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Sample records for lumbosacral radiculopathy preganglionic

  1. Electrodiagnostic examination of lumbosacral radiculopathies.

    PubMed

    Weber, F; Albert, U

    2000-06-01

    To determine the diagnostic efficacy of late responses and of magnetic stimulation in the electrodiagnostic evaluation of lumbosacral radiculopathies, 42 patients with acute monoradiculopathies of L5 or S1 were examined. We performed conventional nerve conduction studies, F-wave studies, needle electrode examination (NEE) and magnetic stimulation. The results were compared with a control group of 36 persons. In the patients with weakness, we found a diagnostic sensitivity for NEE of 90% in L5 and of 80% in S1. F-waves had the same sensitivity as NEE in the patients with weakness and were more sensitive in the group of patients without weakness (L5 80%, S1 67%). Magnetic stimulation had a sensitivity of 40% in all groups. There were also abnormalities of NEE and of F-wave studies in the patients with abnormal magnetic stimulation. It is concluded that NEE is the single most effective method in acute LSR and that F-wave studies are able to provide complementary information. Magnetically evoked motor nerve root stimulation was not found of clinically relevant diagnostic value.

  2. Neuromyelitis Optica Masquerading as Lumbosacral Radiculopathy: A Case Report

    PubMed Central

    2016-01-01

    Neuromyelitis optica spectrum disorders (NMOSD) is a demyelinating syndrome of the central nervous system. This case report describes a 31-year-old woman whose electromyography revealed radiculopathy in the left L5-S1 spinal segment without anatomical abnormalities on lumbosacral magnetic resonance imaging (MRI). She was diagnosed with NMOSD based on gadolinium contrast whole spine and brain MRI and anti-aquaporin-4 antibody findings. Her peripheral nervous system might have been damaged during the early course of NMOSD. Therefore, it is necessary to consider NMOSD for patients who have radiculopathy in electromyography if lumbosacral MRI shows no abnormalities. PMID:27847726

  3. Postradiation lumbosacral radiculopathy with spinal root cavernomas mimicking carcinomatous meningitis

    PubMed Central

    Ducray, François; Guillevin, Rémy; Psimaras, Dimitri; Sanson, Marc; Mokhtari, Karima; Delanian, Sylvie; Navarro, Soledad; Maisonobe, Thierry; Cornu, Philippe; Hoang-Xuan, Khê; Delattre, Jean-Yves; Pradat, Pierre-François

    2008-01-01

    Lumbosacral radiculopathy is a rare complication of radiotherapy and may be challenging to differentiate from diagnosis of a tumor recurrence. We reviewed the records of three patients with a past history of cancer and radiotherapy who were referred for suspicion of carcinomatous meningitis on lumbar MRI, but whose final diagnosis was radiation-induced lumbosacral radiculopathy. The three patients developed a progressive lumbosacral radiculopathy at 20, 13, and 47 years after lumbar radiotherapy delivered for renal cancer, Hodgkin’s disease, and a seminoma, respectively. MRI showed a diffuse, nodular enhancement of the cauda equina nerve roots on T1 sequences, suggestive of leptomeningeal metastasis. A slowly progressive clinical course over several years and negative cerebrospinal fluid cytologic analysis ruled out the diagnosis of carcinomatous meningitis. Because of the radiologic findings, a biopsy was performed in two patients. In the first, a biopsy limited to the arachnoid excluded a malignant infiltration. In the second, a biopsy of the enhancing lesions demonstrated spinal root cavernomas. These observations, together with three recent case reports in the literature, delineate a syndrome of “radiation-induced lumbosacral radiculopathy with multiple spinal root cavernomas” that mimics carcinomatous meningitis on MRI. Its diagnosis is important in order to avoid inappropriate treatment and useless or dangerous spinal root biopsies. PMID:18755918

  4. Lumbosacral plexus compression by fetus: an unusual cause of radiculopathy during teenage pregnancy.

    PubMed

    Turgut, F; Turgut, M; Menteş, E

    1997-06-01

    A case is reported of a lumbosacral plexus compression by the fetus in a young 34-weeks pregnant woman, who had low-back pain and progressive muscular weakness of the leg. Neurological examination showed a grade IV motor weakness of the iliopsoas, quadriceps femoris and biceps femoris muscles. Mechanical stretch manoeuvers were negative. Electromyography revealed denervation activity in L4 and L5 muscles. Lumbosacral plexus radiculopathy was diagnosed. Although fetal compression appears to be an uncommon cause of lumbosacral radiculopathy during teenage pregnancy, both neurosurgeons and obstetricians should be aware of the possibility.

  5. Postirradiation lumbosacral radiculopathy following seminoma treatment presenting as flaccid neuropathic bladder: a case report

    PubMed Central

    2011-01-01

    Introduction Postirradiation lumbosacral syndrome is a radiculopathy induced by radiation injury to the spinal cord. Its usual presentation is motor deficit and or sensory loss involving the lower limbs. Visceral involvement has not been reported previously. Case presentation We describe a case of severe hypotonic bladder caused by radiation-induced spinal cord injury following treatment of stage Ι testicular seminoma in a 38-year-old Caucasian man who had undergone radical orchidectomy and prophylactic paraaortic lymph node irradiation for stage Ι seminoma. Three years later he had clinical and urodynamic findings of hypotonic bladder. The magnetic resonance imaging results suggested a radiation-induced injury. Conclusion Such an unusual presentation of the syndrome of postirradiation lumbosacral radiculopathy can impose a clinical challenge to practicing clinicians. Future studies are required to further delineate the mechanism of injury and further management plans. PMID:21492468

  6. Lumbosacral radiculopathy secondary to abdominal aortic aneurysms. Report of three cases.

    PubMed

    Wilberger, J E

    1983-06-01

    Focal neurological deficits as the initial manifestation of expanding or ruptured abdominal aortic aneurysms are uncommon. When such a situation does occur, the femoral nerve is most often involved due to retroperitoneal or iliopsoas hematoma. Three cases of typical lumbosacral radiculopathy caused by an abdominal aortic aneurysm are reported to emphasize the importance of considering this diagnosis in the older patient with leg pain and radiculopathic findings.

  7. Lumbo-sacral radiculopathy referral decision-making and primary care management. A case report.

    PubMed

    Haswell, Kate; Gilmour, John Martin; Moore, Barbara Joyce

    2015-04-01

    Low back pain guideline recommendations can inform a decision in primary care to refer for surgical assessment. The purpose of this report is to present a patient with clinical signs and symptoms of lumbo-sacral radiculopathy who experienced pain of high intensity, severe paresis and depression. The guideline informed decision-making process resulted in a decision not to refer. This case report aims to increase awareness of referral guidelines and to demonstrate radicular pain and weakness, disability and depression outcomes subsequent to primary care management.

  8. Intrasubstance Schwannoma of Posterior Tibial Nerve Presenting as Lumbo-Sacral Radiculopathy

    PubMed Central

    Banshelkikar, Santosh; Nistane, Pruthviraj

    2015-01-01

    Introduction: Peripheral nerve tumours are rarely acknowledged as a cause of radiating pain in lower limbs and suspicion is almost always pointed towards lumbo-sacral causes. Schwannomas are tumours of peripheral nerve sheaths occurring anywhere along the peripheral nervous system. Often it can produce symptoms, which can be misleading in cases where obvious swelling is not present. The diagnosis may therefore be delayed by several years of emergence of symptoms. Very few such cases have been reported previously and none of them had an intrasubstance location of the tumour as in our case. Case Report: We present a case of a middle aged female patient presenting with radiating pain in left lower limb, which was diagnosed and treated as lumbo-sacral radiculopathy for five years before an obvious swelling appeared, which on further investigations led to diagnosis of schwannoma of tibial nerve. Intraoperatively, the schwannoma was found to be intrasubstance in location which has never been reported in the past literatures making its excision, without damaging the conducting elements, a challenge. Conclusion: The possibility of peripheral nerve tumour should always be kept in mind while dealing with long standing cases diagnosed as radiculopathy and which do not get better with treatment on similar lines. A thorough clinical examination of the entire limb including Tinel’s sign can clinch the diagnosis earlier in cases where obvious swelling is not present. Even unusual presentations, as in our case, can be dealt surgically with good results. PMID:27299039

  9. A Comparison of Interside Asymmetries of Lower Extremity Somatosensory Evoked Potentials in Anesthetized Patients with Unilateral Lumbosacral Radiculopathy

    PubMed Central

    Hale, Tyson; Knecht, Aaron

    2017-01-01

    Study Design Prospective cohort study. Purpose This study was to investigate interside asymmetries of three lower extremity somatosensory evoked potentials (SSEPs) in anesthetized patients with unilateral lumbosacral radiculopathy. Overview of Literature Although interside asymmetry is an established criterion of abnormal SSEP, little is known which of the lower SSEPs is more sensitive in detecting interside asymmetry in anesthetized patients. Methods Superficial peroneal nerve SSEP (SPN-SSEP), posterior tibial nerve SSEP (PTN-SSEP), and sural nerve SSEP were obtained in 31 lumbosacral surgery patients with unilateral lumbosacral radiculopathy, and compared with a group of 22 control subjects. Results The lumbosacral group showed significant larger interside asymmetry ratios of P37 latencies in SPN-SSEP and PTN-SSEP, and significant larger interside asymmetry ratio of P37-N45 amplitude in SPN-SSEP, when comparing with the control group. Within the lumbosacral group but not the control group, SPN-SSEP displayed significant larger interside asymmetry ratio in P37 latency. When referencing to the control group, more patients in the lumbosacral group displayed abnormal interside SPN-SSEP latency asymmetries which corroborated the symptom laterality. Conclusions The data suggested that SPN-SSEP was more sensitive in detecting interside latency asymmetry in anesthetized patients. PMID:28243377

  10. The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy.

    PubMed

    Baron, Ralf; Freynhagen, Rainer; Tölle, Thomas R; Cloutier, Christian; Leon, Teresa; Murphy, T Kevin; Phillips, Kem

    2010-09-01

    We evaluated the efficacy of pregabalin in patients with chronic lumbosacral radiculopathy. This randomized, controlled, withdrawal trial included five phases: screening (4-18 days); run-in (4-10 days) to screen out placebo responders; single-blind (28 days) to identify pregabalin responders; double-blind to randomize responders to pregabalin or placebo (35 days); and final study medication taper (7 days). The primary endpoint was time to loss of response (LOR) during the double-blind phase (1-point increase in pain, discontinuation, or rescue-medication use). In the single-blind phase, 58% of patients had 30% pain reduction. In the double-blind phase, pregabalin (n=110) and placebo (n=107) groups did not differ significantly in time to LOR. Adverse events caused the discontinuation of 9.9% and 5.6% of pregabalin-treated and placebo-treated patients, respectively. Most patients with chronic lumbosacral radiculopathy responded to pregabalin therapy; however, time to LOR did not significantly differ between pregabalin and placebo. Considering the results of all phases of the study, it is difficult to draw definitive conclusions from it, suggesting a need for further work to understand the clinical potential of pregabalin treatment for lumbosacral radiculopathy.

  11. Pelvic radiculopathies, lumbosacral plexopathies, and neuropathies in oncologic disease: a multidisciplinary approach to a diagnostic challenge

    PubMed Central

    Berry, Jonathan; Nisbet, Angus; Bloomfield, David; Burkill, Guy

    2013-01-01

    Abstract The purpose of this article is to familiarize the reader with the anatomy of the major pelvic nerves and the clinical features of associated lumbosacral plexopathies. To demonstrate this we illustrate several cases of malignant lumbosacral plexopathy on computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography. A new lumbosacral plexopathy in a patient with a prior history of abdominal or pelvic malignancy is usually of malignant etiology. Biopsies may be required to definitively differentiate tumour from posttreatment fibrosis, and in cases of inconclusive sampling or where biopsies are not possible, follow-up imaging may be necessary. In view of the complexity of clinical findings often confounded by a history of prior surgery and/or radiotherapy, a multidisciplinary approach between oncologists, neurologists, and radiologists is often required for what can be a diagnostic challenge. PMID:24433993

  12. Post-irradiation lumbosacral radiculopathy associated with multiple cavernous malformations of the cauda equina: Case report and review of the literature

    PubMed Central

    Drazin, Doniel; Kappel, Ari; Withrow, Stefan; Perry, Tiffany; Chu, Ray; Phuphanich, Surasak

    2017-01-01

    Background: Multiple radiation-induced cavernous malformations of the cauda equina are extremely rare. A review of the literature suggested that the post-irradiation lumbosacral radiculopathy in our patient was most likely associated with a diagnosis of multiple radiation-induced cavernous malformations of the cauda equina. Case Description: A 76-year-old man with a remote history of abdominal radiation therapy presented with a 6-month history of progressively worsening right foot drop and balance impairment. Magnetic resonance imaging (MRI) revealed multiple enhancing areas of the cauda equina concerning for carcinomatous meningitis, however, cerebrospinal fluid (CSF) analysis was unrevealing. Intraoperative findings were consistent with multiple radiation-induced cavernous malformations of the cauda equina. Conclusions: Multiple radiation-induced cavernous malformations of the cauda equina may mimic carcinomatous or infectious meningitis. Clinicians should be suspicious of this diagnosis when CSF and MRI findings are inconsistent with metastatic disease or infectious meningitis in patients who present with radiculopathy and a history of radiation therapy. PMID:28303206

  13. Incremental value of magnetic resonance neurography of Lumbosacral plexus over non-contributory lumbar spine magnetic resonance imaging in radiculopathy: A prospective study

    PubMed Central

    Chhabra, Avneesh; Farahani, Sahar J; Thawait, Gaurav K; Wadhwa, Vibhor; Belzberg, Allan J; Carrino, John A

    2016-01-01

    AIM: To test the incremental value of 3T magnetic resonance neurography (MRN) in a series of unilateral radiculopathy patients with non-contributory magnetic resonance imaging (MRI). METHODS: Ten subjects (3 men, 7 women; mean age 54 year and range 22-74 year) with unilateral lumbar radiculopathy and with previous non-contributory lumbar spine MRI underwent lumbosacral (LS) plexus MRN over a period of one year. Lumbar spine MRI performed as part of the MRN LS protocol as well as bilateral L4-S1 nerves, sciatic, femoral and lateral femoral cutaneous nerves were evaluated in each subject for neuropathy findings on both anatomic (nerve signal, course and caliber alterations) and diffusion tensor imaging (DTI) tensor maps (nerve signal and caliber alterations). Minimum fractional anisotropy (FA) and mean apparent diffusion coeffcient (ADC) of L4-S2 nerve roots, sciatic and femoral nerves were recorded. RESULTS: All anatomic studies and 80% of DTI imaging received a good-excellent imaging quality grading. In a blinded evaluation, all 10 examinations demonstrated neural and/or neuromuscular abnormality corresponding to the site of radiculopathy. A number of contributory neuropathy findings including double crush syndrome were observed. On DTI tensor maps, nerve signal and caliber alterations were more conspicuous. Although individual differences were observed among neuropathic appearing nerve (lower FA and increased ADC) as compared to its contralateral counterpart, there were no significant mean differences on statistical comparison of LS plexus nerves, femoral and sciatic nerves (P > 0.05). CONCLUSION: MRN of LS plexus is useful modality for the evaluation of patients with non-contributory MRI of lumbar spine as it can incrementally delineate the etiology and provide direct objective and non-invasive evidence of neuromuscular pathology. PMID:26834949

  14. Cervical Radiculopathy (Pinched Nerve)

    MedlinePlus

    ... help relieve pain, strengthen neck muscles, and improve range of motion. In some cases, traction can be used to ... Learn more about surgery for radiculopathy online at Cervical ... a wide range of musculoskeletal conditions and injuries. All articles are ...

  15. Distinguishing Radiculopathies from Mononeuropathies

    PubMed Central

    Robblee, Jennifer; Katzberg, Hans

    2016-01-01

    Identifying “where is the lesion” is particularly important in the approach to the patient with focal dysfunction where a peripheral localization is suspected. This article outlines a methodical approach to the neuromuscular patient in distinguishing focal neuropathies versus radiculopathies, both of which are common presentations to the neurology clinic. This approach begins with evaluation of the sensory examination to determine whether there are irritative or negative sensory signs in a peripheral nerve or dermatomal distribution. This is followed by evaluation of deep tendon reflexes to evaluate if differential hyporeflexia can assist in the two localizations. Finally, identification of weak muscle groups unique to a nerve or myotomal pattern in the proximal and distal extremities can most reliably assist in a precise localization. The article concludes with an application of the described method to the common scenario of distinguishing radial neuropathy versus C7 radiculopathy in the setting of a wrist drop and provides additional examples for self-evaluation and reference. PMID:27468275

  16. [Lumbosacral nerve bowstring disease].

    PubMed

    Shi, J G; Xu, X M; Sun, J C; Wang, Y; Guo, Y F; Yang, H S; Kong, Q J; Yang, Y; Shi, G D; Yuan, W; Jia, L S

    2017-03-21

    Objective: To define a novel disease-lumbosacral nerve bowstring disease, and propose the diagnostic criteria, while capsule surgery was performed and evaluated in the preliminary study. Methods: From June 2016 to December 2016, a total of 30 patients (22 male and 8 female; mean age of 55.1±9.7 years) with lumbosacral nerve bowstring disease were included in Department of Spine Surgery, Changzheng Hospital, the Second Military Medical University.Lumbosacral nerve bowstring disease was defined as axial hypertension of nerve root and spinal cord caused by congenital anomalies, which could be accompanied by other lesions as lumbar disc herniation, spinal cord stenosis or spondylolisthesis, or aggravated by iatrogenic lesions, resulting in neurological symptoms.This phenomenon is similar to a stretched string, the higher tension on each end the louder sound.Meanwhile, the shape of lumbosacral spine looks like a bow, thus, the disease is nominated as lumbosacral nerve bowstring disease.All the patients underwent capsule surgery and filled out Owestry disability index (ODI) and Tempa scale for kinesiophobia (TSK) before and after surgery. Results: The mean surgery time was (155±36) min, (4.3±0.4) segments were performed surgery.The pre-operative VAS, TSK and ODI scores were (7.6±0.8), (52.0±10.3) and (68.4±12.7), respectively.The post-operative VAS, TSK and ODI scores were (3.3±0.4), ( 24.6±5.2) and (32.1±7.4)(P<0.05, respectively), respectively. Conclusion: The definition and diagnostic criteria of lumbosacral nerve bowstring disease was proposed.Capsule surgery was an effective strategy with most patients acquired excellent outcomes as symptoms relieved and quality of life improved.

  17. The identification and characteristics of sacral parasympathetic preganglionic neurones.

    PubMed

    De Groat, W C; Ryall, R W

    1968-06-01

    1. Sacral parasympathetic preganglionic neurones were identified by intracellular and extracellular micro-electrode recording of antidromic potentials in response to stimulation of the pelvic nerve or the second or third sacral ventral roots.2. The segmental distribution of autonomic neurones varied in different cats. In some cats they were mainly in S2 segment, in others in S3 and in the remainder, in both S2 and S3.3. The antidromic potentials showed initial segment-somadendritic (IS-SD) inflexions and delayed depolarizations and were slightly less prolonged than those of sympathetic neurones but more prolonged than those of spinal motoneurones. After-hyperpolarization was observed after the antidromic spike potential.4. The conduction velocities for sacral parasympathetic preganglionic fibres were less than 12.5 m/sec and thus were similar to those of sympathetic preganglionic fibres.5. Parasympathetic neurones were not excited by micro-electro-phoretically applied 5-hydroxytryptamine, noradrenaline or acetylcholine.

  18. Comparison between bipolar pulsed radiofrequency and monopolar pulsed radiofrequency in chronic lumbosacral radicular pain

    PubMed Central

    Chang, Min Cheol; Cho, Yun Woo; Ahn, Sang Ho

    2017-01-01

    Abstract Background: Chronic lumbosacral radicular pain is a challenging medical problem with respect to therapeutic management. Many patients with lumbosacral radicular pain complain of persistent leg pain after transforaminal epidural steroid injection. Nowadays, pulsed radiofrequency (PRF) stimulation on the dorsal root ganglion (DRG) is widely used for controlling lumbosacral radicular pain. Methods: We evaluated the effect of bipolar PRF on the DRG for the management of lumbosacral radicular pain. In addition, we compared the effect of bipolar PRF to monopolar PRF. Fifty patients with chronic lumbosacral radicular pain were included in the study and randomly assigned to 1 of 2 groups, the bipolar or monopolar PRF group (n = 25 per group). Pain intensity was evaluated using a numeric rating scale (NRS) at pretreatment, and 1, 2, and 3 months after treatment. Results: When compared to the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at 1, 2, and 3 months after treatment. Reductions in the NRS scores over time were significantly larger in the bipolar PRF group. Three months after treatment, 19 patients (76.0%) in the bipolar PRF group and 12 patients (48.0%) in the monopolar PRF group reported successful pain relief (pain relief of ≥50%). Conclusion: The use of bipolar PRF on the DRG can be an effective and safe interventional technique for chronic refractory lumbosacral radiculopathy, particularly in patients whose pain are refractory to epidural steroid injection or monopolar PRF stimulation. PMID:28248888

  19. Brainstem origin of preganglionic cardiac motoneurons in the muskrat.

    PubMed

    Panneton, W M; McCulloch, P F; Tan, Y; Tan, Y; Yavari, P

    1996-11-04

    The muskrat, and aquatic rodent with a brisk and reliable diving response, shows a remarkable bradycardia after nasal stimulation. However, the medullary origin of cardiac preganglionic motoneurons is unknown in this species. We injected fat pads near the base of the heart of muskrats with a WGA-HRP solution to label retrogradely preganglionic parasympathetic neurons that project to the cardiac plexi. Results showed that the preponderance of labeled neurons was in ventrolateral parts of the medulla from 1.5 mm caudal to the obex to 2.0 mm rostral. Eighty-nine percent of the labeled neurons were located bilaterally in the external formation of the nucleus ambiguus, 5.6% were in the lateral extreme of the dorsal motor nucleus of the vagus nerve and 5.3% were found in the intermediate area in between these two nuclei. Although controversy still exists concerning the medullary origin of preganglionic cardiac motoneurons, our results from muskrats agree with those from most other species where preganglionic cardiac motoneurons were located just ventral to the nucleus ambiguus.

  20. Tarlov cyst as a rare cause of S1 radiculopathy: A case report.

    PubMed

    Nadler, S F; Bartoli, L M; Stitik, T P; Chen, B

    2001-05-01

    A 37-year-old female physician presented with a chief complaint of left posterior thigh pain, which began insidiously approximately 4 months before her initial examination. Initially, she had been evaluated by her physician, and magnetic resonance imaging (MRI) was ordered. The MRI scan was reported to be within normal limits, with the exception of minimal disc bulging at L4-5. She had received physical therapy with little benefit and was referred for physiatric assessment. Review of the patient's original MRI scan showed the presence of perineurial (Tarlov) cysts within the sacral canal at the level of S2, with compression of the adjacent nerve root. Subsequent electrodiagnostic testing showed axonal degeneration consistent with an S1 radiculopathy. Tarlov cysts can be a rare cause of lumbosacral radiculopathy and should be considered in the differential diagnosis of radicular leg pain.

  1. Anterior lumbosacral polyradiculopathy after intrathecal administration of methotrexate.

    PubMed

    Pascual, Ana M; Coret, Francisco; Casanova, Bonaventura; Láinez, Miguel J A

    2008-04-15

    Transient paraparesis has been reported with intrathecal chemotherapy agents and the most common cause is an incomplete inflammatory myelopathy. We report a case of a 30-year-old man diagnosed with acute lymphoblastic leukaemia who developed subacute anterior lumbosacral polyradiculopathy following intrathecal methotrexate, an unusual complication of intrathecal chemotherapy in adults. Spinal magnetic resonance discarded myelopathy. Cerebrospinal fluid exam showed elevation of protein, mononuclear pleocytosis and immunoglobulin synthesis. Electrodiagnostic study showed alterations of sensory and motor conductions only in lower limbs, consistent with multilevel radiculopathy. Differential diagnosis included toxic and neoplastic polyradiculopathy, and axonal variant of acute inflammatory demyelinating polyradiculoneuropathy. The authors review possible pathogenic mechanisms and propose several therapeutic and preventive options.

  2. Patient-reported-outcomes in subjects with painful lumbar or cervical radiculopathy treated with pregabalin: evidence from medical practice in primary care settings.

    PubMed

    Saldaña, María Teresa; Navarro, Ana; Pérez, Concepción; Masramón, Xavier; Rejas, Javier

    2010-06-01

    The objective of this study was to evaluate the effect of pregabalin in painful cervical or lumbosacral radiculopathy treated in Primary Care settings under routine clinical practice. An observational, prospective 12-week secondary analysis was carried-out. Male and female above 18 years, naïve to PGB, with refractory chronic pain secondary to cervical/lumbosacral radiculopathy were enrolled. SF-MPQ, Sheehan Disability Inventory, MOS Sleep Scale, Hospital Anxiety and Depression Scale and the EQ-5D were administered. A total of 490 (34%) patients were prescribed PGB-monotherapy, 702 (48%) received PGB add-on, and 159 (11%) were administered non-PGB drugs. After 12 weeks, significant improvements in pain, associated symptoms of anxiety, depression and sleep disturbances, general health; and level of disability were observed in the three groups, being significantly greater in PGB groups. In routine medical practice, monotherapy or add-on pregabalin is associated with substantial pain alleviation and associated symptoms improvements in painful cervical or lumbosacral radiculopathy.

  3. Patient-reported-outcomes in subjects with painful lumbar or cervical radiculopathy treated with pregabalin: evidence from medical practice in primary care settings

    PubMed Central

    Navarro, Ana; Pérez, Concepción; Masramón, Xavier; Rejas, Javier

    2009-01-01

    The objective of this study was to evaluate the effect of pregabalin in painful cervical or lumbosacral radiculopathy treated in Primary Care settings under routine clinical practice. An observational, prospective 12-week secondary analysis was carried-out. Male and female above 18 years, naïve to PGB, with refractory chronic pain secondary to cervical/lumbosacral radiculopathy were enrolled. SF-MPQ, Sheehan Disability Inventory, MOS Sleep Scale, Hospital Anxiety and Depression Scale and the EQ-5D were administered. A total of 490 (34%) patients were prescribed PGB-monotherapy, 702 (48%) received PGB add-on, and 159 (11%) were administered non-PGB drugs. After 12 weeks, significant improvements in pain, associated symptoms of anxiety, depression and sleep disturbances, general health; and level of disability were observed in the three groups, being significantly greater in PGB groups. In routine medical practice, monotherapy or add-on pregabalin is associated with substantial pain alleviation and associated symptoms improvements in painful cervical or lumbosacral radiculopathy. PMID:19798503

  4. Does Electrodiagnostic Confirmation of Radiculopathy Predict Pain Reduction after Transforaminal Epidural Steroid Injection? A Multicenter Study

    PubMed Central

    McCormick, Zachary; Cushman, Daniel; Caldwell, Mary; Marshall, Benjamin; Ghannad, Leda; Eng, Christine; Patel, Jaymin; Makovitch, Steven; Chu, Samuel K; Babu, Ashwin N.; Walega, David R.; Marciniak, Christina; Press, Joel; Kennedy, David J.; Plastaras, Christopher

    2015-01-01

    Objective Minimal definitive literature identifies patients with radicular pain who would benefit most from epidural steroid injection (ESI). This study investigated if electromyographic (EMG) confirmation of radiculopathy with active or chronic denervation predicts a positive treatment outcome following ESI. Design Longitudinal cohort study of adults who underwent EMG and subsequent transforaminal ESI within 6 months. The proportion of individuals who experienced >50% pain relief and mean change in daily morphine equivalents (DME) were calculated. Results 170 individuals with respective mean (Standard Deviation) age and duration of symptoms of 55 (15) years and 36 (56) months were included. Mean time to <30 day and >30 day follow-up post-injection were 18 (6) and 99 (130) days, respectively. At >30 day follow-up, a larger proportion of EMG-confirmed individuals (37.7%) reported >50% pain reduction compared to EMG-negative individuals (17.8%) (p=0.03). This was significant for lumbosacral (40% vs. 15%, p=0.01) but not cervical symptoms (p>0.05). Mean decrease in DME at long-term follow-up in EMG-confirmed compared to EMG-negative individuals trended toward significance (-4 vs. -1, p=0.11). There was no significant relationship between myotomal spontaneous activity and pain or opioid use. Conclusions Needle EMG predicts long-term pain reduction from transforaminal ESI in patients with lumbosacral radiculopathy, regardless of the presence of active denervation. PMID:26251843

  5. Lumbosacral nerve root avulsion.

    PubMed

    Chin, C H; Chew, K C

    1997-01-01

    Lumbosacral nerve root avulsion is a rare clinical entity. Since the first description in 1955, only 35 cases have been reported. It is often associated with pelvic fractures and may be missed in the initial clinical examination as these patients usually present with multiple injuries. We present three such cases with clinical and radiological findings. These patients were involved in road traffic accidents. Two had fractures of the sacroiliac joint with diastasis of the symphysis pubis (Tile type C 1.2) and one had fractures of the public rami (Tile type B 2.1). All three had various degrees of sensory and motor deficit of the lower limbs. Lumbar myelogram shows characteristic pseudomeningoceles in the affected lumboscral region. Magnetic resonance (MR) imaging provides an additional non-invasive modality to diagnose this condition.

  6. Pseudo-radiculopathy in subacute trochanteric bursitis of the subgluteus maximus bursa.

    PubMed

    Swezey, R L

    1976-08-01

    Seventy patients, averaging 82 years of age, were referred for low back pain and/or a suspected herniated disk. Objective neurological deficits consistent with L5 or S1 root involvement were identified in 5 of the 70 patients. Trochanteric bursitis (TB), often mimicking radiculitis, was diagnosed in 31 patients. Trochanteric bursitis was associated with lumbosacral strain and lumbar osteoarthrosis in 21 of 31 patients and with an S1 disk in 1 of those 31 patients. Degenerative joint disease of the ipsilateral hip was present in 4 of 20 of these patients with TB. Six patients with low back pain had both hip and knee arthritis (including two patients with rheumatoid arthritis). Three patients had degenerative hip disease without low back complaints. The remaining patient had TB associated with left hemiparesis. All patients had limitation of lumbosacral motion. Patients with arthritic hips had apparent shortening of the affected leg of one-half inch or greater. Trochanteric bursitis is a common complication of lumbosacral strain, frequently mimicking radiculopathy. Gait alteration associated with back pain or static traction on gluteal musculature during rest therapy may be predisposing factors. The association of TB with hip disease and/or leg length discrepancies was again confirmed.

  7. Anhidrosis in multiple system atrophy: a preganglionic sudomotor dysfunction?

    PubMed

    Donadio, Vincenzo; Nolano, Maria; Elam, Mikael; Montagna, Pasquale; Provitera, Vincenzo; Bugiardini, Enrico; Baruzzi, Agostino; Santoro, Lucio; Liguori, Rocco

    2008-04-30

    Anhidrosis occurs in the majority of multiple system atrophy (MSA) patients but the underlying site of lesion is not well established. We describe three patients with long-standing MSA and anhidrosis diagnosed on the basis of a thermoregulatory sweating test. In biopsies of anhidrotic skin, immunofluorescence analysis disclosed a well preserved postganglionic sudomotor innervation in all three patients supporting the hypothesis of a preganglionic nerve fiber lesion underlying their anhidrosis. Postganglionic sudomotor fiber integrity was also confirmed by normal electrodermal responses in one patient, whereas such responses and microneurographically detectable skin sympathetic nerve activity were absent in the other two MSA patients, suggesting a functional inactivity of structurally intact postganglionic sympathetic skin fibers.

  8. Nonoperative Management of Cervical Radiculopathy.

    PubMed

    Childress, Marc A; Becker, Blair A

    2016-05-01

    Cervical radiculopathy describes pain in one or both of the upper extremities, often in the setting of neck pain, secondary to compression or irritation of nerve roots in the cervical spine. It can be accompanied by motor, sensory, or reflex deficits and is most prevalent in persons 50 to 54 years of age. Cervical radiculopathy most often stems from degenerative disease in the cervical spine. The most common examination findings are painful neck movements and muscle spasm. Diminished deep tendon reflexes, particularly of the triceps, are the most common neurologic finding. The Spurling test, shoulder abduction test, and upper limb tension test can be used to confirm the diagnosis. Imaging is not required unless there is a history of trauma, persistent symptoms, or red flags for malignancy, myelopathy, or abscess. Electrodiagnostic testing is not needed if the diagnosis is clear, but has clinical utility when peripheral neuropathy of the upper extremity is a likely alternate diagnosis. Patients should be reassured that most cases will resolve regardless of the type of treatment. Nonoperative treatment includes physical therapy involving strengthening, stretching, and potentially traction, as well as nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage. Epidural steroid injections may be helpful but have higher risks of serious complications. In patients with red flag symptoms or persistent symptoms after four to six weeks of treatment, magnetic resonance imaging can identify pathology amenable to epidural steroid injections or surgery.

  9. Lumbosacral spine x-ray

    MedlinePlus

    X-ray - lumbosacral spine; X-ray - lower spine ... The test is done in a hospital x-ray department or your health care provider's office by an x-ray technician. You will be asked to lie on the x-ray table ...

  10. Thoracic Radiculopathy due to Rare Causes

    PubMed Central

    2016-01-01

    Thoracic radiculopathy represents an uncommon spinal disorder that is frequently overlooked in the evaluation of thoracic, or abdominal pain syndrome. The clinical representation of this uncommon disorder is often atypical. With many differential diagnoses to consider, it is not surprising that the cause of thoracic radiculopathy is often not discovered for months, or years, after the symptoms arise. We report two rare cases of thoracic radiculopathy; one case was caused by extraskeletal Ewing sarcoma (EES) along the thoracic paraspinal area, and the other by foraminal stenosis, due to a bony spur of the thoracic vertebra. As such, thoracic radiculopathy should be considered in the diagnosis of patients with thoracic and abdominal pain, especially if initial diagnostic studies are inconclusive. PMID:27446792

  11. [Follow-up in coal miners suffering from lumbo-sacral radiculopathy].

    PubMed

    Yakovleva, N M; Gorblyansky, Yu Yu; Pictushanskaya, T E

    2015-01-01

    The results of a retrospective dynamic monitoring in 1976-2014 of the workers of coal mines of main (n = 1732) and auxiliary (n = 1059) occupations, with diagnosed occupational sciatica (OS) in the center of occupational medicineare viewed. It was found that the workers of the main occupationson average of 3 years earlier than initially treated at the center of occupational medicine, and occupational disease OS sets for them 1.5-2 years earlier. The analysis of the formation of risk groups depending on the diagnosis and treatment of the primary analysis of the incidence of OS.

  12. Introduction to Lumbosacral and Sacropelvic Fixation Strategies.

    PubMed

    Hsieh, Patrick C; Mummaneni, Praveen V

    2016-07-01

    We are pleased to present this Neurosurgical Focus video supplement on lumbosacral and sacropelvic fixation strategies. Despite advancement in surgical techniques and technologies in spine, achieving consistent solid fusion across the lumbosacral junction remains a major challenge. The anatomy of the lumbosacral junction allows for a higher range of motion compared to other areas of the thoracolumbar spine. The L5-S1 interspace is exposed to significant shear forces. As a result, complications such as pseudoarthrosis, screw pull-out, implant fracture, or sacral fractures can occur. Complications are particularly seen in long fusion constructs ending across the lumbosacral junction. To reduce these complications, various lumbosacral and sacropelvic fixation techniques have been developed and utilized. The current supplement is intended to provide instructional videos that illustrate several current techniques for lumbosacral and sacropelvic fixation. The collection includes techniques for anterior L5-S1 interbody fusion, minimally invasive L5-S1 interbody fusions, lumbosacral pedicle screw placement, sacroiliac fusion, and sacro-alar-iliac screw placement. The authors of the videos in the supplement have provided detailed narration and video illustration to describe the nuances of the various open and minimally invasive techniques for lumbosacral and sacral-pelvic fixation. We are pleased to have such a collection of quality video illustration from experts in the field. It's been our privilege to serve as guest editors for this supplement and we believe that you will enjoy the contents of this supplement.

  13. The role of Gd-enhanced three-dimensional MRI fast low-angle shot (FLASH) in the evaluation of symptomatic lumbosacral nerve roots.

    PubMed

    Kikkawa, I; Sugimoto, H; Saita, K; Ookami, H; Nakama, S; Hoshino, Y

    2001-01-01

    In the field of lumbar spine disorders, three-dimensional (3-D) magnetic resonance imaging (MRI) can clearly depict a lumbar nerve root from the distal region to the dorsal root ganglion. In this study, we used a gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) enhanced-three-dimensional (3-D) fast low-angle shot (FLASH) sequence when examining lumbosacral disorders. The subjects were 33 patients (14 men and 19 women) in whom lumbosacral neural compression had been diagnosed clinically. Twenty-one patients had lumbar disc herniation, 11 had lumbar spinal stenosis, and 1 had lumbar radiculopathy caused by rheumatoid arthritis. Five subjects with low back pain were also studied as a control group. In all patients and in all 5 of the controls, the dorsal root ganglion of every root was enhanced clearly. There was no root enhancement in the 5 controls. Enhancement of the symptomatic nerve roots, caused by compression, was found in 11 of the 33 patients. All 11 patients had radiculopathy, and muscle weakness was more frequent in patients with enhanced nerve roots than in those without enhancement. There was no enhancement of the cauda equina, even in the patients with cauda syndrome. The enhancement effect may reflect some pathological condition of the compressed nerve root and needs to be studied further.

  14. Surgical techniques for lumbo-sacral fusion.

    PubMed

    Tropiano, P; Giorgi, H; Faure, A; Blondel, B

    2017-02-01

    Lumbo-sacral (L5-S1) fusion is a widely performed procedure that has become the reference standard treatment for refractory low back pain. L5-S1 is a complex transition zone between the mobile lordotic distal lumbar spine and the fixed sacral region. The goal is to immobilise the lumbo-sacral junction in order to relieve pain originating from this site. Apart from achieving inter-vertebral fusion, the main challenge lies in the preoperative determination of the fixed L5-S1 position that will be optimal for the patient. Many lumbo-sacral fusion techniques are available. Stabilisation can be achieved using various methods. An anterior, posterior, or combined approach may be used. Recently developed minimally invasive techniques are gaining in popularity based on their good clinical outcomes and high fusion rates. The objective of this conference is to resolve the main issues faced by spinal surgeons in their everyday practice.

  15. Restless legs syndrome mimicking S1 radiculopathy.

    PubMed

    Zambelis, Th; Wolgamuth, B R; Papoutsi, S N; Economou, N T

    2016-01-01

    Α case of a chronic idiopathic form of a severe type of Restless Legs Syndrome (RLS), which developed during pregnancy and persisted after this, misdiagnosed for 34 years as radiculopathy S1, is reported. In spite of the thorough clinical and laboratory investigation, in addition to constant changes of the therapeutic approach, the diagnosis of S1 radiculopathy could not be confirmed, resulting in a chronic clinical course; the latter was characterized by relapses and remissions not attributed or linked in any way to the treatment (various types of). In fact, it was due to a routine workup in a sleep clinic, where the patient was referred because of a coincident chronic insomnia (Restless Legs Syndrome is a known and important cause of insomnia/chronic insomnia), which resulted in a proper diagnosis and treatment of this case. With the use of Restless Legs Syndrome appropriate treatment (Pramipexole 0.18 mg taken at bedtime, a dopaminergic agent and Level A recommended drug for Restless Legs Syndrome) an excellent response and immediate elimination of symptoms was achieved. Restless Legs Syndrome may present with a variety of symptoms (with the most prominent shortly being reported with the acronym URGE: Urge to move the legs usually associated with unpleasant leg sensations, Rest induces symptoms, Getting active brings relief, Evening and night deteriorate symptoms); given the fact that Restless Legs Syndrome presents with a great variety and heterogeneity of symptoms (mostly pain, dysesthesia and paresthesia), which may occur in several other diseases (the so called "RLS mimics"), proper diagnosis of Restless Legs Syndrome usually fails. Restless Legs Syndrome misinterpreted as S1 radiculopathy, to the best of our knowledge, has not been reported yet in the literature. Here, case history, clinical course and common RLS mimics are presented. Different forms of Restless Legs Syndrome manifestations, which are commonly -as in this case- misinterpreted due to their

  16. Reflex patterns in preganglionic sympathetic neurons projecting to the superior cervical ganglion in the rat.

    PubMed

    Bartsch, T; Jänig, W; Häbler, H J

    2000-09-01

    Reflex patterns in preganglionic neurons projecting in the cervical sympathetic trunk (CST) were analyzed in response to stimulation of various afferent systems. We focused on the question whether these preganglionic neurons can be classified into functionally distinct subpopulations. Reflex responses were elicited by stimulation of trigeminal and spinal nociceptive, thermoreceptive as well as baroreceptor and chemoreceptor afferents. Multi- and single fiber preparations were studied in baroreceptor intact and sino-aortically denervated animals. Spontaneous activity of 36 preganglionic single neurons ranged from 0.2 to 3.5 imp/s (median= 1.11 imp/s). The degree of cardiac rhythmicity (CR) in the activity of sympathetic neurons was 69.5+/-13% (mean+/-S.D.; N=52; range=39-95%). Noxious stimulation of acral skin activated the majority (67%) of sympathetic preparations by 37+/-25% (N=35) above pre-stimulus activity; 15% were inhibited. In these neurons the response to noxious stimulation of acral skin was significantly correlated with the degree of CR (P<0.001, N=52) in that neurons showing the strongest excitation to noxious stimulation displayed the strongest CR. Noxious mechanical stimulation of body trunk skin (N=60) inhibited the majority (80%) of fiber preparations tested (by 34+/-18% of pre-stimulus activity, N=48); an activation was not observed. Cold stimulation of acral (N=9) and body trunk skin (N=42) activated most fiber preparations. Trigeminal stimulation evoked a uniform reflex activation of preganglionic neurons (+79+/-73% of pre-stimulus activity, N=32). Chemoreceptor stimulation by systemic hypercapnia elicited inhibitory (-31+/-19%, N=8) as well as excitatory (+59+/-5%, N=4) responses. These results show that preganglionic sympathetic neurons projecting to target organs in the head exhibit distinct reflex patterns to stimulation of various afferent systems; however, a clear classification into different functional subgroups did not emerge

  17. Development of a novel experimental rat model for neonatal pre-ganglionic upper brachial plexus injury.

    PubMed

    Ochiai, Hidenobu; Ikeda, Tomoaki; Mishima, Kenichi; Yoshikawa, Tetsuya; Aoo, Naoya; Iwasaki, Katsunori; Fujiwara, Michihiro; Ikenoue, Tsuyomu; Nakano, Shinichi; Wakisaka, Shinichiro

    2002-09-15

    A neonatal upper brachial plexus injury, referred to as Erb's palsy, is a serious obstetric problem. Some surgical methods are used to treat this injury, but they are inadequate. To seek new treatments for Erb's palsy, we used a model for cervical preganglionic root transection in neonate rats and evaluated the behavioral and histological compatibility of this model with Erb's palsy. Two groups were used in this study. In the group, receiving the Erb operation, the left anterior and posterior roots of spinal vertebra C5-C7 were transected at the preganglionic level, and the results were compared with those of a group that received a sham operation. In the group, receiving the Erb operation, walking difficulties and behavioral abnormalities were observed. These observations were noted on the side where the transection took place, and the problems were attributed to proximal muscle weakness in the forelimb. Additionally, the forepaw grip was not impaired. Furthermore, in this group, the number of anterior horn cells in the cervical cord on the transected side was significantly lower than that on the contralateral side (P < 0.001). The results of this study indicate that the model fulfills the criteria for the clinical symptoms of Erb's palsy and that it may also serve as a new method for enabling treatment of the condition.

  18. Lumbosacral intervertebral disk disease in six cats.

    PubMed

    Harris, Jennipher E; Dhupa, Sarit

    2008-01-01

    Medical records of six cats diagnosed with lumbosacral intervertebral disk disease were reviewed. Clinical signs included reluctance to jump, low tail carriage, elimination outside the litter box, reluctance to ambulate, pelvic-limb paresis, urinary incontinence, and constipation. All cats had lumbosacral hyperpathia on palpation. Computed tomography in four cats revealed evidence of extradural spinal cord compression at the seventh lumbar (L(7)) to first sacral (S(1)) vertebral interspace. Compression was confirmed via myelography in three of these four cats, with confirmation in the fourth cat at the time of decompressive laminectomy. Each of the six cats underwent dorsal decompressive laminectomy at the L(7) to S(1) interspace. Postoperative clinical follow-up lasted 3 to 35 months, with most cats having excellent outcomes.

  19. A symptomatic lumbosacral perineural cyst -A case report-

    PubMed Central

    Choi, Byung Hee; Kim, Jin Mo

    2012-01-01

    Lumbosacral perineural cysts are formed by the arachnoid membrane of the nerve root at the lumbosacral level. Most of these cysts are asymptomatic and are found incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) for other causes of chronic lower back pain. This type of cyst requires a differential diagnosis to distinguish it from other causes of radiating pain and neurological symptoms. In the present case, a symptomatic lumbosacral perineural cyst was found, and pain relief was achieved by non-surgical treatment. A lumbosacral perineural cyst was identified from a differential diagnosis of a lumbar disc disorder that presented as radiating pain and neurological symptoms. PMID:22679550

  20. Lumbosacral plexus in Brazilian Common Opossum.

    PubMed

    Senos, R; Ribeiro, M S; Benedicto, H G; Kfoury Júnior, J R

    2016-01-01

    The opossum has been suggested as an animal model for biomedical studies due to its adaptability to captivity and number of births per year. Despite many studies on morphology and experimental neurology using this opossum model, the literature does not offer details of the nerves of the lumbosacral plexus in this species. Ten lumbosacral plexus were dissected to describe the peripheral innervations of the Brazilian Common Opossum (Didelphis aurita) and compare the results with Eutheria clade species. The tensor fasciae latae muscle was absent and there was only one sartorius muscle for each limb. The distribution of the nerves were similar to other mammals, except for the caudal gluteal nerve, sartorius muscle innervations and the position of the pudendal nerve which arose from the major ischiatic foramen together with the ischiatic nerve, the cranial gluteal nerve and the caudal gluteal nerve. No anatomical variation was found. The special position of the pudendal nerve suggested that the Brazilian Common Opossum is a better model than rats or rabbits in surgical procedures with that specific nerve. In addition, the study revealed that the pelvic limb nerves are not an invariable structure of reference for muscle homology and homonym as reported previously. New investigation using other species of opossums are necessary to best comprehend the lumbosacral plexus distribution in the Methatheria clade and to confirm that other opossum species is eligible as a good model for pudendal nerve studies.

  1. [Antalgic radiotherapy in lumbosacral carcinomatous neuropathies].

    PubMed

    Russi, E G; Gaeta, M; Pergolizzi, S; Settineri, N; Frosina, P; De Renzis, C

    1994-06-01

    Lumbosacral carcinomatous neuropathy (LCN) may be caused by infiltration or compression of the lumbosacral plexi and nerves from intrapelvic or paraaortic neoplasms. The authors submitted 23 patients complaining of LCN with CT documented intrapelvic or paraaortic tumors to palliative radiotherapy. Megavoltage external beam irradiation was administered using a 6-MV linear accelerator. Treatment field sizes ranged from 56 cm2 to 235 cm2 (mean: 150.54 cm2) and encompassed only the site where the disease involved the lumbosacral plexus or its branches. > or = 3 Gy/day fractions were used. Twenty-one of 22 assessable patients (95.4%) obtained LCN pain relief; 19 (86.3%) obtained complete LCN pain relief. The median time to pain progression (TPP) was 150 days (range: 39-510 days). The median survival was 165 days. Seven patients were LCN pain-free at death. Two patients are alive and LCN pain-free. The remaining 12 patients had recurrent LCN pain: four of them were reirradiated at the site of previous neuropathy and only two had partial relief again. The authors conclude that it is advisable to submit to palliative radiotherapy the inoperable disseminated and/or recurrent cancer patients complaining of LCN, to use large fractions not to occupy the extant time of their already short life-expectancy, and to design small fields to avoid acute side-effects.

  2. Arachnoiditis Following Caudal Epidural Injections for the Lumbo-Sacral Radicular Pain

    PubMed Central

    Nanjayan, Shashi Kumar; Yallappa, Sachin; Bommireddy, Rajendra

    2013-01-01

    Caudal epidural steroid injection is a very common intervention in treatment of low back pain and sciatica symptoms. Although extensively used, it is not devoid of complications. A few reports of chemical and infective arachnoiditis exist following lumbar epidural anaesthesia, but none following a caudal epidural steroid injection.We report a case of arachnoiditis following caudal epidural steroid injections for lumbar radiculopathy. The patient presented with contralateral sciatica, worsening low back pain and urinary retention few days following the injection, followed by worsening motor functions in L4/L5/S1 myotomes with resultant dense foot drop. Gadolinium-enhanced magnetic resonance imaging suggested infective arachnoiditis with diffuse enhancement and clumping of the nerve roots within the lumbar and sacral thecal sac. As the number of injections in the management of back pain and lumbo-sacral radicular pain is increasing annually, it is imperative to have a thorough understanding of this potentially dangerous complication and educate the patients appropriately. PMID:24353855

  3. Ballroom dancing and cervical radiculopathy: a case report.

    PubMed

    Tsung, P A; Mulford, G J

    1998-10-01

    Dance injuries associated with cervical radiculopathy have not been described in the literature. This report describes the case of an international-style ballroom dancer who developed a cervical radiculopathy as a result of frequent lateral rotation and hyperextension of the cervical spine during dancing. The patient's symptoms and signs suggestive of a left C7 radiculopathy were confirmed and documented by both magnetic resonance imaging and electrodiagnostic testing. The patient was treated conservatively with activity modification, nonsteroidal anti-inflammatory drugs, and alternative medicine approaches, including herbs and acupuncture. Her neck pain and cervical radicular symptoms declined in severity, but continued even 4 1/2 months after the onset of her symptoms. She did not wish to try steroids either through an oral or epidural route and refused surgical intervention. This case report illustrates an unconventional manner in which a left cervical radiculopathy was clinically produced. The neck motions and positions of frequent hyperextension and lateral rotation demonstrated by this ballroom dancer simulated a pattern and sequence of movements that promoted the development of signs and symptoms of a left cervical radiculopathy.

  4. Sympathetic preganglionic efferent and afferent neurons mediated by the greater splanchnic nerve in rabbit

    NASA Technical Reports Server (NTRS)

    Torigoe, Yasuhiro; Cernucan, Roxana D.; Nishimoto, Jo Ann S.; Blanks, Robert H. I.

    1985-01-01

    As a part of the study of the vestibular-autonomic pathways involved in motion sickness, the location and the morphology of preganglionic sympathetic neurons (PSNs) projecting via the greater splanchnic nerve were examined. Retrograde labeling of neurons was obtained by application of horseradish peroxidase to the cut end of the greater splanchnic nerve. Labeled PSNs were found, ipsilaterally, within the T1 to T11 spinal cord segments, with the highest density of neurons in T6. Most PSNs were located within the intermediolateral column, but a significant portion also occurred within the lateral funiculus, the intercalated region, and the central autonomic area; the proportion of labeling between the four regions depended on the spinal cord segment.

  5. Spinal manipulation or mobilization for radiculopathy: a systematic review.

    PubMed

    Leininger, Brent; Bronfort, Gert; Evans, Roni; Reiter, Todd

    2011-02-01

    In this systematic review, we present a comprehensive and up-to-date systematic review of the literature as it relates to the efficacy and effectiveness of spinal manipulation or mobilization in the management of cervical, thoracic, and lumbar-related extremity pain. There is moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy. The quality of evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low. At present, no evidence exists for the treatment of thoracic radiculopathy. Future high-quality studies should address these conditions.

  6. The chiropractic management of two cases of cervical spondylotic radiculopathy

    PubMed Central

    Dufton, John A.; Giantomaso, Tony

    2003-01-01

    Cervical spondylotic radiculopathy (CSR) is one of the potential sources of radiculopathy, particularly in patients aged 40 to 60 years. The hallmark sign of cervical-brachial pain presents in the majority of the cases, however a definitive clinical diagnosis is often difficult in the absence of reliable and valid diagnostic tests. Two cases of presumed CSR illustrate the usefulness of applying a comprehensive mechanical assessment that guides the patient's rehabilitation regardless of the traditional anatomical diagnosis. A brief overview of the epidemiology, clinical presentation, and management of CSR is also presented.

  7. A novel method of anterior lumbosacral cage reconstruction.

    PubMed

    Mathios, Dimitrios; Kaloostian, Paul Edward; Bydon, Ali; Sciubba, Daniel M; Wolinsky, Jean Paul; Gokaslan, Ziya L; Witham, Timothy F

    2014-02-01

    Reconstruction of the lumbosacral junction is a considerable challenge for spinal surgeons due to the unique anatomical constraints of this region as well as the vectors of force that are applied focally in this area. The standard cages, both expandable and nonexpendable, often fail to reconstitute the appropriate anatomical alignment of the lumbosacral junction. This inadequate reconstruction may predispose the patient to continued back pain and neurological symptoms as well as possible pseudarthrosis and instrumentation failure. The authors describe their preoperative planning and the technical characteristics of their novel reconstruction technique at the lumbosacral junction using a cage with adjustable caps. Based precisely on preoperative measurements that maintain the appropriate Cobb angle, they performed reconstruction of the lumbosacral junction in a series of 3 patients. All 3 patients had excellent installation of the cages used for reconstruction. Postoperative CT scans were used to radiographically confirm the appropriate reconstruction of the lumbosacral junction. All patients had a significant reduction in pain, had neurological improvement, and experienced no instrumentation failure at the time of latest follow-up. Taking into account the inherent morphology of the lumbosacral junction and carefully planning the technical characteristics of the cage installation preoperatively and intraoperatively, the authors achieved favorable clinical and radiographic outcomes in all 3 cases. Based on this small case series, this technique for reconstruction of the lumbosacral junction appears to be a safe and appropriate method of reconstruction of the anterior spinal column in this technically challenging region of the spine.

  8. Lumbar discal cyst as a cause of radiculopathy: case report.

    PubMed

    Cho, Newton; Keith, Julia; Pirouzmand, Fahard

    2016-12-01

    Lumbar discal cysts are rare entities causing radicular pain with unknown etiologies. We report a case of a 42-year-old man who developed radiculopathy secondary to a lumbar discal cyst. Our case sheds some light on anatomy, possible etiological association and clinical course which can help management.

  9. Restless Leg Syndrome and Sleep Quality in Lumbar Radiculopathy Patients

    PubMed Central

    Terzi, Murat; Akpinar, Kursad; Paksoy, Kemal; Cebeci, Ibrahim; Iyigun, Omer

    2014-01-01

    Background. To investigate the frequency of restless leg syndrome (RLS), sleep quality impairment, depression, fatigue, and sleep behavior disorder and to determine the effects of surgery on these parameters in radiculopathy patients resistant to conservative treatment. Methods. The present study included 66 lumbar radiculopathy patients, who were resistant to conservative treatment and had indication of surgery. Five different questionnaires were performed to assess depression (the Beck Depression Inventory (BDI)), sleep quality (the Pittsburgh Sleep Quality Index (PSQI)), fatigue (the Fatigue Severity Scale (FSS)), and presence of RLS and rapid eye movement sleep behavior disorder (RBD). The same questionnaires were also performed on a control group (n = 61). Results. Of the radiculopathy patients, 68.1% had RLS and 92.4% had fatigue. Of the controls, 16.4% had RLS and 59% had fatigue. RBD was present in 8 (12.1%) patients and 3 (4.9%) controls. The PSQI revealed that sleep quality was impaired in 46 (69.7%) patients and 35 (57.4%) controls (P > 0.05). The number of individuals having substantial depression according to the BDI was significantly higher in the patients than in the controls. Conclusions. There was a significant increase in the frequency of RLS, which was significantly decreased in the postoperative period in the radiculopathy patients. PMID:25110396

  10. Pelvic anatomy relative to lumbosacral instrumentation.

    PubMed

    Miller, F; Moseley, C; Koreska, J

    1990-06-01

    Anatomical study of 72 pelves revealed that the most substantial area of bone that could best support a rod for surgical fixation is the body of the ilium, with the best part of the bone being the area above the sciatic notch. Placement of the rods into the body of the ilium provides good fixation but requires complex bending of the rods and a good three-dimensional perception of the osseous anatomy of the pelvis. This study was undertaken to define the intraosseous anatomy and the range of anatomical variation of the ilium. The results of this study are useful in developing a prebent spinal fixation rod, providing a better understanding of this anatomical area from a three-dimensional perspective and providing better lumbosacral spinal instrumentation.

  11. Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge.

    PubMed

    Yoshihara, Hiroyuki

    2012-09-01

    Recently, the sacroiliac joint (SIJ) has gained increased attention as a source of persistent or new pain after lumbar/lumbosacral fusion. The underlying pathophysiology of SIJ pain may be increased mechanical load, iliac crest bone grafting, or a misdiagnosis of SIJ syndrome. Imaging studies show more frequent degeneration of the SIJ in patients with lumbar/lumbosacral fusion than in patients without such fusion. Using injection tests, it has been shown that SIJ pain is the cause of persistent symptoms in a considerable number of patients after fusion surgery. Recent articles reporting on surgical outcomes of SIJ fusion include a high percentage of patients who had lumbar/lumbosacral fusion or surgery before, although well-controlled clinical studies are necessary to assess the efficacy of surgical treatment. Taking these findings into consideration, the possibility that the SIJ is the source of pain should be considered in patients with failed back surgery syndrome after lumbar/lumbosacral fusion.

  12. Lumbosacral arachnoid cyst with tethered cord: A rare case report

    PubMed Central

    Jain, S. K.; Sundar, I. Vijay; Sharma, Vinod; Goel, Ravishankar S.

    2012-01-01

    Arachnoid cysts are cerebrospinal fluid collections in the spine that can present with neurological symptoms or be discovered accidentally. Intradural location of such cysts especially in the lumbosacral region is relatively rare. The association of such cysts with other congenital anomalies such as tethered cord lends evidence to the developmental origin of arachnoid cysts. We report a case of lumbosacral arachnoid cyst with tethered cord in a 6-year-old male child and discuss the etiopathogenesis and management options. PMID:24082689

  13. Peroneal neuropathy misdiagnosed as L5 radiculopathy: a case report

    PubMed Central

    2013-01-01

    Objective The purpose of this case report is to describe a patient who presented with a case of peroneal neuropathy that was originally diagnosed and treated as a L5 radiculopathy. Clinical features A 53-year old female registered nurse presented to a private chiropractic practice with complaints of left lateral leg pain. Three months earlier she underwent elective left L5 decompression surgery without relief of symptoms. Intervention and outcome Lumbar spine MRI seven months prior to lumbar decompression surgery revealed left neural foraminal stenosis at L5-S1. The patient symptoms resolved after she stopped crossing her legs. Conclusion This report discusses a case of undiagnosed peroneal neuropathy that underwent lumbar decompression surgery for a L5 radiculopathy. This case study demonstrates the importance of a thorough clinical examination and decision making that ensures proper patient diagnosis and management. PMID:23618508

  14. C7 radiculopathy: importance of scapular winging in clinical diagnosis.

    PubMed

    Makin, G J; Brown, W F; Ebers, G C

    1986-06-01

    Lesions of the seventh cervical (C7) root are common and cause a readily recognised neurological syndrome. Recognition of this pattern is essential in differentiating C7 root lesions from lesions of the brachial plexus or peripheral nerves. Serratus anterior weakness is not generally included in this syndrome. We report six verified cases of C7 radiculopathy in which weakness of the serratus anterior was present in addition to the usual findings. This was manifest as winging of the scapula, when pushing forward against a wall, either with the hands at shoulder level or, in some cases, only when the hands were lowered to waist level. This latter method of testing places the muscle at a mechanical disadvantage and reveals partial paralysis. Analysis of this clinical finding complements anatomical evidence suggesting that the powerful lower digitations of the muscle may be primarily supplied by the C7 root in some cases. Scapular winging, apparent either in the usual position or the modified position described here, should be recognised as consistent with a diagnosis of C7 radiculopathy. When present, this sign serves to differentiate C7 radiculopathy from lesions of the brachial plexus or radial nerve.

  15. C7 radiculopathy: importance of scapular winging in clinical diagnosis.

    PubMed Central

    Makin, G J; Brown, W F; Ebers, G C

    1986-01-01

    Lesions of the seventh cervical (C7) root are common and cause a readily recognised neurological syndrome. Recognition of this pattern is essential in differentiating C7 root lesions from lesions of the brachial plexus or peripheral nerves. Serratus anterior weakness is not generally included in this syndrome. We report six verified cases of C7 radiculopathy in which weakness of the serratus anterior was present in addition to the usual findings. This was manifest as winging of the scapula, when pushing forward against a wall, either with the hands at shoulder level or, in some cases, only when the hands were lowered to waist level. This latter method of testing places the muscle at a mechanical disadvantage and reveals partial paralysis. Analysis of this clinical finding complements anatomical evidence suggesting that the powerful lower digitations of the muscle may be primarily supplied by the C7 root in some cases. Scapular winging, apparent either in the usual position or the modified position described here, should be recognised as consistent with a diagnosis of C7 radiculopathy. When present, this sign serves to differentiate C7 radiculopathy from lesions of the brachial plexus or radial nerve. Images PMID:3734820

  16. Endoscopic foraminotomy for recurrent lumbar radiculopathy after TLIF: Technical report

    PubMed Central

    Telfeian, Albert E.

    2015-01-01

    Background: Transforaminal lumbar interbody fusion (TLIF) is a well-accepted fusion technique that uses unilateral facet removal as an oblique corridor for inserting an interbody spacer. This manuscript focused on five cases of endoscopic foraminotomy for patients presenting with recurrent radiculopathy after TLIF procedures. Methods: After Institutional Review Board approval, charts from five patients with lumbar radiculopathy and instrumented TLIF procedures who underwent subsequent endoscopic procedures between 2011 and 2013 were reviewed. Results: The average pain relief 1 year postoperatively was reported to be 63.8%, good results as defined by MacNab. The average preoperative visual analog scale (VAS) score was 9.5, indicated in our questionnaire as severe and constant pain. The average 1 year postoperative VAS score was 3.5, indicated in our questionnaire as mild and intermittent pain. Conclusion: 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: Lifespan: IRB Study # 600415 PMID:25949850

  17. Reflex secretion of proteins into submandibular saliva in conscious rats, before and after preganglionic sympathectomy.

    PubMed

    Matsuo, R; Garrett, J R; Proctor, G B; Carpenter, G H

    2000-08-15

    1. An indwelling catheter was placed in the left submandibular duct of rats, under pentobarbitone anaesthesia, and connected to an outflow cannula that emerged above the skull. 2. Saliva was collected from the outflow cannula in conscious rats, the same day after recovery from anaesthesia, under four different reflex conditions: grooming, heat exposure, rejection of a bitter tasting substance and feeding on softened chow, repeated in different orders. 3. Saliva flow was greatest for grooming and least for rejection. Protein concentrations were least with heat but much greater and similar for the other stimulations. Acinar peroxidase activity was high for feeding, intermediate for grooming and rejection, and again lowest with heat. Tubular tissue kallikrein activities were moderately low, being greatest with feeding and least with grooming. Secretory immunoglobulin A (SIgA) concentration was least with heat and similar for the other stimulations. 4. The next day, under pentobarbitone anaesthesia, the left preganglionic sympathetic trunk was sectioned (sympathetic decentralization) and, after recovery, the preceding stimulations were repeated. Flow of saliva showed little change, but protein and peroxidase concentrations and outputs decreased dramatically with grooming, rejection and feeding to levels similar to those with heat, which showed little change. Tissue kallikrein was lowered less dramatically, but the reductions in output were significant except with heat. Patterns of proteins resolved by electrophoresis changed for grooming, rejection and feeding and became similar to saliva from heat, which showed little change. No significant effects on SIgA concentrations occurred. 5. Gland weights from the sympathetically decentralized side were greater than from the intact side at the end of the experiments and histologically showed retention of acinar mucin. 6. Thus reflex sympathetic drive varied with the different stimulations; it was least during heat, but it had

  18. Brain-to-stomach transfer of α-synuclein via vagal preganglionic projections.

    PubMed

    Ulusoy, Ayse; Phillips, Robert J; Helwig, Michael; Klinkenberg, Michael; Powley, Terry L; Di Monte, Donato A

    2017-03-01

    Detection of α-synuclein lesions in peripheral tissues is a feature of human synucleinopathies of likely pathogenetic relevance and bearing important clinical implications. Experiments were carried out to elucidate the relationship between α-synuclein accumulation in the brain and in peripheral organs, and to identify potential pathways involved in long-distance protein transfer. Results of this in vivo study revealed a route-specific transmission of α-synuclein from the rat brain to the stomach. Following targeted midbrain overexpression of human α-synuclein, the exogenous protein was capable of reaching the gastric wall where it was accumulated into preganglionic vagal terminals. This brain-to-stomach connection likely involved intra- and inter-neuronal transfer of non-fibrillar α-synuclein that first reached the medulla oblongata, then gained access into cholinergic neurons of the dorsal motor nucleus of the vagus nerve and finally traveled via efferent fibers of these neurons contained within the vagus nerve. Data also showed a particular propensity of vagal motor neurons and efferents to accrue α-synuclein and deliver it to peripheral tissues; indeed, following its midbrain overexpression, human α-synuclein was detected within gastric nerve endings of visceromotor but not viscerosensory vagal projections. Thus, the dorsal motor nucleus of the vagus nerve represents a key relay center for central-to-peripheral α-synuclein transmission, and efferent vagal fibers may act as unique conduits for protein transfer. The presence of α-synuclein in peripheral tissues could reflect, at least in some synucleinopathy patients, an ongoing pathological process that originates within the brain and, from there, reaches distant organs innervated by motor vagal projections.

  19. Lumbosacral Sagittal Alignment in Association to Intervertebral Disc Diseases

    PubMed Central

    Maleki, Farid; Meybodi, Ali Tayebi; Mahdavi, Ali; Saberi, Hooshang

    2014-01-01

    Study Design A cross-sectional case-control study was designed to compare the sagittal alignment of lumbosacral regions in two groups of patients suffering from low back pain, one with intervertebral disc pathologies and one without. Purpose To evaluate the correlation between lumbosacral sagittal alignment and disc degeneration. Overview of Literature Changes in lumbar lordosis and pelvic parameters in degenerative disc lesions have been assessed in few studies. Overall, patients with discopathy were shown to have lower lumbar lordosis and more vertical sacral profiles. Methods From patients with intractable low back pain undergoing lumbosacral magnetic resonance imaging, 50 subjects with disc degeneration and 50 controls with normal scans were consecutively enrolled. A method was defined with anterior tangent-lines going through anterior bodies of L1 and S1 to measure global lumbosacral angle, incorporating both lumbar lordosis and sacral slope. Global lumbosacral angle using the proposed method and lumbar lordosis using Cobb's method were measured in both groups. Results Lumbar lordosis based on Cobb's method was lower in group with discopathy (20°-67°; mean, 40.48°±9.89°) than control group (30°-62°; mean, 44.96°±7.68°), although it was not statistically significant. The proposed global lumbosacral angle in subject group (53°-103°; mean, 76.5°±11.018°) was less than control group (52°-101°; mean, 80.18°±9.95°), with the difference being statistically significant (p=0.002). Conclusions Patients with intervertebral disc lesions seem to have more straightened lumbosacral profiles, but it has not been proven which comes first: disc degeneration or changes in sagittal alignment. Finding an answer to this dilemma demands more comprehensive long-term prospective studies. PMID:25558325

  20. Accuracy of physical examination for chronic lumbar radiculopathy

    PubMed Central

    2013-01-01

    Background Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain. Methods A total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed. Results The prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR <0.4. The overall clinical evaluation was slightly more accurate, with a positive LR of 6.28 (95% CI 1.06–37.21) for L4, 1.74 (95% CI 1.04–2.93) for L5, and 1.29 (95% CI 0.97–1.72) for S1 nerve root impingement. An overall clinical evaluation, concluding on the level and side of the radiculopathy was also performed, and receiver operating characteristic (ROC) analysis with area under the curve (AUC) calculation for diagnostic accuracy of this evaluation was performed. Conclusions The accuracy of individual clinical index tests used to predict imaging findings of nerve root impingement in patients with chronic lumbar

  1. ALPHA-SYNUCLEIN-IMMUNOPOSITIVE MYENTERIC NEURONS AND VAGAL PREGANGLIONIC TERMINALS: AUTONOMIC PATHWAY IMPLICATED IN PARKINSON’S DISEASE?

    PubMed Central

    Phillips, Robert J.; Walter, Gary C.; Wilder, Sarah L.; Baronowsky, Elizabeth A.; Powley, Terry L.

    2008-01-01

    The protein alpha-synuclein is implicated in the development of Parkinson’s disease. The molecule forms Lewy body aggregates that are hallmarks of the disease, has been associated with the spread of neuropathology from the peripheral to the central nervous system, and appears to be involved with the autonomic disorders responsible for the gastrointestinal (GI) symptoms of individuals afflicted with Parkinson’s. To characterize the normative expression of alpha-synuclein in the innervation of the GI tract, we examined both the postganglionic neurons and the preganglionic projections by which the disease is postulated to retrogradely invade the CNS. Specifically, in Fischer 344 and Sprague Dawley rats, immunohistochemistry in conjunction with injections of the tracer Dextran-Texas Red was used to determine, respectively, the expression of alpha-synuclein in the myenteric plexus and in the vagal terminals. Alpha-synuclein is expressed in a subpopulation of myenteric neurons, with the proportion of positive somata increasing from the stomach (~3%) through duodenum (proximal, ~6%; distal, ~13%) to jejunum (~22%). Alpha-synuclein is co-expressed with the nitrergic enzyme NOS or the cholinergic markers calbindin and calretinin in regionally specific patterns: ~90% of forestomach neurons positive for alpha-synuclein express NOS, whereas ~92% of corpus-antrum neurons positive for alpha-synuclein express cholinergic markers. Vagal afferent endings in the myenteric plexus and the GI smooth muscle do not express alpha-synuclein, whereas, virtually all vagal preganglionic projections to the gut express alpha-synuclein, both in axons and in terminal varicosites in apposition with myenteric neurons. Vagotomy eliminates most, but not all, alpha-synuclein-positive neurites in the plexus. Some vagal preganglionic efferents expressing alpha-synuclein form varicose terminal rings around myenteric plexus neurons that are also positive for the protein, thus providing a candidate

  2. Intraoperative conjoined lumbosacral nerve roots associated with spondylolisthesis.

    PubMed

    Popa, Iulian; Poenaru, Dan V; Oprea, Manuel D; Andrei, Diana

    2013-07-01

    Lumbosacral nerve roots anomalies may produce low back pain. These anomalies are reported to be a cause for failed back surgery. They are usually left undiagnosed, especially in endoscopic discectomy techniques. Any surgery for entrapment disorders, performed on a patient with undiagnosed lumbosacral nerve roots anomaly, may lead to serious neural injuries because of an improper surgical technique or decompression. In this report, we describe our experience with a case of L5-S1 spondylolisthesis and associated congenital lumbosacral nerve root anomalies discovered during the surgical intervention, and the difficulties raised by such a discovery. Careful examination of coronal and axial views obtained through high-quality Magnetic Resonance Imaging may lead to a proper diagnosis of this condition leading to an adequate surgical planning, minimizing the intraoperatory complications.

  3. Distinct degree of radiculopathy at different levels of peripheral nerve injury

    PubMed Central

    2012-01-01

    Background Lumbar radiculopathy is a common clinical problem, characterized by dorsal root ganglion (DRG) injury and neural hyperactivity causing intense pain. However, the mechanisms involved in DRG injury have not been fully elucidated. Furthermore, little is known about the degree of radiculopathy at the various levels of nerve injury. The purpose of this study is to compare the degree of radiculopathy injury at the DRG and radiculopathy injury proximal or distal to the DRG. Results The lumbar radiculopathy rat model was created by ligating the L5 nerve root 2 mm proximal to the DRG or 2 mm distal to the DRG with 6.0 silk. We examined the degree of the radiculopathy using different points of mechanical sensitivity, immunohistochemistry and in vivo patch-clamp recordings, 7 days after surgery. The rats injured distal to the DRG were more sensitive than those rats injured proximal to the DRG in the behavioral study. The number of activated microglia in laminas I–II of the L5 segmental level was significantly increased in rats injured distal to the DRG when compared with rats injured proximal to the DRG. The amplitudes and frequencies of EPSC in the rats injured distal to the DRG were higher than those injured proximal to the DRG. The results indicated that there is a different degree of radiculopathy at the distal level of nerve injury. Conclusions Our study examined the degree of radiculopathy at different levels of nerve injury. Severe radiculopathy occurred in rats injured distal to the DRG when compared with rats injured proximal to the DRG. This finding helps to correctly diagnose a radiculopathy. PMID:22537715

  4. Intermittent claudication due to ischaemia of the lumbosacral plexus

    PubMed Central

    Wohlgemuth, W.; Rottach, K.; Stoehr, M

    1999-01-01

    The distinct clinical syndrome of exercise induced ischaemia of the lumbosacral plexus is not a widely known cause for intermittent claudication. Eight patients with the mentioned syndrome were investigated clinically, neurophysiologically, and with imaging techniques. The clinical examination showed a typical exercise induced sequence of symptoms: pain, paraesthesia, and sensory and motor deficits. The underlying vascular conditions were high grade stenoses or occlusions of the arteries supplying the lumbosacral plexus. Spinal stenosis could be excluded in all cases. Five patients received successful interventional radiological therapy. The syndrome can be diagnosed clinically and successful therapy is possible by interventional radiology.

 PMID:10567501

  5. Current techniques in the management of cervical myelopathy and radiculopathy.

    PubMed

    Gerard, Carter S; O'Toole, John E

    2014-04-01

    Posterior decompressive procedures are a fundamental component of the surgical treatment of symptomatic cervical degenerative disease. Posterior approaches have the appeal of avoiding complications associated with anterior approaches such as esophageal injury, recurrent laryngeal nerve paralysis, dysphagia, and adjacent-level disease after fusion. Although open procedures are effective, the extensive subperiosteal stripping of the paraspinal musculature leads to increased blood loss, longer hospital stays, and more postoperative pain, and potentially contributes to instability. Minimally invasive access has been developed to limit approach-related morbidity. This article reviews current techniques in minimally invasive surgical management of cervical myelopathy and radiculopathy.

  6. [Brachioradial pruritus as a symptom of cervical radiculopathy].

