesis. The diagnostic codes assigned by the physician were compared with the codes that had been assigned during the ordinary course of events by personnel in the medical records department of each of the eight hospitals. The accuracy of coding was also compared among the eight hospitals, and it was found to vary depending on the diagnosis. Although there were both false-negative and false-positive codes at each institution, most errors were related to the low sensitivity of coding for previous spinal operations: only seventeen (28 per cent) of sixty-one such diagnoses were coded correctly. Other errors in coding were less frequent, but their implications for conclusions drawn from the information in administrative databases depend on the frequency of a diagnosis and its importance in an analysis. This study demonstrated that the accuracy of a diagnosis of a spinal disorder recorded in an administrative database varies according to the specific condition being evaluated. It is necessary to document the relative accuracy of specific ICD-9-CM diagnostic codes in order to improve the ability to validate the conclusions derived from investigations based on administrative databases.

Predictive value of 3-month lumbar discectomy outcomes in the NeuroPoint-SD Registry.

PubMed

Whitmore, Robert G; Curran, Jill N; Ali, Zarina S; Mummaneni, Praveen V; Shaffrey, Christopher I; Heary, Robert F; Kaiser, Michael G; Asher, Anthony L; Malhotra, Neil R; Cheng, Joseph S; Hurlbert, John; Smith, Justin S; Magge, Subu N; Steinmetz, Michael P; Resnick, Daniel K; Ghogawala, Zoher

2015-10-01

The authors have established a multicenter registry to assess the efficacy and costs of common lumbar spinal procedures using prospectively collected outcomes. Collection of these data requires an extensive commitment of resources from each site. The aim of this study was to determine whether outcomes data from shorter-interval follow-up could be used to accurately estimate long-term outcome following lumbar discectomy. An observational prospective cohort study was completed at 13 academic and community sites. Patients undergoing single-level lumbar discectomy for treatment of disc herniation were included. SF-36 and Oswestry Disability Index (ODI) data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Quality-adjusted life year (QALY) data were calculated using SF-6D utility scores. Correlations among outcomes at each follow-up time point were tested using the Spearman rank correlation test. One hundred forty-eight patients were enrolled over 1 year. Their mean age was 46 years (49% female). Eleven patients (7.4%) required a reoperation by 1 year postoperatively. The overall 1-year follow-up rate was 80.4%. Lumbar discectomy was associated with significant improvements in ODI and SF-36 scores (p < 0.0001) and with a gain of 0.246 QALYs over the 1-year study period. The greatest gain occurred between baseline and 3-month follow-up and was significantly greater than improvements obtained between 3 and 6 months or 6 months and 1 year(p < 0.001). Correlations between 3-month, 6-month, and 1-year outcomes were similar, suggesting that 3-month data may be used to accurately estimate 1-year outcomes for patients who do not require a reoperation. Patients who underwent reoperation had worse outcomes scores and nonsignificant correlations at all time points. This national spine registry demonstrated successful collection of high-quality outcomes data for spinal procedures in actual practice. Three-month outcome data may be used to accurately estimate outcome at future time points and may lower costs associated with registry data collection. This registry effort provides a practical foundation for the acquisition of outcome data following lumbar discectomy.

Invasive histiocytic sarcoma of the lumbar spine in a ferret (Mustela putorius furo).

PubMed

Warschau, M; Hoffmann, M; Dziallas, P; Hansmann, F; Baumgärtner, W; Mischke, R; Cichowski, S; Fehr, M

2017-02-01

This report describes the history, clinical examination and histopathology of a histiocytic sarcoma in a domestic ferret. Clinical signs were acute paraplegia and dysuria. Physical examination revealed a firm, smooth, touch-sensitive mass in and around the lumbar vertebral column. Neurologic examination was consistent with a lesion between spinal cord segments T3 and L3. Magnetic resonance images revealed bone lesions of L2 and L3 combined with compression of the spinal cord due to a homogenous, isointense mass that was diagnosed as a malignant round cell tumour and the ferret was euthanased. Histopathology confirmed the diagnosis of an infiltrative histiocytic sarcoma. © 2017 British Small Animal Veterinary Association.

Do "whiplash" victims with neck pain differ from those with neck pain and other symptoms?

PubMed

Tencer, A F; Mirza, S; Cummings, P

2001-01-01

Studying 432 patients with "whiplash" neck pain after a low speed rear-end crash, we determined whether those who reported associated symptoms (arm or low back pain) differed from those with neck pain only. Exposure variables were: age, gender, height, weight, surprised by impact, rotated position of the head, and pre-existing cervical or lumbar spinal degeneration. Immediate symptoms were considered. Odds ratios (OR) were derived from logistic regression. Only pre-existing lumbar spinal degeneration was associated with having arm symptoms (OR = 9.6, CI = 1.1, 83.6) or low back pain (OR = 23.3, CI = 2.6, 206.7) along with neck pain.

Muscle gap approach under a minimally invasive channel technique for treating long segmental lumbar spinal stenosis

PubMed Central

Bin, Yang; De cheng, Wang; wei, Wang Zong; Hui, Li

2017-01-01

Abstract This study aimed to compare the efficacy of muscle gap approach under a minimally invasive channel surgical technique with the traditional median approach. In the Orthopedics Department of Traditional Chinese and Western Medicine Hospital, Tongzhou District, Beijing, 68 cases of lumbar spinal canal stenosis underwent surgery using the muscle gap approach under a minimally invasive channel technique and a median approach between September 2013 and February 2016. Both approaches adopted lumbar spinal canal decompression, intervertebral disk removal, cage implantation, and pedicle screw fixation. The operation time, bleeding volume, postoperative drainage volume, and preoperative and postoperative visual analog scale (VAS) score and Japanese Orthopedics Association score (JOA) were compared between the 2 groups. All patients were followed up for more than 1 year. No significant difference between the 2 groups was found with respect to age, gender, surgical segments. No diversity was noted in the operation time, intraoperative bleeding volume, preoperative and 1 month after the operation VAS score, preoperative and 1 month after the operation JOA score, and 6 months after the operation JOA score between 2 groups (P > .05). The amount of postoperative wound drainage (260.90 ± 160 mL vs 447.80 ± 183.60 mL, P < .001) and the VAS score 6 months after the operation (1.71 ± 0.64 vs 2.19 ± 0.87, P = .01) were significantly lower in the muscle gap approach group than in the median approach group (P < .05). In the muscle gap approach under a minimally invasive channel group, the average drainage volume was reduced by 187 mL, and the average VAS score 6 months after the operation was reduced by an average of 0.48. The muscle gap approach under a minimally invasive channel technique is a feasible method to treat long segmental lumbar spinal canal stenosis. It retains the integrity of the posterior spine complex to the greatest extent, so as to reduce the adjacent spinal segmental degeneration and soft tissue trauma. Satisfactory short-term and long-term clinical results were obtained. PMID:28796075

Influence of lumbar lordosis restoration on thoracic curve and sagittal position in lumbar degenerative kyphosis patients.

PubMed

Jang, Jee-Soo; Lee, Sang-Ho; Min, Jun-Hong; Maeng, Dae Hyeon

2009-02-01

A retrospective study. To determine postsurgical correlations between thoracic and lumbar sagittal curves in lumbar degenerative kyphosis (LDK) and to determine predictability of spontaneous correction of thoracic curve and sacral angle after surgical restoration of lumbar lordosis and fusion. To our knowledge, there are only a limited number of articles about the relationship between thoracic and lumbar curve in sagittal thoracic compensated LDK. Retrospective review of 53 consecutive patients treated with combined anterior and posterior spinal arthrodesis. We included patients with sagittal thoracic compensated LDK caused by sagittal imbalance in this study. Total lumbar lordosis, thoracic kyphosis, sacral slope, and C7 plumb line were measured on the pre- and postoperative whole spine lateral views. Postoperative changes in thoracic kyphosis, sacral slope, and C7 plumb line according to the surgical lumbar lordosis restoration were measured and evaluated. The mean preoperative sagittal imbalance by plumb line was 78.3 mm (+/-76.5); this improved to 13.6 mm (+/-25) after surgery (P < 0.0001). Mean lumbar lordosis was 9.4 degrees (+/-19.2) before surgery and increased to 38.4 degrees (+/-13.1) at follow-up (P < 0.0001). Mean thoracic kyphosis was 1.1 degrees (+/-12.7) before surgery and increased to 17.6 degrees (+/-12.2) at follow-up (P < 0.0001). Significant preoperative correlations existed between kyphosis and lordosis (r = 0.772, P < 0.0001) and between lordosis and sacral slope (r = 0.785, P < 0.0001). Postoperative lumbar lordosis is correlated to thoracic kyphosis increase (r = 0.620, P < 0.0001). Postoperative lumbar lordosis is correlated to sacral slope increase (r = 0.722, P < 0.0001). Reciprocal relationship exists between lumbar lordosis and thoracic kyphosis in sagittal thoracic compensated LDK. Surgical restoration of lumbar lordosis for LDK brings about high level of statistical correlation to thoracic kyphosis improvement. At the same time, the reciprocal relationship is maintained.

Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF).

PubMed

Phan, Kevin; Maharaj, Monish; Assem, Yusuf; Mobbs, Ralph J

2016-09-01

Lumbar interbody fusion represents an effective surgical intervention for patients with lumbar degenerative diseases, spondylolisthesis, disc herniation, pseudoarthrosis and spinal deformities. Traditionally, conventional open anterior lumbar interbody fusion and posterior/transforaminal lumbar interbody fusion techniques have been employed with excellent results, but each with their own advantages and caveats. Most recently, the antero-oblique trajectory has been introduced, providing yet another corridor to access the lumbar spine. Termed the oblique lumbar interbody fusion, this approach accesses the spine between the anterior vessels and psoas muscles, avoiding both sets of structures to allow efficient clearance of the disc space and application of a large interbody device to afford distraction for foraminal decompression and endplate preparation for rapid and thorough fusion. This review aims to summarize the early clinical results and complications of this new technique and discusses potential future directions of research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Extraforaminal Lumbar Interbody Fusion at the L5-S1 Level: Technical Considerations and Feasibility.

PubMed

Kurzbuch, Arthur Robert; Kaech, Denis; Baranowski, Pawel; Baranowska, Alicja; Recoules-Arche, Didier

2017-09-01

Background  Extraforaminal lumbar interbody fusion (ELIF) surgery is a muscle-sparing approach that allows the treatment of various degenerative spinal diseases. It is technical challenging to perform the ELIF approach at the L5-S1 level because the sacral ala obstructs the view of the intervertebral disk space. Methods  We reported earlier on the ELIF technique in which the intervertebral disk is targeted at an angle of 45 degrees relative to the midline. In this article we describe the technical process we developed to overcome the anatomic relation between the sacral ala and the intervertebral disk space L5-S1 that hinders the ELIF approach at this level. We then report in a retrospective analysis on the short-term clinical and radiologic outcome of 100 consecutive patients with degenerative L5-S1 pathologies who underwent ELIF surgery. Results  The L5-S1 ELIF approach could be realized in all patients. The short-term clinical outcome was evaluated 5 months after surgery: 92% of the patients were satisfied with their postoperative result; 8% had a poor result. Overall, 17% of the patients presented light radicular or low back pain not influencing their daily activity, and 82% of the patients working before surgery returned to work 3 to 7 months after surgery. The radiologic outcome was documented by computed tomography at 5 months after surgery and showed fusion in 99% of the patients. Lumbar magnetic resonance imaging performed in 5 patients at 6 months after surgery revealed the integrity of the paraspinal muscles. Conclusions  ELIF surgery at the L5-S1 level is technically feasible for various degenerative spinal diseases. Analysis of the clinical and radiologic data in a consecutive retrospective cohort of patients who underwent this surgical procedure showed a good short-term clinical outcome and fusion rate. Georg Thieme Verlag KG Stuttgart · New York.

Spinal epidural abscess: Report on 27 cases

PubMed Central

Khursheed, Nayil; Dar, Sultan; Ramzan, Altaf; Fomda, Bashir; Humam, Nisar; Abrar, Wani; Singh, Sarbjit; Sajad, Arif; Mahek, Masood; Yawar, Shoaib

2017-01-01

Background: Spinal epidural abscess, although an uncommon disease, often correlates with a high morbidity owing to significant delay in diagnosis. Methods: In a prospective 5-year study, the clinical and magnetic resonance (MR) findings, treatment protocols, microbiology, and neurological outcomes were analyzed for 27 patients with spinal epidural abscess. Results: Patients were typically middle-aged with underlying diabetes and presented with lumbar abscesses. Those undergoing surgical intervention >36 h after the onset of symptoms had poor neurological outcomes. Conclusion: Early recognition and timely evacuation of spinal abscesses minimized neurological morbidity and potential mortality. PMID:29026676

Spinal epidural abscess: Report on 27 cases.

PubMed

Khursheed, Nayil; Dar, Sultan; Ramzan, Altaf; Fomda, Bashir; Humam, Nisar; Abrar, Wani; Singh, Sarbjit; Sajad, Arif; Mahek, Masood; Yawar, Shoaib

2017-01-01

Spinal epidural abscess, although an uncommon disease, often correlates with a high morbidity owing to significant delay in diagnosis. In a prospective 5-year study, the clinical and magnetic resonance (MR) findings, treatment protocols, microbiology, and neurological outcomes were analyzed for 27 patients with spinal epidural abscess. Patients were typically middle-aged with underlying diabetes and presented with lumbar abscesses. Those undergoing surgical intervention >36 h after the onset of symptoms had poor neurological outcomes. Early recognition and timely evacuation of spinal abscesses minimized neurological morbidity and potential mortality.

The insertional torque of a pedicle screw has a positive correlation with bone mineral density in posterior lumbar pedicle screw fixation.

PubMed

Lee, J H; Lee, J-H; Park, J W; Shin, Y H

2012-01-01

In patients with osteoporosis there is always a strong possibility that pedicle screws will loosen. This makes it difficult to select the appropriate osteoporotic patient for a spinal fusion. The purpose of this study was to determine the correlation between bone mineral density (BMD) and the magnitude of torque required to insert a pedicle screw. To accomplish this, 181 patients with degenerative disease of the lumbar spine were studied prospectively. Each underwent dual-energy x-ray absorptiometry (DEXA) and intra-operative measurement of the torque required to insert each pedicle screw. The levels of torque generated in patients with osteoporosis and osteopenia were significantly lower than those achieved in normal patients. Positive correlations were observed between BMD and T-value at the instrumented lumbar vertebrae, mean BMD and mean T-value of the lumbar vertebrae, and mean BMD and mean T-value of the proximal femur. The predictive torque (Nm) generated during pedicle screw insertion was [-0.127 + 1.62 × (BMD at the corresponding lumbar vertebrae)], as measured by linear regression analysis. The positive correlation between BMD and the maximum torque required to insert a pedicle screw suggests that pre-operative assessment of BMD may be useful in determining the ultimate strength of fixation of a device, as well as the number of levels that need to be fixed with pedicle screws in patients who are suspected of having osteoporosis.

Three-dimensional primary and coupled range of motions and movement coordination of the pelvis, lumbar and thoracic spine in standing posture using inertial tracking device.

PubMed

Narimani, M; Arjmand, N

2018-03-01

Evaluation of spinal range of motions (RoMs) and movement coordination between its segments (thorax, lumbar, and pelvis) has clinical and biomechanical implications. Previous studies have not recorded three-dimensional primary/coupled motions of all spinal segments simultaneously. Moreover, magnitude/direction of the coupled motions of the thorax/pelvis in standing posture and lumbopelvic rhythms in the frontal/transverse planes have not been investigated. This study, hence, used an inertial tracking device to measure T1, T5, T12, total (T1-T12) thoracic, lower (T5-T12) and upper (T1-T5) thoracic, lumbar (T12-S1), and pelvis primary and coupled RoMs as well as their movement coordination in all anatomical planes/directions in twenty-two healthy individuals. RoMs were statistically compared between the anatomical planes and spinal segments as well as with available data in the literature. The spine had different primary RoMs in different planes/directions (flexion: lumbar: 55.4 ± 12.4°, pelvis: 42.8 ± 21.6°, and T1-T12 thoracic: 19.9 ± 6.4°, extension: lumbar: 23.4 ± 10.1°, thoracic: 11.7 ± 3.4°, and pelvis: 10.2 ± 6.4°, left/right lateral bending: thoracic: 24.5 ± 7.4°/26.5 ± 6.1°, lumbar: 16.4 ± 7.2°/18.3 ± 5.7°, and pelvis: 11.0 ± 4.4°/9.3 ± 6.2°, and left/right axial rotation: thoracic: 33.5 ± 10.0°/37.1 ± 11.7°, pelvis: 31.6 ± 12.5°/27.2 ± 12.0° and lumbar: 7.5 ± 4.5°/9.2 ± 7.3°). Pelvis, lumbar and thoracic spine had different/varying contributions/rhythms to generate total trunk (T1) movement, both within and between planes. Pattern of the coupled motions was inconsistent between subjects but side bending was generally associated with twisting to the same side at the thoracic spine and to the opposite side at the lumbar spine. Copyright © 2018 Elsevier Ltd. All rights reserved.