    PubMed

    Mataix, J; Silvestre, J F; Climent, J M; Pastor, N; Lucas, A

    2008-11-01

    Brachioradial pruritus is characterized by the presence of pruritus on the lateral aspect of the arms. The etiology of this enigmatic entity is the subject of some debate some authors claim that brachioradial pruritus is a photodermatosis whereas others attribute it to the presence of underlying cervical radiculopathy. In these case reports, we present our experience with brachioradial pruritus and discuss the role of underlying neuropathy in its etiology and that of other types of localized pruritus such as notalgia paresthetica, anogenital pruritus, and burning mouth syndrome.

  7. MR neurography in diagnosing nondiabetic lumbosacral radiculoplexus neuropathy.

    PubMed

    Filosto, Massimiliano; Pari, Elisa; Cotelli, Mariasofia; Todeschini, Alice; Vielmi, Valentina; Rinaldi, Fabrizio; Padovani, Alessandro; Gasparotti, Roberto

    2013-10-01

    Here we describe the imaging findings in a 73-year-old woman who had pain in the right inguinal region, followed by progressive weakness of muscles innervated by the right femoral and obturator nerves, diagnosed as nondiabetic lumbosacral radiculoplexus neuropathy. Magnetic resonance neurography showed thickening and increase in signal intensity of the right femoral and obturator nerves.

  8. [Radiculopathy in patients with Heerfordt's syndrome: two case presentations and review of the literature].

    PubMed

    Fukuhara, Kousuke; Fukuhara, Aika; Tsugawa, Jun; Oma, Shinji; Tsuboi, Yoshio

    2013-08-01

    As a subtype of the clinical presentations associated with sarcoidosis, the combination of uveitis, parotid gland swelling, and facial nerve palsy is known as Heerfordt's syndrome. This syndrome is an extremely rare disorder that has been estimated to affect only 4.1-5.6% of patients with sarcoidosis. We present 2 cases of Heerfordt's syndrome associated with radiculopathy in the trunk. The 2 patients experienced unilateral or bilateral radiculopathy in the trunk and in the trigeminal nerve area associated with Heerfordt's syndrome. Radiculopathy is also a rare manifestation in patients with neurosarcoidosis. A literature review revealed that only 51 cases of radiculopathy associated with sarcoidosis have been documented. A diagnosis of Heerfordt's syndrome was observed in 7 out of these 51 cases. Together with our 2 cases, 9 out of 53 patients with radiculopathy associated with sarcoidosis have been diagnosed as having Heerfordt's syndrome (estimated frequency, 16.9%). In conclusion, radiculopathy is a common neurological manifestation in patients with Heerfordt's syndrome. On the basis of our experience, we suggest that physicians consider the possibility of Heerfordt's syndrome in cases of radiculopathy with unknown cause.

  9. Spinal Myeloid Sarcoma "Chloroma" Presenting as Cervical Radiculopathy: Case Report.

    PubMed

    Hu, Xiaobang; Shahab, Imran; Lieberman, Isador H

    2015-06-01

    Study Design Case report. Objective Myeloid sarcoma (also known as chloroma) is a rare, extramedullary tumor composed of immature granulocytic cells. It may occur early in the course of acute or chronic leukemia or myeloproliferative disorders. Spinal cord invasion by myeloid sarcoma is rare. The authors report a rare case of spinal myeloid sarcoma presenting as cervical radiculopathy. Methods A previously healthy 43-year-old man presented with progressive neck, right shoulder, and arm pain. Cervical magnetic resonance imaging (MRI) revealed a very large enhancing extradural soft tissue mass extending from C7 through T1, with severe narrowing of the thecal sac at the T1 level. The patient underwent posterior cervical open biopsy, laminectomy, and decompression. Histologic examination of the surgical specimen confirmed the diagnosis of myeloid sarcoma. Postoperatively, a bone marrow biopsy was done, which showed myeloproliferative neoplasm with eosinophilia. The patient then received systemic chemotherapy and radiotherapy. Results At the 10-month follow-up, the patient reported complete relief of arm pain and neck pain. X-rays showed that the overall cervical alignment was intact and there was no evidence of a recurrent lesion. MRI showed no evidence of compressive or remnant lesion. Conclusions Spinal myeloid sarcoma presenting as cervical radiculopathy is rare, and it may be easily misdiagnosed. Knowledge of its clinical presentation, imaging, and histologic characterization can lead to early diagnosis and appropriate treatment.

  10. Sacral Stress Fracture Mimicking Lumbar Radiculopathy in a Mounted Police Officer: Case Report and Literature Review

    PubMed Central

    Bednar, Drew A.; Almansoori, Khaled

    2015-01-01

    Study Design Case report and review of the literature. Objective To present a unique case of L5 radiculopathy caused by a sacral stress fracture without neurologic compression. Methods We present our case and its clinical evolution and review the available literature on similar pathologies. Results Relief of the unusual mechanical loading causing sacral stress fracture led to rapid resolution of radiculopathy. Conclusion L5 radiculopathy can be caused by a sacral stress fracture and can be relieved by simple mechanical treatment of the fracture. PMID:26430605

  11. Office evaluation of spine and limb pain: spondylotic radiculopathy and other nonstructural mimickers.

    PubMed

    Watson, James

    2011-02-01

    Low back and neck pain, with or without radiculopathy, are one of the most common reasons for referral to an outpatient neurology practice. Determining appropriate treatment relies on establishing an accurate diagnosis of the etiology of the spine or limb pain. The author reviews structural radiculopathies as a result of diskogenic and spondylotic etiologies with an emphasis on the clinical approach and evaluation of these patients (including imaging and electrodiagnostics), identifying management altering neurogenic mimickers of structural radiculopathies (such as infectious, inflammatory, and neoplastic myeloradiculitis and radiculoplexopathies), and stratifying patients for treatment.

  12. Transitional lumbosacral segment with unilateral transverse process anomaly (Castellvi type 2A) resulting in extraforaminal impingement of the spinal nerve: a pathoanatomical study of four specimens and report of two clinical cases.

    PubMed

    Weber, Jochen; Ernestus, Ralf-Ingo

    2010-04-01

    The spinal nerve can be pinched between the transverse process of the fifth lumbar vertebra and the sacral ala. The patients are divided into two types: elderly persons with degenerative scoliosis and somewhat younger adults with isthmic spondylolisthesis. For the first time, we describe extraforaminal impingement of the spinal nerve in transitional lumbosacral segment with unilateral transverse process anomaly. Selective nerve root blocks were performed in two clinical cases. One patient underwent nerve root decompression via a posterior approach. One year after operation, this patient reported no radicular or lumbar pain. The pathoanatomical study demonstrated pseudoarthrosis between the transverse process and the ala of the sacrum and showed dysplastic facet joints at the level below the transitional vertebra in all specimens. Furthermore, we present the oldest illustration of this pathological condition, published in a book by Carl Wenzel in 1824. Extraforaminal entrapment of the spinal nerve in transitional lumbosacral segment with unilateral transverse process anomaly can cause radiculopathy, and osteophytes are the cause of the entrapment. Dysplastic facet joints on the level below the transitional vertebra could be one reason for "micromotion" resulting in pseudoarthrosis with osteophytes. Sciatica relief was obtained by means of selective nerve root blocks or posterior decompression via a dorsomedial approach.

  13. Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study

    PubMed Central

    Hanling, Steven; Bicket, Mark C; White, Ronald L; Veizi, Elias; Kurihara, Connie; Zhao, Zirong; Hayek, Salim; Guthmiller, Kevin B; Griffith, Scott R; Gordin, Vitaly; White, Mirinda Anderson; Vorobeychik, Yakov; Pasquina, Paul F

    2015-01-01

    Objective To evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbosacral radiculopathy. Design A multicenter randomized study conducted between 2011 and 2014. Computer generated randomization was stratified by site. Patients and evaluating physicians were blinded to treatment outcomes. Settings Eight military, Veterans Administration, and civilian hospitals. Participants 145 people with lumbosacral radicular pain secondary to herniated disc or spinal stenosis for less than four years in duration and in whom leg pain is as severe or more severe than back pain. Interventions Participants received either epidural steroid injection plus placebo pills or sham injection plus gabapentin. Main outcome measures Average leg pain one and three months after the injection on a 0-10 numerical rating scale. A positive outcome was defined as a ≥2 point decrease in leg pain coupled with a positive global perceived effect. All patients had one month follow-up visits; patients whose condition improved remained blinded for their three month visit. Results There were no significant differences for the primary outcome measure at one month (mean pain score 3.3 (SD 2.6) and mean change from baseline −2.2 (SD 2.4) in epidural steroid injection group versus 3.7 (SD 2.6) and −1.7 (SD 2.6) in gabapentin group; adjusted difference 0.4, 95% confidence interval −0.3 to 1.2; P=0.25) and three months (mean pain score 3.4 (SD 2.7) and mean change from baseline −2.0 (SD 2.6) versus 3.7 (SD 2.8) and −1.6 (SD 2.7), respectively; adjusted difference 0.3, −0.5 to 1.2; P=0.43). Among secondary outcomes, one month after treatment those who received epidural steroid injection had greater reductions in worst leg pain (−3.0, SD 2.8) than those treated with gabapentin (−2.0, SD 2.9; P=0.04) and were more likely to experience a positive successful outcome (66% v 46%; number needed to treat=5.0, 95% confidence interval 2.8 to 27.0; P=0.02). At three

  14. Hypothalamic neuron projection to autonomic preganglionic levels related with glucose metabolism: a fluorescent labelling study in the rat.

    PubMed

    Portillo, F; Carrasco, M; Vallo, J J

    1996-06-07

    The location of hypothalamic paraventricular neurons projecting to sympathetic preganglionic levels and related to the autonomic regulation of various organs involved in glucose metabolism (OGM) was determined by ipsilateral injections of two fluorescent tracers, Diamidino Yellow into the left dorsal motor nucleus of the vagus and Fast Blue into the left intermediolateral cell column of the T8-T9 spinal cord. Hypothalamospinal neurons were mainly located in the dorsal part of the paraventricular hypothalamic nucleus (PVH) and the hypothalamobulbar neurons were most abundant in the ventral, medial and extreme lateral parts of the PVH. No double-labelled neurons were found in the hypothalamus. These results can help the knowledge of the neural hypothalamic network related with the autonomic hypothalamic control.

  15. Physical examination signs, clinical symptoms, and their relationship to electrodiagnostic findings and the presence of radiculopathy.

    PubMed

    Lauder, Tamara D

    2002-08-01

    The validity of the history and physical examination varies with study method and the gold standard used. In general, symptoms are more sensitive than specific, and most patients with radiculopathy do present with some characteristic complaints. With the exception of the ipsilateral SLR, most physical examination findings are more specific than sensitive. In patients with suspected radiculopathy, having at least one abnormal physical examination finding makes the probability of having an abnormal electrodiagnostic study more likely than if the results of the physical examination are normal. Having a normal physical examination, however, does not rule out the possibility of having a radiculopathy that is revealed either electrodiagnostically or surgically. Although the history and physical examination may not be perfect tools for the diagnosis of radiculopathy or predicting electrodiagnostic outcome, they are an essential part of the clinical evaluation to assist in formulating a differential diagnosis and guiding the electrodiagnostic study.

  16. Comparing Utility Scores in Common Spinal Radiculopathies: Results of a Prospective Valuation Study

    PubMed Central

    Nayak, Nikhil R.; Stephen, James H.; Abdullah, Kalil G.; Stein, Sherman C.; Malhotra, Neil R.

    2015-01-01

    Study Design Prospective observational study. Objective To determine whether preference-based health utility scores for common spinal radiculopathies vary by specific spinal level. Methods We employed a standard gamble study using the general public to calculate individual preference-based quality of life for four common radiculopathies: C6, C7, L5, and S1. We compared utility scores obtained for each level of radiculopathy with analysis of variance and t test. Multivariable regression was used to test the effects of the covariates age, sex, and years of education. We also reviewed the literature for publications reporting EuroQol-5 Dimensions (EQ-5D) scores for patients with radiculopathy. Results Two hundred participants were included in the study. Average utility for the four spinal levels fell within a narrow range (0.748 to 0.796). There were no statistically significant differences between lumbar and cervical radiculopathies, nor were there significant differences among the different spinal levels (F = 0.0850, p = 0.086). Age and sex had no significant effect on utility scores. There was a significant correlation between years of education and utility values for S1 radiculopathy (p = 0.037). On review of the literature, no study separated utility values by specific spinal level. EQ-5D utilities for both cervical and lumbar radiculopathy were considerably lower than the results of our study. Conclusions Utility values associated with the most common levels of cervical and lumbar radiculopathy do not significantly differ from each other, validating the current practice of grouping utility by spinal segment rather than by specific root levels. The discrepancy in average utility values between our study and the EQ-5D highlights the need to be mindful of the underlying instruments used when assessing outcomes studies from different sources. PMID:27099818

  17. High resolution neurography of the lumbosacral plexus on 3T magneteic resonance imaging.

    PubMed

    Cejas, C; Escobar, I; Serra, M; Barroso, F

    2015-01-01

    Magnetic resonance neurography is a technique that complements clinical and electrophysiological study of the peripheral nerves and brachial and lumbosacral plexuses. Numerous focal processes (inflammatory, traumatic, primary tumors, secondary tumors) and diffuse processes (diabetic polyneuropathy, chronic idiopathic demyelinating polyneuropathy due to amyloidosis or Charcot-Marie-Tooth disease) can involve the lumbosacral plexus. This article reviews the anatomy of the lumbosacral plexus, describes the technique for neurography of the plexus at our institution, and shows the diverse diseases that affect it.

  18. Conjoined lumbosacral nerve roots: current aspects of diagnosis.

    PubMed

    Böttcher, J; Petrovitch, A; Sörös, P; Malich, A; Hussein, S; Kaiser, W A

    2004-03-01

    Conjoined lumbosacral nerve roots (CLNR) are the most common anomalies involving the lumbar nerve structures which can be one of the origins of failed back syndromes. They can cause sciatica even without the presence of a additional compressive impingement (such as disc herniation, spondylolisthesis or lateral recess stenosis), and often congenital lumbosacral spine anomalies (such as bony defects) are present at the "conjoined sheaths". This congenital anomaly has been reported in 14% of cadaver studies, but myelographic or computed tomographic studies have revealed an incidence of approximately 4% only. Diagnostic methods such as magnetic resonance imaging (MRI) are helpful for determination of the exact anatomical relations in this context. We present five typical cases of conjoined nerve roots observed during a 1 year period, equivalent to 6% of our out-patients without a history of surgical treatment on the lumbar spine. In all cases with suspicious radiological findings MRI or lumbar myelography combined with CT and multiplanar reconstructions is recommended.

  19. The evolution of image-guided lumbosacral spine surgery

    PubMed Central

    Faulkner, Austin R.; Pasciak, Alexander S.; Bradley, Yong C.

    2015-01-01

    Techniques and approaches of spinal fusion have considerably evolved since their first description in the early 1900s. The incorporation of pedicle screw constructs into lumbosacral spine surgery is among the most significant advances in the field, offering immediate stability and decreased rates of pseudarthrosis compared to previously described methods. However, early studies describing pedicle screw fixation and numerous studies thereafter have demonstrated clinically significant sequelae of inaccurate surgical fusion hardware placement. A number of image guidance systems have been developed to reduce morbidity from hardware malposition in increasingly complex spine surgeries. Advanced image guidance systems such as intraoperative stereotaxis improve the accuracy of pedicle screw placement using a variety of surgical approaches, however their clinical indications and clinical impact remain debated. Beginning with intraoperative fluoroscopy, this article describes the evolution of image guided lumbosacral spinal fusion, emphasizing two-dimensional (2D) and three-dimensional (3D) navigational methods. PMID:25992368

  20. Lumbosacral Transitional Vertebrae and Its Prevalence in the Australian Population

    PubMed Central

    French, Heath D.; Somasundaram, Arjuna J.; Schaefer, Nathan R.; Laherty, Richard W.

    2014-01-01

    Study Design Retrospective cohort study. Objective Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly, and they can be accurately identified on anteroposterior (AP) radiographs of the lumbosacral spine. This study attempts to determine the prevalence of this congenital anomaly and to increase awareness among all clinicians to reduce the risk of surgical and procedural errors in patients with LSTV. Methods A retrospective review of 5,941 AP and lateral lumbar radiographs was performed. Transitional vertebrae were identified and categorized under the Castellvi classification. Results The prevalence of LSTV in the study population was 9.9%. Lumbarized S1 and sacralized L5 were seen in 5.8 and 4.1% of patients, respectively. Conclusion LSTV are a common normal variant and can be a factor in spinal surgery at incorrect levels. It is essential that all clinicians are aware of this common congenital anomaly. PMID:25396103

  1. Evaluation and Management of Lumbosacral Myelomeningoceles in Children

    PubMed Central

    Kural, Cahit; Solmaz, Ilker; Tehli, Ozkan; Temiz, Caglar; Kutlay, Murat; Daneyemez, Mehmet K.; Izci, Yusuf

    2015-01-01

    Objective: Myelomeningoceles are the common form of open neural tube defects that are usually associated with neurological deficits. Many techniques of repair and methods of prevention have been proposed with respect to the size of defect and the neurological condition of patient. The aim of this study was to report our experience on the management of lumbosacral myelomeningoceles in children. Materials and Methods: We retrospectively analysed the data of 36 paediatric cases of surgically lumbosacral myelomeningocele treated in our department between 1998 and 2013. Twenty (56%) patients were female and sixteen were male, with a mean age of 4 months (ranged between 0 and 24 months). All patients had neurological deficits in the preoperative period. Computed tomography was performed in 33 (92%) patients and magnetic resonance imaging in 15 (42%) patients in the preoperative period. Repair of the myelomeningocele and closure of the skin defect were performed in all patients. The mean follow-up period was 36 months. Results: Thirty (83%) patients were operated for hydrocephalus and 10 (28%) patients were re-operated for tethered cord syndrome during the follow-up period. Neurological worsening was not observed in any patient while cerebrospinal fluid fistula was detected in 2 patients. Conclusion: Surgical treatment using appropriate microsurgical techniques is crucial for lumbosacral myelomeningoceles in children. Early surgical intervention with close follow-up will improve the neurological condition of the patients. PMID:26644765

  2. Study on lumbosacral nerve root compression using DTI

    PubMed Central

    Li, Jinfeng; Wang, Yonghao; Wang, Yueyi; Lv, Yang; Ma, Lin

    2016-01-01

    Diffusion tensor imaging (DTI) can objectively describe the distribution of nerve roots in morphology, and provide a set of objective reference data on the quantitative indicators. The present study aimed to investigate the value of DTI in lumbosacral nerve root compression in patients with lumbar intervertebral disc degeneration. DTI was performed in 45 patients with lumbar intervertebral disc degeneration. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured in compressed and normal nerve roots. Fiber tracking imaging was also applied to observe the lumbosacral nerve roots. ADC value was significantly lower in the compressed group (1.314±0.14 mm2/sec) compared to in the uncompressed group (1.794±0.11 mm2/sec) (P<0.05). The FA value was significantly lower in the compressed group (0.196±0.020) compared to the uncompressed group (0.272±0.016) (P<0.05). DTI can evidently reveal the compressed nerve roots. DTI could be used to evaluate the lumbosacral nerve injury in patients with lumbar intervertebral disc degeneration to quantitatively assess nerve roots. PMID:27602215

  3. Calibration method for lumbosacral dimensions in wearable sensor system of lumbar alignment.

    PubMed

    Tsuchiya, Yoshio; Kusaka, Takashi; Tanaka, Takayuki; Matsuo, Yoshikazu; Oda, Makoto; Sasaki, Tsukasa; Kamishima, Tamotsu; Yamanaka, Masanori

    2015-01-01

    Anteflexion of the spine is essential for many physical activities in everyday life. However, this motion places the lumbar disks under heavy load due to changes in the shape of the lumbar spine and can lead to low back pain. With the aim of reducing low back pain, here we developed a wearable sensor system that can estimate lumbosacral alignment and lumbar load by measuring the shape of the lumbar skin when the lumbosacral alignment changes. In addition, we used this system to measure the parameters of anteflexion and studied the change in dimensions of the lumbar spine from changes in posture. By determining the dimensions of the lumbosacral spine on an X-ray image, a lumbosacral dimensions calibration method based on body surface area and height was developed. By using this method, lumbosacral alignment and lumbar load could be accurately estimated using the wearable sensor system.

  4. Specific innervation of guinea-pig superior cervical ganglion cells by preganglionic fibres arising from different levels of the spinal cord.

    PubMed Central

    Njå, A; Purves, D

    1977-01-01

    1. The synaptic contribution of preganglionic nerve fibres arising from the last cervical (C8) and the first seven thoracic spinal cord segments (T1-T7) to neurones of the guinea-pig superior cervical ganglion has been studied by means of intracellular recording during ventral root stimulation in vitro. 2. The majority of neurones received innervation from the middle segments (T2 and T3) of the length of spinal cord from which preganglionic fibres derive; an intermediate number of ganglion cells were innervated by fibres from the segments adjacent to these (T1, T4, and T5), and relatively few neurones by fibres from the most rostral and caudal segments supplying innervation to the ganglion (C8, T6 and T7). 3. Each neurone received preganglionic terminals from multiple thoracic segments (range 1-7, mean = 4-0). The estimated minimum number of preganglionic fibres contacting each neurone was 10, on average. 4. As a rule, the spinal segments innervating a neurone were contiguous. Thus we rarely encountered neurones innervated by segments located both rostrally and caudally to a segment which failed to provide innervation. 5. Neurones tended to be innervated predominantly by axons arising from a single spinal segment, with adjacent segments contributing a synaptic influence that diminished as a function of their distance from the dominant segment. All segments provided dominant innervation to at least some neurones. 6. Stimulating the ventral roots of C8-T7 in vivo showed that the axons arising from each segment produced a characteristic pattern of peripheral effects. Thus different populations of neurones in the superior cervical ganglion of the guinea-pig are innervated by preganglionic axons from different levels of the spinal cord, as originally suggested by Langley (1892) for the cat, dog, and rabbit. 7. On the basis of our in vitro studies we conclude that underlying the specificity of innervation of neurones of the superior cervical ganglion that can be inferred

  5. Jingtong Granule: A Chinese Patent Medicine for Cervical Radiculopathy

    PubMed Central

    Zhu, Liguo; Gao, Jinghua; Yu, Jie; Feng, Minshan; Li, Jinyu; Wang, Shangquan; Wei, Xu

    2015-01-01

    Objective. This paper systematically assessed the efficacy and safety of Jingtong granule (JG) for cervical radiculopathy (CR). Methods. Randomized controlled trials comparing JG with no intervention, placebo, or conventional therapies were retrieved. The trials testing JG combined with conventional therapies versus conventional therapies were also enrolled. Study selection, methodological assessment, data extraction, and analysis were conducted in accordance with the Cochrane standards. The strength of evidence was evaluated according to GRADE approach. Results. Three trials with 400 participants were included. Methodological quality was evaluated as generally low. One study found that JG showed significant difference on decreasing pain scores compared with placebo. Meta-analysis indicated that JG plus conventional analgesic exhibited a significant immediate effect on the pain scores (WMD = 1.63; 95% CI: 1.29 to 1.98; P < 0.00001). Additionally, JG combined with analgesic presented beneficial immediate effect on neck disability index. However, the treatment effects of JG demonstrated in the trials were not large, and the safety of JG was unproven. Finally the evidence level was evaluated to be low. Conclusions. Our results indicated that JG showed some potential benefits for CR. Nevertheless, treatment effects are uncertain due to both the methodological concerns and the very modest reported improvements. PMID:26064154

  6. The lumbosacral segment as a vulnerable region in various postures

    NASA Technical Reports Server (NTRS)

    Rosemeyer, B.

    1978-01-01

    The lumbosacral region in man is exposed to special static and dynamic load. In a supine position, the disc size increases because of the absence of axial load. In a standing position, with physiological posture of the spine, strain discomfort occurs which is increased even more in the sitting position due to the curvature of the lumbar region of the spine and the irregular distribution of pressure in the discs as a result of this. This special problem of sitting posture can be confirmed by examinations.

  7. Cervical Radiculopathy: Incidence and Treatment of 1,420 Consecutive Cases

    PubMed Central

    Nemani, Venu M.; Piyaskulkaew, Chaiwat; Vargas, Samuel Romero; Riew, K. Daniel

    2016-01-01

    Study Design Retrospective case series. Purpose To determine the incidence of cervical radiculopathy requiring operative intervention by level and to report on the methods of treatment. Overview of Literature Cervical radiculopathy is a common cause of pain and can result in progressive neurological deficits. Although the pathology is well understood, the actual incidence of cervical radiculopathy at particular spinal levels ultimately requiring operative intervention is unknown. Methods A large consecutive series of patients operated on by a single surgeon were retrospectively analyzed. The incidence of cervical radiculopathy at each level was defined for every patient. Procedures used for operative treatment were noted. Health related quality of life (HRQL) scores were collected both pre-operatively and postoperatively. Results There were 1305 primary and 115 revision operations performed. The most common primary procedures performed were anterior cervical discectomy and fusion (ACDF, 50%) and anterior cervical corpectomy and fusion (ACCF, 28%). The most commonly affected levels were C6 (66%) and C7 (62%). Reasons for revision were pseudarthrosis (27%), clinical adjacent segment pathology (CASP, 63%), persistent radiculopathy (11%), and hardware-related (2.6%). The most common procedures performed in the revision group were posterior cervical decompression and fusion (PCDF, 42%) and ACDF (40%). The most commonly affected levels were C7 (43%) and C5 (30%). Among patients that had their index surgery at our institution, the revision rate was 6.4%. In both primary and revision cases there was a significant improvement in Neck Disability Index and visual analogue scale scores postoperatively. Postoperative HRQL scores in the revision cases were significantly worse than those in the primary cases (p <0.01). Conclusions This study provides the largest description of the incidence of cervical radiculopathy by level and operative outcomes in patients undergoing cervical

  8. Quantitative analysis in outcome assessment of instrumented lumbosacral arthrodesis.

    PubMed

    Champain, Sabina; Mazel, Christian; Mitulescu, Anca; Skalli, Wafa

    2007-08-01

    The outcome assessment in instrumented lumbosacral fusion mostly focuses on clinical criteria, complications and scores, with a high variability of imaging means, methods of fusion grading and parameters describing degenerative changes, making comparisons between studies difficult. The aim of this retrospective evaluation was to evaluate the interest of quantified radiographic analysis of lumbar spine in global outcome assessment and to highlight the key biomechanical factors involved. Clinical data and Beaujon-Lassale scores were collected for 49 patients who underwent lumbosacral arthrodesis after prior lumbar discectomy (mean follow-up: 5 years). Sagittal standing and lumbar flexion-extension X-ray films allowed quantifying vertebral, lumbar, pelvic and kinematic parameters of the lumbar spine, which were compared to reference values. Statistics were performed to assess evolution for all variables. At long-term follow-up, 90% of patients presented satisfactory clinical outcomes, associated to normal sagittal alignment; vertebral parameters objectified adjacent level degeneration in four cases (8%). Clinical outcome was correlated (r = 0.8) with fusion that was confirmed in 80% of cases, doubtful in 16% and pseudarthrosis seemed to occur in 4% (2) of cases. In addition to clinical data (outcomes comparable to the literature), quantitative analysis accurately described lumbar spine geometry and kinematics, highlighting parameters related to adjacent level's degeneration and a significant correlation between clinical outcome and fusion. Furthermore, criteria proposed to quantitatively evaluate fusion from lumbar dynamic radiographs seem to be appropriate and in agreement with surgeon's qualitative grading in 87% of cases.

  9. Cranial and lumbosacral hypertrophic pachymeningitis associated with systemic lupus erythematosus

    PubMed Central

    Han, Fei; Zhong, Ding-Rong; Hao, Hong-Lin; Kong, Wei-Ze; Zhu, Yi-Cheng; Guan, Hong-Zhi; Cui, Li-Ying

    2016-01-01

    Abstract Background: Hypertrophic pachymeningitis (HP) is a chronic disease characterized by inflammatory hypertrophy and fibrosis of dura mater. It can be divided into cranial and spinal forms depending on the location of the lesion. HP involving 2 separate sites simultaneously is quite uncommon. Case summary: This study presents a case of a 49-year-old woman with pathologically confirmed cranial and lumbosacral hypertrophic pachymeningitis associated with systemic lupus erythematosus (SLE), which is a rare etiology of HP. She experienced persistent numbness and pain of the left lower limb, followed by headache and seizures. In laboratory tests, levels of erythrocyte sedimentation rate and C-reactive protein were elevated, and antinuclear antibodies and anti–double-strand deoxyribonucleic acid (DNA) antibodies were detected. Magnetic resonance imaging revealed dural thickening with homogenous gadolinium enhancement both at lumbosacral level and over cerebral convexities. Histology suggested chronic inflammation in spinal dura mater with extensive fibrosis, dense lymphoplasmacytic infiltrate, and focal vasculitis. Treatment with corticosteroids and cyclophosphamide was started with significant clinical and radiological improvement. Conclusion: HP is etiologically heterogeneous. Despite its rarity, SLE should be considered in the differential diagnosis of HP. Early recognition and therapy may provide an optimal outcome. PMID:27684799

  10. Osteoid osteoma near the intervertebral foramen may induce radiculopathy through tumorous inflammation.

    PubMed

    Zenmyo, Michihisa; Yamamoto, Takuya; Ishidou, Yasuhiro; Komiya, Setsuro; Ijiri, Kosei

    2011-01-19

    Osteoid osteoma of the spine is a relatively rare bone-forming tumor. Pain that is worse at night and relieved by aspirin and muscle contracture are the most characteristic symptoms of spinal osteoid osteoma. Although radicular pain occasionally occurs in spinal osteoid osteoma, spinal cord and nerve root compression is absent in most cases. Although radicular pain appears to be associated with tumorous inflammation, there have been no presentations of histological findings of inflammation around the nerve root. We present here two rare cases of spinal osteoid osteoma causing radiculopathy and the first histological evidence of tumorous inflammation as a cause of radiculopathy in osteoid osteoma near the intervertebral foramen.

  11. Double labeling of vagal preganglionic and sympathetic postganglionic fibers in celiac ganglion, superior mesenteric arteries and myenteric plexus.

    PubMed

    Ting, Shi-Jane; Kao, Chih-Kuan; Wang, Feng-Bin

    2017-02-28

    Sympathetic efferents regulate the “fight-or-flight” response and sympathetic and vagal fibers have been suggested to retrogradely and centrally spread pathogens associated with Parkinson’s disease. To examine the arrangement of the vagal and sympathetic motor fibers in the celiac ganglion (CG), gastrointestinal tract, and along the superior mesenteric artery and its sub-branches, we double-labeled the vagal efferents by injecting Dextran-Texas Red into the dorsal motor nucleus of the vagus and the sympathetic postganglionics with tyrosine hydroxylase immunohistochemistry in male Sprague-Dawley rats (n = 18). The laser scanning confocal microscope was used for image analysis. Vagal nerve endings were densely distributed around the CG neurons, and the right CG received more. Vagal and sympathetic efferent endings formed various ring or string shapes that tangled closely in the myenteric plexus of the forestomach, duodenum, jejunum and ileum. Vagal and sympathetic efferents coursed within the same nerve bundles before reaching the myenteric plexus, had in-apposition varicosities, and ran parallel with the superior mesenteric artery and its sub-branches. Although a complete sympathetic tracing and an incomplete tracing and/or damage to the vagal preganglionic neurons may lead to a sampling bias, the sympathetic innervations in the blood vessels and myenteric plexus are stronger than in the vagus. The in-apposition innervation varicosities of the vagal and sympathetic efferents within the same nerve bundles and in the myenteric plexus of the gut with complex innervation patterns may offer a network to automatically control gastrointestinal functions and an infection route of the Parkinson’s disease between the autonomic efferent endings.

  12. The effect of calcium ions on the binomial statistic parameters that control acetylcholine release at preganglionic nerve terminals.

    PubMed Central

    Bennett, M R; Florin, T; Pettigrew, A G

    1976-01-01

    1. A study has been made of the effects of changing [Ca]O and [Mg]O on the binomial statistic parameters p and n that control the average quantal content (m) of the excitatory post-synaptic potential (e.p.s.p.) due to acetylcholine release at preganglionic nerve terminals. 2. When [Ca]O was increased in the range from 0-2 to 0-5 mM, p increased as the first power of [Ca]O whereas n increased as the 0-5 power of [Ca]O; when [Mg]O was increased in the range from 5 to 200 mM, p decreased as the first power of [Mg]O whereas n decreased as the 0-5 power of [Mg]O. 3. The increase in quantal release of a test impulse following a conditioning impulse was primarily due to an increase in n; the increase in quantal content of successive e.p.s.p.s in a short train was due to an increase in n and p, and the increase in n was quantitatively described in terms of the accumulation of a Ca-receptor complex in the nerve terminal. 4. The decrease in quantal content of successive e.p.s.p.s during long trains of impulses over several minutes was primarily due to a decrease in n. These results are discussed in terms of an hypothesis concerning the physical basis of n and p in the release process. PMID:181562

  13. Dimensions Underlying Measures of Disability, Personal Factors, and Health Status in Cervical Radiculopathy

    PubMed Central

    Halvorsen, Marie; Kierkegaard, Marie; Harms-Ringdahl, Karin; Peolsson, Anneli; Dedering, Åsa

    2015-01-01

    Abstract This cross-sectional study sought to identify dimensions underlying measures of impairment, disability, personal factors, and health status in patients with cervical radiculopathy. One hundred twenty-four patients with magnetic resonance imaging-verified cervical radiculopathy, attending a neurosurgery clinic in Sweden, participated. Data from clinical tests and questionnaires on disability, personal factors, and health status were used in a principal-component analysis (PCA) with oblique rotation. The PCA supported a 3-component model including 14 variables from clinical tests and questionnaires, accounting for 73% of the cumulative percentage. The first component, pain and disability, explained 56%. The second component, health, fear-avoidance beliefs, kinesiophobia, and self-efficacy, explained 9.2%. The third component including anxiety, depression, and catastrophizing explained 7.6%. The strongest-loading variables of each dimension were “present neck pain intensity,” “fear avoidance,” and “anxiety.” The three underlying dimensions identified and labeled Pain and functioning, Health, beliefs, and kinesiophobia, and Mood state and catastrophizing captured aspects of importance for cervical radiculopathy. Since the variables “present neck pain intensity,” “fear avoidance,” and “anxiety” had the strongest loading in each of the three dimensions; it may be important to include them in a reduced multidimensional measurement set in cervical radiculopathy. PMID:26091482

  14. Lumbosacral Osteomyelitis and Discitis with Phlegmon Following Laparoscopic Sacral Colpopexy

    PubMed Central

    Scranton, Robert; Antosh, Danielle D; Simpson, Richard K

    2016-01-01

    Lumbosacral osteomyelitis and discitis are usually a result of hematogenous spread; rarely it can result from direct inoculation during a surgical procedure. Bacteria may also track along implanted devices to a different location. This is a rare complication seen from pelvic organ prolapse surgery with sacral colpopexy. A 67-year-old female developed increasing lower back pain four months following a laparoscopic sacral colpopexy. Imaging revealed lumbar 5-sacral 1 (L5-S1) osteomyelitis and discitis with associated phlegmon confirmed by percutaneous biopsy and culture. The patient was treated conservatively with antibiotics, but required laparoscopic removal of the pelvic and vaginal mesh followed by twelve weeks of intravenous antibiotics. The patient has experienced clinical improvement of her back pain. This is an uncommon complication of sacral colpopexy, but physicians must be vigilant and manage aggressively to avoid more serious complications and permanent deficit. PMID:27551651

  15. Lumbo-sacral spine disease due to bovine tuberculosis in a patient with concurrent pulmonary disease.

    PubMed

    Ahmad, Nawaid; Srinivasan, Koottalai; Panayi, Jeannette; Moudgil, Harmesh

    2011-12-01

    Lumbo-sacral spinal disease due to bovine tuberculosis (TB) in a patient with concurrent pulmonary disease is rare. We report this unpredicted finding in an immunocompetent patient and discuss the natural history in an area of low prevalence.

  16. Lumbo-sacro-pelvic Fixation Using Iliac Screws for the Complex Lumbo-sacral Fractures.

    PubMed

    Rhee, Woo-Tack; You, Seung-Hoon; Jang, Yeon-Gyu; Lee, Sang-Youl

    2007-12-01

    Fractures of lumbo-sacral junction involving bilateral sacral wings are rare. Posterior lumbo-sacral fixation does not always provide with sufficient stability in such cases. Various augmentation techniques including divergent sacral ala screws, S2 pedicle screws and Galveston rods have been reported to improve lumbo-sacral stabilization. Galveston technique using iliac bones would be the best surgical approach especially in patients with bilateral comminuted sacral fractures. However, original Galveston surgery is technically demanding and bending rods into the appropriate alignment is time consuming. We present a patient with unstable lumbo-sacral junction fractures and comminuted U-shaped sacral fractures treated by lumbo-sacro-pelvic fixation using iliac screws and discuss about the advantages of the iliac screws over the rod system of Galveston technique.

  17. Quantitative analysis in outcome assessment of instrumented lumbosacral arthrodesis

    PubMed Central

    Mazel, Christian; Mitulescu, Anca

    2007-01-01

    The outcome assessment in instrumented lumbosacral fusion mostly focuses on clinical criteria, complications and scores, with a high variability of imaging means, methods of fusion grading and parameters describing degenerative changes, making comparisons between studies difficult. The aim of this retrospective evaluation was to evaluate the interest of quantified radiographic analysis of lumbar spine in global outcome assessment and to highlight the key biomechanical factors involved. Clinical data and Beaujon–Lassale scores were collected for 49 patients who underwent lumbosacral arthrodesis after prior lumbar discectomy (mean follow-up: 5 years). Sagittal standing and lumbar flexion-extension X-ray films allowed quantifying vertebral, lumbar, pelvic and kinematic parameters of the lumbar spine, which were compared to reference values. Statistics were performed to assess evolution for all variables. At long-term follow-up, 90% of patients presented satisfactory clinical outcomes, associated to normal sagittal alignment; vertebral parameters objectified adjacent level degeneration in four cases (8%). Clinical outcome was correlated (r = 0.8) with fusion that was confirmed in 80% of cases, doubtful in 16% and pseudarthrosis seemed to occur in 4% (2) of cases. In addition to clinical data (outcomes comparable to the literature), quantitative analysis accurately described lumbar spine geometry and kinematics, highlighting parameters related to adjacent level’s degeneration and a significant correlation between clinical outcome and fusion. Furthermore, criteria proposed to quantitatively evaluate fusion from lumbar dynamic radiographs seem to be appropriate and in agreement with surgeon’s qualitative grading in 87% of cases. PMID:17216227

  18. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome

    PubMed Central

    Jancuska, Jeffrey M.; Spivak, Jeffrey M.

    2015-01-01

    Background Lumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant associated with altered patterns of degenerative spine changes. This review will focus on the clinical significance of LSTV, disruptions in normal spine biomechanics, imaging techniques, diagnosis, and treatment. Methods A Pubmed search using the specific key words “LSTV,” “lumbosacral transitional vertebrae,” and “Bertolotti's Syndrome” was performed. The resulting group of manuscripts from our search was evaluated. Results LSTV are associated with alterations in biomechanics and anatomy of spinal and paraspinal structures, which have important implications on surgical approaches and techniques. LSTV are often inaccurately detected and classified on standard AP radiographs and MRI. The use of whole-spine images as well as geometric relationships between the sacrum and lumbar vertebra increase accuracy. Uncertainty regarding the cause, clinical significance, and treatment of LSTV persists. Some authors suggest an association between LSTV types II and IV and low back pain. Pseudoarticulation between the transverse process and the sacrum creates a “false joint” susceptible to arthritic changes and osteophyte formation potentially leading to nerve root entrapment. The diagnosis of symptomatic LSTV is considered with appropriate patient history, imaging studies, and diagnostic injections. A positive radionuclide study along with a positive effect from a local injection helps distinguish the transitional vertebra as a significant pain source. Surgical resection is reserved for a subgroup of LSTV patients who fail conservative treatment and whose pain is definitively attributed to the anomalous pseudoarticulation. Conclusions Due to the common finding of low back pain and the wide prevalence of LSTV in the general population, it is essential to differentiate between symptoms originating from an anomalous psuedoarticulation from other potential

  19. The Association between Urinary Incontinence and Low Back Pain and Radiculopathy in Women

    PubMed Central

    Kaptan, Hulagu; Kulaksızoğlu, Haluk; Kasımcan, Ömür; Seçkin, Bedreddin

    2016-01-01

    AIM: Urinary incontinence (UI) is a common dysfunction, affecting especially women of all ages. The terminology of low back pain (LBP) and radiculopathy (RP) may be misused interchangeably with each other. There are many reports of the association with LBP and incontinence but those involving compression of nerve root(as RP), has not been distinguished from isolated low back pain. This study was structured to analyse the association of UI, LBP and RP. METHODS: One hundred twenty patients were included in the study. Patients with spinal or urinary infection, tumour (spinal or others), cauda equine, pelvic operation, spinal trauma, spinal surgery, urogenital pathology were not accepted for this study. Age and weight of all patients were determined. Oswestry Disability Index (ODI) was utilised for assessment of loss of function and SEAPI incontinence index was used for urinary incontinence. All patients were examined for neurological pathology to differentiate between the LBP and RP by department of neurosurgery. Student t-test and Mann-Whitney-U tests were used for statistical significance. RESULTS: There was no statistical significance between low back pain with overall urinary incontinence (p = 0.131), urge (p = 0.103) or stress incontinence (p = 0.68), respectively. However; The statistical aspects were identified relationship between overall (p = 0.026) and urge (p = 0.001) urinary incontinence with radiculopathy. The association of urge incontinence and radiculopathy seems to show a more significant relationship. Yet there was no correlation between radiculopathy and stress incontinence (P = 0.062). CONCLUSION: Low back pain should not be regarded as a predisposing factor for urinary incontinence; however, radiculopathy has a statistically positive correlation between overall incontinence and urge incontinence. PMID:28028410

  20. The Study of Diagnostic Efficacy of Nerve Conduction Study Parameters in Cervical Radiculopathy

    PubMed Central

    Pawar, Sachin; Kashikar, Aditi; Shende, Vinod; Waghmare, Satish

    2013-01-01

    Background: Cervical Radiculopathy (CR) is a neurologic condition characterised by dysfunction of a cervical spinal nerve, the roots of the nerve, or both. Diagnostic criteria for CR are not well defined, and no universally accepted criteria for its diagnosis have been established. Clinical examination, radiological imaging and electrophysiologic evaluation are the different modalities to diagnose CR. The incidence of Cervical Spondylosis and related conditions is increasing in the present scenario and the use of radiologic examination is time consuming and uneconomical for the common Indian setup. Thus, there is a definite need to establish a cost effective, reliable, and accurate means for establishing the diagnosis of cervical radiculopathy. Electrodiagnostic tests are the closest to fulfill these criteria. Aim: To evaluate diagnostic utility of various motor and sensory nerve conduction study parameters in cervical radiculopathy. Setting and Design: It was a cross-sectional study conducted on 100 subjects of age > 40 years. Material and Methods: The consecutive patients clinically diagnosed to have cervical radiculopathy, referred from department of Orthopaedics were prospectively recruited for the motor and sensory nerve conduction study using RMS EMG EP Mark-II. Parameters studied were Compound Muscle Action Potential (CMAP), Distal Motor Latency (DML) and Conduction Velocity (CV) for motor nerves and Sensory Nerve Action Potential (SNAP) and CV for sensory nerves. Statistical Analysis: Study observations and results were analysed to find the Specificity, Sensitivity, Positive Predictive Value and Negative Predictive Value using SPSS 16.0. Results: Among various motor nerve conduction parameters CMAP was found to be more sensitive with high positive predicative value. CV was found to have greater specificity and DML had least negative predictive value. Sensory nerve conduction parameters were found to have less sensitivity but higher specificity as compared

  1. Asymmetric lumbosacral transitional vertebra and subsequent disc protrusion in a cocker spaniel.

    PubMed

    Archer, Rebecca; Sissener, Thomas; Connery, Neil; Spotswood, Tim

    2010-03-01

    A 10-year-old cocker spaniel bitch presented with severe lumbosacral pain and acute onset left pelvic limb lameness. A diagnosis of asymmetric lumbosacral transitional vertebra with disc protrusion at L6-L7 was made by computed tomography. The cauda equina and left L6 nerve root were surgically decompressed with a dorsal laminectomy and lateral foraminotomy, which led to rapid resolution of the clinical signs.

  2. Antinociceptive effects of low dose lumbosacral epidural ropivacaine in healthy ponies.

    PubMed

    van Loon, Johannes P A M; Menke, Eveline S; Doornenbal, Arie; Back, Willem; Hellebrekers, Ludo J

    2012-07-01

    The objective of this study was to evaluate the safety and efficacy of low dose lumbosacral epidural ropivacaine in ponies. Antinociceptive effects of epidural ropivacaine were evaluated by means of mechanical nociceptive thresholds (MNTs) at several spinal levels in conscious ponies. The effects of ropivacaine on nociceptive afferent transmission to the spinal cord were also assessed by measuring spinal cord somatosensory evoked potentials (SSEPs) in anaesthetised ponies. Ataxia scores were determined in conscious ponies to assess the effects on motor function. A randomised, placebo controlled, double blind cross-over design was used. Low dose lumbosacral epidural ropivacaine led to increases in MNTs at various anatomical locations with a maximum effect at the lumbosacral and sacrococcygeal regions, both with respect to increase in threshold and duration of effect. Analysis of SSEPs showed that epidural ropivacaine influenced both Aβ- and Aδ-mediated afferent transmission to the spinal cord at the level of the lumbosacral junction. Ponies showed mild ataxia after low dose lumbosacral epidural ropivacaine, but all ponies remained standing. Application of low dose lumbosacral epidural ropivacaine provided safe and efficacious antinociceptive effects in conscious and anaesthetised ponies, and could therefore be a valuable addition to multimodal analgesic protocols in Equidae.

  3. Iliacus abscess with radiculopathy mimicking herniated nucleus pulposus: Additional diagnostic value of magnetic resonance imaging.

    PubMed

    Kim, D H; Woo, S H; Lee, W J

    2017-03-01

    An iliacus abscess is an extremely rare cause of low back pain. With an iliacus abscess, the classical signs seen with a psoas abscess are frequently absent. Therefore, a timely diagnosis at the initial visit is difficult and inadequate treatment usually results in high mortality. Here, we report the case of 19-year-old man who presented with acute low back pain with radiculopathy and was ultimately diagnosed with an iliacus muscle abscess.

  4. Prospective medium-term results of multimodal pain management in patients with lumbar radiculopathy

    PubMed Central

    Benditz, A.; Madl, M.; Loher, M.; Grifka, J.; Boluki, D.; Linhardt, O.

    2016-01-01

    Lumbar radiculopathy is one of the most common diseases of modern civilisation. Multimodal pain management (MPM) represents a central approach to avoiding surgery. Only few medium-term results have been published in the literature so far. This study compared subjective and objective as well as anamnestic and clinical parameters of 60 patients who had undergone inpatient MPM because of lumbar radiculopathy before and 1 year ±2 weeks after treatment. The majority of patients were very satisfied (35%) or satisfied (52%) with the treatment outcome. Merely 8 patients commented neutrally and none negatively. The finger-floor distance had decreased significantly (p < 0.01), and 30 patients (50%) had shown improved mobility of the spine after therapy. The need for painkillers had also been significantly reduced after 1 year. The arithmetical average of pain on a visual analogue scale was 7.21 before treatment, which had significantly decreased to 3.58 at follow-up (p < 0.01). MPM is an effective approach for treating lumbar radiculopathy by mechanical nerve root irritation. Therefore, in the absence of an absolute indication for surgery or an absolute contradiction for MPM, patients should first be treated with this minimally invasive therapy. PMID:27305956

  5. Persons with unilateral transfemoral amputation have altered lumbosacral kinetics during sitting and standing movements.

    PubMed

    Hendershot, Brad D; Wolf, Erik J

    2015-07-01

    Increases in spinal loading have been related to altered movements of the lower back during gait among persons with lower limb amputation, movements which are self-perceived by these individuals as contributing factors in the development of low back pain. However, the relationships between altered trunk kinematics and associated changes in lumbosacral kinetics during sit-to-stand and stand-to-sit movements in this population have not yet been assessed. Three-dimensional lumbosacral kinetics (joint moments and powers) were compared between 9 persons with unilateral transfemoral amputation (wearing both a powered and passive knee device), and 9 uninjured controls, performing five consecutive sit-to-stand and stand-to-sit movements. During sit-to-stand movements, lumbosacral joint moments and powers were significantly larger among persons with transfemoral amputation relative to uninjured controls. During stand-to-sit movements, lumbosacral joint moments and powers were also significantly larger among persons with transfemoral amputation relative to uninjured controls, with the exception of sagittal joint powers. Minimal differences in kinetic measures were noted between the powered and passive knee devices among persons with transfemoral amputation across all conditions. Altered lumbosacral kinetics during sitting and standing movements, important activities of daily living, may play a biomechanical role in the onset and/or recurrence of low back pain or injury among persons with lower-limb amputation.

  6. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review.

    PubMed

    Luijsterburg, Pim A J; Verhagen, Arianne P; Ostelo, Raymond W J G; van Os, Ton A G; Peul, Wilco C; Koes, Bart W

    2007-07-01

    Patients with a lumbosacral radicular syndrome are mostly treated conservatively first. The effect of the conservative treatments remains controversial. To assess the effectiveness of conservative treatments of the lumbosacral radicular syndrome (sciatica). Relevant electronic databases and the reference lists of articles up to May 2004 were searched. Randomised clinical trials of all types of conservative treatments for patients with the lumbosacral radicular syndrome selected by two reviewers. Two reviewers independently assessed the methodological quality and the clinical relevance. Because the trials were considered heterogeneous we decided not to perform a meta-analysis but to summarise the results using the rating system of levels of evidence. Thirty trials were included that evaluated injections, traction, physical therapy, bed rest, manipulation, medication, and acupuncture as treatment for the lumbosacral radicular syndrome. Because several trials indicated no evidence of an effect it is not recommended to use corticosteroid injections and traction as treatment option. Whether clinicians should prescribe physical therapy, bed rest, manipulation or medication could not be concluded from this review. At present there is no evidence that one type of treatment is clearly superior to others, including no treatment, for patients with a lumbosacral radicular syndrome.

  7. Cervical Interlaminar Epidural Steroid Injection for Unilateral Cervical Radiculopathy: Comparison of Midline and Paramedian Approaches for Efficacy

    PubMed Central

    Yoon, Ji Young; Yoon, Young Cheol; Lee, Jongseok

    2015-01-01

    Objective The objective of this study was to compare the clinical outcomes of the cervical interlaminar epidural steroid injection (CIESI) for unilateral radiculopathy by the midline or paramedian approaches and to determine the prognostic factors of CIESI. Materials and Methods We retrospectively analyzed 182 patients who underwent CIESI from January 2009 to December 2012. Inclusion criteria were no previous spinal steroid injection, presence of a cross-sectional image, and presence of follow-up records. Exclusion criteria were patients with bilateral cervical radiculopathy and/or dominant cervical axial pain, combined peripheral neuropathy, and previous cervical spine surgery. Short-term clinical outcomes were evaluated at the first follow-up after CIESI. We compared the clinical outcomes between the midline and paramedian approaches. Possible prognostic factors for the outcome, such as age, gender, duration of radiculopathy, and cause of radiculopathy were also analyzed. Results Cervical interlaminar epidural steroid injections were effective in 124 of 182 patients (68.1%) at the first follow-up. There was no significant difference in the clinical outcomes of CIESI, between midline (69.6%) and paramedian (63.7%) approaches (p = 0.723). Cause of radiculopathy was the only significant factor affecting the efficacy of CIESI. Patients with disc herniation had significantly better results than patients with neural foraminal stenosis (82.9% vs. 56.0%) (p < 0.001). Conclusion There is no significant difference in treatment efficacy between the midline and paramedian approaches in CIESI, for unilateral radiculopathy. The cause of the radiculopathy is significantly associated with the treatment efficacy; patients with disc herniation experience better pain relief than those with neural foraminal stenosis. PMID:25995690

  8. Cervical Radiculopathy and Carpal Tunnel Syndrome: A Prospective Determination of the Reliability, Diagnostic Accuracy, and Predictive Validity fo Commonly Used Clinical

    DTIC Science & Technology

    2007-11-02

    Patients with cervical radiculopathy and carpal tunnel syndrome result in significant medical and occupational costs annually. There is a need to...of diagnostic accuracy. and predictive validity of items of the clinical examination used for the diagnosis of cervical radiculopathy and carpal tunnel syndrome.

  9. Massive Lumbosacral Subcutaneous Exudate After Surgical Treatment of a Large Lipomyelocele

    PubMed Central

    Gao, Jun; Kong, Xiangyi; Yang, Yi; Ma, Wenbin; Wang, Renzhi; Li, Yongning

    2015-01-01

    Abstract Lipomyelocele is an uncommon type of lipoma that occurs with spina bifida. We present the clinical course and therapeutic process of a female who underwent resection of a lipomyelocele and developed a massive lumbosacral subcutaneous exudate postoperatively. The therapeutic process is described in detail, and a review of the relevant literature on lipomyelocele is presented. A 23-year-old woman presented to our institution complaining of a large lumbosacral subcutaneous mass. She underwent surgical resection of the mass and untethering of the spinal cord under intraoperative neurophysiologic monitoring. A massive lumbosacral subcutaneous exudate developed postoperatively. After excluding cerebrospinal fluid (CSF) leakage, we placed a suction drain. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal. Because of this, there is no need to conduct special ethic review and the ethical approval is not necessary. Postoperative pathologic examination confirmed the diagnosis of lipomyelocele. Continuation of the negative-pressure drain for 1 week yielded >1000 mL of fluid. The patient recovered well and developed no further subcutaneous exudate. In a patient with massive lumbosacral subcutaneous exudate after surgical treatment of a large lipomyelocele, continuous negative-pressure drainage can be an effective treatment method after excluding CSF leakage. PMID:26426667

  10. Development and Validation of a Method to Measure Lumbosacral Motion Using Ultrasound Imaging.

    PubMed

    van den Hoorn, Wolbert; Coppieters, Michel W; van Dieën, Jaap H; Hodges, Paul W

    2016-05-01

    The study aim was to validate an ultrasound imaging technique to measure sagittal plane lumbosacral motion. Direct and indirect measures of lumbosacral angle change were developed and validated. Lumbosacral angle was estimated by the angle between lines through two landmarks on the sacrum and lowest lumbar vertebrae. Distance measure was made between the sacrum and lumbar vertebrae, and angle was estimated after distance was calibrated to angle. This method was tested in an in vitro spine and an in vivo porcine spine and validated to video and fluoroscopy measures, respectively. R(2), regression coefficients and mean absolute differences between ultrasound measures and validation measures were, respectively: 0.77, 0.982, 0.67° (in vitro, angle); 0.97, 0.992, 0.82° (in vitro, distance); 0.94, 0.995, 2.1° (in vivo, angle); and 0.95, 0.997, 1.7° (in vivo, distance). Lumbosacral motion can be accurately measured with ultrasound. This provides a basis to develop measurements for use in humans.

  11. Changes in muscular activity and lumbosacral kinematics in response to handling objects of unknown mass magnitude.

    PubMed

    Elsayed, Walaa; Farrag, Ahmed; El-Sayyad, Mohsen; Marras, William

    2015-04-01

    The aim of this study was to evaluate the main and interaction effects of mass knowledge and mass magnitude on trunk muscular activity and lumbosacral kinematics. Eighteen participants performed symmetric box lifts of three different mass magnitudes (1.1 kg, 5 kg, 15 kg) under known and unknown mass knowledge conditions. Outcome measures were normalized peak electromyography of four trunk muscles in addition to three dimensional lumbosacral angles and acceleration. The results indicated that three out of four muscles exhibited significantly greater activity when handling unknown masses (p<.05). Meanwhile, only sagittal angular acceleration was significantly higher when handling unknown masses (115.6 ± 42.7°/s(2)) compared to known masses (109.3 ± 31.5°/s(2)). Similarly, the mass magnitude and mass knowledge interaction significantly impacted the same muscles along with the sagittal lumbosacral angle and angular acceleration (p<.05) with the greatest difference between knowledge conditions being consistently occurring under the 1.1 kg mass magnitude condition. Thus, under these conditions, it was concluded that mass magnitude has more impact than mass knowledge. However, handling objects of unknown mass magnitude could be hazardous, particularly when lifting light masses, in that they can increase mechanical burden on the lumbosacral spine due to increased muscular exertion and acceleration.

  12. Changes in Midbrain Pain Receptor Expression, Gait and Behavioral Sensitivity in a Rat Model of Radiculopathy

    PubMed Central

    Hwang, Priscilla Y; Allen, Kyle D; Shamji, Mohammed F; Jing, Liufang; Mata, Brian A; Gabr, Mostafa A; Huebner, Janet L; Kraus, Virginia B; Richardson, William J; Setton, Lori A

    2012-01-01

    Intervertebral disc herniation may contribute to inflammatory processes that associate with radicular pain and motor deficits. Molecular changes at the affected dorsal root ganglion (DRG), spinal cord, and even midbrain, have been documented in rat models of radiculopathy or nerve injury. The objective of this study was to evaluate gait and the expression of key pain receptors in the midbrain in a rodent model of radiculopathy. Radiculopathy was induced by harvesting tail nucleus pulposus (NP) and placing upon the right L5 DRG in rats (NP-treated, n=12). Tail NP was discarded in sham-operated animals (n=12). Mechanical allodynia, weight-bearing, and gait were evaluated in all animals over time. At 1 and 4 weeks after surgery, astrocyte and microglial activation was tested in DRG sections. Midbrain sections were similarly evaluated for immunoreactivity to serotonin (5HT2B), mu-opioid (µ-OR), and metabotropic glutamate (mGluR4 and 5) receptor antibodies. NP-treated animals placed less weight on the affected limb 1 week after surgery and experienced mechanical hypersensitivity over the duration of the study. Astroctye activation was observed at DRGs only at 4 weeks after surgery. Findings for pain receptors in the midbrain of NP-treated rats included an increased expression of 5HT2B at 1, but not 4 weeks; increased expression of µ-OR and mGluR5 at 1 and 4 weeks (periaqueductal gray region only); and no changes in expression of mGluR4 at any point in this study. These observations provide support for the hypothesis that the midbrain responds to DRG injury with a transient change in receptors regulating pain responses. PMID:22962568

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

    PubMed Central

    2011-01-01

    Background Currently, herniated nucleus pulposus (HNP) with radiculopathy and other preconditions are regarded as relative or absolute contraindications for lumbar total disc replacement (TDR). In Switzerland it is left to the surgeon's discretion when to operate. The present study is based on the dataset of SWISSspine, a governmentally mandated health technology assessment registry. We hypothesized that preoperative nucleus pulposus status and presence or absence of radiculopathy has an influence on clinical outcomes in patients treated with mono-segmental lumbar TDR. Methods Between March 2005 and April 2009, 416 patients underwent mono-segmental lumbar TDR, which was documented in a prospective observational multicenter mode. The data collection consisted of perioperative and follow-up data (physician based) and clinical outcomes (NASS, EQ-5D). Patients were divided into four groups according to their preoperative status: 1) group degenerative disc disease ("DDD"): 160 patients without HNP and no radiculopathy, classic precondition for TDR; 2) group "HNP-No radiculopathy": 68 patients with HNP but without radiculopathy; 3) group "Stenosis": 73 patients without HNP but with radiculopathy, and 4) group "HNP-Radiculopathy": 132 patients with HNP and radiculopathy. The groups were compared regarding preoperative patient characteristics and pre- and postoperative VAS and EQ-5D scores using general linear modeling. Results Demographics in all four groups were comparable. Regarding the improvement of quality of life (EQ-5D) there were no differences across the four groups. For the two main groups DDD and HNP-Radiculopathy no differences were found in the adjusted postoperative back- and leg pain alleviation levels, in the stenosis group back- and leg pain relief were lower. Conclusions Despite higher preoperative leg pain levels, outcomes in lumbar TDR patients with HNP and radiculopathy were similar to outcomes in patients with the classic indication; this because

  14. Metrizamide CT myelography in cervical myelopathy and radiculopathy: correlation with conventional myelography and surgical findings

    SciTech Connect

    Badami, J.P.; Norman, D.; Barbaro, N.M.; Cann, C.E.; Weinstein, P.R.; Sobel, D.F.

    1985-04-01

    Conventional myelography, metrizamide computed tomographic (CT) myelography, and surgical findings were correlated in 30 patients with cervical radiculopathy and/or myelopathy. In 60% of patients, metrizamide CT myelography provided significant additional information including better characterization of the abnormality, lateralization if the conventional myelogram was indeterminate, more definitive demonstration of cord atrophy, foraminal narrowing not appreciated on myelography, and demonstration of abnormalities distal to a myelographic block. In no case was a myelographic abnormality not detected on metrizamide CT meyelography. In patients with cervical myelopathy, a cross-sectional diameter of the cord equaling less than 50% of the subarachnoid space is predictive of poor patient response to surgical intervention.

  15. Traumatic unilateral lumbosacral jumped facet without fracture in a child - presentation of a safe treatment strategy for a rare injury.

    PubMed

    Szentirmai, Oszkar; Seinfeld, Joshua; Beauchamp, Kathryn; Patel, Vikas

    2008-11-10

    The vast majority of pediatric lumbosacral spondylolisthesis have developmental etiology. Of the very rare type of pediatric lumbosacral facet dislocations, there are only three reported cases of a pediatric unilateral jumped facet injury. All of these cases are associated with fracture dislocation of L5-S1. Hyperflexion with rotation is thought to provoke this uncommon type of spine injury.The authors report the first pediatric patient reported in literature to date with a traumatic unilateral jumped facet at the lumbosacral joint without fracture. The presentation, surgical treatment, hospital course, outcome and management options with the review of the literature is summarized.

  16. Treatment strategies for early neurological deficits related to malpositioned pedicle screws in the lumbosacral canal

    PubMed Central

    Du, J-Y.; Wu, J-S.; Wen, Z-Q.

    2016-01-01

    Objectives To employ a simple and fast method to evaluate those patients with neurological deficits and misplaced screws in relatively safe lumbosacral spine, and to determine if it is necessary to undertake revision surgery. Methods A total of 316 patients were treated by fixation of lumbar and lumbosacral transpedicle screws at our institution from January 2011 to December 2012. We designed the criteria for post-operative revision scores of pedicle screw malpositioning (PRSPSM) in the lumbosacral canal. We recommend the revision of the misplaced pedicle screw in patients with PRSPSM = 5′ as early as possible. However, patients with PRSPSM < 5′ need to follow the next consecutive assessment procedures. A total of 15 patients were included according to at least three-stage follow-up. Results Five patients with neurological complications (PRSPSM = 5′) underwent revision surgery at an early stage. The other ten patients with PRSPSM < 5′ were treated by conservative methods for seven days. At three-month follow-up, only one patient showed delayed onset of neurological complications (PRSPSM 7′) while refusing revision. Seven months later, PRSPSM decreased to 3′ with complete rehabilitation. Conclusions This study highlights the significance of consecutively dynamic assessments of PRSPSMs, which are unlike previous implementations based on purely anatomical assessment or early onset of neurological deficits.and also confirms our hypothesis that patients with early neurological complications may not need revision procedures in the relatively broad margin of the lumbosacral canal. Cite this article: X-J. Lin. Treatment strategies for early neurological deficits related to malpositioned pedicle screws in the lumbosacral canal: A pilot study. Bone Joint Res 2016;5:46–51. DOI: 10.1302/2046-3758.52.2000477. PMID:26868892

  17. Spinal Myeloid Sarcoma “Chloroma” Presenting as Cervical Radiculopathy: Case Report

    PubMed Central

    Hu, Xiaobang; Shahab, Imran; Lieberman, Isador H.

    2015-01-01

    Study Design Case report. Objective Myeloid sarcoma (also known as chloroma) is a rare, extramedullary tumor composed of immature granulocytic cells. It may occur early in the course of acute or chronic leukemia or myeloproliferative disorders. Spinal cord invasion by myeloid sarcoma is rare. The authors report a rare case of spinal myeloid sarcoma presenting as cervical radiculopathy. Methods A previously healthy 43-year-old man presented with progressive neck, right shoulder, and arm pain. Cervical magnetic resonance imaging (MRI) revealed a very large enhancing extradural soft tissue mass extending from C7 through T1, with severe narrowing of the thecal sac at the T1 level. The patient underwent posterior cervical open biopsy, laminectomy, and decompression. Histologic examination of the surgical specimen confirmed the diagnosis of myeloid sarcoma. Postoperatively, a bone marrow biopsy was done, which showed myeloproliferative neoplasm with eosinophilia. The patient then received systemic chemotherapy and radiotherapy. Results At the 10-month follow-up, the patient reported complete relief of arm pain and neck pain. X-rays showed that the overall cervical alignment was intact and there was no evidence of a recurrent lesion. MRI showed no evidence of compressive or remnant lesion. Conclusions Spinal myeloid sarcoma presenting as cervical radiculopathy is rare, and it may be easily misdiagnosed. Knowledge of its clinical presentation, imaging, and histologic characterization can lead to early diagnosis and appropriate treatment. PMID:26131394

  18. Development of a preoperative neuroscience educational program for patients with lumbar radiculopathy.

    PubMed

    Louw, Adriaan; Butler, David S; Diener, Ina; Puentedura, Emilio J

    2013-05-01

    Postoperative rehabilitation for lumbar radiculopathy has shown little effect on reducing pain and disability. Current preoperative education programs with a focus on a biomedical approach feature procedural and anatomical information, and these too have shown little effect on postoperative outcomes. This report describes the development of an evidence-based educational program and booklet for patients undergoing lumbar surgery for radiculopathy using a recently conducted systematic review of neuroscience education for musculoskeletal pain. The previous systematic review produced evidence for neuroscience education as well as best-evidence synthesis of the content and delivery methods for neuroscience education for musculoskeletal pain. These evidence statements were extracted and developed into patient-centered messages and a booklet, which was then evaluated by peer and patient review. The neuroscience educational booklet and preoperative program convey key messages from the previous systematic review aimed at reducing fear and anxiety before surgery and assist in developing realistic expectations regarding pain after surgery. Key topics include the decision to undergo surgery, pain processing, peripheral nerve sensitization, effect of anxiety and stress on pain, surgery and the nervous system, and decreasing nerve sensitization. Feedback from the evaluations of the booklet and preoperative program was favorable from all review groups, suggesting that this proposed evidence-based neuroscience educational program may be ready for clinical application.

  19. Cervical disc arthroplasty for the treatment of spondylotic myelopathy and radiculopathy.

    PubMed

    Khong, Peter; Bogduk, Nikolai; Ghahreman, Ali; Davies, Mark

    2013-10-01

    The concept of cervical disc arthroplasty (CDA) for the anterior treatment of cervical pathology has existed for approximately half a decade. In this time, multiple devices have been developed for this purpose, with the ultimate aim to provide an alternative to fusion. Fifty-five patients with cervical spondylotic radiculopathy and myelopathy underwent CDA over a 5 year period. Data was collected on 46 patients, which included Visual Analogue Scale scores for neck pain and arm pain, Neck Disability Index scores, Short Form-36 v2 (SF-36) and Nurick grades for myelopathy patients. Preoperative data and data obtained at the latest clinical follow-up (median 48 months, range, 10-76 months) were analysed to assess the intermediate term efficacy of the procedure. In patients with radiculopathy, arm pain improved by 88% (p<0.001). In those presenting with myelopathy, the Nurick grades improved from a median of 1 to 0 (p<0.001). In both groups of patients, improvements in pain and neurologic deficit were accompanied by significant improvements in multiple domains of the SF-36. Using a composite system which considered neck pain, arm pain, function and myelopathy, we arrived at an overall success rate of 73%. We concluded that CDA is an effective intervention for improving neurologic deficit, arm pain and local neck symptoms that translated into improvements in physical and social functioning in the intermediate term.

  20. The comparison of the efficacy of radiofrequency nucleoplasty and targeted disc decompression in lumbar radiculopathy

    PubMed Central

    Adakli, Barıs; Turhan, K. Sanem Cakar; Asik, Ibrahim

    2015-01-01

    Chronic low back pain is a common clinical condition causing medical, socioeconomic, and treatment difficulties. In our study, we aimed to compare early and long-term efficacy of lumbar radiofrequency thermocoagulation (RFTC) nucleoplasty and targeted disc decompression (TDD) in patients with lumbar radiculopathy in whom previous conventional therapy had failed. The medical records of 37 patients undergoing TDD and 36 patients undergoing lumbar RFTC nucleoplasty were retrospectively examined and assigned to the Group D and Group N, respectively. In all patients Visual Analogue Scale (VAS) and Functional Rating Index (FRI) were recorded before treatment and after one, six and twelve months after the procedure. The North American Spine Society Satisfaction Scale (NASSSS) was also recoreded twelve months after the therapeutic procedure. Statistically significant postprocedural improvement in VAS and FRI was evident in both groups. VAS scores after one, six, and twelve month were slightly higher in Group N, compared to Group D. The overall procedure-related patient satisfaction ratio was 67.5% in the Group D, compared to 75% in the Group N. Regardless of the different mechanism of action, both methods are effective therapies for lumbar radiculopathy, with TDD showing long-term lower pain scores. PMID:26042514

  1. Complementary and Alternative Medicine for the Management of Cervical Radiculopathy: An Overview of Systematic Reviews

    PubMed Central

    Wei, Xu; Wang, Shangquan; Li, Jinxue; Gao, Jinghua; Yu, Jie; Feng, Minshan; Zhu, Liguo

    2015-01-01

    Background. Complementary and alternative medicine (CAM) is widely applied in the clinical practice of neck pain owing to cervical radiculopathy (CR). While many systematic reviews exist in CAM to improve CR, research is distributed across population, intervention, comparison, and setting. Objective. This overview aims to summarize the characteristics and evaluate critically the evidence from systematic reviews. Methods. A comprehensive literature search was performed in the six databases without language restrictions on February 24, 2015. We had identified relevant systematic reviews that examined the subjects with neck pain due to cervical radiculopathy undergoing CAM. Two authors independently appraised the methodological quality using the revised assessment of multiple systematic reviews instrument. Results. We had included eight systematic reviews. The effectiveness and safety of acupotomy, acupuncture, Jingfukang granule, manual therapies, and cervical spine manipulation were investigated. Based on available evidence, the systematic reviews supported various forms of CAM for CR. Nevertheless, the methodological quality for most of systematic reviews was low or moderate. In addition, adverse reactions of primary studies were infrequent. Conclusions. Current systematic reviews showed potential advantages to CAM for CR. Due to the frequently poor methodological quality of primary studies, the conclusions should be treated with caution for clinical practice. PMID:26345336

  2. Somatosensory evoked potentials following nerve and segmental stimulation do not confirm cervical radiculopathy with sensory deficit.

    PubMed Central

    Schmid, U D; Hess, C W; Ludin, H P

    1988-01-01

    Twenty eight patients with unilateral cervical radiculopathy were studied by somatosensory evoked potentials (SEPs) from nerve stimulation at the wrist and from skin stimulation at the first, third or fifth finger depending on the root involved. In order to evaluate the reliability of various "radicular SEP patterns" as described in the literature, absolute latencies and side-to-side differences of the brachial plexus component from the supraclavicular fossa (N9), the medullary component (N13) from the cervical vertebra Cv7, and the primary cortical component (N20, P25) were assessed. Side-to-side differences of the amplitudes of N20/P25 and of the conduction times across the intervertebral fossa (interval N9-N13) were analysed. After nerve stimulation, 68% of the patients had false negative findings on the symptomatic, while 36% had positive findings on the asymptomatic side. After segmental stimulation, 72% of the patients had false negative findings on the symptomatic, while 22% had positive findings on the asymptomatic side. It is concluded that SEPs following nerve and segmental stimulation do not reliably confirm clear-cut already established diagnoses of unilateral radiculopathy with sensory and motor deficit. Therefore, they will not be helpful in the electrophysiological investigation of cervicobrachialgias of unknown origin. PMID:2831303

  3. Dimensions Underlying Measures of Disability, Personal Factors, and Health Status in Cervical Radiculopathy: A Cross-Sectional Study.

    PubMed

    Halvorsen, Marie; Kierkegaard, Marie; Harms-Ringdahl, Karin; Peolsson, Anneli; Dedering, Åsa

    2015-06-01

    This cross-sectional study sought to identify dimensions underlying measures of impairment, disability, personal factors, and health status in patients with cervical radiculopathy. One hundred twenty-four patients with magnetic resonance imaging-verified cervical radiculopathy, attending a neurosurgery clinic in Sweden, participated. Data from clinical tests and questionnaires on disability, personal factors, and health status were used in a principal-component analysis (PCA) with oblique rotation. The PCA supported a 3-component model including 14 variables from clinical tests and questionnaires, accounting for 73% of the cumulative percentage. The first component, pain and disability, explained 56%. The second component, health, fear-avoidance beliefs, kinesiophobia, and self-efficacy, explained 9.2%. The third component including anxiety, depression, and catastrophizing explained 7.6%. The strongest-loading variables of each dimension were "present neck pain intensity," "fear avoidance," and "anxiety." The three underlying dimensions identified and labeled Pain and functioning, Health, beliefs, and kinesiophobia, and Mood state and catastrophizing captured aspects of importance for cervical radiculopathy. Since the variables "present neck pain intensity," "fear avoidance," and "anxiety" had the strongest loading in each of the three dimensions; it may be important to include them in a reduced multidimensional measurement set in cervical radiculopathy.

  4. Lumbo-sacral neural crest contributes to the avian enteric nervous system independently of vagal neural crest.

    PubMed

    Hearn, C; Newgreen, D

    2000-07-01

    Most of the avian enteric nervous system is derived from the vagal neural crest, but a minority of the neural cells in the hindgut, and to an even lesser extent in the midgut, are of lumbo-sacral crest origin. Since the lumbo-sacral contribution was not detected or deemed negligible in the absence of vagal cells, it had been hypothesised that lumbo-sacral neural crest cells require vagal crest cells to contribute to the enteric nervous system. In contrast, zonal aganglionosis, a rare congenital human bowel disease led to the opposite suggestion, that lumbo-sacral cells could compensate for the absence of vagal cells to construct a complete enteric nervous system. To test these notions, we combined E4 chick midgut and hindgut, isolated prior to arrival of neural precursors, with E1. 7 chick vagal and/or E2.7 quail lumbo-sacral neural tube as crest donors, and grafted these to the chorio-allantoic membrane of E9 chick hosts. Double and triple immuno-labelling for quail cells (QCPNA), neural crest cells (HNK-1), neurons and neurites (neurofilament) and glial cells (GFAP) indicated that vagal crest cells produced neurons and glia in large ganglia throughout the entire intestinal tissues. Lumbo-sacral crest contributed small numbers of neurons and glial cells in the presence or absence of vagal cells, chiefly in colorectum, but not in nearby small intestinal tissue. Thus for production of enteric neural cells the avian lumbo-sacral neural crest neither requires the vagal neural crest, nor significantly compensates for its lack. However, enteric neurogenesis of lumbo-sacral cells requires the hindgut microenvironment, whereas that of vagal cells is not restricted to a particular intestinal region.