A perspective on the use of an enhanced recovery program in open, non-instrumented day surgery for degenerative lumbar and cervical spinal conditions.

PubMed

Venkata, Hari K; van Dellen, James R

2018-06-01

A means of significantly shortening patients' length of hospital stay, improving their outcome and thereby also reducing costs is to use an enhanced recovery program (ERP) which is increasingly being used in a number of surgical sub-specialties. This paper provides a perspective on its prospective use in a wide-ranging, unselected cohort of patients undergoing open spinal surgery for degenerative lumbar and cervical spinal conditions. Selected spinal cases undergoing day surgery have been increasingly reported. A prospective, unselected, consecutive cohort of 246 cases, over an 18-month period, undergoing open, non-instrumented decompression spinal surgery and using ERP (and the concept of "bundles of care") was analyzed. Nine cases could not be included as they did not fully meet the entry criteria. No routine follow-up was arranged for the study group. The ages ranged widely, from 23-90 years (mean 57). In 187 the surgery for degenerative conditions was lumbar and in 50 cervical. The ASA (American Association of Anesthesiologists) ratings were 108=1; 107=2 and 22=3. Using the United Kingdom (UK) National Health Service (NHS) definitions of length of stay 225 (95%) could be finally classified as "ambulatory" and 12 (5%) were "short stay". A sub-cohort of 126 (53.2%) were "day cases". The follow-up was >1 year for all. There were no wound infections reported; 5 postdischarge cases (2.1%) needed to be seen in the Accident and Emergency (A&E) Department (less than 4 days postsurgery), but none needed re-admission; and there were 7 re-admissions (2.5%), between 4 and 30 days, and of these 6 required a further surgical procedure. There were no long-term instability complications reported in this cohort. ERP can be used for spinal surgery. There were identifiable and correctable medical and social factors found on analysis which could significantly increase the "day cases" number to over 90%.

Steadiness of Spinal Regions during Single-Leg Standing in Older Adults with and without Chronic Low Back Pain

PubMed Central

Kuo, Yi-Liang; Huang, Kuo-Yuan; Chiang, Pei-Tzu; Lee, Pei-Yun; Tsai, Yi-Ju

2015-01-01

The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP) and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above) with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. Measurements were steadiness index of spinal regions (trunk, thoracic spine, lumbar spine, and pelvis) during single-leg standing including relative holding time (RHT) and relative standstill time (RST), and clinical balance tests (timed up and go test and 5-repetition sit to stand test). The LBP group had a statistically significantly smaller RHT than the control group, regardless of one leg stance on the painful or non-painful sides. The RSTs on the painful side leg in the LBP group were not statistically significantly different from the average RSTs of both legs in the control group; however, the RSTs on the non-painful side leg in the LBP group were statistically significantly smaller than those in the control group for the trunk, thoracic spine, and lumbar spine. No statistically significant intra-group differences were found in the RHTs and RSTs between the painful and non-painful side legs in the LBP group. Measurements of clinical balance tests also showed insignificant weak to moderate correlations with steadiness index. In conclusion, older adults with chronic LBP demonstrated decreased spinal steadiness not only in the symptomatic lumbar spine but also in the other spinal regions within the kinetic chain of the spine. When treating older adults with chronic LBP, clinicians may also need to examine their balance performance and spinal steadiness during balance challenging tests. PMID:26024534

Does experimental low back pain change posteroanterior lumbar spinal stiffness and trunk muscle activity? A randomized crossover study.

PubMed

Wong, Arnold Y L; Parent, Eric C; Prasad, Narasimha; Huang, Christopher; Chan, K Ming; Kawchuk, Gregory N

2016-05-01

While some patients with low back pain demonstrate increased spinal stiffness that decreases as pain subsides, this observation is inconsistent. Currently, the relation between spinal stiffness and low back pain remains unclear. This study aimed to investigate the effects of experimental low back pain on temporal changes in posteroanterior spinal stiffness and concurrent trunk muscle activity. In separate sessions five days apart, nine asymptomatic participants received equal volume injections of hypertonic or isotonic saline in random order into the L3-L5 interspinous ligaments. Pain intensity, spinal stiffness (global and terminal stiffness) at the L3 level, and the surface electromyographic activity of six trunk muscles were measured before, immediately after, and 25-minute after injections. These outcome measures under different saline conditions were compared by generalized estimating equations. Compared to isotonic saline injections, hypertonic saline injections evoked significantly higher pain intensity (mean difference: 5.7/10), higher global (mean difference: 0.73N/mm) and terminal stiffness (mean difference: 0.58N/mm), and increased activity of four trunk muscles during indentation (P<0.05). Both spinal stiffness and trunk muscle activity returned to baseline levels as pain subsided. While previous clinical research reported inconsistent findings regarding the association between spinal stiffness and low back pain, our study revealed that experimental pain caused temporary increases in spinal stiffness and concurrent trunk muscle co-contraction during indentation, which helps explain the temporal relation between spinal stiffness and low back pain observed in some clinical studies. Our results substantiate the role of spinal stiffness assessments in monitoring back pain progression. Copyright © 2016 Elsevier Ltd. All rights reserved.

Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia: A Feasible Economical Alternative.

PubMed

Kejriwal, Aditya Kumar; Begum, Shaheen; Krishan, Gopal; Agrawal, Richa

2017-01-01

Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial. We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient. We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml -1 mixed with 0.5 ml of fentanyl 50 μg ml -1 . Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension, or pruritus during or after surgery. The patient was reviewed 2 days postoperatively in ward. The thoracic spinal anesthetia was performed easily in the patient. Some discomfort which was readily treated with 1mg midazolam and 20 mg ketamine intravenously. There was no neurological deficit and hemodynamic parameters were in normal range intra and post-operatively and recovery was uneventful. We used a narrow gauze (26G) spinal needle which minimized the trauma to the patient and the chances of PDPH, which was more if 16 or 18G epidural needle had been used and could have increased further if there have been accidental dura puncture. Also using spinal anesthesia was economical although it should be done cautiously as we are giving spinal anesthesia above the level of termination of spinal cord.

Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia: A Feasible Economical Alternative

PubMed Central

Kejriwal, Aditya Kumar; Begum, Shaheen; Krishan, Gopal; Agrawal, Richa

2017-01-01

Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial. We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient. We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml−1 mixed with 0.5 ml of fentanyl 50 μg ml−1. Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension, or pruritus during or after surgery. The patient was reviewed 2 days postoperatively in ward. The thoracic spinal anesthetia was performed easily in the patient. Some discomfort which was readily treated with 1mg midazolam and 20 mg ketamine intravenously. There was no neurological deficit and hemodynamic parameters were in normal range intra and post-operatively and recovery was uneventful. We used a narrow gauze (26G) spinal needle which minimized the trauma to the patient and the chances of PDPH, which was more if 16 or 18G epidural needle had been used and could have increased further if there have been accidental dura puncture. Also using spinal anesthesia was economical although it should be done cautiously as we are giving spinal anesthesia above the level of termination of spinal cord. PMID:28928589

Cost-effectiveness of cell saver in short-segment lumbar laminectomy and fusion (≤3 levels).

PubMed

Kelly, Patrick D; Parker, Scott L; Mendenhall, Stephen K; Bible, Jesse E; Sivasubramaniam, Priya; Shau, David N; McGirt, Matthew J; Devin, Clinton J

2015-09-01

Mixed retrospective-prospective cohort study. To characterize practice patterns for the use of Cell Saver at our institution, investigate its cost-effectiveness, and propose a new tool for patient selection. Blood loss is an exceedingly common complication of spine surgery, and Cell Saver intraoperative cell salvage has been used to decrease reliance on allogeneic blood transfusions for blood volume replacement. The cost-effectiveness of Cell Saver has not been established for lumbar spinal surgery, and no universal guidelines exist for clinicians to decide when to utilize this tool. Other authors have proposed cutoffs for anticipated blood loss volumes which indicate that Cell Saver should be used. Five hundred and eight patients undergoing lumbar laminectomy in 3 or fewer levels were reviewed from our prospective spinal outcomes registry. Cost information for Cell Saver and allogeneic transfusions was collected from our institution's billing and collections department. Logistic regression was used to identify patient characteristics associated with use of Cell Saver. An incremental cost effectiveness ratio was calculated based on transfusion and cost data. A clinical prediction score was derived using logistic regression. Use of Cell Saver correlated with increased age, higher body mass index, diabetes, greater American Society of Anesthesiologists classification, and greater number of previous spine surgeries. Outcomes for patients who did and did not have Cell Saver set up intraoperatively were equivocal. Cell Saver was not cost effective based on current usage patterns, but may become cost effective if used for patients with high expected blood loss. A simple clinical prediction rule is proposed which may aid in selection of patients to have Cell Saver present intraoperatively. Cell Saver is not a cost-effective intervention but may become cost effective if a threshold of expected intraoperative blood loss is used to select patients more judiciously. 3.

Outcomes of extended transforaminal lumbar interbody fusion for lumbar spondylosis.

PubMed

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

2015-11-01

This study aims to assess the results of extended transforaminal lumbar interbody fusion (TLIF) for a two surgeon, single institution series. In total, extended TLIF with bilateral decompression was performed in 57 patients. Pain, American Spinal Injury Association scores, patient demographics, body mass index (BMI), perioperative indices and radiographic measurements were recorded and analysed. The surgeries were performed between February 2011 and January 2014 on 38 women and 19 men. The mean patient age was 62.86 years, and the mean BMI was 30.31 kg/m(2). In 49 patients, spondylolisthesis was the primary indication. The mean intraoperative time was 284.65 min, and this decreased as the series progressed. The median length of stay was 5 days (range: 2-9). The surgical complication rate was 19.3%. Two patients died from cardiopulmonary complications. Single level TLIF was performed in 78.9% of the cohort, with L4/5 the most commonly fused level. Significant pain reduction was achieved from a mean (± standard deviation) preoperative visual analogue scale (VAS) of 8.28 ± 1.39 to 1.50 ± 1.05 at 12 months postoperatively. No patients deteriorated neurologically. Spondylolisthesis was significantly corrected from a preoperative mean of 6.82 mm to 2.80 mm postoperatively. Although there is a learning curve associated with the procedure, extended TLIF with bilateral facet joint removal and decompression appeared to be a safe and effective alternative to other fusion techniques, and our results were comparable to other published case series. The stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life. Copyright © 2015 Elsevier Ltd. All rights reserved.

Spinal alignment in surgical, multisegmental, transpedicular correction of adolescent idiopathic scoliosis

PubMed Central

Nowakowski, Andrzej; Dworak, Lechosław B.; Kubaszewski, Łukasz; Kaczmarczyk, Jacek

2012-01-01

Summary The objective of this study was to discuss the variables influencing alignment mechanisms of the spine, with particular consideration of post-surgical alignment in adolescent idiopathic scoliosis. The analysis is based on information currently available in the literature, and on the authors’ own experience, which includes surgical material from over 2200 cases of idiopathic scoliosis. Over 50% of cases of adolescent idiopathic scoliosis are decompensated before surgical treatment. Spinal alignment is most significantly influenced by the position of the pelvis. Surgical restoration of lumbar lordosis is more important than attempting to restore thoracic kyphosis in the sagittal plane. The sagittal profile has an essential impact on spinal alignment. The same curves in the coronal plane can have various 3-dimensional configurations. Clinical difficulties in the assessment of thoracic kyphosis and lumbar lordosis result from the fact that they undergo constant change with age. Thoracic hypokyphosis diagnosed before surgery is a very frequent symptom of curve progression. The presence of proximal (thoraco-thoracic) and distal (thoraco-lumbar) junctional kyphosis is very important for planning the scope of spondylodesis. The natural tendency of the spine for alignment (compensation) after surgery nowadays occurs more naturally by applying derotational forces through pedicle screws, compared to the distraction devices (eg, Harrington rod) used in the past. PMID:23229319

Multichannel Detrended Fluctuation Analysis Reveals Synchronized Patterns of Spontaneous Spinal Activity in Anesthetized Cats

PubMed Central

Rodríguez, Erika E.; Hernández-Lemus, Enrique; Itzá-Ortiz, Benjamín A.; Jiménez, Ismael; Rudomín, Pablo

2011-01-01

The analysis of the interaction and synchronization of relatively large ensembles of neurons is fundamental for the understanding of complex functions of the nervous system. It is known that the temporal synchronization of neural ensembles is involved in the generation of specific motor, sensory or cognitive processes. Also, the intersegmental coherence of spinal spontaneous activity may indicate the existence of synaptic neural pathways between different pairs of lumbar segments. In this study we present a multichannel version of the detrended fluctuation analysis method (mDFA) to analyze the correlation dynamics of spontaneous spinal activity (SSA) from time series analysis. This method together with the classical detrended fluctuation analysis (DFA) were used to find out whether the SSA recorded in one or several segments in the spinal cord of the anesthetized cat occurs either in a random or in an organized manner. Our results are consistent with a non-random organization of the sets of neurons involved in the generation of spontaneous cord dorsum potentials (CDPs) recorded either from one lumbar segment (DFA- mean = 1.040.09) or simultaneously from several lumbar segments (mDFA- mean = 1.010.06), where  = 0.5 indicates randomness while 0.5 indicates long-term correlations. To test the sensitivity of the mDFA method we also examined the effects of small spinal lesions aimed to partially interrupt connectivity between neighboring lumbosacral segments. We found that the synchronization and correlation between the CDPs recorded from the L5 and L6 segments in both sides of the spinal cord were reduced when a lesion comprising the left dorsal quadrant was performed between the segments L5 and L6 (mDFA- = 0.992 as compared to initial conditions mDFA- = 1.186). The synchronization and correlation were reduced even further after a similar additional right spinal lesion (mDFA- = 0.924). In contrast to the classical methods, such as correlation and coherence quantification that define a relation between two sets of data, the mDFA method properly reveals the synchronization of multiple groups of neurons in several segments of the spinal cord. This method is envisaged as a useful tool to characterize the structure of higher order ensembles of cord dorsum spontaneous potentials after spinal cord or peripheral nerve lesions. PMID:22046288

Morphology of the lumbar transversospinal muscles examined in a mouse bearing a muscle fiber-specific nuclear marker.

PubMed

Cornwall, Jon; Deries, Marianne; Duxson, Marilyn

2010-12-01

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.

[MR myelography: analysis of 126 cases].

PubMed

Wang, W; Zhang, X; Lu, Y

2000-03-01

To investigate the value and limitation of MR myelography (MRM) in depicting the spinal canal obstruction. Heavily T2-weighted coronal MR myelography was performed with 3D fast-spin-echo (FSE) and fat-suppression sequence in 126 cases, including 6 cerebellomedullary cistern, 18 cervical, 19 thoracic and 83 lumbar cases. The resulting slice were then projected into a composite image using a standard maxium intensity projection (MIP) algorithm. 90.5% (114/126) of MRM yielded reproducible high-quality image of the spinal thecal sac. 106 lesions (extradural, intradural, intramedullary) were detected in 101 cases (80.2%). The level and degree of spinal canal obstruction were visualized and confirmed by operation in 66 cases with a high sensitivity of 100%, and a diagnostic accuracy of 91.3%. Heavily T2 FSE MR myelography is a noninvasive and reliable method. MRM surpasses conventional and CT myelography and could replace them in some degree.

Maladaptive spinal plasticity opposes spinal learning and recovery in spinal cord injury

PubMed Central

Ferguson, Adam R.; Huie, J. Russell; Crown, Eric D.; Baumbauer, Kyle M.; Hook, Michelle A.; Garraway, Sandra M.; Lee, Kuan H.; Hoy, Kevin C.; Grau, James W.

2012-01-01

Synaptic plasticity within the spinal cord has great potential to facilitate recovery of function after spinal cord injury (SCI). Spinal plasticity can be induced in an activity-dependent manner even without input from the brain after complete SCI. A mechanistic basis for these effects is provided by research demonstrating that spinal synapses have many of the same plasticity mechanisms that are known to underlie learning and memory in the brain. In addition, the lumbar spinal cord can sustain several forms of learning and memory, including limb-position training. However, not all spinal plasticity promotes recovery of function. Central sensitization of nociceptive (pain) pathways in the spinal cord may emerge in response to various noxious inputs, demonstrating that plasticity within the spinal cord may contribute to maladaptive pain states. In this review we discuss interactions between adaptive and maladaptive forms of activity-dependent plasticity in the spinal cord below the level of SCI. The literature demonstrates that activity-dependent plasticity within the spinal cord must be carefully tuned to promote adaptive spinal training. Prior work from our group has shown that stimulation that is delivered in a limb position-dependent manner or on a fixed interval can induce adaptive plasticity that promotes future spinal cord learning and reduces nociceptive hyper-reactivity. On the other hand, stimulation that is delivered in an unsynchronized fashion, such as randomized electrical stimulation or peripheral skin injuries, can generate maladaptive spinal plasticity that undermines future spinal cord learning, reduces recovery of locomotor function, and promotes nociceptive hyper-reactivity after SCI. We review these basic phenomena, how these findings relate to the broader spinal plasticity literature, discuss the cellular and molecular mechanisms, and finally discuss implications of these and other findings for improved rehabilitative therapies after SCI. PMID:23087647

Association of lumbar spine stiffness and flexion-relaxation phenomenon with patient-reported outcomes in adults with chronic low back pain - a single-arm clinical trial investigating the effects of thrust spinal manipulation.

PubMed

Xia, Ting; Long, Cynthia R; Vining, Robert D; Gudavalli, Maruti R; DeVocht, James W; Kawchuk, Gregory N; Wilder, David G; Goertz, Christine M

2017-06-09

Spinal manipulation (SM) is used commonly for treating low back pain (LBP). Spinal stiffness is routinely assessed by clinicians performing SM. Flexion-relaxation ratio (FRR) was shown to distinguish between LBP and healthy populations. The primary objective of this study was to examine the association of these two physiological variables with patient-reported pain intensity and disability in adults with chronic LBP (>12 weeks) receiving SM. A single-arm trial provided 12 sessions of side-lying thrust SM in the lumbosacral region over 6 weeks. Inclusion criteria included 21-65 years old, Roland-Morris Disability Questionnaire (RMDQ) score ≥ 6 and numerical pain rating score ≥ 2. Spinal stiffness and FRR were assessed pre-treatment at baseline, after 2 weeks and after 6 weeks of treatment. Lumbar spine global stiffness (GS) were calculated from the force-displacement curves obtained using i) hand palpation, ii) a hand-held device, and iii) an automated indenter device. Lumbar FRR was assessed during trunk flexion-extension using surface electromyography. The primary outcomes were RMDQ and pain intensity measured by visual analog scale (VAS). Mixed-effects regression models were used to analyze the data. The mean age of the 82 participants was 45 years; 48% were female; and 84% reported LBP >1 year. The mean (standard deviation) baseline pain intensity and RMDQ were 46.1 (18.1) and 9.5 (4.3), respectively. The mean reduction (95% confidence interval) after 6 weeks in pain intensity and RMDQ were 20.1 mm (14.1 to 26.1) and 4.8 (3.7 to 5.8). There was a small change over time in the palpatory GS but not in the hand-held or automated GS, nor in FRR. The addition of each physiologic variable did not affect the model-estimated changes in VAS or RMDQ over time. There was no association seen between physiological variables and LBP intensity. Higher levels of hand-held GS at L3 and automated GS were significantly associated with higher levels of RMDQ (p = 0.02 and 0.03, respectively) and lower levels of flexion and extension FRR were significantly associated with higher levels of RMDQ (p = 0.02 and 0.008, respectively) across the 3 assessment time points. Improvement in pain and disability observed in study participants with chronic LBP was not associated with the measured GS or FRR. NCT01670292 on clinicaltrials.gov, August 2, 2012.

A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents.

PubMed

Sundar, Swetha J; Healy, Andrew T; Kshettry, Varun R; Mroz, Thomas E; Schlenk, Richard; Benzel, Edward C

2016-05-01

OBJECTIVE Pedicle and lateral mass screw placement is technically demanding due to complex 3D spinal anatomy that is not easily visualized. Neurosurgical and orthopedic surgery residents must be properly trained in such procedures, which can be associated with significant complications and associated morbidity. Current training in pedicle and lateral mass screw placement involves didactic teaching and supervised placement in the operating room. The objective of this study was to assess whether teaching residents to place pedicle and lateral mass screws using navigation software, combined with practice using cadaveric specimens and Sawbones models, would improve screw placement accuracy. METHODS This was a single-blinded, prospective, randomized pilot study with 8 junior neurosurgical residents and 2 senior medical students with prior neurosurgery exposure. Both the study group and the level of training-matched control group (each group with 4 level of training-matched residents and 1 senior medical student) were exposed to a standardized didactic education regarding spinal anatomy and screw placement techniques. The study group was exposed to an additional pilot program that included a training session using navigation software combined with cadaveric specimens and accessibility to Sawbones models. RESULTS A statistically significant reduction in overall surgical error was observed in the study group compared with the control group (p = 0.04). Analysis by spinal region demonstrated a significant reduction in surgical error in the thoracic and lumbar regions in the study group compared with controls (p = 0.02 and p = 0.04, respectively). The study group also was observed to place screws more optimally in the cervical, thoracic, and lumbar regions (p = 0.02, p = 0.04, and p = 0.04, respectively). CONCLUSIONS Surgical resident education in pedicle and lateral mass screw placement is a priority for training programs. This study demonstrated that compared with a didactic-only training model, using navigation simulation with cadavers and Sawbones models significantly reduced the number of screw placement errors in a laboratory setting.

Effects of orally administered OP-1206 alpha-CD with loxoprofen-Na on walking dysfunction in the rat neuropathic intermittent claudication model.

PubMed

Nakai, Katsuhiko; Takenobu, Yoshifumi; Takimizu, Hideyuki; Akimaru, Shinji; Ito, Hidenori; Maegawa, Hitoshi; Marsala, Martin; Katsube, Nobuo

2003-10-01

An orally active prostaglandin E1 analogue, OP-1206 alpha-CD improves walking dysfunction in the rat spinal stenosis model. Loxoprofen-Na, a non-steroidal anti-inflammatory drug, is used to relieve chronic pain in patients with lumbar spinal canal stenosis. To determine whether the OP-1206 alpha-CD in combination with loxoprofen-Na could induce a greater therapeutical effect on walking dysfunction and spinal cord blood flow (SCBF) than OP-1206 alpha-CD treatment alone after chronic spinal stenosis in the rat. Spinal stenosis was induced by placing two pieces of silicon rubber strips in the lumbar (L4 and L6) epidural space of rats. After surgery, walking function was measured using a treadmill apparatus and SCBF was measured using a laser-Doppler flow meter. Drugs were administered orally twice a day for 11 days from the day 3 post-surgery. OP-1206 alpha-CD elicited a significant improvement of walking dysfunction on days 7 and 14 post-surgery and significantly increased spinal cord blood flow on day 15, whereas walking dysfunction and SCBF of rats treated with loxoprofen-Na alone remained unchanged. Combined treatment of OP-1206 alpha-CD with loxoprofen-Na did not provide additive therapeutical effect. These results suggest that a significant improvement seen after OP-1206 alpha-CD treatment is primarily mediated by improvement of the local spinal cord blood flow. This effect is not ameliorated or potentiated by a combined treatment with loxoprofen-Na.

Operative techniques of percutaneous endoscopic mini-hemilaminectomy using a uniportal approach in dogs

PubMed Central

MOON, Hee-Sup; HWANG, Yong-Hyun; LEE, Hee-Chun; LEE, Jae-Hoon

2017-01-01

The present study aimed to investigate the technical feasibility of percutaneous endoscopic mini-hemilaminectomy via a uniportal approach, and to evaluate the possibility of decompression and endoscopic examination of the thoracic and lumbar spinal canals in small dogs during such procedures. Fresh canine cadavers of mixed-breed dogs (n=7) were used in this study. Following injection of a barium and agarose mixture (BA-gel) to stimulate intervertebral disc herniation, percutaneous endoscopic mini-hemilaminectomy was performed using a lateral approach to the thoracic and lumbar vertebrae. BA-gel was removed to decompress the spinal cord using an elevator and rongeurs after mini-hemilaminectomy. Pre and post-operative computed tomography (CT) scans were obtained to evaluate surgical outcomes. Intra-operative complications, incision length, and procedure time were recorded. All procedures were completed with clear visualization of the spinal cord and floor of the spinal canal. The mean total operating time was 58.00 ± 18.06 min. Lengths of incision were under 1 cm in all dogs. Intra-operative complications included iatrogenic nerve root injuries caused by the micro-rongeur in two dogs. CT imaging revealed that removal of BA-gel resulted in sufficient spinal cord decompression. Our findings indicated that percutaneous endoscopic thoracolumbar mini-hemilaminectomy is feasible for spinal cord decompression and allows for adequate observation of the spinal canal. Thus, this technique may be an alternative surgical option for treatment of thoracolumbar disk disease in dogs. PMID:28757523

Spinal Epidural Haemangioma Associated with Extensive Gastrointestinal Haemangiomas

PubMed Central

Cheng, L.T.E.; Lim, W.E.H.

2005-01-01

Summary A case of spinal epidural cavernous haemangioma associated with gastrointestinal haemangiomas is discussed. The patient was a young Chinese female presenting with chronic lower back pain. She had a history of extensive gastric and small bowel haemangiomas. Lumbar spine MRI showed a heterogeneously enhancing epidural mass infiltrating the paravertebral muscles. Open biopsy confirmed an epidural cavernous haemangioma. To our knowledge, an association between spinal epidural cavernous haemangiomas and gastrointestinal haemangiomas has not been reported. PMID:20584496

Coordination of spinal motion in the transverse and frontal planes during walking in people with and without recurrent low back pain.

PubMed

Crosbie, Jack; de Faria Negrão Filho, Ruben; Nascimento, Dafne Port; Ferreira, Paulo

2013-03-01

Observational cohort study. To investigate spinal coordination during preferred and fast speed walking in pain-free subjects with and without a history of recurrent low back pain (LBP). Dynamic motion of the spine during walking is compromised in the presence of back pain (LBP), but its analysis often presents some challenges. The coexistence of significant symptoms may change gait because of pain or adaptation of the musculoskeletal structures or both. A history of LBP without the overlay of a current symptomatic episode allows a better model in which to explore the impact on spinal coordination during walking. Spinal and lower limb segmental motions were tracked using electromagnetic sensors. Analyses were conducted to explore the synchrony and spatial coordination of the segments and to compare the control and subjects with LBP. We found no apparent differences between the groups for either overall amplitude of motion or most indicators of coordination in the lumbar region; however, there were significant postural differences in the mid-stance phase and other indicators of less phase locking in controls compared with subjects with LBP. The lower thoracic spinal segment was more affected by the history of back pain than the lumbar segment. Although small, there were indicators that alterations in spinal movement and coordination in subjects with recurrent LBP were due to adaptive changes rather than the presence of pain.

Effects of anodal tDCS on lumbar propriospinal system in healthy subjects.

PubMed

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

2012-05-01

It has recently been shown that transcranial direct current stimulation (tDCS) (1) can modify lumbar spinal network excitability and (2) decreases cervical propriospinal system excitability. Thus the purpose of this series of experiments was to determine if anodal tDCS applied over the leg motor cortex area induces changes in lumbar propriospinal system excitability. To that end, the effects of anodal tDCS and sham tDCS on group I and group II propriospinal facilitation of quadriceps motoneurones were studied in healthy subjects. Common peroneal nerve group I and group II quadriceps H-reflex facilitation was assessed in 15 healthy subjects in two randomised conditions: anodal tDCS condition and sham tDCS condition. Recordings were performed before, during and after the end of the cortical stimulation. Compared to sham, anodal tDCS decreases significantly CPN-induced group I and II quadriceps H-reflex facilitation during and also after the end of the cortical stimulation. Anodal tDCS induces (1) modulation of lumbar propriospinal system excitability (2) post-effects on spinal network. These results open a new vista to regulate propriospinal lumbar system excitability in patients and suggest that anodal tDCS would be interesting for neuro-rehabilitation of patients with central nervous system lesions. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Sympathetic activation of cat spinal neurons responsive to noxious stimulation of deep tissues in the low back.

PubMed

Gillette, R G; Kramis, R C; Roberts, W J

1994-01-01

Prior findings from diverse studies have indicated that activity in axons located in the lumbar sympathetic chains contributes to the activation of spinal pain pathways and to low back pain; these studies have utilized sympathetic blocks in patients, electrical stimulation of the chain in conscious humans, and neuroanatomical mapping of afferent fiber projections. In the present study, dorsal horn neurons receiving nociceptor input from lumbar paraspinal tissues were tested for activation by electrical stimulation of the lumbar sympathetic chain in anesthetized cats. Of 83 neurons tested, 70% were responsive to sympathetic trunk stimulation. Excitatory responses, observed in both nociceptive specific and wide-dynamic-range neurons, were differentiable into two classes: non-entrained and entrained responses. Non-entrained responses were attenuated or blocked by systemic administration of the alpha-adrenergic antagonist phentolamine and are thought to result from sympathetic efferent activation of primary afferents in the units' receptive fields. Entrained responses were unaffected by phentolamine and are thought to result from electrical activation of somatic and/or visceral afferent fibers ascending through the sympathetic trunk into the dorsal horn. These findings from nocireceptive neurons serving lumbar paraspinal tissues suggest that low back pain may be exacerbated by activity in both efferent and afferent fibers located in the lumbar sympathetic chain, the efferent actions being mediated indirectly through sympathetic-sensory interactions in somatic and/or visceral tissues.

Analysis of 78 patients with spinal injuries in the 2008 Sichuan, China, earthquake.

PubMed

Chen, Rigao; Song, Yuemin; Kong, Qingquan; Zhou, Chunguang; Liu, Limin

2009-05-01

To analyze the clinical features of patients with spinal injuries and to better cope with future disasters, we retrospectively reviewed 78 patients' medical records after the 2008 Sichuan, China, earthquake. All patients survived, and the mean time patients spent under rubble was 12.2 hours. The largest number of victims were in the 30- to 39-year age group (24.3%), followed by the 20- to 29-year age group (21.8%) and the 40- to 49-year age group (20.5%). Isolated spinal injuries occurred in 55 patients (71.5%). Multilevel spinal injuries occurred in 23 patients (29.5%). The most common region for spinal injuries was the lumbar spine (38.5%), followed by the thoracic spine and the cervical spine. Nearly 53.8% of these spinal injuries resulted in some form of neurologic disability. Thoracic injury contributed to the majority of the neurologic injury. Lumbar injury seldom resulted in neurologic damage. Almost all cervical injuries were associated with severe spinal cord injury. The majority of patients sustained injuries in addition to their spinal injuries. More than one-third of patients (35.7%) had upper extremity fractures, 12.1% had pelvic fractures, and 44.5% had lower extremity fractures. The most commonly injured bone in the upper extremity was the humerus and in the lower extremity, the femur. Other associated injuries included head (19.6%), thoracic (39.8%), abdominal (8.9%), and urologic (2.56%) injuries. The high frequency of multilevel injuries of the spine and additional injuries reaffirms the need for vigilance in patient assessment.

Reduction of microhemorrhages in the spinal cord of symptomatic ALS mice after intravenous human bone marrow stem cell transplantation accompanies repair of the blood-spinal cord barrier.

PubMed

Eve, David J; Steiner, George; Mahendrasah, Ajay; Sanberg, Paul R; Kurien, Crupa; Thomson, Avery; Borlongan, Cesar V; Garbuzova-Davis, Svitlana

2018-02-13

Blood-spinal cord barrier (BSCB) alterations, including capillary rupture, have been demonstrated in animal models of amyotrophic lateral sclerosis (ALS) and ALS patients. To date, treatment to restore BSCB in ALS is underexplored. Here, we evaluated whether intravenous transplantation of human bone marrow CD34 + (hBM34 + ) cells into symptomatic ALS mice leads to restoration of capillary integrity in the spinal cord as determined by detection of microhemorrhages. Three different doses of hBM34 + cells (5 × 10 4 , 5 × 10 5 or 1 × 10 6 ) or media were intravenously injected into symptomatic G93A SOD1 mice at 13 weeks of age. Microhemorrhages were determined in the cervical and lumbar spinal cords of mice at 4 weeks post-treatment, as revealed by Perls' Prussian blue staining for ferric iron. Numerous microhemorrhages were observed in the gray and white matter of the spinal cords in media-treated mice, with a greater number of capillary ruptures within the ventral horn of both segments. In cell-treated mice, microhemorrhage numbers in the cervical and lumbar spinal cords were inversely related to administered cell doses. In particular, the pervasive microvascular ruptures determined in the spinal cords in late symptomatic ALS mice were significantly decreased by the highest cell dose, suggestive of BSCB repair by grafted hBM34 + cells. The study results provide translational outcomes supporting transplantation of hBM34 + cells at an optimal dose as a potential therapeutic strategy for BSCB repair in ALS patients.

The temporal profile of the reaction of microglia, astrocytes, and macrophages in the delayed onset paraplegia after transient spinal cord ischemia in rabbits.