  5. Cervical laminoforaminotomy for radiculopathy: Symptomatic and functional outcomes in a large cohort with long-term follow-up

    PubMed Central

    Church, Ephraim W.; Halpern, Casey H.; Faught, Ryan W.; Balmuri, Usha; Attiah, Mark A.; Hayden, Sharon; Kerr, Marie; Maloney-Wilensky, Eileen; Bynum, Janice; Dante, Stephen J.; Welch, William C.; Simeone, Frederick A.

    2014-01-01

    Background: The efficacy and safety of cervical laminoforaminotomy (FOR) in the treatment of cervical radiculopathy has been demonstrated in several series with follow-up less than a decade. However, there is little data analyzing the relative effectiveness of FOR for radiculopathy due to soft disc versus osteophyte disease. In the present study, we review our experience with FOR in a single-center cohort, with long-term follow-up. Methods: We examined the charts of patients who underwent 1085 FORs between 1990 and 2009. A cohort of these patients participated in a telephone interview designed to assess improvement in symptoms and function. Results: A total of 338 interviews were completed with a mean follow-up of 10 years. Approximately 90% of interviewees reported improved pain, weakness, or function following FOR. Ninety-three percent of patients were able to return to work after FOR. The overall complication rate was 3.3%, and the rate of recurrent radiculopathy requiring surgery was 6.2%. Soft disc subtypes compared to osteophyte disease by operative report were associated with improved symptoms (P < 0.05). The operative report of these pathologic subtypes was associated with the preoperative magnetic resonance imaging (MRI) interpretation (P < 0.001). Conclusions: These results suggest that FOR is a highly effective surgical treatment for cervical radiculopathy with a low incidence of complications. Radiculopathy due to soft disc subtypes may be associated with a better prognosis compared to osteophyte disease, although osteophyte disease remains an excellent indication for FOR. PMID:25593773

  6. [Rhabdomyolysis and lumbosacral plexopathy in intravenous drug addict: report of a case].

    PubMed

    Diaz Guzman, J; Pastor Valverde, C; Gil Grande, R; Alonso Ortiz, A; Trueba Gutierrez, J L

    1996-02-01

    There are several neuromuscular complications in the intravenous heroin addict (IHA). Someone may be due to direct toxic effect of the substance, but other ones may be associated to abuser's typical diseases (i.e. HIV infection). We present a 27 year-old IHA patient, HIV positive, that develop acute rhabdomyolisis with severe neuromuscular involvement, and consistent clinical and electrodiagnostic features of lumbosacral plexus neuropathy, forteen hours after an heroin inyection. Thirty months later, the patient is severely disabled, but her initial painfull and paretic picture have improved. The association of rhabdomyolisis-lumbosacral plexopathy (RLPS) is ocasionally reported. It has been proposed that RLSP is etiologically related to mecanic, toxic and immunologic factors.

  7. Evaluation of Outcome of Posterior Decompression and Instrumented Fusion in Lumbar and Lumbosacral Tuberculosis

    PubMed Central

    Jain, Ravikant; Kiyawat, Vivek

    2016-01-01

    Background For surgical treatment of lumbar and lumbosacral tuberculosis, the anterior approach has been the most popular approach because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The posterior approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach. The purpose of this study was to evaluate the outcome (functional, neurological, and radiological) in patients with lumbar and lumbosacral tuberculosis operated through the posterior approach. Methods Twenty-eight patients were diagnosed with tuberculosis of the lumbar and lumbosacral region from August 2012 to August 2013. Of these, 13 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent posterior decompression and pedicle screw fixation with posterolateral fusion. Antitubercular therapy was given till signs of radiological healing were evident (9 to 16 months). Functional outcome (visual analogue scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediately postoperatively and 3 months, 6 months, and 1 year postoperatively. Results The mean VAS score for back pain improved from 7.89 (range, 9 to 7) preoperatively to 2.2 (range, 3 to 1) at 1-year follow-up. Frankel grading was grade B in 3, grade C in 7, and grade D in 3 patients preoperatively, which improved to grade D in 7 and grade E in 6 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. The mean correction of segmental kyphosis was 9.85° postoperatively. The mean loss of correction at final follow-up was 3.15°. Conclusions

  8. Decoding intravesical pressure from local field potentials in rat lumbosacral spinal cord

    NASA Astrophysics Data System (ADS)

    Im, Changkyun; Park, Hae Yong; Koh, Chin Su; Ryu, Sang Baek; Seo, In Seok; Kim, Yong Jung; Kim, Kyung Hwan; Shin, Hyung-Cheul

    2016-10-01

    Chronic monitoring of intravesical pressure is required to detect the onset of intravesical hypertension and the progression of a more severe condition. Recent reports demonstrate the bladder state can be monitored from the spiking activity of the dorsal root ganglia or lumbosacral spinal cord. However, one of the most serious challenges for these methods is the difficulty of sustained spike signal acquisition due to the high-electrode-location-sensitivity of spikes or neuro-degeneration. Alternatively, it has been demonstrated that local field potential recordings are less affected by encapsulation reactions or electrode location changes. Here, we hypothesized that local field potential (LFP) from the lumbosacral dorsal horn may provide information concerning the intravesical pressure. LFP and spike activities were simultaneously recorded from the lumbosacral spinal cord of anesthetized rats during bladder filling. The results show that the LFP activities carry significant information about intravesical pressure along with spiking activities. Importantly, the intravesical pressure is decoded from the power in high-frequency bands (83.9-256 Hz) with a substantial performance similar to that of the spike train decoding. These findings demonstrate that high-frequency LFP activity can be an alternative intravesical pressure monitoring signal, which could lead to a proper closed loop system for urinary control.

  9. Symptomatic lumbosacral perineural cysts: A report of three cases and review of literature

    PubMed Central

    Sharma, Mayur; Velho, Vernon; Mally, Rahul; Khan, Shadma W.

    2015-01-01

    Lumbosacral perineural cysts (Tarlov's cysts) are nerve root cysts, which are usually asymptomatic and are detected incidentally on imaging. These cysts are rare with an incidence of 4.6%. We report three cases of Lumbosacral Tarlov's cysts, which presented with cauda equina syndrome and radicular pain syndrome. Two of our patients had symptoms of cauda equina syndrome, and one had acute sciatica. Complete excision of the cyst was achieved in two patients and marsupialization of the cyst was done in another patient due to its large size and dense adherence to the sacral nerve roots. All the patients were relieved of the radicular pain with no new neurological deficit following surgery. Symptomatic lumbosacral Tarlov's cyst is a rare lesion, and the presentation can be low back pain, cauda equina syndrome or sciatica. Therefore, this entity should be kept in the differential diagnosis of patients presenting with these symptoms. Complete Surgical excision of these symptomatic cysts is the treatment of choice to achieve a cure. PMID:26396612

  10. Traumatic Lumbosacral Spondyloptosis: A Case Report and Review of the Literature

    PubMed Central

    Akesen, Burak; Mutlu, Müren; Kara, Kürşat; Aydınlı, Ufuk

    2013-01-01

    Study Design Case report and review of the literature. Objective To report a case of traumatic L5–S1 spondyloptosis and review the literature. Method A 28-year-old man presented with severe low back pain, numbness at the soles of feet, and bowel and bladder dysfunction. Two days before admission, a tree trunk fell on his back while he was seated. A two-stage posterior-anterior procedure was performed. At the first stage, posterior decompression, reduction, and fusion with instrumentation were performed. At the second stage, which was performed 6 days after the first stage, the patient underwent anterior lumbar interbody fusion. The patient received physical therapy 1 week after the second stage. Results The patient's numbness improved immediately after the first posterior surgery. His fecal and urinary incontinence improved 6 months after discharge. He has been pain-free for a year and has returned to work. Conclusion A PubMed search was performed using the following keywords: lumbosacral spondyloptosis, lumbosacral dislocation, and L5–S1 traumatic dislocation. The search returned only nine reported cases of traumatic spondyloptosis. Traumatic spondyloptosis at the lumbosacral junction is a rare ailment that should be suspected in cases of high, direct, and posterior impact on the low lumbar area, and surgical treatment should be the standard choice of care. PMID:24494183

  11. Traumatic lumbosacral spondyloptosis: a case report and review of the literature.

    PubMed

    Akesen, Burak; Mutlu, Müren; Kara, Kürşat; Aydınlı, Ufuk

    2014-02-01

    Study Design Case report and review of the literature. Objective To report a case of traumatic L5-S1 spondyloptosis and review the literature. Method A 28-year-old man presented with severe low back pain, numbness at the soles of feet, and bowel and bladder dysfunction. Two days before admission, a tree trunk fell on his back while he was seated. A two-stage posterior-anterior procedure was performed. At the first stage, posterior decompression, reduction, and fusion with instrumentation were performed. At the second stage, which was performed 6 days after the first stage, the patient underwent anterior lumbar interbody fusion. The patient received physical therapy 1 week after the second stage. Results The patient's numbness improved immediately after the first posterior surgery. His fecal and urinary incontinence improved 6 months after discharge. He has been pain-free for a year and has returned to work. Conclusion A PubMed search was performed using the following keywords: lumbosacral spondyloptosis, lumbosacral dislocation, and L5-S1 traumatic dislocation. The search returned only nine reported cases of traumatic spondyloptosis. Traumatic spondyloptosis at the lumbosacral junction is a rare ailment that should be suspected in cases of high, direct, and posterior impact on the low lumbar area, and surgical treatment should be the standard choice of care.

  12. Acute cervical motor radiculopathy induced by neck and limb immobilization in a patient with Parkinson disease.

    PubMed

    Shimizu, Toshio; Komori, Tetsuo; Hayashi, Hideaki

    2006-01-01

    A 68-year-old woman with Parkinson disease (PD) presented with acute monoplegia of her left upper extremity after the neck and limb immobilization for several hours. Her sensory function was normal, and the chest X-ray showed left phrenic nerve palsy. Electrophysiological studies showed multi-segment muscle involvement (C3 to T1) including denervation potentials and reduced interference of motor units in needle electromyography. M wave amplitude in peripheral nerve stimulation was preserved except for the ulnar nerve, suggesting both axonal injury and conduction block at the anterior spinal roots. The patient showed fair recovery in several months, suggesting sufficient reinnervation and recovery of conduction block. Incomplete root avulsion was thought to be the pathomechanism of acute cervical motor radiculopathy.

  13. Brain meningioma with initial manifestation similar to cervical radiculopathy: a case report

    PubMed Central

    Huang, Yu-Hsuan; Hong, Chang-Zern; Wu, Wei-Ting; Li, Kun-Ta; Chou, Li-Wei

    2014-01-01

    Meningiomas are the most common benign brain tumors, and are characterized by slow growth and a long asymptomatic period. Once the tumor becomes symptomatic, the various presentations may be related to the location and compression of adjacent structures. Meningioma is primarily treated through surgical intervention, and thus earlier diagnosis is likely to result in better prognosis. The symptoms of the meningioma may mimic other diseases, making precise diagnosis difficult, which will then delay treatment. We report a case of brain meningioma that showed initial signs and symptoms similar to cervical radiculopathy. The symptoms extended gradually, and the ultimate diagnosis of meningioma was confirmed based on brain-image studies. After brain-tumor excision, postoperation radiotherapy, and aggressive rehabilitation, the patient was able to perform better in daily activities. PMID:25028552

  14. Psychologic and Biologic Factors Associated with Fatigue in Patients with Persistent Radiculopathy

    PubMed Central

    Starkweather, Angela

    2013-01-01

    Fatigue is a common symptom associated with neuropathic pain (NP) and can have negative consequences on psychosocial functioning, physical endurance, and quality of life. Recent evidence indicates that immune activation modulated through the increased release of proinflammatory cytokines can predict fatigue in some patient populations. Although earlier studies have shown that immune activation is a pathophysiologic feature of NP, there have been no studies to examine the relationship between immune activation and fatigue in persons with NP. Therefore, the purpose of this exploratory study was to: 1) determine the relationships among fatigue, pain, psychosocial factors, and selected biologic markers of immune activation (interleukin [IL] 6 and soluble IL-6 receptor [sIL-6R]) in participants with persistent radiculopathy; and 2) determine the differences in these variables based on fatigue severity. Participants (n = 80) were classified according to their level of fatigue as low (27.5%), moderate (32.5%), or high (40%), and significant differences were found between fatigue categories (p =.001). Multivariate analyses of variance revealed that individuals with moderate to high levels of fatigue differed from those with the lowest levels of fatigue in psychologic distress, depressive symptoms, IL-6, and sIL-6R, whereas the differences between moderate and high levels of fatigue were significant for psychologic distress and sIL-6R only. The findings suggest that immune activation affects fatigue severity and possibly other behavioral responses, offering important information when providing care to patients with persistent radiculopathy. The integration of biobehavioral nursing interventions in pain management may have a greater impact on quality of life than treatment focused only on pain. PMID:23452526

  15. Protective effects of resveratrol on autologous nucleus pulposus model of radiculopathy

    PubMed Central

    Lin, Bin; Yu, Hui; He, Yongzhi; Xu, Yang; Zhang, Wenbin; Lu, Chengwu; Ao, Qingfang

    2016-01-01

    Nucleus pulposus (NP) has been suggested to trigger an autoimmune response if exposed to the immune system, which plays a key role in neuropathic pain. Therefore, appropriate suppression of inflammation is a key factor for treating the radiculopathy caused by intervertebral disk (IVD) degeneration. Resveratrol, a key component of red wine, has been suggested to exhibit anti-inflammatory properties in vitro and in vivo. However, the effects of resveratrol on NP-mediated pain in vivo have not been studied. The aim of the present study was to investigate whether resveratrol may be useful in treating NP-mediated pain in an autologous NP model of radiculopathy. A total of 36 adult male Sprague-Dawley rats were allocated randomly into sham (group I), saline-treated (group II) and resveratrol-treated (group III) groups. Animal behavior in response to non-noxious mechanical stimulation with von Frey filaments was compared at days 0 (baseline), 3, 7, 14 and 21 following surgery. The expression of proinflammatory cytokines such as tumor necrosis factor α (TNF-α) and interleukin-1 (IL-1) were assessed at days 7 and 14. The data showed that resveratrol exhibited an anti-inflammatory effect on the expression of proinflammatory cytokines. Compared with group II, the expression of TNF-α and IL-1 was significantly decreased at each time point in group III. In addition, resveratrol significantly reduced pain behavior triggered by the application of NP tissue on the dorsal root ganglion for up to 14 days. These data suggest that resveratrol has potential for the treatment of NP-mediated pain, indicating a potential clinical application. PMID:28101174

  16. Preoperative education for lumbar radiculopathy: A survey of US spine surgeons

    PubMed Central

    Louw, Adriaan; Butler, David S.; Diener, Ina; Puentedura, Emilio J.

    2012-01-01

    Background We sought to determine current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Methods An online cross-sectional survey was used to study a random sample of spine surgeons in the United States. The Spinal Surgery Education Questionnaire (SSEQ) was developed based on previous related surveys and assessed for face and content validity by an expert panel. The SSEQ captured information on demographics, content, delivery methods, utilization, and importance of preoperative education as rated by surgeons. Descriptive statistics were used to describe the current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Results Of 200 surgeons, 89 (45% response rate) responded to the online survey. The majority (64.2%) provide preoperative education informally during the course of clinical consultation versus a formal preoperative education session. The mean time from the decision to undergo surgery to the date of surgery was 33.65 days. The highest rated educational topics are surgical procedure (96.3%), complications (96.3%), outcomes/expectations (93.8%), anatomy (92.6%), amount of postoperative pain expected (90.1%), and hospital stay (90.1%). Surgeons estimated spending approximately 20% of the preoperative education time specifically addressing pain. Seventy-five percent of the surgeons personally provide the education, and nearly all surgeons (96.3%) use verbal communication with the use of a spine model. Conclusions Spine surgeons believe that preoperative education is important and use a predominantly biomedical approach in preparing patients for surgery. Larger studies are needed to validate these findings. PMID:25694882

  17. Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography?

    PubMed Central

    Seo, Tae Gyu; Kim, In-Soo; Son, Eun Seok

    2016-01-01

    Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA. PMID:27152289

  18. A novel technique to repair a transverse sacral fracture in a previously fused lumbosacral spondylolisthesis

    PubMed Central

    Noh, Thomas; Chedid, Mokbel K.

    2016-01-01

    Background: Transverse fractures of the sacrum are rare, and surgical treatment for these fractures ranges from conservative to challenging. Transverse stress fractures of the sacrum after placement of lumbar-to-sacral instrumentation have been previously described. We report a new technique to repair a transverse Type-2 Roy-Camille fracture with spondylolisthesis of S1 over S2 in a previously fused instrumented high-grade L4-L5, L5-S1 spondylolisthesis. Case Description: A 64-year-old female who previously had an L4-L5, L5-S1 fusion for spondylolisthesis presented with excruciating lower back pain and radiculopathy for over 6 months. She was found to have an S1-S2 transverse fracture caused by previous implantation of pedicle screws. She underwent repositioning of several failed right lumbar and sacral screws and then had bilateral S1-S2 screws placed directly across the fracture line. The patient had an unremarkable postoperative course. She discontinued most of her pain medications within 6 weeks postoperatively. In the months following surgery, she reported only minimal lower back pain and no radiculopathy with the last appointment 5 years postoperatively. Conclusions: We describe a novel technique to reduce an iatrogenic transverse type-2 Roy-Camille fracture at S1-S2 in a previously instrumented high-grade L4-L5, L5-S1 spondylolisthesis. The patient's fracture achieved adequate reduction and fusion with symptomatic relief. PMID:28028448

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

    PubMed

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

    2015-01-01

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

  20. Thyrotropin-releasing hormone causes a tonic excitatory postsynaptic current and inhibits the phasic inspiratory inhibitory inputs in inspiratory-inhibited airway vagal preganglionic neurons.

    PubMed

    Hou, L; Zhou, X; Chen, Y; Qiu, D; Zhu, L; Wang, J

    2012-01-27

    The airway vagal preganglionic neurons (AVPNs) in the external formation of the nucleus ambiguus (eNA), which include the inspiratory-activated AVPNs (IA-AVPNs) and inspiratory-inhibited AVPNs (II-AVPNs), predominate in the control of the trachea and bronchia. The AVPNs receive particularly dense inputs from terminals containing thyrotropin-releasing hormone (TRH). TRH microinjection into the nucleus ambiguus (NA) caused constriction of the tracheal smooth muscles. However, it is unknown whether TRH affects all subtypes of the AVPNs in the eNA, and as a result affects the control of all types of target tissues in the airway (smooth muscles, submucosal glands, and blood vessels). It is also unknown how TRH affects the AVPNs at neuronal and synaptic levels. In this study, the AVPNs in the eNA were retrogradely labeled from the extrathoracic trachea, the II-AVPNs were identified in rhythmically firing brainstem slices, and the effects of TRH were examined using patch-clamp. TRH (100 nmol L(-1)) enhanced both the rhythm and the intensity of the hypoglossal bursts, and caused a tonic excitatory inward current in the II-AVPNs at a holding voltage of -80 mV. The frequency of the spontaneous excitatory postsynaptic currents (EPSCs) in the II-AVPNs, which showed no respiratory-related change in a respiratory cycle, was not significantly changed by TRH. At a holding voltage of -50 mV, the II-AVPNs showed both spontaneous and phasic inspiratory (outward) inhibitory postsynaptic currents (IPSCs). TRH had no effect on the spontaneous IPSCs but significantly attenuated the phasic inspiratory outward currents, in both the amplitude and area. After focal application of strychnine, an antagonist of glycine receptors, to the II-AVPNs, the spontaneous IPSCs were extremely scarce and the phasic inspiratory inhibitory currents were abolished; and further application of TRH had no effect on these currents. Under current clamp configuration, TRH caused a depolarization and increased the

  1. Inhibitory effects of endomorphin-2 on excitatory synaptic transmission and the neuronal excitability of sacral parasympathetic preganglionic neurons in young rats

    PubMed Central

    Chen, Ying-Biao; Huang, Fen-Sheng; Fen, Ban; Yin, Jun-Bin; Wang, Wei; Li, Yun-Qing

    2015-01-01

    The function of the urinary bladder is partly controlled by parasympathetic preganglionic neurons (PPNs) of the sacral parasympathetic nucleus (SPN). Our recent work demonstrated that endomorphin-2 (EM-2)-immunoreactive (IR) terminals form synapses with μ-opioid receptor (MOR)-expressing PPNs in the rat SPN. Here, we examined the effects of EM-2 on excitatory synaptic transmission and the neuronal excitability of the PPNs in young rats (24–30 days old) using a whole-cell patch-clamp approach. PPNs were identified by retrograde labeling with the fluorescent tracer tetramethylrhodamine-dextran (TMR). EM-2 (3 μM) markedly decreased both the amplitude and the frequency of the spontaneous and miniature excitatory postsynaptic currents (sEPSCs and mEPSCs) of PPNs. EM-2 not only decreased the resting membrane potentials (RMPs) in 61.1% of the examined PPNs with half-maximal response at the concentration of 0.282 μM, but also increased the rheobase current and reduced the repetitive action potential firing of PPNs. Analysis of the current–voltage relationship revealed that the EM-2-induced current was reversed at −95 ± 2.5 mV and was suppressed by perfusion of the potassium channel blockers 4-aminopyridine (4-AP) or BaCl2 or by the addition of guanosine 5′-[β-thio]diphosphate trilithium salt (GDP-β-S) to the pipette solution, suggesting the involvement of the G-protein-coupled inwardly rectifying potassium (GIRK) channel. The above EM-2-invoked inhibitory effects were abolished by the MOR selective antagonist D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2 (CTOP), indicating that the effects of EM-2 on PPNs were mediated by MOR via pre- and/or post-synaptic mechanisms. EM-2 activated pre- and post-synaptic MORs, inhibiting excitatory neurotransmitter release from the presynaptic terminals and decreasing the excitability of PPNs due to hyperpolarization of their membrane potentials, respectively. These inhibitory effects of EM-2 on PPNs at the spinal cord level may

  2. Non-diabetic lumbosacral radiculoplexus neuropathy: natural history, outcome and comparison with the diabetic variety.

    PubMed

    Dyck, P J; Norell, J E; Dyck, P J

    2001-06-01

    Diabetic lumbosacral radiculoplexus neuropathy (DLSRPN) (other names include diabetic amyotrophy) is well recognized, unlike the non-diabetic lumbosacral radiculoplexus neuropathy (LSRPN), which has received less attention. Our objective was to characterize the natural history and outcome of LSRPN and to assess whether it is similar to the diabetic variety in its symptoms, course, electrophysiological features, quantitative sensory and autonomic findings, and the underlying pathophysiology. We studied 57 patients with LSRPN and 33 patients with DLSRPN. We found that the age of onset, course, kind and distribution of symptoms and impairments, laboratory findings and outcomes are essentially alike. Both disorders are a lumbosacral plexus neuropathy associated with weight loss, often beginning focally or asymmetrically in the thigh or leg but usually progressing to involve the initially unaffected segment and the contralateral side. Both have prolonged morbidity due to pain, paralysis, autonomic involvement and sensory loss. In biopsied distal LSRPN nerves, we found changes similar to those found in DLSRPN-alterations typical of ischaemic injury and of microvasculitis. The long-term outcome was determined in 42 LSRPN patients: two had become diabetic, seven had relapsed and only three had recovered completely, although all had improved. We conclude that: (i) LSRPN is a subacute, asymmetrical, painful and debilitating neuropathy of the lower limbs associated with weight loss, and we think it is under-recognized; (ii) recovery from the long-term impairments of LSRPN is usually delayed and incomplete and only a small minority of patients develop diabetes mellitus; (iii) LSRPN mirrors the diabetic variety in its clinical features, course, pathological findings (ischaemic injury from microvasculitis) and long-term outcome; and (iv) LSRPN should be set apart from chronic inflammatory demyelinating polyradiculoneuropathy and from systemic necrotizing vasculitis. We infer an

  3. Lumbosacral transitional vertebra and thoracic limb malformations in a Chihuahua puppy.

    PubMed

    Schultz, V A; Watson, A G

    1995-01-01

    A three-month-old, male Chihuahua puppy with congenital absence of the distal 40% of the right thoracic limb was examined. The limb ended as a short, rounded, skin-covered stump. Radiography revealed a 40% shortened humerus tapered to a blunt end without its distal extremity. Dissection of the left thoracic limb identified luxation of the elbow joint and absence of the fourth digital pad. Alizarin-red staining and clearing demonstrated syndactylous fourth and fifth digits in the left thoracic limb and an anomalous eighth lumbar vertebra. This additional vertebra was unilaterally sacralized and constituted a lumbosacral transitional vertebra.

  4. A Consistent, Quantifiable, and Graded Rat Lumbosacral Spinal Cord Injury Model

    PubMed Central

    Wen, Junxiang; Sun, Dongming; Tan, Jun

    2015-01-01

    Abstract The purpose of this study is to develop a rat lumbosacral spinal cord injury (SCI) model that causes consistent motoneuronal loss and behavior deficits. Most SCI models focus on the thoracic or cervical spinal cord. Lumbosacral SCI accounts for about one third of human SCI but no standardized lumbosacral model is available for evaluating therapies. Twenty-six adult female Sprague-Dawley rats were randomized to three groups: sham (n=9), 25 mm (n=8), and 50 mm (n=9). Sham rats had laminectomy only, while 25 mm and 50 mm rats were injured by dropping a 10 g rod from a height of 25 mm or 50 mm, respectively, onto the L4-5 spinal cord at the T13/L1 vertebral junction. We measured footprint length (FL), toe spreading (TS), intermediate toe spreading (ITS), and sciatic function index (SFI) from walking footprints, and static toe spreading (STS), static intermediate toe spreading (SITS), and static sciatic index (SSI) from standing footprints. At six weeks, we assessed neuronal and white matter loss, quantified axons, diameter, and myelin thickness in the peroneal and tibial nerves, and measured cross-sectional areas of tibialis anterior and gastrocnemius muscle fibers. The result shows that peroneal and tibial motoneurons were respectively distributed in 4.71 mm and 5.01 mm columns in the spinal cord. Dropping a 10-g weight from 25 mm or 50 mm caused 1.5 mm or 3.75 mm gaps in peroneal and tibial motoneuronal columns, respectively, and increased spinal cord white matter loss. Fifty millimeter contusions significantly increased FL and reduced TS, ITS, STS, SITS, SFI, and SSI more than 25 mm contusions, and resulted in smaller axon and myelinated axon diameters in tibial and peroneal nerves and greater atrophy of gastrocnemius and anterior tibialis muscles, than 25 mm contusions. This model of lumbosacral SCI produces consistent and graded loss of white matter, motoneuronal loss, peripheral nerve axonal changes, and anterior tibialis

  5. Cervical Radiculopathy Due to Disc Herniation with Adjacent Facet Hypertrophy: Case Report

    PubMed Central

    YAMAHATA, Hitoshi; YASUDA, Muneyoshi; AOYAMA, Tatsuro; OSUKA, Koji; ARITA, Kazunori; TAKAYASU, Masakazu

    2014-01-01

    We report a rare case of cervical radiculopathy associated with facet hypertrophy and disc herniation. The patient was a 38-year-old woman with sudden-onset left arm pain. As conservative therapy failed to alleviate her symptoms she was referred to us. On physical examination she manifested no neurological deficits except pain and dysesthesia in the left C7 territory. Computed tomography revealed hypertrophic ossified changes in the left T1 facet joint with encroachment on the spinal canal. Magnetic resonance imaging showed compression of the spinal cord at C6/7 by disc herniation at C6/7. Anterior cervical decompression and fusion by corpectomy (C7 corpectomy and C6/T1 fixation with a titanium cage) ameliorated her pain. Facet hypertrophy in a morphologically normal cervicothoracic spine is extremely rare and its etiology is unknown. We speculate the possibility that our patient harbored a congenital anomaly and that the morphologic changes were the consequence of an injury she sustained in a traffic accident. PMID:24477059

  6. Preoperative therapeutic neuroscience education for lumbar radiculopathy: a single-case fMRI report.

    PubMed

    Louw, Adriaan; Puentedura, Emilio J; Diener, Ina; Peoples, Randal R

    2015-01-01

    Therapeutic neuroscience education (TNE) has been shown to be effective in the treatment of mainly chronic musculoskeletal pain conditions. This case study aims to describe the changes in brain activation on functional magnetic resonance imaging (fMRI) scanning, before and after the application of a newly-designed preoperative TNE program. A 30-year-old female with a current acute episode of low back pain (LBP) and radiculopathy participated in a single preoperative TNE session. She completed pre- and post-education measures including visual analog scale (VAS) for LBP and leg pain; Oswestry Disability Index (ODI); Fear Avoidance Beliefs Questionnaire (FABQ); Pain Catastrophizing Scale (PCS) and a series of Likert-scale questions regarding beliefs and attitudes to lumbar surgery (LS). After a 30-minute TNE session, ODI decreased by 10%, PCS decreased by 10 points and her beliefs and attitudes shifted positively regarding LS. Immediately following TNE straight leg raise increased by 7° and forward flexion by 8 cm. fMRI testing following TNE revealed 3 marked differences compared to pre-education scanning: (1) deactivation of the periaqueductal gray area; (2) deactivation of the cerebellum; and (3) increased activation of the motor cortex. The immediate positive fMRI, psychometric and physical movement changes may indicate a cortical mechanism of TNE for patients scheduled for LS.

  7. Appropriateness of physicians’ lumbosacral MRI requests in private and public centers in Tehran, Iran

    PubMed Central

    Mohammadi, Navid; Farahmand, Ferial; Hadizadeh Kharazi, Homayoun; Mojdehipanah, Hossein; Karampour, Hossein; Nojomi, Marzieh

    2016-01-01

    Background: Back pain is a common patients’ complaint, and its etiology is important because of different potential treatment approaches (based on causes). For a better diagnosis, magnetic resonance imaging (MRI) is widely used in clinical settings that may result in inappropriate requests. This study aims to evaluate the appropriateness of the lumbosacral MRI requests in patients with back pain in two public/referral and private imaging centers in Tehran. Methods: In this cross-sectional study, 279 patients from both centers were recruited in 2014. A checklist was developed based on the internationally recognized clinical guidelines (NICE, and AHRQ) for determining the indications. An expert panel of related specialties finalized them. Patients’ demographic and some anthropometric measures, as well as MRI reports, were collected. Results: The mean±SD age of patients was 47.9±14.78 years with a dominance of females (M/F=38.4/61.6). About 77% (n=214) of lumbosacral MRIs were requested in accordance with the guidelines. Indicated MRI requests were significantly higher in the private imaging center (p=0.019, OR=2.087, CI 95%: 1.13-3.85). In the private center, 80.6% and in the public center, 70.4% of the MRI requests were in accordance with the guidelines. Conclusion: The proportion of non-indicated MRI requests based on the valid guidelines is about ¼ of all requests that is compatible with some other studies mostly from developed countries. PMID:28210580

  8. Comparison between methods of assessing lumbosacral curve obtained by radiographic image

    PubMed Central

    Vacari, Daiane Aparecida; Neves, Eduardo Borba; Ulbricht, Leandra

    2015-01-01

    OBJECTIVE: To investigate the correlation between different radiographic methods in the evaluation of the lumbosacral concavity. METHODS: The sample consisted of 52 individuals with ages ranging from 18 to 28 years old. The procedures related to radiographic image collection were carried out in collaboration with a diagnostic imaging center of a hospital in Curitiba, PR, Brazil. The angles of the lumbosacral concavity were evaluated by the following methods: Centroid, Cobb1L1-S1, Cobb2L1-L5, Cobb3L2-S1 Cobb4T12-S1, Posterior Tangent and Trall. RESULTS: High correlation coefficients (r ranging from 0.77 to 0.89) were found among variations of the Cobb method. Additionally, we propose a categorical classification of angle values obtained by each method. We also analyzed the influence of the level of the inflection point between the lumbar lordosis and thoracic kyphosis in determining the evaluation method to be used. The inflection point had a higher incidence in the region between the twelfth thoracic vertebra and the first lumbar vertebra (63.5%). CONCLUSION: The correlation and agreement between methods vary considerably. Moreover, the thoracolumbar inflection point should be considered when choosing the method of assessing patients. Level of Evidence I, Diagnostic Study. PMID:27069403

  9. The Influence of “wuqinxi” exercises on the Lumbosacral Multifidus

    PubMed Central

    Zhang, Feng; Bai, Yu-Hua; Zhang, Jing

    2014-01-01

    [Purpose] To investigate the effect of the five animals (wuqinxi) exercises on the lumbosacral multifidus. [Subjects and Methods] This study enrolled two groups of volunteers, 15 volunteers who did the five animals exercises, the experimental group, and 15 volunteers who did aerobic exercise (walking), the control group. Both before and after the 1 year exercise intervention, the average surface electromyography (ASEMG) of the two groups in the process of flexion and extension was recorded and analyzed using DASYLab10.0 software, and the flexion extension ratio (FER) was calculated. [Results] The ASEMG in the process of flexion was lower than the ASEMG in the process of extension both before and after the 1 year exercise intervention on both sides of all volunteers. There was no significant difference in FER between the experimental group and control group before the 1 year exercise intervention; however, the FER of experimental group was lower than that of the control group after the 1 year exercise intervention. There was no significant difference between the two sides in any individual both before and after the 1 year exercise intervention in both groups. [Conclusion] The “wuqinxi” exercises improved the function of the lumbosacral multifidus, and might be an alternative method of reducing low back pain. PMID:25013288

  10. Dorsal midline hemivertebra at the lumbosacral junction: report of 2 cases.

    PubMed

    Ansari, Shaheryar F; Rodgers, Richard B; Fulkerson, Daniel H

    2015-01-01

    Congenital scoliosis from laterally located hemivertebrae at the lumbosacral junction has been described previously. However, dorsally located midline hemivertebrae at this location have not been reported. The authors describe the presentation, treatment, and outcomes of 2 patients (1 male and 1 female) with this rare malformation. All clinical and radiographic records were reviewed. Outcomes were recorded using survey instruments (Oswestry Disability Index and the 36-Item Short Form Health Survey). Radiographic assessment of bony fusion was performed using CT scanning 1 year after surgery. Both patients presented with back and leg pain, urinary hesitancy/incontinence, difficulty sitting and lying down, waddling gait, and restriction of movement. Imaging showed a wedge-shaped dorsal deformity that stretched the nerve roots and compressed the canal. Both patients underwent resection of the hemivertebra with posterolateral instrumented fusion from L-2 to the pelvis. The female patient had a low-lying conus and underwent sectioning of the filum terminale. Both patients showed improvement in the ability to sit and lie flat and in bowel and bladder function after surgery. The authors describe their experience with 2 patients with similar, rare congenital bony deformities at the lumbosacral junction. To their knowledge, similar cases have not been previously reported.

  11. In vitro biomechanical evaluation of internal fixation techniques on the canine lumbosacral junction

    PubMed Central

    Dillard, Stacy; Roe, Simon

    2015-01-01

    Few biomechanical studies have evaluated the effect of internal stabilization techniques after decompressive surgery on the stability of the canine lumbosacral junction. The purpose of this canine cadaver study is to evaluate the stability of the canine lumbosacral (LS) spine in flexion and extension following laminectomy and discectomy and then stabilization with each of the three techniques: pins and polymethylmethacrylate (P/PMMA), two dorsal locking plates (SOP) or bilateral transarticular facet screws (FACET).Using a cantilever biomechanical system, bending moments were applied to the LS and range of motion (ROM) was recorded via a rotational potentiometer. With 3 Nm, the ROM (n = 4 in each group) for P/PMMA, SOP and FACET were 1.92 ± 0.96°, 2.56 ± 0.55°and 3.18 ± 1.14°, respectively. With moments up to 35 Nm, the P/PMMA specimens appeared stable. Sacroiliac motion in the SOP and FACET groups invalidated further comparisons. Each of the stabilization techniques (P/PMMA, SOP, and FACET) significantly decreased the range of motion in flexion and extension for low bending moments. PMID:26312169

  12. In vitro biomechanical evaluation of internal fixation techniques on the canine lumbosacral junction.

    PubMed

    Early, Peter; Mente, Peter; Dillard, Stacy; Roe, Simon

    2015-01-01

    Few biomechanical studies have evaluated the effect of internal stabilization techniques after decompressive surgery on the stability of the canine lumbosacral junction. The purpose of this canine cadaver study is to evaluate the stability of the canine lumbosacral (LS) spine in flexion and extension following laminectomy and discectomy and then stabilization with each of the three techniques: pins and polymethylmethacrylate (P/PMMA), two dorsal locking plates (SOP) or bilateral transarticular facet screws (FACET).Using a cantilever biomechanical system, bending moments were applied to the LS and range of motion (ROM) was recorded via a rotational potentiometer. With 3 Nm, the ROM (n = 4 in each group) for P/PMMA, SOP and FACET were 1.92 ± 0.96°, 2.56 ± 0.55°and 3.18 ± 1.14°, respectively. With moments up to 35 Nm, the P/PMMA specimens appeared stable. Sacroiliac motion in the SOP and FACET groups invalidated further comparisons. Each of the stabilization techniques (P/PMMA, SOP, and FACET) significantly decreased the range of motion in flexion and extension for low bending moments.

  13. Lumbar artery perforator (LAP) flap: a salvage tool for extended lumbo-sacral necrosis after bilateral internal iliac arteries embolization

    PubMed Central

    di Summa, Pietro Giovanni; Schaffer, Clara; Zaugg, Patrice; Bauquis, Olivier; Raffoul, Wassim

    2016-01-01

    Abstract We report the case of a 52-year-old man presenting an extensive lumbosacral necrosis after bilateral internal iliac arteries embolization following unstable pelvic fracture. Coverage of the defect was performed using two extended lumbar artery perforator flaps in a propeller fashion. Good functional and esthetic result was achieved at one-year follow-up. PMID:27583264

  14. Conflicting calculations of pelvic incidence and pelvic tilt secondary to transitional lumbosacral anatomy (lumbarization of S-1): case report.

    PubMed

    Crawford, Charles H; Glassman, Steven D; Gum, Jeffrey L; Carreon, Leah Y

    2017-01-01

    Advancements in the understanding of adult spinal deformity have led to a greater awareness of the role of the pelvis in maintaining sagittal balance and alignment. Pelvic incidence has emerged as a key radiographic measure and should closely match lumbar lordosis. As proper measurement of the pelvic incidence requires accurate identification of the S-1 endplate, lumbosacral transitional anatomy may lead to errors. The purpose of this study is to demonstrate how lumbosacral transitional anatomy may lead to errors in the measurement of pelvic parameters. The current case highlights one of the potential complications that can be avoided with awareness. The authors report the case of a 61-year-old man who had undergone prior lumbar surgeries and then presented with symptomatic lumbar stenosis and sagittal malalignment. Radiographs showed a lumbarized S-1. Prior numbering of the segments in previous surgical and radiology reports led to a pelvic incidence calculation of 61°. Corrected numbering of the segments using the lumbarized S-1 endplate led to a pelvic incidence calculation of 48°. Without recognition of the lumbosacral anatomy, overcorrection of the lumbar lordosis might have led to negative sagittal balance and the propensity to develop proximal junction failure. This case illustrates that improper identification of lumbosacral transitional anatomy may lead to errors that could affect clinical outcome. Awareness of this potential error may help improve patient outcomes.

  15. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

    PubMed Central

    Pool, Jan J. M.; van Tulder, Maurits W.; Riphagen, Ingrid I.; de Vet, Henrica C. W.

    2006-01-01

    Clinical provocative tests of the neck, which position the neck and arm inorder to aggravate or relieve arm symptoms, are commonly used in clinical practice in patients with a suspected cervical radiculopathy. Their diagnostic accuracy, however, has never been examined in a systematic review. A comprehensive search was conducted in order to identify all possible studies fulfilling the inclusion criteria. A study was included if: (1) any provocative test of the neck for diagnosing cervical radiculopathy was identified; (2) any reference standard was used; (3) sensitivity and specificity were reported or could be (re-)calculated; and, (4) the publication was a full report. Two reviewers independently selected studies, and assessed methodological quality. Only six studies met the inclusion criteria, which evaluated five provocative tests. In general, Spurling’s test demonstrated low to moderate sensitivity and high specificity, as did traction/neck distraction, and Valsalva’s maneuver. The upper limb tension test (ULTT) demonstrated high sensitivity and low specificity, while the shoulder abduction test demonstrated low to moderate sensitivity and moderate to high specificity. Common methodological flaws included lack of an optimal reference standard, disease progression bias, spectrum bias, and review bias. Limitations include few primary studies, substantial heterogeneity, and numerous methodological flaws among the studies; therefore, a meta-analysis was not conducted. This review suggests that, when consistent with the history and other physical findings, a positive Spurling’s, traction/neck distraction, and Valsalva’s might be indicative of a cervical radiculopathy, while a negative ULTT might be used to rule it out. However, the lack of evidence precludes any firm conclusions regarding their diagnostic value, especially when used in primary care. More high quality studies are necessary in order to resolve this issue. PMID:17013656

  16. Cerebrospinal fluid dynamics at the lumbosacral level in patients with spinal stenosis: A pilot study.

    PubMed

    Chun, Se-Woong; Lee, Hack-Jin; Nam, Koong-Ho; Sohn, Chul-Ho; Kim, Kwang Dong; Jeong, Eun-Jin; Chung, Sun G; Kim, Keewon; Kim, Dong-Joo

    2017-01-01

    Spinal stenosis is a common degenerative condition. However, how neurogenic claudication develops has not been clearly elucidated. Moreover, cerebrospinal fluid physiology at the lumbosacral level has not received adequate attention. This study was conducted to compare cerebrospinal fluid hydrodynamics at the lumbosacral spinal level between patients with spinal stenosis and healthy controls. Twelve subjects (four patients and eight healthy controls; 25-77 years old; seven males) underwent phase-contrast magnetic resonance imaging to quantify cerebrospinal fluid dynamics. The cerebrospinal fluid flow velocities were measured at the L2 and S1 levels. All subjects were evaluated at rest and after walking (to provoke neurogenic claudication in the patients). The caudal peak flow velocity in the sacral spine (-0.25 ± 0.28 cm/s) was attenuated compared to that in the lumbar spine (-0.93 ± 0.46 cm/s) in both patients and controls. The lumbar caudal peak flow velocity was slower in patients (-0.65 ± 0.22 cm/s) than controls (-1.07 ± 0.49 cm/s) and this difference became more pronounced after walking (-0.66 ± 0.37 cm/s in patients, -1.35 ± 0.52 cm/s in controls; p = 0.028). The sacral cerebrospinal fluid flow after walking was barely detectable in patients (caudal peak flow velocity: -0.09 ± 0.03 cm/s). Cerebrospinal fluid dynamics in the lumbosacral spine were more attenuated in patients with spinal stenosis than healthy controls. After walking, the patients experiencing claudication did not exhibit an increase in the cerebrospinal fluid flow rate as the controls did. Altered cerebrospinal fluid dynamics may partially explain the pathophysiology of spinal stenosis. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:104-112, 2017.

  17. Social and economic outcome after posterior microforaminotomy for cervical spondylotic radiculopathy.

    PubMed

    Schöggl, Andreas; Reddy, Marion; Saringer, Walter; Ungersböck, Karl

    2002-03-28

    Between 1993 and 1998, the surgical technique of posterior cervical foraminotomy as described by Frykholm, with individual cervical nerve root decompression had been applied at the Neurosurgical Department of the University of Vienna. We conducted a retrospective study to assess the functional and socio-economic outcome. Thirty-two patients were included in this study, 21 men and 11 women with a median age of 48 years (range 30 to 70 years). Prior to surgical management, median duration of symptoms had been 7 weeks (range 1-50 weeks), with cervicobrachialgia in 28 of the patients, 27 of the patients had sustained radicular sensory loss, and in 25 of the patients radicular paresis occurred. Measured by the Prolo Functional Economic Outcome Rating Scale, 64% of the patients were classified with a good outcome (scale 8-10), 18% of the patients were classified with a moderate outcome (scale 5-7), and 18% of the patients were classified with a poor outcome (scale < 5). Two of the patients required additional anterior cervical discectomy and one patient suffered a superficial wound infection which needed surgical drainage. This study confirms that posterior microforaminotomy is a useful technique for degenerative disease causing cervical radiculopathy with the advantage of avoiding fusion and immobilisation. Criteria for evaluating the results of treating cervical spinal disorders vary widely. Comparative analyses of outcome among different therapy protocols are compromised by the diversity among the groups studied, as well as by the varying methods of measuring success. We propose a scale based on the socio-economic and functional status of the patient before and after treatment This scale is easily applicable and can delineate pre- and postoperative conditions of patients. A more universal acceptance of common criteria for judging the outcome of spinal operations should facilitate comparisons among various methods of treatment.

  18. Use of the Rat Grimace Scale to Evaluate Neuropathic Pain in a Model of Cervical Radiculopathy.

    PubMed

    Philips, Blythe H; Weisshaar, Christine L; Winkelstein, Beth A

    2017-02-01

    Although neck and low-back pain are common sources of neuropathic pain with high societal costs, the pathophysiology of neuropathic pain is not well-defined. Traditionally, most rodent pain studies rely on evoked reflex-based testing to measure pain. However, these testing methods do not reveal spontaneous pain, particularly early after injury. The rat grimace scale (RGS) for quantifying spontaneous pain has been validated after visceral, incisional, orthopedic, and inflammatory insults but not neuropathic pain. The current study used a rat model of radiculopathy to investigate the time course of RGS, the effect of the NSAID meloxicam on RGS, and the reliability and consistency of RGS across testers. RGS values at baseline and at 3, 6, 24, and 48 h after cervical nerve root compression (NRC) that induced robust evoked pain responses were compared with those obtained after sham surgery. The RGS was also evaluated at 6 h after NRC in another set of rats that had received meloxicam treatment prior to surgery. At 6 h, NRC induced higher RGS scores (1.27 ± 0.18) than did sham surgery (0.93 ± 0.20), and scores remained above baseline for as long as 48 h. Treatment with meloxicam before NRC reduced RGS at 6 h to sham levels, which were lower than those of injury without treatment. The RGS was associated with very good interobserver reliability (intraclass correlation coefficient, 0.91) and excellent internal consistency (Cronbach α, 0.87). These findings suggest that RGS is a useful approach to identifying and monitoring acute neuropathic pain in rats.

  19. Methods for determining hip and lumbosacral joint centers in a seated position from external anatomical landmarks.

    PubMed

    Peng, Junfeng; Panda, Jules; Van Sint Jan, Serge; Wang, Xuguang

    2015-01-21

    A global coordinate system (GCS) method is proposed to estimate hip and lumbosacral joint centers (HJC and LSJC) from at least three distances between joint center of interest and target anatomic landmarks (ALs). The distances from HJC and LSJC to relevant pelvis and femur ALs were analyzed with respect to usual pelvis and femur scaling dimensions. Forty six pelves and related pairs of femurs from a same sample of adult specimens were examined. The corresponding regression equations were obtained. These equations can be used to estimate HJC and LSJC in conditions where a very limited number of ALs are available: for example, during seated posture analysis as performed in the automotive industry. Compared to currently existing HJC and LSJC methods from ALs, the proposed method showed better results with an average error less than 11 mm.

  20. [The use of acupuncture in combined balneotherapy of erectile dysfunction in patients with lumbosacral osteochondrosis].

    PubMed

    Zhuravlev, I E; Tereshin, A T

    2010-01-01

    The objective of the present study was to elucidate effects of therapeutic and preventive measures on restoration of compromised erectile function in patients with osteochondrosis of the lumbosacral spine segment (LSSS). The patients were treated using corporal and auricular acupuncture, Narzan mineral water baths, manual therapy, remedial gymnastics, and psychotherapeutic correction of sexual dysadaptation. This combined treatment resulted in the elimination of algic syndrome in 77.5% of the patients, restoration of sexual function in 62.5%, and normalization of hemodynamics in cavernous bodies in 65.2%. The functional activity of the hypothalamo-pituitary-testicular axis was normalized in 65% of the LSSS patients of strong and moderate sexual constitution. Introduction of acupuncture in the combined medicamentous therapy increased its efficiency by 15%. In 57.5% of the patients with strong and moderate sexual constitution, the restored sexual function persisted for at least 12 months.

  1. Morphometric study of the lumbosacral spine and some of its related angles in Lebanese adult females.

    PubMed

    Atta-Alla, El Sayed S; Saab, Ibtissam M; El Shishtawy, Mohamed; Hassan, Khodor Haidar

    2014-01-01

    The present study was undertaken to examine the morphometric characteristics of lumbar vertebrae, lumbar intervertebral discs and some important related angles in Lebanese adult females. The subjects of this study were thirty Lebanese adult females aged between 18-22 years. The subjects were selected among students of the faculty of health sciences, Beirut Arab University. Two plain radiographic views for the lumbosacral spine were taken for each subject, an anteroposterior view and a lateral view. Measurements were made directly on the X-ray films using Vernier calliper and were recorded to the nearest tenth of a millimetre. The following measurements were taken for each lumbar vertebra: the anterior height of the body, the posterior height of the body, the horizontal diameter of the pedicle, the vertical diameter of the pedicle, the interpedicular distance, the width (transverse diameter) of the body. Also the anterior height, the posterior height and the anteroposterior diameter (disc depth) of the intervertebral disc were measured. In addition, the following angles were measured: the angle of lumbar lordosis, the lumbosacral angle and the angle of sacral inclination. The mean and standard deviation were calculated and recorded. The results offer a base line reference for normal Lebanese adult females and a guidance to clinicians for the evaluation and management of subjects complaining of low back pain, in order to propose specific preventive or rehabilitation protocols to prevent low back pain as a function of spinal alignment. Moreover, these normal figures could also be of forensic importance because of the observed racial, ethnic and regional variations.

  2. Periodic modulation of repetitively elicited monosynaptic reflexes of the human lumbosacral spinal cord.

    PubMed

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

    2015-07-01

    In individuals with motor-complete spinal cord injury, epidural stimulation of the lumbosacral spinal cord at 2 Hz evokes unmodulated reflexes in the lower limbs, while stimulation at 22-60 Hz can generate rhythmic burstlike activity. Here we elaborated on an output pattern emerging at transitional stimulation frequencies with consecutively elicited reflexes alternating between large and small. We analyzed responses concomitantly elicited in thigh and leg muscle groups bilaterally by epidural stimulation in eight motor-complete spinal cord-injured individuals. Periodic amplitude modulation of at least 20 successive responses occurred in 31.4% of all available data sets with stimulation frequency set at 5-26 Hz, with highest prevalence at 16 Hz. It could be evoked in a single muscle group only but was more strongly expressed and consistent when occurring in pairs of antagonists or in the same muscle group bilaterally. Latencies and waveforms of the modulated reflexes corresponded to those of the unmodulated, monosynaptic responses to 2-Hz stimulation. We suggest that the cyclical changes of reflex excitability resulted from the interaction of facilitatory and inhibitory mechanisms emerging after specific delays and with distinct durations, including postactivation depression, recurrent inhibition and facilitation, as well as reafferent feedback activation. The emergence of large responses within the patterns at a rate of 5.5/s or 8/s may further suggest the entrainment of spinal mechanisms as involved in clonus. The study demonstrates that the human lumbosacral spinal cord can organize a simple form of rhythmicity through the repetitive activation of spinal reflex circuits.

  3. Measurement of Lumbosacral Angle in Normal Radiographs: A Retrospective Study in Southeast Nigeria

    PubMed Central

    Okpala, FO

    2014-01-01

    Background: A retrospective study of lumbosacral angle (LSA) in normal lateral supine lumbosacral radiographs of 274 Nigerians (aged 15-74 years) of Southeast region. A supine lateral lumbar spine radiograph is a very accurate means of measuring lordotic angles. The LSA is one of such angles, and can be used in the investigation, treatment and follow-up of low back disorders. Little is known about what the normal value for our population is and therefore, what constitutes hypo-/hyper-lordosis; most of the data in use in medical practice are based on studies on other races. Aim: To quantify the normal LSA in our population. Materials and Methods: LSA was measured by the Ferguson's technique and the data analyzed with SPSS Statistics version 17.0 (Chicago IL, USA). Results: LSA varied between 18° and 71°. With a 95.0 confidence interval of 43.3-45.6°, the mean (standard deviation) was 44.5 (9.9)° and showed no significant variation with sex and between various age groups; it compared favorably (though with small difference) with some of the literature values currently in use. Conclusion: This study had established the normal lordosis and the possible values at which to consider hypo-lordosis (below 15°), and hyper-lordosis (above 75°) in our population. Also established is that the development of lumbar lordosis ceases at spinal maturity, and that in normal lumbar lordosis measurement, the retrospective approach is a credible alternative to the prospective method. PMID:25328789

  4. Clinical Evidence of Chinese Massage Therapy (Tui Na) for Cervical Radiculopathy: A Systematic Review and Meta-Analysis

    PubMed Central

    Wang, Shangquan; Li, Linghui

    2017-01-01

    Objective. The review is to assess the current evidence of Chinese massage therapy (Tui Na) for cervical radiculopathy. Methods. Seven databases were searched. Randomised controlled trials incorporating Tui Na alone or Tui Na combined with conventional treatment were enrolled. The authors in pairs independently assessed the risk of bias and extracted the data. Results. Five studies involving 448 patients were included. The pooled analysis from the 3 trials indicated that Tui Na alone showed a significant lowering immediate effects on pain score (SMD = −0.58; 95% CI: −0.96 to −0.21; Z = 3.08, P = 0.002) with moderate heterogeneity compared to cervical traction. The meta-analysis from 2 trials revealed significant immediate effects of Tui Na plus cervical traction in improving pain score (MD = −1.73; 95% CI: −2.01 to −1.44; Z = 11.98, P < 0.00001) with no heterogeneity compared to cervical traction alone. No adverse effect was reported. There was very low quality or low quality evidence to support the results. Conclusions. Tui Na alone or Tui Na plus cervical traction may be helpful to cervical radiculopathy patients, but supportive evidence seems generally weak. Future clinical studies with low risk of bias and adequate follow-up design are recommended. PMID:28303163

  5. Regional variations in the extent and timing of motoneuron cell death in the lumbosacral spinal cord of the chick embryo.

    PubMed

    Williams, C; Wohlenberg, G; O'Donovan, M J

    1987-08-01

    We have examined the distribution of motoneurons in different segments of the chick lumbosacral spinal cord before and after the period of motoneuron cell death. The extent of cell death was found to be greatest at the boundaries of the lumbosacral cord where over 60% of the motoneurons died and least in the central region where only 30% died. After cell death at stage 40 the number of motoneurons in each segment was linearly correlated with segment length, suggesting that growth of the segment and motoneuron numbers may be regulated by a common factor. The time of completion of motoneuron cell death exhibited a rostrocaudal gradient along the lumbar cord. Cell death was complete in the anterior segments by stage 35 but not until stage 38 in the caudal 4 segments. The regional variations in the extent and timing of motoneuron cell death suggest that the relative importance of the factors mediating cell death vary in different regions of the lumbar cord.

  6. USE OF CONTRAST-ENHANCED COMPUTED TOMOGRAPHY TO STUDY THE CRANIAL MIGRATION OF A LUMBOSACRAL INJECTATE IN CADAVER DOGS.

    PubMed

    Kawalilak, Lukas T; Tucker, Russell L; Greene, Stephen A

    2015-01-01

    Volumes used in lumbosacral epidural injections for anesthesia have remained unchanged since the 1960s. The goals of this cross-sectional observational study were to characterize the three-dimensional spread of a lumbosacral epidural injection, as well as confirm that the commonly used volume of 0.2 ml/kg injected into the lumbosacral epidural space reaches the thoracolumbar (TL) junction in the majority (≥80%) of dogs. Ten clinically normal, adult, nonpregnant, mixed-breed dogs were obtained within five minutes of euthanasia and 0.2 ml/kg of radiopaque contrast medium was injected into the lumbosacral epidural space. A computed tomography scan of the TL spine was performed immediately following the injection. Migration of contrast reached the TL junction in 8 of 10 (80%) dogs. Contrast was well visualized in all epidural planes with contrast travelling predominantly in the dorsal epidural space in 7 of 10 (70%) dogs. There was no significant difference in the weight of dogs where the epidural injectate reached the TL junction and those where it did not (P = 0.16), or in the weight of dogs where the cranial-most point of the contrast column was in the dorsal versus the ventral epidural space (P = 0.32). This preliminary study supports the use of computed tomography to characterize injectate distribution in the canine thoracolumbar epidural space and provides evidence that a 0.2-ml/kg volume is likely to reache the TL junction in most dogs. Further studies are needed in live dogs to determine if variables affecting human epidural injectate doses have similar effects in the dog.

  7. [Changes in various neurophysiological indices in treatment of lumbosacral osteochondrosis by combined osteoperiostal electroacupuncture and laser puncture].

    PubMed

    Ahmed, Y M; Korkushko, A O

    2000-09-01

    The conducted dynamic rheovasographic investigations in 67 patients with neurological manifestations of lumbosacral osteochondrosis as well as determination of skin temperature in 162 patients, and employment of stimulation electromyography in 40 patients showed the presence of definite positive shifts (P < 0.001) both in patients with lumboischialgia and in those with the radicular pain syndrome, which fact was evidenced by the clinical data suggesting to us the feasibility of use of osteoperiostal electropuncture combined with laseropuncture with infrared radiation.

  8. Developmental changes in the distribution of gamma-aminobutyric acid-immunoreactive neurons in the embryonic chick lumbosacral spinal cord.

    PubMed

    Antal, M; Berki, A C; Horváth, L; O'Donovan, M J

    1994-05-08

    The development of gamma-aminobutyric acid (GABA)-immunoreactive neurons was investigated in the embryonic and posthatch chick lumbosacral spinal cord by using pre- and postembedding immunostaining with an anti-GABA antiserum. The first GABA-immunoreactive cells were detected in the ventral one-half of the spinal cord dorsal to the lateral motor column at E4. GABAergic neurons in this location sharply increased in number and, with the exception of the lateral motor column, appeared throughout the entire extent of the ventral one-half of the spinal gray matter by E6. Thereafter, GABA-immunoreactive neurons extended from ventral to dorsal regions. Stained perikarya first appeared at E8 and then progressively accumulated in the dorsal horn, while immunoreactive neurons gradually declined in the ventral horn. The general pattern of GABA immunoreactivity characteristic of mature animals had been achieved by E12 and was only slightly altered afterwards. In the dorsal horn, most of the stained neurons were observed in laminae I-III, both at the upper (LS 1-3) and at the lower (LS 5-7) segments of the lumbosacral spinal cord. In the ventral horn, the upper and lower lumbosacral segments showed marked differences in the distribution of stained perikarya. GABAergic neurons were scattered in a relatively large region dorsomedial to the lateral motor column at the level of the upper lumbosacral segments, whereas they were confined to the dorsalmost region of lamina VII at the lower segments. The early expression of GABA immunoreactivity may indicate a trophic and synaptogenetic role for GABA in early phases of spinal cord development.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Lumbosacral compression in maximal lifting efforts in sagittal plane with varying mechanical disadvantage in isometric and isokinetic modes.

    PubMed

    Kumar, S

    1994-12-01

    Nine normal male subjects (mean age 28.2 years and mean weight 72.6 kg) performed 20 standardized maximal effort lifting tasks. They were asked to perform stoop and squat lifts at half, three-quarters and full individual horizontal reach distances in mid-sagittal plane in isometric and isokinetic modes (fixed velocity 60 cm/s). Both stoop and squat lifts were initiated at the floor level and terminated at the individual's knuckle height keeping the horizontal distance constant throughout the lift. The isometric stoop lifts were performed with hip at 60 degrees and 90 degrees of flexion with hands at preselected reach distances. The isometric squat lifts were performed with knees at 90 degrees and 135 degrees of flexion with hands at similarly preselected reach distances. The force was measured using a Static Dynamic Strength Tester with load cell (SM 1000). The postures were recorded using a two-dimensional Peak Performance System with an event synchronizing unit. The load cell was sampled at 60 Hz and the video filming was done at 60 frames per second. The force and postural data were fed to a biomechanical model (Cheng and Kumar 1991) to extract external moment and lumbosacral compression. The strengths generated in different conditions were significantly different (p < 0.01). The strength variation ranged by up to 73% whereas the lumbosacral compression varied by only up to 15%. A high level of lumbosacral compression was maintained in all conditions.

  10. The effect of sling exercise on sagittal lumbosacral angle and intervertebral disc area of chronic low back pain patients

    PubMed Central

    Lee, Seung-Bum; Cho, Won-Je

    2016-01-01

    The purpose of this study was to observe the change of lumbosacral angle and intervertebral disc (IVD) area. The study was conducted on chronic low back pain (CLBP) female patients for 12 weeks by operating sling exercise and general physical therapy. The 57 CLBP were divided into 2 groups which, sling exercise group (SEG, n=34) and general physical therapy group (PTG, n=23). The experiment was conducted three times a week for 12 weeks. The lumbosacral angle, which means the angle between the L1–L2 lumbar was measured by plain radiography. The IVD area, which means the IVD height and volume was measured by magnetic resonance imaging. The pain was measured by visual analogue scale (VAS). As a result, after 12-week exercise, VAS had decreased in all groups. The angle of L3–4 and L4–5 and the height of IVD had increased in SEG. Also, IVD height and volume has more improved in SEG compare the PTG. Therefore, the sling exercise is proper treatment for CLBP patients’ recovery because It improve the lumbosacral angle and IVD area. PMID:27807527

  11. The change of pain and lumbosacral sagittal alignment after sling exercise therapy for patients with chronic low back pain

    PubMed Central

    Roh, Hee Sook; Cho, Won Je; Ryu, Won Jong; Park, Seung Jin; An, Chang Sik

    2016-01-01

    [Purpose] This study was conducted to quantify the effect of sling exercise therapy in the recovery of lumbosacral sagittal alignment (LSA) and in the control of low back pain. [Subjects and Methods] A total of 102 chronic low back pain patients were divided into two groups, a physical therapy group and a sling exercise group. In both groups, programs were conducted thrice a week for twelve weeks. With respect to LSA, pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were measured with plain radiography. Pain was measured on a visual analogue scale (VAS). [Results] Differences were found in visual analogue scale, delta score of visual analogue scale, pelvic tilt, delta score of pelvic tilt, and delta score of pelvic incidence between sling exercise therapy and physical therapy groups. VAS, pelvic tilt, and pelvic incidence was positively changed after sling exercise. However, only the visual analogue scale was found to be improved after physical therapy. [Conclusion] Sling exercise therapy and physical therapy were effective in reducing pain. However, pelvic tilt and pelvic incidence were positively changed after sling exercise therapy for Lumbosacral Sagittal Alignment, but were unchanged after physical therapy. Therefore, sling exercise therapy is more effective than physical therapy for the recovery of Lumbosacral Sagittal Alignment in patients with chronic low back pain. PMID:27821936

  12. Using magnetic resonance imaging to identify the lumbosacral segment in children.

    PubMed

    Milicić, Gordana; Krolo, Ivan; Vrdoljak, Javor; Marotti, Miljenko; Roić, Goran; Hat, Josip

    2006-03-01

    Identification of the lumbosacral (L-S) segment on magnetic resonance (MR) images is important for appropriate treatment of disease in the lumbosacral (L-S) area. In the study, data obtained from plain A-P radiographs of the L-S spine and sagittal MR imaging scans (sagittal T1- and T2-weighted sequences) of the L-S spine and sacrum with the coccygeal bone, are analyzed. Twenty-six children aged 10 to 14 years were examined for back pain. On the standard A-P radiographs of the L-S spine, a L-S transitional vertebra as classified according to the method of Castellvi et al. was found in 17 subjects. The problem arose as to whether this was lumbalisation or sacralisation, and how to determine which vertebra was L5 wich S1. On the sagittal MR imaging studies the same question applied. A need emerged for a simple method which would identify the L-S segment on the sagittal MR imaging studies of the L-S spine in children so that in case of a tumor, inflammation, spondilolystesis, or protrusion of a disc, the level in the L-S spine where the problem is localized can be accurately identified. To this objective we selected the method using detection of the S1 vertebra. This involved that, in addition to the sagittal MR imaging scans of the L-S spine, sagittal images of the sacrum and coccygeal bone be also obtained. on the T2-weighted sequence, the sacrum can be clearly distinquished from the coccygeal bone. By counting from the S5 up, the S1 vertebra can be accurately identified. Determination of the S1 vertebra enables detection of the L5 vertebra and, in turn, of all other lumbar vertebrae. In patients in whom a T2-weighted MR studies were done S1 could be precisely determined and so could the L5 vertebra. In this process, whether the patient had a transitional vertebra or whether there was lumbarisation or sacralisation was irrelevant.

  13. The scaling of postcranial muscles in cats (Felidae) II: hindlimb and lumbosacral muscles.

    PubMed

    Cuff, Andrew R; Sparkes, Emily L; Randau, Marcela; Pierce, Stephanie E; Kitchener, Andrew C; Goswami, Anjali; Hutchinson, John R

    2016-07-01

    In quadrupeds the musculature of the hindlimbs is expected to be responsible for generating most of the propulsive locomotory forces, as well as contributing to body support by generating vertical forces. In supporting the body, postural changes from crouched to upright limbs are often associated with an increase of body mass in terrestrial tetrapods. However, felids do not change their crouched limb posture despite undergoing a 300-fold size increase between the smallest and largest extant species. Here, we test how changes in the muscle architecture (masses and lengths of components of the muscle-tendon units) of the hindlimbs and lumbosacral region are related to body mass, to assess whether there are muscular compensations for the maintenance of a crouched limb posture at larger body sizes. We use regression and principal component analyses to detect allometries in muscle architecture, with and without phylogenetic correction. Of the muscle lengths that scale allometrically, all scale with negative allometry (i.e. relative shortening with increasing body mass), whereas all tendon lengths scale isometrically. Only two muscles' belly masses and two tendons' masses scale with positive allometry (i.e. relatively more massive with increasing body mass). Of the muscles that scale allometrically for physiological cross-sectional area, all scale positively (i.e. relatively greater area with increasing body mass). These muscles are mostly linked to control of hip and thigh movements. When the architecture data are phylogenetically corrected, there are few significant results, and only the strongest signals remain. None of the vertebral muscles scaled significantly differently from isometry. Principal component analysis and manovas showed that neither body size nor locomotor mode separate the felid species in morphospace. Our results support the inference that, despite some positively allometric trends in muscle areas related to thigh movement, larger cats have

  14. Cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck Disability Index

    PubMed Central

    Rodine, Robert J.; Vernon, Howard

    2012-01-01

    Cervical radiculopathy (CR), while less common than conditions with neck pain alone, can be a significant cause of neck pain and disability; thus the determination of adequate treatment options for patients is essential. Currently, inadequate scientific literature restricts specific conservative management recommendations for CR. Despite a paucity of evidence for high-velocity low-amplitude (HVLA) spinal manipulation in the treatment for CR, this strategy has been frequently labeled as contraindicated. Scientific support for appropriate outcome measures for CR is equally deficient. While more scientific data is needed to draw firm conclusions, the present review suggests that spinal manipulation may be cautiously considered as a therapeutic option for patients suffering from CR. With respect to outcome measures, the Neck Disability Index appears well-suited for spinal manipulative treatment of CR. PMID:22457538

  15. Arginine Vasopressin Alters Both Spontaneous and Phase-Locked Synaptic Inputs to Airway Vagal Preganglionic Neuron via Activation of V1a Receptor: Insights into Stress-Related Airway Vagal Excitation

    PubMed Central

    Yan, Xianxia; Chen, Xingxin; Guo, Yuhong; He, Ding; Chen, Yonghua; Xia, Chunmei; Wang, Jijiang

    2017-01-01

    The airway vagal preganglionic neurons (AVPNs) in the external formation of the nucleus ambiguus (eNA) play a major role in the vagal control of tracheobronchial smooth muscle tone and maintenance of airway resistance. The eNA receives vasopressinergic projection from the hypothalamic paraventricular nucleus (PVN), the key node for the genesis of psychological stress. Since airway vagal excitation is reportedly to be associated with the psychological stress-induced/exacerbated airway hyperresponsiveness in asthmatics, arginine vasopressin (AVP) might be involved in stress-related airway vagal excitation. However, this possibility has not been validated. This study aimed to test whether and how AVP regulates AVPNs. In rhythmically active medullary slices of newborn rats, retrogradely labeled AVPNs were identified as inspiratory-activated and inspiratory-inhibited AVPNs (IA- and II-AVPNs) using patch-clamp techniques according to their inspiratory-related firing behavior and synaptic activities. The results show that under current clamp, AVP depolarized both IA- and II-AVPNs, and significantly increased their spontaneous firing rate. Under voltage clamp, AVP elicited a slow inward current, and significantly increased the frequency of spontaneous excitatory postsynaptic currents (sEPSCs) in both types of AVPNs. In addition, AVP significantly enhanced the phase-locked excitatory inspiratory inward current in inspiratory-activated airway vagal preganglionic neurons (IA-AVPNs), but significantly suppressed the phase-locked inhibitory inspiratory outward current in II-AVPNs. In both types AVPNs, AVP significantly increased the frequency and amplitude of pharmacologically isolated spontaneous GABAergic and glycinergic inhibitory postsynaptic currents (IPSCs). All of the AVP-induced effects were prevented by SR49059, an antagonist of V1a receptors, but unaffected by SSR149415, an antagonist of V1b receptors. AVP did not cause significant changes in the miniature excitatory

  16. Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy

    PubMed Central

    Ghori, Ahmer; Konopka, Joseph F.; Cha, Thomas D.; Bono, Christopher M.

    2016-01-01

    Background Current literature suggests that anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) have comparable clinical outcomes for the treatment of cervical radiculopathy. Given similar outcomes, an understanding of differences in long-term societal costs can help guide resource utilization. The purpose of this study was to compare the relative long-term societal costs of anterior cervical discectomy and fusion (ACDF) to cervical disc arthroplasty (CDA) for the treatment of single level cervical disc disease by considering upfront surgical costs, lost productivity, and risk of subsequent revision surgery. Methods We completed an economic and decision analysis using a Markov model to evaluate the long-term societal costs of ACDF and CDA in a theoretical cohort of 45-65 year old patients with single level cervical disc disease who have failed nonoperative treatment. Results The long-term societal costs for a 45-year old patient undergoing ACDF are $31,178 while long-term costs for CDA are $24,119. Long-term costs for CDA remain less expensive throughout the modeled age range of 45 to 65 years old. Sensitivity analysis demonstrated that CDA remains less expensive than ACDF as long as annual reoperation rate remains below 10.5% annually. Conclusions Based on current data, CDA has lower long-term societal costs than ACDF for patients 45-65 years old by a substantial margin. Given reported reoperation rates of 2.5% for CDA, it is the preferred treatment for cervical radiculopathy from an economic perspective. PMID:26913221

  17. A case report of extramedullary haematopoeisis in lumbosacral region presenting as cauda equina syndrome

    PubMed Central

    Tharadara, G D; Chhatrala, Naitik; Jain, Shubham

    2016-01-01

    Introduction Extramedullary hematopoeisis (EMH) is defined as formation of blood cells outside the bone marrow. It occurs most commonly in the liver and spleen in patients having disorders that lead to chronic anaemia. EMH in spinal canal is a very rare site and cauda equina syndrome due to EMH has very few cases presented in literature. Case Presentation A 28 year old male patient presented with complain of incontinenance of bladder and bowel along with saddle anaesthesia from 10 days. Patient was a known case of beta-thalassemia intermedia. And MRI scan of the spine showed multiple well circumscribed, enhancing lesions in the epidural space extending from L5 to S3 and resulting in compression of the cauda equina. Patient underwent posterior neural decompression by a laminectomy from L5 to S3. At 3 months follow up patient had partial recovery of his bladder control and complete recovery of sensation. Conclusion EMH should be recognized early on the basis of clinical features and MRI findings. The various modalities available for treatment of such cases includes blood transfusion, low dose radiotherapy, hydroxyurea and surgical decompression. There are very few cases noted in the literature of such phenomenon in the lumbosacral spine. In cases of acute presentations like cauda equine surgical decompression is a treatment modality of choice. PMID:27652196

  18. Upper body movement during walking in children with lumbo-sacral myelomeningocele.

    PubMed

    Bartonek, A; Saraste, H; Eriksson, M; Knutson, L; Cresswell, A G

    2002-04-01

    Eight children with lumbo-sacral myelomeningocele (MMC) underwent three-dimensional movement analysis to determine whether or not differing levels of lower extremity strength affected the extent of shoulder, trunk and pelvis movement during independent walking when wearing orthoses. Fourteen control children were also investigated. The patterns of upper body movements in all MMC children were well defined and consistent, showing small standard deviations from the mean. In the frontal and transverse planes, segment displacements of the MMC children assigned into Group II (hip extensor and abductor muscle strength grade 0-2) were almost twice that of the MMC children in Group I (hip extensor and abductor muscle strength grade 3-4). All segment displacements in the frontal, transverse and sagittal planes for Group I and Group II children were significantly greater than those for the controls. In the frontal plane these differences were approximately 4-10 times greater, with the Group II children having the largest peak-to-peak displacements. These results indicate that the motion amplitudes of the upper body segments are related to the degree of muscle weakness of the lower limbs. No significant differences were found when comparing segment motions during walking with either the Ferrari type knee-ankle-foot or ankle-foot orthoses.

  19. Valgus knee stress in lumbosacral myelomeningocele: a gait-analysis evaluation.

    PubMed

    Lim, R; Dias, L; Vankoski, S; Moore, C; Marinello, M; Sarwark, J

    1998-01-01

    Twenty-five independent community-ambulating patients with lumbosacral-level myelomeningocele (N = 50 limbs) underwent gait analysis. The limbs of these patients were divided into two groups based on thigh-foot angle (TFA): Group I (n = 20) had marked external tibial torsion, TFA > or = 20 degrees, and group II had TFA between 10 and 20 degrees. Ten limbs were excluded because of neutral or internal alignment. Twenty normal limbs with TFA = 10 degrees served as controls. An abnormal internal varus knee stress during stance was identified in all group I limbs and 12 (70%) of 20 limbs group II limbs compared with controls, which demonstrated an internal valgus stress. This internal varus moment was greater in group I limbs than in the abnormal limbs in group II (p < 0.05). Knee flexion was the only other parameter found to correlate with this stress and only in group I limbs. We conclude that (a) in this patient group, increased external tibial torsion is likely to result in an abnormal internal varus knee stress; (b) TFA > 20 degrees appears significantly to increase this stress; and (c) knee flexion is an important related parameter, but only in limbs with TFA between 10 and 20 degrees. We believe that this abnormal stress may predispose the knee to late arthrosis and that derotational osteotomies to normalize the TFA may prove to have a favorable long-term effect.

  20. Lumbosacral transitional vertebrae in dogs: classification, prevalence, and association with sacroiliac morphology.

    PubMed

    Damur-Djuric, Natascha; Steffen, Frank; Hässig, Michael; Morgan, Joe P; Flückiger, Mark A

    2006-01-01

    The prevalence of lumbosacral transitional vertebrae (LTV) was determined by reviewing the pelvic radiographs of 4000 medium- and large-breed dogs of 144 breeds routinely screened for canine hip dysplasia. An LTV was seen in 138 (3.5%) dogs. The prevalence was higher in German Shepherd dogs and Greater Swiss Mountain dogs than in the other breeds, suggesting a genetic predisposition. There was no gender predisposition. The transverse processes of the LTV were divided into three types based on their morphological characteristics: lumbar type or type 1; intermediate type or type 2; and sacral type or type 3. In a symmetric LTV, both transverse processes are of the same type, while in an asymmetric LTV they are not. The frequency of occurrence of symmetric and asymmetric LTV was similar. In symmetric LTV, intermediate-type transverse processes predominated. Most of the asymmetric LTV had an intermediate-type transverse process combined with a lumbar or sacral type, respectively. Highly asymmetric LTV were often angled relative to the adjacent vertebrae. We hypothesize that an LTV is not the result of transformation of a lumbar into a sacral vertebra or vice versa, but rather is an autonomous intermediate type of vertebra. It occurs when the point of contact of the pelvis with the vertebral column is slightly cranial or caudal to its normal position. The resulting formative stimulus on the vertebral ossification centers, sagittally still separated, causes the various morphologies seen in LTV including the asymmetric variations.

  1. In lumbosacral plexus injuries can we identify indicators that predict spontaneous recovery or the need for surgical treatment? Results from a clinical study on 72 patients

    PubMed Central

    2014-01-01

    Background Post-traumatic lumbosacral plexus injuries seem to be rare events, spontaneously recovering in high percentage: as surgery is often challenging and results in poor outcome, many Authors have advocated conservative treatment only. Nevertheless surgery should not be ruled out: in invalidating injuries, it can restore basic function in the lower extremities. Therefore, it might be necessary to establish guidelines for the management and the indication to surgery in such cases. This study aims to identify indicators predicting spontaneous recovery or the need for surgery. Method The clinical and radiological data of 72 patients with a post-traumatic lumbosacral plexus injury were reviewed. A follow up equal or superior to 3 years is available in 42 cases. Results Lumbosacral plexus injuries mostly occurred during road accidents. The incidence of associated lesions was relevant: bone injuries were found in 85% of patients, internal lesions in 30% and vascular injuries in 8%. Lumbosacral trunk and sacral plexus palsies were the most frequent injury patterns. Root avulsions were revealed in 23% of cases and only in sacral plexus and complete lumbosacral plexus injuries: L5 and S1 were the roots more prone to avulsions. About 70% of cases recovered spontaneously, mostly in 18 months. Spontaneous recovery was the rule in lumbar plexus and lumbosacral trunk injuries (where root avulsions never occurred) or in sacral and complete lumbosacral plexus palsies due to compression injuries. The causative mechanism correlated with the injury pattern, the associated bone injury being often predictive of the severity of the nerve injury. Lumbosacral plexus injuries occurred in car crashes were generally associated with fractures causing compression on the nerves, thus resulting in injuries often amenable of spontaneous recovery. Motorcycle accidents implied high kinetic energy traumas where traction played an important role, as the high percentage of sacroiliac joint

  2. Differences in Gait Characteristics of Patients with Lumbar Spinal Canal Stenosis (L4 Radiculopathy) and Those with Osteoarthritis of the Hip.

    PubMed

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

    2015-01-01

    It is important to differentially diagnose thigh pain from lumbar spinal stenosis (particularly lumbar fourth nerve root radiculopathy) and osteoarthritis of the hip. In this study, using a treadmill and a motion analysis method, gait characteristics were compared between these conditions. Patients with lumbar fourth nerve root radiculopathy had increased physiological knee flexion immediately after foot-ground contact, possibly owing to a slight decrease in the muscle strength of the quadriceps femoris muscle. Patients with osteoarthritis of the hip had decreased range of motion of the hip joint probably due to anatomically limited mobility as well as gait strategy to avoid pain resulting from increased internal pressure on the hip joint during its extension. Our facile and noninvasive method can be useful for the differential diagnosis of lumbar spinal canal stenosis from osteoarthritis of the hip.

  3. Positive medium-term influence of multimodal pain management on socioeconomic factors and health care utilization in patients with lumbar radiculopathy: a prospective study

    PubMed Central

    Benditz, Achim; Loher, Martin; Boluki, Daniel; Grifka, Joachim; Völlner, Florian; Renkawitz, Tobias; Maderbacher, Günther; Götz, Jürgen

    2017-01-01

    Background Multimodal pain management (MPM) represents a central approach to avoiding surgery in patients with lumbar radiculopathy. Independent of the type of health system, cost effectiveness and socioeconomic factors are becoming increasingly important. This study investigated the medium-term influence of conservative MPM on health care utilization and socioeconomic factors. Methods This study compared subjective, objective, and socioeconomic factors of 60 patients after inpatient MPM because of lumbar radiculopathy, before and 1 year ± 2 weeks after treatment. Results Over the course of the 1-year follow-up, one-third of the patients had not required any conservative treatment in comparison to 100% of patients before MPM therapy. The number of patients requiring analgesics could be significantly reduced from 26 to 12, and the number of patients who did not require any analgesics had increased from 14 to 32. After 1 year, the number of patients who had to regularly contact a physician because of low back pain (once per month for 6 months) had been reduced from 58 to 27. Conclusion MPM is an effective approach to treating lumbar radiculopathy and reducing its negative influence on socioeconomic factors. Therapeutic benefits also include a decrease in health care utilization. Therefore, health care providers should place the mid-term success for patients and socioeconomic factors before the short-term costs of therapy. PMID:28243143

  4. Expression of lumbosacral HOX genes, crucial in kidney organogenesis, is systematically deregulated in clear cell kidney cancers.

    PubMed

    Cantile, Monica; Schiavo, Giulia; Franco, Renato; Cindolo, Luca; Procino, Alfredo; D'Armiento, Maria; Facchini, Gaetano; Terracciano, Luigi; Botti, Gerardo; Cillo, Clemente

    2011-06-01

    Homeobox-containing genes are involved in different stages of kidney organogenesis, from the early events in intermediate mesoderm to terminal differentiation of glomerular and tubular epithelia. The HOX genes show a unique genomic network organization and regulate normal development. The targeted disruption of paralogous group 11 HOX genes (HOX A11, HOX C11 and HOX D11) results in a complete loss of metanephric kidney induction. Despite a large amount of data are related to the early events in the kidney development, not much is known about HOX genes in advanced kidney organogenesis and carcinogenesis. Here, we compare the expression of the whole HOX gene network in late-stage human foetal kidney development with the same patterns detected in 25 pairs of normal clear cell renal carcinomas (RCCs) and 15 isolated RCC biopsy samples. In the majority of RCCs tested, HOX C11 is upregulated, whereas HOX D11, after an early involvement becomes active again at the 23rd week of the foetal kidney development, is always expressed in normal adult kidneys and is deregulated, together with HOX A11 and lumbosacral locus D HOX genes. Thus, through its function of regulating phenotype cell identity, the HOX network plays an important role in kidney carcinogenesis. Lumbosacral HOX genes are involved in the molecular alterations associated with clear cell kidney cancers and represent, through their deregulation, a molecular mark of tubular epithelial dedifferentiation occurring along tumour evolution, with the restoration of genetic programs associated with kidney organogenesis. The deregulation of lumbosacral HOX genes in RCCs supports (i) the consideration of the HOX gene transcriptome as the potential prognostic tool in kidney carcinogenesis and (ii) the possibility to foresee clinical trials with the purpose of targeting these genes to achieve a therapeutic effect in RCC patients.

  5. In vivo characterization of colorectal and cutaneous inputs to lumbosacral dorsal horn neurons in the mouse spinal cord.

    PubMed

    Farrell, K E; Rank, M M; Keely, S; Brichta, A M; Graham, B A; Callister, R J

    2016-03-01

    Chronic abdominal pain is a common symptom of inflammatory bowel disease and often persists in the absence of gut inflammation. Although the mechanisms responsible for ongoing pain are unknown, clinical and preclinical evidence suggests lumbosacral spinal cord dorsal horn neurons contribute to these symptoms. At present, we know little about the intrinsic and synaptic properties of this population of neurons in either normal or inflammed conditions. Therefore, we developed an in vivo preparation to make patch-clamp recordings from superficial dorsal horn (SDH) neurons receiving colonic inputs in naïve male mice. Recordings were made in the lumbosacral spinal cord (L6-S1) under isoflurane anesthesia. Noxious colorectal distension (CRD) was used to determine whether SDH neurons received inputs from mechanical stimulation/distension of the colon. Responses to hind paw/tail cutaneous stimulation and intrinsic and synaptic properties were also assessed, as well as action potential discharge properties. Approximately 11% of lumbosacral SDH neurons in the cohort of neurons sampled responded to CRD and a majority of these responses were subthreshold. Most CRD-responsive neurons (80%) also responded to cutaneous stimuli, compared with <50% of CRD-non-responsive neurons. Furthermore, CRD-responsive neurons had more hyperpolarized resting membrane potentials, larger rheobase currents, and reduced levels of excitatory drive, compared to CRD-non-responsive neurons. Our results demonstrate that CRD-responsive neurons can be distinguished from CRD-non-responsive neurons by several differences in their membrane properties and excitatory synaptic inputs. We also demonstrate that SDH neurons with colonic inputs show predominately subthreshold responses to CRD and exhibit a high degree of viscerosomatic convergence.

  6. The rat lumbosacral spinal cord adapts to robotic loading applied during stance.

    PubMed

    Timoszyk, W K; De Leon, R D; London, N; Roy, R R; Edgerton, V R; Reinkensmeyer, D J

    2002-12-01

    Load-related afferent information modifies the magnitude and timing of hindlimb muscle activity during stepping in decerebrate animals and spinal cord-injured humans and animals, suggesting that the spinal cord mediates load-related locomotor responses. In this study, we found that stepping on a treadmill by adult rats that received complete, midthoracic spinal cord transections as neonates could be altered by loading the hindlimbs using a pair of small robotic arms. The robotic arms applied a downward force to the lower shanks of the hindlimbs during the stance phase and measured the position of the lower shank during stepping. No external force was applied during the swing phase of the step. When applied bilaterally, this stance force field perturbed the hindlimb trajectories so that the ankle position was shifted downward during stance. In response to this perturbation, both the stance and step cycle durations decreased. During swing, the hindlimb initially accelerated toward the normal, unperturbed swing trajectory and then tracked the normal trajectory. Bilateral loading increased the magnitude of the medial gastrocnemius electromyographic (EMG) burst during stance and increased the amplitude of the semitendinosus and rectus femoris EMG bursts. When the force field was applied unilaterally, stance duration decreased in the loaded hindlimb, while swing duration was decreased in the contralateral hindlimb, thereby preserving interlimb coordination. These results demonstrate the feasibility of using robotic devices to mechanically modulate afferent input to the injured spinal cord during weight-supported locomotion. In addition, these results indicate that the lumbosacral spinal cord responds to load-related input applied to the lower shank during stance by modifying step timing and muscle activation patterns, while preserving normal swing kinematics and interlimb coordination.

  7. The spinal nerves that constitute the lumbosacral plexus and their distribution in the chinchilla.

    PubMed

    Martinez-Pereira, M A; Rickes, E M

    2011-09-01

    In this study, the spinal nerves that constitute the lumbosacral plexus (plexus lumbosacrales) (LSP) and its distribution in Chinchilla lanigera were investigated. Ten chinchillas (6 males and 4 females) were used in this research. The spinal nerves that constitute the LSP were dissected and the distribution of pelvic limb nerves originating from the plexus was examined. The iliohypogastric nerve arose from L1 and L2, giving rise to the cranial and caudal nerves, and the ilioinguinal nerve arose from L3. The other branch of L3 gave rise to the genitofemoral nerve and 1 branch from L4 gave rise to the lateral cutaneous femoral nerve. The trunk formed by the union of L4-5 divided into medial (femoral nerve) and lateral branches (obturator nerve). It was found that the LSP was formed by all the ventral branches of L4 at L6 and S1 at S3. At the caudal part of the plexus, a thick branch, the ischiadic plexus, was formed by contributions from L5-6 and S1. This root gave rise to the nerve branches which were disseminated to the posterior limb (cranial and caudal gluteal nerves, caudal cutaneous femoral nerve and ischiadic nerve). The ischiadic nerve divided into the caudal cutaneous surae, lateral cutaneous surae, common fibular and tibial nerve. The pudendal nerve arose from S1-2 and the other branch of S2 and S3 formed the rectal caudal nerve. The results showed that the origins and distribution of spinal nerves that constitute the LSP of chinchillas were similar to those of a few rodents and other mammals.

  8. [Computed tomographic variants of vertebrogenic lumbosacral radicular lesions in patients with radicular and non-radicular lumbar ischialgias].

    PubMed

    Mikhaĭlov, M K; Altunbaev, R A

    2002-01-01

    The paper considers the CT features of vertebrogenic lumbosacral radicular lesions in patients with radicular and nonradicular lumbar ischialgias. Ninety patients were divided into three groups according to the degree of clinical manifestations of radicular disorders. Four CT patterns of radicular alterations were identified: dislocation, compression, aggregation, and conglomeration. There were differences in the frequency of different CT patterns in patients from different clinical groups. Combining the CT patterns of radicular lesions into occupational and contact types determined a correlation of the severity of radicular disorders and the occupational type of changes in the root.

  9. A Randomized Controlled Clinical Trial to Determine the Effectiveness of Caudal Epidural Steroid Injection in Lumbosacral Sciatica

    PubMed Central

    Chowdhery, Abhishek

    2017-01-01

    Introduction Caudal epidural steroid injection have been a part of nonsurgical management of lumbosacral sciatica since last half a century but various randomized controlled trials fail to provide convincing evidence in favour of its effectiveness. Aim To assess the efficacy of caudal epidural steroid injection in patients of lumbosacral sciatica in comparison to placebo. Materials and Methods The study consisted of patients of sciatica caused by lumbosacral disc prolapse (observed on Magnetic Resonance Imaging (MRI) scan). Caudal epidural injections of 80 mg methyl prednisolone were injected in 47 patients in one group. The other group consisted of 46 patients who were injected isotonic saline as placebo. Self-evaluation was the main judgment criterion at 4th week using a descriptive four item scale (recovery, marked improvement, slight improvement, or worse). Patients rating the improvement as “recovery” or “marked improvement” were considered as success. Patients rating the improvement as “slight improvement” or “worse” were considered as failure. Only paracetamol were authorized and patients requiring Non Steroidal Anti-inflammatory Drugs (NSAIDs) before 4th week were also considered as failure. Results On analysis per protocol, at 4 weeks, the two groups differed significantly with respect to the primary outcome: among the 93 patients, 8/46 (17%) in the placebo group and 32/47 (68%) in the steroid group (p=0.000) were considered as success (difference 50.7%; 95% CI for the difference 33.4 to 67.99). But at the end of the study (week 12) there was no significant difference in primary outcome between the groups: 22/46 (48%) patients in the placebo group and 28/47 (60%) in the steroid group (p=0.25) were considered as success (difference 11.8%; 95% CI for the difference -8.38 to 31.9). Conclusion Caudal epidural steroid injections provide no additional improvement over placebo in the long term natural history of lumbosacral sciatica. However, it

  10. Specializations in the lumbosacral vertebral canal and spinal cord of birds: evidence of a function as a sense organ which is involved in the control of walking.

    PubMed

    Necker, Reinhold

    2006-05-01

    Birds are bipedal animals with a center of gravity rostral to the insertion of the hindlimbs. This imposes special demands on keeping balance when moving on the ground. Recently, specializations in the lumbosacral region have been suggested to function as a sense organ of equilibrium which is involved in the control of walking. Morphological, electrophysiological, behavioral and embryological evidence for such a function is reviewed. Birds have two nearly independent kinds of locomotion and it is suggested that two different sense organs play an important role in their respective control: the vestibular organ during flight and the lumbosacral system during walking.

  11. Combined epidural morphine and bupivacaine in the treatment of lumbosacral radicular neuropathic pain: a noncontrolled prospective study

    PubMed Central

    Vigneri, Simone; Sindaco, Gianfranco; La Grua, Marco; Zanella, Matteo; Ravaioli, Laura; Paci, Valentina; Pari, Gilberto

    2016-01-01

    Objective The aim of this study was to investigate the therapeutic effectiveness of epidural morphine and bupivacaine in patients with chronic lumbosacral radicular neuropathic pain after the cessation of treatment. Methods Twenty-two patients with chronic lumbosacral pain with neuropathic features were enrolled. An indwelling catheter was placed into the epidural space, and each patient received an epidural injection of morphine chlorhydrate and bupivacaine up to three times a day. The medication was administered for 4 weeks. The pain intensity score on a 0–10 numeric rating scale (NRS), the total pain rating index rank (PRIr-T), and its coefficients were evaluated before treatment and 1 month after catheter removal. P-value <0.05 was considered statistically significant. Results NRS and PRIr-T were significantly reduced at follow-up (P=0.001 and P=0.03, respectively), whereas the parallel evolution of the two scores (r=0.75 and P<0.001, respectively) confirmed significant pain relief lasting up to 1 month after treatment cessation. None of the four pain rating coefficients was significantly modified compared to the others in either responders or nonresponders. Successful clinical outcome (pain reduction >30% in NRS) was reached and maintained in half of the patients at follow-up. Conclusion Combined epidural morphine and bupivacaine seems to be effective in the treatment of neuropathic pain. PMID:27920574

  12. [Neurogenic deformities of the foot due to congenital malformations of the lumbosacral spine. Their clinical and therapeutic characteristics].

    PubMed

    De Palma, L; Serra, F; Coletti, V

    1990-01-01

    The authors illustrate the different types of nervous disorders of the foot caused by congenital deformations of the lumbosacral spine. They classify these clinical forms according to the level of the neurological lesions, although emphasizing that more complex neurological damage may cause very atypical deformities that are difficult to classify. Today the treatment of nervous disorders of the foot caused by congenital deformations of the lumbosacral spine seems almost promising when compared to neurological and urological problems which have therapeutic priority. Possible methods of surgical correction, as well as indications that differ according to the age of the patient and the type and extent of the deformity, are discussed. These deformities of the foot evolve very quickly; treatment must be timely or reduction is difficult. Furthermore, their peculiar tendency to relapse necessitates periodic comprehensive follow-up exams and regular maintenance therapy (orthetic and physiatric). Special care must be taken before and during treatment to prevent trophic skin lesions. For this reason, solutions other than casts (external fixation, for example) may be preferable for the maintenance of the correction. The treatment of these deformities, whether conservative or surgical, should aim primarily to achieve adequate plantar support for future aided or autonomous ambulation.

  13. The identification and neurochemical characterization of central neurons that target parasympathetic preganglionic neurons involved in the regulation of choroidal blood flow in the rat eye using pseudorabies virus, immunolabeling and conventional pathway tracing methods

    PubMed Central

    Li, Chunyan; Fitzgerald, Malinda E. C.; Del Mar, Nobel; Cuthbertson-Coates, Sherry; LeDoux, Mark S.; Gong, Suzhen; Ryan, James P.; Reiner, Anton

    2015-01-01

    The choroidal blood vessels of the eye provide the main vascular support to the outer retina. These blood vessels are under parasympathetic vasodilatory control via input from the pterygopalatine ganglion (PPG), which in turn receives its preganglionic input from the superior salivatory nucleus (SSN) of the hindbrain. The present study characterized the central neurons projecting to the SSN neurons innervating choroidal PPG neurons, using pathway tracing and immunolabeling. In the initial set of studies, minute injections of the Bartha strain of the retrograde transneuronal tracer pseudorabies virus (PRV) were made into choroid in rats in which the superior cervical ganglia had been excised (to prevent labeling of sympathetic circuitry). Diverse neuronal populations beyond the choroidal part of ipsilateral SSN showed transneuronal labeling, which notably included the parvocellular part of the paraventricular nucleus of the hypothalamus (PVN), the periaqueductal gray, the raphe magnus (RaM), the B3 region of the pons, A5, the nucleus of the solitary tract (NTS), the rostral ventrolateral medulla (RVLM), and the intermediate reticular nucleus of the medulla. The PRV+ neurons were located in the parts of these cell groups that are responsive to systemic blood pressure signals and involved in systemic blood pressure regulation by the sympathetic nervous system. In a second set of studies using PRV labeling, conventional pathway tracing, and immunolabeling, we found that PVN neurons projecting to SSN tended to be oxytocinergic and glutamatergic, RaM neurons projecting to SSN were serotonergic, and NTS neurons projecting to SSN were glutamatergic. Our results suggest that blood pressure and volume signals that drive sympathetic constriction of the systemic vasculature may also drive parasympathetic vasodilation of the choroidal vasculature, and may thereby contribute to choroidal baroregulation during low blood pressure. PMID:26082687

  14. Pharmacological characterization of the rhythmic synaptic drive onto lumbosacral motoneurons in the chick embryo spinal cord.

    PubMed

    Sernagor, E; Chub, N; Ritter, A; O'Donovan, M J

    1995-11-01

    The isolated spinal cord of the chick embryo generates episodes of rhythmic bursting in which sartorius (hip flexor) and femorotibialis (knee extensor) motoneurons exhibit characteristic patterns of activity. At the beginning of each cycle both sets of motoneurons discharge synchronously. Following this brief synchronous activation sartorius motoneurons stop firing at the time of peak femorotibialis activity, producing a period of alternation between the two sets of motoneurons. Intracellular recording from motoneurons has suggested that the pause is mediated by a synaptically induced shunt conductance. However, the pharmacological basis for this shunt and the nature of the excitatory drive to motoneurons is unknown. To address these questions we have investigated the pharmacology of the rhythmic, synaptic drive to lumbosacral motoneurons using local and bath application of several excitatory and inhibitory antagonists, and documenting their effects on motor output in E10-E12 chick embryos. Local application of bicuculline or picrotoxin over sartorius motoneurons abolished the pause in firing recorded from the sartorius muscle nerve. As a consequence, the pattern of sartorius and femorotibialis activity was similar and the motoneurons were coactive. The pause in sartorius firing was shortened following local application of the glycine antagonist strychnine the nicotinic, cholinergic antagonists mecamylamine, and dihydro-beta-erythroidine and several excitatory amino acid antagonists. Application of the GABA uptake inhibitor nipecotic acid depressed the slow potentials and discharge recorded from the sartorius muscle nerve. These findings suggest that the pause is determined primarily by synaptic inputs acting at motoneuron GABAA receptors with contributions from glycinergic, cholinergic, and glutamatergic inputs. The actions of locally applied GABA onto spinal neurons are consistent with these findings because the neurotransmitter depolarizes spinal neurons and

  15. The development of sensorimotor synaptic connections in the lumbosacral cord of the chick embryo.

    PubMed

    Lee, M T; Koebbe, M J; O'Donovan, M J

    1988-07-01

    We have examined the development of synaptic connections between afferents and motoneurons in the lumbosacral spinal cord of the chick embryo between stages 28 and 39. The central projection of afferents was visualized following injection of dorsal root ganglia with HRP. Afferent fibers first entered the dorsal gray matter between stages 29 and 31. They grew in a ventrolateral direction, reaching motoneuron dendrites by stage 32. Quantitative analysis of axon numbers suggested that individual axons did not begin to branch extensively until they approached the lateral motor column at stage 36. Connectivity between afferents and motoneurons was assessed by stimulating dorsal roots or nerves supplying the femorotibialis muscle and recording the resulting motoneuron synaptic potentials intracellularly or from the cut ventral roots. At stages 37-39, low-intensity stimulation produced a short-latency positive potential that was followed at higher stimulus currents by slower positive potentials. All of these potentials were abolished in solutions that block chemical synaptic transmission (zero Ca2+/2 mM Mn2+). The early potential, which includes the monosynaptic EPSP produced by muscle afferents, persisted in the presence of the N-methyl-D-aspartate antagonist, 2-amino-5-phosphonovaleric acid (APV), but was largely eliminated by the more general excitatory amino acid antagonist, kynurenic acid. Therefore, in the chick, as in other species, a glutamate-like transmitter appears to be released at the synapses between muscle afferents and motoneurons. The APV-resistant potential was reduced in amplitude during bath application of the glycine and GABA antagonists, strychnine and picrotoxin, suggesting that it was composed of depolarizing inhibitory as well as excitatory components at these stages. The monosynaptic EPSP could be recorded in ventral roots as early as stages 32-33, when muscle afferents first grew into the vicinity of motoneuron dendrites. The EPSP in these young

  16. Organization of hindlimb muscle afferent projections to lumbosacral motoneurons in the chick embryo.

    PubMed

    Lee, M T; O'Donovan, M J

    1991-08-01

    We have examined the organization of muscle afferent projections to motoneurons in the lumbosacral spinal cord of chick embryos between stage 37, when muscle afferents first reach the motor nucleus, and stage 44, which is just before hatching. Connectivity between afferents and motoneurons was assessed by stimulating individual muscle nerves and recording the resulting motoneuron synaptic potentials intracellularly or electrotonically from other muscle nerves. Most of the recordings were made in the presence of DL-2-amino-5-phosphonovaleric acid (APV), picrotoxin, and strychnine to block long-latency excitatory and inhibitory pathways. Activation of muscle afferents evoked slow, positive potentials in muscle nerves but not in cutaneous nerves. These potentials were abolished in 0 mM Ca2+, 2mM Mn2+ solutions, indicating that they were generated by the action of chemical synapses. The muscle nerve recordings revealed a wide-spread pattern of excitatory connections between afferents and motoneurons innervating six different thigh muscles, which were not organized according to synergist-antagonist relationships. This pattern of connectivity was confirmed using intracellular recording from identified motoneurons, which allowed the latency of the responses to be determined. Short-latency potentials in motoneurons were produced by activation of homonymous afferents and the heteronymous afferents innervating the hip flexors sartorius and anterior iliotibialis. Stimulation of anterior iliotibialis afferents also resulted in some short-latency excitatory postsynaptic potentials (EPSPs) in motoneurons innervating the knee extensor femorotibialis, though other connections were of longer latency. Afferents from the adductor, a hip extensor, did not evoke short-latency EPSPs in any of these three types of motoneurons. Short-latency, but not long-latency EPSPs, persisted during repetitive stimulation at 5 Hz, suggesting that they were mediated monosynaptically. Long

  17. Effect of a titanium cage as a stand-alone device on biomechanical stability in the lumbosacral spine of canine cadavers.

    PubMed

    Teunissen, M; van der Veen, A J; Smit, T H; Tryfonidou, M A; Meij, B P

    2017-02-01

    Degenerative lumbosacral stenosis is a common disease in dogs characterised by intervertebral disc herniation, loss of disc height and stenosis. Decompressive dorsal laminectomy and partial discectomy can cause spinal instability and worsen foraminal stenosis. Pedicle screw and rod fixation (PSRF) with an intervertebral body cage allows for distraction and restoration of disc height and restores foraminal apertures. The aim of this study was to evaluate the ex vivo biomechanical properties of a titanium intervertebral cage alone and in combination with PSRF in the lumbosacral spine of dogs. The range of motion, neutral zone, neutral zone stiffness and elastic zone stiffness of the lumbosacral joint (L7-S1) of nine canine cadavers were determined in flexion/extension, lateral bending and axial rotation for four conditions: (1) native (unmodified) spine; (2) dorsal laminectomy and discectomy; (3) stand-alone cage; and (4) cage in combination with PSRF. The intervertebral disc height decreased after dorsal laminectomy, but increased after insertion of the cage. Insertion of the stand-alone cage decreased the range of motion and neutral zone compared to the laminectomy-discectomy and increased neutral zone stiffness in all directions. The range of motion further decreased after PSRF. From a biomechanical point of view, the use of a stand-alone intervertebral cage is a potential alternative to dorsal fixation of the lumbosacral junction, since it increases spinal stability and restores disc height.

  18. Outcomes of bilateral sacroiliac joint fusions and the importance of understanding potential coexisting lumbosacral pathology that might also require surgical treatment.

    PubMed

    Dall, Bruce E; Eden, Sonia V

    2015-06-01

    Only one study in the literature describes performing a bilateral sacroiliac joint fusion, and the results were poor. Many patients needing a bilateral sacroiliac joint fusion frequently have had previous lumbosacral surgeries and present with lumbosacral pain as well. This study reviews our results in consecutive patients having had a bilateral sacroiliac joint fusion over a five-year period. Fifteen patients had bilateral sacroiliac joint fusions with 13 having concurrent lumbosacral fusions. The modified posterior midline fascial splitting approach, first described by Belanger was utilized. Patients were followed for an average of 30.3 months. There were no infections, neurovascular injuries, lasting morbidity or deaths. One non-union of a sacroiliac joint (7%) occurred, which after revision was satisfactory. There was a statistically significant drop in pain (p=0.01488) using the VAS, and patient satisfaction rates were 86%. With all those patients saying they would have the surgery again for the same result. There was no significant increase in functionality. Patients needing bilateral sacroiliac joint fusions frequently fall into the "failed back" category, and it is important to evaluate both the sacroiliac joints and the lumbosacral spine for potential pain generators. This study shows that by treating all the pain generators in both areas there were significant decreases in pain, low complications, low re-operation rates, and high patient satisfaction scores. Overall functionality, however, was not positively affected.

  19. Feasibility of Early and Repeated Low-dose Interscalene Brachial Plexus Block for Residual Pain in Acute Cervical Radiculopathy Treated with NSAIDS

    PubMed Central

    Mitoro, Mari; Kuzumoto, Naoya

    2014-01-01

    Background To improve residual pain management in acute cervical radiculopathy treated with NSAIDs, the feasibility of early and repeated low-dose interscalene brachial plexus block (IS-BPB) needs to be assessed. Methods This was a prospective study on patients receiving NSAIDs (loxoprofen) for cervical radiculopathy of ≤ 2-week onset. Pain was assessed using the visual analogue scale (VAS). A low-dose ultrasonography (USG)-guided IS-BPB (dexamethasone [1.65 mg; 0.5 ml] and mepivacaine [1%; 3.0 ml]) was performed at baseline and weekly thereafter for 4 weeks in an outpatient setting for the intervention group. All patients were evaluated using a visual satisfaction score (VSS) at week 4. Patients with baseline VAS scores < 70 (mild to moderate pain; MM group) and ≥ 70 (severe pain; SE group) were compared to the controls receiving NSAIDs. Results A total of 316 IS-BPBs were performed in the intervention group. There was a significant difference in the decline in the VAS from week 0 to week 3 in the MM and SE groups (P < 0.05); however, from week 3 to week 4, the therapeutic effect exhibited no significant difference. Thirteen patients at week 2 (15.5%; MM: 27.7%; SE: 0%), 43 at week 3 (51.2%; MM: 83.0%; SE: 10.8%), and 47 at week 4 (56.0%; MM: 85.1%; SE: 18.9%) achieved a VAS score of ≤ 20. Patient satisfaction was high, and the decrease in VAS scores in both groups was significant (P < 0.05) compared to the controls. Conclusions Weekly, low-dose, USG-guided IS-BPB can be implemented for early pain relief in acute cervical radiculopathy, with high patient satisfaction. PMID:24748940

  20. Study protocol for a randomised controlled multicentre study: the Foraminotomy ACDF Cost-Effectiveness Trial (FACET) in patients with cervical radiculopathy

    PubMed Central

    Broekema, A E H; Kuijlen, J M A; Lesman-Leegte, G A T; Bartels, R H M A; van Asselt, A D I; Vroomen, P C A J; Reneman, M F; Soer, R; Groen, R J M

    2017-01-01

    Introduction Cervical radiculopathy due to discogenic or spondylotic stenosis of the neuroforamen can be surgically treated by an anterior discectomy with fusion (ACDF) or a posterior foraminotomy (FOR). Most surgeons prefer ACDF, although there are indications that FOR is as effective as ACDF, has a lower complication rate and is less expensive. A head-to-head comparison of the 2 surgical techniques in a randomised controlled trial has not yet been performed. The study objectives of the Foraminotomy ACDF Cost-Effectiveness Trial (FACET) study are to compare clinical outcomes, complication rates and cost-effectiveness of FOR to ACDF. Methods and analysis The FACET study is a prospective randomised controlled trial conducted in 7 medical centres in the Netherlands. The follow-up period is 2 years. The main inclusion criterion is a radiculopathy of the C4, C5, C6 or C7 nerve root, due to a single-level isolated cervical foraminal stenosis caused by a soft disc and/or osteophytic component, requiring operative decompression. A sample size of 308 patients is required to test the hypothesis of clinical non-inferiority of FOR versus ACDF. Primary outcomes are: ‘operative success’, the measured decrease in radiculopathy assessed by the visual analogue scale and ‘patient success’, assessed by the modified Odom's criteria. Secondary outcomes are: Work Ability Index (single-item WAI), quality of life (EuroQol 5 Dimensions 5 level Survey, EQ-5D-5L), Neck Disability Index (NDI) and complications. An economic evaluation will assess cost-effectiveness. In addition, a budget impact analysis will be performed. Ethics and dissemination Ethical approval was obtained from the Institutional Ethics Committee of the University Medical Center Groningen. Results of this study will be disseminated through national and international papers. The participants and relevant patient support groups will be informed about the results of the study. Trial registration number NTR5536, pre

  1. Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck-arm pain.

    PubMed

    Tampin, Brigitte; Slater, Helen; Hall, Toby; Lee, Gabriel; Briffa, Noelle Kathryn

    2012-12-01

    The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were compared to healthy control (HC) subjects and a positive control group comprising patients with fibromyalgia (FM). Quantitative sensory testing (QST) of thermal and mechanical detection and pain thresholds, pain sensitivity and responsiveness to repetitive noxious mechanical stimulation was performed in the maximal pain area, the corresponding dermatome and foot of 23 patients with painful C6 or C7 cervical radiculopathy, 8 patients with NSNAP in a C6/7 dermatomal pain distribution, 31 HC and 22 patients with FM. For both neck-arm pain groups, all QST parameters were within the 95% confidence interval of HC data. Patients with cervical radiculopathy were characterised by localised loss of function (thermal, mechanical, vibration detection P<.009) in the maximal pain area and dermatome (thermal detection, vibration detection, pressure pain sensitivity P<.04), consistent with peripheral neuronal damage. Both neck-arm pain groups demonstrated increased cold sensitivity in their maximal pain area (P<.03) and the foot (P<.009), and this was also the dominant sensory characteristic in patients with NSNAP. Both neck-arm pain groups differed from patients with FM, the latter characterised by a widespread gain of function in most nociceptive parameters (thermal, pressure, mechanical pain sensitivity P<.027). Despite commonalities in pain characteristics between the 2 neck-arm pain groups, distinct sensory profiles were demonstrated for each group.

  2. Three-year follow-up of a randomized controlled trial comparing preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy

    PubMed Central

    Louw, Adriaan; Diener, Ina; Landers, Merrill R.; Zimney, Kory

    2016-01-01

    Background Results from a previous multicenter randomized controlled trial (RCT) on preoperative pain neuroscience education (PNE) for lumbar radiculopathy found no significant difference in patient reported outcomes between groups. However, patients who received PNE viewed their surgical experience more favorably and utilized significantly less healthcare compared to those that did not. The purpose is to determine if the reduction in healthcare costs from 1-year would be continued at 3-year following surgery, and to explore differences (if any) in patient reported outcomes. Study design—analysis of 3-year follow-up data from RCT on preoperative PNE for lumbar radiculopathy. Methods Participating patients from the previous RCT were contacted for 3-year follow-up. Of the 67 patients who commenced in the study, there were 61 who completed 1-year follow-up. Data packets were sent to these 61 patients to examine post-operative utilization of healthcare (Utilization of Healthcare Questionnaire); LBP [numeric rating scale (NRS)]; leg pain (NRS); function (Oswestry disability index); and beliefs and experiences related to LS (10 item survey with Likert responses). Results At 3-year follow-up, 50 patients (29 females) responded, with 22 patients in the experimental group (EG) and 28 in the control group (CG). Cumulative medical expenses were 37% lower for the EG, with those patients spending less on X-rays and visits to their family physician, physical therapist, and massage therapist. There were no differences in patient reported outcomes between groups. Patients who received PNE continued to view their surgical experience more favorably compared to those that did not. Conclusions Adding a single PNE session prior to surgery for lumbar radiculopathy results in significant healthcare savings over 3 years. Educating such patients about normal responses to lumbar surgery (LS) in a neuroscience framework may result in lasting behavior changes following surgery. PMID

  3. Initial clinical experience with a next-generation artificial disc for the treatment of symptomatic degenerative cervical radiculopathy

    PubMed Central

    Reyes-Sanchez, Alejandro; Miramontes, Victor; Olivarez, Luis M. Rosales; Aquirre, Armando Alpizar; Quiroz, Alfredo Ortega; Zarate-Kalfopulos, Baron

    2010-01-01

    Background A feasibility trial was conducted to evaluate the initial safety and clinical use of a next-generation artificial cervical disc (M6-C artificial cervical disc; Spinal Kinetics, Sunnyvale, CA) for the treatment of patients with symptomatic degenerative cervical radiculopathy. A standardized battery of validated outcome measures was utilized to assess condition-specific functional impairment, pain severity, and quality of life. Methods Thirty-six consecutive patients were implanted with the M6-C disc and complete clinical and radiographic outcomes for 25 patients (mean age, 44.5 ± 10.1 years) with radiographically-confirmed cervical disc disease and symptomatic radiculopathy unresponsive to conservative medical management are included in this report. All patients had disc-osteophyte complex causing neural compression and were treated with discectomy and artificial cervical disc replacement at either single level (n = 12) or 2-levels (n = 13). Functional impairment was evaluated using the Neck Disability Index (NDI). Evaluation of arm and neck pain severity utilized a standard 11-point numeric scale, and health-related quality of life was evaluated with the SF-36 Health Survey. Quantitative radiographic assessments of intervertebral motion were performed using specialized motion analysis software, QMA (Quantitative Motion Analysis; Medical Metrics, Houston, TX). All outcome measures were evaluated pre-treatment and at 6 weeks, 3, 6, 12, and 24 months. Results The mean NDI score improved from 51.6 ± 11.3% pre-treatment to 27.9 ± 16.9% at 24 months, representing an approximate 46% improvement (P <.0001). The mean arm pain score improved from 6.9 ± 2.5 pre-treatment to 3.9 ± 3.1 at 24 months (43%, P =.0006). The mean neck pain score improved from 7.8 ± 2.0 pre-treatment to 3.8 ± 3.0 at 24 months (51%, P <.0001). The mean PCS score of the SF-36 improved from 34.8 ± 7.8 pre-treatment to 43.8 ± 9.3 by 24 months (26%, P =.0006). Subgroup analyses found

  4. Anatomical differences in patients with lumbosacral transitional vertebrae and implications for minimally invasive spine surgery.

    PubMed

    Josiah, Darnell T; Boo, SoHyun; Tarabishy, Abdul; Bhatia, Sanjay

    2017-02-01

    OBJECTIVE The objective of this study was to investigate the neurovascular and anatomical differences in patients with lumbosacral transitional vertebrae (LSTV) and the associated risk of neurovascular injury in minimally invasive spine surgery. METHODS The authors performed a retrospective study of CT and MR images of the lumbar spine obtained at their institution between 2010 and 2014. The following characteristics were evaluated: level of the iliac crest in relation to the L4-5 disc space, union level of the iliac veins and arteries in relation to the L4-5 disc space, distribution of the iliac veins and inferior vena cava according to the different Moro zones (A, I, II, III, IV, P) at the L4-5 disc space, and the location of the psoas muscle at the L4-5 disc space. The findings were compared with findings on images obtained in 28 age- and sex-matched patients without LSTV who underwent imaging studies during the same time period. RESULTS Twenty-eight patients (12 male, 16 female) with LSTV and the required imaging studies were identified; 28 age- and sex-matched patients who had undergone CT and MRI studies of the thoracic and lumbar spine imaging but did not have LSTV were selected for comparison (control group). The mean ages of the patients in the LSTV group and the control group were 52 and 49 years, respectively. The iliac crest was located at a mean distance of 12 mm above the L4-5 disc space in the LSTV group and 4 mm below the L4-5 disc space in the controls. The iliac vein union was located at a mean distance of 8 mm above the L4-5 disc space in the LSTV group and 2.7 mm below the L4-5 disc space in the controls. The iliac artery bifurcation was located at a mean distance of 23 mm above the L4-5 disc space in the LSTV group and 11 mm below the L4-5 disc space in controls. In patients with LSTV, the distribution of iliac vein locations was as follows: Zone A, 7.1%; Zone I only, 78.6%; Zone I encroaching into Zone II, 7.1%; and Zone II only, 7.1%. In the

  5. Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

    PubMed Central

    Repantis, Thomas; Zacharatos, Spyros; Zafiropoulos, Andreas

    2009-01-01

    Delayed complications following lumbar spine fusion may occur amongst which is adjacent segment degeneration (ASD). Although interspinous implants have been successfully used in spinal stenosis to authors’ knowledge such implants have not been previously used to reduce ASD in instrumented lumbar fusion. This prospective controlled study was designed to investigate if the implantation of an interspinous implant cephalad to short lumbar and lumbosacral instrumented fusion could eliminate the incidence of ASD and subsequently the related re-operation rate. Groups W and C enrolled initially each 25 consecutive selected patients. Group W included patients, who received the Wallis interspinous implant in the unfused vertebral segment cephalad to instrumentation and the group C selected age-, diagnosis-, level-, and instrumentation-matched to W group patients without interspinous implant (controls). The inclusion criterion for Wallis implantation was UCLA arthritic grade UCLA grade II in the adjacent two segments cephalad to instrumentation. All patients suffered from symptomatic spinal stenosis and underwent decompression and 2–4 levels stabilization with rigid pedicle screw fixation and posterolateral fusion by a single surgeon. Lumbar lordosis, disc height (DH), segmental range of motion (ROM), and percent olisthesis in the adjacent two cephalad to instrumentation segments were measured preoperatively, and postoperatively until the final evaluation. VAS, SF-36, and Oswestry Disability Index (ODI) were used. One patient of group W developed pseudarthrosis: two patients of group C deep infection and one patient of group C ASD in the segment below instrumentation and were excluded from the final evaluation. Thus, 24 patients of group W and 21 in group C aged 65+ 13 and 64+ 11 years, respectively were included in the final analysis. The follow-up averaged 60 ± 6

  6. Current trends in pedicle screw stimulation techniques: lumbosacral, thoracic, and cervical levels.

    PubMed

    Isley, Michael R; Zhang, Xiao-Feng; Balzer, Jeffrey R; Leppanen, Ronald E

    2012-06-01

    justification" of intraoperative neuromonitoring"... is the perception that the safety and efficacy of pedicle screw fixation are enhanced..." (Resnick et al. 2005b). However in summarizing a massive (over 1000 papers taken from the National Library of Medicine), contemporary, literature review spanning nearly a decade (1996 to 2003), this invited panel (Resnick et al. 2005b) recognized that the evidence-based documents contributing to the parts related to pedicle screw fixation and neuromonitoring were "... full of potential sources of error ..." and lacked appropriate, randomized, prospective studies for formulating rigid standards and guidelines. Nevertheless, current trends support the routine use and clinical utility of these neuromonitoring techniques. In particular free-run and triggered EMG have been well recognized in numerous publications for improving both the accuracy and safety of pedicle screw implantation. Currently, treatment with pedicle screw instrumentation routinely involves all levels of the spine - lumbosacral, thoracic, and cervical. Significant historical events, various neuromonitoring modalities, intraoperative alarm criteria, clinical efficacy, current trends, and caveats related to pedicle screw stimulation along the entire vertebral column will be reviewed.

  7. Bilateral Maxillary, Sphenoid Sinuses and Lumbosacral Spinal Cord Extramedullary Relapse of CML Following Allogeneic Stem Cell Transplant

    PubMed Central

    Hosseini, Soudabeh; Ansari, Shahla; Vosough, Parvaneh; Bahoush, Gholamreza; Hamidieh, Amir Ali; Chahardouli, Bahram; Shamsizadeh, Morteza; Mehrazma, Mitra; Dorgalaleh, Akbar

    2016-01-01

    Isolated extramedullary relapse of chronic myelogenous leukemia (CML) after allogeneic stem cell transplant is rare. There is a case report of a child who developed a granulocytic sarcoma of the maxillary and sphenoid sinuses and lumbosacral spinal cord mass 18 months after allogeneic bone marrow transplant for CML. He was presented with per orbital edema and neurological deficit of lower extremities and a mass lesion was found on spinal cord imaging. No evidence of hematologic relapse was identified at that time by bone marrow histology or cytogenetic. The patient died 1 month later with a picture of pneumonia, left ventricular dysfunction and a cardiopulmonary arrest on a presumed underlying sepsis with infectious etiology. Granulocytic sarcoma should be considered in the differential diagnosis of mass lesions presenting after allogeneic bone marrow transplantation for CML, even if there is no evidence of bone marrow involvement. PMID:27252811

  8. Postnatal development of the gastrin-releasing peptide system in the lumbosacral spinal cord controlling male reproductive function in rats.

    PubMed

    Katayama, Nao; Oti, Takumi; Takanami, Keiko; Sakamoto, Tatsuya; Sakamoto, Hirotaka

    2016-01-01

    A sexually dimorphic spinal gastrin-releasing peptide (GRP) system in the lumbosacral spinal cord, which projects to the lower spinal centers, controls erection and ejaculation in rats. However, little is known about the postnatal development of this system. In this study, we therefore examined the postnatal development of the male-dominant spinal GRP system and its sexual differentiation in rats using immunohistochemistry. Our results show that male-dominant expression of GRP is prominent from the onset of puberty and that sexually dimorphism persists into adulthood. These results suggest that androgen surge during male puberty plays an important role in the development and maintenance of the male-specific GRP function in the rat spinal cord.

  9. Postnatal development of the gastrin-releasing peptide system in the lumbosacral spinal cord controlling male reproductive function in rats

    PubMed Central

    KATAYAMA, Nao; OTI, Takumi; TAKANAMI, Keiko; SAKAMOTO, Tatsuya; SAKAMOTO, Hirotaka

    2016-01-01

    A sexually dimorphic spinal gastrin-releasing peptide (GRP) system in the lumbosacral spinal cord, which projects to the lower spinal centers, controls erection and ejaculation in rats. However, little is known about the postnatal development of this system. In this study, we therefore examined the postnatal development of the male-dominant spinal GRP system and its sexual differentiation in rats using immunohistochemistry. Our results show that male-dominant expression of GRP is prominent from the onset of puberty and that sexually dimorphism persists into adulthood. These results suggest that androgen surge during male puberty plays an important role in the development and maintenance of the male-specific GRP function in the rat spinal cord. PMID:26860455

  10. Dislodgement and gastrointestinal tract penetration of bone cement used for spinal reconstruction after lumbosacral vertebral tumor excision

    PubMed Central

    Nagae, Masateru; Mikami, Yasuo; Mizuno, Kentaro; Harada, Tomohisa; Ikeda, Takumi; Tonomura, Hitoshi; Takatori, Ryota; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2016-01-01

    Abstract Introduction: Polymethylmethacrylate (PMMA) cement is useful for spinal reconstruction, but can cause complications including new vertebral fractures, neurological disorders and pulmonary embolism. We report a case in PMMA cement used for spinal reconstruction after tumor curettage dislodged and penetrated the gastrointestinal tract. Diagnoses: The patient was diagnosed with a retroperitoneal extragonadal germ cell tumor at age 27 years. After chemotherapy and tumor resection, the tumor remained. It gradually increased in size and infiltrated lumbosacral vertebrae, causing him to present at age 35 years with increased low back pain. Image findings showed bone destruction in the vertebral bodies accompanied by neoplastic lesions. The left and right common iliac arteries and inferior vena cava were enclosed in the tumor on the anterior side of the vertebral bodies. Lumbosacral bone tumor due to direct extragonadal germ cell tumor infiltration was diagnosed. A 2-step operation was planned; first, fixation of the posterior side of the vertebral bodies, followed by tumor resection using an anterior transperitoneal approach, and spinal reconstruction using PMMA cement. After surgery, the PMMA cement gradually dislodged towards the anterior side and, 2 years 9 months after surgery, it had penetrated the retroperitoneum. The patient subsequently developed nausea and abdominal pain and was readmitted to hospital. The diagnosis was intestinal blockage with dislodged PMMA cement, and an operation was performed to remove the cement present in the small intestine. There was strong intra-abdominal adhesion, the peritoneum between the vertebral bodies and intestine could not be identified, and no additional treatment for vertebral body defects could be performed. After surgery, gastrointestinal symptoms resolved. Conclusion: Although this was a rare case, when using bone cement for vertebral body reconstruction, the way of anchoring for the cement must be thoroughly

  11. Accuracy of Percutaneous Lumbosacral Pedicle Screw Placement Using the Oblique Fluoroscopic View Based on Computed Tomography Evaluations

    PubMed Central

    Sato, Koji; Kanemura, Tokumi; Iwase, Toshiki; Togawa, Daisuke; Matsuyama, Yukihiro

    2016-01-01

    Study Design Retrospective. Purpose This study aims to investigate the accuracy of the oblique fluoroscopic view, based on preoperative computed tomography (CT) images for accurate placement of lumbosacral percutaneous pedicle screws (PPS). Overview of Literature Although PPS misplacement has been reported as one of the main complications in minimally invasive spine surgery, there is no comparative data on the misplacement rate among different fluoroscopic techniques, or comparing such techniques with open procedures. Methods We retrospectively selected 230 consecutive patients who underwent posterior spinal fusion with a pedicle screw construct for degenerative lumbar disease, and divided them into 3 groups, those who had undergone: minimally invasive percutaneous procedure using biplane (lateral and anterior-posterior views using a single C-arm) fluoroscope views (group M-1), minimally invasive percutaneous procedure using the oblique fluoroscopic view based on preoperative CT (group M-2), and conventional open procedure using a lateral fluoroscopic view (group O: controls). The relative position of the screw to the pedicle was graded for the pedicle breach as no breach, <2 mm, 2–4 mm, or >4 mm. Inaccuracy was calculated and assessed according to the spinal level, direction and neurological deficit. Inter-group radiation exposure was estimated using fluoroscopy time. Results Inaccuracy involved an incline toward L5, causing medial or lateral perforation of pedicles in group M-1, but it was distributed relatively equally throughout multiple levels in groups M-2 and controls. The mean fluoroscopy time/case ranged from 1.6 to 3.9 minutes. Conclusions Minimally invasive lumbosacral PPS placement using the conventional fluoroscopic technique carries an increased risk of inaccurate screw placement and resultant neurological deficits, compared with that of the open procedure. Inaccuracy tended to be distributed between medial and lateral perforations of the L5 pedicle

  12. On the load-sharing along the ligamentous lumbosacral spine in flexed and extended postures: Finite element study.

    PubMed

    Naserkhaki, Sadegh; Jaremko, Jacob L; Adeeb, Samer; El-Rich, Marwan

    2016-04-11

    A harmonic synergy between the load-bearing and stabilizing components of the spine is necessary to maintain its normal function. This study aimed to investigate the load-sharing along the ligamentous lumbosacral spine under sagittal loading. A 3D nonlinear detailed Finite Element (FE) model of lumbosacral spine with realistic geometry was developed and validated using wide range of numerical and experimental (in-vivo and in-vitro) data. The model was subjected to 500 N compressive Follower Load (FL) combined with 7.5 Nm flexion (FLX) or extension (EXT) moments. Load-sharing was expressed as percentage of total internal force/moment developed along the spine that each spinal component carried. These internal forces and moments were determined at the discs centres and included the applied load and the resisting forces in the ligaments and facet joints. The contribution of the facet joints and ligaments in supporting bending moments produced additional forces and moments in the discs. The intervertebral discs carried up to 81% and 68% of the total internal force in case of FL combined with FLX and EXT, respectively. The ligaments withstood up to 67% and 81% of the total internal moment in cases of FL combined with EXT and FLX, respectively. Contribution of the facet joints in resisting internal force and moment was noticeable at levels L4-S1 only particularly in case of FL combined with EXT and reached up 29% and 52% of the internal moment and force, respectively. This study demonstrated that spinal load-sharing depended on applied load and varied along the spine.

  13. Comparison of Two Doses of Ropivacaine Hydrochloride for Lumbosacral Epidural Anaesthesia in Goats Undergoing Laparoscopy Assisted Embryo Transfer.

    PubMed

    Khajuria, Anubhav; Fazili, Mujeeb Ur Rehman; Shah, Riaz Ahmad; Khan, Firdous Ahmad; Bhat, Maajid Hassan; Yaqoob, Syed Hilal; Naykoo, Niyaz Ahmad; Ganai, Nazir Ahmad

    2014-01-01

    Goats (n = 12) undergoing laparoscopy assisted embryo transfer were randomly allotted to two groups (I and II) and injected same volume of ropivacaine hydrochloride at 1.0 mg/kg and 0.5 mg/kg body weight, respectively, at the lumbosacral epidural space. The hind quarters of all the animals were lifted up for the first 3.0 minutes following injection. Immediately after induction the animals were restrained in dorsal recumbency in Trendelenburg position in a cradle. Laparoscopy was performed after achieving pneumoperitoneum using filtered room air. Regional analgesia and changes in physiological parameters were recorded. The mean induction time in animals of group I (n = 6) was 12.666 ± 1.994 minutes. In these animals the analgesia extended up to the umbilical region and lasted for 60 minutes. Only two animals in group II were satisfactorily induced in 11.333 ± 2.333 minutes. In animals of group I, the time taken for regaining the full motor power was significantly long (405 ± 46.314 min) when compared to group II goats (95 ± 9.219 min). From this study it was concluded that ropivacaine did not produce adequate analgesia in most of the goats at 0.5 mg/kg. When used at 1.0 mg/kg, it produced satisfactory regional analgesia lasting for one hour but the prolonged motor loss precludes its use. Additional studies using ropivacaine hydrochloride at doses in between the two extremes used here may be undertaken before recommending it for lumbosacral anaesthesia in goats undergoing laparoscopy.

  14. Diagnosis and treatment of pain in plexopathy, radiculopathy, peripheral neuropathy and phantom limb pain. Evidence and recommendations from the Italian Consensus Conference on Pain on Neurorehabilitation.

    PubMed

    Ferraro, Francesco; Jacopetti, Marco; Spallone, Vincenza; Padua, Luca; Traballesi, Marco; Brunelli, Stefano; Cantarella, Cristina; Ciotti, Cristina; Coraci, Daniele; Dalla Toffola, Elena; Mandrini, Silvia; Morone, Giovanni; Pazzaglia, Costanza; Romano, Marcello; Schenone, Angelo; Togni, Rossella; Tamburin, Stefano

    2016-12-01

    Pain may affect all aspects of social life and reduce the quality of life. Neuropathic pain (NP) is common in patients affected by plexopathy, radiculopathy, mononeuropathy, peripheral neuropathy. Phantom limb pain (PLP) is a painful sensation that is common after amputation, and its pathophysiological mechanisms involve changes in the peripheral and central nervous system. Given the lack of conclusive evidence and specific guidelines on these topics, the aim of the Italian Consensus Conference on Pain on Neurorehabilitation (ICCPN) was to collect evidence and offer recommendations to answer currently open questions on the assessment and treatment of NP associated with the above conditions and PLP. When no evidence was available, recommendations were based on consensus between expert opinions. Current guidelines on the assessment and pharmacological treatment of NP can be applied to plexopathy, radiculopathy, mononeuropathy, peripheral neuropathy, while evidence for invasive treatments and physical therapy is generally poor because of the low quality of studies. Treatment of PLP is still unsatisfactory. Data on the functional outcome and impact of pain on neurorehabilitation outcome in these conditions are lacking. In most cases, a multidisciplinary approach is recommended to offer a better outcome and reduce side effects. High quality studies are requested to address the unmet needs in this field.

  15. Cox Decompression Manipulation and Guided Rehabilitation of a Patient With a Post Surgical C6-C7 Fusion With Spondylotic Myelopathy and Concurrent L5-S1 Radiculopathy

    PubMed Central

    Joachim, George C.

    2014-01-01

    Objective The purpose of this case report is to describe combined treatment utilizing Cox distraction manipulation and guided rehabilitation for a patient with spine pain and post-surgical C6-7 fusion with spondylotic myelopathy and L5-S1 radiculopathy. Clinical features A 38-year-old man presented to a chiropractic clinic with neck pain and a history of an anterior cervical spine plate fusion at C6-7 after a work related accident 4 years earlier. He had signs and symptoms of spondolytic myelopathy and right lower back, right posterior thigh pain and numbness. Intervention and outcome The patient was treated with Cox technique and rehabilitation. The patient experienced a reduction of pain on a numeric pain scale from 8/10 to 3/10. The patient was seen a total of 12 visits over 3 months. No adverse effects were reported. Conclusions A patient with a prior C6-7 fusion with spondylotic myelopathy and concurrent L5-S1 radiculopathy improved after a course of rehabilitation and Cox distraction manipulation. Further research is needed to establish its efficiency. PMID:25685119

  16. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

    PubMed

    Armon, Carmel; Argoff, Charles E; Samuels, Jeffrey; Backonja, Misha-Miroslav

    2007-03-06

    Based on the available evidence, the Therapeutics and Technology Assessment subcommittee concluded that 1) epidural steroid injections may result in some improvement in radicular lumbosacral pain when assessed between 2 and 6 weeks following the injection, compared to control treatments (Level C, Class I-III evidence). The average magnitude of effect is small and generalizability of the observation is limited by the small number of studies, highly selected patient populations, few techniques and doses, and variable comparison treatments; 2) in general, epidural steroid injection for radicular lumbosacral pain does not impact average impairment of function, need for surgery, or provide long-term pain relief beyond 3 months. Their routine use for these indications is not recommended (Level B, Class I-III evidence); 3) there is insufficient evidence to make any recommendation for the use of epidural steroid injections to treat radicular cervical pain (Level U).

  17. Use of chemical shift encoded magnetic resonance imaging (CSE-MRI) for high resolution fat-suppressed imaging of the brachial and lumbosacral plexuses

    PubMed Central

    Grayev, Allison; Reeder, Scott; Hanna, Amgad

    2016-01-01

    Purpose In the era of increasingly complex surgical techniques for peripheral nerve repair, there is a need for high spatial resolution imaging of the neural plexuses in the body. We describe our experience with chemical shift encoded MRI and its implications for patient management. Materials and methods IDEAL water-fat separation is a chemical shift based method of homogeneously suppressing signal from fat, while maintaining adequate signal. This technique was used in clinical practice and the patient images reviewed. Results IDEAL water-fat separation was shown to improve visualization of the brachial and lumbosacral plexuses with good fat suppression and high signal to noise ratio. Conclusion IDEAL water − fat separation is an excellent technique to use in the imaging of the brachial and lumbosacral plexuses as it balances the need for homogeneous fat suppression with maintenance of excellent signal to noise ratio. PMID:27161071

  18. INCREASED TRPV4 EXPRESSION IN URINARY BLADDER AND LUMBOSACRAL DORSAL ROOT GANGLIA IN MICE WITH CHRONIC OVEREXPRESSION OF NGF IN UROTHELIUM

    PubMed Central

    Girard, Beatrice M.; Merrill, Liana; Malley, Susan; Vizzard, Margaret A.

    2013-01-01

    Transient receptor potential vanilloid (TRPV) family member 4 (TRPV4) expression has been demonstrated in urothelial cells and dorsal root ganglion (DRG) neurons and roles in normal micturition reflexes as well as micturition dysfunction have been suggested. TRP channel expression and function is dependent upon target tissue expression of growth factors. These studies expand upon the target tissue dependence of TRPV4 expression in the urinary bladder and lumbosacral DRG using a recently characterized transgenic mouse model with chronic overexpression of nerve growth factor (NGF-OE) in the urothelium. Immunohistochemistry with image analyses, real-time quantitative polymerase chain reaction (Q-PCR) and western blotting were used to determine TRPV4 protein and transcript expression in the urinary bladder (urothelium + suburothelium, detrusor) and lumbosacral DRG from littermate wildtype (WT) and NGF-OE mice. Antibody specificity controls were performed in TRPV4-/- mice. TRPV4 transcript and protein expression was significantly (p ≤ 0.001) increased in the urothelium + suburothelium and suburothelial nerve plexus of the urinary bladder and in small- and medium-sized lumbosacral (L1, L2, L6-S1) DRG cells from NGF-OE mice compared to littermate WT mice. NGF-OE mice exhibit significant (p ≤ 0.001) increases in NGF transcript and protein in the urothelium + suburothelium and lumbosacral DRG. These studies demonstrate regulation of TRPV4 expression by NGF in lower urinary tract tissues. Ongoing studies are characterizing the functional roles of TRPV4 expression in the sensory limb (DRG, urothelium) of the micturition reflex. PMID:23690258

  19. Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

    PubMed Central

    Moustafa, Ibrahim M.; Diab, Aliaa A.

    2014-01-01

    Objective The purpose of this study was to investigate the immediate and long-term effects of a 1-year multimodal program with the addition of 2 different traction approaches on the pain, function, disability, and nerve root function in patients with discogenic cervical radiculopathy (CR). This study also attempted to identify the optimal traction angle based on the maximum recovery of the peak-to-peak amplitude of the flexor carpi radialis (FCR) H-reflex. Methods This randomized clinical trial with one-year follow-up included a total of 216 (101 female) patients with unilateral lower discogenic CR were randomly assigned to 1 of 3 groups. The standard care group (C) received the multimodal program (pain relief methods, muscle strengthening, and thoracic spine manipulation). The ventroflexion traction group (A) received the same multimodal program as group C, with added traditional ventroflexion traction. The novel traction group (B) received the same multimodal program as group C in addition to a flexor carpi radialis (FCR) H-reflex-based traction method. Primary outcomes were the Neck Disability Index (NDI) and secondary outcomes included neck pain, arm pain, and the amplitude and latency of the H-reflex. Patients were assessed at 3 intervals (pre-treatment, 4 weeks post-treatment, and the 1-year follow-up). Results The mixed linear model with repeated measures indicated a significant group × time effect in favor of the novel cervical traction group (B) for measures of NDI (F = 412.6, P < .0005), neck pain (F = 108.9, P < .0005), arm pain (F = 91.3, P < .0005), H- reflex amplitude (F = 207.7, P < .0005), and H-reflex latency (F = 58.9 P < .0005). We found that the extension position of cervical spine (5° extension) was the position that achieved the maximum improvement in the novel cervical traction method. Conclusions This preliminary study showed that a multimodal program with a novel cervical traction method added improved NDI, neck pain, arm pain, and the

  20. Reliability and Validity Measurement of Sagittal Lumbosacral Quiet Standing Posture with a Smartphone Application in a Mixed Population of 183 College Students and Personnel

    PubMed Central

    Nikoloudaki, Maria; Thacheth, Sara; Zagli, Kalliroi; Bitrou, Konstantina; Nigritinos, Andreas; Botton, Leon

    2016-01-01

    Accurate recording of spinal posture with simple and accessible measurement devices in clinical practice may lead to spinal loading optimization in occupations related to prolonged sitting and standing postures. Therefore, the purpose of this study was to establish the level of reliability of sagittal lumbosacral posture in quiet standing and the validity of the method in differentiating between male and female subjects, establishing in parallel a normative database. 183 participants (83 males and 100 females), with no current low back or pelvic pain, were assessed using the “iHandy Level” smartphone application. Intrarater reliability (3 same-day sequential measurements) was high for both the lumbar curve (ICC2,1: 0.96, SEM: 2.13°, and MDC95%: 5.9°) and the sacral slope (ICC2,1: 0.97, SEM: 1.61°, and MDC95%: 4.46°) sagittal alignment. Data analysis for each gender separately confirmed equally high reliability for both male and female participants. Correlation between lumbar curve and sacral slope was high (Pearson's r = 0.86, p < 0.001). Between-gender comparisons confirmed the validity of the method to differentiate between male and female lumbar curve and sacral slope angles, with females generally demonstrating greater lumbosacral values (p < 0.001). The “iHandy Level” application is a reliable and valid tool in the measurement of lumbosacral quiet standing spinal posture in the sagittal plane. PMID:27843650

  1. Developmental expression of glycine immunoreactivity and its colocalization with GABA in the embryonic chick lumbosacral spinal cord.

    PubMed

    Berki, A C; O'Donovan, M J; Antal, M

    1995-11-27

    The development of immunoreactivity for the putative inhibitory amino acid neurotransmitter glycine was investigated in the embryonic and posthatched chick lumbosacral spinal cord by using postembedding immunocytochemical methods. Glycine immunoreactive perikarya were first observed at embryonic day 8 (E8) both in the dorsal and ventral gray matters. The number of immunostained neurons sharply increased by E10 and was gradually augmented further at later developmental stages. The general pattern of glycine immunoreactivity characteristic of mature animals had been achieved by E12 and was only slightly altered afterward. Most of the immunostained neurons were located in the presumptive deep dorsal horn (laminae IV-VI) and lamina VII, although glycine-immunoreactive neurons were scattered throughout the entire extent of the spinal gray matter. By using some of our previously obtained and published data concerning the development of gamma-aminobutyric acid (GABA)-ergic neurons in the embryonic chick lumbosacral spinal cord, we have compared the numbers, sizes, and distribution of glycine- and GABA-immunoreactive spinal neurons at various developmental stages and found the following marked differences in the developmental characteristics of these two populations of putative inhibitory interneurons. (i) GABA immunoreactivity was expressed very early (E4), whereas immunoreactivity for glycine appeared relatively late (E8) in embryonic development. (ii) In the ventral horn, GABA immunoreactivity declined, whereas immunoreactivity for glycine gradually increased from E8 onward in such a manner that the sum of glycinergic and GABAergic perikarya remained constant during the second half of embryonic development. (iii) Glycinergic and GABAergic neurons showed different distribution patterns in the spinal gray matter throughout the entire course of embryogenesis as well as in the posthatched animal. When investigating the colocalization of glycine and GABA immunoreactivities

  2. Clinical and Radiographic Results of Indirect Decompression and Posterior Cervical Fusion for Single-Level Cervical Radiculopathy Using an Expandable Implant with 2-Year Follow-Up.

    PubMed

    Siemionow, Kris; Janusz, Piotr; Phillips, Frank M; Youssef, Jim A; Isaacs, Robert; Tyrakowski, Marcin; McCormack, Bruce

    2016-11-01

    Background Indirect posterior cervical nerve root decompression and fusion performed by placing bilateral posterior cervical cages in the facet joints from a posterior approach has been proposed as an option to treat select patients with cervical radiculopathy. The purpose of this study was to report 2-year clinical and radiologic results of this treatment method. Methods Patients who failed nonsurgical management for single-level cervical radiculopathy were recruited. Surgical treatment involved a posterior approach with decortication of the lateral mass and facet joint at the treated level followed by placement of the DTRAX Expandable Cage (Providence Medical Technology, Lafayette, California, United States) into both facet joints. Iliac crest bone autograft was mixed with demineralized bone matrix and used in all cases. The Neck Disability Index (NDI), visual analog scale (VAS) for neck and arm pain, and SF-12 v.2 questionnaire were evaluated preoperatively and 2 years postoperatively. Segmental (treated level) and overall C2-C7 cervical lordosis, disk height, adjacent segment degeneration, and fusion were assessed on computed tomography scans and radiographs acquired preoperatively and 2 years postoperatively. Results Overall, 53 of 60 enrolled patients were available at 2-year follow-up. There were 35 females and 18 males with a mean age of 53 years (range: 40-75 years). The operated level was C3-C4 (N = 3), C4-C5 (N = 6), C5-C6 (N = 36), and C6-C7 (N = 8). The mean preoperative and 2-year scores were NDI: 32.3 versus 9.1 (p < 0.0001); VAS Neck Pain: 7.4 versus 2.6 (p < 0.0001); VAS Arm Pain: 7.4 versus 2.6 (p < 0.0001); SF-12 Physical Component Summary: 34.6 versus 43.6 (p < 0.0001), and SF-12 Mental Component Summary: 40.8 versus 51.4 (p < 0.0001). No significant changes in overall or segmental lordosis were noted after surgery. Radiographic fusion rate was 98.1%. There was no device failure, implant lucency, or

  3. A 5- to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone.

    PubMed

    Engquist, Markus; Löfgren, Håkan; Öberg, Birgitta; Holtz, Anders; Peolsson, Anneli; Söderlund, Anne; Vavruch, Ludek; Lind, Bengt

    2017-01-01

    OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than

  4. Restricted patterns of Hoxd10 and Hoxd11 set segmental differences in motoneuron subtype complement in the lumbosacral spinal cord

    PubMed Central

    Misra, Mala; Shah, Veeral; Carpenter, Ellen; McCaffery, Peter; Lance-Jones, Cynthia

    2009-01-01

    During normal vertebrate development, Hoxd10 and Hoxd11 are expressed by differentiating motoneurons in restricted patterns along the rostrocaudal axis of the lumbosacral (LS) spinal cord. To assess the roles of these genes in the attainment of motoneuron subtypes characteristic of LS subdomains, we examined subtype complement after overexpression of Hoxd10 or Hoxd11 in the embryonic chick LS cord and in a Hoxd10 loss-of-function mouse embryo. Data presented here provide evidence that Hoxd10 defines the position of the lateral motor column (LMC) as a whole and, in rostral LS segments, specifically promotes the development of motoneurons of the lateral subdivision of the lateral motor column (LMCl). In contrast, Hoxd11 appears to impart a caudal and medial LMC (LMCm) identity to some motoneurons and molecular profiles suggestive of a suppression of LMC development in others. We also provide evidence that Hoxd11 suppresses the expression of Hoxd10 and the retinoic acid synthetic enzyme, retinaldehyde dehydrogenase 2 (RALDH2). In a normal chick embryo, Hoxd10 and RALDH2 are expressed throughout the LS region at early stages of motoneuron differentiation but their levels decline in Hoxd11-expressing caudal LS segments that ultimately contain few LMCl motoneurons. We hypothesize that one of the roles played by Hoxd11 is to modulate Hoxd10 and local retinoic acid levels and thus, perhaps define the caudal boundaries of the LMC and its subtype complement. PMID:19306865

  5. Long-term response of neuropathic pain to intravenous immunoglobulin in relapsing diabetic lumbosacral radiculoplexus neuropathy. A case report.

    PubMed

    Tamburin, Stefano; Magrinelli, Francesca; Favaro, Flaviano; Briani, Chiara; Zanette, Giampietro

    2014-02-01

    Diabetic lumbosacral radiculoplexus neuropathy (DLRPN) is a rare painful peripheral neuropathic complication of diabetes mellitus. The clinical features of DLRPN include severe neuropathic pain, weakness, atrophy, and sensory loss in the lower limbs with asymmetrical distribution. Nerve ischemia due to inflammation and microvasculitis has been suggested as the pathophysiological mechanism for DLRPN. Analgesics and drugs for neuropathic pain often cannot achieve adequate pain control in DLRPN. Some reports suggest that intravenous immunoglobulin (IVIg) may reduce pain in DLRPN, but the mechanisms of this effect are unclear. We report a patient with relapsing DLRPN who was followed up for 8 years and whose pain improved after IVIg on nine occasions. We measured serum cytokines before and after IVIg; serum tumor necrosis factor α was increased when the patient reported pain and normalized after IVIg in parallel with pain improvement. Our data extend the notion that some types of pain, including peripheral neuropathic pain, may respond to IVIg and give some clue on the mechanism of this therapeutic effect. They are also consistent with the suggested role of the immune system in the pathophysiology of neuropathic pain and offer support to the hypothesis that cytokines may contribute to the pathogenesis of neuropathic pain.

  6. The effect of sustained natural apophyseal glide (SNAG) combined with neurodynamics in the management of a patient with cervical radiculopathy: a case report.

    PubMed

    Anandkumar, Sudarshan

    2015-02-01

    This case report describes a 47-year-old female who presented with complaints of pain in the right elbow radiating down to the thumb. Physical examination revealed symptom reproduction with Spurling A test, upper limb neurodynamic testing-1 and right cervical rotation along with reduced symptoms with neck distraction. Clinical diagnosis of cervical radiculopathy (CR) was made based on a clinical prediction rule. This case report speculates a potentially first-time description of successful conservative management of CR in a patient utilizing simultaneous combination of sustained natural apophyseal glide and neurodynamic mobilization. Immediate improvements were seen in pain, cervical range of motion and functional abilities. The patient was discharged from physical therapy by the second week after four treatment sessions with complete pain resolution maintained at a four-month follow-up period.

  7. Low back pain, radiculopathy.

    PubMed

    Selkirk, Stephen M; Ruff, Robert

    2016-01-01

    Low back pain is a pervasive problem in the adult population. Most patients with low back pain will not require imaging as spontaneous recovery within 12 weeks is the rule. However, a small percentage of patients with low back pain will have serious underlying pathology requiring more intensive investigation. This chapter delineates the signs and symptoms related to potential serious underlying causes and discusses appropriate imaging modalities that should be utilized in patients with low back pain.

  8. Effect of Epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study

    PubMed Central

    Harkema, Susan; Gerasimenko, Yury; Hodes, Jonathan; Burdick, Joel; Angeli, Claudia; Chen, Yangsheng; Ferreira, Christie; Willhite, Andrea; Rejc, Enrico; Grossman, Robert G.; Edgerton, V. Reggie

    2011-01-01

    Summary Background Repeated periods of stimulation of the spinal cord and training seems to have amplified the ability to consciously control movement. Methods An individual three years post C7-T1 subluxation presented with a complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment. Following 170 locomotor training sessions, a 16-electrode array was surgically placed on the dura (L1-S1 cord segments) to allow for chronic electrical stimulation. After implantation and throughout stand retraining with epidural stimulation, 29 experiments were performed. Extensive stimulation combinations and parameters were tested to achieve standing and stepping. Findings Epidural stimulation enabled the human lumbosacral spinal circuitry to dynamically elicit full weight-bearing standing with assistance provided only for balance for 4·25 minutes in a subject with a clinically motor complete SCI. This occurred when using stimulation at parameters optimized for standing while providing bilateral load-bearing proprioceptive input. Locomotor-like patterns were also observed when stimulation parameters were optimized for stepping. In addition, seven months after implantation, the subject recovered supraspinal control of certain leg movements, but only during epidural stimulation. Interpretation Even after a severe low cervical spinal injury, the neural networks remaining within the lumbosacral segments can be reactivated into functional states so that it can recognize specific details of ensembles of sensory input to the extent that it can serve as the source of neural control. In addition, newly formed supraspinal input to this same lumbosacral segments can re-emerge as another source of control. Task specific training with epidural stimulation may have reactivated previously silent spared neural circuits or promoted plasticity. This suggests that these interventions could be a viable clinical approach for

  9. The effects of adding epinephrine or xylazine to lidocaine solution for lumbosacral epidural analgesia in fat-tailed sheep.