PubMed

Matsumoto, Satoshi; Matsumoto, Mishiya; Yamashita, Atsuo; Ohtake, Kazunobu; Ishida, Kazuyoshi; Morimoto, Yasuhiro; Sakabe, Takefumi

2003-06-01

In the present study, we sought to elucidate the temporal profile of the reaction of microglia, astrocytes, and macrophages in the progression of delayed onset motor dysfunction after spinal cord ischemia (15 min) in rabbits. At 2, 4, 8, 12, 24, and 48 h after reperfusion (9 animals in each), hind limb motor function was assessed, and the lumbar spinal cord was histologically examined. Delayed motor dysfunction was observed in most animals at 48 h after ischemia, which could be predicted by a poor recovery of segmental spinal cord evoked potentials at 15 min of reperfusion. In the gray matter of the lumbar spinal cord, both microglia and astrocytes were activated early (2 h) after reperfusion. Microglia were diffusely activated and engulfed motor neurons irrespective of the recovery of segmental spinal cord evoked potentials. In contrast, early astrocytic activation was confined to the area where neurons started to show degeneration. Macrophages were first detected at 8 h after reperfusion and mainly surrounded the infarction area later. Although the precise roles of the activation of microglia, astrocytes, and macrophages are to be further determined, the results indicate that understanding functional changes of astrocytes may be important in the mechanism of delayed onset motor dysfunction including paraplegia. Microglia and macrophages play a role in removing tissue debris after transient spinal cord ischemia. Disturbance of astrocytic defense mechanism, breakdown of the blood-spinal cord barrier, or both seemed to be involved in the development of delayed motor dysfunction.

Clinical application of the Panjabi neutral zone hypothesis: the Stabilimax NZ posterior lumbar dynamic stabilization system.

PubMed

Yue, James J; Timm, Jens P; Panjabi, Manohar M; Jaramillo-de la Torre, Jorge

2007-01-15

The neutral zone (NZ) is a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. The NZ appears to be a clinically important measure of spinal stability function. Its size may increase with injury to the spinal column, which in turn may result in spinal instability or low-back pain. Dynamic stabilization systems are designed to support and stabilize the spine while maintaining range of motion (ROM). The Stabilimax NZ device has been designed to reduce the NZ after spinal injury to treat pain while preserving ROM.

Hybrid Biosynthetic Autograft Extender for Use in Posterior Lumbar Interbody Fusion: Safety and Clinical Effectiveness.

PubMed

Chedid, Mokbel K; Tundo, Kelly M; Block, Jon E; Muir, Jeffrey M

2015-01-01

Autologous iliac crest bone graft is the preferred option for spinal fusion, but the morbidity associated with bone harvest and the need for graft augmentation in more demanding cases necessitates combining local bone with bone substitutes. The purpose of this study was to document the clinical effectiveness and safety of a novel hybrid biosynthetic scaffold material consisting of poly(D,L-lactide-co-glycolide) (PLGA, 75:25) combined by lyophilization with unmodified high molecular weight hyaluronic acid (10-12% wt:wt) as an extender for a broad range of spinal fusion procedures. We retrospectively evaluated all patients undergoing single- and multi-level posterior lumbar interbody fusion at an academic medical center over a 3-year period. A total of 108 patients underwent 109 procedures (245 individual vertebral levels). Patient-related outcomes included pain measured on a Visual Analog Scale. Radiographic outcomes were assessed at 6 weeks, 3-6 months, and 1 year postoperatively. Radiographic fusion or progression of fusion was documented in 221 of 236 index levels (93.6%) at a mean (±SD) time to fusion of 10.2+4.1 months. Single and multi-level fusions were not associated with significantly different success rates. Mean pain scores (+SD) for all patients improved from 6.8+2.5 at baseline to 3.6+2.9 at approximately 12 months. Improvements in VAS were greatest in patients undergoing one- or two-level fusion, with patients undergoing multi-level fusion demonstrating lesser but still statistically significant improvements. Overall, stable fusion was observed in 64.8% of vertebral levels; partial fusion was demonstrated in 28.8% of vertebral levels. Only 15 of 236 levels (6.4%) were non-fused at final follow-up.

The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis.

PubMed

Chun, Se-Woong; Lim, Chai-Young; Kim, Keewon; Hwang, Jinseub; Chung, Sun G

2017-08-01

Clinicians regard lumbar lordotic curvature (LLC) with respect to low back pain (LBP) in a contradictory fashion. The time-honored point of view is that LLC itself, or its increment, causes LBP. On the other hand, recently, the biomechanical role of LLC has been emphasized, and loss of lordosis is considered a possible cause of LBP. The relationship between LLC and LBP has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP. This study aimed to (1) determine the difference in LLC in those with and without LBP and (2) investigate confounding factors that might affect the association between LLC and LBP. Systematic review and meta-analysis. The inclusion criteria consisted of observational studies that included information on lumbar lordotic angle (LLA) assessed by radiological image, in both patients with LBP and healthy controls. Studies solely involving pediatric populations, or addressing spinal conditions of nondegenerative causes, were excluded. A systematic electronic search of Medline, Embase, Cochrane Library, CINAHL, Scopus, PEDro, and Web of Science using terms related to lumbar alignment and Boolean logic was performed: (lumbar lordo*) or (lumbar alignment) or (sagittal alignment) or (sagittal balance). Standardized mean differences (SMD) and 95% confidence intervals (CI) were estimated, and chi-square and I 2 statistics were used to assess within-group heterogeneity by random effects model. Additionally, the age and gender of participants, spinal disease entity, and the severity and duration of LBP were evaluated as possible confounding factors. A total of 13 studies consisting of 796 patients with LBP and 927 healthy controls were identified. Overall, patients with LBP tended to have smaller LLA than healthy controls. However, the studies were heterogeneous. In the meta-regression analysis, the factors of age, severity of LBP, and spinal disease entity were revealed to contribute significantly to variance between studies. In the subgroup analysis of the five studies that compared patients with disc herniation or degeneration with healthy controls, patients with LBP had smaller LLA (SMD: -0.94, 95% CI: -1.19 to -0.69), with sufficient homogeneity based on significance level of .1 (I 2 =45.7%, p=.118). In the six age-matched studies, patients with LBP had smaller LLA than healthy controls (SMD: -0.33, 95% CI: -0.46 to -0.21), without statistical heterogeneity (I 2 =0%, p=.916). This meta-analysis demonstrates a strong relationship between LBP and decreased LLC, especially when compared with age-matched healthy controls. Among specific diseases, LBP by disc herniation or degeneration was shown to be substantially associated with the loss of LLC. Copyright © 2017 Elsevier Inc. All rights reserved.

Flight Physical Standards of the 1980’s: Spinal Column Considerations

DTIC Science & Technology

1979-10-01

disease and spondylosis deformans. In addition, the role of vertebral body fractures oni subsequent spinal column impact is discussed. SECURITY...11 Spondylosis D eform ans ......................................... ................... 11 III...5th lumbar vertebra supports the superimposed weight of the torso upon the inclined plane of the sacrum. The necessity for bony continuity of the 5th

Terminations of reticulospinal fibers originating from the gigantocellular reticular formation in the mouse spinal cord.

PubMed

Liang, Huazheng; Watson, Charles; Paxinos, George

2016-04-01

The present study investigated the projections of the gigantocellular reticular nucleus (Gi) and its neighbors--the dorsal paragigantocellular reticular nucleus (DPGi), the alpha/ventral part of the gigantocellular reticular nucleus (GiA/V), and the lateral paragigantocellular reticular nucleus (LPGi)--to the mouse spinal cord by injecting the anterograde tracer biotinylated dextran amine (BDA) into the Gi, DPGi, GiA/GiV, and LPGi. The Gi projected to the entire spinal cord bilaterally with an ipsilateral predominance. Its fibers traveled in both the ventral and lateral funiculi with a greater presence in the ventral funiculus. As the fibers descended in the spinal cord, their density in the lateral funiculus increased. The terminals were present mainly in laminae 7-10 with a dorsolateral expansion caudally. In the lumbar and sacral cord, a considerable number of terminals were also present in laminae 5 and 6. Contralateral fibers shared a similar pattern to their ipsilateral counterparts and some fibers were seen to cross the midline. Fibers arising from the DPGi were similarly distributed in the spinal cord except that there was no dorsolateral expansion in the lumbar and sacral segments and there were fewer fiber terminals. Fibers arising from GiA/V predominantly traveled in the ventral and lateral funiculi ipsilaterally. Ipsilaterally, the density of fibers in the ventral funiculus decreased along the rostrocaudal axis, whereas the density of fibers in the lateral funiculus increased. They terminate mainly in the medial ventral horn and lamina 10 with a smaller number of fibers in the dorsal horn. Fibers arising from the LPGi traveled in both the ventral and lateral funiculi and the density of these fibers in the ventral and lateral funiculi decreased dramatically in the lumbar and sacral segments. Their terminals were present in the ventral horn with a large portion of them terminating in the motor neuron columns. The present study is the first demonstration of the termination pattern of fibers arising from the Gi, DPGi, GiA/GiV, and LPGi in the mouse spinal cord. It provides an anatomical foundation for those who are conducting spinal cord injury and locomotion related research.

Effects of a single session of posterior-to-anterior spinal mobilization and press-up exercise on pain response and lumbar spine extension in people with nonspecific low back pain.

PubMed

Powers, Christopher M; Beneck, George J; Kulig, Kornelia; Landel, Robert F; Fredericson, Michael

2008-04-01

Posterior-to-anterior (PA) mobilization and press-up exercises are common physical therapy interventions used to treat low back pain. The purpose of this study was to examine the immediate effects of PA mobilization and a press-up exercise on pain with standing extension and lumbar extension in people with nonspecific low back pain. The study participants were 30 adults (19 women and 11 men) who were 18 to 45 years of age and had a diagnosis of nonspecific low back pain. Lumbar segmental extension during a press-up maneuver was measured by dynamic magnetic resonance imaging prior to and immediately following a single session of either PA spinal mobilization or a press-up exercise. Pain scores before and after intervention were recorded with a visual analog scale. Differences between the treatment groups in pain and total lumbar extension were compared over time by use of a 2-way analysis of variance. Following both interventions, there was a significant reduction in the average pain scores for both groups (significant main effect for time, no interaction). Similarly, total lumbar extension significantly increased in both the PA mobilization group and the press-up group (significant main effect for time, no interaction). No significant differences between the 2 interventions in pain or lumbar extension were found. The findings of this study support the use of PA mobilization and a press-up exercise for improving lumbar extension in people with nonspecific low back pain. Although statistically significant within-group changes in pain were detected, the clinical meaningfulness of these changes is questionable.

Recombinant human bone morphogenetic protein-2-induced radiculitis in elective minimally invasive transforaminal lumbar interbody fusions: a series review.

PubMed

Mindea, Stefan A; Shih, Patrick; Song, John K

2009-06-15

Retrospective single center analysis. The purpose of our study is to quantify the development of a postoperative radiculitis in our minimally invasive transforaminal lumbar interbody fusion patient population. The application of recombinant human Bone Morphogenetic Protein-2 (BMP) in spinal surgery has allowed for greater success in spinal fusions. This has led to the FDA approving its use in anterior lumbar interbody fusion. However, its well-recognized benefits have generated its "off-label" use in the cervical, thoracic, and lumbar spine. Despite its benefits, the adverse effects of its inflammatory properties are just starting to get recognized. Some clear adverse reactions have been documented in the literature in the cervical spine. However, we feel that these inflammatory properties may be present in the lumbar spine as well. We performed a retrospective chart review of 43 patients who had undergone a minimally invasive transforaminal lumbar interbody fusions. Thirty-five of these patients had BMP and 8 patients did not have BMP. We documented whether there was a preoperative radiculopathy present and whether a radiculopathy was present postoperative. We reviewed radiographic postoperative imaging to establish a structural cause for any radiculopathy. If new or increasing radicular symptoms were present, we attempted to assess the duration of these symptoms. Our analysis, showed that 0 of the 8 patients of the non-BMP group had new radicular symptoms that were not attributed to structural causes. In the BMP group, 4 of the 35 patients (11.4%) had new radicular symptoms without structural etiology. Our analysis suggest that patients undergoing minimally invasive transforaminal lumbar interbody fusions procedures have a higher incidence of developing new radicular symptoms that could be attributed to BMP.

Surgical Treatment of Angular Pott’s Kyphosis with Posterior Approach, Pedicular Wedge Osteotomy and Canal Widening

PubMed Central

Kinkpe, CV; Onimus, M; Sarr, L; Niane, MM; Traore, MM; Daffe, M; Gueye, AB

2017-01-01

Background: It has been observed that the correction of severe posttuberculous angular kyphosis is still a challenge, mainly because of the neurologic risk. Methods: Nine patients were reviewed after surgery (mean follow-up 18 months). There were 2 thoracic, 4 thoraco-lumbar and 3 lumbar kyphosis. The mean age at surgery was 23. Clinical results were evaluated by the Oswestry Disability Index (ODI) and by the neurologic evaluation. Preoperative, postoperative and final follow-up X-rays were assessed. The surgery included a posterior approach with cord release and correction by transpedicular wedge osteotomy and widening of the spinal canal. Results: Average kyphotic angulation was 72° before surgery, 10° after surgery and 12° at follow-up. Three out of four patients with neural deficit showed improvement. Neurologic complications included a transitory quadriceps paralysis, likely by foraminal compression of the root. Conclusion: A posterior transpedicular wedge osteotomy allows a substantial correction of the kyphosis, more by deflexion than by elongation, with limited neurologic risks. However it is mandatory to widely enlarge the spinal canal on the levels adjacent to the osteotomy, in order to allow the dura to expand backwards. PMID:28567156

Image Guidance to Aid Pedicle Screw Fixation of a Lumbar Fracture-Dislocation Injury in a Toddler.

PubMed

Houten, John K; Nahkla, Jonathan; Ghandi, Shashank

2017-09-01

Pedicle screw fixation of the lumbar spine in children age <2 years is particularly challenging, as successful cannulation of the small pedicle dimensions requires a high level of precision and there are no implants specifically designed for the infant spine. Image-guided navigation is commonly used in adult spinal surgery and may be particularly helpful for the placement of spinal screws in areas where the bony anatomy is small and/or anatomically complex, as in the upper cervical area. A 19-month-old female presented with a fracture-dislocation injury of L1-2. Intraoperative imaging using the O-arm multidimensional imaging system was networked to a workstation, and neuronavigation was used to place pedicle instrumentation with 3.5-mm-diameter polyaxial screws designed for posterior cervical fixation. At a 48-month follow-up, the patient was neurologically intact, demonstrated normal physical development, and was engaging in normal physical activity for her age. Radiographs obtained approximately 4 years postsurgery showed no evidence of loss for fixation. Image-guided placement of pedicle screws may be a useful aid in achieving accurate and safe fixation in the small dimensions of the infant spine. Copyright © 2017 Elsevier Inc. All rights reserved.

Facet Joint Osteoarthritis Affects Spinal Segmental Motion in Degenerative Spondylolisthesis.

PubMed

Kitanaka, Shigeyuki; Takatori, Ryota; Arai, Yuji; Nagae, Masateru; Tonomura, Hitoshi; Mikami, Yasuo; Inoue, Nozomu; Ogura, Taku; Fujiwara, Hiroyoshi; Kubo, Toshikazu

2018-06-15

This is a retrospective clinical case series (case-control study). To clarify the influence of facet joint osteoarthritis (FJOA) on the pathology of degenerative spondylolisthesis (DS) using in vivo 3-dimensional image analysis. There are no radical treatments to prevent progression of DS in patients with lumbar spinal canal stenosis associated with DS. Therefore, an effective treatment method based on the pathology of DS should be developed. In total, 50 patients with lumbar spinal canal stenosis involving L4/5 who underwent dynamic computed tomography were divided into 2 groups: with DS [spondylolisthesis (Sp) group; 12 male, 14 female; mean age, 74 y]; and without DS (non-Sp group; 15 male, 9 female; mean age, 70 y). Degeneration of the intervertebral disk and FJOA at L4/5 were evaluated using magnetic resonance imaging. Disk and intervertebral foramen heights, the distance between the craniocaudal edges of the facet joint, and the interspinous distance were measured on dynamic computed tomographic images. Also, in vivo 3-dimensional segmental motion was evaluated using the volume merge method. There were no significant differences in degenerative findings for the intervertebral disk; however, progressive FJOA was detected in the Sp group. Dynamic changes in the distance between the craniocaudal edges of the facet joints were significantly larger in the Sp group. In this study, progressive FJOA and larger segmental motion in the distance between the craniocaudal edges of the facet joints were found in the Sp group. We clarified for the first time that DS involves ligament laxity due to FJOA that affects spinal segmental motion in vivo. We consider that a treatment method based on FJOA would be useful for treating patients with DS. Level IV.

Anesthetic management of super-morbidly obese parturients for cesarean delivery with a double neuraxial catheter technique: a case series.