    PubMed

    Rostami, Maryam; Vesal, Nasser

    2012-03-02

    This blinded, randomised experimental study was designed to compare the analgesic effects of lumbosacral epidural administration of lidocaine-epinephrine or lidocaine-xylazine combinations in fat-tailed sheep. Nine healthy fat-tailed male lambs (mean ± s.d. age, 4.6 ± 0.4 months; weight, 24.6 kg ± 2.5 kg) were randomly allocated into four groups of six sheep: lidocaine 2% (LID), lidocaine-epinephrine 5 µg/mL (LIDEP), lidocaine-xylazine 0.05 mg/kg (LIDXY) or bupivacaine 0.5% (BUP). The onset and duration of flank, perineum and hindlimb anaesthesia and the onset and duration of hindlimb paralysis were recorded. Epidural administration of LID, LIDEP, LIDXY or BUP produced anaesthesia within 6.6 min, 7.6 min, 3.4 min and 8.4 min, respectively. The mean onset of anaesthesia in the LIDXY group was significantly shorter compared with the BUP group (p = 0.02). The mean duration of anaesthesia was 107.9 min, 190.4 min, 147.6 min and 169.7 min for LID, LIDEP, LIDXY and BUP, respectively. The onset of hindlimb paralysis was faster in the LIDXY group than in the BUP group; however, the duration of hindlimb paralysis was shorter in LIDXY compared with LIDEP. Epidural administration of LIDEP or LIDXY provides a comparable duration of local anaesthesia without any adverse effects in fat-tailed sheep. Epidural LIDXY did not appear to be advantageous over epidural LIDEP.

  10. Gelatin-agar lumbosacral spine phantom: a simple model for learning the basic skills required to perform real-time sonographically guided central neuraxial blocks.

    PubMed

    Li, Jia Wei; Karmakar, Manoj K; Li, Xiang; Kwok, Wing Hong; Ngan Kee, Warwick Dean

    2011-02-01

    This report describes the preparation of a gelatin-agar spine phantom that was used for spinal sonography and to practice the hand-eye coordination skills required to perform sonographically guided central neuraxial blocks. The phantom was prepared by embedding a lumbosacral spine model into a mixture of gelatin and agar in a plastic box. Cellulose powder and chlorhexidine were also added to the mixture, after which it was allowed to solidify. Sonography of the osseous elements of the lumbosacral spine in the phantom was then performed, and their sonographic appearances were compared to those in volunteers. Simulated real-time sonographically guided paramedian spinal needle insertions were also performed in the phantom. The texture and echogenicity of the phantom were subjectively comparable to those of tissue in vivo. The osseous elements of the spine in the phantom were clearly delineated, and their sonographic appearances were comparable to those seen in vivo in the volunteers. During the simulated sonographically guided spinal injections, the needle could be clearly visualized, but the phantom provided little tactile feedback. In conclusion, the gelatin-agar spine phantom is a simple and inexpensive sonographic spine model that has a tissuelike texture and echogenicity. It can be used to study the osseous anatomy of the lumbar spine and practice the skills required to perform sonographically guided central neuraxial blocks.

  11. Perforator-to-perforator musculocutaneous anterolateral thigh flap for reconstruction of a lumbosacral defect using the lumbar artery perforator as recipient vessel.

    PubMed

    Mureau, Marc A M; Hofer, Stefan O P

    2008-05-01

    Reconstruction of large-sized lumbosacral or sacral defects often is not possible using local or regional flaps, making the use of free flaps necessary. However, the difficulty of any microsurgical procedure in this region is complicated by the need to search for potential recipient vessels to revascularize the flap. In the present case, a free musculocutaneous anterolateral thigh flap to cover a large-sized and deep lumbosacral defect was used. Arterial anastomosis was performed, connecting the cutaneous anterolateral thigh (ALT) perforator to the perforator of the second lumbar artery. In this fashion, the arterial circulation through the flap was flowing reversely through the muscle. The concomitant vein of the descending branch of the lateral circumflex femoral artery was hooked up to the thoracodorsal vein using a long interposition vein graft because the perforator of the second lumbar vein was too small. Postoperative healing was uneventful. In conclusion, a successful reconstruction of a lumbar defect has shown that local perforators in the lumbar area may be accessible for easier perforator-to-perforator anastomoses and that the muscular part of the musculocutaneous ALT flap can survive on retrograde arterial perfusion from a perforator of the skin island.

  12. Disturbed apoptosis and cell proliferation in developing neuroepithelium of lumbo-sacral neural tubes in retinoic acid-induced spina bifida aperta in rat.

    PubMed

    Wei, Xiaowei; Li, Hui; Miao, Jianing; Zhou, Fenghua; Liu, Bo; Wu, Di; Li, Shujing; Wang, Lili; Fan, Yang; Wang, Weilin; Yuan, Zhengwei

    2012-08-01

    Spina bifida is a complex congenital malformation resulting from failure of fusion in the spinal neural tube during embryogenesis. However, the cellular mechanism underlying spina bifida is not fully understood. Here, we investigated cell apoptosis in whole embryos and proliferation of neural progenitor cells in the spinal neural tube during neurulation in all-trans retinoic acid (atRA)-induced spina bifida in fetal rats. Cell apoptosis was assessed by TUNEL assay on whole-mount and serially sectioned samples of rat embryos with spina bifida. Cell proliferation of lumbo-sacral neural progenitor cells was assessed by staining for the mitotic marker Ki67 and pH3. We found an excess of apoptosis in the neuroepithelium of embryos with spina bifida, which became more marked as embryos progress from E11 to E13. Conversely, there was a reduction in cell proliferation in spina bifida embryos, with a progressively greater difference from controls with stage from E11 to 13. Thus, atRA-induced spina bifida in rat shows perturbed apoptosis and proliferation of neural progenitors in the lumbo-sacral spinal cord during embryonic development, which might contribute to the pathogenesis of spina bifida.

  13. Treatment of radiculopathies: a study of efficacy and tollerability of paravertebral oxygen-ozone injections compared with pharmacological anti-inflammatory treatment.

    PubMed

    Melchionda, D; Milillo, P; Manente, G; Stoppino, L; Macarini, L

    2012-01-01

    The study was performed to evaluate the effectiveness of lumbar paravertebral injections of a gas mixture of Oxygen and Ozone in patients with lumbar radiculopathies caused by L4-L5 or L5-S1 disk herniations compared to a pharmacological therapy based on non-steroidal anti-inflammatory drugs. Lumbar radiculopathy caused by disc herniation is widely spread. Many therapeutic options are available before steering patients to the surgery. Low back pain and sciatica represent some of the most frequent causes of antinflammatory-analgesic drugs overuse. Recent findings have shown that medical Ozone can be used in the treatment of radicular syndrome caused by herniated intervertebral discs. Although widely spread, there are insufficient published data supporting the effectiveness of this approach in clinical practice. We studied 38 affected patients with acute L5 or S1 radicolopathy. The patients were randomly divided in two groups: A) 20 patients treated with lumbar paravertebral injections of Oxygen and Ozone; B) 18 patients treated pharmacologically with antinflammatory-analgesic drugs. All patients underwent a clinical and neurological examination at baseline (T1) and after 1 (T2), 2 (T3), 4 weeks (T4) and after 3 (T5) and 6 months (T6). An MRI and EMG examination were performed at baseline and after 6 months. The intensity of pain and the outcome of treatments were evaluated in all patients with the Visual Analogue Scale and with the Oswestry Disability Index. We found a reduction of pain and discomfort soon after one week with oxygen-ozone injections compared with pharmacological treatment, but this difference of response became statistically significant after two weeks (50 percent vs 16.6 percent) and is confirmed after 3 and 6 months, when 80 percent of patients treated with injections turned out pain free compared with half of the patients treated pharmacologically. No statistical difference were found in MRI and EMG examinations. No adverse effects were found in

  14. Anterior Cervical Discectomy and Fusion with Stand-Alone Trabecular Metal Cages as a Surgical Treatment for Cervical Radiculopathy: Mid-Term Outcomes

    PubMed Central

    ElAbed, Khaldoun; Shawky, Ahmad; Ainscow, Donald

    2016-01-01

    Study Design Retrospective case cohort study done between 2002 and 2012. Purpose To assess the mid-term clinical and radiological outcomes of 1-level and 2-level anterior cervical discectomy and fusion (ACDF) with stand-alone trabecular metal cages. Overview of Literature ACDF is the gold standard surgical treatment for cervical degenerative disease. The usual surgical practice is to use an anteriorly placed fusion plate with or without interdiscal cages. Methods Patients between 36 and 64 years of age diagnosed with cervical radiculopathy who underwent ACDF using stand-alone trabecular metal cages with at least 3 years follow-up were included in this study. Recorded clinical outcomes included residual axial neck pain, radicular arm pain, upper extremity weakness, and upper extremity altered sensation. Visual Analogue scores were also recorded. Fusion was assessed by lateral radiographs looking for bone breaching and radiolucent lines around the device at the latest follow-up. Results Ninety patients were included in the study. Fifty-one patients underwent 2-level surgery and 39 patients underwent 1-level surgery. Mean age was 44±10.4 years and mean follow-up time was 4.5±2.6 years. Patients reported excellent or good outcomes (90%), as well as improvements in axial neck pain (80%), radicular arm pain (95%), upper extremity weakness (85%), and upper extremity altered sensation (90%). Most patients (90%) progressed to fusion at the 1-year follow-up. The reoperation rate was 3.6%. There was no reported persistent dysphagia, voice complaints, dural tear, or tracheal or oesophageal perforation in any of the patients. One patient developed a deep methicillin-resistant Staphylococcus aureus infectious infarction of the spinal cord, which was treated with antibiotics. Recovery was complete at the 1-year follow up. Conclusions Mid-term results show that surgical treatment with ACDF with trabecular metal cages is a safe and effective treatment of single and 2-level

  15. Monosynaptic EPSPs in cat lumbosacral motoneurones from group Ia afferents and fibres descending in the spinal cord.

    PubMed Central

    Harrison, P J; Jack, J J; Kullmann, D M

    1989-01-01

    1. Excitatory postsynaptic potentials (EPSPs) were elicited in lumbosacral motoneurones of pentobarbitone-anaesthetized cats by stimulating the ventral quadrants (VQ) of the thoracic spinal cord. These EPSPs were compared with monosynaptic EPSPs from small numbers of group Ia afferents, obtained by stimulating hindlimb muscle nerves with most of the dorsal roots severed. 2. EPSPs with average peak amplitude less than 1 mV were selected for fluctuation analysis. Three out of fourteen (21%) VQ EPSPs with peak voltage less than 150 mu V fluctuated in amplitude from trial to trial no more than could be accounted for by the background intracellular noise. Similarly, nine out of thirty-nine (23%) Ia EPSPs smaller than 150 mu V fluctuated to a comparable extent as the noise. These results are consistent with the view that there is little variation in the postsynaptic signal produced by an individual transmitter release event. 3. Of the EPSPs which did fluctuate more than the background noise, maximum likelihood estimates were obtained for the fluctuation patterns of ten VQ and fourteen Ia EPSPs. This was achieved by assuming that synaptic signals sum linearly with noise, but without constraining the results to conform to a statistical description of transmitter release. The fluctuation of both VQ and Ia EPSPs was made up of discrete amplitudes separated by roughly equal increments, in accordance with the quantal hypothesis of synaptic transmission. 4. Fluctuation patterns were obtained simultaneously for VQ and Ia EPSPs in seven motoneurones. The amplitudes of the quanta, defined as the mean increments between discrete amplitudes, were correlated (r = 0.90), suggesting common postsynaptic mechanisms. 5. For most EPSPs the time course of the voltage transient could be used to estimate the electrical distance from the soma at which the synaptic current was injected. There was a comparable distribution for VQ and Ia EPSPs. For those in which a quantal analysis was performed

  16. Minimally Invasive Magnetic Resonance Imaging-Guided Free-Hand Aspiration of Symptomatic Nerve Route Compressing Lumbosacral Cysts Using a 1.0-Tesla Open Magnetic Resonance Imaging System

    SciTech Connect

    Bucourt, Maximilian de Streitparth, Florian Collettini, Federico; Guettler, Felix; Rathke, Hendrik; Lorenz, Britta; Rump, Jens; Hamm, Bernd; Teichgraeber, U. K.

    2012-02-15

    Purpose: To evaluate the feasibility of minimally invasive magnetic resonance imaging (MRI)-guided free-hand aspiration of symptomatic nerve route compressing lumbosacral cysts in a 1.0-Tesla (T) open MRI system using a tailored interactive sequence. Materials and Methods: Eleven patients with MRI-evident symptomatic cysts in the lumbosacral region and possible nerve route compressing character were referred to a 1.0-T open MRI system. For MRI interventional cyst aspiration, an interactive sequence was used, allowing for near real-time position validation of the needle in any desired three-dimensional plane. Results: Seven of 11 cysts in the lumbosacral region were successfully aspirated (average 10.1 mm [SD {+-} 1.9]). After successful cyst aspiration, each patient reported speedy relief of initial symptoms. Average cyst size was 9.6 mm ({+-}2.6 mm). Four cysts (8.8 {+-} 3.8 mm) could not be aspirated. Conclusion: Open MRI systems with tailored interactive sequences have great potential for cyst aspiration in the lumbosacral region. The authors perceive major advantages of the MR-guided cyst aspiration in its minimally invasive character compared to direct and open surgical options along with consecutive less trauma, less stress, and also less side-effects for the patient.

  17. Comparison of fluoroscopic Guided Transforaminal Epidural Injections of Steroid and Local Anaesthetic with Conservative Management in Patients with Chronic Lumbar Radiculopathies

    PubMed Central

    Mehta, Nandita; Salaria, Misbah; Salaria, A. Q.

    2017-01-01

    Background: Chronic lumbar radiculopathy is a common medical problem and the treatment modalities used over years have been many ranging from conservative or symptomatic management to open decompression surgery. This study was aimed at to compare two modalities of treatment, i.e., conservative and lumbar transforaminal epidural steroid injections (TFESIs). Materials and Methods: A total of 120 patients of American Society of Anesthesiology class - (a healthy patient or a patient with mild systemic disease) were randomized to two groups. Group C (n = 60) were managed conservatively with bed rest, analgesics, and physiotherapy. Group T (n = 60) received lumbar TFESIs with methylprednisolone 40 mg with 2 ml bupivacaine (0.5%). Measurements using visual analog scale (VAS) were taken before treatment and at various time intervals after the start of treatment. Results: There was no statistically significant difference regarding the demographic characteristics of both groups. The VAS scores were less and statistically significant in Group T after 30 min postinjection, at the 2nd week and after 1 month. Recovery rate of straight leg raise test was found to be 98% in those treated with TFESI. The Group T had significantly better patient satisfaction score and additionally there was drug dose intake reduction before and after the treatment. Conclusion: Patients treated with fluoroscopic-guided TFESI have better pain relief, quality-of-life, and less analgesic requirement than those managed conservatively. PMID:28298750

  18. Immediate and lasting effects of a thoracic spine manipulation in a patient with signs of cervical radiculopathy and upper extremity hyperalgesia: A case report.

    PubMed

    Deschenes, Beth K; Zafereo, Jason

    2017-01-01

    Patients with cervical radiculopathy (CR) may present with accompanying symptoms of hyperalgesia, allodynia, heaviness in the arm, and non-segmental pain that do not appear to be related to a peripheral spinal nerve. These findings may suggest the presence of central or autonomic nervous system involvement, requiring a modified management approach. The purpose of this case report is to describe the treatment of a patient with signs of CR and upper extremity (UE) hyperalgesia who had a significant decrease in her UE pain and hypersensitivity after a single thoracic spine manipulation (TSM). A 48-year-old female presented to physical therapy with acute neck pain radiating into her left UE that significantly limited her ability to sleep and work. After a single TSM, the patient demonstrated immediate and lasting reduction in hyperalgesia, hypersensitivity to touch, elimination of perceived heaviness and coldness in her left UE, and improved strength in the C6-8 myotome, allowing for improved functional activity capacity and tolerance to a multi-modal PT program. Based on these results, clinicians should consider the early application of TSM in patients with CR who have atypical, widespread, or severe neurological symptoms that limit early mobilization and tolerance to treatment at the painful region.

  19. Lumbosacral spine CT

    MedlinePlus

    ... Pinched nerve Tumor Vertebral fracture (broken spine bone) Risks The most common type of contrast given into ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

  20. Effects of spinal and peripheral nerve lesions on the intersegmental synchronization of the spontaneous activity of dorsal horn neurons in the cat lumbosacral spinal cord.

    PubMed

    García, C A; Chávez, D; Jiménez, I; Rudomin, P

    2004-05-06

    In the anesthetized and paralyzed cat, spontaneous negative cord dorsum potentials (nCDPs) appeared synchronously in the L3 to S1 segments, both ipsi- and contralaterally. The acute section of both the intact sural and the superficial peroneal nerve increased the variability of the spontaneous nCDPs without affecting their intersegmental coupling. On the other hand, the synchronization between the spontaneous nCDPs recorded in segments L5-L6 was strongly reduced following an interposed lesion of the left (ipsilateral) dorsolateral spinal quadrant and it was almost completely abolished by an additional lesion of the contralateral dorsolateral quadrant at the same level. Our observations support the existence of a system of spontaneously active dorsal horn neurons that is bilaterally distributed along the lumbosacral segments and affects, in a synchronized and organized manner, impulse transmission along many reflex pathways, including those mediating presynaptic inhibition.

  1. Lumbosacral transitional vertebrae, canine hip dysplasia, and sacroiliac joint degenerative changes on ventrodorsal radiographs of the pelvis in police working German shepherd dogs.

    PubMed

    Komsta, Renata; Łojszczyk-Szczepaniak, Anna; Dębiak, Piotr

    2015-03-01

    Lumbosacral transitional vertebrae (LTV) frequently occur in German shepherd dogs. The aim of the study was to evaluate the prevalence and interdependence between LTV and canine hip dysplasia (CHD) as well as sacroiliac joint degenerative changes visualized on ventrodorsal radiographs of the pelvis in both working and companion German shepherd dogs. The presence of LTV was found in 12% of working dogs and in 33% of companion dogs. Similar incidence of hip dysplasia in both the groups was found. It has been shown that dogs with LTV have a higher frequency of severe CHD. A higher percentage of sacroiliac joint degenerative changes was observed in dogs with no signs of LTV and in working dogs.

  2. Real-Time Ultrasound/MRI Fusion for Suprasacral Parallel Shift Approach to Lumbosacral Plexus Blockade and Analysis of Injectate Spread: An Exploratory Randomized Controlled Trial

    PubMed Central

    Pedersen, Erik Morre; Al-Karradi, Sinan Naseer Hussain; Bendtsen, Mathias Alrø Fichtner; Bjørn, Siska; Dam, Mette; Daugaard, Morten; Hansen, Martin Sejr; Linnet, Katrine Danker; Søballe, Kjeld

    2017-01-01

    Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21–36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%]; p = 1.00). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552–1023] versus 196 [167–228], p < 0.001 and 333 [254–439] versus 216 [176–294], p = 0.001). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).

  3. Effects of Lumbosacral Manipulation on Isokinetic Strength of the Knee Extensors and Flexors in Healthy Subjects: A Randomized, Controlled, Single-Blind Crossover Trial

    PubMed Central

    Sanders, Grant D.; Nitz, Arthur J.; Abel, Mark G.; Symons, T. Brock; Shapiro, Robert; Black, W. Scott; Yates, James W.

    2015-01-01

    Objective The purpose of this study was to investigate the effect of manual manipulations targeting the lumbar spine and/or sacroiliac joint on concentric knee extension and flexion forces. Torque production was measured during isometric and isokinetic contractions. Methods This was a randomized, controlled, single-blind crossover design with 21 asymptomatic, college-aged subjects who had never received spinal manipulation. During 2 separate sessions, subjects’ peak torques were recorded while performing maximal voluntary contractions on an isokinetic dynamometer. Isometric knee extension and flexion were recorded at 60° of knee flexion, in addition to isokinetic measurements obtained at 60°/s and 180°/s. Baseline measurements were acquired before either treatment form of lumbosacral manipulation or sham manipulation, followed by identical peak torque measurements within 5 and 20 minutes posttreatment. Data were analyzed with a repeated measures analysis of variance. Results A statistically significant difference did not occur between the effects of lumbosacral manipulation or the sham manipulation in the percentage changes of knee extension and flexion peak torques at 5 and 20 minutes posttreatment. Similar, nonsignificant results were observed in the overall percentage changes of isometric contractions (spinal manipulation 4.0 ± 9.5 vs sham 1.2 ± 6.3, P = .067), isokinetic contractions at 60°/s (spinal manipulation − 4.0 ± 14.2 vs sham − 0.3 ± 8.2, P = .34), and isokinetic contractions at 180°/s (spinal manipulation − 1.4 ± 13.9 vs sham − 5.5 ± 20.0, P = .18). Conclusion The results of the current study suggest that spinal manipulation does not yield an immediate strength-enhancing effect about the knee in healthy, college-aged subjects when measured with isokinetic dynamometry. PMID:26793035

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

    PubMed

    Jinkins, J R

    2001-01-01

    In earlier evolutionary times, mammals were primarily quadrupeds. However, other bipeds have also been represented during the course of the Earth's several billion year history. In many cases, either the bipedal stance yielded a large tail and hypoplastic upper extremities (e.g., Tyrannosaurus rex and the kangaroo), or it culminated in hypoplasia of the tail and further development and specialization of the upper extremities (e.g., nonhuman primates and human beings). In the human species this relatively recently acquired posture resulted in a more or less pronounced lumbosacral kyphosis. In turn, certain compensatory anatomic features have since occurred. These include the normal characteristic posteriorly directed wedge-shape of the L5 vertebral body and the L5-S1 intervertebral disk; the L4 vertebral body and the L4-L5 disk may be similarly visibly affected. These compensatory mechanisms, however, have proved to be functionally inadequate over the long term of the human life span. Upright posture also leads to increased weight bearing in humans that progressively causes excess stresses at and suprajacent to the lumbosacral junction. These combined factors result in accelerated aging and degenerative changes and a predisposition to frank biomechanical failure of the subcomponents of the spinal column in these spinal segments. One other specific problem that occurs at the lumbosacral junction that predisposes toward premature degeneration is the singular relationship that exists between a normally mobile segment of spine (i.e., the lumbar spine) and a normally immobile one (i.e., the sacrum). It is well known that mobile spinal segments adjacent to congenitally or acquired fused segments have a predilection toward accelerated degenerative changes. The only segment of the spine in which this is invariably normally true is at the lumbosacral junction (i.e., the unfused lumbar spine adjoining the fused sacrum). Nevertheless, biomechanical failures of the human spine

  5. Using the cervical range of motion (CROM) device to assess head repositioning accuracy in individuals with cervical radiculopathy in comparison to neck- healthy individuals.

    PubMed

    Wibault, Johanna; Vaillant, Jacques; Vuillerme, Nicolas; Dedering, Åsa; Peolsson, Anneli

    2013-10-01

    This study had two purposes: to compare head repositioning accuracy (HRA) using the cervical range of motion (CROM) device between individuals with cervical radiculopathy caused by disc disease (CDD; n = 71) and neck- healthy individuals (n = 173); and to evaluate the test-retest reliability of the CROM device in individuals with CDD, and criterion validity between the CROM device and a laser in neck-healthy individuals, with quantification of measurement errors. Parameters of reliability and validity were expressed with intra- class- correlation coefficients (ICCs), and measurement errors with standard error of measurement (SEM) and Bland Altman limits of agreement. HRA (Mdn, IQR) differed significantly between individuals with CDD and neck- healthy individuals after rotation right 2.7° (6.0), 1.7° (2.7); and rotation left 2.7° (3.3), 1.3° (2.7) (p < = 0.021); 31% of individuals with CDD were classified as having impairment in HRA. The test-retest reliability of the CROM device in individuals with CDD showed ICCs of 0.79- 0.85, and SEMs of 1.4°- 2°. The criterion validity between the CROM device and the laser in neck-healthy individuals showed ICCs of 0.43- 0.91 and SEMs of 0.8°- 1.3°. The results support the use of the CROM device for quantifying HRA impairment in individuals with CDD in clinical practice; however, criterion validity between the CROM device and a laser in neck-healthy individuals was questionable. HRA impairment in individuals with CDD may be important to consider during rehabilitation and evaluated with the criterion established with the CROM device in neck-healthy individuals.

  6. Adjacent Segment Disease in a Patient With Klippel-Feil Syndrome and Radiculopathy: Surgical Treatment With Two-Level Disc Replacement

    PubMed Central

    Reyes-Sánchez, Alejandro; Rosales-Olivares, Luis Miguel

    2007-01-01

    Klippel-Feil syndrome (KFS) is a complex congenital condition characterized by improper segmentation of cervical motion segments that could contribute to undesirable adjacent segment degeneration. KFS patients have a strong tendency to present with disease in the adjacent segments. When this condition is present, anterior decompression followed by total disc replacement can be performed safely and can lead to good clinical results. This treatment has theoretical advantages compared with anterior decompression and fusion. Comparative studies and long-term follow-up are needed. Complications associated with fusion include loss of a motion segment, disc height loss, subsidence of the graft, progressive degenerative changes at the adjacent level, graft-related complications, and graft-site complications. Such new technologies as motion preservation spine arthroplasty represent attempts to avoid these complications. Here we present a case report of a 62-year-old female patient with type I congenital fusion at the C5–6 level, with a history of neck pain and right radiculopathy at C5–7. X-rays and MRI show evidence of adjacent segment degeneration at levels above and below congenital fusion. The patient's preoperative visual analog score (VAS) for neck pain was 7 out of a possible 10, her score for right upper extremity pain was 8 out of 10, and her Neck Disability Index (NDI) was 32%. Surgical treatment consisted of anterior decompression and total disc replacement at both levels. At 1-year follow-up, the patient's VAS for neck pain was 2 out of 10, her VAS score for right upper extremity pain was 1 of 10, and her NDI was 9%. PMID:25802590

  7. Adjacent segment disease in a patient with klippel-feil syndrome and radiculopathy: surgical treatment with two-level disc replacement.

    PubMed

    Reyes-Sánchez, Alejandro; Zárate-Kalfópulos, Barón; Rosales-Olivares, Luis Miguel

    2007-01-01

    Klippel-Feil syndrome (KFS) is a complex congenital condition characterized by improper segmentation of cervical motion segments that could contribute to undesirable adjacent segment degeneration. KFS patients have a strong tendency to present with disease in the adjacent segments. When this condition is present, anterior decompression followed by total disc replacement can be performed safely and can lead to good clinical results. This treatment has theoretical advantages compared with anterior decompression and fusion. Comparative studies and long-term follow-up are needed. Complications associated with fusion include loss of a motion segment, disc height loss, subsidence of the graft, progressive degenerative changes at the adjacent level, graft-related complications, and graft-site complications. Such new technologies as motion preservation spine arthroplasty represent attempts to avoid these complications. Here we present a case report of a 62-year-old female patient with type I congenital fusion at the C5-6 level, with a history of neck pain and right radiculopathy at C5-7. X-rays and MRI show evidence of adjacent segment degeneration at levels above and below congenital fusion. The patient's preoperative visual analog score (VAS) for neck pain was 7 out of a possible 10, her score for right upper extremity pain was 8 out of 10, and her Neck Disability Index (NDI) was 32%. Surgical treatment consisted of anterior decompression and total disc replacement at both levels. At 1-year follow-up, the patient's VAS for neck pain was 2 out of 10, her VAS score for right upper extremity pain was 1 of 10, and her NDI was 9%.

  8. Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial

    PubMed Central

    Hazra, Arindam Kumar; Bhattacharya, Dipasri; Mukherjee, Sayantan; Ghosh, Santanu; Mitra, Manasij; Mandal, Mohanchandra

    2016-01-01

    Background and Aims: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP). Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultrasound guidance for caudal epidural steroid injection with respect to the time needed for correct placement of the needle and clinical effectiveness in patients with chronic LBP. Methods: Fifty patients with chronic LBP with radiculopathy, not responding to conventional medical management, were randomly allocated to receive injection depot methyl prednisolone (40 mg) through caudal route either using ultrasound guidance (Group U, n = 25) or fluoroscopy guidance (Group F, n = 25). Pre-procedural visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were noted. During the procedure, the time needed for correct placement of needle was observed. Adverse events, if any, were also noted. All patients were followed up for next 2 months to evaluate Visual Analogue Scale (VAS) score and ODI at the 2nd week and again at the end of 1st and 2nd month. Results: The needle-placement time was less using ultrasound guidance as compared to fluoroscopy guidance (119 ± 7.66 vs. 222.28 ± 29.65 s, respectively, P < 0.001). Significant reduction in VAS score and ODI (clinical improvement) was noted in the follow-up time points and comparable between the groups at all time points. Conclusion: Ultrasound guidance can be a safe alternative tool for achieving faster needle placement in caudal epidural space. Clinical effectiveness (reduction of VAS and ODI scores) remains comparable between both the techniques. PMID:27330199

  9. Development of a Standardized Method for Contouring the Lumbosacral Plexus: A Preliminary Dosimetric Analysis of this Organ at Risk Among 15 Patients Treated With Intensity-Modulated Radiotherapy for Lower Gastrointestinal Cancers and the Incidence of Radiation-Induced Lumbosacral Plexopathy

    SciTech Connect

    Yi, Sun K.; Mak, Walter; Yang, Claus C.; Liu Tianxiao; Cui Jing; Chen, Allen M.; Purdy, James A.; Monjazeb, Arta M.; Do, Ly

    2012-10-01

    Purpose: To generate a reproducible step-wise guideline for the delineation of the lumbosacral plexus (LSP) on axial computed tomography (CT) planning images and to provide a preliminary dosimetric analysis on 15 representative patients with rectal or anal cancers treated with an intensity-modulated radiotherapy (IMRT) technique. Methods and Materials: A standardized method for contouring the LSP on axial CT images was devised. The LSP was referenced to identifiable anatomic structures from the L4-5 interspace to the level of the sciatic nerve. It was then contoured retrospectively on 15 patients treated with IMRT for rectal or anal cancer. No dose limitations were placed on this organ at risk during initial treatment planning. Dosimetric parameters were evaluated. The incidence of radiation-induced lumbosacral plexopathy (RILSP) was calculated. Results: Total prescribed dose to 95% of the planned target volume ranged from 50.4 to 59.4 Gy (median 54 Gy). The mean ({+-}standard deviation [SD]) LSP volume for the 15 patients was 100 {+-} 22 cm{sup 3} (range, 71-138 cm{sup 3}). The mean maximal dose to the LSP was 52.6 {+-} 3.9 Gy (range, 44.5-58.6 Gy). The mean irradiated volumes of the LSP were V40Gy = 58% {+-} 19%, V50Gy = 22% {+-} 23%, and V55Gy = 0.5% {+-} 0.9%. One patient (7%) was found to have developed RILSP at 13 months after treatment. Conclusions: The true incidence of RILSP in the literature is likely underreported and is not a toxicity commonly assessed by radiation oncologists. In our analysis the LSP commonly received doses approaching the prescribed target dose, and 1 patient developed RILSP. Identification of the LSP during IMRT planning may reduce RILSP. We have provided a reproducible method for delineation of the LSP on CT images and a preliminary dosimetric analysis for potential future dose constraints.

  10. [Validation of the questionnaire for adolescents concerning ailments of lumbosacral region. Part I: reliability of questions about presence and character of pain].

    PubMed

    Baczkiewicz, Maja; Demczuk-Włodarczyk, Ewa

    2011-01-01

    The first part of the series of articles is dedicated to the process and the results of reliability testing of the questionnaire designed for pupils aged 13-18, the tested questions concerning ailments of the lumbosacral region (LBP) and their characteristics. 124 persons aged 13-17 took part in the research. The "test-retest" method was used, the questionannaires being filled in twice by every pupil in no more than 7-day period. Questions were asked about LBP, the accompanying ailments, the intensity of pain, the length of the episode, the cause of the beginning, the constant pain, the activities that worsen or reduce symptoms, the necessity of therapy, the presence of functional disorders connected with LBP, height, weight and basic ,,red flags" which could indicate pain of specific origin. Results that were obtained in the process of testing indicated that reasoning was invalid when based on questions about the length of episode (60% repeatable, rank correlation 0.3) and on questions about activities that worsen or reduce pain (respectively 34 i 35% repeatable answers). The rest of questions were found acceptably reliable.

  11. The Prognostic Value of Enhanced-MRI and Fluoroscopic Factors for Predicting the Effects of Transforaminal Steroid Injections on Lumbosacral Radiating Pain

    PubMed Central

    2016-01-01

    Objective To investigate the predictive value of enhanced-magnetic resonance imaging (MRI) and fluoroscopic factors regarding the effects of transforaminal epidural steroid injections (TFESIs) in low back pain (LBP) patients with lumbosacral radiating pain. Methods A total of 51 patients who had LBP with radiating pain were recruited between January 2011 and December 2012. The patient data were classified into the two groups ‘favorable group’ and ‘non-favorable group’ after 2 weeks of follow-up results. The favorable group was defined as those with a 50%, or more, reduction of pain severity according to the visual analogue scale (VAS) for back or leg pain. The clinical and radiological data were collected for univariate and multivariate analyses to determine the predictors of the effectiveness of TFESIs between the two groups. Results According to the back or the leg favorable-VAS group, the univariate analysis revealed that the corticosteroid approach for the enhanced nerve root, the proportion of the proximal flow, and the contrast dispersion of epidurography are respectively statistically significant relative to the other factors. Lastly, the multiple logistic regression analysis showed a significant association between the corticosteroid approach and the enhanced nerve root in the favorable VAS group. Conclusion Among the variables, MRI showed that the corticosteroid approach for the enhanced target root is the most important prognostic factor in the predicting of the clinical parameters of the favorable TFESIs group. PMID:28119838

  12. Cervical Stenosis, Myelopathy and Radiculopathy

    MedlinePlus

    ... cervical spine refers to that portion of the spinal column that is within our neck. This portion of ... spinal nerves that travel through it. The cervical spinal column is made up of seven vertebrae and the ...

  13. Study on the anatomy of the lumbosacral anterior great vessels pertinent to L5/S1 anterior interbody surgery with computer tomography angiography.

    PubMed

    Liu, Liehua; Liang, Yong; Zhou, Qiang; Zhang, Hong; Wang, Haoming; Li, Songtao; Zhao, Chen; Hou, Tianyong; Liu, Ling

    2014-12-01

    We investigate the anatomy of the lumbosacral anterior great vessels using computer tomography (CT) angiography before L5/S1 anterior interbody surgery. Sixty-two adult patients were selected. The location of the abdominal aortic bifurcation and common iliac venous confluence in the lumbar vertebrae and the anatomic parameters of the iliac vascular space (e.g., distances from the included angle vertex of the iliac vascular space to the median sagittal plane and to the inferior boundary of L5 and distances between the left and right iliac vessels on the inferior boundary of L5 and on the superior boundary of S1) were analysed. Overall, 67.73% of the 62 cases had an abdominal aortic bifurcation located at L4 and L4/5 intervertebral disc; 61.29%, the common iliac venous confluence located at L5. The four distances mentioned above were 0.98 cm ± 0.38 cm, 2.01 cm ± 1.26 cm, 3.11 cm ± 1.35 cm and 4.34 cm ± 1.10 cm, respectively. A classification system of types A, B and C was developed. The calculated L5/S1 intervertebral space exposure percentages of types A, B and C were 32.21%, 82.58% and 54.68%, respectively. During L5/S1 anterior interbody surgery, type B intervertebral discs can be exposed conveniently, preventing injury of the iliac vessels, which was also observed in 54.68% and 32.21% of the type C and type A discs, respectively. Because the type A intervertebral disc has minimal exposure, the risk of iliac vascular injury is relatively high in these patients.

  14. [L5 sciatica caused by the compression of the lumbo-sacral trunk of osseous origin at the sacro-iliac level. Treatment by an antero-lateral subperitoneal approach].

    PubMed

    Chataigner, H; Onimus, M

    1998-07-01

    A 42 years old patient presented with a 4 years history of a left L5 sciatica unresponsive to a previous L4-L5 surgical decompression. CT scan showed a solid tumor developed on the anterior aspect of the sacro-iliac joint, in contact with the lumbo-sacral trunk. An antero-lateral extraperitoneal approach was performed, with progressive subperitoneal dissection along the inner aspect of the iliac wing to the sacro-iliac joint and sacral ala. The exostosis was removed with "en block" excision, Postoperatively pain completely disappeared. Considerations are made on the mechanism of the compression as well as on the surgical approach performed.

  15. The structure and development of avian lumbosacral specializations of the vertebral canal and the spinal cord with special reference to a possible function as a sense organ of equilibrium.

    PubMed

    Necker, R

    2005-08-01

    The avian lumbosacral vertebral column and spinal cord show a number of specializations which have recently been interpreted as a sense organ of equilibrium. This sense organ is thought to support balanced walking on the ground. Although most of the peculiar structures have been described previously, there was a need to reevaluate the specializations with regard to the possible function as a sense organ. Specializations were studied in detail in the adult pigeon. The development of the system was studied both in the pigeon (semiprecocial at hatching) and in the chicken (precocial). Specializations in the vertebral canal consist of a considerable enlargement, which is not due to an increase in the size of the spinal nervous tissue, but to a large glycogen body embedded in a dorsal rhomboid sinus. The dorsal wall of the vertebral canal shows segmented bilateral dorsal grooves, which are covered by the meninges towards the lumen of the vertebral canal leaving openings in the midline and laterally. This results in a system of lumbosacral canals which look and may function similar to the semicircular canals in the inner ear. Laterally these canals open above ventrolateral protrusions or accessory lobes of the spinal cord which contain neurons. There are large subarachnoidal cerebrospinal fluid spaces, lateral and ventral to the accessory lobes. Movement of this fluid is thought to stimulate the lobes mechanically. As to the development of avian lumbosacral specializations, main attention was given to the organization of the lobes and the adjacent fluid spaces including the dorsal canals. In the pigeon the system is far from being adult-like at hatching but maturates rapidly after hatching. In the chicken the system looks already adult-like at hatching. The implications derived from the structural findings are discussed with regard to a possible function of the lumbosacral specializations as a sense organ of equilibrium. The adult-like organization in the newly hatched

  16. [Association of blood serum biochemical markers with neurologic syndromes in the exacerbation of dorsolumbar osteochondrosis].

    PubMed

    Shumakher, G I; Goriacheva, M V; Sencheva, N A; Travnikova, T Iu; Kuznetsova, M P

    2012-01-01

    The content of C-reactive albumin (CRA) and endothelin-1 in patients with neurologic syndromes of dorsolumbar osteochondrosis (lumbodynia, lumboischialgia, lumbosacral radiculopathy) during exacerbation was investigated. CRA concentration in blood serum was determined by a highly sensitive quantitative method (in the interval from 0.1 g/l), based on the reaction of immunoprecipitation. Endothelin-1 content in the blood serum was determined by means of immunoenzymometric analysis method. The statistically significant (p<0,05) increase in concentrations of C-reactive albumin and endothelin-1 in the peripheral blood serum was found in 43 patients with lumbosacral radiculopathy compared to the control group and groups of patients with syndromes of lumbodynia and lumboischialgia. The direct correlation (r=0,71; p<0,01) between the content of CRA and endothelin-1 in the peripheral blood serum in patients with lumbosacral radiculopathy was established.

  17. Reduced Field-of-View Diffusion-Weighted Imaging of the Lumbosacral Enlargement: A Pilot In Vivo Study of the Healthy Spinal Cord at 3T

    PubMed Central

    Grussu, Francesco; Louka, Polymnia; Prados, Ferran; Samson, Rebecca S.; Battiston, Marco; Altmann, Daniel R.; Ourselin, Sebastien; Miller, David H.; Gandini Wheeler-Kingshott, Claudia A. M.

    2016-01-01

    Diffusion tensor imaging (DTI) has recently started to be adopted into clinical investigations of spinal cord (SC) diseases. However, DTI applications to the lower SC are limited due to a number of technical challenges, related mainly to the even smaller size of the SC structure at this level, its position relative to the receiver coil elements and the effects of motion during data acquisition. Developing methods to overcome these problems would offer new means to gain further insights into microstructural changes of neurological conditions involving the lower SC, and in turn could help explain symptoms such as bladder and sexual dysfunction. In this work, the feasibility of obtaining grey and white matter (GM/WM) DTI indices such as axial/radial/mean diffusivity (AD/RD/MD) and fractional anisotropy (FA) within the lumbosacral enlargement (LSE) was investigated using a reduced field-of-view (rFOV) single-shot echo-planar imaging (ss-EPI) acquisition in 14 healthy participants using a clinical 3T MR system. The scan-rescan reproducibility of the measurements was assessed by calculating the percentage coefficient of variation (%COV). Mean FA was higher in WM compared to GM (0.58 and 0.4 in WM and GM respectively), AD and MD were higher in WM compared to GM (1.66 μm2ms-1 and 0.94 μm2ms-1 in WM and 1.2 μm2ms-1 and 0.82 μm2ms-1 in GM for AD and MD respectively) and RD was lower in WM compared to GM (0.58 μm2ms-1 and 0.63 μm2ms-1 respectively). The scan-rescan %COV was lower than 10% in all cases with the highest values observed for FA and the lowest for MD. This pilot study demonstrates that it is possible to obtain reliable tissue-specific estimation of DTI indices within the LSE using a rFOV ss-EPI acquisition. The DTI acquisition and analysis protocol presented here is clinically feasible and may be used in future investigations of neurological conditions implicating the lower SC. PMID:27741303

  18. A RANDOMIZED CLINICAL TRIAL COMPARING EXTENSIBLE AND INEXTENSIBLE LUMBOSACRAL ORTHOSES AND STANDARD CARE ALONE IN THE MANAGEMENT OF LOWER BACK PAIN

    PubMed Central

    Morrisette, David C.; Cholewicki, Jacek; Patenge, Walter F.; Logan, Sarah; Seif, Gretchen; McGowan, Stephanie

    2015-01-01

    Study Design Single blinded, randomized clinical trial for the evaluation of lumbosacral orthoses (LSOs) in the management of lower back pain (LBP). Objective To evaluate the effects of two types of LSO on self-rated disability in patients with lower back pain. Summary of Background Data LSOs are commonly used for the management of LBP, but their effectiveness may vary due to design. An inextensible LSO (iLSO) reduce trunk motion and increases trunk stiffness, whereas an extensible LSO (eLSO) does not. Methods 98 participants with LBP were randomized to three groups: 1) Standard care group (SC), which included medication and physical therapy (n=29), 2) SC with eLSO (eLSO group) (n=32), and 3) SC with iLSO (iLSO group) (n=37). Outcome measures were evaluated before and after 2 weeks of treatment: modified Oswestry Disability Index (ODI), Patient Specific Activity Score (PSAS), pain ratings, and Fear and Avoidance Beliefs Questionnaire (FABQ). Results There were no statistically significant differences between groups at baseline. Compared to the SC alone, iLSO group showed greater improvement on the ODI scores (p=.01), but not the eLSO group. The ODI scores improved by a mean of 2.4 (95% CI −2.2, 7.1), 8.1 (95% CI 2.8, 13.4), and 14.0 (95% CI 8.2, 19.8) points for SC, eLSO, and iLSO groups respectively. Individuals wearing the iLSO had 4.7 times higher odds of achieving 50% or greater improvement in the ODI scores compared to those assigned to SC (95% CI 1.2, 18.5, p=0.03). Both the eLSO and iLSO groups had a greater improvement in the PSAS scores compared to SC (p=.05 and p=.01, respectively), but the change did not meet the minimal clinically important difference. Pain ratings improved for all three groups, with no statistical difference between them. Finally, no significant differences across groups were found for the FABQ. Conclusions An iLSO led to greater improvement in ODI scores in comparison with SC and an eLSO. We surmise that the likely mechanism

  19. Lumbosacral pain in an athlete.

    PubMed

    Delvaux, K; Lysens, R

    2001-05-01

    This report presents a case of a stress fracture in the sacrum. The diagnosis of a stress fracture in the sacrum is an uncommon localization and has been reported infrequently in the English literature. Association of this type of stress fracture with a pneumatocyst has not previously been reported.

  20. Identification of the sexually dimorphic gastrin-releasing peptide system in the lumbosacral spinal cord that controls male reproductive function in the mouse and Asian house musk shrew (Suncus murinus).

    PubMed

    Tamura, Kei; Kobayashi, Yasuhisa; Hirooka, Asuka; Takanami, Keiko; Oti, Takumi; Jogahara, Takamichi; Oda, Sen-Ichi; Sakamoto, Tatsuya; Sakamoto, Hirotaka

    2016-11-02

    Several regions of the brain and spinal cord control male reproductive function. We previously demonstrated that the gastrin-releasing peptide (GRP) system, located in the lumbosacral spinal cord of rats, controls spinal centers to promote penile reflexes during male copulatory behavior. However, little information exists on the male-specific spinal GRP system in animals other than rats. The objective of this study was to examine the functional generality of the spinal GRP system in mammals using the Asian house musk shrew (Suncus murinus; suncus named as the laboratory strain), a specialized placental mammal model. Mice are also used for a representative model of small laboratory animals. We first isolated complementary DNA encoding GRP in suncus. Phylogenetic analysis revealed that suncus preproGRP was clustered to an independent branch. Reverse transcription-PCR showed that GRP and its receptor mRNAs were both expressed in the lumbar spinal cord of suncus and mice. Immunohistochemistry for GRP demonstrated that the sexually dimorphic GRP system and male-specific expression/distribution patterns of GRP in the lumbosacral spinal cord in suncus are similar to those of mice. In suncus, we further found that most GRP-expressing neurons in males also express androgen receptors, suggesting that this male-dominant system in suncus is also androgen-dependent. Taken together, these results indicate that the sexually dimorphic spinal GRP system exists not only in mice but also in suncus, suggesting that this system is a conserved property in mammals. This article is protected by copyright. All rights reserved.

  1. Comparative Analysis between Total Disc Replacement and Posterior Foraminotomy for Posterolateral Soft Disc Herniation with Unilateral Radiculopathy : Clinical and Biomechanical Results of a Minimum 5 Years Follow-up

    PubMed Central

    Kim, Kyoung-Tae; Cho, Dae-Chul; Sung, Joo-Kyung; Kim, Young-Baeg; Kim, Du Hwan

    2017-01-01

    Objective To compare the clinical outcomes and biomechanical effects of total disc replacement (TDR) and posterior cervical foraminotomy (PCF) and to propose relative inclusion criteria. Methods Thirty-five patients who underwent surgery between 2006 and 2008 were included. All patients had single-level disease and only radiculopathy. The overall sagittal balance and angle and height of a functional segmental unit (FSU; upper and lower vertebral body of the operative lesion) were assessed by preoperative and follow-up radiographs. C2–7 range of motion (ROM), FSU, and the adjacent segment were also checked. Results The clinical outcome of TDR (group A) was tended to be superior to that of PCF (group B) without statistical significance. In the group A, preoperative and postoperative upper adjacent segment level motion values were 8.6±2.3 and 8.4±2.0, and lower level motion values were 8.4±2.2 and 8.3±1.9. Preoperative and postoperative FSU heights were 37.0±2.1 and 37.1±1.8. In the group B, upper level adjacent segment motion values were 8.1±2.6 and 8.2±2.8, and lower level motion values were 6.5±3.3 and 6.3±3.1. FSU heights were 37.1±2.0 and 36.2±1.8. The postoperative FSU motion and height changes were significant (p<0.05). The patient’s satisfaction rates for surgery were 88.2% in group A and 88.8% in group B. Conclusion TDR and PCF have favorable outcomes in patients with unilateral soft disc herniation. However, patients have different biomechanical backgrounds, so the patient’s biomechanical characteristics and economic status should be understood and treated using the optimal procedure. PMID:28061490

  2. Unusual Spinal Epidural Lipomatosis and Lumbosacral Instability

    PubMed Central

    Ruiz Picazo, David; Ramírez Villaescusa, José

    2016-01-01

    Introduction. Epidural lipomatosis is most frequently observed in patients on chronic steroid treatment. Only a few idiopathic epidural lipomatosis cases have been described. Material and Methods. 64-year-old male patient presented with low back pain and left leg pain. Later, the patient experienced neurogenic claudication and radicular pain in the left leg without urinary dysfunction. Plain radiography and magnetic resonance imaging demonstrated an abnormal fat tissue overgrowth in the epidural space with compression of the dural sac, degenerative disc disease at L4-L5 level, and instability at L5-S1. Endocrinopathic diseases and chronic steroid therapy were excluded. If conservative treatment failed, surgical treatment can be indicated. Results. After surgery, there was a gradual improvement in symptoms and signs, and six months later the patient returned to daily activities and was neurologically normal. Conclusion. In the absence of common causes of neurogenic claudication, epidural lipomatosis should be considered. The standard test for the diagnosis of epidural lipomatosis is magnetic resonance (MR). At first, conservative treatment must be considered; weight loss and the suspension of prior corticosteroid therapy are indicated. In the presence of neurological impairment, the operative treatment of wide surgical decompression must be performed soon after diagnosis. PMID:27069704

  3. Differentiation of vasodilator and sudomotor responses in the cat paw pad to preganglionic sympathetic stimulation.

    PubMed Central

    Bell, C; Jänig, W; Kümmel, H; Xu, H

    1985-01-01

    We monitored sweat secretion (using skin potential) and blood flow (using skin temperature) in the hind-paw skin of chloralose-anaesthetized cats pre-treated with guanethidine, and studied the responses to electrical stimulation of the ipsilateral lumbar sympathetic trunk. Stimulation caused sweat secretion and an increase in skin blood flow which was almost entirely restricted to the paw pads and was completely ipsilateral. Stimulation of the tibial nerve trunk produced similar effects, except that the increase in blood flow was more prolonged. The vasodilator effect of sympathetic trunk stimulation was not affected by chronic deafferentation of the paw. Atropine methonitrate (0.5-1 mg/kg I.V.) abolished the sudomotor response to sympathetic stimulation, but did not attenuate the blood flow response. Hexamethonium (1-2 mg/kg I.V.) abolished the vasodilator response to sympathetic stimulation, but did not affect the sudomotor response. Larger doses of hexamethonium (10-20 mg/kg) abolished both responses. The data suggest that the lumbar post-ganglionic neurones mediating vasodilatation in the skin of the cat paw pad are distinct from those that mediate sudomotor secretion. PMID:4032308

  4. Anterior tarsal tunnel syndrome: a misunderstood and a misleading entrapment neuropathy.

    PubMed

    Logullo, Francesco; Ganino, Cristiana; Lupidi, Francesca; Perozzi, Cecilia; Di Bella, Paolo; Provinciali, Leandro

    2014-05-01

    Anterior tarsal tunnel syndrome (ATTS) is a rare entrapment neuropathy of the deep peroneal nerve beneath the extensor retinaculum on the top of the ankle. ATTS is often asymptomatic or olygosymptomatic. There are few reports describing the ATTS. We describe the clinical and electrophysiological features of 85 patients with unilateral or bilateral ATTS prospectively collected between January 2000 and December 2010 in our laboratory of Clinical Neurophysiology. This entrapment neuropathy remains poorly diagnosed and it might be misleading when performing a diagnostic EMG-ENG examination for suspected polyneuropathy or lumbosacral radiculopathy.

  5. A cured patient who came back for consultation: neuropathic scrotal pruritus relieved after ipsilateral inguinal hernia repair.

    PubMed

    Koh, W L; Liu, T T

    2010-09-01

    When no demonstrable cause is uncovered after excluding inflammatory dermatosis, infectious disease or a manifestation of anorectal disease, anogenital pruritus is often described as 'idiopathic'. Lumbosacral radiculopathy was described by Cohen et al. as one of the possible causes of 'idiopathic' anogenital pruritus. We report a case of a patient with chronic pruritus of the right scrotum that was relieved immediately post-ipsilateral inguinal hernia repair. This is, to the best of our knowledge, the first case of neuropathic scrotal pruritus secondary to direct nerve compression by an inguinal hernia. We propose that a proper examination for the presence of inguinal hernia be performed in the work-up for scrotal pruritus.

  6. [Myxoid liposarcoma of the lumbosacral spine. Clinical case report].

    PubMed

    Granados-López, Sandy Lucero; Tavares-García, Juana Sonia; Pérez-Contreras, Alberto

    2013-01-01

    Introducción: el liposarcoma es un tumor maligno de tejidos blandos que constituye el grupo más numeroso de sarcomas en el adulto. La variante mixoide representa 30 a 35 % de todos los liposarcomas. Comúnmente se observa en los muslos. En la literatura se han informado solo dos pacientes con liposarcoma en la columna vertebral. Caso clínico: mujer de 28 años de edad con síntomas de compresión medular (marcha claudicante, fuerza en la extremidad derecha 4/5, disminución de la sensibilidad). La imagen por resonancia magnética confirmó una masa paravertebral derecha que se extendía desde L4 hasta S2, multinodular, sólido quística, que seguía el trayecto de los forámenes de conjunción de S1 y S2 hacia el espacio presacro, con señales hipointensas en T1 e hiperintensas en T2. Con los estudios radiológicos se concluyó que presentaba un neurofibroma. Se realizó resección extra e intrarraquídea, de la que se extrajo un tumor. El estudio histopatológico definitivo indicó que se trataba de un liposarcoma mixoide. Conclusiones: la columna vertebral es una localización poco frecuente para esta neoplasia, así como para sus metástasis. Es difícil lograr una resección completa en este sitio, por lo que la tasa de recurrencia es alta.

  7. Ischaemic neuropathy of the lumbosacral plexus following intragluteal injection.

    PubMed Central

    Stöhr, M; Dichgans, J; Dörstelmann

    1980-01-01

    A lesion of the lumbo sacral plexus may result from an inadvertent intra-arterial injection of vasotoxic drugs into one of the gluteal arteries. Symptoms and follow-up of three cases are reported. The neuropathy is attributed to a toxic endarteritis with retrograde propagation of spasm and thrombosis. Swelling an bluish discoloration of the buttocks ("embolia cutis medicamentosa") as well as an impaired circulation in the homolateral leg are associated with the neurological syndrome in fully developed cases and makes possible a correct diagnosis. Images PMID:7205289

  8. Fungal Contamination of Methylprednisolone Causing Recurrent Lumbosacral Intradural Abscess

    PubMed Central

    Frenkel, Mark B.; Hsu, Wesley

    2017-01-01

    Fungal meningitis transmitted through injections of methylprednisolone contaminated with Exserohilum rostratum affected 753 persons and caused 61 deaths in the United States in 2012. We report a case of infection recurrence after 24-months with the unique manifestation of an intradural fungal abscess. Fungal disease should remain on the differential diagnosis list for previously exposed patients. PMID:28221116

  9. Adductor T reflex abnormalities in patients with decreased patellar reflexes.

    PubMed

    Tataroglu, Cengiz; Deneri, Ersin; Ozkul, Ayca; Sair, Ahmet; Yaycioglu, Soner

    2009-08-01

    The adductor reflex (AR) is a tendon reflex that has various features that differ from other tendon reflexes. This reflex was tested in different disorders presenting with diminished patellar reflexes such as diabetic lumbosacral radiculoplexus neuropathy (DLRPN), L2-L4 radiculopathy, and distal symmetric diabetic neuropathy (diabetic PNP). The AR and crossed-AR (elicited by tapping the contralateral patellar tendon) were recorded using concentric needle electrodes. Additionally, the patellar T reflex (vm-TR) and vastus medialis H reflex (vm-HR) were recorded using surface electrodes. AR was recorded in only one out of eight patients with DLRPN, but it was recorded in 21 out of 22 patients with L2-L4 radiculopathy (95.5%). Of these reflexes, only AR showed prolonged latency in the L2-L4 radiculopathy group. The latencies of AR, vm-TR, and vm-HR were prolonged in patients with diabetic PNP. We conclude that AR can be useful in the differential diagnosis of some lower motor neuron disorders that present with patellar reflex disturbance. Muscle Nerve 40: 264-270, 2009.

  10. Migration of traumatic intracranial subdural hematoma to lumbar spine causing radiculopathy

    PubMed Central

    Li, Charles H.; Yew, Andrew Y.; Lu, Daniel C.

    2013-01-01

    Background: There have been rare reports of intracranial subdural hematoma (SDH) that migrated into the spine. All previous cases have been surgically managed and in this case report, we describe the first case of conservatively managed spinal hematoma secondary to migratory intracranial SDH. Case Description: A 26-year-old male presented with a left tentorial SDH after blunt trauma. He was conservatively managed and discharged home. He presented 8 days later with worsening lower back pain that was found to be secondary to a spinal SDH. Conclusion: Spinal hematomas can be a serious sequelae of migrated intracranial hematomas. Tentorial and other caudally located intracranial hematomas may be more prone to this phenomenon. PMID:23869281

  11. The Relief of Unilateral Painful Thoracic Radiculopathy without Headache from Remote Spontaneous Spinal Cerebrospinal Fluid Leak

    PubMed Central

    Son, Byung-chul; Ha, Sang-woo; Lee, Si-hoon; Choi, Jin-gyu

    2016-01-01

    Spontaneous intracranial hypotension (SIH) caused by spontaneous spinal cerebrospinal fluid (CSF) leaks produces orthostatic headaches. Although upper arm pain or paresthesia is reportedly associated with SIH from spontaneous spinal CSF leak in the presence of orthostatic headache, low thoracic radicular pain due to spontaneous spinal CSF leak unassociated with postural headache is extremely rare. We report a 67-year-old female who presented with chronic, positional radicular right T11 pain. Computed tomography myelography showed a spontaneous lumbar spinal CSF leak at L2-3 and repeated lumbar epidural blood patches significantly alleviated chronic, positional, and lower thoracic radiculopathic pain. The authors speculate that a chronic spontaneous spinal CSF leak not severe enough to cause typical orthostatic headache or epidural CSF collection may cause local symptoms such as irritation of a remote nerve root. There might be considerable variabilities in the clinical features of SIH which can present a diagnostic challenge. PMID:27445613

  12. Postoperative Shingles Mimicking Recurrent Radiculopathy after Anterior Cervical Diskectomy and Fusion

    PubMed Central

    Montgomery, Jason T.; Lawrence, Brandon D.; Brodke, Darrel S.; Patel, Alpesh A.

    2015-01-01

    Study Design Case report and review of literature. Objective To report the case of a 67-year-old woman who developed delayed onset (6 months) of symptomatic shingles after cervical nerve root decompression in a previously symptomatic dermatome. Methods The patient's clinic course and outcomes were retrospectively reviewed. The study required no outside funding. The study authors have no financial interest in any of the products or techniques discussed. Results The patient received definitive treatment for shingles once the zoster form rash manifested. The patient, however, developed postherpetic neuralgia and remained symptomatic at her 2-year postoperative visit. Conclusions Although shingles is a common disease state affecting patients in the fifth and sixth decades of life, it is rarely seen in the setting of cervical nerve root decompression. This case demonstrates the need to include shingles on the differential diagnosis of recurrent neurogenic pain after anterior cervical decompression and fusion. PMID:26131388

  13. Neurovascular Compression Caused by Popliteus Muscle Enlargement Without Discrete Trauma

    PubMed Central

    2016-01-01

    Popliteal entrapment syndrome caused by isolated popliteus muscle enlargement is very rare, although its occurrence has been reported after discrete trauma. However, popliteal artery stenosis with combined peroneal and proximal tibial neuropathy caused by popliteus muscle enlargement without preceding trauma has not been reported. A 57-year-old man presented with a tingling sensation and pain in his left calf. He had no previous history of an injury. The symptoms were similar to those of lumbosacral radiculopathy. Calf pain became worse despite treatment, and the inability to flex his toes progressed. Computed tomography angiography and magnetic resonance imaging of the lower extremity showed popliteal artery stenosis caused by popliteus muscle enlargement and surrounding edema. An electrodiagnostic study confirmed combined peroneal and proximal tibial neuropathy at the popliteal fossa. Urgent surgical decompression was performed because of the progressive neurologic deficit and increasing neuropathic pain. The calf pain disappeared immediately after surgery, and he was discharged after the neurologic functions improved. PMID:27446794

  14. Confusion after spine injury: cerebral fat embolism after traumatic rupture of a Tarlov cyst: Case report

    PubMed Central

    2010-01-01

    Background Acute low back pain is a very common symptom and reason for many medical consultations. In some unusual circumstances it could be linked to a rare aetiology. Case presentation We report a 70-year-old man with an 8-month history of left posterior thigh and leg pain who had sudden confusion after a fall from standing. It was due to cerebral fat embolism suspected by computed tomography scan, later confirmed by brain magnetic resonance imaging (MRI). A spinal MRI scan was then performed and revealed a sacral fracture which drained into an unknown perineurial cyst (Tarlov cyst). Under medical observation the patient fully recovered within three weeks. Conclusions Sacral perineurial cysts are rare, however they remain a potential cause of lumbosacral radiculopathy. PMID:20712856

  15. Lumbar spinal stenosis.

    PubMed Central

    Ciricillo, S F; Weinstein, P R

    1993-01-01

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

  16. Diagnosis and management of sacral Tarlov cysts. Case report and review of the literature.

    PubMed

    Acosta, Frank L; Quinones-Hinojosa, Alfredo; Schmidt, Meic H; Weinstein, Philip R

    2003-08-15

    Perineurial (Tarlov) cysts are meningeal dilations of the posterior spinal nerve root sheath that most often affect sacral roots and can cause a progressive painful radiculopathy. Tarlov cysts are most commonly diagnosed by lumbosacral magnetic resonance imaging and can often be demonstrated by computerized tomography myelography to communicate with the spinal subarachnoid space. The cyst can enlarge via a net inflow of cerebrospinal fluid, eventually causing symptoms by distorting, compressing, or stretching adjacent nerve roots. It is generally agreed that asymptomatic Tarlov cysts do not require treatment. When symptomatic, the potential surgery-related benefit and the specific surgical intervention remain controversial. The authors describe the clinical presentation, treatment, and results of surgical cyst fenestration, partial cyst wall resection, and myofascial flap repair and closure in a case of a symptomatic sacral Tarlov cyst. They review the medical literature, describe various theories on the origin and pathogenesis of Tarlov cysts, and assess alternative treatment strategies.

  17. Compression of Root Level in a Patient with Hereditary Neuropathy with Liability to Pressure Palsy Diagnosed by Magnetic Resonance Imaging.

    PubMed

    Park, Donghwi; Ryu, Ju Seok; Kim, Ki-Jeong

    2016-09-01

    Hereditary neuropathy with liability to pressure palsies (HNPP) is characterized by acute, painless, and recurrent mononeuropathies that are secondary to compression or minor trauma. This case is the first to report an intraspinal compression of the radicular nerve by schwannoma in a patient with HNPP. A 66-year-old woman developed left foot drop and paresthesia of the lateral aspects of left distal lower leg. An electromyography showed left L5 radiculopathy and severe peripheral polyneuropathy. A lumbosacral magnetic resonance imaging revealed a radicular nerve in the intradural and extramedullary space being compressed by schwannoma. She previously had symptoms of foot drop several years ago, and HNPP was confirmed by peripheral myelin protein 22 deletion. She was surgically treated for L5 radiculopathy, which might have been caused by a traction of the nerve root by schwannoma at the intradural and extramedullary space. After surgical treatment, her symptoms of foot drop had improved from zero grade to IV+ grade within 4 weeks. The occurrence of HNPP and schwannoma in the same patient may be coincidental, but it is tempting to speculate that they share a common genetic basis. Therefore, for patients with HNPP, it is important to consider not only an electrophysiologic study but also a magnetic resonance imaging to locate the exact pathologic site.

  18. Lumbosacral dumb-bell neurilemmoma approached by microsurgical interlaminar foraminotomy. A case report.

    PubMed

    Uchida, K; Baba, H; Maezawa, Y; Chen, Q; Imura, S

    1996-01-01

    The case history of a patient with a dumb-bell neurilemmoma arising from the L5 nerve root is described. The tumour extended into the outlet of the neural foramen at L5-S1 on the left and was also compressing the dural sac and the S1 nerve root. A limited laminotomy at L4-5 and L5-S1, with preservation of the neural arch, was followed by microsurgical medial foraminotomy at L5-S1 which allowed visualisation of the nerve root and enucleation of the tumour. The technique maintains stability of the posterior elements and spinal movement, and is recommended for the removal of this type of tumour.

  19. Electrophysiological Mapping of Rat Sensorimotor Lumbosacral Spinal Networks after Complete Paralysis

    PubMed Central

    Gad, Parag; Roy, Roland R.; Choe, Jaehoon; Zhong, Hui; Nandra, Mandheeraj Singh; Tai, Y.C.; Gerasimenko, Yury; Edgerton, V. Reggie

    2015-01-01

    Stimulation of the spinal cord has been shown to have great potential for improving function after motor deficits caused by injury or pathological conditions. Using a wide range of animal models, many studies have shown that stimulation applied to the neural networks intrinsic to the spinal cord can result in a dramatic improvement of motor ability, even allowing an animal to step and stand after a complete spinal cord transection. Clinical use of this technology, however, has been slow to develop due to the invasive nature of the implantation procedures and the difficulty of ascertaining specific sites of stimulation that would provide optimal amelioration of the motor deficits. Moreover, the development of tools available to control precise stimulation chronically via biocompatible electrodes has been limited. In this paper, we outline the use of a multisite electrode array in the spinal rat model to identify and stimulate specific sites of the spinal cord to produce discrete motor behaviors in spinal rats. The results demonstrate that spinal rats can stand and step when the spinal cord is stimulated tonically via electrodes located at specific sites on the spinal cord. The quality of stepping and standing was dependent on the location of the electrodes on the spinal cord, the specific stimulation parameters, and the orientation of the cathode and anode. The spinal motor evoked potentials (sMEP) in selected muscles during standing and stepping are shown to be critical tools to study selective activation of interneuronal circuits via responses of varying latencies. The present results provide further evidence that the assessment of functional networks in the background of behaviorally relevant functional states is likely to be a physiological tool of considerable importance in developing strategies to facilitate recovery of motor function after a number of neuromotor disorders. PMID:25890138

  20. Electrophysiological mapping of rat sensorimotor lumbosacral spinal networks after complete paralysis.

    PubMed

    Gad, Parag; Roy, Roland R; Choe, Jaehoon; Zhong, Hui; Nandra, Mandheeraj Singh; Tai, Yu-Chong; Gerasimenko, Yury; Edgerton, V Reggie

    2015-01-01

    Stimulation of the spinal cord has been shown to have great potential for improving function after motor deficits caused by injury or pathological conditions. Using a wide range of animal models, many studies have shown that stimulation applied to the neural networks intrinsic to the spinal cord can result in a dramatic improvement of motor ability, even allowing an animal to step and stand after a complete spinal cord transection. Clinical use of this technology, however, has been slow to develop due to the invasive nature of the implantation procedures and the difficulty of ascertaining specific sites of stimulation that would provide optimal amelioration of the motor deficits. Moreover, the development of tools available to control precise stimulation chronically via biocompatible electrodes has been limited. In this chapter, we outline the use of a multisite electrode array in the spinal rat model to identify and stimulate specific sites of the spinal cord to produce discrete motor behaviors in spinal rats. The results demonstrate that spinal rats can stand and step when the spinal cord is stimulated tonically via electrodes located at specific sites on the spinal cord. The quality of stepping and standing was dependent on the location of the electrodes on the spinal cord, the specific stimulation parameters, and the orientation of the cathode and anode. The spinal motor evoked potentials in selected muscles during standing and stepping are shown to be critical tools to study selective activation of interneuronal circuits via responses of varying latencies. The present results provide further evidence that the assessment of functional networks in the background of behaviorally relevant functional states is likely to be a physiological tool of considerable importance in developing strategies to facilitate recovery of motor function after a number of neuromotor disorders.

  1. [Validation of the questionnaire for adolescents concerning ailments of lumbosacral region. Part III: validity].

    PubMed

    Baczkiewicz, Maja; Demczuk-Włodarczyk, Ewa

    2011-01-01

    The third part of the series of articles includes the results of validity and coherence check conducted over the LBP questionnaire designed for pupils aged 13-18. 22 adolescents aged 13-17 were randomly chosen from the group of 124 pupils, who filled in the questionnaire using stratification to 3 groups: without LBP, LBP in a life time, but not in the week preceding the testing and LBP in the preceding week. The validity of questions was tested by comparison to the data obtained from parents and in clinical testing conducted by a physiotherapist, which took place within two weeks from the first questionnaire session. The questions were found valid if the answers or indexes counted from the answers were consistent with data from clinical testing and from parents. For birth date, height and weight data from parents were used. Data from clinical testing served to verify: height, weight, presence and location of pain (local symptoms of overloading were palpated), faulty posture and directional preference according to McKenzie. With reference to some questions the coherence check was performed, by comparing the answers to questions logically linked. As a result of validity and coherence check rejected were the questions about: intensive growth period (small number of answers together with many incoherent ones), about beginning of pain episode (lack of coherence), about directional preference (differences with clinical testing) and about faulty posture (not consistent with findings in clinical testing). On the other hand the question about presence of LBP proved to be highly specific, good results were also found as to the questions about birth date, height and weight. The rest of the questions tested were found acceptable.

  2. The Influence of Environment Geometry on Injury Outcome: II. Lumbosacral Spine

    NASA Astrophysics Data System (ADS)

    Shaibani, Saami J.

    2006-03-01

    It is widely agreed that the type of motor vehicle in which an occupant is situated can sometimes make a noticeable difference in injury potential even when the insult suffered is the same. A simple example might be the same occupant being in a sports car as opposed to a minivan, but such anecdotal experience does not usually help to distinguish the effect of particular features within the same category of vehicle. Other research has addressed the role of environment geometry in neck injury,[1] and this paper adopts the same methodology for the low back. The heights, lengths and angles of the seat cushion and seat back (including head rest) are all examined as descriptors of passenger compartment geometry, and any changes caused by these are determined. Useful results are feasible with the large patient population available even if clear patterns in these are not always present. As in earlier work, there is still the option of finding individual outcomes on a case-by-case basis. [1] The influence of environment geometry on injury outcome: I. Cervical spine, Bull Am Phys Soc, in press (2006).

  3. Transmission of Insult in Out-of-Position Subjects: II. Lumbosacral Injury

    NASA Astrophysics Data System (ADS)

    Shaibani, Saami J.

    2002-03-01

    The occurrence, or not, of injuries in vehicular collisions can depend critically on the initial seating position of vehicle occupants. Careful application of physics in an earlier study[1] was successful in determining the causation of injury for an occupant with a highly unconventional posture. A similarly unexpected outcome in another low-severity impact is explained here for an occupant lying fully backward at the time of impact. Again, this was achieved by evaluating the nature and extent of how each part of the body articulated throughout the impact. The effect on the low back was found from the associated kinematics, which in turn allowed the spinal injury mechanism to be ascertained. The methodology employed in both this study and the previous one is continued in a third paper[2] for an analysis in a different type of geometrical environment. 1. Transmission of Insult in Out-of-Position Subjects: I. Shoulder Injury, Bull. Am. Phys. Soc. in press (2002); 2. ibid: III. Thoracic Spine Injury.

  4. Deep vein thrombosis due to migrated graft bone after posterior lumbosacral interbody fusion. Case report.

    PubMed

    Yoshimoto, Hisashi; Sato, Shigenobu; Nakagawa, Izumi; Hyakumachi, Takahiko; Yanagibashi, Yasushi; Nitta, Fumihito; Masuda, Takeshi

    2007-01-01

    The authors report the case of an 83-year-old woman with refractory sciatica attributable to isthmic spondylolisthesis at L-5. Her symptoms were successfully improved after posterior lumbar interbody fusion (PLIF) at L5-S1; however, notable swelling in her left leg suddenly developed 2 days postoperatively. Anterior migration of a fragment of bone graft was demonstrated on computed tomography scanning, and there was obvious occlusion of the left common iliac vein (CIV) on magnetic resonance venography. Ultrasonography revealed a thrombus in the left CIV at the site of compression. To prevent a pulmonary embolism during manipulation of the affected vein, an inferior vena cava filter was placed just before excision of the migrated bone fragment. The swelling in the patient's leg subsided quickly after the surgery, and she was treated with heparin and warfarin to prevent recurrent deep vein thrombosis (DVT). Six months after the second surgery, complete restoration of blood flow to the left CIV and no recurrence of DVT were demonstrated on magnetic resonance venography. Especially in elderly patients with degenerative disc disease, excessive curettage and impaction of disc materials during the PLIF procedure may cause migration of bone graft fragments. Surgeons should be aware of the possible vascular complications of PLIF.

  5. Multidisciplinary Approach to an Extended Pressure Sore at the Lumbosacral Area

    PubMed Central

    Yoon, Sehoon; Lázaro, Hudson Alex

    2016-01-01

    A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery. PMID:27896193

  6. [Caudal epidural injection in the management of lumbosacral nerve pain syndromes].

    PubMed

    Apáthy, A; Penczner, G; Licker, E; Eiben, A; Bálint, G; Genti, G; Paksy, A

    1999-05-09

    The effect of epidural steroid injections was assessed in 39 patients with lumbar nerve root compression syndromes in a double-blind controlled trial, the patients were allocated at random to 3 groups. In group A (n = 13) the patients received a caudal epidural injection of 1 ml (7 mg) bethametason (Diprophos) in 10 ml normal saline and 20 ml local anesthetic (Lignocaine 1%). The second group B (n = 13) received a caudal epidural injection of 20 ml local anaesthetic (Lignocaine 1%) and 10 ml normal saline. The third group C (n = 13) received a superficial injection of 1 ml (7 mg) bethametason around of the sacral hiatus. All injections were performed by the same experienced anaesthesiologist. An independent physician, who was not aware which type of injection had been given, carried out the clinical measurements and the evaluation. Taking of analgesic drug Tramadol was permitted. The symptoms were assessed by visual analogue scale (VAS 100 mm), lumbar flexion (Schober and finger-floor distance), the angle of raised leg sign (RLS degrees), and by complete neurological examination, the investigation was made 5 times (1 hour, 24 hours, 48 hours, 1 week, and 4 weeks after epidural injections). The results between 0-1 week and 0-4 week were statistically analysed by Student-, Wilcoxon-, and Mann-Whitney test and analysis of variance (ANOVA). The mean VAS values decreased in time in all patient groups. There was no difference between the three treatment groups either after one or after 4 weeks by ANOVA. The mobility of the lumbar spine improved in all patient groups, but there was no significant difference between the three treatment groups. The raised led sign--values improved in all patient groups. There was a significant difference between the three treatment groups by ANOVA after one week, due to the difference between group A and C. After four weeks there was no significant difference. No major complications or side effects were seen in our trial. The raised leg sign due to epidural steroid injection showed better results in comparison to steroid injection around of the sacral hiatus were seen.