PubMed

Polin, C M; Hale, B; Mauritz, A A; Habib, A S; Jones, C A; Strouch, Z Y; Dominguez, J E

2015-08-01

Parturients with super-morbid obesity, defined as body mass index greater than 50kg/m(2), represent a growing segment of patients who require anesthetic care for labor and delivery. Severe obesity and its comorbid conditions place the parturient and fetus at greater risk for pregnancy complications and cesarean delivery, as well as surgical and anesthetic complications. The surgical approach for cesarean delivery in these patients may require a supra-umbilical vertical midline incision due to a large pannus. The dense T4-level of spinal anesthesia can cause difficulties with ventilation for the obese patient during the procedure, which can be prolonged. Patients also may have respiratory complications in the postoperative period due to pain from the incision. We describe the anesthetic management of three parturients with body mass index ranging from 73 to 95kg/m(2) who had a cesarean delivery via a supra-umbilical vertical midline incision. Continuous lumbar spinal and low thoracic epidural catheters were placed in each patient for intraoperative anesthesia and postoperative analgesia, respectively. Continuous spinal catheters were dosed with incremental bupivacaine boluses to achieve surgical anesthesia. In one case, the patient required respiratory support with non-invasive positive pressure ventilation. Two cases were complicated by intraoperative hemorrhage. All patients had satisfactory postoperative analgesia with a thoracic epidural infusion. None suffered postoperative respiratory complications or postdural puncture headache. The use of a continuous lumbar spinal catheter and a low thoracic epidural provides several advantages in the anesthetic management of super-morbidly obese parturients for cesarean delivery. Copyright © 2015 Elsevier Ltd. All rights reserved.

Spinal case of the month with short perspective: How would you treat this L3-L4 synovial cyst?

PubMed

Epstein, Nancy E

2018-01-01

In this new section, Case of the Month with Short Perspective from Surgical Neurology International, we want to see how various spine surgeons would approach different spinal pathologies. In this first case, an elderly male presented with 3 years of lower back pain and progressive neurogenic claudication with bilateral radiculopathy that had exacerbated over the prior 6 months. An outside physician performed a magnetic resonance (MR) study of the lumbar spine that showed a massive synovial cyst filling the spinal canal (e.g., large bilateral cysts) at the L3-L4 level with grade I spondylolisthesis. The MR and CT studies also both demonstrated moderate L2-L3, and severe L3-L4 stenosis. Despite the massive synovial cyst filling the spinal canal at the L3-L4 level, pain management (anesthesia training) spent 3 months performing three successive epidural steroid injections accompanied by attempts at percutaneous synovial cyst aspiration/rupture. By the time the patient presented to neurosurgery, he had developed severe neurogenic claudication, radiculopathy, myelopathy, and a cauda equina syndrome. Dynamic X-rays revealed a mild grade I degenerative spondylolisthesis at the L3-L4 level without active motion, while both computed tomography (CT) and MR studies confirmed moderate stenosis stenosis/ossification of the yellow ligament at the L2-L3 level, severe stenosis at L3-L4 level with spondylolisthesis, and massive bilateral synovial cysts at the L3-L4 level filling the spinal canal. Following an L2-L4 decompressive laminectomy without fusion (note the absence of motion intraoperatively at the L3-L4 level), the patient's symptoms resolved, and he regained normal function. How would you have managed this patient?

Biomechanical effects of fusion levels on the risk of proximal junctional failure and kyphosis in lumbar spinal fusion surgery.

PubMed

Park, Won Man; Choi, Dae Kyung; Kim, Kyungsoo; Kim, Yongjung J; Kim, Yoon Hyuk

2015-12-01

Spinal fusion surgery is a widely used surgical procedure for sagittal realignment. Clinical studies have reported that spinal fusion may cause proximal junctional kyphosis and failure with disc failure, vertebral fracture, and/or failure at the implant-bone interface. However, the biomechanical injury mechanisms of proximal junctional kyphosis and failure remain unclear. A finite element model of the thoracolumbar spine was used. Nine fusion models with pedicle screw systems implanted at the L2-L3, L3-L4, L4-L5, L5-S1, L2-L4, L3-L5, L4-S1, L2-L5, and L3-S1 levels were developed based on the respective surgical protocols. The developed models simulated flexion-extension using hybrid testing protocol. When spinal fusion was performed at more distal levels, particularly at the L5-S1 level, the following biomechanical properties increased during flexion-extension: range of motion, stress on the annulus fibrosus fibers and vertebra at the adjacent motion segment, and the magnitude of axial forces on the pedicle screw at the uppermost instrumented vertebra. The results of this study demonstrate that more distal fusion levels, particularly in spinal fusion including the L5-S1 level, lead to greater increases in the risk of proximal junctional kyphosis and failure, as evidenced by larger ranges of motion, higher stresses on fibers of the annulus fibrosus and vertebra at the adjacent segment, and higher axial forces on the screw at the uppermost instrumented vertebra in flexion-extension. Therefore, fusion levels should be carefully selected to avoid proximal junctional kyphosis and failure. Copyright © 2015 Elsevier Ltd. All rights reserved.

THE COMPARISON OF THE LUMBAR MULTIFIDUS MUSCLES FUNCTION BETWEEN GYMNASTIC ATHLETES WITH SWAY-BACK POSTURE AND NORMAL POSTURE.

PubMed

Mahdavie, Elnaz; Rezasoltani, Asghar; Simorgh, Leila

2017-08-01

The prevalence of sway back posture (SBP) is very high among elite gymnasts. This posture may be partly due to the improper function of lumbar multifidus muscles (LMM) as lumbar stabilizers muscles. The aim of this study was to compare the thicknesses of LMM measured at rest and during the contraction elicited during an arm lift between elite gymnasts with SBP and normal posture. Observational, descriptive, comparative. The participants consist of twenty gymnasts between the ages of 17 and 30 who had trained in gymnastics for more than ten years. They were assigned to two groups: SBP (n=10) and control (n=10). Posture analysis with grid paper and plumb line was performed for all subjects. The thickness of LMM on dominant side of spinal column was measured by a real-time ultrasound at five lumbar levels. The thickness of the LMM was measured both at rest and during the contraction elicited during an arm lift. The variation between the LMM thickness between the muscle at rest and muscle at the peak of contraction was regarded as LMM muscle function. The thickness of LMM was less in SBP group than the control group at all lumbar segments. The variation in LMM thickness between the state of rest and muscle contraction was significantly less in athletes with SBP than controls when compared at all levels of the lumbar spine (p < 0.05). The function of LMM may be disturbed in athletes with SBP as demonstrated by decreased thicknesses of LMM found in gymnasts with SBP. Additionally, the thickness of the LMM as a strong antigravity and stabilizing muscle group was decreased during arm raising in gymnasts with SBP. 3a.

Intrathecal injection of carbenoxolone, a gap junction decoupler, attenuates the induction of below-level neuropathic pain after spinal cord injury in rats.

PubMed

Roh, Dae-Hyun; Yoon, Seo-Yeon; Seo, Hyoung-Sig; Kang, Suk-Yun; Han, Ho-Jae; Beitz, Alvin J; Lee, Jang-Hern

2010-07-01

The most common type of chronic pain following spinal cord injury (SCI) is central neuropathic pain and SCI patients typically experience mechanical allodynia and thermal hyperalgesia. The present study was designed to examine the potential role of astrocyte gap junction connectivity in the induction and maintenance of "below-level" neuropathic pain in SCI rats. We examined the effect of intrathecal treatment with carbenoxolone (CARB), a gap junction decoupler, on SCI-induced bilateral thermal hyperalgesia and mechanical allodynia during the induction phase (postoperative days 0 to 5) and the maintenance phase (days 15 to 20) following T13 spinal cord hemisection. Immunohistochemistry was performed to determine potential SCI-induced changes in spinal astrocyte activation and phosphorylation of the NMDA receptor NR1 subunit (pNR1). CARB administered during the induction period dose-dependently attenuated the development of bilateral thermal hyperalgesia and mechanical allodynia. Intrathecal CARB also significantly reduced the bilateral SCI-induced increase in GFAP-immunoreactive (ir) staining and the number of pNR1-ir cell profiles in the spinal cord dorsal horn compared to vehicle-treated rats. In contrast, CARB treatment during the maintenance phase had no effect on the established thermal hyperalgesia and mechanical allodynia nor on spinal GFAP expression or the number of pNR1-ir cell profiles. These results indicate that gap junctions play a critical role in the activation of astrocytes distant from the site of SCI and in the subsequent phosphorylation of NMDA receptors in the lumbar spinal cord. Both of these processes appear to contribute to the induction of bilateral below-level pain in SCI rats. Copyright 2010 Elsevier Inc. All rights reserved.

Effect of slump stretching versus lumbar mobilization with exercise in subjects with non-radicular low back pain: a randomized clinical trial

PubMed Central

Nagrale, Amit Vinayak; Patil, Shubhangi Pandurang; Gandhi, Rita Amarchand; Learman, Ken

2012-01-01

Previous case reports, case series, and pilot studies have suggested that slump stretching may enhance the effects of spinal mobilization and stabilization exercises in patients with non-radicular low back pain (NRLBP). The purpose of this trial was to determine if slump stretching results in improvements in pain, disability, and fear and avoidance beliefs in patients with NRLBP with neural mechanosensitivity. Sixty patients, 18–60 years of age presenting with NRLBP with symptom duration >3 months, were randomized into one of two, 3-week physical therapy programs. Group one received lumbar spinal mobilization with stabilization exercises while group two received slump stretching in addition to lumbar spinal mobilization with exercise. Outcomes including the modified Oswestry disability index (ODI), numeric pain rating scale (NPRS), and the fear–avoidance belief questionnaire (FABQ) were collected at baseline, and at weeks 1, 2, 3, and 6. A doubly multivariate analysis of variance revealed a significant group–time interaction for ODI, NPRS, and FABQ. There were large within-group changes for all outcomes with P<0·01 and large between-group differences at weeks 3 and 6 for the ODI and weeks 1, 2, 3, and 6 for the NPRS and FABQ at P<0·01. A linear mixed-effect model comparing the composite slopes of the improvement lines revealed significant differences favoring the slump stretching group at P<0·01. The findings of the present study further support the use of slump stretching with spinal mobilization and stabilization exercises when treating NRLBP. PMID:23372392

Effect of slump stretching versus lumbar mobilization with exercise in subjects with non-radicular low back pain: a randomized clinical trial.

PubMed

Nagrale, Amit Vinayak; Patil, Shubhangi Pandurang; Gandhi, Rita Amarchand; Learman, Ken

2012-02-01

Previous case reports, case series, and pilot studies have suggested that slump stretching may enhance the effects of spinal mobilization and stabilization exercises in patients with non-radicular low back pain (NRLBP). The purpose of this trial was to determine if slump stretching results in improvements in pain, disability, and fear and avoidance beliefs in patients with NRLBP with neural mechanosensitivity. Sixty patients, 18-60 years of age presenting with NRLBP with symptom duration >3 months, were randomized into one of two, 3-week physical therapy programs. Group one received lumbar spinal mobilization with stabilization exercises while group two received slump stretching in addition to lumbar spinal mobilization with exercise. Outcomes including the modified Oswestry disability index (ODI), numeric pain rating scale (NPRS), and the fear-avoidance belief questionnaire (FABQ) were collected at baseline, and at weeks 1, 2, 3, and 6. A doubly multivariate analysis of variance revealed a significant group-time interaction for ODI, NPRS, and FABQ. There were large within-group changes for all outcomes with P<0·01 and large between-group differences at weeks 3 and 6 for the ODI and weeks 1, 2, 3, and 6 for the NPRS and FABQ at P<0·01. A linear mixed-effect model comparing the composite slopes of the improvement lines revealed significant differences favoring the slump stretching group at P<0·01. The findings of the present study further support the use of slump stretching with spinal mobilization and stabilization exercises when treating NRLBP.

Characterization of the frequency and muscle responses of the lumbar and thoracic spines of seated volunteers during sinusoidal whole body vibration.

PubMed

Baig, Hassam A; Dorman, Daniel B; Bulka, Ben A; Shivers, Bethany L; Chancey, Valeta C; Winkelstein, Beth A

2014-10-01

Whole body vibration has been postulated to contribute to the onset of back pain. However, little is known about the relationship between vibration exposure, the biomechanical response, and the physiological responses of the seated human. The aim of this study was to measure the frequency and corresponding muscle responses of seated male volunteers during whole body vibration exposures along the vertical and anteroposterior directions to define the transmissibility and associated muscle activation responses for relevant whole body vibration exposures. Seated human male volunteers underwent separate whole body vibration exposures in the vertical (Z-direction) and anteroposterior (X-direction) directions using sinusoidal sweeps ranging from 2 to 18 Hz, with a constant amplitude of 0.4 g. For each vibration exposure, the accelerations and displacements of the seat and lumbar and thoracic spines were recorded. In addition, muscle activity in the lumbar and thoracic spines was recorded using electromyography (EMG) and surface electrodes in the lumbar and thoracic region. Transmissibility was determined, and peak transmissibility, displacement, and muscle activity were compared in each of the lumbar and thoracic regions. The peak transmissibility for vertical vibrations occurred at 4 Hz for both the lumbar (1.55 ± 0.34) and thoracic (1.49 ± 0.21) regions. For X-directed seat vibrations, the transmissibility ratio in both spinal regions was highest at 2 Hz but never exceeded a value of 1. The peak muscle response in both spinal regions occurred at frequencies corresponding to the peak transmissibility, regardless of the direction of imposed seat vibration: 4 Hz for the Z-direction and 2-3 Hz for the X-direction. In both vibration directions, spinal displacements occurred primarily in the direction of seat vibration, with little off-axis motion. The occurrence of peak muscle responses at frequencies of peak transmissibility suggests that such frequencies may induce greater muscle activity, leading to muscle fatigue, which could be a contributing mechanism of back pain.

Impact of McKenzie Method Therapy Enriched by Muscular Energy Techniques on Subjective and Objective Parameters Related to Spine Function in Patients with Chronic Low Back Pain

PubMed Central

Szulc, Paweł; Wendt, Michał; Waszak, Małgorzata; Tomczak, Maciej; Cieślik, Krystyna; Trzaska, Tadeusz

2015-01-01

Background The high incidence and inconsistencies in diagnostic and therapeutic process of low back pain (LBP) stimulate the continuing search for more efficient treatment modalities. Integration of the information obtained with various therapeutic methods and a holistic approach to the patient seem to be associated with positive outcomes. The aim of this study was to analyze the efficacy of combined treatment with McKenzie method and Muscle Energy Technique (MET), and to compare it with the outcomes of treatment with McKenzie method or standard physiotherapy in specific chronic lumbar pain. Material/Methods The study included 60 men and women with LBP (mean age 44 years). The patients were randomly assigned to 1 of 3 therapeutic groups, which were further treated with: 1) McKenzie method and MET, 2) McKenzie method alone, or 3) standard physiotherapy for 10 days. The extent of spinal movements (electrogoniometry), level of experienced pain (Visual Analogue Scale and Revised Oswestry Pain Questionnaire), and structure of the spinal discs (MRI) were examined prior to the intervention, immediately thereafter, and 3 months after the intervention. Results McKenzie method enriched with MET had the best therapeutic outcomes. The mobility of cervical, thoracic, and lumbar spine normalized at levels corresponding to 87.1%, 66.7%, and 95% of respective average normative values. Implementation of McKenzie method, both alone and combined with MET, was associated with a significant decrease in Oswestry Disability Index, significant alleviation of pain (VAS), and significantly reduced size of spinal disc herniation. Conclusions The combined method can be effectively used in the treatment of chronic LBP. PMID:26418868

Earthquake-related versus non-earthquake-related injuries in spinal injury patients: differentiation with multidetector computed tomography

PubMed Central

2010-01-01

Introduction In recent years, several massive earthquakes have occurred across the globe. Multidetector computed tomography (MDCT) is reliable in detecting spinal injuries. The purpose of this study was to compare the features of spinal injuries resulting from the Sichuan earthquake with those of non-earthquake-related spinal trauma using MDCT. Methods Features of spinal injuries of 223 Sichuan earthquake-exposed patients and 223 non-earthquake-related spinal injury patients were retrospectively compared using MDCT. The date of non-earthquake-related spinal injury patients was collected from 1 May 2009 to 22 July 2009 to avoid the confounding effects of seasonal activity and clothing. We focused on anatomic sites, injury types and neurologic deficits related to spinal injuries. Major injuries were classified according to the grid 3-3-3 scheme of the Magerl (AO) classification system. Results A total of 185 patients (82.96%) in the earthquake-exposed cohort experienced crush injuries. In the earthquake and control groups, 65 and 92 patients, respectively, had neurologic deficits. The anatomic distribution of these two cohorts was significantly different (P < 0.001). Cervical spinal injuries were more common in the control group (risk ratio (RR) = 2.12, P < 0.001), whereas lumbar spinal injuries were more common in the earthquake-related spinal injuries group (277 of 501 injured vertebrae; 55.29%). The major types of injuries were significantly different between these cohorts (P = 0.002). Magerl AO type A lesions composed most of the lesions seen in both of these cohorts. Type B lesions were more frequently seen in earthquake-related spinal injuries (RR = 1.27), while we observed type C lesions more frequently in subjects with non-earthquake-related spinal injuries (RR = 1.98, P = 0.0029). Conclusions Spinal injuries sustained in the Sichuan earthquake were located mainly in the lumbar spine, with a peak prevalence of type A lesions and a high occurrence of neurologic deficits. The anatomic distribution and type of spinal injuries that varied between earthquake-related and non-earthquake-related spinal injury groups were perhaps due to the different mechanism of injury. PMID:21190568

PROXIMAL JUNCTIONAL KYPHOSIS IN ADULT RECONSTRUCTIVE SPINE SURGERY RESULTS FROM INCOMPLETE RESTORATION OF THE LUMBAR LORDOSIS RELATIVE TO THE MAGNITUDE OF THE THORACIC KYPHOSIS

PubMed Central

Mendoza-Lattes, Sergio; Ries, Zachary; Gao, Yubo; Weinstein, Stuart L

2011-01-01

Background Proximal junctional kyphosis (PJK) is defined as: 1) Proximal junction sagittal Cobb angle >≥10°, and 2) Proximal junction sagittal Cobb angle of at least 10° greater than the pre-operative measurement PJK is a common complication which develops in 39% of adults following surgery for spinal deformity. The pathogenesis, risk factors and prevention of this complication are unclear. Methods Of 54 consecutive adults treated with spinal deformity surgery (age≥59.3±10.1 years), 19 of 54 (35%) developed PJK. The average follow-up was 26.8months (range 12 - 42). Radiographic parameters were measured at the pre-operative, early postoperative (4-6 weeks), and final follow-up visits. Sagittal alignment was measured by the ratio between the C7-plumbline and the sacral-femoral distance. Binary logistic regression model with predictor variables included: Age, BMI, C7-plumbline, and whether lumbar lordosis, thoracic kyphosis and sacral slope were present Results Patients who developed PJK and those without PJK presented with comparable age, BMI, pelvic incidence and sagittal imbalance before surgery. They also presented with comparable sacral slope and lumbar lordosis. The average magnitude of thoracic kyphosis was significantly larger than the lumbar lordosis in the proximal junctional kyphosis group, both at baseline and in the early postoperative period, as represented by [(-lumbar )lordosis - (thoracic kyphosis)]; no- PJK versus PJK; 6.6°±23.2° versus -6.6°±14.2°; p≥0.012. This was not effectively addressed with surgery in the PJK group [(-LL-TK): 6.2°±13.1° vs. -5.2°±9.6°; p≥0.004]. This group also presented with signs of pelvic retroversion with a sacral slope of 29.3°±8.2° pre-operatively that was unchanged after surgery (30.4°±8.5° postoperatively). Logistic regression determined that the magnitude of thoracic kyphosis and sagittal balance (C7-plumbline) was the most important predictor of proximal junctional kyphosis. Conclusions Proximal junctional kyphosis developed in those patients where the thoracic kyphosis remained greater in magnitude relative to the lumbar lordosis, and where the sagittal balance seemed corrected, but part of thise correction was secondary to pelvic retroversion. Level of Evidence Prognostic case-control study – Level III. PMID:22096442

Epidural Cystic Spinal Meningioma

PubMed Central

Zhang, Ji; Chen, Zheng-he; Wang, Zi-feng; Sun, Peng; Jin, Jie-tian; Zhang, Xiang-heng; Zhao, Yi-ying; Wang, Jian; Mou, Yong-gao; Chen, Zhong-ping

2016-01-01

Abstract Cystic spinal meningioma (CSM) is an uncommon meningioma variant. Extradural CSMs are particularly rare and difficult to distinguish from other intraaxial tumors. This study presents a case of a 36-year-old woman with intraspinal extradual CSM at the thoracolumbar spine. She experienced persistent weakness, progressive numbness, and sensory disturbance in the right lower limb. Magnetic resonance imaging (MRI) of the patient revealed an irregular cystic mass at the thoracic 11 to lumbar 3 levels dorsally. This case was misdiagnosed as other neoplasms prior to surgery because of the atypical radiographic features and location of the tumor. Extradural CSMs should be considered in the differential diagnosis of intraspinal extradural cystic neoplasms. Complete removal of cystic wall provides an optimal outcome, rendering the lesion curable. PMID:26986119

Iliac Crest Bone Graft versus Local Autograft or Allograft for Lumbar Spinal Fusion: A Systematic Review.

PubMed

Tuchman, Alexander; Brodke, Darrel S; Youssef, Jim A; Meisel, Hans-Jörg; Dettori, Joseph R; Park, Jong-Beom; Yoon, S Tim; Wang, Jeffrey C

2016-09-01

Systematic review. To compare the effectiveness and safety between iliac crest bone graft (ICBG) and local autologous bone and allograft in the lumbar spine. A systematic search of multiple major medical reference databases identified studies evaluating spinal fusion in patients with degenerative joint disease using ICBG, local autograft, or allograft in the thoracolumbar spine. Six comparative studies met our inclusion criteria. A "low" strength of the overall body of evidence suggested no difference in fusion percentages in the lumbar spine between local autograft and ICBG. We found no difference in fusion percentages based on low evidence comparing allograft with ICBG autograft. There were no differences in pain or functional results comparing local autograft or allograft with ICBG autograft. Donor site pain and hematoma/seroma occurred more frequently in ICBG autograft group for lumbar fusion procedures. There was low evidence around the estimate of patients with donor site pain following ICBG harvesting, ranging from 16.7 to 20%. With respect to revision, low evidence demonstrated no difference between allograft and ICBG autograft. There was no evidence comparing patients receiving allograft with local autograft for fusion, pain, functional, and safety outcomes. In the lumbar spine, ICBG, local autograft, and allograft have similar effectiveness in terms of fusion rates, pain scores, and functional outcomes. However, ICBG is associated with an increased risk for donor site-related complications. Significant limitations exist in the available literature when comparing ICBG, local autograft, and allograft for lumbar fusion, and thus ICBG versus other fusion methods necessitates further investigation.

Impact of Lumbar Fusion on Health Care Resource Utilization.

PubMed

Mina, Curtis; Carreon, Leah Y; Glassman, Steven D

2016-02-01

A longitudinal cohort. The aim of this study was to determine the extent of health care resource utilization decrease 2 years after lumbar spinal fusion. Despite the assumption that surgery will minimize the need for ongoing nonsurgical treatment, the impact of lumbar fusion on subsequent health care resource utilization has not been effectively studied. Patients who had continuous coverage by a major insurer during the year before decompression and posterolateral instrumented spinal fusion, and the 2 and a half years following were identified. All charges processed during this time-period were collected. Charges associated with the index surgery, the 90-day postoperative period, and those unrelated to spinal care were excluded. Associations with Oswestry Disability Index (ODI) score improvement at 2 years after surgery and health care resource utilization were determined. Sixty-six patients were included in the analysis. The mean age was 59 years and 39% were males. There was a decrease in health care utilization costs 1 year after surgery ($3267.59) compared with pre-op ($4246.32), but this was not statistically significant (P = 0.197). There was a statistically significant decrease in costs during the second year after surgery ($1420.97) compared with either pre-op (P = 0.000) or 1-year costs (P = 0.001). No statistically significant correlations could be found between change in ODI scores and costs incurred at either year post-op. Health care utilization decreased at 1 year and significantly at 2 years after lumbar fusion. However, there was no correlation between use of nonsurgical resources and clinical outcome based on ODI scores. This raises the question as to whether these resources were used in a rational manner. This cooperative study between a major insurer and a tertiary spine center provides improved insight into the cost profile of lumbar fusion surgery. Further study is needed to determine whether ongoing post-op treatment is necessary or simply established practice. 2.

Acute deterioration in occult Chiari malformation following missile spinal trauma. Case report.

PubMed

Shahlaie, Kiarash; Hartman, Jonathan; Utter, Garth H; Schrot, Rudolph J

2008-04-01

Patients with Chiari malformation (CM) Type I typically experience chronic, slowly progressive symptoms. Rarely, however, do they suffer acute neurological deterioration following an iatrogenic decrease in caudal cerebrospinal fluid pressure due to, for example, a lumbar puncture. To our knowledge, acute neurological deterioration following missile spinal injury in CM has not been previously described. The authors report on a 16-year-old girl who was shot in the abdomen and lumbar spine. Although neurologically intact on initial workup, she developed precipitous quadriplegia and apnea in a delayed fashion. Tonsillar herniation with medullary compression and cerebellar infarction was diagnosed on magnetic resonance imaging. Suboccipital decompression resulted in significant neurological improvement. Well-formed tonsillar ectopia diagnosed at surgery suggested a preexisting CM. The authors conclude that missile spinal trauma can precipitate medullary compression and acute neurological decline, especially in patients with preexisting tonsillar ectopia. Immediate operative decompression to relieve impaction at the cervicomedullary junction can result in significant neurological recovery.

Nanomolar Oxytocin Synergizes with Weak Electrical Afferent Stimulation to Activate the Locomotor CPG of the Rat Spinal Cord In Vitro

PubMed Central

Dose, Francesco; Zanon, Patrizia; Coslovich, Tamara; Taccola, Giuliano

2014-01-01

Synergizing the effect of afferent fibre stimulation with pharmacological interventions is a desirable goal to trigger spinal locomotor activity, especially after injury. Thus, to better understand the mechanisms to optimize this process, we studied the role of the neuropeptide oxytocin (previously shown to stimulate locomotor networks) on network and motoneuron properties using the isolated neonatal rat spinal cord. On motoneurons oxytocin (1 nM–1 μM) generated sporadic bursts with superimposed firing and dose-dependent depolarization. No desensitization was observed despite repeated applications. Tetrodotoxin completely blocked the effects of oxytocin, demonstrating the network origin of the responses. Recording motoneuron pool activity from lumbar ventral roots showed oxytocin mediated depolarization with synchronous bursts, and depression of reflex responses in a stimulus and peptide-concentration dependent fashion. Disinhibited bursting caused by strychnine and bicuculline was accelerated by oxytocin whose action was blocked by the oxytocin antagonist atosiban. Fictive locomotion appeared when subthreshold concentrations of NMDA plus 5HT were coapplied with oxytocin, an effect prevented after 24 h incubation with the inhibitor of 5HT synthesis, PCPA. When fictive locomotion was fully manifested, oxytocin did not change periodicity, although cycle amplitude became smaller. A novel protocol of electrical stimulation based on noisy waveforms and applied to one dorsal root evoked stereotypic fictive locomotion. Whenever the stimulus intensity was subthreshold, low doses of oxytocin triggered fictive locomotion although oxytocin per se did not affect primary afferent depolarization evoked by dorsal root pulses. Among the several functional targets for the action of oxytocin at lumbar spinal cord level, the present results highlight how small concentrations of this peptide could bring spinal networks to threshold for fictive locomotion in combination with other protocols, and delineate the use of oxytocin to strengthen the efficiency of electrical stimulation to activate locomotor circuits. PMID:24658101

Potential involvement of μ-opioid receptor dysregulation on the reduced antinociception of morphine in the inflammatory pain state in mice.

PubMed

Aoki, Yuta; Mizoguchi, Hirokazu; Watanabe, Chizuko; Takeda, Kumiko; Sakurada, Tsukasa; Sakurada, Shinobu

2014-01-01

The antinociceptive effect of morphine in the inflammatory pain state was described in the von Frey filament test using the complete Freund's adjuvant (CFA)-induced mouse inflammatory pain model. After an i.pl. injection of CFA, mechanical allodynia was observed in the ipsilateral paw. The antinociceptive effect of morphine injected s.c. and i.t. against mechanical allodynia was reduced bilaterally at 1 day and 4 days after the CFA pretreatment. The expression level of mRNA for μ-opioid receptors at 1 day after the CFA pretreatment was reduced bilaterally in the lumbar spinal cord and dorsal root ganglion (DRG). In contrast, the protein level of μ-opioid receptors at 1 day after CFA pretreatment was decreased in the ipsilateral side in the DRG but not the lumbar spinal cord. Single or repeated i.t. pretreatment with the protein kinase Cα (PKCα) inhibitor Ro-32-0432 completely restored the reduced morphine antinociception in the contralateral paw but only partially restored it in the ipsilateral paw in the inflammatory pain state. In conclusion, reduced morphine antinociception against mechanical allodynia in the inflammatory pain state is mainly mediated via a decrease in μ-opioid receptors in the ipsilateral side and via the desensitization of μ-opioid receptors in the contralateral side by PKCα-induced phosphorylation.

Axonal loss in the multiple sclerosis spinal cord revisited.

PubMed

Petrova, Natalia; Carassiti, Daniele; Altmann, Daniel R; Baker, David; Schmierer, Klaus

2018-05-01

Preventing chronic disease deterioration is an unmet need in people with multiple sclerosis, where axonal loss is considered a key substrate of disability. Clinically, chronic multiple sclerosis often presents as progressive myelopathy. Spinal cord cross-sectional area (CSA) assessed using MRI predicts increasing disability and has, by inference, been proposed as an indirect index of axonal degeneration. However, the association between CSA and axonal loss, and their correlation with demyelination, have never been systematically investigated using human post mortem tissue. We extensively sampled spinal cords of seven women and six men with multiple sclerosis (mean disease duration= 29 years) and five healthy controls to quantify axonal density and its association with demyelination and CSA. 396 tissue blocks were embedded in paraffin and immuno-stained for myelin basic protein and phosphorylated neurofilaments. Measurements included total CSA, areas of (i) lateral cortico-spinal tracts, (ii) gray matter, (iii) white matter, (iv) demyelination, and the number of axons within the lateral cortico-spinal tracts. Linear mixed models were used to analyze relationships. In multiple sclerosis CSA reduction at cervical, thoracic and lumbar levels ranged between 19 and 24% with white (19-24%) and gray (17-21%) matter atrophy contributing equally across levels. Axonal density in multiple sclerosis was lower by 57-62% across all levels and affected all fibers regardless of diameter. Demyelination affected 24-48% of the gray matter, most extensively at the thoracic level, and 11-13% of the white matter, with no significant differences across levels. Disease duration was associated with reduced axonal density, however not with any area index. Significant association was detected between focal demyelination and decreased axonal density. In conclusion, over nearly 30 years multiple sclerosis reduces axonal density by 60% throughout the spinal cord. Spinal cord cross sectional area, reduced by about 20%, appears to be a poor predictor of axonal density. © 2017 The Authors. Brain Pathology published by John Wiley & Sons Ltd on behalf of International Society of Neuropathology.

Proteomic analysis of ligamentum flavum from patients with lumbar spinal stenosis.

PubMed

Kamita, Masahiro; Mori, Taiki; Sakai, Yoshihito; Ito, Sadayuki; Gomi, Masahiro; Miyamoto, Yuko; Harada, Atsushi; Niida, Shumpei; Yamada, Tesshi; Watanabe, Ken; Ono, Masaya

2015-05-01

Lumbar spinal stenosis (LSS) is a syndromic degenerative spinal disease and is characterized by spinal canal narrowing with subsequent neural compression causing gait disturbances. Although LSS is a major age-related musculoskeletal disease that causes large decreases in the daily living activities of the elderly, its molecular pathology has not been investigated using proteomics. Thus, we used several proteomic technologies to analyze the ligamentum flavum (LF) of individuals with LSS. Using comprehensive proteomics with strong cation exchange fractionation, we detected 1288 proteins in these LF samples. A GO analysis of the comprehensive proteome revealed that more than 30% of the identified proteins were extracellular. Next, we used 2D image converted analysis of LC/MS to compare LF obtained from individuals with LSS to that obtained from individuals with disc herniation (nondegenerative control). We detected 64 781 MS peaks and identified 1675 differentially expressed peptides derived from 286 proteins. We verified four differentially expressed proteins (fibronectin, serine protease HTRA1, tenascin, and asporin) by quantitative proteomics using SRM/MRM. The present proteomic study is the first to identify proteins from degenerated and hypertrophied LF in LSS, which will help in studying LSS. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The effects of dorso-lumbar motion restriction on the ground reaction force components during running.

PubMed

Morley, Joseph J; Traum, Edward

2016-04-01

The effects of restricting dorso-lumbar spine mobility on ground reaction forces in runners was measured and assessed. A semi-rigid cast was used to restrict spinal motion during running. Subjects ran across a force platform at 3.6 m/s, planting the right foot on the platform. Data was collected from ten running trials with the cast and ten without the cast and analysed. Casted running showed that the initial vertical heel strike maximum was increased (p < .02) and that the anterior-posterior deceleration impulse was increased (p < .01). The maximum vertical ground reaction force was decreased in casted running (p < .01), as was the anterior-posterior acceleration impulse (p < .02). There was a trend for increased medial-lateral impulse in the uncasted state, but this was not statistically significant. Spinal mobility and fascia contribute to load transfer between joints and body segments. Experimentally restricting spinal motion during running results in measurable and repeatable alterations in ground reaction force components. Alterations in load transfer due to decreased spinal motion may be a factor contributing to selected injuries in runners. Copyright © 2015 Elsevier Ltd. All rights reserved.

Slump sitting X-ray of the lumbar spine is superior to the conventional flexion view in assessing lumbar spine instability.