  7. [Lateral motor nucleus in the lumbosacral segment of the spinal cord of the horse].

    PubMed

    Flieger, S; Sławomirski, J; Boratyński, Z; Jastrzebski, M

    1984-01-01

    Two medullae oblongatae of horses were cut into 15 microns cross-sections and stained according to the modified method of Nissel. The lateral motor nucleus lies in the lateral and median part of the ventral column of spinal cord grey matter. It adjoins medially nucleus motorius medialis of the spinal ventral column. Cells of this nucleus occur both along the whole lumbar and sacral segment of the spinal cord. In the lateral motor nucleus three cell groups are distinguished - median, basal and lateral. The latter is divided in some segments into subgroups - dorsal and ventral. Along the nucleus quite numerous constrictions and intervals are found, which are caused by various numbers of cells in particular cross-sections. Nucleus motorius lateralis is formed mainly of large and medium multipolar or single spindle cells.

  8. [Nucleus motorius lateralis in the lumbosacral segment of the spinal cord in horses].

    PubMed

    Flieger, S; Sławomirski, J; Boratyński, Z; Jastrzebski, M

    1984-01-01

    Two medullae oblongatae of horses were cut into 15 microns cross-sections and stained according to the modified method of Nissel. The lateral motor nucleus lies in the lateral and median part of the ventral column of spinal cord grey matter. It adjoins medially nucleus motorius medialis of the spinal ventral column. Cells of this nucleus occur both along the whole lumbar and sacral segment of the spinal cord. In the lateral motor nucleus three cell groups are distinguished-median, basal and lateral. The latter is divided in some segments into subgroups-dorsal and ventral. Along the nucleus quite numerous constrictions and intervals are found, which are caused by various numbers of cells in particular cross-sections. Nucleus motorius lateralis is formed mainly of large and medium multipolar or single spindle cells.

  9. Experimental use of a laser as one of the methods of physiotherapeutical treatment in lumbosacral rachialgia

    NASA Astrophysics Data System (ADS)

    Jagielski, Jerzy

    1995-03-01

    The author presents the initial comparative investigations on treatment with laser beam, diadynamic current, and combined operation of diadynamic currents and classic massage. The investigations were performed in three groups on 78 patients. The obtained results indicate great therapeutic effectiveness of laser biostimulation, better than in other treatments and a larger scope of indications for treatment with that method. According to the modified Laitinen's scale the obtained improvement was from the range of two points, corresponding to strong pain, to 0.3 points, almost complete regression of the pain.

  10. The clinical use of dermatomal somatosensory evoked potentials in lumbosacral spinal stenosis.

    PubMed

    Storm, Seneca A; Kraft, George H

    2004-02-01

    DSEPs provide clinicians with a safe, noninvasive technique useful in determining which patients with anatomic spinal stenosis have the added component of neurogenic compromise. Based on physiologic principles, level-by-level prolongation of DSEP latencies, reduction of amplitude, asymmetry, or a complete absence of response is associated with dysfunction in that particular afferent neurologic pathway. This dysfunction does not correspond to the exact level of stenosis noted on MRI because the rootlets in the lumbar and sacral regions pass through multiple spinal segments as they course rostrally through the spinal canal. Given that LSSS typically develops over time, the degree of abnormality likely would correspond to the physiologic slowing occurring in the multiple rootlets of the cauda equina. These recordings are not easy to perform and interpret, but when done correctly, they provide the best evidence for the type of neurophysiologic dysfunction in LSSS that responds favorably to surgical decompression. Similarly, DSEPs might provide a means of neurophysiologically monitoring clinically significant findings in a program of conservative management.

  11. Dermatomal somatosensory-evoked potentials in the evaluation of lumbosacral spinal stenosis.

    PubMed

    Kraft, George H

    2003-02-01

    DSEPs are very useful in determining which patients with degenerative lumbar spine disease have the added component of neurogenic compromise. Based on sound physiologic principles, level-by-level prolongation of DSEP latencies, reduction of amplitude, asymmetry, or a complete absence of response is associated with dysfunction in that particular neurologic pathway. This result does not necessarily correspond to the exact level of stenosis noted on MRI, because the rootlets in the lumbar and sacral regions pass through multiple spinal segments as they course through the spinal canal. Given that LSSS develops typically over time, it is not unlikely that the degree of abnormality will be variable between different levels. The pattern of abnormality will correspond to the physiologic slowing occurring in the multiple rootlets of the cauda equina. These recordings are not easy to perform and interpret; but, when done correctly, they provide the best evidence for the type of neurophysiologic dysfunction in LSSS that responds favorably to surgical decompression.

  12. Successful Postoperative Treatment of a Lumbosacral Ulcer in a Neonate after Myelomeningocele

    PubMed Central

    Meszes, Angéla; Tálosi, Gyula; Máder, Krisztina; Kiss, Judit; Sánta, Csilla; Kemény, Lajos; Csoma, Zsanett

    2014-01-01

    Wound care in neonates demands special awareness of the anatomical and physiological characteristics of their skin, and the danger of adverse mechanical and toxicological events. Here, we present the case of a full-term neonate born with myelomeningocele. Following the closing surgery on the 3rd day of postuterine life, the operated region became inflamed, the sutures opened and a necrotic discharging ulcer developed. Besides parenteral antibiotic treatment based on the microbiological findings, intelligent hydrofiber dressings were applied to the wound with regard to the special characteristics of wound care in neonates. After 72 days, the ulcer had healed with a small residual scar, and the infant is currently demonstrating normal physical and mental development. PMID:24707251

  13. Long standing lumbosacral dermoid tumor and intracranial fat droplet dissemination: A case report

    PubMed Central

    Babashahi, Ali; Taheri, Morteza; Fattahi, Arash

    2016-01-01

    Background: Dermoid tumors are slow growing, benign CNS lesions. Case Description: This case study concerns a 29-year-old female with a 6-year history of lower extremity paresthesias attributed to magnetic resonance (MR)/computed tomography (CT) documented intradural dermoid tumor that extended from L1 to S1. On MR, it was hypointense on T1, hyperintense on T2, and did not enhance with gadolinium. CT showed hyperdensity at the L1-L2 levels. The craniocervical MR imaging showed small hyperintense foci in the cisternal space favoring “fat dissemination.” L1-S2 laminectomy revealed an intradural lesion characterized by “a solid and firm component compatible with fat tissue adherent to the conus medullaris and a solid-soft component within the cauda equina;” there were also “multiple fragments of white-creamy soft tissue with hair.” Following tumor resection, the brain CT scan demonstrated fat dissemination within the intraventricular and cisternal space. Histopathologic examination confirmed the diagnosis of a dermoid tumor. Conclusion: Dermoid tumors should be considered among the differential diagnosis of intradural lesions in young patients even without any other congenital abnormality. PMID:28028445

  14. Influence of snow shovel shaft configuration on lumbosacral biomechanics during a load-lifting task.

    PubMed

    Lewinson, Ryan T; Rouhi, Gholamreza; Robertson, D Gordon E

    2014-03-01

    Lower-back injury from snow shovelling may be related to excessive joint loading. Bent-shaft snow shovels are commonly available for purchase; however, their influence on lower back-joint loading is currently not known. Therefore, the purpose of this study was to compare L5/S1 extension angular impulses between a bent-shaft and a standard straight-shaft snow shovel. Eight healthy subjects participated in this study. Each completed a simulated snow-lifting task in a biomechanics laboratory with each shovel design. A standard motion analysis procedure was used to determine L5/S1 angular impulses during each trial, as well as peak L5/S1 extension moments and peak upper body flexion angle. Paired-samples t-tests (α = 0.05) were used to compare variables between shovel designs. Correlation was used to determine the relationship between peak flexion and peak moments. Results of this study show that the bent-shaft snow shovel reduced L5/S1 extension angular impulses by 16.5% (p = 0.022), decreased peak moments by 11.8% (p = 0.044), and peak flexion by 13.0% (p = 0.002) compared to the straight-shaft shovel. Peak L5/S1 extension moment magnitude was correlated with peak upper body flexion angle (r = 0.70). Based on these results, it is concluded that the bent-shaft snow shovel can likely reduce lower-back joint loading during snow shovelling, and thus may have a role in snow shovelling injury prevention.

  15. Syringomyelia and Arnold-Chiari malformation associated with neck pain and left arm radiculopathy treated with spinal manipulation.

    PubMed

    Tieppo Francio, Vinicius

    2014-11-09

    An 18-year-old female patient presented with left dominant neck pain after a motor vehicle collision. Her cervical spine MRI revealed syringomyelia with associated Type I Arnold-Chiari malformation. Some researchers have reported that these might be considered contraindications to spinal manipulation. Nevertheless, her benign and functional clinical examination suggested otherwise and she underwent four manipulative treatments in 2 weeks. By the end of the treatment plan and after 1-month follow-up, she was asymptomatic, no adverse effects were noted and her outcome assessment score decreased from 56% to 0%. This case illustrates that spinal manipulation may be a useful adjunctive treatment procedure for spinal pain, even in the presence of syringomyelia and Chiari malformation, which may not necessarily be a contraindication to spinal manipulation, when performed by a skilled and well-trained physician.

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

    PubMed Central

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

    2015-01-01

    Objectives: Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc. Methods: In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed. Results: There were 27 male and 23 female with followup mean follow up of 115 months (range 105–130 months) with a mean age was 52 years (range 26–74 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L3–4 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions. Conclusions: Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective. PMID:25767571

  17. Syringomyelia and Arnold-Chiari malformation associated with neck pain and left arm radiculopathy treated with spinal manipulation

    PubMed Central

    Tieppo Francio, Vinicius

    2014-01-01

    An 18-year-old female patient presented with left dominant neck pain after a motor vehicle collision. Her cervical spine MRI revealed syringomyelia with associated Type I Arnold-Chiari malformation. Some researchers have reported that these might be considered contraindications to spinal manipulation. Nevertheless, her benign and functional clinical examination suggested otherwise and she underwent four manipulative treatments in 2 weeks. By the end of the treatment plan and after 1-month follow-up, she was asymptomatic, no adverse effects were noted and her outcome assessment score decreased from 56% to 0%. This case illustrates that spinal manipulation may be a useful adjunctive treatment procedure for spinal pain, even in the presence of syringomyelia and Chiari malformation, which may not necessarily be a contraindication to spinal manipulation, when performed by a skilled and well-trained physician. PMID:25385566

  18. A single neurosurgical center's experience of the resolution of cervical radiculopathy after dorsal foraminotomy and ventral discectomy.

    PubMed

    Schebesch, Karl-Michael; Albert, Ruth; Schödel, Petra; Proescholdt, Martin; Lange, Max; Brawanski, Alexander

    2011-08-01

    Monosegmental cervical disc herniation can be removed either by dorsal foraminotomy and sequesterectomy (Frykholm's method) or by a ventral approach with extensive removal of the affected disc with subsequent segmental fusion (modified Cloward's method). The choice of method largely depends on the surgeon's individual preference and experience. We evaluated the neurological outcomes of both surgical methods in a retrospective series of 100 consecutive patients (50 male, 50 female; mean age=47.7 years) who underwent surgery within a 3-year period. Fifty-one patients (30 male, 21 female; mean age=50.1 years) underwent a dorsal foraminotomy and 49 patients (20 male, 29 female; mean age=45.3 years) underwent surgery by the ventral approach with consecutive segmental fusion. We identified demographic data and analysed the postoperative neurological performance (motor and sensory activity) and the resolution of the radiating and local pain during the in-hospital stay. Patients in the Cloward Group recovered significantly better from cervicobrachialgia (p=0.02), neck pain (p=0.01) and sensory deficits (p=0.003). Furthermore, the Cloward Group showed a trend towards better outcomes for paresis. Complete removal of the affected cervical disc via a ventral approach and segmental fusion results in a superior neurological performance in the short-term compared to a dorsal foraminotomy and nerve root decompression by sequestrectomy. However, assessment of the long-term outcome is required and further studies are required to confirm our results.

  19. Sacral laminoplasty and cystic fenestration in the treatment of symptomatic sacral perineural (Tarlov) cysts: Technical case report

    PubMed Central

    Smith, Zachary A.; Li, Zhenzhou; Raphael, Dan; Khoo, Larry T.

    2011-01-01

    Background: Perineural cysts of the sacrum, or Tarlov cysts, are cerebrospinal fluid (CSF)-filled sacs that commonly occur at the intersection of the dorsal root ganglion and posterior nerve root in the lumbosacral spine. Although often asymptomatic, these cysts have the potential to produce significant symptoms, including pain, weakness, and/or bowel or bladder incontinence. We present a case in which the sacral roof is removed and reconstructed via plated laminoplasty and describe how this technique could be of potential use in maximizing outcomes. Methods: We describe technical aspects of a sacral laminoplasty in conjunction with cyst fenestration for a symptomatic sacral perineural cyst in a 50-year-old female with severe sacral pain, lumbosacral radiculopathy, and progressive incontinence. This patient had magnetic resonance imaging (MRI) and computed tomography (CT)-myelographic evidence of a non-filling, 1.7 × 1.4 cm perineural cyst that was causing significant compression of the cauda equina and sacral nerve roots. This surgical technique was also employed in a total of 18 patients for symptomatic tarlov cysts with their radiographic and clinical results followed in a prospective fashion. Results: Intraoperative images, drawings, and video are presented to demonstrate both the technical aspects of this technique and the regional anatomy. Postoperative MRI scan demonstrated complete removal of the Tarlov cyst. The patient's symptoms improved dramatically and she regained normal bladder function. There was no evidence of radiographic recurrence at 12 months. At an average 16 month followup interval 10/18 patients had significant relief with mild or no residual complaints, 3/18 reported relief but had persistent coccydynia around the surgical area, 2/18 had primary relief but developed new low back pain and/or lumbar radiculopathy, 2/18 remained at their preoperative level of symptoms, and 1/18 had relief of their preoperative leg pain but developed new pain

  20. Precision of a needle localization technic in the lumbosacral multifidus muscles for segmental specific needle electromyographic study: a cadaveric study.

    PubMed

    Chinsethagij, Kosum; Wongphaet, Parit; Su-archawaratana, Siripim; Dangprasert, Tanyarat

    2003-08-01

    The authors studied 14 cadavers to evaluate the claimed precision of needle placement into segment specific multifidus fascicles when using the "paraspinal mapping" electromyographic technic. Injection of acrylic dye was made according to landmarks proposed by Haig. The dissection showed 86.6 per cent of the injected dye in the correct fascicles. Only 1.4 per cent of the dye was lost. Spinous process level misidentification was the cause of the other 11.8 per cent incorrect injection. The authors expected that in living humans, in which the spinous processes are move identificable than embalmed cadavers, the precisions may be as high as 98.5 per cent. This remains to be studied in a further "in vivo" study.

  1. Diagnosis of lumbosacral diskospondylosis in a bucking bull assisted by high-definition thermal and nuclear scintigraphic imaging.

    PubMed

    Caldwell, Marc; Passler, Thomas; Purohit, Ram C; Pascoe, David; Wolfe, Dwight F

    2017-03-01

    CASE DESCRIPTION An 8-year-old Brahman-cross bull was evaluated for left hind limb lameness of 2 months' duration. The lameness was first noticed during a rodeo bucking performance, immediately after the bull appeared to land inappropriately on the affected limb. CLINICAL FINDINGS Physical examination findings revealed left hind limb lameness, ataxia, and left-sided epaxial muscle atrophy. Palpation per rectum along the lumbar portion of the vertebral column revealed evidence of exostosis of the ventral aspect. High-definition infrared thermal imaging revealed a pattern of reduced skin temperature in the area of the left lumbar and gluteal regions suggestive of a disruption in the sympathetic control of peripheral blood flow. Nuclear scintigraphy revealed a focal area of increased radioisotope uptake on the left ventrolateral aspect of the L2-3 intervertebral joint. A presumptive diagnosis of ventrolateral vertebral spondylosis resulting in spinal nerve impingement was made. TREATMENT AND OUTCOME 200 mg of methylprednisolone was epidurally injected at the site of the lesion, and treatment with polysulfated glycosaminoglycans was initiated (500 mg, IM, every 4 days for 7 treatments, then monthly thereafter). The lameness and ataxia observed in the left hind limb resolved within 1 week after treatment began. Subsequently, the bull was discharged from the hospital and was used successfully for semen collection and live-cover breeding. CLINICAL RELEVANCE Use of thermography for the bull of this report provided additional insight into neurovascular physiologic function that classical imaging modalities are unable to provide and, when combined with nuclear scintigraphy, aided in identifying the most critical lesion in a complex clinical case.

  2. [Validation of the questionnaire for adolescents concerning ailments of lumbosacral region. Part II: reliability of questions about risk factors].

    PubMed

    Baczkiewicz, Maja; Demczuk-Włodarczyk, Ewa

    2011-01-01

    The second part of the series of articles presents the reliability testing results of questions concerning factors that could influence or originate the symptoms of low back pain (LBP). The questions are a part of the questionnaire designed for pupils aged 13-18. 124 persons aged 13-17 were tested. The questionannaires were filled in twice by every pupil in no more than 7-day period, and then the answers were compared according to the test-retest method. The questions concerning risk factors were about: the intensive growth period, chronic diseases, the medical diagnosis of LBP, concomitant faulty posture, sport training and leisure time physical activities, leisure time spent sitting, possible nutritional deficiencies, the amount of sleep, the impact of lifting and dislike for school. Results that were obtained in the process of testing indicated that reasoning would be invalid if based on questions about sports (45% repeatable answers), about leisure time physical activities (Polish version of the leisure time exercise questionnaire of Godin and Shepard--correlation for the Godin and Shepard index was 0,29) and about intensive growth period (small number of valid responses indicates that the question is incomprehensible for adolescents). The rest of questions were found acceptably reliable.

  3. Spinal column shortening for tethered cord syndrome associated with myelomeningocele, lumbosacral lipoma, and lipomyelomeningocele in children and young adults.

    PubMed

    Aldave, Guillermo; Hansen, Daniel; Hwang, Steven W; Moreno, Amee; Briceño, Valentina; Jea, Andrew

    2017-03-31

    OBJECTIVE Tethered cord syndrome is the clinical manifestation of an abnormal stretch on the spinal cord, presumably causing mechanical injury, a compromised blood supply, and altered spinal cord metabolism. Tethered cord release is the standard treatment for tethered cord syndrome. However, direct untethering of the spinal cord carries potential risks, such as new neurological deficits from spinal cord injury, a CSF leak from opening the dura, and retethering of the spinal cord from normal scar formation after surgery. To avoid these risks, the authors applied spinal column shortening to children and transitional adults with primary and secondary tethered cord syndrome and report treatment outcomes. The authors' aim with this study was to determine the safety and efficacy of spinal column shortening for tethered cord syndrome by analyzing their experience with this surgical technique. METHODS The authors retrospectively reviewed the demographic and procedural data of children and young adults who had undergone spinal column shortening for primary or secondary tethered cord syndrome. RESULTS Seven patients with tethered cord syndrome caused by myelomeningocele, lipomyelomeningocele, and transitional spinal lipoma were treated with spinal column shortening. One patient with less than 24 months of follow-up was excluded from further analysis. There were 3 males and 4 females; the average age at the time was surgery was 16 years (range 8-30 years). Clinical presentations for our patients included pain (in 5 patients), weakness (in 4 patients), and bowel/bladder dysfunction (in 4 patients). Spinal column osteotomy was most commonly performed at the L-1 level, with fusion between T-12 and L-2 using a pedicle screw-rod construct. Pedicle subtraction osteotomy was performed in 6 patients, and vertebral column resection was performed in 1 patient. The average follow-up period was 31 months (range 26-37 months). Computed tomography-based radiographic outcomes showed solid fusion and no instrumentation failure in all cases by the most recent follow-up. Five of 7 patients (71%) reported improvement in preoperative symptoms during the follow-up period. The mean differences in initial and most recent Scoliosis Research Society Outcomes Questionnaire and Oswestry Disability Index scores were 0.26 and -13%, respectively; minimum clinically important difference in SRS-22 and ODI were assumed to be 0.4% and -12.8%, respectively. CONCLUSIONS Spinal column shortening seems to represent a safe and efficacious alternative to traditional untethering of the spinal cord for tethered cord syndrome.

  4. Potential of adult mammalian lumbosacral spinal cord to execute and acquire improved locomotion in the absence of supraspinal input

    NASA Technical Reports Server (NTRS)

    Edgerton, V. R.; Roy, R. R.; Hodgson, J. A.; Prober, R. J.; de Guzman, C. P.; de Leon, R.

    1992-01-01

    The neural circuitry of the lumbar spinal cord can generate alternating extension and flexion of the hindlimbs. The hindlimbs of adult cats with complete transection of the spinal cord at a low thoracic level (T12-T13) can perform full weight-supporting locomotion on a treadmill belt moving at a range of speeds. Some limitations in the locomotor capacity can be associated with a deficit in the recruitment level of the fast extensors during the stance phase and the flexors during the swing phase of a step cycle. The level of locomotor performance, however, can be enhanced by daily training on a treadmill while emphasizing full weight-support stepping and by providing appropriately timed sensory stimulation, loading, and/or pharmacologic stimulation of the hindlimb neuromuscular apparatus. Furthermore, there appears to be an interactive effect of these interventions. For example, the maximum treadmill speed that a spinal adult cat can attain and maintain is significantly improved with daily full weight-supporting treadmill training, but progressive recruitment of fast extensors becomes apparent only when the hindlimbs are loaded by gently pulling down on the tail during the stepping. Stimulation of the sural nerve at the initiation of the flexion phase of the step cycle can likewise markedly improve the locomotor capability. Administration of clonidine, in particular in combination with an elevated load, resulted in the most distinct and consistent alternating bursts of electromyographic activity during spinal stepping. These data indicate that the spinal cord has the ability to execute alternating activation of the extensor and flexor musculature of the hindlimbs (stepping) and that this ability can be improved by several interventions such as training, sensory stimulation, and use of some pharmacologic agents. Thus, it appears that the spinal cord, without supraspinal input, is highly plastic and has the potential to "learn," that is, to acquire and improve its ability to execute full weight-supporting locomotion on a treadmill belt.

  5. [Overactive muscles: it can be more serious than common myalgia or cramp].

    PubMed

    Molenaar, Joery P F; Snoeck, Marc M J; Voermans, Nicol C; van Engelen, Baziel G M

    2016-01-01

    Positive muscle phenomena are due to muscle overactivity. Examples are cramp, myalgia, and stiffness. These manifestations have mostly acquired causes, e.g. side-effects of medication, metabolic disorders, vitamin deficiency, excessive caffeine intake or neurogenic disorders. We report on three patients with various positive muscle phenomena, to illustrate the clinical signs that indicate an underlying myopathy. Patient A, a 56-year-old man, was diagnosed with muscle cramp in the context of excessive coffee use and previous lumbosacral radiculopathy. Patient B, a 71-year-old man, was shown to have RYR1-related myopathy. Patient C, a 42-year-old man, suffered from Brody myopathy. We propose for clinicians to look out for a number of 'red flags' that can point to an underlying myopathy, and call for referral to neurology if indicated. Red flags include second wind phenomenon, familial occurrence of similar complaints, marked muscle stiffness, myotonia, muscle weakness, muscle hypertrophy, and myoglobinuria. Establishing a correct diagnosis is important for proper treatment. Certain myopathies call for cardiac or respiratory screening.

  6. Bilateral Sciatic Neuropathy after an Autologous Breast Reconstruction in a Massive Weight Loss Patient

    PubMed Central

    Ablavsky, Michael; Shteynberg, Aleksandr

    2017-01-01

    Summary: Perioperative compression neuropathy is a known potential complication of prolonged surgical procedures. Sciatic postoperative neuropathy has rarely been reported. We present a 34-year-old woman who underwent right breast reconstruction with supercharged (venous anastomosis) transverse rectus abdominis flap and developed bilateral sciatic compression neuropathy. Her history was remarkable for sleeve gastrectomy 2 years earlier resulting in 105 pound weight loss 1 year before breast reconstruction. During the procedure, the patient was in the supine position for 8 hours and in the semirecumbent position for an additional 2 hours with the torso flexed at 30 degrees and knees flexed at approximately 45 degrees in addition to standard padding. Postoperatively, the patient was found to have loss of sensation and motor paralysis distal to her knees bilaterally. Pain sensation was preserved distally and no other neurological abnormalities were noted. Laboratory tests, magnetic resonance imaging, electromyography, and nerve conduction studies all revealed no evidence of neurological lesions and peroneal or lumbosacral radiculopathy. Motor strength gradually returned to her lower extremities over 4–5 weeks, whereas sensory function continued to improve over 7 weeks. The patient had complete neurological recovery 2 months postoperatively. PMID:28203505

  7. Tarlov cysts: clinical evaluation of an italian cohort of patients.

    PubMed

    Marino, D; Carluccio, M A; Di Donato, I; Sicurelli, F; Chini, E; Di Toro Mammarella, L; Rossi, F; Rubegni, A; Federico, A

    2013-09-01

    Tarlov cyst syndrome is a rare, often asymptomatic disorder, characterised by isolated or multiple nerve-root cysts, usually occurring in the sacral spine, near the dorsal root ganglion, between the perineurium and endoneurium. The cysts may cause lower back pain, sacral radiculopathy, dyspareunia and urinary incontinence. There is little data in the literature on the relationship between Tarlov cysts and symptoms. Here, we report further details on the clinical impact of Tarlov cysts and investigate their pathogenesis and role as a cause of lumbosacral symptoms. We examined 157 patients with MRI evidence of symptomatic Tarlov cysts. Patients underwent complete neurological examination and were scored by the Hamilton Depression Rating Scale and the Visual Analogue Scale. Complete lower limb electromyography was performed in 32 patients. Clinical picture was correlated with size and number of cysts detected by MRI. Family history was recorded for signs of genetic inheritance. Almost all patients suffered perineal or lower back pain; 34 complained of sphincter and 46 of sexual disorders. Hamilton scores were abnormal, and family history was positive in a few cases. The scanty literature on Tarlov cysts mainly regards therapy by a neurosurgical approach. Our results provide new data on clinical impact and possible pathogenetic mechanisms.

  8. Bilateral Vocal Cord Paralysis and Cervicolumbar Radiculopathy as the Presenting Paraneoplastic Manifestations of Small Cell Lung Cancer: A Case Report and Literature Review

    PubMed Central

    Pringle, C. Elizabeth; Sekhon, Harmanjatinder S.; Macdonald, Kristian

    2016-01-01

    Introduction. Bilateral vocal cord paralysis (BVCP) is a potential medical emergency. The Otolaryngologist plays a crucial role in the diagnosis and management of BVCP and must consider a broad differential diagnosis. We present a rare case of BVCP secondary to anti-Hu paraneoplastic syndrome. Case Presentation. A 58-year-old female presented to an Otolaryngology clinic with a history of progressive hoarseness and dysphagia. Flexible nasolaryngoscopy demonstrated BVCP. Cross-sectional imaging of the brain and vagus nerves was negative. An antiparaneoplastic antibody panel was positive for anti-Hu antibodies. This led to an endobronchial biopsy of a paratracheal lymph node, which confirmed the diagnosis of small cell lung cancer. Conclusion. Paraneoplastic neuropathy is a rare cause of BVCP and should be considered when more common pathologies are ruled out. This is the second reported case of BVCP as a presenting symptom of paraneoplastic syndrome secondary to small cell lung cancer. PMID:27668114

  9. Herniated disk

    MedlinePlus

    Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; Slipped disk; Ruptured disk; Herniated nucleus pulposus: Low back pain - herniated disk; LBP - herniated disk; Sciatica - herniated disk; Herniated disk

  10. Tubercular Spinal Epidural Abscess of the Lumbosacral Region without Osseous Involvement: Comparison of Spinal MRI and Pathological Findings of the Resected Tissue.

    PubMed

    Zhang, QingLong; Koga, Hisashi

    2016-01-01

    We herein present a case of tubercular spinal epidural abscess (SEA) without osseous involvement that mimicked an acute bacterial abscess. This case manifested quite unusual findings not only radiographically, but also clinically compared with previously reported cases of tubercular SEA.

  11. Alleviating Autonomic Dysreflexia after Spinal Cord Injury

    DTIC Science & Technology

    2015-10-01

    develop from 1) aberrant plasticity and 2) the loss of tonic input onto sympathetic preganglionic neurons (SPN) in the spinal cord that drive...life. Another cause of autonomic dysreflexia is aberrant plasticity of spinal circuits that increase activity of the sympathetic preganglionic neurons...modulatory circuitry and pharmacological mitigation of hyperexcitability resulting from aberrant plasticity will result in greater mitigation of

  12. MRI and low back pain

    MedlinePlus

    Backache - MRI; Low back pain - MRI; Lumbar pain - MRI; Back strain - MRI; Lumbar radiculopathy - MRI; Herniated intervertebral disk - MRI; Prolapsed intervertebral disk - MRI; Slipped disk - MRI; Ruptured ...

  13. The effects on postural control and low back pain according to the types of orthoses in chronic low back pain patients

    PubMed Central

    Kang, Jeong-Il; Kwon, Hye-Min; Jeong, Dae-Keun; Choi, Hyun; Moon, Young-Jun; Park, Jun-Su

    2016-01-01

    [Purpose] This study investigated how types of lumbosacral orthoses applied to patients with chronic lumbar pain affect postural control and low back pain. [Subjects and Methods] Ten subjects were randomly selected and allocated to each a group wearing soft lumbosacral orthoses and a group wearing rigid lumbosacral orthoses. They wore the lumbosacral orthoses for 4 weeks. Pain index and postural control were measured on the first day of wearing lumbosacral orthoses and 4 weeks later. Pain index was evaluated using a visual analogue scale, and postural control was measured using a Balance measurement system. The measurements examined included the overall balance index, anteroposterior balance index, and mediolateral balance index. [Results] There were statistically meaningful within-group differences in all variables, the visual analogue scale, overall balance index, anteroposterior balance index, and mediolateral balance index, in the group wearing soft lumbosacral orthoses. There were meaningful differences in visual analogue scale, overall balance index, and mediolateral balance index in the group wearing rigid lumbosacral orthoses. Furthermore, there was a meaningful difference in anteroposterior balance index between the group wearing soft lumbosacral orthoses and the group wearing rigid lumbosacral orthoses. [Conclusion] The results of the present study showed that wearing soft lumbosacral orthoses was more effective than wearing rigid lumbosacral orthoses. PMID:27942123

  14. Segmental origins of cardiac sympathetic nerve activity in rats.

    PubMed

    Pracejus, Natasha H; Farmer, David G S; McAllen, Robin M

    2015-01-01

    The segmental origins of cardiac sympathetic nerve activity (CSNA) were investigated in 8 urethane-anesthetized, artificially ventilated rats. The left upper thoracic sympathetic chain was exposed retropleurally after removing the heads of the second to fourth ribs. The preganglionic inputs to the chain from segments T1-T3 and the trunk distal to T3 were marked for later sectioning. CSNA was recorded conventionally, amplified, rectified and smoothed. Its mean level was quantified before and after each preganglionic input was cut, usually in rostro-caudal sequence. The level after all inputs were cut (i.e. noise and residual ECG pickup) was subtracted from previous measurements. The signal decrement from cutting each preganglionic input was then calculated as a percentage. CSNA in all rats depended on preganglionic drive from two or more segments, which were not always contiguous. Over the population, most preganglionic drive came from T3 and below, while the least came from T1. But there was striking inter-individual variation, such that the strongest drive to CSNA in any one rat could come from T1, T2, T3, or below T3. These findings provide new functional data on the segmental origins of CSNA in rats.

  15. Faun tail: a rare cutaneous sign of spinal dysraphism.

    PubMed

    Kurtipek, Gülcan Saylam; Cihan, Fatma Göksin; Öner, Vefa; Ataseven, Arzu; Özer, İlkay; Akman, Zahide

    2015-01-01

    Faun tail is a triangle-shaped hypertrichosis of the lumbosacral region. It is a rare condition and it can be a cutaneous marker of underlying spinal cord anomaly. We report on a 17-year-old female patient with hypertrichosis on the lumbosacral area since birth that was later diagnosed with tethered cord in magnetic resonance imaging.

  16. Association of Transcutaneous Electrical Nerve Stimulation and Hypnosis

    ClinicalTrials.gov

    2016-06-16

    Limbs Arthrosis; Non Arthrosic Limbs Arthralgia; Chronic Lomboradiculalgia; Chronic Back Pain; Cervical Radiculopathy; Post-herpetic Neuralgia; Post-surgical Peripheral Neuropathic Pain; Post Trauma Neuropathic Pain; Complex Regional Pain Syndrome Type I or II; Tendinopathy

  17. Antidepressants: Another Weapon Against Chronic Pain

    MedlinePlus

    ... injury, stroke, radiculopathy) Tension headache Migraine Facial pain Fibromyalgia Low back pain Pelvic pain The painkilling mechanism ... or excessive sweating. Milnacipran is used to relieve fibromyalgia pain and can cause side effects, such as ...

  18. Sciatica

    MedlinePlus

    Neuropathy - sciatic nerve; Sciatic nerve dysfunction; Low back pain - sciatica; LBP - sciatica; Lumbar radiculopathy - sciatica ... right away if you have: Unexplained fever with back pain Back pain after a severe blow or fall ...

  19. Centrally evoked increase in adrenal sympathetic outflow elicits immediate secretion of adrenaline in anaesthetized rats.

    PubMed

    Tsuchimochi, Hirotsugu; Nakamoto, Tomoko; Matsukawa, Kanji

    2010-01-01

    To examine whether feedforward control by central command activates preganglionic adrenal sympathetic nerve activity (AdSNA) and releases catecholamines from the adrenal medulla, we investigated the effects of electrical stimulation of the hypothalamic locomotor region on preganglionic AdSNA and secretion rate of adrenal catecholamines in anaesthetized rats. Pre- or postganglionic AdSNA was verified by temporary sympathetic ganglionic blockade with trimethaphan. Adrenal venous blood was collected every 30 s to determine adrenal catecholamine output and blood flow. Hypothalamic stimulation for 30 s (50 Hz, 100-200 microA) induced rapid activation of preganglionic AdSNA by 83-181% depending on current intensity, which was followed by an immediate increase of 123-233% in adrenal adrenaline output. Hypothalamic stimulation also increased postganglionic AdSNA by 42-113% and renal sympathetic nerve activity by 94-171%. Hypothalamic stimulation induced preferential secretion of adrenal adrenaline compared with noradrenaline, because the ratio of adrenaline to noradrenaline increased greatly during hypothalamic stimulation. As soon as the hypothalamic stimulation was terminated, preganglionic AdSNA returned to the prestimulation level in a few seconds, and the elevated catecholamine output decayed within 30-60 s. Adrenal blood flow and vascular resistance were not affected or slightly decreased by hypothalamic stimulation. Thus, it is likely that feedforward control of catecholamine secretion from the adrenal medulla plays a role in conducting rapid hormonal control of the cardiovascular system at the beginning of exercise.

  20. Melatonin, the Pineal Gland, and Circadian Rhythms

    DTIC Science & Technology

    1993-05-31

    temperature and sleep rhyhms in the rat. Physlol. Behav. 32: 357-368, 1984. 19. Edgar , D. M., and C. A. Fuller. Effect of SCN lesions on sleep in...Reuss, S., R. F. Johnson, L. P. Morin , and R. Y. Moore. Localization of sympathetic preganglionic neurons in the spinal cord of the goldm hamste. hrin

  1. [Functional alterations in the retina following a 10 Gy gamma irradiation localized in the eye].

    PubMed

    Bagot, J D; Courant, D; Court, L

    1980-11-17

    A single-eye irradiation of 10 Gy (0.8 Gy. min-1) induces impairments of the electrical responses of the rabbit retina in dark adaptation. These are associated with reversible alteration of the photoreceptors and the preganglionic neurons and a disturbance of all the mechanisms of adaptation. Possible relationships between these functional alterations and the effects of irradiation are discussed.

  2. Guidelines for use of lumbar spine radiography

    SciTech Connect

    Kelen, G.D.; Noji, E.K.; Doris, P.E.

    1986-03-01

    In deciding whether to obtain lumbosacral spine films, the emergency physician must not ask whether a diagnosis can be established, but whether obtaining films will affect management. Low back pain is a considerable problem for society with cost in billions of dollars. Gonadal radiation from lumbosacral radiographs is significant, and thus ordering films should be minimized. Plain radiographs are rarely indicated in otherwise healthy patients 20 to 50 years old with mechanical or root pain on initial presentation. In other patients alternative diagnostic methodologies such as computed tomography may be superior, with less radiation risk. Specific recommendations for emergency radiographic evaluation of the lumbosacral spine are offered.68 references.

  3. Tri-Service Disability Evaluation Systems Database Analysis and Research. Annual Report 2011

    DTIC Science & Technology

    2011-12-28

    unfitting condition, and analogous coding that also utilizes a VASRD code that best approximates the functional impairment rendered by a medical...Lumbosacral or cervical strain 560 10.0 5237: Lumbosacral or cervical strain 139 12.8 5262: Tibula and Fibula, Impairment of 354 6.3 5024...Musculoskeletal analogous code 103 3.0 9304: Dementia due to brain trauma 528 2.8 5024: Tenosynovitis 86 2.5 5262: Tibula and Fibula, Impairment

  4. Neurogenic muscle hypertrophy in a 12-year-old girl.

    PubMed

    Zutelija Fattorini, Matija; Gagro, Alenka; Dapic, Tomislav; Krakar, Goran; Marjanovic, Josip

    2017-01-01

    Muscular hypertrophy secondary to denervation is very rare, but well-documented phenomena in adults. This is the first report of a child with neurogenic unilateral hypertrophy due to S1 radiculopathy. A 12-year-old girl presented with left calf hypertrophy and negative history of low back pain or trauma. The serum creatinine kinase level and inflammatory markers were normal. Magnetic resonance imaging showed muscle hypertrophy of the left gastrocnemius and revealed a protruded lumbar disc at the L5-S1 level. The protruded disc abuts the S1 root on the left side. Electromyography showed mild left S1 radiculopathy. Passive stretching and work load might clarify the origin of neurogenic hypertrophy but there is still a need for further evidence. Clinical, laboratory, magnetic resonance imaging and electromyography findings showed that S1 radiculopathy could be a cause of unilateral calf swelling in youth even in the absence of a history of back or leg pain.

  5. Fractures of the articular processes of the cervical spine

    SciTech Connect

    Woodring, J.H.; Goldstein, S.J.

    1982-08-01

    Fractures of the articular processes occurred in 16 (20.8%) of 77 patients with cervical spine fractures as demonstrated by multidirectional tomography. Plain films demonstrated the fractures in only two patients. Acute cervical radiculopathy occurred in five of the patients with articular process fractures (superior process, two cases; inferior process, three cases). Persistent neck pain occurred in one other patient without radiculopathy. Three patients suffered spinal cord damage at the time of injury, which was not the result of the articular process fracture itself. In the other seven cases, no definite sequelae occurred. However, disruption of the facet joint may predispose to early degenerative joint disease and chronic pain; unilateral or bilateral facet dislocation was present in five patients. In patients with cervical trauma who develop cervical radiculopathy, tomography should be performed to evaluate the articular processes.

  6. Lumbar discal cyst with spontaneous regression and subsequent occurrence of lumbar disc herniation.

    PubMed

    Takeshima, Yasuhiro; Takahashi, Toshiyuki; Hanakita, Junya; Watanabe, Mizuki; Kitahama, Yoshihiro; Kuraishi, Keita; Uesaka, Toshio; Minami, Manabu; Nakase, Hiroyuki

    2011-01-01

    A 39-year-old man presented with an extremely rare discal cyst at the L3-4 level manifesting as a left L4 radiculopathy. Two months after onset, he suffered right L4 radiculopathy with new lumbar disc protrusion. Five months after medical treatment, the patient's symptoms improved, and the discal cyst showed complete regression on magnetic resonance imaging. Most cases of discal cyst are surgically treated, with only two previous cases of spontaneous regression. The present case suggests clinical and radiological recovery of symptomatic lumbar discal cyst can be obtained by only conservative therapy.

  7. 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

  8. The Natural History and Clinical Syndromes of Degenerative Cervical Spondylosis

    PubMed Central

    Kelly, John C.; Groarke, Patrick J.; Butler, Joseph S.; Poynton, Ashley R.; O'Byrne, John M.

    2012-01-01

    Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal can result in spinal cord compression, ultimately resulting in cervical spondylosis myelopathy. This review article examines the current literature in relation to the cervical spondylosis and describes the three clinical syndromes of axial neck pain, cervical radiculopathy and cervical myelopathy PMID:22162812

  9. Degeneration and regeneration in the superior cervical sympathetic ganglion after Latrodectus venom.

    PubMed

    Daniel, S E

    1989-06-01

    The effects of the venom of the spider Latrodectus mactans hasselti on the superior cervical ganglion were studied in the guinea pig. Under anaesthesia the ganglion was bathed in venom solution for 15 min. Shortly afterwards animals salivated profusely and later developed unilateral ptosis and enophthalmos. Postoperative survival times ranged from 15 min to 10 weeks. Electron microscopy showed acute swelling of preganglionic cholinergic nerve terminals, followed by degeneration with separation of synapses. Other ganglionic elements appeared to be undamaged, although after detachment of synapses the dendritic postsynaptic specializations were reduced in number. Recovery was very rapid; axon growth cones were identifiable at 18 h and synapse reformation was well established by 2 weeks. With longer survival times there was progressive restoration of normal morphology such that by 8 weeks regeneration appeared complete. These experiments indicate that the preganglionic cholinergic nerve terminals are selectively affected by Latrodectus venom and have a considerable capacity for appropriate regeneration.

  10. The Effects of False Physiological Feeback, on Sexual Arousal in Sexually Functional and Dysfunctional Men

    DTIC Science & Technology

    2004-03-31

    majority of neurologically based erection problems are due to spinal cord injury (Murray, Geisser and Murphy, 1995). The nature, location, and extent...explanations tended to focus on physiological or neurological problems such as treated hypertension, spinal injury , diabetes mellitus, and vascular...cholinergic preganglionic neurons residing within the sacral spinal cord (S2-S4) (Boyle, 1999) (Figure 5). Sympathetic nervous stimulation of the cavernous

  11. Identification of autonomic neuronal chains innervating gingiva and lip.

    PubMed

    Szabó, E; Csáki, Á; Boldogkői, Zs; Tóth, Zs; Köves, K

    2015-07-01

    The major goals of this present study were 1) to further clarify which parasympathetic ganglion sends postganglionic fibers to the lower gingiva and lip that may be involved in the inflammatory processes besides the local factors; 2) to separately examine the central pathways regulating sympathetic and parasympathetic innervation; and 3) to examine the distribution of central premotor neurons on both sides. A retrogradely transported green fluorescent protein conjugated pseudorabies virus was injected into the lower gingiva and lip of intact and sympathectomized adult female rats. Some animals received virus in the adrenal medulla which receive only preganglionic sympathetic fibers to separately clarify the sympathetic nature of premotor neurons. After 72-120h of survival and perfusion, the corresponding thoracic part of the spinal cord, brainstem, hypothalamus, cervical, otic, submandibular and trigeminal ganglia were harvested. Frozen sections were investigated under a confocal microscope. Green fluorescence indicated the presence of the virus. The postganglionic sympathetic neurons related to both organs are located in the three cervical ganglia, the preganglionic neurons in the lateral horn of the spinal cord on ipsilateral side; premotor neurons were found in the ventrolateral medulla, locus ceruleus, gigantocellular and paraventricular nucleus and perifornical region in nearly the same number on both sides. The parasympathetic postganglionic neurons related to the gingiva are present in the otic and related to the lip are present in the otic and submandibular ganglia and the preganglionic neurons are in the salivatory nuclei. Third order neurons were found in the gigantocellular reticular and hypothalamic paraventricular nuclei and perifornical area.

  12. Maintenance Manual for NATICK’s Footwear Database

    DTIC Science & Technology

    1992-01-01

    radiculopathy; metatarsal stress fracture (calcaneal stress fractures are rare); tarsal tunnel syndrome ; gout; Reiter’s disease; ankylosing... syndrome plantar fascia crush injury foot injury BIOMECHANICS foot powder/antiperspirants barefoot adaptation fracture biomechanics friction blister...electromyography frost bite energy transfer iliotibial band syndrome load injury modelling injury rates sensory attenuation knee injury lower extremity

  13. Spinal hydatid with meralgia paresthetica in a female: A rare case report

    PubMed Central

    Lonkar, Yeshwant; Amale, Amar; Acharya, Sourya; Banode, Pankaj; Yeola, Meenakshi

    2012-01-01

    Meralgia paresthetica presents as tingling sensation in the antero-lateral aspect of thigh. It occurs due to compression of the lateral cutaneous nerve of thigh. Proximal spinal lesions may present as meralgia paresthetica due to radiculopathy. We present a rare case of spinal hydatid with meralgia paresthetica. PMID:24082690

  14. Preliminary Derivation of Test Item Clusters for Predicting Injuries, Poor Physical Performance, and Overall Attrition in Basic Combat Training

    DTIC Science & Technology

    2006-12-01

    examination and patient self-report measures for cervical radiculopathy. Spine. Jan 1 2003;28(1):52-62. 36 11. Wainner RS, Fritz JM, Irrgang JJ...foot orthosis use and modified activity: a preliminary investigation. Phys Ther. Jan 2004;84(1):49-61. 18. Solomon DH, Avorn J, Warsi A, et al

  15. Pseudarthrosis of the Cervical Spine: Risk Factors, Diagnosis and Management

    PubMed Central

    Leven, Dante

    2016-01-01

    Cervical myelopathy and radiculopathy are common pathologies that often improve with spinal decompression and fusion. Postoperative complications include pseudarthrosis, which can be challenging to diagnose and manage. We reviewed the literature with regard to risk factors, diagnosis, controversies, and management of cervical pseudarthrosis. PMID:27559462

  16. [Blood circulation of cauda equina and nerve root].

    PubMed

    Kobayashi, Shigeru; Baba, Hisatoshi; Uchida, Kenzo; Kokubo, Yasuo; Yayama, Takafumi; Takeno, Kenichi; Negoro, Kohei

    2005-03-01

    It is generally considered that the genesis of radiculopathy associated with pathologic conditions of the spine, such as lumbar disc herniaton and lumbarl canal stenosis, may result from both mechanical compression and vascular problems. In this article, we have reviewed about the blood circulation of cauda equina and nerve root under normal and pathologic conditions.

  17. Spontaneous hemorrhage into a lumbar synovial cyst

    PubMed Central

    Alen, Jose F.; Ramos, Ana; Lobato, Ramiro D.; Lagares, Alfonso

    2010-01-01

    Lumbar synovial cysts frequently present with back pain, chronic radiculopathy and/or progressive symptoms of spinal canal compromise. These cysts generally appear in the context of degenerative lumbar spinal disease. Few cases of spontaneous hemorrhage into synovial cysts have been reported in the literature. PMID:20174835

  18. [Diabetic neuropathy].

    PubMed

    Lechleitner, Monika; Abrahamian, Heidemarie; Francesconi, Claudia; Kofler, Markus

    2016-04-01

    These are the guidelines for diagnosis and treatment of diabetic neuropathy. This diabetic late complication comprises a number of mono- and polyneuropathies, plexopathies, radiculopathies and autonomic neuropathy. The position statement summarizes characteristic clinical symptoms and techniques for diagnostic assessment of diabetic neuropathy. Recommendations for the therapeutic management of diabetic neuropathy, especially for the control of pain in sensorimotor neuropathy, are provided.

  19. A Prospective Investigation of Injury Incidence and Risk Factors Among Army Recruits in Combat Engineer Training

    DTIC Science & Technology

    2013-03-05

    neuropathy , radiculopathy, shin splints, synovitis, sprains, strains, and musculoskeletal pain (not otherwise specified). Recruits that attrited from...between body weight, body fat, and abdominal fat in occupational standards. Diabetes Technol Ther 2004, 6:732–749. 46. Cureton KJ: Effects of

  20. Postlaminectomy Bilateral Lumbar Intraspinal Synovial Cysts

    PubMed Central

    Cho, Sung Ik; Lee, Jung Hwan

    2016-01-01

    Lumbar intraspinal synovial cysts are included in the difference diagnosis of lumbar radiculopathy. Developing imaging modalities has result in increased reporting about these lesions. However, the case of bilateral new lumbar intraspinal synovial cysts after laminectomy has been rarely reported. We report of a rare case with bilateral lumbar intraspinal synovial cysts after laminectomy, requiring surgical excision. PMID:27799997

  1. A sacro-caudal spinal cord choroid plexus papilloma in a shar-pei dog.

    PubMed

    Giannuzzi, A Pasquale; Gernone, F; Ricciardi, M; De Simone, A; Mandara, M Teresa

    2013-10-01

    A seven-year-old shar-pei dog was referred because of severe lumbosacral pain and faecal incontinence of 20 days' duration. Neurological examination was characterised by plegic tail, absence of perineal reflex, dilated anus, perineum and tail analgesia, and severe lumbosacral pain. The neurological clinical signs were suggestive of a selective lesion involving sacral and caudal spinal cord segments and/or related nerve roots. A magnetic resonance imaging of lumbosacral spine was performed and was suggestive of an intradural lesion. Primary or secondary neoplasia was considered as the most probable differential diagnosis. The dog was euthanased upon the owner's request. Histopathological examination confirmed the presence of an intradural-extramedullary neoplastic tissue enveloping intradural tract of spinal nerve roots. On the basis of histological and immunohistochemical findings, a diagnosis of well-differentiated choroid plexus papilloma was made. To the authors's knowledge, this is the first case of primary or metastatic spinal choroid plexus papilloma in dogs.

  2. Healthcare Coverage and Disability Evaluation for Reserve Component Personnel: Research for the 11th Quadrennial Review of Military Compensation

    DTIC Science & Technology

    2012-01-01

    organ condition 6000–6299 608 4 29 Skin condition 7800–7899 433 4 30 Lumbosacral or cervical strain 5237 2,366 3 31 Spinal fusion 5241 1,188 5 32...1.7 Lumbosacral or cervical strain 6.8 7.8 7.5 11.7 Spinal fusion 2.5 5.5 3.2 7.6 Degenerative arthritis 4.5 8.3 6.4 12.1 Intervertebral disc...to allowing more time for recovery before a final disability determina- tion is made (Office of the Under Secretary of Defense [Personnel and

  3. An electron microscopic study on nerve endings on adrenomedullary adrenaline cells in golden hamsters: position, size and changes due to pinealectomy.

    PubMed

    Yamauchi, Takao; Kachi, Takashi

    2008-09-01

    Effects of sham-pinealectomy and pinealectomy on preganglionic nerve endings on adrenomedullary adrenaline cells were investigated electron microscopically. Adult male golden hamsters from the normal, sham-pinealectomy and pinealectomy groups maintained under 24 h light-dark cycle and constant temperature were used at 28 days after surgery. From conventional electron microscopic specimens, montage photographs made of the adrenaline cell region at a magnification of x 11,000 were used for qualitative and quantitative electron microscopic analyses in 14 animals in each experimental group. The preganglionic nerve endings were localized mainly in the following three sites: the basal lamina part, the follicular lumen-junctional intercellular part, and the adrenaline cell-invaginated part. In the latter two parts, nerve endings and fibers had no envelope frequently, and in the former two parts, nerve endings sometimes showed the invagination complex. The frequency of nerve endings was highest in the follicular lumen-intercellular part, next highest in the basal lamina part and lowest in the A cell-invaginated part. The frequency of nerve endings in the basal lamina part was lower in the pinealectomy group than in the sham-pinealectomy group (P < 0.021), and those in the other two parts showed opposite changes, more evidently in the A cell-invaginated part. Nerve ending profiles in the adrenaline cell-invaginated part--which displayed a more rounded shape--increased in size in the pinealectomy group (longer diameter: P < 0.04; shorter diameter: P < 0.05). In conclusion, preganglionic nerve endings in the adrenal medulla of the golden hamster show differential morphological changes following PX depending on the intracellular part of A cells.

  4. Origins of the vagal drive controlling left ventricular contractility

    PubMed Central

    Machhada, Asif; Marina, Nephtali; Korsak, Alla; Stuckey, Daniel J.; Lythgoe, Mark F.

    2016-01-01

    Key points The strength, functional significance and origins of parasympathetic innervation of the left ventricle remain controversial.This study tested the hypothesis that parasympathetic control of left ventricular contractility is provided by vagal preganglionic neurones of the dorsal motor nucleus (DVMN).Under β‐adrenoceptor blockade combined with spinal cord (C1) transection (to remove sympathetic influences), systemic administration of atropine increased left ventricular contractility in rats anaesthetized with urethane, confirming the existence of a tonic inhibitory muscarinic influence on cardiac inotropy.Increased left ventricular contractility in anaesthetized rats was observed when DVMN neurones were silenced.Functional neuroanatomical mapping revealed that vagal preganglionic neurones that have an impact on left ventricular contractility are located in the caudal region of the left DVMN.These neurones provide functionally significant parasympathetic control of left ventricular inotropy. Abstract The strength, functional significance and origins of direct parasympathetic innervation of the left ventricle (LV) remain controversial. In the present study we used an anaesthetized rat model to first confirm the presence of tonic inhibitory vagal influence on LV inotropy. Using genetic neuronal targeting and functional neuroanatomical mapping we tested the hypothesis that parasympathetic control of LV contractility is provided by vagal preganglionic neurones located in the dorsal motor nucleus (DVMN). It was found that under systemic β‐adrenoceptor blockade (atenolol) combined with spinal cord (C1) transection (to remove sympathetic influences), intravenous administration of atropine increases LV contractility in rats anaesthetized with urethane, but not in animals anaesthetized with pentobarbital. Increased LV contractility in rats anaesthetized with urethane was also observed when DVMN neurones targeted bilaterally to express an inhibitory Drosophila

  5. PACAP signaling exerts opposing effects on neuroprotection and neuroinflammation during disease progression in the SOD1(G93A) mouse model of amyotrophic lateral sclerosis☆

    PubMed Central

    Ringer, Cornelia; Büning, Luisa-Sybille; Schäfer, Martin K.H.; Eiden, Lee E.; Weihe, Eberhard; Schütz, Burkhard

    2014-01-01

    Pituitary adenylate cyclase-activating polypeptide (PACAP) is a pleiotropic peptide with autocrine neuroprotective and paracrine anti-inflammatory properties in various models of acute neuronal damage and neurodegenerative diseases. Therefore, we examined a possible beneficial role of endogenous PACAP in the superoxide dismutase 1, SOD1(G93A), mouse model of amyotrophic lateral sclerosis (ALS), a lethal neurodegenerative disease particularly affecting somatomotor neurons. In wild-type mice, somatomotor and visceromotor neurons in brain stem and spinal cord were found to express the PACAP specific receptor PAC1, but only visceromotor neurons expressed PACAP as a potential autocrine source of regulation of these receptors. In SOD1(G93A) mice, only a small subset of the surviving somatomotor neurons showed induction of PACAP mRNA, and somatomotor neuron degeneration was unchanged in PACAP-deficient SOD1(G93A) mice. Pre-ganglionic sympathetic visceromotor neurons were found to be resistant in SOD1(G93A) mice, while pre-ganglionic parasympathetic neurons degenerated during ALS disease progression in this mouse model. PACAP-deficient SOD1(G93A) mice showed even greater pre-ganglionic parasympathetic neuron loss compared to SOD1(G93A) mice, and additional degeneration of pre-ganglionic sympathetic neurons. Thus, constitutive expression of PACAP and PAC1 may confer neuroprotection to central visceromotor neurons in SOD1(G93A) mice via autocrine pathways. Regarding the progression of neuroinflammation, the switch from amoeboid to hypertrophic microglial phenotype observed in SOD1(G93A) mice was absent in PACAP-deficient SOD1(G93A) mice. Thus, endogenous PACAP may promote microglial cytodestructive functions thought to drive ALS disease progression. This hypothesis was consistent with prolongation of life expectancy and preserved tongue motor function in PACAP-deficient SOD1(G93A) mice, compared to SOD1(G93A) mice. Given the protective role of PACAP expression in

  6. Incoming synapses and size of small granule-containing cells in a rat sympathetic ganglion after post-ganglionic axotomy.

    PubMed Central

    Case, C P; Matthews, M R

    1986-01-01

    A quantitative ultrastructural study has been made of the reaction of the incoming synapses of small granule-containing cells after axotomy of the major post-ganglionic branches of the superior cervical ganglion of the young adult rat. These cells are intrinsic and interneurone-like in this ganglion, receiving a preganglionic input and giving outgoing synapses to principal post-ganglionic neurones. Unlike their outgoing synapses, which are lost after post-ganglionic axotomy (Case & Matthews, 1986), the incoming synapses of the small granule-containing cells in axotomized ganglia increased in incidence post-operatively. The increase first became clearly evident 5-7 days post-operatively and was greater, being both more sustained and progressive, after bilateral than after unilateral axotomy. After bilateral axotomy the incidence of incoming synapses rose to more than four times that of normal ganglia and was still elevated at 128 days post-operatively, but was within normal limits at 390 days. After a unilateral lesion, increases of similar extent and time course to those in the axotomized ganglia were seen in the incoming synapses of small granule-containing cells in the uninjured contralateral ganglia. The incoming synapses of the small granule-containing cells are multifocal, i.e. show several points or active foci of synaptic specialization. The increase in synapses expressed itself both through an increased incidence of these synaptic active foci per nerve terminal and through an increase in the number of presynaptic nerve terminal profiles associated with the cells. Control observations indicated that the increase in synapses was not due to surgical stress, nor was it attributable solely to post-operative ageing. The nerve terminals which were presynaptic to the small granule-containing cells post-operatively were all of preganglionic origin: no incoming synapses or presynaptic nerve terminals remained at 2 days after a preganglionic denervation of axotomized

  7. Anorgasmia in anterior spinal cord syndrome.

    PubMed

    Berić, A; Light, J K

    1993-05-01

    Three male and two female patients with anorgasmia and dissociated sensory loss due to an anterior spinal cord syndrome are described. Clinical, neurophysiological and quantitative sensory evaluation revealed preservation of the large fibre dorsal column functions from the lumbosacral segments with concomitant severe dysfunction or absence of the small fibre neospinothalamic mediated functions. These findings indicate a role for the spinothalamic system in orgasm.

  8. Managing low back pain second edition

    SciTech Connect

    Kirkaldy-Willis, W.H. )

    1988-01-01

    This book contains 26 chapters. Some of the titles are: Magnetic resonance imaging of the lumbar spine; Diagnostic techniques; The site and nature of the lesion; The anatomy of the lumbosacral spine; The perception of pain; Differential diagnosis of low back pain; and A comprehensive outline of treatment.

  9. The effects of a simple intervention on exposures to low back pain risk factors during traditional posterior load carriage.

    PubMed

    Muslim, Khoirul; Nussbaum, Maury A

    2017-03-01

    Traditional posterior load carriage (PLC), typically performed without the use of an assistive device, is associated with a high prevalence of low back pain (LBP). However, there are few studies that have evaluated potential interventions to reduce exposures to LBP risk factors. This work examined the effects of a simple, potentially low-cost intervention using an assistive device (i.e., carrying aid) on exposures to factors related to LBP risk during PLC. Torso kinematics and kinetics, slip risk, and ratings of perceived discomfort (RPD) were obtained during simulated PLC on a walkway. Consistent with earlier results, increasing load mass substantially increased torso flexion and lumbosacral flexion moment, as well as RPDs in all anatomical regions evaluated. Using the carrying aid with a higher load placement resulted in substantially lower mean lumbosacral moments when carrying the heaviest load. In contrast, using the carrying aid with a lower load placement resulted in substantially higher torso flexion angles, higher mean lumbosacral moments when carrying heavier loads, and higher peak lumbosacral moments across all load masses. With use of the carrying aid, both higher and lower load placement resulted in significantly lower RPDs in the elbows and hands compared to the control condition. In summary, use of a carrying aid with higher load placement may be beneficial in reducing the risk of LBP during PLC. Future studies are needed, though, to improve the device design and to enhance external validity.

  10. Spinal alignment evolution with age: A prospective gait analysis study

    PubMed Central

    Pesenti, Sébastien; Blondel, Benjamin; Peltier, Emilie; Viehweger, Elke; Pomero, Vincent; Authier, Guillaume; Fuentes, Stéphane; Jouve, Jean-Luc

    2017-01-01

    AIM To describe, using gait analysis, the development of spinal motion in the growing child. METHODS Thirty-six healthy children aged from 3 to 16 years old were included in this study for a gait analysis (9 m-walk). Various kinematic parameters were recorded and analyzed such as thoracic angle (TA), lumbar angle (LA) and sagittal vertical axis (SVA). The kinetic parameters were the net reaction moments (N.m/kg) at the thoracolumbar and lumbosacral junctions. RESULTS TA and LA curves were not statistically correlated to the age (respectively, P = 0.32 and P = 0.41). SVA increased significantly with age (P < 0.001). Moments in sagittal plane at the lumbosacral junction were statistically correlated to the age (P = 0.003), underlining the fact that sagittal mechanical constraints at the lumbosacral junction increase with age. Moments in transversal plane at the thoracolumbar and lumbosacral junctions were statistically correlated to the age (P = 0.0002 and P = 0.0006), revealing that transversal mechanical constraints decrease with age. CONCLUSION The kinetic analysis showed that during growth, a decrease of torsional constraint occurs while an increase of sagittal constraint is observed. These changes in spine biomechanics are related to the crucial role of the trunk for bipedalism acquisition, allowing stabilization despite lower limbs immaturity. With the acquisition of mature gait, the spine will mainly undergo constraints in the sagittal plane. PMID:28361018

  11. Gross anatomical study of the nerve supply of genitourinary structures in female mongrel hound dogs.

    PubMed

    Gomez-Amaya, S M; Ruggieri, M R; Arias Serrato, S A; Massicotte, V S; Barbe, M F

    2015-04-01

    Anatomical variations in lumbosacral plexus or nerves to genitourinary structures in dogs are under described, despite their importance during surgery and potential contributions to neuromuscular syndromes. Gross dissection of 16 female mongrel hound dogs showed frequent variations in lumbosacral plexus classification, sympathetic ganglia, ventral rami input to nerves innervating genitourinary structures and pudendal nerve (PdN) branching. Lumbosacral plexus classification types were mixed, rather than pure, in 13 (82%) of dogs. The genitofemoral nerve (GFN) originated from ventral ramus of L4 in 67% of nerves, differing from the expected L3. Considerable variability was seen in ventral rami origins of pelvic (PN) and Pd nerves, with new findings of L7 contributions to PN, joining S1 and S2 input (23% of sides in 11 dogs) or S1-S3 input (5%), and to PdN, joining S1-S2, unilaterally, in one dog. L7 input was confirmed using retrograde dye tracing methods. The PN also received CG1 contributions, bilaterally, in one dog. The PdN branched unusually in two dogs. Lumbosacral sympathetic ganglia had variant intra-, inter- and multisegmental connectivity in 6 (38%). Thus, the anatomy of mongrel dogs had higher variability than previously described for purebred dogs. Knowledge of this variant innervation during surgery could aid in the preservation of nerves and reduce risk of urinary and sexual dysfunctions.

  12. Disseminated Mycobacterium avium infection in a cat

    PubMed Central

    Barry, Maureen; Taylor, Judith; Woods, Paul

    2002-01-01

    A domestic shorthair cat was presented for lethargy and ataxia. Clinical findings included an abdominal mass, lumbosacral pain, ataxia. Aspirates from the liver and lymph nodes revealed intracellular, negative-staining rods. Treatment for presumptive mycobacterium infection was unsuccessful and the cat was euthanized. Disseminated Mycobacterium avium was confirmed on culture. PMID:12001504

  13. Cervical perineural cyst masquerading as a cervical spinal tumor.

    PubMed

    Joshi, Vijay P; Zanwar, Atul; Karande, Anuradha; Agrawal, Amit

    2014-04-01

    Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor.

  14. Cervical Perineural Cyst Masquerading as a Cervical Spinal Tumor

    PubMed Central

    Joshi, Vijay P; Zanwar, Atul; Karande, Anuradha

    2014-01-01

    Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor. PMID:24761204

  15. Intraoperative stimulation of pedicle screws: a new method for verification of screw placement.

    PubMed

    Young, W F; Morledge, D E; Martin, W; Park, K B

    1995-12-01

    Pedicular fixation of the lumbosacral spine has become a popular procedure for improving fusion rates. Even in experienced hands, it can be associated with a significant rate of screw malpositioning and potential nerve root injury. In this report, we describe a technique for improving screw localization utilizing evoked electromyography responses from direct stimulation of pedicle instrumentation.

  16. Development and characterization of pathways descending to the spinal cord in the embryonic chick.

    PubMed

    Sholomenko, G N; O'Donovan, M J

    1995-03-01

    1. We used an isolated preparation of the embryonic chick brain stem and spinal cord to examine the origin, trajectory, and effects of descending supraspinal pathways on lumbosacral motor activity. The in vitro preparation remained viable for < or 24 h and was sufficiently stable for electrophysiological, pharmacological, and neuroanatomic examination. In this preparation, as in the isolated spinal cord, spontaneous episodes of both forelimb and hindlimb motor activity occur in the absence of phasic afferent input. Motor activity can also be evoked by brain stem electrical stimulation or modulated by the introduction of neurochemicals to the independently perfused brain stem. 2. At embryonic day (E)6, lumbosacral motor activity could be evoked by brain stem electrical stimulation. At E5, neither brain stem nor spinal cord stimulation evoked activity in the lumbosacral spinal cord, although motoneurons did express spontaneous activity. 3. Lesion and electrophysiological studies indicated that axons traveling in the ventral cord mediated the activation of lumbosacral networks by brain stem stimulation. 4. Partition of the preparation into three separately perfused baths, using a zero-Ca2+ middle bath that encompassed the cervical spinal cord, demonstrated that the brain stem activation of spinal networks could be mediated by long-axoned pathways connecting the brain stem and lumbosacral spinal cord. 5. Using retrograde tracing from the spinal cord combined with brain stem stimulation, we found that the brain stem regions from which spinal activity could be evoked lie in the embryonic reticular formation close to neurons that send long descending axons to the lumbosacral spinal cord. The cells giving rise to these descending pathways are found in the ventral pontine and medullary reticular formation, a region that is the source of reticulospinal neurons important for motor activity in adult vertebrates. 6. Electrical recordings from this region revealed that the

  17. Adhesive capsulitis of the glenohumeral joint with an unusual neuropathic presentation: a case report.

    PubMed

    Simotas, A C; Tsairis, P

    1999-01-01

    A 37-yr-old woman presented with a 7-mo history of unilateral shoulder girdle stiffness, pain, and weakness and had already been diagnosed with frozen shoulder. Physical examination revealed scapular winging and suspicious focal paralysis of shoulder girdle muscles. Subsequently, electrodiagnostic studies reported denervation of deltoid, infraspinatus, serratus anterior, and lower cervical paraspinal muscles, in addition to a prolonged long thoracic nerve latency. The history, physical examination, and cervical magnetic resonance imaging scan seemed most consistent with neuralgic amyotrophy, although the electrodiagnostic examination could be interpreted as cervical radiculopathy. Some of the difficulties in identifying neuralgic amyotrophy and distinguishing it from cervical radiculopathy are discussed herein. Historically, frozen shoulder has seemed to develop as a complication of the neuropathic process. Both neuralgic amyotrophy and frozen shoulder have a poorly understood pathogenesis, and their combined presence is presumed to be rare. Because of difficulties inherent in the physical examination of frozen shoulder, a coexistent neuropathic process may go undetected.

  18. Progressive paralyzing sciatica revealing a pelvic pseudoaneurysm a year after hip surgery in a 12yo boy.

    PubMed

    Boulouis, Grégoire; Shotar, Eimad; Dangouloff-Ros, Volodia; Janklevicz, Pierre-Henri; Boddaert, Nathalie; Naggara, Olivier; Brunelle, Francis

    2016-01-01

    Identifying extra spinal causes of a lumbar radiculopathy or polyneuropathy can be a tricky diagnosis challenge, especially in children. Among them, traumatic or iatrogenic pseudoaneurysms of iliac arteries have been seldom reported, in adults' series. The authors report an unusual case of progressive paralyzing left sciatica and lumbar plexopathy in a 12 years old boy, 12 months after a pelvic osteotomy for bilateral hip luxation secondary to osteochondritis dissecans. Spine MRI and pelvic CT angiography revealed a giant internal iliac artery pseudoaneurysm, enclosed in a chronic hematoma. The patient was successfully treated with endovascular coil embolization, and subsequent surgical hematoma evacuation. However, three months after treatment, neurological recovery was incomplete. This case highlights the importance of a rapid and extensive diagnosis work up of all causes of lower limb radiculopathies in children, including pelvic arteries lesions especially after pelvic surgery to avoid therapeutic delays that may jeopardize the chances of neurological recovery.

  19. [Tarlov cysts: report of four cases].

    PubMed

    Sá, Márcia Cristina da Paixão Rodrigues Miranda de; Sá, Renato Carlos Ferreira Leite Miranda de

    2004-09-01

    Four perineurial cysts cases (Tarlov's cysts) are reported. The purpose of this study is to describe and to compare them with data from a literature review. The evaluation was performed among 88 adult patients with symptoms of radiculopathy, sacral pain, low back pain. Four patients revealed Tarlov's cysts (4.5%). The diagnosis was made by magnetic resonance imaging. Four cases underwent sacral laminectomy. Following surgery, the claudication pain resolved with no motor or sensory deficits. Tarlov's cysts should be considered as a differential diagnosis of sacral radiculopathy, sacral or lumbar pain syndromes and mainly to the lumbar disc prolapse. The goal of the surgical treatment is to relieve the neural compression and stop bone erosion.

  20. Symptomatic Tarlov cyst: report and review.

    PubMed

    Chaiyabud, Pradit; Suwanpratheep, Kitti

    2006-07-01

    Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion. The cysts are relatively rare and most of them are asymptomatic. Some Tarlov cysts can exert pressure on nerve elements resulting in pain, radiculopathy and even multiple radiculopathy of cauda equina. There is no consensus on the appropriate therapeutic options of Tarlov cysts. The authors present a case of two sacral cysts diagnosed with magnetic resonance imaging. The initial symptoms were low back pain and sciatica and progressed to cauda equina syndrome. Surgical treatment was performed by sacral laminectomy and wide cyst fenestration. The neurological deficits were recovered and had not recurred after a follow-up period of nine months. The literature was reviewed and discussed. This is the first reported case in Thailand.

  1. Osteochondroma of the cervical spine extending multiple segments with cord compression.

    PubMed

    Moon, Kyung-Sub; Lee, Jung-Kil; Kim, Yeon-Seong; Kwak, Hyung-Jun; Joo, Sung-Pil; Kim, In-Young; Kim, Jae-Hyoo; Kim, Soo-Han

    2006-01-01

    Involvement of the cervical spinal cord by a solitary osteochondroma is rare. We describe a case of cervical osteochondroma extending from C5 to C7 in a 16-year-old male. The tumor, arising from the inner aspect of the C6 spinous process, projected longitudinally into the spinal canal and compressed the spinal cord; this caused clinical symptoms associated with myelopathy and radiculopathy. Total excision of the tumor by C5-C7 hemilaminectomy resulted in a good functional recovery.

  2. Sacral plexus injury after radiotherapy for carcinoma of cervix

    SciTech Connect

    Stryker, J.A.; Sommerville, K.; Perez, R.; Velkley, D.E. )

    1990-10-01

    A 42-year-old woman developed lower extremity weakness and sensory loss 1 year after external and intracavitary radiotherapy for Stage IB carcinoma of cervix. She has been followed for 5 years posttreatment, and the neurologic abnormalities have persisted, but no evidence of recurrent carcinoma has been found. We believe this to be a rare case of sacral plexus radiculopathy developing as a late complication after radiotherapy. Suggestions are made for improving the radiotherapy technique to prevent this complication in future cases.

  3. Lumbar nerve root: the enigmatic eponyms.

    PubMed

    Dyck, P

    1984-01-01

    Man's quest for recognition has not escaped the physician, whose contributions to medicine perpetuate his name in print. It is a final grasp for professional immortality, which for men like Imhotep and Hippocrates, has prevailed for millennia. This fervor was particularly evident in the latter 19th century, which created a flurry of eponyms, often two or more physicians publishing the same clinical observation. This article reviews the eponym epidemic as it relates to lumbar radiculopathy.

  4. [Evoked somatosensory plexus and cervical evoked potentials in cervicobrachialgia].

    PubMed

    Rossi, L; Ubiali, E; Merli, R; Rottoli, M R

    1983-01-01

    The authors study the sensitive potential evoked from point of Erb and from cervical spine in C6-C7, obtained by stimulation of median nerve in a control group (normals) and in a greater group of 40 cases from patients affected by radiculopathie with or without discal protrusion and by myelopathie spondiloartrosic. The date supply significant informations and are (obicurred in analytique) analyzed with accuracy.

  5. [Tarlov cyst and symptomatic bladder disfuction].

    PubMed

    Ruibal Moldes, M; Sánchez Rodríguez-Losada, J; López García, D; Casas Agudo, V; Janeiro País, J M; González Martín, M

    2008-01-01

    Tarlov cysts or perineural cyst are lesions of the nerve roots located at the sacral level and uncertain aetiology. Most of these cysts remain asymptomatic with no clinical relevance. The symptomatic cysts are uncommon and the usual symptoms are pain or radiculopathy. We report the case of a 53-year-old woman witha symptomatic cyst (with a history of frequency and urgency syndrom), that disappears after surgery.

  6. Minimally invasive lumbar foraminotomy.

    PubMed

    Deutsch, Harel

    2013-07-01

    Lumbar radiculopathy is a common problem. Nerve root compression can occur at different places along a nerve root's course including in the foramina. Minimal invasive approaches allow easier exposure of the lateral foramina and decompression of the nerve root in the foramina. This video demonstrates a minimally invasive approach to decompress the lumbar nerve root in the foramina with a lateral to medial decompression. The video can be found here: http://youtu.be/jqa61HSpzIA.