PubMed

Hey, Hwee Weng Dennis; Lau, Eugene Tze-Chun; Lim, Joel-Louis; Choong, Denise Ai-Wen; Tan, Chuen-Seng; Liu, Gabriel Ka-Po; Wong, Hee-Kit

2017-03-01

Flexion radiographs have been used to identify cases of spinal instability. However, current methods are not standardized and are not sufficiently sensitive or specific to identify instability. This study aimed to introduce a new slump sitting method for performing lumbar spine flexion radiographs and comparison of the angular range of motions (ROMs) and displacements between the conventional method and this new method. This study used is a prospective study on radiological evaluation of the lumbar spine flexion ROMs and displacements using dynamic radiographs. Sixty patients were recruited from a single spine tertiary center. Angular and displacement measurements of lumbar spine flexion were carried out. Participants were randomly allocated into two groups: those who did the new method first, followed by the conventional method versus those who did the conventional method first, followed by the new method. A comparison of the angular and displacement measurements of lumbar spine flexion between the conventional method and the new method was performed and tested for superiority and non-inferiority. The measurements of global lumbar angular ROM were, on average, 17.3° larger (p<.0001) using the new slump sitting method compared with the conventional method. They were most significant at the levels of L3-L4, L4-L5, and L5-S1 (p<.0001, p<.0001 and p=.001, respectively). There was no significant difference between both methods when measuring lumbar displacements (p=.814). The new method of slump sitting dynamic radiograph was shown to be superior to the conventional method in measuring the angular ROM and non-inferior to the conventional method in the measurement of displacement. Copyright © 2016 Elsevier Inc. All rights reserved.

Oxycodone Plus Ultra-Low-Dose Naltrexone Attenuates Neuropathic Pain and Associated μ-Opioid Receptor–Gs Coupling

PubMed Central

Largent-Milnes, Tally M.; Guo, Wenhong; Wang, Hoau-Yan; Burns, Lindsay H.; Vanderah, Todd W.

2017-01-01

Both peripheral nerve injury and chronic opioid treatment can result in hyperalgesia associated with enhanced excitatory neurotransmission at the level of the spinal cord. Chronic opioid administration leads to a shift in μ-opioid receptor (MOR)–G protein coupling from Gi/o to Gs that can be prevented by cotreatment with an ultra-low-dose opioid antagonist. In this study, using lumbar spinal cord tissue from rats with L5/L6 spinal nerve ligation (SNL), we demonstrated that SNL injury induces MOR linkage to Gs in the damaged (ipsilateral) spinal dorsal horn. This MOR-Gs coupling occurred without changing Gi/o coupling levels and without changing the expression of MOR or Gα proteins. Repeated administration of oxycodone alone or in combination with ultra-low-dose naltrexone (NTX) was assessed on the SNL-induced MOR-Gs coupling as well as on neuropathic pain behavior. Repeated spinal oxycodone exacerbated the SNL-induced MOR-Gs coupling, whereas ultra-low-dose NTX cotreatment slightly but significantly attenuated this Gs coupling. Either spinal or oral administration of oxycodone plus ultra-low-dose NTX markedly enhanced the reductions in allodynia and thermal hyperalgesia produced by oxycodone alone and minimized tolerance to these effects. The MOR-Gs coupling observed in response to SNL may in part contribute to the excitatory neurotransmission in spinal dorsal horn in neuropathic pain states. The antihyperalgesic and antiallodynic effects of oxycodone plus ultra-low-dose NTX (Oxytrex, Pain Therapeutics, Inc., San Mateo, CA) suggest a promising new treatment for neuropathic pain. PMID:18468954

Randomized trial comparing exercise therapy, alternating cold and hot therapy, and low intensity laser therapy for chronic lumbar muscle strain

NASA Astrophysics Data System (ADS)

Liu, Xiaoguang; Li, Jie; Liu, Timon Chengyi; Yuan, Jianqin; Luo, Qingming

2008-12-01

The purpose of this study was to compare the effects of exercise therapy, alternating cold and hot (ACH) therapy and low intensity laser (LIL) therapy in patients with chronic lumbar muscle strain (CLMS). Thirty-two patients were randomly allocated to four groups: exercise group, ACH group, LIL group, and combination group of exercise, ACH and LIL, eight in each group. Sixteen treatments were given over the course of 4 weeks. Lumbar muscle endurance, flexion and lateral flexion measures, visual analogue scale (VAS) and lumbar disability questionnaire (LDQ) were used in the clinical and functional evaluations before, immediately after, and 4 weeks after treatment. It was found that the values of endurance, VAS and LDQ in all groups were significantly improved from before to after treatment (P < 0.01). The combination group showed significantly larger reduction on pain level and functional disability than the other groups immediately and 4 weeks after treatment (P < 0.01). Pain level reduced significantly more in the ACH group than in the exercise group or the LIL group immediately and 4 weeks after treatment (P < 0.05). Lumbar muscle endurance and spinal ranges of motion in all groups were improved after treatment but there was no significant difference between any therapy groups. In conclusion, exercise therapy, ACH therapy and LIL therapy were effective in the treatment of CLMS. ACH therapy was more effective than exercise therapy or LIL therapy. The combination therapy of exercise, ACH and LIL had still better rehabilitative effects on CLMS.

Radiofrequency for the Treatment of Lumbar Radicular Pain: Impact on Surgical Indications.

PubMed

Trinidad, José Manuel; Carnota, Ana Isabel; Failde, Inmaculada; Torres, Luis Miguel

2015-01-01

Study Design. Quasiexperimental study. Objective. To investigate whether radiofrequency treatment can preclude the need for spinal surgery in both the short term and long term. Background. Radiofrequency is commonly used to treat lumbosacral radicular pain. Only few studies have evaluated its effects on surgical indications. Methods. We conducted a quasiexperimental study of 43 patients who had been scheduled for spinal surgery. Radiofrequency was indicated for 25 patients. The primary endpoint was the decision of the patient to reject spinal surgery 1 month and 1 year after treatment (pulsed radiofrequency of dorsal root ganglion, 76%; conventional radiofrequency of the medial branch, 12%; combined technique, 12%). The primary endpoint was the decision of the patient to reject spinal surgery 1 month and 1 year after treatment. In addition, we also evaluated adverse effects, ODI, NRS. Results. We observed after treatment with radiofrequency 80% of patients rejected spinal surgery in the short term and 76% in the long term. We conclude that radiofrequency is a useful treatment strategy that can achieve very similar outcomes to spinal surgery. Patients also reported a very high level of satisfaction (84% satisfied/very satisfied). We also found that optimization of the electrical parameters of the radiofrequency improved the outcome of this technique.

Biomechanical comparison of a two-level Maverick disc replacement with a hybrid one-level disc replacement and one-level anterior lumbar interbody fusion.

PubMed

Erkan, Serkan; Rivera, Yamil; Wu, Chunhui; Mehbod, Amir A; Transfeldt, Ensor E

2009-10-01

Multilevel lumbar disc disease (MLDD) is a common finding in many patients. Surgical solutions for MLDD include fusion or disc replacement. The hybrid model, combining fusion and disc replacement, is a potential alternative for patients who require surgical intervention at both L5-S1 and L4-L5. The indications for this hybrid model could be posterior element insufficiency, severe facet pathology, calcified ligamentum flavum, and subarticular disease confirming spinal stenosis at L5-S1 level, or previous fusion surgery at L5-S1 and new symptomatic pathology at L4-L5. Biomechanical data of the hybrid model with the Maverick disc and anterior fusion are not available in the literature. To compare the biomechanical properties of a two-level Maverick disc replacement at L4-L5, L5-S1, and a hybrid model consisting of an L4-L5 Maverick disc replacement with an L5-S1 anterior lumbar interbody fusion using multidirectional flexibility test. An in vitro human cadaveric biomechanical study. Six fresh human cadaveric lumbar specimens (L4-S1) were subjected to unconstrained load in axial torsion (AT), lateral bending (LB), flexion (F), extension (E), and flexion-extension (FE) using multidirectional flexibility test. Four surgical treatments-intact, one-level Maverick at L5-S1, two-level Maverick between L4 and S1, and the hybrid model (anterior fusion at L5-S1 and Maverick at L4-L5) were tested in sequential order. The range of motion of each treatment was calculated. The Maverick disc replacement slightly reduced intact motion in AT and LB at both levels. The total FE motion was similar to the intact motion. However, the E motion is significantly increased (approximately 50% higher) and F motion is significantly decreased (30%-50% lower). The anterior fusion using a cage and anterior plate significantly reduced spinal motion compared with the condition (p<.05). No significant differences were found between two-level Maverick disc prosthesis and the hybrid model in terms of all motion types at L4-L5 level (p>.05). The Maverick disc preserved total motion but altered the motion pattern of the intact condition. This result is similar to unconstrained devices such as Charité. The motion at L4-L5 of the hybrid model is similar to that of two-level Maverick disc replacement. The fusion procedure using an anterior plate significantly reduced intact motion. Clinical studies are recommended to validate the efficacy of the hybrid model.

LPS-induced knee-joint reactive arthritis and spinal cord glial activation were reduced after intrathecal thalidomide injection in rats.

PubMed

Bressan, Elisângela; Mitkovski, Mišo; Tonussi, Carlos Rogério

2010-10-09

Thalidomide is thought to prevent TNF-α production, and such mechanism could be useful in a spinally delivered drug approach for the control of peripheral inflammation. This study aimed to evaluate the effect of intrathecal thalidomide, in comparison with that of intraperitoneal treatment, on articular incapacitation, edema, synovial leukocyte content, and spinal cord glial activation in a model of Escherichia coli lipopolysaccharide (LPS)-induced reactive arthritis in rats. LPS (30ng) was injected into a knee-joint previously primed with carrageenan (300μg). Systemic (30 and 100mg/kg; intraperitoneal, i.p.) and intrathecal (10 and 100μg; i.t.) thalidomide were given 1h or 20min before LPS injection, respectively. Articular incapacitation and edema were evaluated hourly. After 6h, synovial fluid and lumbar spinal cords were collected for subsequent evaluations of cell migration and expression of CD11b/c and GFAP markers, respectively. Systemic (30 and 100mg/kg) or intrathecal (10 and 100μg) thalidomide reduced articular incapacitation, edema, and polymorphonuclear migration. In addition, i.p. and i.t. thalidomide reduced the expression of CD11b/c and GFAP markers in the lumbar spinal cord. These results suggest that thalidomide can also produce peripheral anti-inflammatory effects through action in the spinal cord that may involve glia inhibition. This study provides new evidence that the direct spinal delivery of immunomodulators may be an alternative for the treatment of arthritic diseases, which require long systemic treatment with drugs associated with undesirable side effects. Copyright © 2010 Elsevier Inc. All rights reserved.

Viral neurotropism, peripheral neuropathy and other morphological abnormalities in bovine ephemeral fever virus-infected downer cattle.

PubMed

Barigye, R; Davis, S; Hunt, R; Hunt, N; Walsh, S; Elliott, N; Burnup, C; Aumann, S; Day, C; Dyrting, K; Weir, R; Melville, L F

2016-10-01

This study assessed the neurotropism of bovine ephemeral fever (BEF) virus (BEFV) and described histomorphological abnormalities of the brain, spinal cord and peripheral nerves that may causally contribute to paresis or paralysis in BEF. Four paralysed and six asymptomatic but virus-infected cattle were monitored, and blood and serum samples screened by qRT-PCR, virus isolation and neutralisation tests. Fresh brain, spinal cord, peripheral nerve and other tissues were qRT-PCR-tested for viral RNA, while formalin-fixed specimens were processed routinely and immunohistochemically evaluated for histomorphological abnormalities and viral antigen distribution, respectively. The neurotropism of BEFV was immunohistochemically confirmed in the brain and peripheral nerves and peripheral neuropathy was demonstrated in three paralysed but not the six aneurological but virus-infected animals. Wallerian degeneration (WD) was present in the ventral funicular white matter of the lumbar spinal cord of a paralysed steer and in cervical and thoracic spinal cord segments of three paralysed animals. Although no spinal cord lesions were seen in the steer euthanased within 7 days of illness, peripheral neuropathy was present and more severe in nerves of the brachial plexuses than in the gluteal or fibular nerves. The only steer with WD in the lumbar spinal cord also showed intrahistiocytic cell viral antigen that was spatially distributed within areas of moderate brain stem encephalitis. The data confirmed neurotropism of BEFV in cattle and documented histomorphological abnormalities in peripheral nerves and brain which, together with spinal cord lesions, may contribute to chronic paralysis in BEFV-infected downer cattle. © 2016 Australian Veterinary Association.

Effect of ramosetron on shivering during spinal anesthesia

PubMed Central

Kim, Min Soo; Kim, Dong Won; Woo, Seung-Hoon; Yon, Jun Heum

2010-01-01

Background Shivering associated with spinal anesthesia is uncomfortable and may interfere with monitoring. The aim of this study is to evaluate the effect of ramosetron, a serotonin-3 receptor antagonist, on the prevention of shivering during spinal anesthesia. Methods We enrolled 52 patients who were ASA I or II and who had undergone knee arthroscopy under spinal anesthesia. Warmed (37°) lactated Ringer's solution was infused over 15 minutes before spinal anesthesia. Patients were randomly allocated to a control group (group S, N = 26) or study group (group R, N = 26). Spinal anesthesia was performed with a 25-G Quincke-type spinal needle between the lumbar 3-4 interspace with 2.2 ml 0.5% hyperbaric bupivacaine. For patients allocated in groups S and R, 2 ml 0.9% saline and 0.3 mg ramosetron, respectively, was intravenously injected immediately before intrathecal injection at identical times. Shivering and spinal block levels were assessed immediately after the completion of subarachnoid injection, as well as 5, 10, 15, 20, 25, 30, 60, and 120 minutes after spinal anesthesia. Systolic and diastolic blood pressures, heart rate, and peripheral oxygen saturation were also recorded. Core temperatures were measured by tympanic thermometer and recorded before and during spinal anesthesia at 30-minute intervals. Results Shivering was observed in 2 patients in group R and 9 patients in group S (P = 0.038, odds ratio = 6.14, 95% C.I. = 1.08-65.5). The difference in core temperature between the groups was not significant. Conclusions Compared to control, ramosetron is an effective way to prevent shivering during spinal anesthesia. PMID:20498774

Recruitment methods and costs for a randomized, placebo-controlled trial of chiropractic care for lumbar spinal stenosis: a single-site pilot study.

PubMed

Cambron, Jerrilyn A; Dexheimer, Jennifer M; Chang, Mabel; Cramer, Gregory D

2010-01-01

The purpose of this article is to describe the methods for recruitment in a clinical trial on chiropractic care for lumbar spinal stenosis. This randomized, placebo-controlled pilot study investigated the efficacy of different amounts of total treatment dosage over 6 weeks in 60 volunteer subjects with lumbar spinal stenosis. Subjects were recruited for this study through several media venues, focusing on successful and cost-effective strategies. Included in our efforts were radio advertising, newspaper advertising, direct mail, and various other low-cost initiatives. Of the 1211 telephone screens, 60 responders (5.0%) were randomized into the study. The most successful recruitment method was radio advertising, generating more than 64% of the calls (776 subjects). Newspaper and magazine advertising generated approximately 9% of all calls (108 subjects), and direct mail generated less than 7% (79 subjects). The total direct cost for recruitment was $40 740 or $679 per randomized patient. The costs per randomization were highest for direct mail ($995 per randomization) and lowest for newspaper/magazine advertising ($558 per randomization). Success of recruitment methods may vary based on target population and location. Planning of recruitment efforts is essential to the success of any clinical trial. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Active extravasation of gadolinium-based contrast agent into the subdural space following lumbar puncture.

PubMed

Kothari, Pranay D; Hanser, Evelyn M; Wang, Harrison; Farid, Nikdokht

2016-01-01

A 38year-old male presented with cauda equina syndrome following multiple lumbar puncture attempts. Lumbar spine magnetic resonance imaging (MRI) showed a subdural hematoma and an area of apparent contrast enhancement in the spinal canal on sagittal post-contrast images. Axial post-contrast images obtained seven minutes later demonstrated an increase in size and change in shape of the region of apparent contrast enhancement, indicating active extravasation of the contrast agent. This is the first reported case of active extravasation of gadolinium-based contrast agent in the spine. Copyright © 2016 Elsevier Inc. All rights reserved.

A Japanese Stretching Intervention Can Modify Lumbar Lordosis Curvature.

PubMed

Kadono, Norio; Tsuchiya, Kazushi; Uematsu, Azusa; Kamoshita, Hiroshi; Kiryu, Kazunori; Hortobágyi, Tibor; Suzuki, Shuji

2017-08-01

Eighteen healthy male adults were assigned to either an intervention or control group. Isogai dynamic therapy (IDT) is one of Japanese stretching interventions and has been practiced for over 70 years. However, its scientific quantitative evidence remains unestablished. The objective of this study was to determine whether IDT could modify lumbar curvature in healthy young adults compared with stretching exercises used currently in clinical practice. None of previous studies have provided data that conventional stretching interventions could modify spinal curvatures. However, this study provides the first evidence that a specific form of a Japanese stretching intervention can acutely modify the spinal curvatures. We compared the effects of IDT, a Japanese stretching intervention (n=9 males), with a conventional stretching routine (n=9 males) used widely in clinics to modify pelvic tilt and lumbar lordosis (LL) angle. We measured thoracic kyphosis (TK) and LL angles 3 times during erect standing using the Spinal Mouse before and after each intervention. IDT consisted of: (1) hip joint correction, (2) pelvic tilt correction, (3) lumbar alignment correction, and (4) squat exercise stretch. The control group performed hamstring stretches while (1) standing and (2) sitting. IDT increased LL angle to 25.1 degrees (±5.9) from 21.2 degrees (±6.9) (P=0.047) without changing TK angle (pretest: 36.8 degrees [±6.9]; posttest: 36.1 degrees [±6.5]) (P=0.572). The control group showed no changes in TK (P=0.819) and LL angles (P=0.744). IDT can thus be effective for increasing LL angle, hence anterior pelvic tilt. Such modifications could ameliorate low back pain and improve mobility in old adults with an unfavorable pelvic position.

Acute inflammation induces segmental, bilateral, supraspinally mediated opioid release in the rat spinal cord, as measured by μ-opioid receptor internalization

PubMed Central

Chen, Wenling; Marvizón, Juan Carlos G.

2009-01-01

The objective of this study was to measure opioid release in the spinal cord during acute and long-term inflammation using μ-opioid receptor (MOR) internalization. In particular, we determined whether opioid release occurs in the segments receiving the noxious signals or in the entire spinal cord, and whether it involves supraspinal signals. Internalization of neurokinin 1 receptors (NK1Rs) was measured to track the intensity of the noxious stimulus. Rats received peptidase inhibitors intrathecally to protect opioids from degradation. Acute inflammation of the hindpaw with formalin induced moderate MOR internalization in the L5 segment bilaterally, whereas NK1R internalization occurred only ipsilaterally. MOR internalization was restricted to the lumbar spinal cord, regardless of whether the peptidase inhibitors were injected in a lumbar or thoracic site. Formalin-induced MOR internalization was substantially reduced by isoflurane anesthesia. It was also markedly reduced by a lidocaine block of the cervical-thoracic spinal cord (which did not affect the evoked NK1R internalization) indicating that spinal opioid release is mediated supraspinally. In the absence of peptidase inhibitors, formalin and hindpaw clamp induced a small amount of MOR internalization, which was significantly higher than in controls. To study spinal opioid release during chronic inflammation, we injected Complete Freund's Adjuvant (CFA) in the hindpaw and peptidase inhibitors intrathecally. Two days later, no MOR or NK1R internalization was detected. Furthermore, CFA inflammation decreased MOR internalization induced by clamping the inflamed hindpaw. These results show that acute inflammation, but not chronic inflammation, induce segmental opioid release in the spinal cord that involves supraspinal signals. PMID:19298846

Acute inflammation induces segmental, bilateral, supraspinally mediated opioid release in the rat spinal cord, as measured by mu-opioid receptor internalization.

PubMed

Chen, W; Marvizón, J C G

2009-06-16

The objective of this study was to measure opioid release in the spinal cord during acute and long-term inflammation using mu-opioid receptor (MOR) internalization. In particular, we determined whether opioid release occurs in the segments receiving the noxious signals or in the entire spinal cord, and whether it involves supraspinal signals. Internalization of neurokinin 1 receptors (NK1Rs) was measured to track the intensity of the noxious stimulus. Rats received peptidase inhibitors intrathecally to protect opioids from degradation. Acute inflammation of the hind paw with formalin induced moderate MOR internalization in the L5 segment bilaterally, whereas NK1R internalization occurred only ipsilaterally. MOR internalization was restricted to the lumbar spinal cord, regardless of whether the peptidase inhibitors were injected in a lumbar or thoracic site. Formalin-induced MOR internalization was substantially reduced by isoflurane anesthesia. It was also markedly reduced by a lidocaine block of the cervical-thoracic spinal cord (which did not affect the evoked NK1R internalization) indicating that spinal opioid release is mediated supraspinally. In the absence of peptidase inhibitors, formalin and hind paw clamp induced a small amount of MOR internalization, which was significantly higher than in controls. To study spinal opioid release during chronic inflammation, we injected complete Freund's adjuvant (CFA) in the hind paw and peptidase inhibitors intrathecally. Two days later, no MOR or NK1R internalization was detected. Furthermore, CFA inflammation decreased MOR internalization induced by clamping the inflamed hind paw. These results show that acute inflammation, but not chronic inflammation, induces segmental opioid release in the spinal cord that involves supraspinal signals.

Comparison of Lumbosacral Alignment in Geriatric and Non-Geriatric patients suffering low back pain.

PubMed

Kocyigit, Burhan Fatih; Berk, Ejder

2018-01-01

Lumbosacral alignment is a crucial factor for an appropriate spinal function. Changes in spinal alignment lead to diminished body biomechanics. Additionally, lumbosacral alignment may affect quality of life, sagittal balance and fall risk in elderly. In this study, we aimed to compare lumbosacral alignment in geriatric and non-geriatric patients suffering from low back pain. A total of 202 (120 male and 82 female) patients who visited to physical medicine and rehabilitation clinic with low back pain between January 2017 and August 2017 were enrolled in this study. Standing lateral lumbar radiographs were obtained from the electronic hospital database. Lumbar lordosis angle, sacral tilt, lumbosacral angle and lumbosacral disc angle were calculated on lateral standing lumbar radiographs. The mean age of the non-geriatric group was 43.02 ± 13.20 years, the geriatric group was 71.61 ± 6.42 years. In geriatric patients, lumbar lordosis angle, sacral tilt and lumbosacral disc angle were significantly smaller (p = 0.042, p = 0.017 and p = 0.017). No significant differences were observed in lumbosacral angle between the groups (p = 0.508). Our study indicates the specific changes in lumbosacral alignment with aging. Identifying these changes in lumbosacral alignment in the geriatric population will enable to create proper rehabilitation strategies.

Lumbar vertebral haemangioma causing pathological fracture, epidural haemorrhage, and cord compression: a case report and review of literature.

PubMed

Vinay, S; Khan, S K; Braybrooke, J R

2011-01-01

Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral column, occurring mostly in the thoracic spine. The vast majority of these are asymptomatic. Infrequently, these can turn symptomatic and cause neurological deficit (cord compression) through any of four reported mechanisms: (1) epidural extension; (2) expansion of the involved vertebra(e) causing spinal canal stenosis; (3) spontaneous epidural haemorrhage; (4) pathological burst fracture. Thoracic haemangiomas have been reported to be more likely to produce cord compression than lumbar haemangiomas. A forty-nine year old male with acute onset spinal cord compression from a pathological fracture in a first lumbar vertebral haemangioma. An MRI delineated the haemangioma and extent of bleeding that caused the cord compression. These were confirmed during surgery and the haematoma was evacuated. The spine was instrumented from T12 to L2, and a cement vertebroplasty was performed intra-operatively. Written consent for publication was obtained from the patient. The junctional location of the first lumbar vertebra, and the structural weakness from normal bone being replaced by the haemangioma, probably caused it to fracture under axial loading. This pathological fracture caused bleeding from the vascularized bone, resulting in cord compression.

Lumbar vertebral haemangioma causing pathological fracture, epidural haemorrhage, and cord compression: a case report and review of literature

PubMed Central

Vinay, S; Khan, SK; Braybrooke, JR

2011-01-01

Context Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral column, occurring mostly in the thoracic spine. The vast majority of these are asymptomatic. Infrequently, these can turn symptomatic and cause neurological deficit (cord compression) through any of four reported mechanisms: (1) epidural extension; (2) expansion of the involved vertebra(e) causing spinal canal stenosis; (3) spontaneous epidural haemorrhage; (4) pathological burst fracture. Thoracic haemangiomas have been reported to be more likely to produce cord compression than lumbar haemangiomas. Findings A forty-nine year old male with acute onset spinal cord compression from a pathological fracture in a first lumbar vertebral haemangioma. An MRI delineated the haemangioma and extent of bleeding that caused the cord compression. These were confirmed during surgery and the haematoma was evacuated. The spine was instrumented from T12 to L2, and a cement vertebroplasty was performed intra-operatively. Written consent for publication was obtained from the patient. Clinical Relevance The junctional location of the first lumbar vertebra, and the structural weakness from normal bone being replaced by the haemangioma, probably caused it to fracture under axial loading. This pathological fracture caused bleeding from the vascularized bone, resulting in cord compression. PMID:21756575

Chiropractic management of a 47-year–old firefighter with lumbar disk extrusion

PubMed Central

Schwab, Matthew J.

2008-01-01

Abstract Objective This case report describes the effect of exercise-based chiropractic treatment on chronic and intractable low back pain complicated by lumbar disk extrusion. Clinical Features A 47-year–old male firefighter experienced chronic, unresponsive low back pain. Pre- and posttreatment outcome analysis was performed on numeric (0-10) pain scale, functional rating index, and the low back pain Oswestry data. Secondary outcome assessments included a 1-rep maximum leg press, balancing times, push-ups and sit-ups the patient performed in 60 seconds, and radiographic analysis. Intervention and Outcome The patient was treated with Pettibon manipulative and rehabilitative techniques. At 4 weeks, spinal decompression therapy was incorporated. After 12 weeks of treatment, the patient's self-reported numeric pain scale had reduced from 6 to 1. There was also overall improvement in muscular strength, balance times, self-rated functional status, low back Oswestry scores, and lumbar lordosis using pre- and posttreatment radiographic information. Conclusion Comprehensive, exercise-based chiropractic management may contribute to an improvement of physical fitness and to restoration of function, and may be a protective factor for low back injury. This case suggests promising interventions with otherwise intractable low back pain using a multimodal chiropractic approach that includes isometric strengthening, neuromuscular reeducation, and lumbar spinal decompression therapy. PMID:19646377

Lumbar Spinal Canal Stenosis

MedlinePlus

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Clinical workflow for spinal curvature measurement with portable ultrasound

NASA Astrophysics Data System (ADS)

Tabanfar, Reza; Yan, Christina; Kempston, Michael; Borschneck, Daniel; Ungi, Tamas; Fichtinger, Gabor

2016-03-01

PURPOSE: Spinal curvature monitoring is essential in making treatment decisions in scoliosis. Monitoring entails radiographic examinations, however repeated ionizing radiation exposure has been shown to increase cancer risk. Ultrasound does not emit ionizing radiation and is safer for spinal curvature monitoring. We investigated a clinical sonography protocol and challenges associated with position-tracked ultrasound in spinal curvature measurement in scoliosis. METHODS: Transverse processes were landmarked along each vertebra using tracked ultrasound snapshots. The transverse process angle was used to determine the orientation of each vertebra. We tested our methodology on five patients in a local pediatric scoliosis clinic, comparing ultrasound to radiographic curvature measurements. RESULTS: Despite strong correlation between radiographic and ultrasound curvature angles in phantom studies, we encountered new challenges in the clinical setting. Our main challenge was differentiating transverse processes from ribs and other structures during landmarking. We observed up to 13° angle variability for a single vertebra and a 9.85° +/- 10.81° difference between ultrasound and radiographic Cobb angles for thoracic curvatures. Additionally, we were unable to visualize anatomical landmarks in the lumbar region where soft tissue depth was 25-35mm. In volunteers with large Cobb angles (greater than 40° thoracic and 60° lumbar), we observed spinal protrusions resulting in incomplete probe-skin contact and partial ultrasound images not suitable for landmarking. CONCLUSION: Spinal curvature measurement using tracked ultrasound is viable on phantom spine models. In the clinic, new challenges were encountered which must be resolved before a universal sonography protocol can be developed.

Utilization of mechanical diagnosis and therapy (MDT) for the treatment of lumbar pain in the presence of known lumbar transverse process fractures: a case study

PubMed Central

Elenburg, J. L.; Foley, B. S.; Roberts, K.; Bayliss, A. J.

2016-01-01

Background Spinal fractures are typically considered a contraindication to mechanical diagnosis and therapy (MDT). Objective and importance The purpose of this case study is to illustrate how MDT was used safely and effectively to treat lumbar pain in a patient with multiple lumbar transverse process fractures. Clinical presentation The subject was a 24-year-old female with left L2-5 transverse process fractures, sustained 10 weeks prior in a pedestrian versus motor vehicle accident. Intervention (and technique) After collaboration with her physiatrist, an MDT examination revealed a presentation consistent with the lumbar derangement syndrome. Conclusion After three visits, utilizing patient generated forces with the extension principle of treatment, her pain, Oswestry disability index (ODI) score, and function all improved. PMID:27559276

Determination of lumbosacral transitional vertebrae in kidney urinary bladder x-ray films in the Saudi population

PubMed Central

Khashoggi, Khalid G.; Hafiz, Rawan M.; Bock, Yasmin M.; Kaki, Abdullah M.

2017-01-01

Objectives: To investigated the rate of occurrence of lumbosacral transitional vertebrae (LSTV), spinal variant, in kidney urinary bladder (KUB) plain radiographs in a Saudi population. Methods: Between January 2012 to January 2015, KUB plain films obtained from patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, were reviewed, and the presence or absence of LSTV was documented and classified as incomplete or complete. Patients who had evidence of spinal surgery that would obscure the view were excluded. Results: A total of 2078 patients underwent KUB examinations during the study period; LSTV anomalies were detected in 158 of these. Sacralization was present in 153 (96.8%) of this cohort, while lumbarization was present in 5 (3.2%). A total of 136 (86.1%) of the sacralized segments were of the incomplete type, whereas 17 (10.7%) were complete. Of the lumbarized vertebrae, 3 (1.8%) were incomplete, and 2 (1.2%) were complete. The most frequent type in men was type Ib (28.5%) for sacralized segments, and type IIb for lumbarized segments (0.6%). In women, type Ia was the most common form of sacralized segments (11.3%) and type IIb was the most common form of lumbarized segments (2.8%). Conclusion: The prevalence of LSTV in Saudi patients is 7.6%, with a higher incidence of sacralization than lumbarization. Further studies with larger sample sizes and longer follow-up time are needed to demonstrate the clinical significance thereof. PMID:28762430

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

PubMed

Schoenfeld, Andrew J; Makanji, Heeren; Jiang, Wei; Koehlmoos, Tracey; Bono, Christopher M; Haider, Adil H

2017-12-01

Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated. (1) Were proportions of interbody fusions higher in the fee-for-service setting as opposed to the salaried Department of Defense setting? (2) Were the odds of interbody fusion increased in a fee-for-service setting after controlling for indications for surgery? Patients surgically treated for lumbar disc herniation, spinal stenosis, and spondylolisthesis (2006-2014) were identified. Patients were divided into two groups based on whether the surgery was performed in the fee-for-service setting (beneficiaries receive care at a civilian facility with expenses covered by TRICARE insurance) or at a Department of Defense facility (direct care). There were 28,344 patients in the entire study, 21,290 treated in fee-for-service and 7054 treated in Department of Defense facilities. Differences in the rates of fusion-based procedures, discectomy, and decompression between both healthcare settings were assessed using multinomial logistic regression to adjust for differences in case-mix and surgical indication. TRICARE beneficiaries treated for lumbar spinal disorders in the fee-for-service setting had higher odds of receiving interbody fusions (fee-for-service: 7267 of 21,290 [34%], direct care: 1539 of 7054 [22%], odds ratio [OR]: 1.25 [95% confidence interval 1.20-1.30], p < 0.001). Purchased care patients were more likely to receive interbody fusions for a diagnosis of disc herniation (adjusted OR 2.61 [2.36-2.89], p < 0.001) and for spinal stenosis (adjusted OR 1.39 [1.15-1.69], p < 0.001); however, there was no difference for patients with spondylolisthesis (adjusted OR 0.99 [0.84-1.16], p = 0.86). The preferential use of interbody fusion procedures was higher in the fee-for-service setting irrespective of the underlying diagnosis. These results speak to the existence of provider inducement within the field of spine surgery. This reality portends poor performance for surgical practices and hospitals in Accountable Care Organizations and bundled payment programs in which provider inducement is allowed to persist. Level III, economic and decision analysis.

Lumbar lateral shift in a patient with interspinous device implantation: a case report.

PubMed

Peterson, Seth; Hodges, Cheri

2016-09-01

Lumbar lateral shift (LLS) is a common clinical observation but has rarely been described in a patient with a history of lumbar surgery. The purpose of the current case report was to describe the use of the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) in the multi-modal treatment of a patient with an LLS and a history of multiple surgical procedures in the lumbar spine, including interspinous process device (IPD) implantation. A 72-year-old female with chronic low back pain (LBP) and a surgical history in the lumbar spine was referred to physical therapy for radiating leg pain and presented with a right LLS. Her chief complaints included sitting for long periods, vacuuming and ascending stairs into her home. The patient was treated during eight visits over 30 days. Treatment interventions included manual shift correction, self-correction and management, joint mobilisation below the level of IPD implantation ,neurophysiology education, and development of a home exercise programme. At discharge, her leg pain was resolved and all goals had been met. The patient reported maintenance of gains at 6-month follow-up. Utilisation of the MDT approach, including LLS correction, produced positive outcomes in a complex patient with previous IPD implantation. Future research should investigate treatment and outcomes after invasive spinal procedures in similar patient populations to better inform clinical management. 4.