  7. Interventional management of neuropathic pain: NeuPSIG recommendations

    PubMed Central

    Dworkin, Robert H.; O’Connor, Alec B.; Kent, Joel; Mackey, Sean C.; Raja, Srinivasa N.; Stacey, Brett R.; Levy, Robert M.; Backonja, Miroslav; Baron, Ralf; Harke, Henning; Loeser, John D.; Treede, Rolf-Detlef; Turk, Dennis C.; Wells, Christopher D.

    2015-01-01

    Neuropathic pain (NP) is often refractory to pharmacologic and non-interventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group (NeuPSIG), the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central post-stroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: (1) epidural injections for herpes zoster; (2) steroid injections for radiculopathy; (3) SCS for FBSS; and (4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor RF lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available of data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials; long-term studies; and head-to-head comparisons among different interventional and non-interventional treatments. PMID:23748119

  8. Interventional management of neuropathic pain: NeuPSIG recommendations.

    PubMed

    Dworkin, Robert H; O'Connor, Alec B; Kent, Joel; Mackey, Sean C; Raja, Srinivasa N; Stacey, Brett R; Levy, Robert M; Backonja, Miroslav; Baron, Ralf; Harke, Henning; Loeser, John D; Treede, Rolf-Detlef; Turk, Dennis C; Wells, Christopher D

    2013-11-01

    Neuropathic pain (NP) is often refractory to pharmacologic and noninterventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group, the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central poststroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: 1) epidural injections for herpes zoster; 2) steroid injections for radiculopathy; 3) SCS for FBSS; and 4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor radiofrequency lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials, long-term studies, and head-to-head comparisons among different interventional and noninterventional treatments.

  9. Deficits in foot skin sensation are related to alterations in balance control in chronic low back patients experiencing clinical signs of lumbar nerve root impingement.

    PubMed

    Frost, Lydia R; Bijman, Marc; Strzalkowski, Nicholas D J; Bent, Leah R; Brown, Stephen H M

    2015-05-01

    Chronic low back pain (LBP) patients with radiculopathy, or sciatica, experience pain, tingling or numbness radiating down their leg due to compression of the lumbar nerve root. The resulting reduction in somatosensory information from the foot sole may contribute to deficits in standing balance control. This work was designed to investigate the relationship between foot skin sensitivity and standing balance control in chronic LBP patients with associated radiculopathy. Patients (n=9) and matched healthy controls (n=9) were recruited to the study, and were tested for balance control in both quiet standing as well as during rapid arm raise perturbation trials on a force plate. Foot skin sensitivity was tested bilaterally for vibratory threshold (3, 40 and 250 Hz) and touch (monofilament) threshold. Results demonstrate that patients had reduced sensitivity to 250 Hz vibration in their affected compared to unaffected foot (at the great toe and heel), as well as compared to controls (at the great toe), but there were no differences with lower frequency vibratory testing or with monofilament testing. While there were no significant between-group differences in balance measures, moderate statistically significant correlations between 250 Hz sensitivity and quiet standing balance parameters were uncovered. Thus, patients demonstrate reduced high-frequency vibratory sensitivity at the foot sole, and correlations with quiet standing balance measures indicate a connection between these foot skin sensitivity deficits and alterations in balance control. Clinically, this identifies high frequency vibration testing as an important measure of skin sensitivity in patients with radiculopathy.

  10. Efficacy of Transcutaneous Electrical Nerve Stimulation in the Treatment of Overactive Bladder

    PubMed Central

    Rekha, Kaja; Srinivasan, Krishnamurthy Jayashree

    2016-01-01

    Introduction Overactive Bladder (OAB) accounts for 40-70% cases of incontinence. The etiology is unknown though detrusor instability is found in urodynamic evaluation of almost all cases. Detrusor instability or hyperreflexia can be inhibited by direct inhibition of impulses in the pre-ganglionic afferent neuron or by inhibition of bladder pre-ganglionic neurons of the efferent limb of micturition reflex. Transcutaneous Electrical Nerve Stimulation (TENS) is based on the gate control theory of abolishing the local micturition reflex arc. Aim To assess the effectiveness and safety of TENS in idiopathic OAB. Materials and Methods It is a prospective experimental study to evaluate the effectiveness of TENS v/s placebo in reducing OAB symptoms. (n1=20, n2 =20). Ten treatment sessions (5 sessions/week) of 30 minutes, were conducted. Results There was a significant improvement in Overactive Bladder Symptom Scores (OABSS) in TENS group and 2 patients were completely dry following TENS therapy. Conclusion In elderly women, patients with OAB where other co-medications have their own anticholinergic side effects and impairment of cognition is a concern, TENS can be a useful intervention. TENS units are safe, economical and easily commercially available. PMID:27891403

  11. Satellite glial cells in sympathetic and parasympathetic ganglia: in search of function.

    PubMed

    Hanani, Menachem

    2010-09-24

    Glial cells are established as essential for many functions of the central nervous system, and this seems to hold also for glial cells in the peripheral nervous system. The main type of glial cells in most types of peripheral ganglia - sensory, sympathetic, and parasympathetic - is satellite glial cells (SGCs). These cells usually form envelopes around single neurons, which create a distinct functional unit consisting of a neuron and its attending SGCs. This review presents the knowledge on the morphology of SGCs in sympathetic and parasympathetic ganglia, and the (limited) available information on their physiology and pharmacology. It appears that SGCs carry receptors for ATP and can thus respond to the release of this neurotransmitter by the neurons. There is evidence that SGCs have an uptake mechanism for GABA, and possibly other neurotransmitters, which enables them to control the neuronal microenvironment. Damage to post- or preganglionic nerve fibers influences both the ganglionic neurons and the SGCs. One major consequence of postganglionic nerve section is the detachment of preganglionic nerve terminals, resulting in decline of synaptic transmission. It appears that, at least in sympathetic ganglia, SGCs participate in the detachment process, and possibly in the subsequent recovery of the synaptic connections. Unlike sensory neurons, neurons in autonomic ganglia receive synaptic inputs, and SGCs are in very close contact with synaptic boutons. This places the SGCs in a position to influence synaptic transmission and information processing in autonomic ganglia, but this topic requires much further work.

  12. Fluorescence histochemical study of the localisation and distribution of beta-adrenergic receptor sites in the spinal cord and cerebellum of the chicken.

    PubMed

    Bondok, A A; Botros, K G; el-Mohandes, E A

    1988-10-01

    The distribution of beta-adrenergic receptor sites has been studied in chicken spinal cord and cerebellum using a fluorescent analogue of propranolol, 9-amino-acridin-propranolol (9-AAP). In the cervical and lumbar regions of the spinal cord, beta-adrenoceptor sites were concentrated on cell bodies of alpha-motor neurons of the dorsolateral and ventrolateral nuclear groups of the ventral horn. In the thoracic region, they were present on cell bodies of the preganglionic sympathetic nucleus (dorsal commissural nucleus). In the dorsal horn, the receptor sites were present mainly on cell bodies of columna dorsalis magnocellularis. Sparse distribution of fluorescence was present in other regions of the gray matter. In the cerebellum, a dense distribution of beta-adrenergic receptor sites was observed on Purkinje cell bodies and their apical dendrites. Sparse distribution of receptor sites was present on fine ramifications of Purkinje cell dendrites in the molecular layer. Receptor sites were absent in the granule cell layer and the white matter. These observations indicate that alpha-motor neurons, preganglionic sympathetic neurons, neurons of columna dorsalis magnocellularis, and Purkinje cells are adrenoceptive, while granule cells are non-adrenoceptive.

  13. Fluorescence histochemical study of the localisation and distribution of beta-adrenergic receptor sites in the spinal cord and cerebellum of the chicken.

    PubMed Central

    Bondok, A A; Botros, K G; el-Mohandes, E A

    1988-01-01

    The distribution of beta-adrenergic receptor sites has been studied in chicken spinal cord and cerebellum using a fluorescent analogue of propranolol, 9-amino-acridin-propranolol (9-AAP). In the cervical and lumbar regions of the spinal cord, beta-adrenoceptor sites were concentrated on cell bodies of alpha-motor neurons of the dorsolateral and ventrolateral nuclear groups of the ventral horn. In the thoracic region, they were present on cell bodies of the preganglionic sympathetic nucleus (dorsal commissural nucleus). In the dorsal horn, the receptor sites were present mainly on cell bodies of columna dorsalis magnocellularis. Sparse distribution of fluorescence was present in other regions of the gray matter. In the cerebellum, a dense distribution of beta-adrenergic receptor sites was observed on Purkinje cell bodies and their apical dendrites. Sparse distribution of receptor sites was present on fine ramifications of Purkinje cell dendrites in the molecular layer. Receptor sites were absent in the granule cell layer and the white matter. These observations indicate that alpha-motor neurons, preganglionic sympathetic neurons, neurons of columna dorsalis magnocellularis, and Purkinje cells are adrenoceptive, while granule cells are non-adrenoceptive. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 PMID:2855328

  14. Anatomy of the Vestibulo-automatic Outflow to the Gut

    NASA Technical Reports Server (NTRS)

    Torigoe, Y.

    1985-01-01

    Motion sickness can be induced by vestibular effects on the sympathetic portion of the autonomic nervous system. However, the pathways linking the vestibular and autonomic pathways are unknown. As a first step in this analysis, the locations of preganglionic sympathetic neurons (PSN) and dorsal root afferent ganglionic neurons (DRG) which supply sympathetic innervation to major portions of the gastrointestinal tract in rabbits were identified. The objective of a second series of experiments is to determine which of the brainstem nuclei project to the autonomic regions of the spinal cord that control gastrointestinal motility. To achieve this goal, a trans-synaptic retrograde tracer (3H-tetanus toxoid) is applied to the greater splanchnic nerve. This method allows the labeling of neurons within the brainstem that project only to the preganglionic synpathetic neurons. One structure that has been strongly implicated in mediating vestibulo-autonomic control is the cerebellum (i.e., nodulus and uvula). The outflow of these lobules to the autonomic regions of the brainstem is mediated by the fastigial nucleus. To determine the precise projections of the fastigial nucleus to the brainstem nuclei involved in emesis, anterograde tracer (3H-leucine) was injected into the fastigial nucleus in a third series of experiments.

  15. Functional neuroanatomy of the central noradrenergic system.

    PubMed

    Szabadi, Elemer

    2013-08-01

    The central noradrenergic neurone, like the peripheral sympathetic neurone, is characterized by a diffusely arborizing terminal axonal network. The central neurones aggregate in distinct brainstem nuclei, of which the locus coeruleus (LC) is the most prominent. LC neurones project widely to most areas of the neuraxis, where they mediate dual effects: neuronal excitation by α₁-adrenoceptors and inhibition by α₂-adrenoceptors. The LC plays an important role in physiological regulatory networks. In the sleep/arousal network the LC promotes wakefulness, via excitatory projections to the cerebral cortex and other wakefulness-promoting nuclei, and inhibitory projections to sleep-promoting nuclei. The LC, together with other pontine noradrenergic nuclei, modulates autonomic functions by excitatory projections to preganglionic sympathetic, and inhibitory projections to preganglionic parasympathetic neurones. The LC also modulates the acute effects of light on physiological functions ('photomodulation'): stimulation of arousal and sympathetic activity by light via the LC opposes the inhibitory effects of light mediated by the ventrolateral preoptic nucleus on arousal and by the paraventricular nucleus on sympathetic activity. Photostimulation of arousal by light via the LC may enable diurnal animals to function during daytime. LC neurones degenerate early and progressively in Parkinson's disease and Alzheimer's disease, leading to cognitive impairment, depression and sleep disturbance.

  16. Diagnostic Value and Surgical Implications of the 3D DW-SSFP MRI On the Management of Patients with Brachial Plexus Injuries

    PubMed Central

    Qin, Ben-Gang; Yang, Jian-Tao; Yang, Yi; Wang, Hong-Gang; Fu, Guo; Gu, Li-Qiang; Li, Ping; Zhu, Qing-Tang; Liu, Xiao-Lin; Zhu, Jia-Kai

    2016-01-01

    Three-dimensional diffusion-weighted steady-state free precession (3D DW-SSFP) of high-resolution magnetic resonance has emerged as a promising method to visualize the peripheral nerves. In this study, the application value of 3D DW-SSFP brachial plexus imaging in the diagnosis of brachial plexus injury (BPI) was investigated. 33 patients with BPI were prospectively examined using 3D DW-SSFP MR neurography (MRN) of brachial plexus. Results of 3D DW-SSFP MRN were compared with intraoperative findings and measurements of electromyogram (EMG) or somatosensory evoked potentials (SEP) for each injured nerve root. 3D DW-SSFP MRN of brachial plexus has enabled good visualization of the small components of the brachial plexus. The postganglionic section of the brachial plexus was clearly visible in 26 patients, while the preganglionic section of the brachial plexus was clearly visible in 22 patients. Pseudomeningoceles were commonly observed in 23 patients. Others finding of MRN of brachial plexus included spinal cord offset (in 16 patients) and spinal cord deformation (in 6 patients). As for the 3D DW-SSFP MRN diagnosis of preganglionic BPI, the sensitivity, the specificity and the accuracy were respectively 96.8%, 90.29%, and 94.18%. 3D DW-SSFP MRN of brachial plexus improve visualization of brachial plexus and benefit to determine the extent of injury. PMID:27782162

  17. Effects of axotomy on the expression and ultrastructural localization of N-cadherin and neural cell adhesion molecule in the quail ciliary ganglion: an in vivo model of neuroplasticity.

    PubMed

    Squitti, R; De Stefano, M E; Edgar, D; Toschi, G

    1999-01-01

    Postganglionic nerve crush of the avian ciliary ganglion induces detachment of preganglionic terminals from the soma of the injured ciliary neurons, followed by reattachment at about the same time that the postganglionic axons regenerate to their targets. In order to determine the role played by cell adhesion molecules in this response, we have studied injury-induced changes in the amount and distribution of N-cadherin and neural cell adhesion molecule, together with modifications in the expression of their messenger RNAs. Both N-cadherin and neural cell adhesion molecule immunoreactivities associated with postsynaptic specializations decreased between one and three days following postganglionic nerve crush, preceding the detachment of the preganglionic boutons. Immunoreactivities subsequently increased between 13 and 20 days, in parallel with restoration of synaptic contacts on the ganglion cells and the progressive reinnervation of the peripheral targets. In contrast to the rapid decrease in immunoreactivity, the messenger RNA levels of N-cadherin and neural cell adhesion molecule both increased after crush, and remained elevated throughout the 20-day period of the experiment. These results are consistent with roles for N-cadherin and neural cell adhesion molecule in the maintenance of synaptic contacts. The rapid regulation of these proteins in injury-induced synaptic plasticity occurs at the post-transcriptional level, whereas longer term regulation associated with the re-establishment of synapses may be promoted by the increased levels of gene expression.

  18. Ionic mechanisms involved in the release of /sup 3/H-norepinephrine from the cat superior cervical ganglion

    SciTech Connect

    Alder-Graschinsky, E.; Filinger, E.J.; Martinez, A.E.

    1984-02-27

    It has previously been reported that in the isolated cat superior cervical ganglion (SCG) labeled with tritiated norepinephrine (/sup 3/H-NE), the stimulation of the preganglionic trunk at 10 Hz as well as the exposure to 100 ..mu..M exogenous acetylcholine (ACh), produced a Ca/sup + +/-dependent release of /sup 3/H-NE. The present results show that a Ca/sup + +/-dependent release of /sup 3/H-NE was produced also by exposure to either 50 ..mu..M veratridine or 60 mM KCl. Tetrodotoxin (0.5 ..mu..M) abolished the release of /sup 3/H-NE induced by preganglionic stimulation, ACh and veratridine but did not modify the release evoked by KCl. The metabolic distribution of the radioactivity released by the different depolarizing stimuli showed that the /sup 3/H-NE was collected mainly unmetabolized. In the cat SCG neither the release of /sup 3/H-NE evoked by KCl nor the endogenous content of NE was modified by pretreatment with 6-OH-dopamine (6-OH-DA). On the other hand, this chemical sympathectomy depleted the endogenous content of NE in the cat nictitating membrane, whose nerve terminals arise from the SCG. The data presented suggest that the depolarization-coupled release of NE from the cat SCG involves structures that are different to nerve terminals and that contain Na/sup +/ channels as well as Ca/sup + +/.

  19. Ionic mechanisms involved in the release of /sup 3/H-norepinephrine from the cat superior cervical ganglion

    SciTech Connect

    Adler-Graschinsky, E.; Filinger, E.J.; Martinez, A.E.

    1984-02-27

    It has previously been reported that in the isolated cat superior cervical ganglion (SCG) labeled with tritiated norepinephrine (/sup 3/H-NE), the stimulation of the preganglionic trunk at 10 Hz as well as the exposure to 100 ..mu..M exogenous acetylcholine (ACh), produced a Ca/sup + +/-dependent release of /sup 3/H-NE. The present results show that a Ca/sup + +/-dependent release of /sup 3/H-NE was produced also by exposure to either 50 ..mu..M veratridine or 60 mM KCl. Tetrodotoxin (0.5 ..mu..M) abolished the release of /sup 3/H-NE induced by preganglionic stimulation, ACh and veratridine but did not modify the release evoked by KCl. The metabolic distribution of the radioactivity released by the different depolarizing stimuli showed that the /sup 3/H-NE was collected mainly unmetabolized. In the cat SCG neither the release of /sup 3/H-NE evoked by KCl nor the endogenous content of NE was modified by pretreatment with 6-OH-dopamine (6-OH-DA). On the other hand, this chemical sympathectomy depleted the endogenous content of NE in the cat nictitating membrane, whose nerve terminals arise from the SCG. The data presented suggest that the depolarization-coupled release of NE from the cat SCG involves structure that are different to nerve terminals and that contain Na/sup +/ channels as well as Ca/sup + +/ channels.

  20. Sympathetic and sensory innervation of small intensely fluorescent (SIF) cells in rat superior cervical ganglion.

    PubMed

    Takaki, Fumiya; Nakamuta, Nobuaki; Kusakabe, Tatsumi; Yamamoto, Yoshio

    2015-02-01

    The sympathetic ganglion contains small intensely fluorescent (SIF) cells derived from the neural crest. We morphologically characterize SIF cells and focus on their relationship with ganglionic cells, preganglionic nerve fibers and sensory nerve endings. SIF cells stained intensely for tyrosine hydroxylase (TH), with a few cells also being immunoreactive for dopamine β-hydroxylase (DBH). Vesicular acetylcholine transporter (VAChT)-immunoreactive puncta were distributed around some clusters of SIF cells, whereas some SIF cells closely abutted DBH-immunoreactive ganglionic cells. SIF cells contained bassoon-immunoreactive products beneath the cell membrane at the attachments and on opposite sites to the ganglionic cells. Ganglion neurons and SIF cells were immunoreactive to dopamine D2 receptors. Immunohistochemistry for P2X3 revealed ramified nerve endings with P2X3 immunoreactivity around SIF cells. Triple-labeling for P2X3, TH and VAChT allowed the classification of SIF cells into three types based on their innervation: (1) with only VAChT-immunoreactive puncta, (2) with only P2X3-immunoreactive nerve endings, (3) with both P2X3-immunoreactive nerve endings and VAChT-immunoreactive puncta. The results of retrograde tracing with fast blue dye indicated that most of these nerve endings originated from the petrosal ganglion. Thus, SIF cells in the superior cervical ganglion are innervated by preganglionic fibers and glossopharyngeal sensory nerve endings and can be classified into three types. SIF cells might modulate sympathetic activity in the superior cervical ganglion.

  1. Selective loss of alpha motor neurons with sparing of gamma motor neurons and spinal cord cholinergic neurons in a mouse model of spinal muscular atrophy.

    PubMed

    Powis, Rachael A; Gillingwater, Thomas H

    2016-03-01

    Spinal muscular atrophy (SMA) is a neuromuscular disease characterised primarily by loss of lower motor neurons from the ventral grey horn of the spinal cord and proximal muscle atrophy. Recent experiments utilising mouse models of SMA have demonstrated that not all motor neurons are equally susceptible to the disease, revealing that other populations of neurons can also be affected. Here, we have extended investigations of selective vulnerability of neuronal populations in the spinal cord of SMA mice to include comparative assessments of alpha motor neuron (α-MN) and gamma motor neuron (γ-MN) pools, as well as other populations of cholinergic neurons. Immunohistochemical analyses of late-symptomatic SMA mouse spinal cord revealed that numbers of α-MNs were significantly reduced at all levels of the spinal cord compared with controls, whereas numbers of γ-MNs remained stable. Likewise, the average size of α-MN cell somata was decreased in SMA mice with no change occurring in γ-MNs. Evaluation of other pools of spinal cord cholinergic neurons revealed that pre-ganglionic sympathetic neurons, central canal cluster interneurons, partition interneurons and preganglionic autonomic dorsal commissural nucleus neuron numbers all remained unaffected in SMA mice. Taken together, these findings indicate that α-MNs are uniquely vulnerable among cholinergic neuron populations in the SMA mouse spinal cord, with γ-MNs and other cholinergic neuronal populations being largely spared.

  2. Prediction model for unsuccessful return to work after hospital-based intervention in low back pain patients

    PubMed Central

    2013-01-01

    Background Many studies on low back pain (LBP) have identified prognostic factors, but prediction models for use in secondary health care are not available. The purpose of this cohort study, based on a randomised clinical study, was to identify risk factors for unsuccessful return to work (U-RTW) in sick-listed LBP patients with or without radiculopathy and to validate a prediction model for U-RTW. Methods 325 sick-listed LBP patients with or without radiculopathy were included in an intervention study and followed for one year. Afterwards, 117 other LBP patients were recruited similarly, included in a validation study and also followed for one year. All patients were subjected to identical procedures and interventions and received a brief intervention by the same rehabilitation doctor and physiotherapist. Half of them received case manager guidance within a multidisciplinary setting. At baseline, they completed a questionnaire and went through a clinical low-back examination. Sciatica was investigated by magnetic resonance imaging (MRI). U-RTW was registered in a national database both initially and at 1-year. Results Neither initial U-RTW (24.0%) nor one-year U-RTW (38.2%) were statistically significantly different in the two intervention groups nor in patients with and without radiculopathy. Multivariate logistic regression analysis identified two clinical and five psychosocial baseline predictors for one-year U-RTW (primary outcome). The clinical predictors included pain score (back+leg pain) and side-flexion. The five psychosocial predictors included ‘bodily distress’ ‘low expectations of RTW’, ‘blaming the work for pain’, ‘no home ownership’ and ‘drinking alcohol less than once/month’. These predictors were not statistically significantly different in patients with and without radiculopathy, and they also predicted initial U-RTW (secondary outcome). Obesity and older age were only supplementary predictors in patients with radiculopathy. A

  3. Sciatica: An Extremely Rare Complication of the Perianal Abscess

    PubMed Central

    Gujrathi, Rahul; Gupta, Kanchan; Ravi, Chetan; Pai, Bhujang

    2016-01-01

    Summary Background Sciatica has been classically described as pain in the back and hip with radiation in the leg along the distribution of the sciatic nerve, secondary to compression or irritation of the sciatic nerve. Spinal abnormality being the most common etiology, is one of the most common indications for MRI of the lumbosacral spine. Here we describe imaging findings secondary to a supralevator perianal abscess causing irritation of the sciatic nerve, which was diagnosed on MRI of the lumbosacral spine. Case Report A 47-year-old male patient presented to the emergency department with severe acute pain in the right hip and right leg which was aggravated by limb movement. Clinically, a possibility of sciatica was suggested and MRI of the lumbosacral spine was ordered. The MRI did not reveal any abnormality in the lumbosacral spine; however, on STIR coronal images, a right perianal abscess with air pockets was seen. The perianal abscess was extending above the levator ani muscle with and was seen tracking along the sciatic nerve, explaining pain along the distribution of the sciatic nerve. The abscess was surgically drained, followed by an antibiotic course. The patient was symptomatically better post-surgery. Post-operative scan done 3 days later revealed significant resolution of the infra- and supralevator perianal abscess. The patient was discharged from hospital on post-operative day 3 on oral antibiotics for 7 days. On 15th post-operative day, the patient was clinically completely asymptomatic with good healing of the perianal surgical wound. Conclusions Extra-spinal causes are rare and most often overlooked in patients with sciatica. While assessing patients with sciatica, extra-spinal causes for the radiation of pain along the distribution of the sciatic nerve should always be looked for if abnormalities in the MRI of the lumbar spine are not found. Inclusion of STIR sequences in the imaging of the lumbosacral spine, more often than not, helps to

  4. Ligaments associated with lumbar intervertebral foramina. 2. The fifth lumbar level.

    PubMed Central

    Amonoo-Kuofi, H S; el-Badawi, M G; Fatani, J A; Butt, M M

    1988-01-01

    The lumbosacral spines of two fetal and twelve adult cadavers have been studied by dissection. Evidence shows that the fifth lumbar intervertebral foramen is crossed on its external aspect by a strong, cord-like corporotransverse ligament passing obliquely downwards, forwards and medially from the inferior aspect of the accessory process of the fifth lumbar vertebra to the lateral surface of the intervertebral disc and the adjacent parts of the bodies of the fifth and first sacral vertebrae. Superficially, the ligament is related to another flat band--the lumbosacral hood. Together these ligaments separate and provide openings for the sympathetic ramus, the ventral ramus and blood vessels related to the intervertebral foramen. On the dorsal aspect, a tripartite ligament, the mamillo-transverso-accessory ligament, bears important relationships to the subdivisions of the dorsal ramus and also the zygapophyseal joint. The significance of these findings is discussed. Images Fig. 2 Fig. 3 Fig. 4 Fig. 1 Fig. 5 PMID:3248957

  5. The renal axes in spina bifida: issues of confusion and fusion.

    PubMed

    Mandell, G A; Maloney, K; Sherman, N H; Filmer, B

    1996-01-01

    The occurrence of horseshoe kidneys in myelodysplasia has been suggested to be overestimated because of the concurrent prevalence of kyphotic spine in the spina bifida population. Pseudohorseshoe kidneys result from the actual medial migration and apposition of the lower renal poles in the deep fossa created by the gibbus deformity. The presence of a lumbosacral kyphosis, however, does not imply there is not a true horseshoe kidney. In our myelodysplasia population of 189 patients, occurrence of true horseshoe kidneys (13 patients) and pseudohorseshoe kidneys (14 patients) was increased. The finding of lumbosacral kyphosis was twice as common in the pseudohorseshoe population as in the true horseshoe population. True horseshoe kidneys were three times more commonly seen in association with congenital vertebral anomalies cephalad to the dysraphic spine. Diagnosis in this study was predominantly based on renal cortical scintigraphy with the posterior pin-hole magnification technique.

  6. Piriformis syndrome--a rare cause of extraspinal sciatica.

    PubMed

    Arooj, Shumaila; Azeemuddin, Muhammad

    2014-08-01

    Piriformis syndrome is a rare entity resulting in severe unilateral isolated buttock pain shooting in nature, non discogenic in origin. MR imaging of pelvis plays an important role in such patients to see the normal anatomy of piriformis muscle and its relationship with sciatic nerve. A 35-year-old woman presented with one year history of radiating leg pain with normal MR lumbosacral spine. MRI pelvis showed an abnormal orientation of left sciatic nerve through cleaved fibers of the piriformis muscle. The patient's symptoms were relieved by surgical decompression. The purpose of this case report is to show the role and importance of MR imaging for tracing sciatic nerve and its relationship to the Piriformis muscle. MR imaging of pelvis for sciatic nerve plays an important role in symptomatic patients with isolated buttock pain having normal MRI lumbosacral spine.

  7. Ryszard Rodzinski-A Forgotten Polish Inventor and Pioneer of Combined Spinal-Epidural Anesthesia.

    PubMed

    Daszkiewicz, Andrzej R; Copik, Maja M; Misiolek, Hanna D; Reiss, Wojciech Z

    2016-10-01

    Dr. Ryszard Rodzinski was a Polish surgeon who, in spite of his short life, had a productive career. His most important discovery was a safer method of performing regional anesthesia for abdominal surgery. The first description of combined spinal epidural anesthesia is generally attributed to Soresi in 1937. In the early 20th century, Rodzinski invented a novel technique, "combined lumbosacral anesthesia," which combined lumbar spinal anesthesia and sacral epidural anesthesia. During the 19th Meeting of Polish Surgeons in July 1922 in Warsaw, Rodzinski presented an article entitled "On Combined Lumbosacral Anaesthesia," in which he described this technique used in surgical clinic in Lwów since October 1921. Given this presentation, Rodzinski could be considered to have made the first known presentation of the combined spinal and epidural anesthesia.

  8. Predict human body indentation lying on a spring mattress using a neural network approach.

    PubMed

    Zhong, Shilu; Shen, Liming; Zhou, Lijuan; Guan, Zhongwei

    2014-08-01

    This article presents a method to predict and assess the interaction between a human body and a spring mattress. A three-layer artificial neural network model was developed to simulate and predict an indentation curve of human spine, characterized with the depth of lumbar lordosis and four inclination angles: cervicothoracic, thoracolumbar, lumbosacral and the back-hip (β). By comparing the spinal indentation curves described by the optimal evaluation parameters (depth of lumbar lordosis, cervicothoracic, thoracolumbar and lumbosacral), a better design of five-zone spring mattresses was obtained for individuals to have an effective support to the main part of the body. Using such approach, an operating process was further introduced, in which appropriate stiffness proportions were proposed to design mattress for the normal body types of Chinese young women. Finally, case studies were undertaken, which show that the method developed is feasible and practical.

  9. Comparative pathogenicity of avian encephalomyelitis viruses in chicken embryos.

    PubMed

    Miyamae, T

    1975-07-01

    Multiplications of wild, various embryo-adapting and completely embryo-adapted avian encephalomyelitis (AE) viruses in chicken embryos were compared by the fluorescent-antibody technique (FAT). With a wild AE virus, viral antigens were randomly seen in the central nervous system (CNS), appearing least often in the cerebellum. Other organs seldom became test positive, except for heart and kidney. Even with 4 chicken brain-passaged viruses in the process of embryo adaptation, there was little augmentation of antigens except in the alimentary tract. However, the 2 midpassage viruses showed a peculiar localization of antigens in the white matter of the lumbosacral cord, together with the appearance of test-positive spinal ganglion cells. With 2 strains of embryo-adapted AE virus, the antigens appeared first in the spinal ganglion cells and secondly in the lumbosacral cord and then spread to the cerebrum. Subsequently, clinical signs of AE were evident. This peculiar invasion order was a prominent feature.

  10. The Spine in Patients With Osteogenesis Imperfecta.

    PubMed

    Wallace, Maegen J; Kruse, Richard W; Shah, Suken A

    2017-02-01

    Osteogenesis imperfecta is a genetic disorder of type I collagen. Although multiple genotypes and phenotypes are associated with osteogenesis imperfecta, approximately 90% of the mutations are in the COL1A1 and COL1A2 genes. Osteogenesis imperfecta is characterized by bone fragility. Patients typically have multiple fractures or limb deformity; however, the spine can also be affected. Spinal manifestations include scoliosis, kyphosis, craniocervical junction abnormalities, and lumbosacral pathology. The incidence of lumbosacral spondylolysis and spondylolisthesis is higher in patients with osteogenesis imperfecta than in the general population. Use of diphosphonates has been found to decrease the rate of progression of scoliosis in patients with osteogenesis imperfecta. A lateral cervical radiograph is recommended in patients with this condition before age 6 years for surveillance of craniocervical junction abnormalities, such as basilar impression. Intraoperative and anesthetic considerations in patients with osteogenesis imperfecta include challenges related to fracture risk, airway management, pulmonary function, and blood loss.

  11. Slow-wave oscillations in the craniosacral space: a hemoliquorodynamic concept of origination.

    PubMed

    Moskalenko, Yu E; Kravchenko, T I; Vainshtein, G B; Halvorson, P; Feilding, A; Mandara, A; Panov, A A; Semernya, V N

    2009-05-01

    The mechanism of formation of rhythmic, slow-wave oscillations in the craniospinal cavity were studied. Synchronous bioimpedance traces were made of the head and lumbosacral part of the spine in five healthy young subjects at rest and during voluntary breath-holding; these reflect changes in the ratios of blood and CSF volumes in these parts of the craniospinal space. Computer amplitude-frequency and spectral analysis of the data (Macintosh G-4, Chart-5.2) demonstrated slow (6-12 cycles/min) and rapid (pulsatile) oscillations in different directions in the cranial and lumbosacral areas. These data suggested a hemoliquorodynamic hypothesis for the craniosacral rhythm. The pulsatile and slow-wave oscillations of cerebrovascular tone and intracranial pressure evidently initiate to-and-fro displacements of the CSF in the caudal direction. The associated tonic contractions of the musculature of the lumbar part of the spine and the mobility of the sacrum are detected manually as the craniosacral rhythm.

  12. Multilocular disseminated Tarlov cysts: Importance of imaging and management options

    PubMed Central

    Padma, Subramanyam; Palaniswamy, Shanmuga Sundaram

    2012-01-01

    With technological advancements and wider availability of multimodality imaging, incidental lesions are frequently identified in patients undergoing various imaging studies. We report here a case of multiloculated disseminated perineural or Tarlov cysts (TCs). The primary aim of this case study was to (1) provide a comprehensive review of the clinical, imaging, and histopathological features of TCs (2) to draw attention to the fact that multiple lumbosacral and dorsal TCs can produce nerve injuries and serious movement disturbances, and (3) to document the usefulness of the magnetic resonance imaging and bone scan in non-invasive diagnosis and guiding management in such cases. These cysts are clearly identified by magnetic resonance imaging (MRI) and computerized tomography imaging of the lumbosacral spine. However, there are no reports on the scintigraphic findings of multilocular disseminated TC in literature. TCs are typically benign, asymptomatic lesions that can simply be monitored. To date, no consensus exists about the best surgical strategy to use when indicated. PMID:23723584

  13. Multilocular disseminated tarlov cysts: importance of imaging.

    PubMed

    Padma, Subramanyam; Sundaram, P Shanmuga

    2014-01-01

    With technological advancements and wider availability of multimodality imaging, incidental lesions are frequently identified in patients undergoing various imaging studies. We report here a case of multiloculated disseminated perineural or Tarlov cysts (TCs). The primary aim of our study was to (1) provide a comprehensive review of the clinical, imaging and histopathological features of TCs (2) to draw attention to the fact that multiple lumbo-sacral and dorsal TCs can produce nerve injuries and serious movement disturbances (3) to document the usefulness of the magnetic resonance imaging (MRI) and bone scan in noninvasive diagnosis and guiding management in such cases. These cysts are clearly identified by MR and computerized tomography imaging of the lumbosacral spine. However, there are no reports on the scintigraphic findings of TCs in literature. TCs are typically benign, asymptomatic lesions that can simply be monitored. Until date, no consensus exists about the best surgical strategy to be followed for their management.

  14. Multilocular disseminated Tarlov cysts: Importance of imaging and management options.

    PubMed

    Padma, Subramanyam; Palaniswamy, Shanmuga Sundaram

    2012-04-01

    With technological advancements and wider availability of multimodality imaging, incidental lesions are frequently identified in patients undergoing various imaging studies. We report here a case of multiloculated disseminated perineural or Tarlov cysts (TCs). The primary aim of this case study was to (1) provide a comprehensive review of the clinical, imaging, and histopathological features of TCs (2) to draw attention to the fact that multiple lumbosacral and dorsal TCs can produce nerve injuries and serious movement disturbances, and (3) to document the usefulness of the magnetic resonance imaging and bone scan in non-invasive diagnosis and guiding management in such cases. These cysts are clearly identified by magnetic resonance imaging (MRI) and computerized tomography imaging of the lumbosacral spine. However, there are no reports on the scintigraphic findings of multilocular disseminated TC in literature. TCs are typically benign, asymptomatic lesions that can simply be monitored. To date, no consensus exists about the best surgical strategy to use when indicated.

  15. Multilocular Disseminated Tarlov Cysts: Importance of Imaging

    PubMed Central

    Padma, Subramanyam; Sundaram, P. Shanmuga

    2014-01-01

    With technological advancements and wider availability of multimodality imaging, incidental lesions are frequently identified in patients undergoing various imaging studies. We report here a case of multiloculated disseminated perineural or Tarlov cysts (TCs). The primary aim of our study was to (1) provide a comprehensive review of the clinical, imaging and histopathological features of TCs (2) to draw attention to the fact that multiple lumbo-sacral and dorsal TCs can produce nerve injuries and serious movement disturbances (3) to document the usefulness of the magnetic resonance imaging (MRI) and bone scan in noninvasive diagnosis and guiding management in such cases. These cysts are clearly identified by MR and computerized tomography imaging of the lumbosacral spine. However, there are no reports on the scintigraphic findings of TCs in literature. TCs are typically benign, asymptomatic lesions that can simply be monitored. Until date, no consensus exists about the best surgical strategy to be followed for their management. PMID:25191117

  16. A Case of Faun Tail Naevus Treated by Intense Pulsed Light

    PubMed Central

    Lee, Hye In; Rho, Yong Kwan; Kim, Myeung Nam

    2009-01-01

    A faun tail is abnormal lumbar hypertrichosis that is characterized by a wide, often triangular or lozenge-shaped patch of coarse hair, and this hair is usually several inches long. Faun tail is a rare entity. A 36-year-old male presented with a triangular shaped hair tuft with terminal hair on the lumbosacral area, and he'd had this unusual hair since birth. There were no neurologic signs or abnormality on his spine X-ray. The MRI scan showed disc degeneration and loss of lodordosis. We report here on a rare case of faun tail, which was a form of localized hypertrichosis on the lumbosacral area, and this was successfully treated with intense pulsed (IPL) light. PMID:20523773

  17. Faun tail: a rare cutaneous marker of spinal dysraphism.

    PubMed

    Polat, Muhterem; Polat, Fazli; Oztaş, Pinar; Kaya, Canan; Alli, Nuran

    2010-01-01

    A 10-year-old girl who was admitted to the urology department with complaints of urinary incontinence was referred to our dermatology outpatient clinic because of a congenital, circumscribed, hypertrichotic area on the lumbosacral region. Cutaneous examination revealed a circumscribed area of coarse, dark terminal hair measuring 25 x 15 cm overlying the lumbosacral area with normal underlying skin (Figure 1). There were erythematous macular lesions on the superior of the hairy area. The lesion had been present since birth, and no other family member had similar lesions. Her history revealed back pain and a long history of urinary incontinence. On neurologic examination, no motor weakness or sensory changes were observed. Babinski reflex was positive on the left. Magnetic resonance imaging (MRI) findings included diastematomyelia between T12 and L1 levels and slight flattening of lumbar lordosis (Figure 2). A diagnosis of faun tail with underlying spinal dysraphism was made. There was also urinary incontinence as late sequelae of spinal dysraphism.

  18. A case of faun tail naevus treated by intense pulsed light.

    PubMed

    Lee, Hye In; Rho, Yong Kwan; Kim, Beom Joon; Kim, Myeung Nam

    2009-05-01

    A faun tail is abnormal lumbar hypertrichosis that is characterized by a wide, often triangular or lozenge-shaped patch of coarse hair, and this hair is usually several inches long. Faun tail is a rare entity. A 36-year-old male presented with a triangular shaped hair tuft with terminal hair on the lumbosacral area, and he'd had this unusual hair since birth. There were no neurologic signs or abnormality on his spine X-ray. The MRI scan showed disc degeneration and loss of lodordosis. We report here on a rare case of faun tail, which was a form of localized hypertrichosis on the lumbosacral area, and this was successfully treated with intense pulsed (IPL) light.

  19. Mystery of Sciatica Resolved - A Rare Case Report

    PubMed Central

    Gopal, Surendra; Sampath, Deepak

    2016-01-01

    Schwannomas are common, benign, slow growing tumours of peripheral nerve sheath arising from the schwann cells of the neuroectoderm. They do not transverse the nerve but remain within the sheath on top of the nerve. They rarely present in the sciatic nerve. Sciatic schwannomas may mimic symptoms of herniated disc, usually with radiation of pain to buttocks and thigh region with inability to walk for long distances and sometimes may present with claudication. In the absence of low back pain and with a normal Lumbo-Sacral MRI study, causes intrinsic to sciatic nerve needs to be thought off, which often delays the diagnosis. Rarity in our case-patient presented with tingling sensation and inability to squat on hard surface for more than 10 minutes with a normal x-ray and MRI study of lumbosacral spine. PMID:26894136

  20. Activity-Dependent Plasticity of Spinal Locomotion: Implications for Sensory Processing

    PubMed Central

    Edgerton, V. Reggie; Roy, Roland R.

    2009-01-01

    The lumbosacral spinal cord of mammals contains the neural circuitry capable of generating full weight-bearing locomotion of the hindlimbs without any supraspinal input. One or more interventions, e.g., pharmacological, epidural stimulation, and/or locomotor training, however, are necessary to gain access to and modulate the properties of this circuitry, and to facilitate recovery of full weight-bearing locomotion after spinal cord injury. PMID:19955866

  1. Are the differences between Stw 431 (Australopithecus africanus) and A.L. 288-1 (A. afarensis) significant?

    PubMed

    Dobson, Seth D

    2005-07-01

    Recent studies of early hominin body proportions paint a complex evolutionary picture, with multiple instances of reversal in body shape. These interpretations rest heavily upon the inferred limb joint proportions of Australopithecus africanus. For example, the partial skeleton Stw 431 has been suggested to show ape-like joint proportions compared to the A. afarensis specimen A.L. 288-1. This suggests an evolutionary reversal in the more recent A. africanus. However, no study has examined the probability of sampling the differences between Stw 431 and A.L. 288-1 from a single extant hominoid species. The present study compares elbow/hip and elbow/lumbosacral joint size ratios between Stw 431 and A.L. 288-1 using exact randomization, based on chimpanzee and human models of variation. Results indicate that differences in elbow/hip proportions between Stw 431 and A.L. 288-1 can be sampled from a single species. In contrast, differences in elbow/lumbosacral proportions between Stw 431 and A.L. 288-1 show a significantly low probability of being sampled from a single species. Thus, Stw 431 and A.L. 288-1 are not significantly different from each with regard to limb joint proportions, but Stw 431 has a significantly smaller lumbosacral joint. This pattern does not conform to previous interpretations of limb proportions in A. africanus. Low statistical power in the present study may account for the discrepancy. Further research is needed to illuminate the functional implications of variation in relative lumbosacral joint size in early hominins.

  2. Laparoscopic approach to intrapelvic nerve entrapments

    PubMed Central

    Lemos, Nucelio; Possover, Marc

    2015-01-01

    It is long known that a large portion of the lumbosacral plexus is located intra-abdominally, in the retroperitoneal space. However, most of literature descriptions of lesions on this plexus refer to its extra-abdominal parts whereas its intra-abdominal portions are often neglected. The objective of this review article is to describe the laparoscopic anatomy of intrapelvic nerve bundles, as well as the findings and advances already achieved by Neuropelveology practitioners. PMID:27011825

  3. Assessing the Short- and Long-Term Health Effects of Decompression Sickness Among U.S. Navy Divers.

    DTIC Science & Technology

    1984-12-01

    diagnosis included DCS for two divers (one had a secondary diagnosis of spinal cord lesion) and vertebrogenic pain syndrome/ lumbalgia for the third, as...admission) 1 year, 8 months Vertebrogenic pain syndrome ( lumbalgia ) (second admission) 6 years, 2 months Vertebrogenic pain syndrome ( lumbalgia ) (third...anomalies of lumbosacral joint (first admission) 3 years, 5 months Vertebrogenic pain syndrome ( lumbalgia ) and sprains and strains of other unspecified

  4. An Analytical Model of a Spinal Root Stimulated Neuromuscular System

    DTIC Science & Technology

    2007-11-02

    revolution. Momentum can be maintained in regions where force is not applied by using a flywheel such as in the Ergys series of cycling ergometers . However...University College London, UK Abstract- Leg Cycle Ergometry using Functional Electrical Stim- ulation provides many health benefits for paraplegic users...The Lumbo-sacral Anterior Root Stimulator Implant provides suffi- cient control over the muscles in the legs for leg powered cycling to be achieved

  5. Cystic Abnormalities of the Spinal Cord and Vertebral Column.

    PubMed

    da Costa, Ronaldo C; Cook, Laurie B

    2016-03-01

    Cystic lesions of the vertebral column and spinal cord are important differential diagnoses in dogs with signs of spinal cord disease. Synovial cysts are commonly associated with degenerative joint disease and usually affect the cervical and lumbosacral regions. Arachnoid diverticulum (previously known as cyst) is seen in the cervical region of large breed dogs and thoracolumbar region of small breed dogs. This article reviews the causes, diagnosis, and treatment of these and other, less common, cystic lesions.

  6. Electromagnetic Navigation in Minimally Invasive Spine Surgery: Results of a Cadaveric Study to Evaluate Percutaneous Pedicle Screw Insertion

    PubMed Central

    Fraser, Justin F.; Von Jako, Ron; Carrino, John A.

    2008-01-01

    Background This cadaveric study compared efficacy and safety of an electromagnetic (EM) guidance system versus conventional fluoroscopy for percutaneous pedicle screw fixation. As percutaneous pedicle screw fixation becomes increasingly common in spinal surgery, intraoperative imaging systems that maximize efficiency while minimizing radiation exposure and inaccurate trajectories will be progressively more important. Published studies have validated the safety of percutaneous screw fixation using conventional fluoroscopic guidance and frameless optical stereotaxy, though EM guidance systems have not been evaluated for percutaneous placement in the lumbosacral spine. The aim of the study was to evaluate the clinical applicability of an EM system for minimally invasive spine fusion in the lumbosacral spine. Methods Five human cadaveric specimens underwent bilateral lumbosacral percutaneous screw fixation from L1 to S1 using conventional anteroposterior (AP) and lateral fluoroscopic techniques on one side and 2-dimesional (2D) EM guidance on each matching side. Intraoperative efficiency was evaluated, and pedicle, vertebral, and critical breach rates were assessed on postoperative computed tomography (CT). Results Overall mean fluoroscopy time per screw was 58.9 ± 44.7 seconds for conventional fluoroscopy compared to 27.4 ± 13.5 seconds for electromagnetic guidance (P = .0003). Pedicle, vertebral, and critical breach rates for the L1-S1 were 32.1%, 10.7%, and 25.0% for conventional fluoroscopy and 42.8%, 10.7%, and 14.1% for electromagnetic guidance (difference not statistically significant [ns]). In comparing critical breaches in the lumbar spine (L1-L5), there was a significant difference between 2-D EM guidance (0) and CF guidance (6) (P = .02). Conclusions Two-dimensional EM navigation provides a modality for lumbosacral percutaneous pedicle screw fixation that is more efficient and safer than conventional fluoroscopy. This data provides a foundation for further

  7. Mondini malformation associated with diastematomyelia and presenting with recurrent meningitis.

    PubMed

    Masri, Amira; Bakri, Faris G; Birkenhäger, Ralf; Alassaf, Abeer; Musharbash, Awni F; Haroun, Azmy; Zak, Imad

    2011-05-01

    The authors report the case of 5-year-old girl who presented with 4 episodes of recurrent meningitis. Her initial workup revealed a lumbosacral dermoid sinus associated with diastematomyelia and a tethered cord. Therefore, a surgical repair to correct the anomaly was performed. However, another episode of meningitis occurred after surgery, and a subsequent temporal bone scan revealed the presence of left Mondini dysplasia. To the authors' knowledge, this is the first report of Mondini dysplasia in association with diastematomyelia.

  8. Tarlov cysts: a report of two cases.

    PubMed

    Sen, Ramesh Kumar; Goyal, Tarun; Tripathy, Sujit Kumar; Chakraborty, Soumya

    2012-04-01

    Perineural cysts are common and usually detected incidentally during magnetic resonance imaging of the lumbosacral spine. Treatment is indicated only when the cyst is symptomatic. We report one such patients presented with cauda equina syndrome and another with low back pain with claudication. They underwent excision and duraplasty; both motor and sensory fibres were carefully separated from the cyst wall using a nerve root retractor and penfield. There was no nerve root damage or neural deficit. Symptoms were relieved postoperatively.

  9. Faun tail nevus

    PubMed Central

    Yamini, M.; Sridevi, K. S.; Babu, N. Prasanna; Chetty, Nanjappa G.

    2011-01-01

    Faun tail nevus is a posterior midline cutaneous lesion of importance to dermatologists as it could be a cutaneous marker for its underlying spine and spinal cord anomaly. We report a 13-year-old girl with excessive hair growth over the lumbosacral region since birth. There was associated spinal anomaly with no neurological manifestation affecting the lower spinal cord. The diagnosis was made on clinical basis. The patient reported for cosmetic disability. This case is reported for its clinical importance. PMID:23130210

  10. Faun tail nevus.

    PubMed

    Yamini, M; Sridevi, K S; Babu, N Prasanna; Chetty, Nanjappa G

    2011-01-01

    Faun tail nevus is a posterior midline cutaneous lesion of importance to dermatologists as it could be a cutaneous marker for its underlying spine and spinal cord anomaly. We report a 13-year-old girl with excessive hair growth over the lumbosacral region since birth. There was associated spinal anomaly with no neurological manifestation affecting the lower spinal cord. The diagnosis was made on clinical basis. The patient reported for cosmetic disability. This case is reported for its clinical importance.

  11. Dopamine is produced in the rat spinal cord and regulates micturition reflex after spinal cord injury.

    PubMed

    Hou, Shaoping; Carson, David M; Wu, Di; Klaw, Michelle C; Houlé, John D; Tom, Veronica J

    2016-11-01

    Dopamine (DA) neurons in the mammalian central nervous system are thought to be restricted to the brain. DA-mediated regulation of urinary activity is considered to occur through an interaction between midbrain DA neurons and the pontine micturition center. Here we show that DA is produced in the rat spinal cord and modulates the bladder reflex. We observed numerous tyrosine hydroxylase (TH)(+) neurons in the autonomic nuclei and superficial dorsal horn in L6-S3 spinal segments. These neurons are dopamine-β-hydroxylase (DBH)(-) and some contain detectable dopamine decarboxylase (DDC), suggesting their capacity to produce DA. Interestingly, following a complete thoracic spinal cord injury (SCI) to interrupt supraspinal projections, more TH(+) neurons emerged in the lumbosacral spinal cord, coincident with a sustained, low level of DA expression there and a partially recovered micturition reflex. Non-selective blockade of spinal DA receptors reduced bladder activity whereas activation of spinal D2-like receptors increased bladder activity and facilitated voiding. Additionally, depletion of lumbosacral TH(+) neurons with 6-hydroxydopamine (6-OHDA) decreased bladder non-voiding contractions and voiding efficiency. Furthermore, injecting the transsynaptic neuronal tracer pseudorabies virus (PRV) into the bladder detrusor labeled TH(+) cells in the lumbosacral cord, confirming their involvement in spinal micturition reflex circuits. These results illustrate that DA is synthesized in the rat spinal cord; plasticity of lumbosacral TH(+) neurons following SCI may contribute to DA expression and modulate the spinal bladder reflex. Thus, spinally-derived DA and receptors could be a novel therapeutic target to improve micturition recovery after SCI.

  12. [Lameness of the hindlimbs of the cat].

    PubMed

    Grevel, V

    1989-08-01

    About six to seven per cent of cats presented at the clinic show neurological signs. The largest group consists of traumatized cats. A complete neurological examination is essential for localizing the lesion and establishing a prognosis. Differential diagnosis for paraparesis/paraplegia of pelvic limbs in cats are discussed. Cats are demonstrated which had spinal cord trauma, disc protrusion, aortic thromboembolism and lumbosacral stenosis and the importance of the evaluation of x-rays, cerebrospinal fluid examination and myelography is stressed.

  13. Redefining Projections of Disease and Nonbattle Injury Patient Condition Code Distributions with Casualty Data from Operation

    DTIC Science & Technology

    2006-07-30

    1.18% 1.70% 201 Strain lumbosacral sacroiliac joint chronic all cases 1.81% 2.61% 148 Sprain ankle closed acute with complete ligament rupture 0.02...database and the Joint Patient Tracking Application were used to identify US military DNBI casualties during the time period of 01 March 2003 to 30...level and scope of medical support needed for a joint operation, as well as provides the capability of evaluating probable courses of action for a

  14. Redefining Projections of Disease and Nonbattle Injury Patient Condition Code Distributions with Casualty Data from Operation Iraqi Freedom

    DTIC Science & Technology

    2006-07-30

    ligament laxity 0.63% 0.90% 262 Tenosynovitis elbow wrist shoulders etc. 1.18% 1.70% 201 Strain lumbosacral sacroiliac joint chronic all cases 1.81...NavyMarine Corps Combat Trauma Registry and the Joint Patient Tracking Application were used to identify US military disease and nonbattle injury casualties...streams. Approach Data from the Navy–Marine Corps Combat Trauma Registry database and the Joint Patient Tracking Application were used to identify US

  15. The organization of spinal motor neurons in a monotreme is consistent with a six-region schema of the mammalian spinal cord.

    PubMed

    Mitchelle, Amer; Watson, Charles

    2016-09-01

    The motor neurons in the spinal cord of an echidna (Tachyglossus aculeatus) have been mapped in Nissl-stained sections from spinal cord segments defined by spinal nerve anatomy. A medial motor column of motor neurons is found at all spinal cord levels, and a hypaxial column is found at most levels. The organization of the motor neuron clusters in the lateral motor column of the brachial (C5 to T3) and crural (L2 to S3) limb enlargements is very similar to the pattern previously revealed by retrograde tracing in placental mammals, and the motor neuron clusters have been tentatively identified according to the muscle groups they are likely to supply. The region separating the two limb enlargements (T4 to L1) contains preganglionic motor neurons that appear to represent the spinal sympathetic outflow. Immediately caudal to the crural limb enlargement is a short column of preganglionic motor neurons (S3 to S4), which it is believed represents the pelvic parasympathetic outflow. The rostral and caudal ends of the spinal cord contain neither a lateral motor column nor a preganglionic column. Branchial motor neurons (which are believed to supply the sternomastoid and trapezius muscles) are present at the lateral margin of the ventral horn in rostral cervical segments (C2-C4). These same segments contain the phrenic nucleus, which belongs to the hypaxial column. The presence or absence of the main spinal motor neuron columns in the different regions echidna spinal cord (and also in that of other amniote vertebrates) provides a basis for dividing the spinal cord into six main regions - prebrachial, brachial, postbrachial, crural, postcrural and caudal. The considerable biological and functional significance of this subdivision pattern is supported by recent studies on spinal cord hox gene expression in chicks and mice. On the other hand, the familiar 'segments' of the spinal cord are defined only by the anatomy of adjacent vertebrae, and are not demarcated by intrinsic gene

  16. Salivation induced better lacrimal gland function in dry eyes.

    PubMed

    Pramanik, T; Ghising, R

    2009-12-01

    The dry eye syndrome is a common eye symptom causing blurry vision. To meet the demand of the modem world students and professionals are compelled to expose themselves to the computer screen for long stretch of time, which is one of the causes of dry eye. It is not always feasible to instil eyes with artificial tears time to time to protect them from dryness. Rather to adopt any simple physiological process associated with optimum lacrimation is a better option to keep eyes moist during computer works. Volunteers (n = 22) having mild dry eyes participated in this study. Tear production was assessed by Schirmer test by keeping Schirmer strip on ocular surface for 5 minutes and recording the length of the moistened area. Then the subject was allowed to keep a piece of lopsy candy (a sour fruit pulp mixed with sugar that is sweet and sour in taste) in mouth for 5 minutes that caused salivation. During salivation, again tear production was assessed. [It was standardized in such a way that, the length of the moistened strip will be 25 - 30 mm for normal eyes, 15 - 10 mm for dry eye, 06 - 10 mm for mild dry eye, 02 - 05 mm for moderate dryness and 00 - 01 mm for severe dry eye.] Tear production was found to be increased significantly (supported by increased length of moistened area of Schirmer strip) during salivation especially in dry eye in all volunteers. The lacrimal gland is the major contributor to the aqueous layer of the tear film which consists of water, electrolytes and proteins; secretion of which are under tight neural control. Anticholinergic agents play an important role in ocular dryness because of hypo-secretion. The sensory root of facial nucleus contains efferent preganglionic parasympathetic fibers for submandibular and sublingual salivary gland and lacrimal gland. The sensory root conveys gustatory fibers from the presulcul area (anterior two-third) of the tongue via the chorda tympani and via the palatine and greater petrosal nerve, taste fibers from

  17. Dorsal vertebral column abnormalities in dogs with disseminated idiopathic skeletal hyperostosis (DISH).

    PubMed

    Decker, S De; Volk, H A

    2014-06-21

    Although disseminated idiopathic skeletal hyperostosis (DISH) most often affects the ventral aspect of the vertebral column, this study evaluated the occurrence, nature and clinical relevance of dorsal vertebral column abnormalities in 10 dogs with DISH for which CT or MRI and a complete neurological examination were available. Dorsal vertebral column abnormalities were present in eight dogs and included articular process hypertrophy (n=7 dogs), periarticular new bone formation (n=1), pseudoarthrosis between spinous processes (n=4) and thickening of the dorsal lamina (n=4). These dorsal vertebral abnormalities caused clinically relevant vertebral canal stenosis in six dogs and were the only cause of clinical signs in four of these dogs. Although the lumbosacral joint was not affected by DISH, these six dogs demonstrated lumbosacral vertebral canal stenosis and clinical signs of cauda equina compression, which included paraparesis (n=5 dogs), lumbosacral pain (n=4), urinary incontinence (n=4), faecal incontinence (n=1) and urinary and faecal incontinence (n=1). There is a possible association between DISH and hypertrophy of dorsal vertebral structures, potentially resulting in vertebral canal stenosis. Although these changes occurred at segments fused by DISH, they predominantly affected adjacent non-affected segments.

  18. Pelvic Fixation in Adult and Pediatric Spine Surgery: Historical Perspective, Indications, and Techniques: AAOS Exhibit Selection.

    PubMed

    Jain, Amit; Hassanzadeh, Hamid; Strike, Sophia A; Menga, Emmanuel N; Sponseller, Paul D; Kebaish, Khaled M

    2015-09-16

    Achieving solid osseous fusion across the lumbosacral junction has historically been, and continues to be, a challenge in spine surgery. Robust pelvic fixation plays an integral role in achieving this goal. The goals of this review are to describe the history of and indications for spinopelvic fixation, examine conventional spinopelvic fixation techniques, and review the newer S2-alar-iliac technique and its outcomes in adult and pediatric patients with spinal deformity. Since the introduction of Harrington rods in the 1960s, spinal instrumentation has evolved substantially. Indications for spinopelvic fixation as a means to achieve lumbosacral arthrodesis include a long arthrodesis (five or more vertebral levels) or use of three-column osteotomies in the lower thoracic or lumbar spine, surgical treatment of high-grade spondylolisthesis, and correction of lumbar deformity and pelvic obliquity. A variety of techniques have been described over the years, including Galveston iliac rods, Jackson intrasacral rods, the Kostuik transiliac bar, iliac screws, and S2-alar-iliac screws. Modern iliac screws and S2-alar-iliac screws are associated with relatively low rates of pseudarthrosis. S2-alar-iliac screws have the advantages of less implant prominence and inline placement with proximal spinal anchors. Collectively, these techniques provide powerful methods for obtaining control of the pelvis in facilitating lumbosacral arthrodesis.

  19. [Slow-wave fluctuations in craniosacral space: hemo-liquorodynamic conception of origin].

    PubMed

    Moskalenko, Iu E; Kravchenko, T I; Baĭnshteĭn, G B; Khal'vorson, P; Feĭlding, A; Mandara, A; Panov, A A; Semernia, V N

    2008-04-01

    In the paper, the mechanism of forming of rhythmic slow-wave fluctuations in craniospinal cavity was investigated. In five young healthy persons, at rest and under voluntary respiration arrest test, the bioimpedansograms of head and lumbosacral part of vertebral column were synchronously registered as these recordings reflect the changes of relationships between blood/CSF volumes in cranial and lumbosacral regions, respectively. The recordings were subjected to frequency and spectral computer analysis (PC Macintosh G-4, Chart 5.2. software). The rapid (pulsatile) as well as slow and counter-directed waves (frequency 6-10 cycles/min) of these processes were revealed in cranial and lumbosacral regions. The data obtained suggest the CSF dynamic concept of origin of the craniosacral rhythm. The pulse and slow-frequency oscillations of the cerebral vessels tone initiate corresponding intracranial pressure waves, and the latter are the motivating forces for to-and-fro CSF shifts in caudal direction. This mechanism is accompanied by tonic contractions of lumbar muscles and sacrum movements, and it is manually perceptible as a craniosacral rhythm.

  20. Prevalence of cystathionine beta synthase gene mutation 852Ins68 as a possible risk for neural tube defects in eastern India.

    PubMed

    Saxena, A K; Gupta, J; Pandey, S; Gangopadhaya, A N; Pandey, L K

    2011-10-07

    Cystathionine beta synthase gene (CβS) catalyzes the condensation of homocysteine with serine, forming cystathionine by the transsulfuration pathway. Disruption of CβS enzyme activity due to defective folic acid metabolism increases the risk factor for neural tube defects. We evaluated the CβS gene mutation in 25 children with neural tube defects (NTDs), including lumbosacral and thoracic myelomeningocele and open NTDs and mothers of cases, along with 25 healthy children and their mothers, serving as controls. Genomic DNA was isolated to assess the polymorphism of 852Ins68 in the CβS gene using PCR-RFLP analysis and nucleotide sequencing techniques. The 68-bp insertion was observed in one of the 25 NTD cases (lumbosacral myelomeningocele), and in two of the mothers of NTD cases. Statistical analysis was carried out using the Fischer exact probability test, which showed a lack of significance (P > 0.05), but the odds ratio of 2.08 with 95% confidence interval of 0.17-24.6 in NTDs mother was quite high because of the small sample size. However, the study was further extended to find out the involvement of specific nucleotide sequences, which again confirmed the 852Ins68 insertion and replacement of nucleotides (TCCAT to GGGG) in lumbosacral myelomeningocele (due to other category of NTDs), suggesting that it could be an independent risk factor for birth defects, including NTDs.

  1. Pelvic nerve input mediates descending modulation of homovisceral processing in the thoracolumbar spinal cord of the rat

    PubMed Central

    Wang, Gexin; Tang, Bin; Traub, Richard J.

    2007-01-01

    Background and aims Colonic afferents project to the lumbosacral and thoracolumbar spinal cord via the pelvic and hypogastric/lumbar colonic nerves, respectively. Both spinal regions process inflammatory colonic stimuli. The role of thoracolumbar segments in processing acute colorectal pain is questionable, however, since the lumbosacral spinal cord appears sufficient to process reflex responses to acute pain. Here we demonstrate that activity in pelvic nerve colonic afferents actively modulates thoracolumbar dorsal horn neuron processing of the same colonic stimulus via a supraspinal loop: homovisceral descending modulation. Methods Dorsal horn neurons were recorded in the rat thoracolumbar spinal cord following acute or chronic pelvic neurectomy and cervical cold block. Results Acute pelvic neurectomy or lidocaine inhibition of lumbosacral dorsal roots facilitated the excitatory response of thoracolumbar dorsal horn neurons to colorectal distention (CRD) and decreased the percentage of neurons inhibited by CRD, suggesting colonic input over the pelvic nerve inhibits thoracolumbar processing of the same stimulus. Ectopic activity developed in the proximal pelvic nerve following chronic neurectomy reactivating the inhibitory circuit, inhibiting thoracolumbar neurons. Cervical cold block alleviated the inhibition in intact or chronic neurectomized rats. However, the facilitated response following acute pelvic neurectomy was inhibited by cervical cold block exposing an underlying descending facilitation. Inhibiting pelvic nerve input following cervical cold block had minimal effect. Conclusion These data demonstrate that input over the pelvic nerve modulates the response of thoracolumbar spinal neurons to CRD via a supraspinal loop, and that increasing thoracolumbar processing increases visceral hyperalgesia. PMID:17916357

  2. A role for motor and somatosensory evoked potentials during anterior cervical discectomy and fusion for patients without myelopathy: Analysis of 57 consecutive cases

    PubMed Central

    Xu, Risheng; Ritzl, Eva K.; Sait, Mohammed; Sciubba, Daniel M.; Wolinsky, Jean-Paul; Witham, Timothy F.; Gokaslan, Ziya L.; Bydon, Ali

    2011-01-01

    Background: Although the usage of combined motor and sensory intraoperative monitoring has been shown to improve the surgical outcome of patients with cervical myelopathy, the role of transcranial electric motor evoked potentials (tceMEP) used in conjunction with somatosensory evoked potentials (SSEP) in patients presenting with radiculopathy but without myelopathy has been less clear. Methods: We retrospectively reviewed all patients (n = 57) with radiculopathy but without myelopathy, undergoing anterior cervical decompression and fusion at a single institution over the past 3 years, who had intraoperative monitoring with both tceMEPs and SSEPs. Results: Fifty-seven (100%) patients presented with radiculopathy, 53 (93.0%) with mechanical neck pain, 35 (61.4%) with motor dysfunction, and 29 (50.9%) with sensory deficits. Intraoperatively, 3 (5.3%) patients experienced decreases in SSEP signal amplitudes and 4 (6.9%) had tceMEP signal changes. There were three instances where a change in neuromonitoring signal required intraoperative alteration of the surgical procedure: these were deemed clinically significant events/true positives. SSEP monitoring showed two false positives and two false negatives, whereas tceMEP monitoring only had one false positive and no false negatives. Thus, tceMEP monitoring exhibited higher sensitivity (33.3% vs. 100%), specificity (95.6% vs. 98.1%), positive predictive value (33.3% vs. 75.0%), negative predictive value (97.7% vs. 100%), and efficiency (91.7% vs. 98.2%) compared to SSEP monitoring alone. Conclusions: Here, we present a retrospective series of 57 patients where tceMEP/SSEP monitoring likely prevented irreversible neurologic damage. Though further prospective studies are needed, there may be a role for combined tceMEP/SSEP monitoring for patients undergoing anterior cervical decompression without myelopathy. PMID:22059128

  3. Effect of Anterior Cervical Discectomy and Fusion on Patients with Atypical Symptoms Related to Cervical Spondylosis.

    PubMed

    Muheremu, Aikeremujiang; Sun, Yuqing; Yan, Kai; Yu, Jie; Zheng, Shan; Tian, Wei

    2016-09-01

    Background A considerable number of patients with cervical spondylosis complain about one or multiple atypical symptoms such as vertigo, palpitations, headache, blurred vision, hypomnesia, and/or nausea. It remains unclear whether surgical intervention for cervical spondylosis can also effectively alleviate those symptoms. The current study was performed to see if anterior cervical diskectomy and fusion (ACDF) offers such an extra benefit for patients with cervical spondylosis. Objective To investigate if patients who received ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy can also achieve alleviation of certain atypical symptoms associated with cervical spondylosis after the surgery in the long run. Methods Sixty-seven patients who underwent ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy were involved in this study. All these patients also complained about various associated atypical symptoms. They were followed up for 26 to 145 months after the surgery. Severity and frequency scores of the atypical symptoms before the surgery and at last follow-up were compared by paired t tests. Results Most patients reported significantly alleviated symptoms at the last follow-up compared with before the surgery. The severity of vertigo, headache, nausea, and palpitations were significantly alleviated at the last follow-up (with p values of p < 0.001, p = 0.001, p = 0.022, p = 0.004, respectively). There were no significant changes in the severity of tinnitus (p = 0.182), blurred vision (p = 0.260), and hypomnesia (p = 0.821). Conclusion ACDF can significantly alleviate vertigo, headache, nausea, and palpitations in most patients with cervical spondylotic myelopathy and/or radiculopathy, but it is not effective in alleviating symptoms such as tinnitus, blurred vision, and hypomnesia. It can be considered for alleviating atypical symptoms when other treatment options prove

  4. Outcomes following cervical disc arthroplasty: a retrospective review.

    PubMed

    Cody, John P; Kang, Daniel G; Tracey, Robert W; Wagner, Scott C; Rosner, Michael K; Lehman, Ronald A

    2014-11-01

    Cervical disc arthroplasty has emerged as a viable technique for the treatment of cervical radiculopathy and myelopathy, with the proposed benefit of maintenance of segmental range of motion. There are relatively few, non-industry sponsored studies examining the outcomes and complications of cervical disc arthroplasty. Therefore, we set out to perform a single center evaluation of the outcomes and complications of cervical disc arthroplasty. We performed a retrospective review of all patients from a single military tertiary medical center undergoing cervical disc arthroplasty from August 2008 to August 2012. The clinical outcomes and complications associated with the procedure were evaluated. A total of 219 consecutive patients were included in the review, with an average follow-up of 11.2 (±11.0)months. Relief of pre-operative symptoms was noted in 88.7% of patients, and 92.2% of patients were able to return to full pre-operative activity. There was a low rate of complications related to the anterior cervical approach (3.2% with recurrent laryngeal nerve injury, 8.9% with dysphagia), with no device/implant related complications. Symptomatic cervical radiculopathy is a common problem in both the civilian and active duty military populations and can cause significant disability leading to loss of work and decreased operational readiness. There exist several surgical treatment options for appropriately indicated patients. Based on our findings, cervical disc arthroplasty is a safe and effective treatment for symptomatic cervical radiculopathy and myelopathy, with a low incidence of complications and high rate of symptom relief.

  5. Cervical disc hernia operations through posterior laminoforaminotomy

    PubMed Central

    Yolas, Coskun; Ozdemir, Nuriye Guzin; Okay, Hilmi Onder; Kanat, Ayhan; Senol, Mehmet; Atci, Ibrahim Burak; Yilmaz, Hakan; Coban, Mustafa Kemal; Yuksel, Mehmet Onur; Kahraman, Umit

    2016-01-01

    Objective: The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. Materials and Methods: We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. Results: The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years). Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). On control examinations, there was no finding of instability or cervical kyphosis. Conclusion: Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis. PMID:27217655

  6. Treatment of Neck Pain

    PubMed Central

    Hurwitz, Eric L.; Cheng, Ivan; Carroll, Linda J.; Nordin, Margareta; Guzman, Jaime; Peloso, Paul; Holm, Lena W.; Côthé, Pierre; Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Cassidy, J. David; Haldeman, Scott

    2008-01-01

    Study Design Best evidence synthesis. Objective To identify, critically appraise, and synthesize literature from 1980 through 2006 on surgical interventions for neck pain alone or with radicular pain in the absence of serious pathologic disease. Summary of Background Data There have been no comprehensive systematic literature or evidence-based reviews published on this topic. Methods We systematically searched Medline for literature published from 1980 to 2006 on percutaneous and open surgical interventions for neck pain. Publications on the topic were also solicited from experts in the field. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our Best Evidence Synthesis. Results Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term out comes are improved with the surgical treatment of cervical radiculopathy compared to non operative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%–20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients. Conclusion Surgical treatment and limited

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

    PubMed Central

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

    2015-01-01

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

  8. Spinal Epidural Varices, a great Mimic of Intervertebral Disc Prolapse - A Case Series

    PubMed Central

    V, Raghavendra; Haridas, Papanaik; Kumar, Anand; K, Ajith

    2014-01-01

    Introduction: Epidural venous plexus enlargement, presenting with low back pain and radiculopathy, is an uncommon cause of nerve roots impingement. This condition commonly mimics a herniated nucleus pulposus radiologically. The radiological diagnosis is often missed and the diagnosis is made during the surgery. We are hereby presenting 2 such cases of epidural varices mimicking intervertebral disc prolapse with lumbar radiculopathy. Case Report: Case 1: 43 yr old female presented with acute exacerbation of low back ache and significant right L5–S1 radiculopathy without neurological deficit. MRI reported as L5-S1 disc prolapse. Intra-operatively engorged dilated epidural vein seen compressing S1 nerve root. Associated Disc bulge removed and Coagulative ablation of the dilated epidural vein was performed Case 2: 45 year old male manual labourer presented with backache with left sided sciatica since 8 months, increased in severity since past 1month associated with sensory blunting in L5 and S1 dermatomes. Neurologic examination revealed normal muscle power in his lower extremities. Sensations was blunted in L5 and S1 dermatomes. MRI was reported as L5-S1 disc prolapsed compressing left S1 nerve root. Decompression of the L5–S1 intervertebral space was performed through a left –sidelaminotomy. Large, engorged serpentine epidural veins was found in the axilla of S1 nerve root, compressing it. Coagulative ablation of the dilated epidural vein was performed. Retrospectively, features of epidural varices were noted in the preoperative magnetic resonance imaging scans. Both patients had significant improvement in radiculopathy immediate postoperatively, and sensory symptoms resolved over the next 6 weeks in second case. At recent follow up, both patients had significant relief of symptoms and no recurrent radicular symptoms. Conclusion: An abnormal dilated epidural venous plexus that mimics a herniated lumbar disc is a rare entity. This pathology should be always kept

  9. Lipoma with dumb-bell extradural extension through the intervertebral foramen into the spinal canal. Case report.

    PubMed

    Park, Jin Soo; Shirachi, Isao; Sato, Kimiaki; Ando, Noriyuki; Nagata, Kensei

    2005-01-01

    The authors present the case of a 60-year-old woman with a neck lipoma that developed dumb-bell extradural extension, causing radiculopathy. To the best of the authors' knowledge, this is the first report of a lipoma originating in the neck with dumb-bell extradural extension through the intervertebral foramen and into the spinal canal. The lipoma was first excised from the foramen via a posterior approach to allow decompression of the nerve roots. The remaining lipomatous tissue was then resected via an anterior approach to avoid the region around the vertebral artery.

  10. Dumb-bell shaped tuberculous abscess across the greater sciatic notch compressing both sciatic nerves.

    PubMed

    Baba, H; Okumura, Y; Furusawa, N; Omori, H; Kawahara, H; Fujita, T; Katayama, K; Noriki, S

    1998-08-01

    We report an instructive case of a 65-year-old man who presented with a dumb-bell shaped tuberculous abscess across the greater sciatic notch bilaterally compressing both sciatic nerves. Clinical symptoms progressed slowly and mimicked lumbar radiculopathy, thus delaying an accurate diagnosis. Anterolateral retroperitoneal and posterolateral gluteal approaches of the greater sciatic notch as well as the acetabulum on both sides were followed in order to provide safe viewing and resection of the abscess. The abscess wall was adherent to the sciatic nerve and surrounding blood vessels. The symptoms completely disappeared after resection of the abscess.

  11. Neurological complications of Mycoplasma pneumoniae infection.

    PubMed

    Hely, M A; Williamson, P M; Terenty, T R

    1984-01-01

    This study documents five patients with neurological disease associated with evidence of recent Mycoplasma pneumoniae infection. Four patients had encephalitis associated with coma. Two of these had hemiparesis (one with dysphasia), one had seizures, and one had cerebellar and brainstem involvement. Two also had evidence of a radiculopathy and peripheral neuropathy. One patient had aseptic meningitis with later transverse myelitis. Three patients had multiple sites of neurological involvement. Respiratory infections preceded the neurological syndromes in four cases. Antibiotic therapy did not appear to alter the course of the disease. All patients had a favourable outcome.

  12. Lumbar discal cyst: Diagnostic discography followed by therapeutic computed tomography-guided aspiration and injection.

    PubMed

    Endo, Yoshimi; Miller, Theodore T; Saboeiro, Gregory R; Cooke, Paul M

    2014-12-01

    Discal cysts are extradural masses that communicate with the intervertebral disk and are a rare cause of lower back pain and lumbar radiculopathy. This case report describes a lumbar discal cyst, the diagnosis of which was confirmed on conventional discography, and which was treated with computed tomography-guided aspiration and steroid injection. Several reports have described this procedure, but only one in the radiology literature, and thus the purpose of this report is to remind the radiology community of the existence of this entity and propose a minimally invasive means of treatment.

  13. Lumbar discal cyst: Diagnostic discography followed by therapeutic computed tomography-guided aspiration and injection

    PubMed Central

    Endo, Yoshimi; Miller, Theodore T.; Saboeiro, Gregory R.; Cooke, Paul M.

    2014-01-01

    Discal cysts are extradural masses that communicate with the intervertebral disk and are a rare cause of lower back pain and lumbar radiculopathy. This case report describes a lumbar discal cyst, the diagnosis of which was confirmed on conventional discography, and which was treated with computed tomography-guided aspiration and steroid injection. Several reports have described this procedure, but only one in the radiology literature, and thus the purpose of this report is to remind the radiology community of the existence of this entity and propose a minimally invasive means of treatment. PMID:25926915

  14. Leg discomfort: beyond the joints.

    PubMed

    Berger, Douglas

    2014-05-01

    Although simple characterization of discomfort as cramps, heaviness, shooting pains, and so forth can be misleading, history and examination are key to accurate diagnosis. Absence of both dorsalis pedis and posterior tibial pulses strongly suggests peripheral arterial disease (PAD), and the presence of either pulse makes PAD less likely. Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are a common cause of lower extremity myalgias. Restless legs syndrome causes nocturnal discomfort but must be distinguished from confounding“mimics." Neurologic causes of leg symptoms include lumbar spinal stenosis, radiculopathy, distal symmetric polyneuropathy, and entrapment neuropathy. Many common causes of leg discomfort can be managed conservatively.

  15. Limbus Vertebra Presenting with Inflammatory Low Back Pain: A Case Report

    PubMed Central

    Özdemir, Tayfun; Öz, Hande Ece

    2016-01-01

    Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation. PMID:27134989

  16. Management of adjacent segment disease after cervical spinal fusion.

    PubMed

    Kepler, Christopher K; Hilibrand, Alan S

    2012-01-01

    Adjacent segment disease (ASD) was described after long-term follow-up of patients treated with cervical fusion. The term describes new-onset radiculopathy or myelopathy referable to a motion segment adjacent to previous arthrodesis and often attributed to alterations in the biomechanical environment after fusion. Evidence suggests that ASD affects between 2% and 3% of patients per year. Although prevention of ASD was one major impetus behind the development of motion-sparing surgery, the literature does not yet clearly distinguish a difference in the rate of ASD between fusion and disk replacement. Surgical techniques during index surgery may reduce the rate of ASD.

  17. [Brachioradial pruritus effectively treated with gabapentin].

    PubMed

    Uldall Pallesen, Kristine Appel; Bygum, Anette

    2012-06-25

    Brachioradial pruritus is a characteristic clinical condition with a deep intense itching, tingling or burning sensation localized to the dorsolateral part of the upper extremities. The symptoms occur primarily in the late summer in fair skin type people who are extensively sun-exposed. The condition is difficult to treat and does not respond to topical steroids and antihistamines. We describe a 57-year-old woman with longstanding brachioradial itching due to cervical radiculopathy and sun exposure, which was successfully treated with gabapentin.

  18. Limbus Vertebra Presenting with Inflammatory Low Back Pain: A Case Report.

    PubMed

    Tuna, Serpil; Özdemir, Tayfun; Öz, Hande Ece

    2016-03-01

    Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation.

  19. Clinics in diagnostic imaging (151). Acromioclavicular joint geyser sign with chronic full-thickness supraspinatus tendon (SST) tear.

    PubMed

    Khor, Andrew Yu Keat; Wong, Steven Bak Siew

    2014-02-01

    An 82-year-old man presented with neck pain, right upper limb radiculopathy and right shoulder pain. Physical examination revealed a soft lump over the right shoulder joint, as well as reduced range of shoulder movements. On magnetic resonance imaging, the soft lump was shown to be a cystic mass over the acromioclavicular joint and was related to a full-thickness supraspinatus tendon tear. This is the classic geyser sign. The pathophysiology and clinical features of the geyser sign, and its imaging features with various imaging modalities, are discussed.

  20. PubMed Central

    Dodig, D.; Ngo, M.; Bailey, D.; Bril, V.

    2010-01-01

    Acute Epstein-Barr virus (EBV) infection is associated with central and peripheral neurological complications such as meningitis, encephalitis, myelitis and radiculopathy in 0.5-7.5% of patients (1). The peripheral nervous system manifestations of acute EBV infection include mononeuropathy, mononeuritis multiplex, autonomic neuropathy, and polyradiculopathy (2). Brachial plexopathy in children and immunocompromised adults with acute EBV infection has been described, likely as a dysimmune neuropathy triggered by the EBV (3, 4). We present a case of brachial plexopathy complicating prior EBV infection in a healthy adult. PMID:21314019

  1. Possible role of alpha-lipoic acid in the treatment of peripheral nerve injuries

    PubMed Central

    2010-01-01

    Recent findings on the antioxidant effects of pretreatment with α-lipoic acid (α-LA) on the crush injury of rat sciatic nerve confirm the possible usefulness of α-LA administration in humans with peripheral nerve injuries. We discussed this issue in relation with our recent results in which the combined employment of α-LA and γ-linolenic acid with a rehabilitation program for six weeks reduced sensory symptoms and neuropathic pain in patients with compressive radiculopathy syndrome from disc-nerve root conflict in comparison with patients submitted to rehabilitation program alone for six weeks. PMID:20807428

  2. Can intestinal innervation be preserved in pancreatoduodenectomy for cancer? Results of an anatomical study.

    PubMed

    Nano, M; Dal Corso, H; Ferronato, M; Solej, M; Hornung, J P

    2003-04-01

    Twenty dissections were carried out, in all of which the splanchnic nerves, celiac plexuses, capital pancreatic plexus and superior mesenteric plexus were identified and traced. The capital pancreatic plexus was formed from two bundles, the first taking its origin from the right celiac plexus, the second from the superior mesenteric plexus. These two bundles joined together just behind the head of the pancreas. Two preganglionic bundles, a ganglion and two postganglionic bundles composed the superior mesenteric plexus. Postganglionic bundles received fibers from both right and left celiac plexuses. In small cancers a thin layer of nervous tissue around the superior mesenteric artery might be spared in order to avoid diarrhea from intestinal denervation. This study has provided anatomical evidence that a part of the mesenteric plexus, which receives fibers from both left and right celiac plexuses, maintains a sufficient intestinal innervation.

  3. Dissection of intercostal nerves by means of assisted video thoracoscopy: experimental study

    PubMed Central

    2013-01-01

    In total brachial plexus preganglionic lesions (C5-C6-C7-C8 and T1) different extraplexual neurotizations are indicated for partial motor function restitution. Mostly for the flexion of the elbow. Neurotization with intercostal nerves (ICN) to musculocutaneous nerve has been known and accepted during many years with different results 2 - 5. The customary technique as described by various authors is carried out by means of a large submammary incision to harvest three or four intercostal nerves (Figure 1). Then are connected by direct suture or grafts to the musculocutaneous nerve or its motor branches 6 - 7. In this article the authors described the possibility of dissection intercostal nerves by means of assisted video thoracoscopy. (VATS-videdo assisted thoracic surgery). PMID:23406448

  4. [The effect of bromantane on the cardiovascular and sympathetic-adrenal systems in animals].

    PubMed

    Morozov, I S; Efimova, L P; Kryzhanovskiĭ, S A

    2000-01-01

    Bromantan administration markedly increases the stroke and minute blood volume at a reduced heart rate and peripheral resistance in anaesthetized rats, while the systemic arterial pressure exhibits an insignificant short-time increase. Bromantan also weakly increases the pressor effects of adrenaline and noradrenaline. In anaesthetized cats, bromantan modifies the shape of the amplitude-frequency characteristic of EEG measured in the upper cervical ganglion, reducing (against the initial level) the induced potential in the frequency range of the preganglionic fiber stimulation (1-10 and 25-30 Hz). In freely moving rats, capable of well-learnt Sidman's [correction of Seedman's] operant activity, bromantan showed a reliable tendency to decrease the rate of noradrenaline and adrenaline excretion with urine.

  5. Sympathetic Nerve Entrapment Point Injection as an Antireflux Procedure for Refractory Laryngopharyngeal Reflux: A First Case Report of Innovative Autonomic Regulation

    PubMed Central

    Lee, Sangsoo; Oh, Chang Jin

    2016-01-01

    Surgical treatment is not suitable for laryngopharyngeal reflux that is refractory to proton pump inhibitors. We present a case of proton pump inhibitor-refractory laryngopharyngeal reflux that was successfully treated with sympathetic nerve entrapment point injection. The patient had previously been diagnosed with laryngopharyngeal reflux and treated with proton pump inhibitors for six months without substantial improvement. After sympathetic nerve entrapment point injection treatment, her reflux symptom index improved from 15 points to 1 point, and this response was maintained for six months. Hyperexcitability of T5 and T6 sympathetic preganglionic fibers appears to be the main cause of laryngopharyngeal reflux. Sympathetic nerve entrapment point injection may represent an alternative to anti-reflux procedures. PMID:28210524

  6. Role of chiropractic and sacro-occipital technique in asthma treatment

    PubMed Central

    Blum, Charles L.

    2002-01-01

    Abstract Asthma is a multifactorial dysfunction of the respiratory system. Nutritional, environmental, genetic, and emotional factors all play animportant part in the etiology of this condition. One form of chiropractic, Sacro Occipital Technique (SOT), offers some conservative alternatives to the treatment of asthma. SOT expands the chiropractic armamentarium of techniques available, allowing methods putatively affecting the viscera, vertebra, post and preganglionic reflexes, as well as cranial and sacral influences on the primary respiratory mechanism. Though more research is needed to evaluate the efficacy of chiropractic care of asthma, the conservative nature of chiropractic care with its minimal side effects, warrants patient and a health practitioner's consideration prior to embarking on any course of treatment that might have serious side effects. PMID:19674555

  7. Role of chiropractic and sacro-occipital technique in asthma treatment.

    PubMed

    Blum, Charles L

    2002-01-01

    Asthma is a multifactorial dysfunction of the respiratory system. Nutritional, environmental, genetic, and emotional factors all play animportant part in the etiology of this condition. One form of chiropractic, Sacro Occipital Technique (SOT), offers some conservative alternatives to the treatment of asthma. SOT expands the chiropractic armamentarium of techniques available, allowing methods putatively affecting the viscera, vertebra, post and preganglionic reflexes, as well as cranial and sacral influences on the primary respiratory mechanism. Though more research is needed to evaluate the efficacy of chiropractic care of asthma, the conservative nature of chiropractic care with its minimal side effects, warrants patient and a health practitioner's consideration prior to embarking on any course of treatment that might have serious side effects.

  8. Autonomic pain: features and methods of assessment

    SciTech Connect

    Gandhavadi, B.; Rosen, J.S.; Addison, R.G.

    1982-01-01

    The distribution of pain originating in the sympathetic nervous system does not match the somatic segmental sensory distribution at the postganglionic level. The two types of distribution are separate and different. At the preganglionic level, fibers show typical segmental sensory distribution, which resembles but is not identical to somatic segmental sensory distribution. Instead, sympathetic pain has its own distribution along the vascular supply and some peripheral nerves. It cannot be called atypical in terms of somatic segmental sensory distribution. Several techniques are available to assess autonomic function in cases of chronic pain. Infrared thermography is superior to any other physiologic or pharmacologic method to assess sympathetic function. Overactivity of sympathetic function in the area of pain is the probable cause of temperature reduction in that area. Accordingly it would appear that in cases in which thermography demonstrates decreased temperature, sympathetic block or sympathectomy would provide relief from the pain.

  9. Unusual Horner's Syndrome in Recurrent Breast Cancer: Evaluation Using (18)F-FDG PET/CT.

    PubMed

    Park, Sohyun; Kim, Tae Sung; Kim, Seok-Ki

    2017-03-01

    (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a widely used imaging modality in the initial diagnosis of cancer, treatment response evaluation and detection of recurrence. Herein, we present the case of a 39-year-old female who presented right ptosis on the follow-up of breast cancer after surgery. Clinicians suspected Horner's syndrome, and the patient underwent FDG PET/CT for the evaluation of recurrence that could cause Horner's syndrome. FDG PET/CT demonstrated a focal hypermetabolic lesion in the right cervicothoracic junction area, corresponding to the preganglionic cervical sympathetic trunk. A subsequent needle biopsy was done, and the lesion was confirmed as metastatic ductal carcinoma. In this case, we could detect the exact location of the recurring lesion that caused Horner's syndrome using FDG PET/CT.

  10. Site of origin and mechanism of action of adenosine in the frog sympathetic ganglion

    SciTech Connect

    Bencherif, M.

    1987-01-01

    The contribution of pre and postsynaptic activation on the release of {sup 3}H-purines was studied in the isolated sympathetic paravertebral ganglion of the frog. Preganglionic stimulation induced an overall release of {sup 3}H-purines. This release is blocked by atropine and curare and can be induced by carbachol and antidromic stimulation. Analyses of the effluent by anion exchange chromatography and by HPLC showed that the non-nucleotide fractions constituted most of the counts released. Hence, nucleosides are the main products released by the ganglion and did not arise from hydrolysis of extracellular ATP. We studied the effect of synaptic activity on tritiated inositol release (IR). This release did not change during orthodromic stimulation. However, upon cessation of the stimulation, release increased rapidly and remained elevated for at least 45 minutes. This increase in IR was reduced by suffusion of the ganglia with either acetylcholine or adenosine.

  11. Stimulation of Baroresponsive Parts of the Nucleus of the Solitary Tract Produces Nitric Oxide-mediated Choroidal Vasodilation in Rat Eye

    PubMed Central

    Li, Chunyan; Fitzgerald, Malinda E. C.; Del Mar, Nobel; Reiner, Anton

    2016-01-01

    Preganglionic parasympathetic neurons of the ventromedial part of the superior salivatory nucleus (SSN) mediate vasodilation of orbital and choroidal blood vessels, via their projection to the nitrergic pterygopalatine ganglion (PPG) neurons that innervate these vessels. We recently showed that the baroresponsive part of the nucleus of the solitary tract (NTS) innervates choroidal control parasympathetic preganglionic neurons of SSN in rats. As this projection provides a means by which blood pressure (BP) signals may modulate choroidal blood flow (ChBF), we investigated if activation of baroresponsive NTS evokes ChBF increases in rat eye, using Laser Doppler Flowmetry (LDF) to measure ChBF transclerally. We found that electrical activation of ipsilateral baroresponsive NTS and its efferent fiber pathway to choroidal SSN increased mean ChBF by about 40–80% above baseline, depending on current level. The ChBF responses obtained with stimulation of baroresponsive NTS were driven by increases in both choroidal blood volume (ChBVol; i.e., vasodilation) and choroidal blood velocity (ChBVel; possibly due to orbital vessel dilation). Stimulation of baroresponsive NTS, by contrast, yielded no significant mean increases in systemic arterial blood pressure (ABP). We further found that the increases in ChBF with NTS stimulation were significantly reduced by administration of the neuronal nitric oxide (NO) synthase inhibitor Nω-propyl-l-arginine (NPA), thus implicating nitrergic PPG terminals in the NTS-elicited ChBF increases. Our results show that the NTS neurons projecting to choroidal SSN do mediate increase in ChBF, and thus suggest a role of baroresponsive NTS in the BP-dependent regulation of ChBF. PMID:27774055

  12. Evidence for a respiratory component, similar to mammalian respiratory sinus arrhythmia, in the heart rate variability signal from the rattlesnake, Crotalus durissus terrificus.

    PubMed

    Campbell, Hamish A; Leite, Cleo A C; Wang, Tobias; Skals, Marianne; Abe, Augusto S; Egginton, Stuart; Rantin, F Tadeu; Bishop, Charles M; Taylor, Edwin W

    2006-07-01

    Autonomic control of heart rate variability and the central location of vagal preganglionic neurones (VPN) were examined in the rattlesnake (Crotalus durissus terrificus), in order to determine whether respiratory sinus arrhythmia (RSA) occurred in a similar manner to that described for mammals. Resting ECG signals were recorded in undisturbed snakes using miniature datalogging devices, and the presence of oscillations in heart rate (fh) was assessed by power spectral analysis (PSA). This mathematical technique provides a graphical output that enables the estimation of cardiac autonomic control by measuring periodic changes in the heart beat interval. At fh above 19 min(-1) spectra were mainly characterised by low frequency components, reflecting mainly adrenergic tonus on the heart. By contrast, at fh below 19 min(-1) spectra typically contained high frequency components, demonstrated to be cholinergic in origin. Snakes with a fh >19 min(-1) may therefore have insufficient cholinergic tonus and/or too high an adrenergic tonus acting upon the heart for respiratory sinus arrhythmia (RSA) to develop. A parallel study monitored fh simultaneously with the intraperitoneal pressures associated with lung inflation. Snakes with a fh<19 min(-1) exhibited a high frequency (HF) peak in the power spectrum, which correlated with ventilation rate (fv). Adrenergic blockade by propranolol infusion increased the variability of the ventilation cycle, and the oscillatory component of the fh spectrum broadened accordingly. Infusion of atropine to effect cholinergic blockade abolished this HF component, confirming a role for vagal control of the heart in matching fh and fv in the rattlesnake. A neuroanatomical study of the brainstem revealed two locations for vagal preganglionic neurones (VPN). This is consistent with the suggestion that generation of ventilatory components in the heart rate variability (HRV) signal are dependent on spatially distinct loci for cardiac VPN. Therefore

  13. Adrenal adrenaline- and noradrenaline-containing cells and celiac sympathetic ganglia are differentially controlled by centrally administered corticotropin-releasing factor and arginine-vasopressin in rats.

    PubMed

    Yamaguchi-Shima, Naoko; Okada, Shoshiro; Shimizu, Takahiro; Usui, Daisuke; Nakamura, Kumiko; Lu, Lianyi; Yokotani, Kunihiko

    2007-06-14

    The adrenal glands and sympathetic celiac ganglia are innervated mainly by the greater splanchnic nerves, which contain preganglionic sympathetic nerves that originated from the thoracic spinal cord. The adrenal medulla has two separate populations of chromaffin cells, adrenaline-containing cells (A-cells) and noradrenaline-containing cells (NA-cells), which have been shown to be differentially innervated by separate groups of the preganglionic sympathetic neurons. The present study was designed to characterize the centrally activating mechanisms of the adrenal A-cells, NA-cells and celiac sympathetic ganglia with expression of cFos (a marker for neural excitation), in regard to the brain prostanoids, in anesthetized rats. Intracerebroventricularly (i.c.v.) administered corticotropin-releasing factor (CRF) induced cFos expression in the adrenal A-cells, but not NA-cells, and celiac ganglia. On the other hand, i.c.v. administered arginine-vasopressin (AVP) resulted in cFos induction in both A-cells and NA-cells in the adrenal medulla, but not in the celiac ganglia. Intracerebroventricular pretreatment with indomethacin (an inhibitor of cyclooxygenase) abolished the CRF- and AVP-induced cFos expression in all regions described above. On the other hand, intracerebroventricular pretreatment with furegrelate (an inhibitor of thromboxane A2 synthase) abolished the CRF-induced cFos expression in the adrenal A-cells, but not in the celiac ganglia, and also abolished the AVP-induced cFos expression in both A-cells and NA-cells in the adrenal medulla. These results suggest that centrally administered CRF activates adrenal A-cells and celiac sympathetic ganglia by brain thromboxane A2-mediated and other prostanoid than thromboxane A2 (probably prostaglandin E2)-mediated mechanisms, respectively. On the other hand, centrally administered AVP activates adrenal A-cells and NA-cells by brain thromboxane A2-mediated mechanisms in rats.

  14. Influences of neck afferents on sympathetic and respiratory nerve activity.

    PubMed

    Bolton, P S; Kerman, I A; Woodring, S F; Yates, B J

    1998-11-15

    It is well established that the vestibular system influences the sympathetic nervous system and the respiratory system; presumably, vestibulosympathetic and vestibulorespiratory responses participate in maintaining stable blood pressure and blood oxygenation during movement and changes in posture. Many brainstem neurons that generate vestibulospinal reflexes integrate signals from the labyrinth and neck muscles to distinguish between head movements on a stable body and whole body movements. In the present study, responses were recorded from the splanchnic (sympathetic), hypoglossal (inspiratory) and abdominal (expiratory) nerves during stimulation of the C2 dorsal root ganglion or C2 or C3 nerve branches innervating dorsal neck muscles. Stimulation of neck afferents using low current intensities, in many cases less than twice the threshold for producing an afferent volley recordable from the cord dorsum, elicited changes in sympathetic and respiratory nerve activity. These data suggest that head rotation on a stable body would elicit both cervical and vestibular inputs to respiratory motoneurons and sympathetic preganglionic neurons. The effects of cervical afferent stimulation on abdominal, splanchnic and hypoglossal nerve activity were not abolished by transection of the brainstem caudal to the vestibular nuclei; thus, pathways in addition to those involving the vestibular nuclei are involved in relaying cervical inputs to sympathetic preganglionic neurons and respiratory motoneurons. Transection of the C1-3 dorsal roots enhanced responses of the splanchnic and abdominal nerves to pitch head rotations on a fixed body but diminished responses of the hypoglossal nerve. Thus, neck and vestibular afferent influences on activity of respiratory pump muscles and sympathetic outflow appear to be antagonistic, so that responses will occur during whole body movements but not head movements on a stationary trunk. In contrast, neck and vestibular influences on tongue

  15. Neurally released pituitary adenylate cyclase-activating polypeptide enhances guinea pig intrinsic cardiac neurone excitability.

    PubMed

    Tompkins, John D; Ardell, Jeffrey L; Hoover, Donald B; Parsons, Rodney L

    2007-07-01

    Intracellular recordings were made in vitro from guinea-pig cardiac ganglia to determine whether endogenous neuropeptides such as pituitary adenylate cyclase-activating polypeptide (PACAP) or substance P released during tetanic neural stimulation modulate cardiac neurone excitability and/or contribute to slow excitatory postsynaptic potentials (sEPSPs). When nicotinic and muscarinic receptors were blocked by hexamethonium and atropine, 20 Hz stimulation for 10 s initiated a sEPSP in all innervated neurones. In 40% of the cells, excitability was enhanced after termination of the sEPSP. This suggested that non-cholinergic receptor-mediated mechanisms contributed to the sEPSP and modulated neuronal excitability. Exogenous PACAP and substance P initiated a slow depolarization in the neurones whereas neuronal excitability was only increased by PACAP. When ganglia were treated with the PAC1 antagonist PACAP6-38 (500 nM), the sEPSP evoked by 20 Hz stimulation was reduced by approximately 50% and an enhanced excitability occurred in only 10% of the cells. These observations suggested that PACAP released from preganglionic nerve terminals during tetanic stimulation enhanced neuronal excitability and evoked sEPSPs. After addition of 1 nM PACAP to the bath, 7 of 9 neurones exhibited a tonic firing pattern whereas in untreated preparations, the neurons had a phasic firing pattern. PACAP6-38 (500 nM) diminished the increase in excitability caused by 1 nM PACAP so that only 4 of 13 neurones exhibited a tonic firing pattern and the other 9 cells retained a phasic firing pattern. These findings indicate that PACAP can be released by tetanic neural stimulation in vitro and increase the excitability of intrinsic cardiac neurones. We hypothesize that in vivo PACAP released during preganglionic firing may modulate neurotransmission within the intrinsic cardiac ganglia.

  16. Source and origin of nerve fibres immunoreactive for substance P and calcitonin gene-related peptide in the normal and chronically denervated superior cervical sympathetic ganglion of the rat.

    PubMed

    Zaidi, Z F; Matthews, M R

    2013-01-01

    Immunohistochemical studies of sympathetic ganglia have indicated that the normal rat superior cervical ganglion contains both SP-IR and CGRP-IR fibres, and CGRP- and SP-immunoreactivity coexist in some fibres. In rat sympathetic ganglia decentralization by preganglionic denervation leads to intraganglionic increase of peptidergic fibres immunoreactive (IR) for substance P (SP) and calcitonin gene-related peptide. We explored the sources of SP- and CGRP-IR fibres in normal and in chronically decentralized rat SCGs. The distribution of immunoreactivities for CGRP and SP was determined in SCGs of normal rats and of rats following preganglionic denervation followed by sensory denervation. Ganglia were studied after short-term (2-5 days) sensory denervation, and long-term (7-16 months) sympathetic denervation followed by short-term (2 days) sensory denervation. To explore for the production of SP and CGRP by intrinsic neurones within the ganglion, normal and chronically decentralized SCGs were examined following pretreatment by local in vivo application of colchicine. Normal and chronically decentralized ganglia were also injected with fluorescent tracer Fluorogold for retrograde tracing of extrinsic fibres back to their neurones of origin. The observations suggest that in normal SCG in the rat the SP-IR and CGRP-IR nerve fibres are derived via direct links from vagus and glossopharyngeal nerves and the cervical plexus, or from nerve fibres running along the cervical sympathetic trunk, and the external carotid and the internal carotid nerves. Sensory nerve inputs to the rat SCG following decentralization may contribute to the low levels of ganglionic activation observable in the autonomic failure of multiple system atrophy in man.

  17. Control of ventricular excitability by neurons of the dorsal motor nucleus of the vagus nerve

    PubMed Central

    Machhada, Asif; Ang, Richard; Ackland, Gareth L.; Ninkina, Natalia; Buchman, Vladimir L.; Lythgoe, Mark F.; Trapp, Stefan; Tinker, Andrew; Marina, Nephtali; Gourine, Alexander V.

    2015-01-01

    Background The central nervous origins of functional parasympathetic innervation of cardiac ventricles remain controversial. Objective This study aimed to identify a population of vagal preganglionic neurons that contribute to the control of ventricular excitability. An animal model of synuclein pathology relevant to Parkinson’s disease was used to determine whether age-related loss of the activity of the identified group of neurons is associated with changes in ventricular electrophysiology. Methods In vivo cardiac electrophysiology was performed in anesthetized rats in conditions of selective inhibition of the dorsal vagal motor nucleus (DVMN) neurons by pharmacogenetic approach and in mice with global genetic deletion of all family members of the synuclein protein. Results In rats anesthetized with urethane (in conditions of systemic beta-adrenoceptor blockade), muscarinic and neuronal nitric oxide synthase blockade confirmed the existence of a tonic parasympathetic control of cardiac excitability mediated by the actions of acetylcholine and nitric oxide. Acute DVMN silencing led to shortening of the ventricular effective refractory period (vERP), a lowering of the threshold for triggered ventricular tachycardia, and prolongation of the corrected QT (QTc) interval. Lower resting activity of the DVMN neurons in aging synuclein-deficient mice was found to be associated with vERP shortening and QTc interval prolongation. Conclusion Activity of the DVMN vagal preganglionic neurons is responsible for tonic parasympathetic control of ventricular excitability, likely to be mediated by nitric oxide. These findings provide the first insight into the central nervous substrate that underlies functional parasympathetic innervation of the ventricles and highlight its vulnerability in neurodegenerative diseases. PMID:26051529

  18. Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

    PubMed Central

    Moon, Jangsup; Kwon, Hyung-Min

    2017-01-01

    Introduction Transforaminal epidural steroid injection (TFESI) is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. Methods We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI. Results After 2 min of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities and within 5 min the patient became quadriplegic. Despite active rehabilitation, the patient remained bed-ridden 4 years after the catastrophic event. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI in Korea. Conclusion Considering the risk of dreadful complications, which appear in an unpredictable manner, TFESI with fluoroscopic guidance should be done only with a nonparticulate steroid. PMID:28203184

  19. Migrating opiate pump: atypical [corrected] cause of meralgia paresthetica.

    PubMed

    Windsor, Robert E; Thampi, Samuel

    2003-10-01

    This is a case report of a 60 year-old female who presented with pain on the anterolateral aspect of her right thigh. The patient had a history of placement of a Drug Administration System (DAS, Opiate pump) in August, 1998 for chronic lumbar radiculopathy and a multiply operated on spine which she had suffered with since October, 1991. She presented with the subacute onset of focal pain on the anterior aspect of her right superior iliac crest region and dysesthesias on the anterolateral aspect of her right thigh. There was no history of recent trauma, worsening low back pain, or any other sensori-motor change. There was no history of anterior iliac crest bone graft for her spinal fusion and she had no anterolateral thigh symptoms related to her lumbar radiculopathy. Her neurological examination was significant only for decreased sensation on the anterolateral aspect of her right thigh. On abdominal examination the DAS pump was found at a low-lying location and was closely abutting the anterior and medial aspect of her superior iliac spine. She underwent revision of the DAS pump site with obliteration of the inferior and lateral aspect of the pump pocket. Her symptoms improved by 30% immediately and completely dissipated within two month following the procedure. This is the first reported case of lateral femoral cutaneous nerve neuropathy with DAS use. Recognition of focal compressive neuropathy by distal migration of a DAS is important, as they are potentially treatable with recognition.

  20. A Genetically Engineered Thermally Responsive Sustained Release Curcumin Depot to Treat Neuroinflammation

    PubMed Central

    Sinclair, S. Michael; Bhattacharyya, Jayanta; McDaniel, Jonathan R.; Gooden, David M.; Gopalaswamy, Ramesh; Chilkoti, Ashutosh; Setton, Lori A.

    2014-01-01

    Radiculopathy, a painful neuroinflammation that can accompany intervertebral disc herniation, is associated with locally increased levels of the pro-inflammatory cytokine tumor necrosis factor alpha (TNFα). Systemic administration of TNF antagonists for radiculopathy in the clinic has shown mixed results, and there is growing interest in the local delivery of anti-inflammatory drugs to treat this pathology as well as similar inflammatory events of peripheral nerve injury. Curcumin, a known antagonist of TNFα in multiple cell types and tissues, was chemically modified and conjugated to a thermally responsive elastin-like polypeptide (ELP) to create an injectable depot for sustained, local delivery of curcumin to treat neuroinflammation. ELPs are biopolymers capable of thermally-triggered in situ depot formation that have been successfully employed as drug carriers and biomaterials in several applications. ELP-curcumin conjugates were shown to display high drug loading, rapidly release curcumin in vitro via degradable carbamate bonds, and retain in vitro bioactivity against TNFα-induced cytotoxicity and monocyte activation with IC50 only two-fold higher than curcumin. When injected proximal to the sciatic nerve in mice via intramuscular (i.m.) injection, ELP-curcumin conjugates underwent a thermally triggered soluble-insoluble phase transition, leading to in situ formation of a depot that released curcumin over 4 days post-injection and decreased plasma AUC 7-fold. PMID:23830979

  1. Traumatic Migration of the Bryan Cervical Disc Arthroplasty.

    PubMed

    Wagner, Scott C; Kang, Daniel G; Helgeson, Melvin D

    2016-02-01

    Study Design Case study. Objective To describe a case of dislodgment and migration of the Bryan Cervical Disc (Medtronic Sofamor Danek, Memphis, Tennessee, United States) arthroplasty more than 6 months after implantation secondary to low-energy trauma. Methods The inpatient, outpatient, and radiographic medical records of a patient with traumatic migration of the Bryan Cervical Disc arthroplasty were reviewed. The authors have no relevant disclosures to report. Results A 36-year-old man with chronic left upper extremity radiculopathy underwent uncomplicated Bryan Cervical Disc arthroplasty at C5-C6, with complete resolution of his symptoms. Approximately 6 months after his index procedure, he sustained low-energy trauma to the posterior cervical spine, after being struck by a book falling from a shelf. The injury forced his neck into flexion, and though he did not have recurrence of his radiculopathy symptoms, radiographs demonstrated anterior migration of the arthroplasty device. He underwent revision to anterior cervical diskectomy and fusion. Conclusions Although extremely rare, it is imperative that surgeons consider the potential for failure of osseous integration in patients undergoing cervical disk arthroplasty, even beyond 3 to 6 months postoperatively. This concern is especially relevant to press-fit or milled devices like the Bryan Cervical Disc arthroplasty, which lack direct fixation into adjacent vertebral bodies. We are considering modification of our postoperative protocol to improve protection of the device after implantation, even beyond 3 months postoperatively.

  2. Manual therapy and exercise for neck pain: A systematic review.

    PubMed

    Miller, Jordan; Gross, Anita; D'Sylva, Jonathan; Burnie, Stephen J; Goldsmith, Charles H; Graham, Nadine; Haines, Ted; Brønfort, Gert; Hoving, Jan L

    2010-06-01

    Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardized mean differences (pSMD) were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain (pSMD-0.87(95% CI:-1.69,-0.06)), function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggests greater short-term pain relief [pSMD-0.50(95% CI:-0.76,-0.24)] than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

  3. Manual therapy and exercise for neck pain: a systematic review.

    PubMed

    Miller, Jordan; Gross, Anita; D'Sylva, Jonathan; Burnie, Stephen J; Goldsmith, Charles H; Graham, Nadine; Haines, Ted; Brønfort, Gert; Hoving, Jan L

    2010-08-01

    Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardized mean differences (pSMD) were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain (pSMD-0.87(95% CI: -1.69, -0.06)), function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggests greater short-term pain relief [pSMD-0.50(95% CI: -0.76, -0.24)] than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

  4. [Management of transient radicular pain after receiving an epidural blood patch for headaches due to spontaneous intracranial hypotension].

    PubMed

    Melo, M C; Revuelta, M E; Santeularia, T; Genové, M; Català, E

    2015-11-01

    Spontaneous intracranial hypotension headache is an uncommon disease that resolves spontaneously in most of the cases and in a short period of time. The initial treatment should be symptomatic. In some patients the symptomatology is extremely disabling, and in these cases both the diagnosis and treatment may be performed by an epidural blood patch. A 49-year-old Caucasian woman, with no previous record of epidural or intrathecal puncture, consulted in the Emergency Department complaining of a 9-day history of frontal headache and diplopia, along with nausea and vomiting. The patient was diagnosed with spontaneous intracranial hypotension headache. Considering the symptomatology and the uncontrolled pain, the Pain Unit of our hospital performed an epidural blood patch. In the first 24h the patient reported a remarkable relief of both headache and diplopia but developed a left lumbar radiculopathy that was treated successfully with supportive measures. Transient lumbar radiculopathy is a common and acceptable event secondary to the use of epidural blood patch as a treatment for spontaneous intracranial hypotension headache.

  5. Endoscopic decompression for intraforaminal and extraforaminal nerve root compression

    PubMed Central

    2011-01-01

    Objective The purpose of this study was to evaluate the outcome of endoscopic decompression surgery for intraforaminal and extraforaminal nerve root compression in the lumbar spine. Methods The records from seventeen consecutive patients treated with endoscopic posterior decompression without fusion for intaforaminal and extraforaminal nerve root compression in the lumbar spine (7 males and 10 females, mean age: 67.9 ± 10.7 years) were retrospectively reviewed. The surgical procedures consisted of lateral or translaminal decompression with or without discectomy. The following items were investigated: 1) the preoperative clinical findings; 2) the radiologic findings including MRI and computed tomography-discography; and 3) the surgical outcome as evaluated using the Japanese Orthopaedic Association scale for lower back pain (JOA score). Results All patients had neurological findings compatible with a radiculopathy, such as muscle weakness and sensory disturbance. MRI demonstrated the obliteration of the normal increased signal intensity fat in the intervertebral foramen. Ten patients out of 14 who underwent computed tomography-discography exhibited disc protrusion or herniation. Selective nerve root block was effective in all patients. During surgery, 12 patients were found to have a protruded disc or herniation that compressed the nerve root. Sixteen patients reported pain relief immediately after surgery. Conclusions Intraforaminal and extraforaminal nerve root compression is a rare but distinct pathological condition causing severe radiculopathy. Endoscopic decompression surgery is considered to be an appropriate and less invasive surgical option. PMID:21439083

  6. Surgical experience of gas-containing disk herniation.

    PubMed

    Choi, Kyung-Chul; Kim, Jin-Sung; Lee, Sang-Ho

    2010-01-01

    Disk herniation with gas or gas-containing disk herniation (GCDH) is rare, although epidural gas is associated with the vacuum phenomenon. The clinical, radiologic, and surgical findings were retrospectively analyzed of 18 patients with GCDH. The demographic, clinical, and radiologic findings including computed tomography and magnetic resonance imaging, as well as operative methods were examined. The mean age was 64.4 years (range 51-84 years). All patients presented with acute radiculopathy or exacerbation of chronic pain associated with GCDH of the lumbar spine. All lumbar GCDHs were related to the vacuum phenomenon. Ruptured disks predominantly compressed the nerve root with gas in 17 cases, except in one with only compressed nerve root by gas without disk herniation. All patients had confirmed GCDH at surgery. All patients underwent removal of GCDH and five with another level of spinal stenosis or disk herniation underwent selective decompression. The six patients with instability underwent fusion. Visual analogue scale score of radicular pain was improved from 7.4 ± 0.9 before surgery to 3.2 ± 0.7 at the 3-month follow-up examination. No recurrence occurred after surgery. GCDH can occur as a space-occupying lesion in epidural space as well as a cause of radiculopathy. GCDH may indicate the source of clinical symptoms in the degenerative spine, especially combined with spinal stenosis or multiple spinal disk herniations.

  7. Upregulation of Ih expressed in IB4-negative Aδ nociceptive DRG neurons contributes to mechanical hypersensitivity associated with cervical radiculopathic pain.

    PubMed

    Liu, Da-Lu; Lu, Na; Han, Wen-Juan; Chen, Rong-Gui; Cong, Rui; Xie, Rou-Gang; Zhang, Yu-Fei; Kong, Wei-Wei; Hu, San-Jue; Luo, Ceng

    2015-11-18

    Cervical radiculopathy represents aberrant mechanical hypersensitivity. Primary sensory neuron's ability to sense mechanical force forms mechanotransduction. However, whether this property undergoes activity-dependent plastic changes and underlies mechanical hypersensitivity associated with cervical radiculopathic pain (CRP) is not clear. Here we show a new CRP model producing stable mechanical compression of dorsal root ganglion (DRG), which induces dramatic behavioral mechanical hypersensitivity. Amongst nociceptive DRG neurons, a mechanically sensitive neuron, isolectin B4 negative Aδ-type (IB4(-) Aδ) DRG neuron displays spontaneous activity with hyperexcitability after chronic compression of cervical DRGs. Focal mechanical stimulation on somata of IB4(-) Aδ neuron induces abnormal hypersensitivity. Upregulated HCN1 and HCN3 channels and increased Ih current on this subset of primary nociceptors underlies the spontaneous activity together with neuronal mechanical hypersensitivity, which further contributes to the behavioral mechanical hypersensitivity associated with CRP. This study sheds new light on the functional plasticity of a specific subset of nociceptive DRG neurons to mechanical stimulation and reveals a novel mechanism that could underlie the mechanical hypersensitivity associated with cervical radiculopathy.

  8. Traumatic Migration of the Bryan Cervical Disc Arthroplasty

    PubMed Central

    Wagner, Scott C.; Kang, Daniel G.; Helgeson, Melvin D.

    2015-01-01

    Study Design Case study. Objective To describe a case of dislodgment and migration of the Bryan Cervical Disc (Medtronic Sofamor Danek, Memphis, Tennessee, United States) arthroplasty more than 6 months after implantation secondary to low-energy trauma. Methods The inpatient, outpatient, and radiographic medical records of a patient with traumatic migration of the Bryan Cervical Disc arthroplasty were reviewed. The authors have no relevant disclosures to report. Results A 36-year-old man with chronic left upper extremity radiculopathy underwent uncomplicated Bryan Cervical Disc arthroplasty at C5–C6, with complete resolution of his symptoms. Approximately 6 months after his index procedure, he sustained low-energy trauma to the posterior cervical spine, after being struck by a book falling from a shelf. The injury forced his neck into flexion, and though he did not have recurrence of his radiculopathy symptoms, radiographs demonstrated anterior migration of the arthroplasty device. He underwent revision to anterior cervical diskectomy and fusion. Conclusions Although extremely rare, it is imperative that surgeons consider the potential for failure of osseous integration in patients undergoing cervical disk arthroplasty, even beyond 3 to 6 months postoperatively. This concern is especially relevant to press-fit or milled devices like the Bryan Cervical Disc arthroplasty, which lack direct fixation into adjacent vertebral bodies. We are considering modification of our postoperative protocol to improve protection of the device after implantation, even beyond 3 months postoperatively. PMID:26835211

  9. Anterior cervical discectomy, fusion and stabilization by plate and screw--early experience.

    PubMed

    Islam, M A; Islam, M A; Habib, M A; Sakeb, N

    2012-08-01

    Anterior cervical plating is commonly performed to stabilize anterior cervical fusion. The aim of the study was to evaluate the clinical and functional outcome, radiological fusion and operative complications in cases of cervical spondylotic myelopathy and radiculopathy who underwent Anterior Cervical Discectomy and Fusion (ACDF) by autograft and stabilized with plate and screw. We evaluated 16 consecutive patients (M: F = 10:6) from January 2008 to December 2010 in Bangabandhu Sheikh Mujib Medical University (BSMMU) and different private hospitals in Dhaka, in cases where adequate conservative treatment failed. Single level ACDF by autograft and stabilization by plate and screw was done in 10 patients and 06 patients had two levels fusion. The mean follow up period was 18 months. The patients improved significantly (p < 0.05) and the recovery rate was 87.50%. All patients showed radiological fusion (p < 0.001). There was no hardware failure, graft extrusion or plate breakage. ACDF with plate and screw is fairly safe and effective therapy for cervical disc degeneration leading to myelo-radiculopathy where major post operative complications are uncommon.

  10. AAEM minimonograph #46: neurogenic muscle hypertrophy.

    PubMed

    Gutmann, L

    1996-07-01

    Muscle hypertrophy occurs uncommonly in several neurogenic disorders including neuropathies, radiculopathies, spinal muscular atrophy, and post-polio syndrome. Its pathogenesis varies in different circumstances. In the presence of generalized myokymia and neuromyotonia (Isaacs' syndrome), symmetrical hypertrophy appears to be the result of continuous spontaneous electrical stimulation of myofibers and, in some cases, results in type 1 myofiber preponderance. Focal hypertrophy occurring with radiculopathies and mononeuropathies was associated with complex repetitive discharges (CRDs) in approximately half the cases. CRDs may play a role in the pathogenesis of myofiber hypertrophy by continuous myofiber stimulation, but in some cases, with and without CRDs, myofiber hypertrophy may be related to mechanical events. Muscle enlargement seen in old polio appears to involve a significant degree of pseudohypertrophy, although some myofiber hypertrophy occurs. The symmetrical occurrence of hypertrophy in genetically determined disorders, such as spinal muscular atrophy, and hereditary motor and sensory neuropathy types 1 and 2 may have both a genetic and a mechanical basis in addition to pseudohypertrophy in some cases.

  11. Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali

    PubMed Central

    Mahadewa Tjokorda, G. B.; Nyoman, Golden; Sri, Maliawan; Junichi, Mizuno

    2016-01-01

    This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome. PMID:27695567

  12. Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali.

    PubMed

    Mahadewa Tjokorda, G B; Nyoman, Golden; Sri, Maliawan; Junichi, Mizuno

    2016-01-01

    This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome.

  13. Florid Suprascapular Neuropathy after Primary Rotator Cuff Repair Attributed to Suprascapular Notch Constriction in the Setting of Double Crush Syndrome

    PubMed Central

    Skedros, John G.; Kiser, Casey J.; Hill, Bryce B.

    2015-01-01

    This report describes a patient who had an open repair of a small supraspinatus tendon tear performed 6 months after an arthroscopic acromioplasty with debridement had failed to provide pain relief. Three months prior to the tendon repair, he had a two-level cervical spine discectomy and fusion (C4–5, C5–6) that improved his neck pain. Florid suprascapular neuropathy was detected 10 weeks after the open rotator cuff repair. Evidence of some nerve recovery resulted in a long period of observation. But unsatisfactory improvement warranted decompression of the suprascapular notch, which was found to be very stenotic. At surgery, there was no evidence of neuroma, cyst, or other compressing lesion or tissue. Therefore, it was ultimately hypothesized that there was an exacerbation of a preexisting, but clinically unrecognized, entrapment of the suprascapular nerve in the suprascapular notch in the setting of cervical radiculopathy (primarily C5). Retrospectively it was also concluded that had this compressive etiology been recognized, it would have favored prompt decompression rather than the long observation period. Three years was required to achieve a good result following suprascapular notch decompression. The underlying C5 radiculopathy may have created a “double crush syndrome” that contributed to the propensity for injury and the prolonged recovery. There should be heightened awareness of this problem in patients who do not have satisfactory improvement in shoulder pain from previous shoulder and neck surgery. PMID:27917243

  14. Scanning pattern of diffusion tensor tractography and an analysis of the morphology and function of spinal nerve roots.

    PubMed

    Tian, Xin; Liu, Huaijun; Geng, Zuojun; Yang, Hua; Wang, Guoshi; Yang, Jiping; Wang, Chunxia; Li, Cuining; Li, Ying

    2013-11-25

    Radiculopathy, commonly induced by intervertebral disk bulging or protrusion, is presently diagnosed in accordance with clinical symptoms because there is no objective quantitative diagnostic criterion. Diffusion tensor magnetic resonance imaging and diffusion tensor tractography revealed the characterization of anisotropic diffusion and displayed the anatomic form of nerve root fibers. This study included 18 cases with intervertebral disc degeneration-induced unilateral radiculopathy. Magnetic resonance diffusion tensor imaging was creatively used to reveal the scanning pattern of fiber tracking of the spinal nerve root. A scoring system of nerve root morphology was used to quantitatively assess nerve root morphology and functional alteration after intervertebral disc degeneration. Results showed that after fiber tracking, compared with unaffected nerve root, fiber bundles gathered together and interrupted at the affected side. No significant alteration was detected in the number of fiber bundles, but the cross-sectional area of nerve root fibers was reduced. These results suggest that diffusion tensor magnetic resonance imaging-based tractography can be used to quantitatively evaluate nerve root function according to the area and morphology of fiber bundles of nerve roots.

  15. Epidemiology, diagnosis, and treatment of neck pain.

    PubMed

    Cohen, Steven P

    2015-02-01

    Neck pain is the fourth leading cause of disability, with an annual prevalence rate exceeding 30%. Most episodes of acute neck pain will resolve with or without treatment, but nearly 50% of individuals will continue to experience some degree of pain or frequent occurrences. History and physical examination can provide important clues as to whether the pain is neuropathic or mechanical and can also be used to identify "red flags" that may signify serious pathology, such as myelopathy, atlantoaxial subluxation, and metastases. Magnetic resonance imaging is characterized by a high prevalence of abnormal findings in asymptomatic individuals but should be considered for cases involving focal neurologic symptoms, pain refractory to conventional treatment, and when referring a patient for interventional treatment. Few clinical trials have evaluated treatments for neck pain. Exercise treatment appears to be beneficial in patients with neck pain. There is some evidence to support muscle relaxants in acute neck pain associated with muscle spasm, conflicting evidence for epidural corticosteroid injections for radiculopathy, and weak positive evidence for cervical facet joint radiofrequency denervation. In patients with radiculopathy or myelopathy, surgery appears to be more effective than nonsurgical therapy in the short term but not in the long term for most people.

  16. Pneumocephalus during cervical transforaminal epidural steroid injections: a case report.

    PubMed

    Kim, Won-Joong; Park, Hae-Gyun; Park, Yong-Hee; Shin, Mee-Ran; Koo, Gill-Hoi; Shin, Hwa-Yong

    2015-01-01

    A cervical transforaminal epidural injection of anesthetic and corticosteroids (CTFESI) is a frequently used procedure for cervical radiculopathy. Most cases of pneumocephalus after an epidural block occur when using an interlaminar approach with the loss-of-resistance technique. The authors present the first case of pneumocephalus after cervical transforaminal epidural injection of anesthetic and corticosteroids. A 64-yr-old woman with left C7 radiculopathy was undergoing C6-7 transforaminal epidural injection of anesthetic and corticosteroids. The epidural spread of contrast was checked by fluoroscope, and 5 mg of dexamethasone in 4 ml of 0.1875% ropivacaine was injected. She lost consciousness 5 mins after the procedure and regained awareness after manual ventilation. She subsequently complained of nausea and headache, and a computed tomography brain scan revealed pneumocephalus. After carefully assessing the fluoroscopic images, the authors believe that the needle may have punctured the dura mater of the nerve root sleeve, allowing air to enter the subdural space. Thus, fluoroscopic images should be carefully examined to reduce dural puncture when performing cervical transforaminal epidural injection of anesthetic and corticosteroids, and air should be completely removed from the needle, extension tube, and syringe.

  17. Transition of a herniated lumbar disc to lumbar discal cyst: A case report

    PubMed Central

    Bansil, Rohit; Hirano, Yoshitaka; Sakuma, Hideo; Watanabe, Kazuo

    2016-01-01

    Background: Another rare cause of lower back pain with radiculopathy is the discal cyst. It is believed to arise from degeneration of a herniated disc, although many other theories of its origin have been proposed. Here, we report a patient with lower back pain/radiculopathy attributed originally to a herniated lumbar disc, which transformed within 6 months into a discal cyst. Case Description: A 42-year-old male had a magnetic resonance (MR) documented herniated lumbar disc at the L4-5 level. It was managed conservatively for 6 months, after which symptoms recurred and progressed. The follow-up MR study revealed a discal cyst at the L4-5 without residual herniated disc. Of interest, the cyst communicated with the L4-5 intervertebral disc, which was herniated under the posterior longitudinal ligament and the disc space. During surgery, the cyst was completely removed, and his symptoms/signs resolved. Conclusion: A discal cyst develops as pathological sequelae of a degenerated herniated disc. Although rare, these lesions must be considered among the differential diagnoses in young patients with radicular back pain. MR study clearly documents these lesions, and surgical excision of the cyst is the treatment of choice. PMID:27843689

  18. Upregulation of Ih expressed in IB4-negative Aδ nociceptive DRG neurons contributes to mechanical hypersensitivity associated with cervical radiculopathic pain

    PubMed Central

    Liu, Da-Lu; Lu, Na; Han, Wen-Juan; Chen, Rong-Gui; Cong, Rui; Xie, Rou-Gang; Zhang, Yu-Fei; Kong, Wei-Wei; Hu, San-Jue; Luo, Ceng

    2015-01-01

    Cervical radiculopathy represents aberrant mechanical hypersensitivity. Primary sensory neuron’s ability to sense mechanical force forms mechanotransduction. However, whether this property undergoes activity-dependent plastic changes and underlies mechanical hypersensitivity associated with cervical radiculopathic pain (CRP) is not clear. Here we show a new CRP model producing stable mechanical compression of dorsal root ganglion (DRG), which induces dramatic behavioral mechanical hypersensitivity. Amongst nociceptive DRG neurons, a mechanically sensitive neuron, isolectin B4 negative Aδ-type (IB4− Aδ) DRG neuron displays spontaneous activity with hyperexcitability after chronic compression of cervical DRGs. Focal mechanical stimulation on somata of IB4- Aδ neuron induces abnormal hypersensitivity. Upregulated HCN1 and HCN3 channels and increased Ih current on this subset of primary nociceptors underlies the spontaneous activity together with neuronal mechanical hypersensitivity, which further contributes to the behavioral mechanical hypersensitivity associated with CRP. This study sheds new light on the functional plasticity of a specific subset of nociceptive DRG neurons to mechanical stimulation and reveals a novel mechanism that could underlie the mechanical hypersensitivity associated with cervical radiculopathy. PMID:26577374

  19. Influence of the paraventricular nucleus and oxytocin on the retrograde stain of pubococcygeus muscle motoneurons in male rats.

    PubMed

    Pérez, César Antonio; Concha, Adriana; Hernández, María Elena; Manzo, Jorge

    2005-04-11

    Lumbosacral cord motoneurons innervating the pubococcygeus muscle (Pcm) at the pelvic floor of male rats were analyzed. We showed previously that these motoneurons participate in sexual functions and are sensitive to fluctuations of systemic androgen and estrogen. Though estrogen receptors have not been identified in Lamina IX at these spinal areas, the release of oxytocin from the paraventricular nucleus of the hypothalamus (PvN) has been found to control pelvic sexual physiology. We therefore worked on the hypothesis that steroid hormones in the PvN induce the release of oxytocin at the lumbosacral level to modulate the function of Pcm motoneurons. Four experiments were developed, and results were observed with the retrograde staining of motoneurons with horseradish peroxidase. Data indicated that morphometric parameters of Pcm motoneurons were significantly reduced after castration or blocking of the steroids at the PvN site, or following complete transection of the spinal cord at the T8 level. In each case, the reduction of the stain was recovered after intrathecal treatment with oxytocin. Thus, present results show that Pcm motoneurons respond to spinal oxytocin. The conclusive model that we propose is that steroids stimulate the PvN, causing the nucleus to release oxytocin at the level of the lumbosacral spinal cord, and the release of the peptide regulates the spread of the stain of Pcm motoneurons. This work also shows that motoneurons distal to a transected area in the spinal cord could respond to exogenous oxytocin, an important finding for the research of spinal cord lesioned subjects.

  20. Training Locomotor Networks

    PubMed Central

    Edgerton, V. Reggie; Courtine, Grégoire; Gerasimenko, Yury P.; Lavrov, Igor; Ichiyama, Ronaldo M.; Fong, Andy J.; Cai, Lance L.; Otoshi, Chad K.; Tillakaratne, Niranjala J.K.; Burdick, Joel W.; Roy, Roland R.

    2008-01-01

    For a complete adult spinal rat to regain some weight-bearing stepping capability, it appears that a sequence of specific proprioceptive inputs that are similar, but not identical, from step to step must be generated over repetitive step cycles. Furthermore, these cycles must include the activation of specific neural circuits that are intrinsic to the lumbosacral spinal cord segments. For these sensorimotor pathways to be effective in generating stepping, the spinal circuitry must be modulated to an appropriate excitability level. This level of modulation is sustained from supraspinal input in intact, but not spinal, rats. In a series of experiments with complete spinal rats, we have shown that an appropriate level of excitability of the spinal circuitry can be achieved using widely different means. For example, this modulation level can be acquired pharmacologically, via epidural electrical stimulation over specific lumbosacral spinal cord segments, and/or by use-dependent mechanisms such as step or stand training. Evidence as to how each of these treatments can “tune” the spinal circuitry to a “physiological state” that enables it to respond appropriately to proprioceptive input will be presented. We have found that each of these interventions can enable the proprioceptive input to actually control extensive details that define the dynamics of stepping over a range of speeds, loads, and directions. A series of experiments will be described that illustrate sensory control of stepping and standing after a spinal cord injury and the necessity for the “physiological state” of the spinal circuitry to be modulated within a critical window of excitability for this control to be manifested. The present findings have important consequences not only for our understanding of how the motor pattern for stepping is formed, but also for the design of rehabilitation intervention to restore lumbosacral circuit function in humans following a spinal cord injury. PMID

  1. Forelimb EMG-based trigger to control an electronic spinal bridge to enable hindlimb stepping after a complete spinal cord lesion in rats

    PubMed Central

    2012-01-01

    Background A complete spinal cord transection results in loss of all supraspinal motor control below the level of the injury. The neural circuitry in the lumbosacral spinal cord, however, can generate locomotor patterns in the hindlimbs of rats and cats with the aid of motor training, epidural stimulation and/or administration of monoaminergic agonists. We hypothesized that there are patterns of EMG signals from the forelimbs during quadrupedal locomotion that uniquely represent a signal for the “intent” to step with the hindlimbs. These observations led us to determine whether this type of “indirect” volitional control of stepping can be achieved after a complete spinal cord injury. The objective of this study was to develop an electronic bridge across the lesion of the spinal cord to facilitate hindlimb stepping after a complete mid-thoracic spinal cord injury in adult rats. Methods We developed an electronic spinal bridge that can detect specific patterns of EMG activity from the forelimb muscles to initiate electrical-enabling motor control (eEmc) of the lumbosacral spinal cord to enable quadrupedal stepping after a complete spinal cord transection in rats. A moving window detection algorithm was implemented in a small microprocessor to detect biceps brachii EMG activity bilaterally that then was used to initiate and terminate epidural stimulation in the lumbosacral spinal cord. We found dominant frequencies of 180–220 Hz in the EMG of the forelimb muscles during active periods, whereas these frequencies were between 0–10 Hz when the muscles were inactive. Results and conclusions Once the algorithm was validated to represent kinematically appropriate quadrupedal stepping, we observed that the algorithm could reliably detect, initiate, and facilitate stepping under different pharmacological conditions and at various treadmill speeds. PMID:22691460

  2. Dysplastic spondylolysis is caused by mutations in the diastrophic dysplasia sulfate transporter gene

    PubMed Central

    Cai, Tao; Yang, Liu; Cai, Wanshi; Guo, Sen; Yu, Ping; Li, Jinchen; Hu, Xueyu; Yan, Ming; Shao, Qianzhi; Jin, Yan; Sun, Zhong Sheng; Luo, Zhuo-Jing

    2015-01-01

    Spondylolysis is a fracture in part of the vertebra with a reported prevalence of about 3–6% in the general population. Genetic etiology of this disorder remains unknown. The present study was aimed at identifying genomic mutations in patients with dysplastic spondylolysis as well as the potential pathogenesis of the abnormalities. Whole-exome sequencing and functional analysis were performed for patients with spondylolysis. We identified a novel heterozygous mutation (c.2286A > T; p.D673V) in the sulfate transporter gene SLC26A2 in five affected subjects of a Chinese family. Two additional mutations (e.g., c.1922A > G; p.H641R and g.18654T > C in the intron 1) in the gene were identified by screening a cohort of 30 unrelated patients with the disease. In situ hybridization analysis showed that SLC26A2 is abundantly expressed in the lumbosacral spine of the mouse embryo at day 14.5. Sulfate uptake activities in CHO cells transfected with mutant SLC26A2 were dramatically reduced compared with the wild type, confirming the pathogenicity of the two missense mutations. Further analysis of the gene–disease network revealed a convergent pathogenic network for the development of lumbosacral spine. To our knowledge, our findings provide the first identification of autosomal dominant SLC26A2 mutations in patients with dysplastic spondylolysis, suggesting a new clinical entity in the pathogenesis of chondrodysplasia involving lumbosacral spine. The analysis of the gene–disease network may shed new light on the study of patients with dysplastic spondylolysis and spondylolisthesis as well as high-risk individuals who are asymptomatic. PMID:26077908

  3. Dosimetric Comparison of Bone Marrow-Sparing Intensity-Modulated Radiotherapy Versus Conventional Techniques for Treatment of Cervical Cancer

    SciTech Connect

    Mell, Loren K.; Tiryaki, Hanifi; Ahn, Kang-Hyun; Mundt, Arno J.; Roeske, John C.; Aydogan, Bulent

    2008-08-01

    Purpose: To compare bone marrow-sparing intensity-modulated pelvic radiotherapy (BMS-IMRT) with conventional (four-field box and anteroposterior-posteroanterior [AP-PA]) techniques in the treatment of cervical cancer. Methods and Materials: The data from 7 cervical cancer patients treated with concurrent chemotherapy and IMRT without BMS were analyzed and compared with data using four-field box and AP-PA techniques. All plans were normalized to cover the planning target volume with the 99% isodose line. The clinical target volume consisted of the pelvic and presacral lymph nodes, uterus and cervix, upper vagina, and parametrial tissue. Normal tissues included bowel, bladder, and pelvic bone marrow (PBM), which comprised the lumbosacral spine and ilium and the ischium, pubis, and proximal femora (lower pelvis bone marrow). Dose-volume histograms for the planning target volume and normal tissues were compared for BMS-IMRT vs. four-field box and AP-PA plans. Results: BMS-IMRT was superior to the four-field box technique in reducing the dose to the PBM, small bowel, rectum, and bladder. Compared with AP-PA plans, BMS-IMRT reduced the PBM volume receiving a dose >16.4 Gy. BMS-IMRT reduced the volume of ilium, lower pelvis bone marrow, and bowel receiving a dose >27.7, >18.7, and >21.1 Gy, respectively, but increased dose below these thresholds compared with the AP-PA plans. BMS-IMRT reduced the volume of lumbosacral spine bone marrow, rectum, small bowel, and bladder at all dose levels in all 7 patients. Conclusion: BMS-IMRT reduced irradiation of PBM compared with the four-field box technique. Compared with the AP-PA technique, BMS-IMRT reduced lumbosacral spine bone marrow irradiation and reduced the volume of PBM irradiated to high doses. Therefore BMS-IMRT might reduce acute hematologic toxicity compared with conventional techniques.

  4. Presence of accessory penis, colonic duplication and several other congenital anomalies in a child: a very rare association.

    PubMed

    Chatterjee, Sayan; Mondal, Prabodh Chandra; Pandey, Shashi Bhushan; Achar, Arun

    2014-10-01

    An accessory penis is a very rare anomaly. Only five cases have been reported thus far to our knowledge. We present the case of a child aged 2 years and 10 months who had a penis-like structure (containing phallus and glans) attached to the right buttock. Associated anomalies were a non-communicating type of colonic duplication, a paramedian stenosed anal opening, a horse-shoe kidney, posterior urethral valves, scoliosis of the lumbo-sacral spine, polydactyly and equino-varus deformity of the right foot. As far as we can tell, this is the first report of an accessory penis associated with colonic duplication and other congenital anomalies.

  5. Granulocytic sarcoma: a rare cause of sciatica

    PubMed Central

    Glover, Thomas Edward

    2017-01-01

    We describe a case report of a man aged 56 years with a 4-month history of right-sided sciatica-type pain with subclinical disc prolapse evident on MRI. Worsening pain together with the appearance of a tender mass in his right buttock prompted further imaging, which demonstrated an infiltrative mass engulfing the lumbosacral plexus. This was later shown to be a granulocytic sarcoma on biopsy. Intervertebral disc herniation can be an incidental finding and is not always the cause of sciatica. PMID:28202486

  6. Cervical extradural and extraspinal ependymoma mimicking dumb-bell schwannoma: an unusual tumor.

    PubMed

    Ramesh, V G; Karthikeyan, K V; Rao, K Ramesh; Balasubramanian, C

    2013-01-01

    Ependymomas are common in intramedullary location and extradural location of the spinal cord is very rare. A few cases in the lumbosacral region have been reported. This report presents a cervical dumb-bell ependymoma with a small intraspinal extradural component and a large extraspinal component in the posterior triangle of the neck. The tumor was excised in two stages. This is probably the first such case report in the cervical region in the world literature. Possible histogenesis of ependymoma in this location is also discussed.

  7. Primary Epidural Varicosis as a Rare Cause of Sciatica: A Case Report

    PubMed Central

    Omidi-Kashani, Farzad; Hasankhani, Ebrahim Ghayem; Fathi, Mahdi

    2015-01-01

    Non-discogenic sciatica can be caused by any lesion along the course of the lumbosacral nerve roots and sciatic nerve. We aim to present a rare case of refractory sciatica in an otherwise healthy 25-year-old man. He complained of left leg pain without significant back pain. Extensor hallucis longus muscle was weak on the left side with limited straight leg rising. On magnetic resonance imaging, a space-occupying lesion resembling a sequestrated disc was noted that after surgical decompression, epidural varicosis was demonstrated. PMID:26538785

  8. [Dropped head syndrome in motor neuron disease].

    PubMed

    Lorenzoni, Paulo José; Lange, Marcos Christiano; Kay, Cláudia S K; Almeida, Luiz G M P de; Teive, Hélio A G; Scola, Rosana H; Werneck, Lineu C

    2006-03-01

    Dropped head is a syndrome caused by weakness of the neck extensor muscles found in different kinds of neuromuscular disorders and also in amyotrophic lateral sclerosis. This is a cases report of three women with motor neuron disease with beginning of dysphagia and cervical weakness that it evolved with dropped head. The investigation showed normal magnetic resonance imaging of brain and cervical column. Needle electromyography showed active and chronic denervation in bulbar muscles and cervical, thoracic and lumbosacral segments. We discuss the characteristic of disease, specially the clinical manifestations and electromyography features, with emphasis at the clinical evaluation of dropped head in the suspicion of motor neuron disease.

  9. Familial spinal neurofibromatosis due to a multiexonic NF1 gene deletion.

    PubMed

    Pizzuti, Antonio; Bottillo, Irene; Inzana, Francesca; Lanari, Valentina; Buttarelli, Francesca; Torrente, Isabella; Giallonardo, Anna Teresa; De Luca, Alessandro; Dallapiccola, Bruno

    2011-08-01

    We report the detailed clinical presentation and molecular features of a spinal neurofibromatosis familial case where a 40-year-old woman, presenting with multiple bilateral spinal neurofibromas and no other clinical feature of neurofibromatosis type 1 (NF1), inherited a paternal large multiexonic deletion (c.5944-?_7126+?del) which resulted in NF1 gene haploinsufficiency at the RNA level. In the clinically unaffected 73-year-old father, spinal cord MRI disclosed bilateral and symmetrical hypertrophy of spinal lumbosacral roots. Our study widens the phenotypic and mutational spectrum of NF1 and illustrates the difficulties of counseling patients with border-line or atypical presentation of this disorder.

  10. Diagnosis of Pentalogy of Cantrell in the First Trimester Using Transvaginal Sonography and Color Doppler

    PubMed Central

    Türkçapar, Ayşe Figen; Sargın Oruc, Ayla; Öksüzoglu, Aysegül; Danışman, Nuri

    2015-01-01

    We report the prenatal diagnosis of Cantrell syndrome in the first trimester. During a routine transabdominal ultrasonographic examination, a midline supraumbilical abdominal wall defect including herniated liver and ectopia cordis with a large omphalocele containing the intestines and cystic hygroma was incidentally identified at the 12th week of gestation. A transvaginal sonography examination revealed a severe lumbosacral scoliosis in addition to the inability to visualize the abdominal aorta which was indicative of a severe intracardiac defect. The parents opted for pregnancy to be terminated. In this case report, we discuss the complementary role of transvaginal sonography and Doppler imaging in the diagnosis of Cantrell syndrome in early pregnancy. PMID:25802780

  11. Differential diagnosis between radiation and tumor plexopathy of the pelvis

    SciTech Connect

    Thomas, J.E.; Cascino, T.L.; Earle, J.D.

    1985-01-01

    Twenty patients were studied with lumbosacral radiculoplexopathy from radiation treatment and 30 patients with plexus damage from pelvic malignancy. Indolent leg weakness occurred early in radiation disease, whereas pain marked the onset of tumor plexopathy. Eventually, all radiation cases had weakness, which was bilateral in most of them and painless in one-half of them. Tumor patients typically had unilateral weakness, which was painful in all of them. Radiation disease often resulted in serious neurologic disability. Of the tumor patients, 86% were dead within 3 1/2 years after onset of neurologic symptoms.

  12. Magnetic resonance neurographic confirmation of extensive Plexiform neurofibroma in neurofibromatosis-1 presenting as ambiguous genitalia

    PubMed Central

    Kumar, Ishan; Verma, Ashish; Ojha, Ritu; Aggarwal, Priyanka; Shukla, Ram C; Srivastava, Arvind

    2016-01-01

    Genitourinary involvement of neurofibromatosis is uncommon and genital neurofibromatosis is even rarer. Involvement of clitoris by neurofibroma can lead to clitoromegaly masquerading as a male penis. We report such a case of ambiguous genitalia in a 7-year-old female child presenting with clitoromegaly since birth, in which magnetic resonance imaging (MRI) revealed the presence of extensive neurofibromatosis in the clitoris and lumbosacral regions. We emphasize the central role of MRI in evaluation of hormonal and non-hormonal causes of ambiguous genitalia. We further discuss the merits of including MR neurography in the imaging protocol for comprehensive delineation of neurofibromatosis. PMID:27857458

  13. Congenital insensitivity to pain: a case report and review of the literature.

    PubMed

    Peddareddygari, Leema Reddy; Oberoi, Kinsi; Grewal, Raji P

    2014-01-01

    Congenital insensitivity to pain (CIP) is a rare autosomal recessive genetic disease caused by mutations in the SCN9A gene. We report a patient with the clinical features consistent with CIP in whom we detected a novel homozygous G2755T mutation in exon 15 of this gene. Routine electrophysiological studies are typically normal in patients with CIP. In our patient, these studies were abnormal and could represent the consequences of secondary complications of cervical and lumbosacral spine disease and associated severe Charcot's joints.

  14. Modeling zero-lag synchronization of dorsal horn neurons during the traveling of electrical waves in the cat spinal cord

    PubMed Central

    Kato, Hideyuki; Cuellar, Carlos A; Delgado-Lezama, Rodolfo; Rudomin, Pablo; Jimenez-Estrada, Ismael; Manjarrez, Elias; Mirasso, Claudio R

    2013-01-01

    The first electrophysiological evidence of the phenomenon of traveling electrical waves produced by populations of interneurons within the spinal cord was reported by our interdisciplinary research group. Two interesting observations derive from this study: first, the negative spontaneous cord dorsum potentials (CDPs) that are superimposed on the propagating sinusoidal electrical waves are not correlated with any scratching phase; second, these CDPs do not propagate along the lumbosacral spinal segments, but they appear almost simultaneously at different spinal segments. The aim of this study was to provide experimental data and a mathematical model to explain the simultaneous occurrence of traveling waves and the zero-lag synchronization of some CDPs. PMID:24303110

  15. Modeling zero-lag synchronization of dorsal horn neurons during the traveling of electrical waves in the cat spinal cord.

    PubMed

    Kato, Hideyuki; Cuellar, Carlos A; Delgado-Lezama, Rodolfo; Rudomin, Pablo; Jimenez-Estrada, Ismael; Manjarrez, Elias; Mirasso, Claudio R

    2013-07-01

    The first electrophysiological evidence of the phenomenon of traveling electrical waves produced by populations of interneurons within the spinal cord was reported by our interdisciplinary research group. Two interesting observations derive from this study: first, the negative spontaneous cord dorsum potentials (CDPs) that are superimposed on the propagating sinusoidal electrical waves are not correlated with any scratching phase; second, these CDPs do not propagate along the lumbosacral spinal segments, but they appear almost simultaneously at different spinal segments. The aim of this study was to provide experimental data and a mathematical model to explain the simultaneous occurrence of traveling waves and the zero-lag synchronization of some CDPs.

  16. Pharmacopuncture in dorsopathy treatment.

    PubMed

    Agasarov, Lev Georgievich

    2008-12-01

    This work further investigates the mechanisms of pharmacopuncture based on clinical data from patients with dorsopathy at the lumbosacral level. For the first time, pharmacopuncture was analyzed from the perspective of "classical" medicine and not using homeopathic medicine preconceptions. This confirmed the benefits of the chondro-protector Alflutop. The reduction of the vaso-reflectory reactions observed in this study indicates an extension of its therapeutic uses at the expense of the pharmacopuncture reflectory mechanisms. In turn, the data obtained point the way to further study into the active mechanism of pharmacopuncture.

  17. Sporadic nonsyndromal anterior cervical hypertrichosis: case report and review of the literature.

    PubMed

    Heitink, Martijn V; Quaedvlieg, Patricia J F; van Neer, Francoise J M A; Frank, Jorge

    2007-11-01

    A 13-year-old girl presented with cosmetically disturbing excessive hair growth in the anterior cervical region that had been present since birth. An X-ray of the cervical and lumbosacral spine did not show any ossal changes. Based on the clinical findings, the diagnosis of anterior cervical hypertrichosis was made. We successfully treated the patient with an intense pulsed light source. Here, we briefly discuss and review the clinical presentation and causes of localized and generalized hypertrichosis as well as possible treatment modalities.

  18. History of surgery for ruptured disk.

    PubMed

    Patwardhan, R V; Hadley, M N

    2001-01-01

    The history of surgery for ruptured disk of the human spine began approximately a century ago. Advances in the understanding of symptoms and signs of root or cord compression, their relationship to the pathology, and the refinement in imaging techniques have contributed to the present surgical management of rupture disk disease. Historical findings relevant to the cervical, thoracic, and lumbosacral regions of the spine, with relevant pathophysiology, imaging, and surgical treatment, including the evolution of various surgical approaches are discussed. Surgeons and other contributors in the medical field are cited for their respective contributions to the evolution of the present operative approaches for disk ruptures in the cervical, thoracic, and lumbar spinal regions.

  19. The effects of excitatory amino acids and their antagonists on the generation of motor activity in the isolated chick spinal cord.

    PubMed

    Barry, M J; O'Donovan, M J

    1987-12-01

    We have investigated the action of excitatory amino acids and their antagonists on spontaneous motor activity produced by an isolated preparation of the chick lumbosacral cord. Bath application of N-methyl-DL-aspartic acid (NMDA) or D-glutamate increased the occurrence and duration of spontaneous episodes of motor activity. Both NMDA-induced and spontaneous activity were reversibly inhibited by several excitatory amino acid antagonists including 2-amino-5-phosphono valeric acid and gamma-D-glutamyl glycine in a dose-dependent manner. These results suggest that motor activity in the chick spinal cord may be regulated by the release of endogenous excitatory amino acids from spinal interneurons.

  20. CT-guided corticosteroid injection as a therapeutic management for the pyriformis syndrome: case report.

    PubMed

    Kabataş, Serdar; Gümüş, Burçak; Yilmaz, Cem; Caner, Hakan

    2008-07-01

    The pyriformis syndrome is a rare entrapment neuropathy in which the sciatic nerve is compromised by the pyriformis muscle or other local structures. It is an important cause of buttock pain that may often be accompanied by sciatica. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The diagnosis relies on the clinical presentation and the electromyelography (EMG) findings. Other causes of symptoms should be excluded by careful examination and detailed neuroradiological studies of the lumbosacral spine, sacro-iliac and hip joints. A case of this syndrome seen in a 36-year-old man who recovered by CT-guided corticosteroid injection is reported.